{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:53:24Z","timestamp":1791204804362,"version":"4.1.0"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Obstructive sleep apnea (OSA) is a prevalent public health concern linked to cardiovascular, metabolic, and neurocognitive consequences. Although polysomnography (PSG) is the diagnostic standard, the availability can be limited with long wait time. Snoring is a common symptom of OSA, but all individuals with snoring do not have OSA. In this study, we hypothesized the characteristics of snoring may be used to detect OSA. We applied an unsupervised clustering method to classify snoring patterns and examine their correlations with OSA parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We enrolled 287 adults with snoring symptoms who underwent overnight PSG at 2 teaching hospitals in Taiwan. Snoring sounds were recorded, and the dominant frequency and loudness were analyzed. A K-means clustering model was first developed using a training cohort (\n                      <jats:italic toggle=\"yes\">n =<\/jats:italic>\n                      50) and applied to classify frequency patterns into 5 clusters. Each cluster was further divided into 2 subclusters based on a loudness threshold (70 dB). An independent validation cohort (\n                      <jats:italic toggle=\"yes\">n =<\/jats:italic>\n                      237) was used to develop an apnea-hypopnea index (AHI) prediction model and evaluate discriminative performance using receiver operating characteristic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Clusters 1, 2, and 5 were significantly associated with higher AHI, oxygen desaturation index, and apnea index. In contrast, clusters 3 and 4 showed little or no association. An AHI prediction model was developed using age, BMI, and significant acoustic clusters. For PSG-defined OSA thresholds of AHI \u2265 5, \u226515, and \u226530 events\/h, the AUC values were 0.90, 0.83, and 0.82, respectively, with sensitivity ranging from 70.5% to 77.5% and specificity ranging from 73.7% to 100%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our study demonstrates an AI-based clustering analysis of snoring patterns can be used to evaluate OSA severity. The snoring pattern analysis can also be an additional screening tool for OSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654261485034","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:40:29Z","timestamp":1790786429000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unsupervised Clustering Analysis of Snoring Identifies Acoustic Biomarkers for the Severity of Obstructive Sleep Apnea"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1900-5229","authenticated-orcid":false,"given":"Shih-Hsing","family":"Yang","sequence":"first","affiliation":[{"name":"Dr. Yang is affiliated with Department of Respiratory Therapy, Fu Jen Catholic University, New Taipei City, Taiwan."},{"name":"Dr. Yang is affiliated with Department of Chest Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9376-6539","authenticated-orcid":false,"given":"Chou-Chin","family":"Lan","sequence":"additional","affiliation":[{"name":"Drs. Lan and Yang are affiliated with Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan."},{"name":"Drs. Lan and Yang are affiliated with School of Medicine, Tzu-Chi University, Hualien, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Chen","family":"Yang","sequence":"additional","affiliation":[{"name":"Drs. Lan and Yang are affiliated with Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan."},{"name":"Drs. Lan and Yang are affiliated with School of Medicine, Tzu-Chi University, Hualien, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsien-Chi","family":"Kuo","sequence":"additional","affiliation":[{"name":"Mr. Kuo and Dr. Wu are affiliated with High-End Technology Sleep Center, Landseed International Hospital, Taoyuan City, Taiwan."},{"name":"Mr. Kuo is affiliated with the Department of Biomedical Sciences and Engineering, PhD in Institute of Translational and Interdisciplinary Medicine, National Central University, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Ching","family":"Chen","sequence":"additional","affiliation":[{"name":"Ms. Chen is affiliated with Ph.D. Program in Pharmaceutical Biotechnology, Fu Jen Catholic University, New Taipei City, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuh-Chin T.","family":"Huang","sequence":"additional","affiliation":[{"name":"Dr. Huang is affiliated with Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Pyng","family":"Wu","sequence":"additional","affiliation":[{"name":"Mr. Kuo and Dr. Wu are affiliated with High-End Technology Sleep Center, Landseed International Hospital, Taoyuan City, Taiwan."},{"name":"Dr. Wu is affiliated with Department of Chest Medicine, Landseed International Hospital, Taoyuan City, Taiwan."},{"name":"Dr. Wu is affiliated with National Defense Medical Center, Taipei City, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23079"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-023-02810-7"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.5935\/1984-0063.20200111"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.05.582"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1767787"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/137.4.895"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001106.pub2"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/NSS.S482614"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-72612-8"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.5935\/1984-0063.20180010"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab030"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-014-1085-7"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27938"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2012.12.015"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7676"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2020.105917"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000032538"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.9292"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13246-020-00876-1"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12938-018-0448-x"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016489850182738"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.5588"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsz305"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2008.11.004"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2014.04.006"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.5604\/01.3001.0009.8409"},{"key":"e_1_3_2_28_1","first-page":"989","article-title":"Snoring\u2014harmless or harmful","volume":"125","author":"Bloch KE","year":"1995","unstructured":"27.Bloch KE, and Russi EW. 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