{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:17:42Z","timestamp":1793726262027,"version":"4.6.1"},"reference-count":40,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veteran Affairs Clinical Science Research and Development (CSR&D) Merit Review Program","id":[{"id":"https:\/\/ror.org\/042tvbw50","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Robert E. Leet and Clara Guthrie Patterson Trust Fellowship Program in Clinical Research, Bank of America, N.A., Trustee","id":[{"id":"https:\/\/ror.org\/006tvg625","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obstructive sleep apnoea (OSA) is a heterogeneous disorder, and improved understanding of physiologic phenotypes and their clinical implications is needed. We aimed to determine whether routine polysomnographic data can be used to identify OSA phenotypes (clusters) and to assess the associations between the phenotypes and cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional and longitudinal analyses of a multisite, observational US Veteran (n=1247) cohort were performed. Principal components-based clustering was used to identify polysomnographic features in OSA\u2019s four pathophysiological domains (sleep architecture disturbance, autonomic dysregulation, breathing disturbance and hypoxia). Using these features, OSA phenotypes were identified by cluster analysis (K-means). Cox survival analysis was used to evaluate longitudinal relationships between clusters and the combined outcome of incident transient ischaemic attack, stroke, acute coronary syndrome or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven patient clusters were identified based on distinguishing polysomnographic features: \u2018mild\u2019, \u2018periodic limb movements of sleep (PLMS)\u2019, \u2018NREM and arousal\u2019, \u2018REM and hypoxia\u2019, \u2018hypopnoea and hypoxia\u2019, \u2018arousal and poor sleep\u2019 and \u2018combined severe\u2019. In adjusted analyses, the risk (compared with \u2018mild\u2019) of the combined outcome (HR (95% CI)) was significantly increased for \u2018PLMS\u2019, (2.02 (1.32 to 3.08)), \u2018hypopnoea and hypoxia\u2019 (1.74 (1.02 to 2.99)) and \u2018combined severe\u2019 (1.69 (1.09 to 2.62)). Conventional apnoea\u2013hypopnoea index (AHI) severity categories of moderate (15\u2264AHI&lt;30) and severe (AHI \u226530), compared with mild\/none category (AHI &lt;15), were not associated with increased risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among patients referred for OSA evaluation, routine polysomnographic data can identify physiological phenotypes that capture risk of adverse cardiovascular outcomes otherwise missed by conventional OSA severity classification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thoraxjnl-2017-210431","type":"journal-article","created":{"date-parts":[[2017,9,21]],"date-time":"2017-09-21T20:55:27Z","timestamp":1506027327000},"page":"472-480","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":234,"title":["Polysomnographic phenotypes and their cardiovascular implications in obstructive sleep apnoea"],"prefix":"10.1136","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0488-9778","authenticated-orcid":false,"given":"Andrey V","family":"Zinchuk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangchoon","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian B","family":"Koo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiting","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn M","family":"Bravata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo J","family":"Selim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kingman P","family":"Strohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy S","family":"Redeker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Concato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry K","family":"Yaggi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,21]]},"reference":[{"key":"2020050723432666000_73.5.472.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201503-0647UP"},{"key":"2020050723432666000_73.5.472.2","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-011-0537-6"},{"key":"2020050723432666000_73.5.472.3","doi-asserted-by":"crossref","first-page":"987","DOI":"10.5664\/jcsm.5010","article-title":"Nonrapid eye movement-predominant obstructive sleep apnea: detection and mechanism","volume":"11","author":"Yamauchi","year":"2015","journal-title":"J Clin Sleep Med"},{"key":"2020050723432666000_73.5.472.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2013.01.005"},{"key":"2020050723432666000_73.5.472.5","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/j.clinph.2014.01.029","article-title":"Characterizing the phenotypes of obstructive sleep apnea: clinical, sleep, and autonomic features of obstructive sleep apnea with and without hypoxia","volume":"125","author":"Palma","year":"2014","journal-title":"Clin Neurophysiol"},{"key":"2020050723432666000_73.5.472.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/420134","article-title":"Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities","volume":"2014","author":"Burgel","year":"2014","journal-title":"Biomed Res Int"},{"key":"2020050723432666000_73.5.472.7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000132"},{"key":"2020050723432666000_73.5.472.8","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-009-0298-7"},{"key":"2020050723432666000_73.5.472.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043104"},{"key":"2020050723432666000_73.5.472.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2013.01.003"},{"key":"2020050723432666000_73.5.472.11","doi-asserted-by":"crossref","first-page":"531","DOI":"10.5665\/sleep.5520","article-title":"Sleep disordered breathing and risk of stroke in older community-dwelling Men","volume":"39","author":"Stone","year":"2016","journal-title":"Sleep"},{"key":"2020050723432666000_73.5.472.12","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-206871"},{"key":"2020050723432666000_73.5.472.13","doi-asserted-by":"crossref","unstructured":"Kendzerska T , Gershon AS , Hawker G , et al . 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