{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T03:38:24Z","timestamp":1789443504180,"version":"build-2803163510"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":1554,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,12,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (Pobs). A development and initial test set of 29 subjects (development\u2009=\u20096, test\u2009=\u200923) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop Pobs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of Pobs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, Pobs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R \u00a02\u2009=\u20090.87, P\u2009&amp;lt;\u20090.001, area under the receiver operating characteristic curve\u2009=\u20090.74; set 2: cubic adj. R \u00a02\u2009=\u20090.83, P\u2009&amp;lt;\u20090.001, area under the receiver operating characteristic curve\u2009=\u20090.7). On a subject level, median Pobs was associated with the median normalized upper airway resistance (set 1: linear adj. R \u00a02\u2009=\u20090.59, P\u2009&amp;lt;\u20090.001; set 2: linear adj. R \u00a02\u2009=\u20090.45, P\u2009&amp;lt;\u20090.001). Median Pobs exhibited low night-to-night variability [intraclass correlation(2, 1)\u2009=\u20090.93].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202011-4055oc","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T13:30:15Z","timestamp":1630071015000},"page":"1452-1462","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":29,"title":["Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep-disordered Breathing"],"prefix":"10.1093","volume":"204","author":[{"given":"Ankit","family":"Parekh","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Tolbert","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Mooney","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Ramos-Cejudo","sequence":"additional","affiliation":[{"name":"Center for Sleep and Brain Health, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo S.","family":"Osorio","sequence":"additional","affiliation":[{"name":"Center for Sleep and Brain Health, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Treml","sequence":"additional","affiliation":[{"name":"Institute of Pneumology at the University of Cologne, Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon-Dominik","family":"Herkenrath","sequence":"additional","affiliation":[{"name":"Institute of Pneumology at the University of Cologne, Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried J.","family":"Randerath","sequence":"additional","affiliation":[{"name":"Institute of Pneumology at the University of Cologne, Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indu","family":"Ayappa","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Rapoport","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New 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