{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T08:03:52Z","timestamp":1784016232848,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"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":["Journal of Sleep Research"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Obstructive sleep apnea (OSA) is a highly prevalent disorder, but reliance on the apnea\u2010hypopnea index (AHI) alone may fail to capture its full physiological burden, particularly in milder cases. This study aimed to identify distinct physiological phenotypes in mild OSA using oximetry\u2010based cluster analysis derived from polysomnography (PSG), and to determine whether these phenotypes exhibit differential patterns of sleep architecture and fragmentation. We conducted a cross\u2010sectional study of 144 adults diagnosed with mild OSA, defined by an AHI between 10 and 15 events per hour. A cluster analysis was performed using conventional and novel oximetric parameters, including desaturation severity and duration. We compared sleep efficiency, sleep stages, and comorbidity burden between the identified groups. Two distinct phenotypes were identified. Cluster 1 showed significantly deeper and longer desaturations than Cluster 2, despite identical AHI levels. Patients in Cluster 1 demonstrated significantly lower sleep efficiency (78.7 vs. 86.9%), increased wakefulness after sleep onset (73.8 vs. 49.5\u2009min), and reduced slow\u2010wave sleep (15.4 vs. 18.4%). No significant differences were found in daytime sleepiness or the prevalence of cardiovascular and metabolic comorbidities. Mild OSA is a physiologically heterogeneous entity that extends beyond the granularity of the AHI. Oximetry\u2010based clustering unveils a distinct phenotype characterized by significant sleep architecture impairment and hypoxic burden, independent of event frequency. These findings suggest that detailed oximetric analysis should be integrated into routine clinical assessment to identify high\u2010risk patients who may warrant earlier therapeutic intervention.<\/jats:p>","DOI":"10.1111\/jsr.70403","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:07:47Z","timestamp":1784012867000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unveiling Mild OSA: Oximetry Clusters Reveal Hidden Sleep Disruption Independent of AHI"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0408-4881","authenticated-orcid":false,"given":"Pedro","family":"Amorim","sequence":"first","affiliation":[{"name":"Sleep and Non\u2010Invasive Ventilation Unit S\u00e3o Jo\u00e3o University Hospital  Porto Portugal"},{"name":"Faculty of Medicine University of Porto (FMUP)  Porto Portugal"},{"name":"School of Health\u2010P.Porto  Porto Portugal"},{"name":"RISE\u2010Health Research Network  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0390-9944","authenticated-orcid":false,"given":"Daniela","family":"Ferreira\u2010Santos","sequence":"additional","affiliation":[{"name":"INESC TEC\u2010Institute for Systems and Computer Engineering, Technology and Science  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermelinda","family":"Eus\u00e9bio","sequence":"additional","affiliation":[{"name":"Sleep and Non\u2010Invasive Ventilation Unit S\u00e3o Jo\u00e3o University Hospital  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Dantas","sequence":"additional","affiliation":[{"name":"Sleep and Non\u2010Invasive Ventilation Unit S\u00e3o Jo\u00e3o University Hospital  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Sofia","family":"Pimentel","sequence":"additional","affiliation":[{"name":"Sleep and Non\u2010Invasive Ventilation Unit S\u00e3o Jo\u00e3o University Hospital  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6773-3503","authenticated-orcid":false,"given":"Marta","family":"Drummond","sequence":"additional","affiliation":[{"name":"Sleep and Non\u2010Invasive Ventilation Unit S\u00e3o Jo\u00e3o University Hospital  Porto Portugal"},{"name":"Faculty of Medicine University of Porto (FMUP)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-6682","authenticated-orcid":false,"given":"Pedro Pereira","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Porto (FMUP)  Porto Portugal"},{"name":"RISE\u2010Health Research Network  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy624"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(19)30198\u20105"},{"key":"e_1_2_11_4_1","volume-title":"The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (Version 2.6)","author":"Berry S. 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J.","year":"2009","journal-title":"Journal of Clinical Sleep Medicine"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00811"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00360\u20102025"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsae295"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15091088"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7806"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.6506"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2022.107120"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.657126"},{"key":"e_1_2_11_19_1","unstructured":"Kassambara A. andF.Mundt.2020.\u201cFactoextra: Extract and Visualize the Results of Multivariate Data Analyses.\u201d"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517\u2010013\u20101039\u20104"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202006\u2010696FR"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00630.2017"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab030"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2022.08.005"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(16)30146\u20101"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/sbr.12078"},{"key":"e_1_2_11_27_1","unstructured":"Mouselimis L.2024.\u201cClusterr: Gaussian Mixture Models K\u2010Means Mini\u2010Batch\u2010Kmeans K\u2010Medoids and Affinity Propagation Clustering.\u201d"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13175001"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.25152"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws342"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13066"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.5886"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.4.406"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2025.108348"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0706446105"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.71940"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arteri.2024.01.004"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202105\u20101274OC"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13944"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1241224"}],"container-title":["Journal of Sleep Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70403","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jsr.70403","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.70403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:07:49Z","timestamp":1784012869000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jsr.70403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":39,"alternative-id":["10.1111\/jsr.70403"],"URL":"https:\/\/doi.org\/10.1111\/jsr.70403","archive":["Portico"],"relation":{},"ISSN":["0962-1105","1365-2869"],"issn-type":[{"value":"0962-1105","type":"print"},{"value":"1365-2869","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"assertion":[{"value":"2026-02-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70403"}}