{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:44:27Z","timestamp":1790736267663,"version":"4.1.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[1999,6,1]],"date-time":"1999-06-01T00:00:00Z","timestamp":928195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The etiology of excessive daytime sleepiness in patients with sleep-disordered breathing (SDB) is not well defined. In this study, we examined the relationships between several clinical and polysomnographic parameters and the degree of hypersomnolence in 741 patients with SDB (apnea\u2013hypopnea index [AHI] \u2265 10 events\/h). The study sample was obese (body mass index [BMI]: 35.3 \u00b1 8.5 kg\/m2) and had evidence of moderate SDB (AHI: 47.6 \u00b1 29.3 events\/h). Hypersomnolence was quantified with the multiple sleep latency test (MSLT) and survival analysis was used to assess the risk factors for hypersomnolence. In a multivariate proportional hazards model, AHI and nocturnal hypoxemia were independent predictors of hypersomnolence (MSLT &amp;lt; 10 min). The adjusted relative risks (RR) of hypersomnolence were 1.00, 1.30, and 1.65 for patients with an AHI of 10 to 29.9, 30 to 59.9, and \u2265 60 events\/h, respectively. A positive association between hypersomnolence and oxyhemoglobin desaturation ( \u0394 SaO2) was observed with RR of 1.00, 1.18, 1.43, and 1.94 for a \u0394 SaO2 of \u2264 5%, 5.1 to 10%, 10.1 to 15%, and &amp;gt; 15%, respectively. Sleep fragmentation, as assessed by the distribution of sleep stages, was also an independent predictor of hypersomnolence. Using stage 1 sleep as a reference, an increase in stage 2 and slow wave sleep (SWS) were protective from hypersomnolence. For a 10% increase in stage 2 or SWS the adjusted RR for hypersomnolence were 0.93 and 0.79, respectively. REM sleep showed no significant association with the degree of hypersomnolence. These results suggest that AHI, nocturnal hypoxemia, and sleep fragmentation are independent determinants of hypersomnolence in SDB.<\/jats:p>","DOI":"10.1164\/ajrccm.159.6.9808095","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:59:16Z","timestamp":1365083956000},"page":"1703-1709","source":"Crossref","is-referenced-by-count":112,"title":["Modeling Hypersomnolence in Sleep-disordered Breathing: A Novel Approach Using Survival Analysis"],"prefix":"10.1093","volume":"159","author":[{"given":"NARESH M.","family":"PUNJABI","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DANIEL J.","family":"O'HEARN","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DAVID N.","family":"NEUBAUER","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. JAVIER","family":"NIETO","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ALAN R.","family":"SCHWARTZ","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PHILIP L.","family":"SMITH","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KAREN","family":"BANDEEN-ROCHE","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine and Department of Psychiatry, Johns Hopkins University and School of Medicine; and Department of Epidemiology and Biostatistics, Johns Hopkins University School of Public Health and Hygiene, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1999,6,1]]},"reference":[{"key":"2026032708595573300_B1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1055\/s-2007-1009389","article-title":"Clinical consequences of obstructive sleep apnea.","volume":"19","author":"Epstein","year":"1998","journal-title":"Semin Respir. Crit. Care Med."},{"key":"2026032708595573300_B2","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/sleep\/9.4.519","article-title":"Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness.","volume":"9","author":"Carskadon","year":"1986","journal-title":"Sleep"},{"key":"2026032708595573300_B3","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1378\/chest.101.4.903","article-title":"Sleepiness and hypertension in obstructive sleep apnea.","volume":"101","author":"Mendelson","year":"1992","journal-title":"Chest"},{"key":"2026032708595573300_B4","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1378\/chest.108.4.966","article-title":"The relationship of sleepiness and blood pressure to respiratory variables in obstructive sleep apnea.","volume":"108","author":"Mendelson","year":"1995","journal-title":"Chest"},{"key":"2026032708595573300_B5","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1378\/chest.100.6.1542","article-title":"Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea.","volume":"100","author":"Colt","year":"1991","journal-title":"Chest"},{"key":"2026032708595573300_B6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1378\/chest.94.1.32","article-title":"Determinants of daytime sleepiness in obstructive sleep apnea.","volume":"94","author":"Guilleminault","year":"1988","journal-title":"Chest"},{"key":"2026032708595573300_B7","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1378\/chest.95.6.1202","article-title":"Predictors of objective level of daytime sleepiness in patients with sleep- related breathing disorders.","volume":"95","author":"Roehrs","year":"1989","journal-title":"Chest"},{"key":"2026032708595573300_B8","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1093\/sleep\/20.1.34","article-title":"How should the multiple sleep latency test be analyzed?","volume":"20","author":"Pollak","year":"1997","journal-title":"Sleep"},{"key":"2026032708595573300_B9"},{"key":"2026032708595573300_B10","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1164\/ajrccm.153.4.8616562","article-title":"The effect of sleep fragmentation on daytime function.","volume":"153","author":"Martin","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026032708595573300_B11","first-page":"242","article-title":"Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome.","volume":"17","author":"Philip","year":"1994","journal-title":"Sleep"},{"key":"2026032708595573300_B12","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1164\/ajrccm\/145.4_Pt_1.817","article-title":"Operation Everest II: arterial oxygen saturation and sleep at extreme simulated altitude.","volume":"145","author":"Anholm","year":"1992","journal-title":"Am. Rev. Respir. Dis."},{"key":"2026032708595573300_B13","first-page":"827","article-title":"What does the multiple sleep latency test measure in a community sample?","volume":"18","author":"Kronholm","year":"1995","journal-title":"Sleep"},{"key":"2026032708595573300_B14","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/archinte.158.12.1333","article-title":"Obesity without sleep apnea is associated with daytime sleepiness.","volume":"158","author":"Vgontzas","year":"1998","journal-title":"Arch. Intern. Med."},{"key":"2026032708595573300_B15","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1210\/jcem.82.5.3950","article-title":"Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity.","volume":"82","author":"Vgontzas","year":"1997","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"2026032708595573300_B16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S1087-0792(98)90050-8","article-title":"Rethinking the assessment of sleepiness.","volume":"2","author":"Johns","year":"1998","journal-title":"Sleep Med. Rev."}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/159\/6\/1703\/67429054\/ajrccm_159_6_1703.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/159\/6\/1703\/67429054\/ajrccm_159_6_1703.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:00:06Z","timestamp":1774616406000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/159\/6\/1703\/8529942"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,6,1]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1999,6,1]]},"published-print":{"date-parts":[[1999,6,1]]}},"URL":"https:\/\/doi.org\/10.1164\/ajrccm.159.6.9808095","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1999,6]]},"published":{"date-parts":[[1999,6,1]]}}}