{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:22:06Z","timestamp":1787656926105,"version":"build-2736575974"},"reference-count":55,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Central (CSA) and obstructive (OSA) sleep apnea are common in heart failure (HF) patients, and treatment options depend on differential classification. To better characterize CSA vs OSA, we evaluated the discriminative value of established and novel polysomnographic traits in patients with HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We analyzed LOFT-HF trial participants with reduced left ventricular ejection fraction (LVEF) and apnea-hypopnea index (AHI) &amp;gt;15 events\/hr. Central versus obstructive events were classified with expert investigator input. Multivariable logistic regression tested whether CSA (&amp;gt;50% of central\/mixed events; otherwise OSA) was associated with increased loop gain, and other mechanistic traits (arousal threshold, collapsibility, muscle compensation). Mechanistic traits together with novel clinically-informed traits (e.g. event periodicity, flow limitation) were modeled to provide a probability score \u201cPr(CSA)\u201d for objective CSA-versus-OSA discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 122 HF patients (CSA:OSA\u2009=\u200984:38), CSA was associated with higher loop gain (OR\u2009=\u20094.4[2.2\u20139.1]), lower arousal threshold (6.4[2.4\u201316.9]), and greater muscle compensation (2.5[1.0\u20136.2]). Novel traits\u2014greater event periodicity, larger event-related drive reduction, and reduced flow limitation\u2014further improved discrimination (likelihood ratio test p\u2009=\u2009.013 vs. mechanistic model). The final model (AUC\u2009=\u20090.88) identified a subgroup enriched for true CSA (OR\u2009=\u20098.4[3.5\u201320.1]). Sensitivity analyses using stricter central apnea\u2013based definitions yielded similar or stronger associations with loop gain and modestly improved discrimination, although fewer individuals met CSA criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with HF and CSA exhibit a distinct set of polysomnographic characteristics compared to OSA, which may facilitate their objective physiology-based characterization along the CSA\u2013OSA continuum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag202","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:54:20Z","timestamp":1784807660000},"source":"Crossref","is-referenced-by-count":0,"title":["Physiological characteristics of central versus obstructive sleep apnea in patients with heart failure"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7544-5595","authenticated-orcid":false,"given":"Raichel","family":"M Alex","sequence":"first","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrokh","family":"Javaheri","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH; Division of Medicine, Ohio State University , Columbus, OH ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Khayat","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Sleep Research and Treatment Center, Sleep Disorders Center, Pennsylvania State University College of Medicine , Hershey, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Utah , Salt Lake City, UT ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruckshanda","family":"Majid","sequence":"additional","affiliation":[{"name":"Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, University of Texas Health Science Center , Houston, TX ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9142-5172","authenticated-orcid":false,"given":"Sanjay R","family":"Patel","sequence":"additional","affiliation":[{"name":"Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh , Pittsburgh, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sairam","family":"Parthasarathy","sequence":"additional","affiliation":[{"name":"University of Arizona Center for Sleep, Circadian, and Neurosciences, University of Arizona , Tucson, AZ ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9383-1644","authenticated-orcid":false,"given":"Bradley A","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia; School of Psychological Sciences, Monash University , Clayton, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9041-3655","authenticated-orcid":false,"given":"Shane","family":"Landry","sequence":"additional","affiliation":[{"name":"Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia; School of Psychological Sciences, Monash University , Clayton, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia; School of Psychological Sciences, Monash University , Clayton, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura K","family":"Gell","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2499-5415","authenticated-orcid":false,"given":"Dwayne L","family":"Mann","sequence":"additional","affiliation":[{"name":"School of Electrical Engineering and Computer Science, University of Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5978-9814","authenticated-orcid":false,"given":"Sara","family":"Op de Beeck","sequence":"additional","affiliation":[{"name":"Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp , Wilrijk ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wellman","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Vader","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Washington University School of Medicine , St Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luqi","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine , St. Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Teodorescu","sequence":"additional","affiliation":[{"name":"James B. Skatrud Pulmonary\/Sleep Research Laboratory, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin; Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryl R","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart Failure and Transplant Cardiology, School of Medicine and Public Health, University of Wisconsin , Madison, WI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis C","family":"Zee","sequence":"additional","affiliation":[{"name":"Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5769-5243","authenticated-orcid":false,"given":"M Safwan","family":"Badr","sequence":"additional","affiliation":[{"name":"John D. 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