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HL070839"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"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>To test whether an interpretable effort-derived Breathing Stability Index (BSI) captures physiology and clinical risk beyond conventional sleep-disordered breathing metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We analyzed 43\u2009611 overnight polysomnography records from two clinical cohorts and one community cohort. BSI was derived from abdominal and thoracic effort envelopes as a continuous measure of respiratory effort instability. We compared BSI with apnea\u2013hypopnea index (AHI), hypoxic burden, arousal index, periodic breathing\/self-similarity, desaturation frequency, sleep stage, and event phenotype; evaluated cognition and nine matched cross-sectional electronic-health-record (EHR) disease labels; and tested mortality in Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>BSI increased across AHI severity and tracked comparator metrics while remaining partly nonredundant. In mutually adjusted models, BSI remained associated with periodic breathing, AHI, arousal index, and desaturation index. Within AHI strata, instability was lowest in deeper non-rapid eye movement (NREM) sleep and higher in lighter sleep and REM sleep. Cognitive associations were cohort dependent and strongest in Osteoporotic Fractures in Men (MrOS), where less stable breathing was associated with worse fluid and total cognition after age\/sex adjustment. In matched EHR disease analyses, BSI features provided modest discrimination (area under the receiver operating characteristic curve 0.509\u20130.642) and age\/sex-adjusted associations for 8 of 9 labels. BSI was associated with all-cause mortality after adjustment for age, sex, and comparator sleep metrics in Massachusetts General Hospital (hazard ratio [HR] 1.38 per SD, 95% confidence interval [CI] 1.23\u20131.54) and Beth Israel Deaconess Medical Center (HR 1.10, 95% CI 1.02\u20131.19), but not MrOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nocturnal breathing stability captures dynamic sleep-disordered breathing physiology that complements event counts and desaturation metrics and relates to cognition, cross-sectional disease labels, and cohort-dependent survival risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsag212","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:45:47Z","timestamp":1785498347000},"source":"Crossref","is-referenced-by-count":0,"title":["Dynamic instability of breathing during sleep predicts cognition, disease, and mortality"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6029-2450","authenticated-orcid":false,"given":"Wolfgang","family":"Ganglberger","sequence":"first","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]},{"name":"Division of Sleep Medicine, Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"McCance Center for Brain Health, Massachusetts General Hospital , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5041-8312","authenticated-orcid":false,"given":"Haoqi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]},{"name":"Division of Sleep Medicine, Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"McCance Center for Brain Health, Massachusetts General Hospital , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M","family":"Quinn","sequence":"additional","affiliation":[{"name":"Division of Sleep Medicine, Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"Division of Pulmonary Critical Care & Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4803-312X","authenticated-orcid":false,"given":"Michael Brandon","family":"Westover","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center , Boston, MA ,","place":["United States"]},{"name":"Division of Sleep Medicine, Harvard Medical School , Boston, MA ,","place":["United States"]},{"name":"McCance Center for Brain Health, Massachusetts General 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