{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:04:18Z","timestamp":1785305058051,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Physio Funct Imaging"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) is linked to arrhythmia and cardiovascular morbidity, but the cardiac response to individual obstructive events is incompletely characterised at minute\u2010scale resolution. We aimed to determine whether ECG\u2010derived autonomic features distinguish apnea from nonapnea minutes and whether these features change before scored event onset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the PhysioNet Apnea\u2010ECG learning set (34 subjects after exclusion of one duplicated recording; 30 male, 4 female; mean age 47.0\u2009\u00b1\u20099.7 years; AHI 0\u201382.4 events\/h). For each 1\u2010min segment, we computed mean heart rate, SDNN, RMSSD, pNN50 and RR irregularity rate from QRS\u2010derived RR intervals. Minutes were classified as baseline, preapnea, apnea, or post\u2010apnea and associations tested using mixed\u2010effects regression with subject random intercepts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analytic dataset comprised 17,004\u2009min; 38.2% were apnea minutes. Apnea minutes showed a heart rate reduction of \u22122.66 bpm (95% CI: \u22122.92 to \u22122.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and an RMSSD increase of +19\u2009ms (95% CI: 15\u201323,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) versus baseline. In multivariable modelling, SDNN was the dominant feature (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009+0.472); RMSSD showed a sign reversal (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.416) and reciprocal logistic odds ratios (SDNN OR 134.9 vs. RMSSD OR 0.034) consistent with substantial collinearity. Preapnea minutes showed directionally similar but smaller changes; post\u2010apnea minutes showed partial normalisation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Obstructive apnea is associated with a reproducible minute\u2010level autonomic signature of bradycardia and increased RR variability, with detectable shifts preceding scored event onset. Variability metrics, particularly SDNN, contribute more than mean heart rate. Findings require validation in cohorts with linked cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cpf.70080","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:53:23Z","timestamp":1782827603000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minute\u2010level ECG\u2010derived autonomic dynamics around obstructive apnea events: A peri\u2010event analysis of the PhysioNet apnea\u2010ECG database"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5275-1952","authenticated-orcid":false,"given":"Pratyush","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine HCA Health Care Kansas City Center point Medical Center HCA Healthcare Centerpoint Medical Center Internal Medicine Residency Program Independence Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Abhishek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine HCA Health Care Kansas City Center point Medical Center HCA Healthcare Centerpoint Medical Center Internal Medicine Residency Program Independence Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankti","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine HCA Health Care Kansas City Center point Medical Center HCA Healthcare Centerpoint Medical Center Internal Medicine Residency Program Independence Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munaf","family":"Siyamwala","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine HCA Health Care Kansas City Center point Medical Center HCA Healthcare Centerpoint Medical Center Internal Medicine Residency Program Independence Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Waxman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine HCA Health Care Kansas City Center point Medical Center HCA Healthcare Centerpoint Medical Center Internal Medicine Residency Program Independence Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy624"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30198-5"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61622-0"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2003.812203"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200707-114MG"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041832"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000136587.68725.8E"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.23.e215"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.11.069"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.0095"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200509-1442OC"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.10.943"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-201X.2003.01091.x"},{"key":"e_1_2_12_15_1","first-page":"255","article-title":"The apnea\u2010ECG database","volume":"27","author":"Penzel T.","year":"2000","journal-title":"Computers in Cardiology"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1901183"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00258"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI118235"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.189420"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.40788.x"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2011.02.005"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.93.5.1043"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200412-1631SO"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.09.002"}],"container-title":["Clinical Physiology and Functional Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cpf.70080","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cpf.70080","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cpf.70080","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:48:56Z","timestamp":1785304136000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cpf.70080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/cpf.70080"],"URL":"https:\/\/doi.org\/10.1111\/cpf.70080","archive":["Portico"],"relation":{},"ISSN":["1475-0961","1475-097X"],"issn-type":[{"value":"1475-0961","type":"print"},{"value":"1475-097X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"assertion":[{"value":"2026-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70080"}}