{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:30:00Z","timestamp":1793410200377,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100013981","name":"American Academy of Sleep Medicine Foundation","doi-asserted-by":"publisher","award":["BS-233-20"],"award-info":[{"award-number":["BS-233-20"]}],"id":[{"id":"10.13039\/100013981","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013981","name":"American Academy of Sleep Medicine Foundation","doi-asserted-by":"publisher","award":["BS-233-20"],"award-info":[{"award-number":["BS-233-20"]}],"id":[{"id":"10.13039\/100013981","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The apnea\u2013hypopnea index (AHI), used for the diagnosis of obstructive sleep apnea, captures only the frequency of respiratory events and has demonstrable limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We propose a novel automated measure, termed \u201cventilatory burden\u201d (VB), that represents the proportion of overnight breaths with less than 50% normalized amplitude, and we show its ability to overcome limitations of AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from two epidemiological cohorts (EPISONO [Sao Paolo Epidemiological Study] and SHHS [Sleep Heart Health Study]) and two retrospective clinical cohorts (DAYFUN; New York University Center for Brain Health) were used in this study to 1) derive the normative range of VB, 2) assess the relationship between degree of upper airway obstruction and VB, and 3) assess the relationship between VB and all-cause and cardiovascular disease (CVD) mortality with and without hypoxic burden that was derived using an in-house automated algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The 95th percentiles of VB in asymptomatic healthy subjects across the EPISONO and the DAYFUN cohorts were 25.2% and 26.7%, respectively (median [interquartile range], VBEPISONO, 5.5 [3.5\u20139.7]%; VBDAYFUN, 9.8 [6.4\u201315.6]%). VB was associated with the degree of upper airway obstruction in a dose\u2013response manner (VBuntreated, 31.6 [27.1]%; VBtreated, 7.2 [4.7]%; VBsuboptimally treated, 17.6 [18.7]%; VBoff-treatment, 41.6 [18.1]%) and exhibited low night-to-night variability (intraclass correlation coefficient [2,1], 0.89). VB was predictive of all-cause and CVD mortality in the SHHS cohort before and after adjusting for covariates including hypoxic burden. Although AHI was predictive of all-cause mortality, it was not associated with CVD mortality in the SHHS cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Automated VB can effectively assess obstructive sleep apnea severity, is predictive of all-cause and CVD mortality, and may be a viable alternative to the AHI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202301-0109oc","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T09:00:15Z","timestamp":1694509215000},"page":"1216-1226","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":74,"title":["Ventilatory Burden as a Measure of Obstructive Sleep Apnea Severity Is Predictive of Cardiovascular and All-Cause Mortality"],"prefix":"10.1093","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5396-0553","authenticated-orcid":false,"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":"Korey","family":"Kam","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":"Sajila","family":"Wickramaratne","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":"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":"Andrew","family":"Varga","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":"Ricardo","family":"Osorio","sequence":"additional","affiliation":[{"name":"Center for Brain Health, New York University Langone, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Andersen","sequence":"additional","affiliation":[{"name":"Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana B. M.","family":"de Godoy","sequence":"additional","affiliation":[{"name":"Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana O.","family":"Palombini","sequence":"additional","affiliation":[{"name":"Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Tufik","sequence":"additional","affiliation":[{"name":"Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de S\u00e3o Paulo, Sao Paulo, Brazil"}],"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 York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"2026012204330601000_bib1","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0140-6736(13)60734-5","article-title":"Adult obstructive sleep apnoea","volume":"383","author":"Jordan","year":"2014","journal-title":"Lancet"},{"key":"2026012204330601000_bib2","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir Med"},{"key":"2026012204330601000_bib3","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1159\/000174821","article-title":"The sleep apnea number game: counting the apnea-hypopnea index","volume":"77","author":"Cherniack","year":"2009","journal-title":"Respiration"},{"key":"2026012204330601000_bib4","doi-asserted-by":"crossref","first-page":"393","DOI":"10.3109\/03091902.2012.712201","article-title":"Total duration of apnea and hypopnea events and average desaturation show significant variation in patients with a similar apnea-hypopnea index","volume":"36","author":"Muraja-Murro","year":"2012","journal-title":"J Med Eng Technol"},{"key":"2026012204330601000_bib5","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1164\/rccm.201707-1435OC","article-title":"Phenotyping pharyngeal pathophysiology using polysomnography in patients with obstructive sleep apnea","volume":"197","author":"Sands","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012204330601000_bib6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2147\/NSS.S61853","article-title":"Apnea-hypopnea index: time to wake up","volume":"6","author":"Shahar","year":"2014","journal-title":"Nat Sci Sleep"},{"key":"2026012204330601000_bib7","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1164\/rccm.202005-1808OC","article-title":"Non-REM apnea and hypopnea duration varies across population groups and physiologic traits","volume":"203","author":"Borker","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012204330601000_bib8","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1164\/rccm.201804-0758OC","article-title":"Apnea-hypopnea event duration predicts mortality in men and women in the Sleep Heart Health Study","volume":"199","author":"Butler","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012204330601000_bib9","first-page":"114","article-title":"Obstructive sleep apnea and driving: a Canadian Thoracic Society and Canadian Sleep Society position paper","volume":"21","author":"Ayas","year":"2014","journal-title":"Can Respir J"},{"key":"2026012204330601000_bib10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1164\/ajrccm.158.1.9709135","article-title":"Automobile accidents in patients with sleep apnea syndrome. 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