{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:10:14Z","timestamp":1779433814173,"version":"3.53.1"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018918","name":"MicroPort","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018918","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2026,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n Study Objectives<\/jats:title>\n Single\u2010night polysomnography assumes stable sleep apnoea (SA) severity; night\u2010to\u2010night variability may identify clinically relevant phenotypes, particularly in women. Sex\/gender\u2010specific longitudinal phenotypes were characterised using device\u2010detected respiratory disturbance index (RDI) and an instability metric independent of mean severity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Pacemaker patients in the prospective ACaSA study with at least 180 valid nightly RDI measurements after a 30\u2010day post\u2010implant period were analysed. Severity was summarised by mean RDI. Variability was summarised by an Instability Index (residual from the log\u2013log regression of RDI standard deviation on mean RDI). Phenotypes were defined by mean RDI (<\u200920 vs. \u2265\u200920 events\/h) and instability (above vs. below median).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n About 37,260 nights from 207 patients (median age 76\u2009years, IQR [69\u201381]) were analysed. Four phenotypes were identified:\n Mild<\/jats:italic>\n \u2010\n Stable<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u200968),\n Mild<\/jats:italic>\n \u2010\n Unstable<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u200967),\n Severe<\/jats:italic>\n \u2010\n Stable<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u200935), and\n Severe<\/jats:italic>\n \u2010\n Unstable<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u200937). Women comprised 37.7% of the total cohort and they were disproportionately overrepresented in the\n Mild<\/jats:italic>\n \u2010\n Unstable<\/jats:italic>\n versus in the\n Mild<\/jats:italic>\n \u2010\n Stable<\/jats:italic>\n phenotype (61.2% vs. 33.8%;\n p<\/jats:italic>\n \u2009=\u20090.002). Among patients with mean RDI <\u200920 (\n n<\/jats:italic>\n \u2009=\u2009135), female sex\/gender (adjusted OR 3.38, 95% CI 1.60\u20137.40;\n p<\/jats:italic>\n \u2009=\u20090.002) and obesity (BMI \u2265\u200930\u2009kg\/m\n 2<\/jats:sup>\n ; adjusted OR 3.80, 95% CI 1.31\u201312.53;\n p<\/jats:italic>\n \u2009=\u20090.019) were independent predictors of the\n Mild<\/jats:italic>\n \u2010\n Unstable<\/jats:italic>\n phenotype. Mild\u2010Unstable had more severe\u2010range nights (RDI \u2265\u200920\/h) than Mild\u2010Stable (7.8% vs. 2.2%;\n p<\/jats:italic>\n \u2009<\u20090.001). Severe\u2010Unstable recorded RDI <\u200920\/h on 33.9% of nights versus 13.9% in Severe\u2010Stable (\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Night\u2010to\u2010night variability identifies longitudinal SA phenotypes not captured by mean RDI. A female\u2010 and obesity\u2010predominant\n Mild<\/jats:italic>\n \u2010\n Unstable<\/jats:italic>\n phenotype shows intermittent severe\u2010range nights despite low average burden, while instability in severe SA increases the likelihood of underestimating severity when classification is based on a single\u2010night test.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/eci.70219","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:32:27Z","timestamp":1778855547000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep Apnoea Variability in Pacemaker Patients: A Women\u2010Predominant Phenotype"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5908-2923","authenticated-orcid":false,"given":"Philipp","family":"Spitaler","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Bilgeri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Feuchtner","sequence":"additional","affiliation":[{"name":"Department of Radiology Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rockenschaub","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin Berlin Germany"},{"name":"Department of Cardiology, Angiology and Intensive Care Medicine Deutsches Herzzentrum der Charit\u00e9 Berlin Germany"},{"name":"Institute of Active Polymers and Berlin\u2010Brandenburg Center for Regenerative Therapies, Helmholtz\u2010Zentrum Hereon Teltow Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birkan","family":"Tugrul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agne","family":"Adukauskaite","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"St\u00fchlinger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard Erich","family":"Pfeifer","sequence":"additional","affiliation":[{"name":"Landesinstitut f\u00fcr Integrierte Versorgung Tirol Innsbruck Austria"},{"name":"Division for Digital Medicine and Telehealth University for Health Sciences, Medical Informatics and Technology (UMIT\u2010Tirol) Hall in Tirol Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Institute of Diversity in Medicine, Medical University of Innsbruck Innsbruck Austria"},{"name":"Charit\u00e9 Centre for Global Health, Global Engagement, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Willeit","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck Innsbruck Austria"},{"name":"Department of Public Health and Primary Care University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Dichtl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III Medical University of Innsbruck Innsbruck 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