{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T20:14:27Z","timestamp":1787948067843,"version":"build-2784847793"},"reference-count":49,"publisher":"European Respiratory Society (ERS)","issue":"3","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-15-IDEX-02"],"award-info":[{"award-number":["ANR-15-IDEX-02"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-19-P3IA-0003"],"award-info":[{"award-number":["ANR-19-P3IA-0003"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2022,11,16]]},"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mechanisms underlying blood pressure changes in obstructive sleep apnoea (OSA) are incompletely understood. Increased respiratory effort is one of the main features of OSA and is associated with sympathetic overactivity, leading to increased vascular wall stiffness and remodelling. This study investigated associations between a new measure of respiratory effort (percentage of total sleep time spent with increased respiratory effort based on measurement of mandibular jaw movements (MJM): REMOV, %TST) and prevalent hypertension in adults referred for evaluation of suspected OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A machine learning model was built to predict hypertension from clinical data, conventional polysomnography (PSG) indices and MJM-derived parameters (including REMOV). The model was evaluated in a training subset and a test subset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis included 1127 patients: 901 (80%) in the training subset and 226 (20%) in the test subset. The prevalence of hypertension was 31% and 30%, respectively, in the training and test subsets. A risk stratification model based on 18 input features including REMOV had good accuracy for predicting prevalent hypertension (sensitivity 0.75 and specificity 0.83). Using the Shapley additive explanation method, REMOV was the best predictor of hypertension after clinical risk factors (age, sex, body mass index and neck circumference) and time with oxygen saturation &lt;90%, ahead of standard PSG metrics (including the apnoea\u2013hypopnoea index and oxygen desaturation index).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proportion of sleep time spent with increased respiratory effort automatically derived from MJM was identified as a potential new reliable metric to predict prevalent hypertension in patients with OSA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.01486-2022","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T13:31:46Z","timestamp":1669901506000},"page":"2201486","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":38,"title":["Respiratory effort during sleep and prevalent hypertension in obstructive sleep apnoea"],"prefix":"10.1183","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8536-7300","authenticated-orcid":false,"given":"Jean-Benoit","family":"Martinot","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhat-Nam","family":"Le-Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"P\u00e9pin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2022,12,1]]},"reference":[{"key":"2024102103095413000_61.3.2201486.1","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":"2024102103095413000_61.3.2201486.2","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.sleep.2021.05.010","article-title":"Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5","volume":"84","author":"Jennum","year":"2021","journal-title":"Sleep Med"},{"key":"2024102103095413000_61.3.2201486.3","doi-asserted-by":"crossref","first-page":"11990","DOI":"10.1038\/s41598-021-91329-6","article-title":"Association between nocturnal activity of the sympathetic nervous system and cognitive dysfunction in obstructive sleep apnoea","volume":"11","author":"Alomri","year":"2021","journal-title":"Sci Rep"},{"key":"2024102103095413000_61.3.2201486.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-015-0859-7"},{"key":"2024102103095413000_61.3.2201486.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7233.479"},{"key":"2024102103095413000_61.3.2201486.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.14.1829"},{"key":"2024102103095413000_61.3.2201486.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005113421901"},{"key":"2024102103095413000_61.3.2201486.8","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.145"},{"key":"2024102103095413000_61.3.2201486.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy624"},{"key":"2024102103095413000_61.3.2201486.10","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1164\/rccm.201804-0758OC","article-title":"Apnea\u2013hypopnea 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":"2024102103095413000_61.3.2201486.11","doi-asserted-by":"crossref","first-page":"e13143","DOI":"10.1111\/jsr.13143","article-title":"Assessment of sleep-disordered-breathing: quest for a metric or search for meaning?","volume":"29","author":"L\u00e9vy","year":"2020","journal-title":"J Sleep Res"},{"key":"2024102103095413000_61.3.2201486.12","doi-asserted-by":"crossref","first-page":"zsab030","DOI":"10.1093\/sleep\/zsab030","article-title":"Metrics of sleep apnea severity: beyond the apnea\u2013hypopnea index","volume":"44","author":"Malhotra","year":"2021","journal-title":"Sleep"},{"key":"2024102103095413000_61.3.2201486.13","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.08.56"},{"key":"2024102103095413000_61.3.2201486.14","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1093\/sleep\/19.5.388","article-title":"Hemodynamic consequences of obstructive sleep apnea","volume":"19","author":"Weiss","year":"1996","journal-title":"Sleep"},{"key":"2024102103095413000_61.3.2201486.15","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1526"},{"key":"2024102103095413000_61.3.2201486.16","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1152\/jappl.1998.85.4.1434","article-title":"Within-night variation in respiratory effort preceding apnea termination and EEG delta power in sleep apnea","volume":"85","author":"Berry","year":"1998","journal-title":"J Appl Physiol"},{"key":"2024102103095413000_61.3.2201486.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)80395-7"},{"key":"2024102103095413000_61.3.2201486.18","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(91)90014-O"},{"key":"2024102103095413000_61.3.2201486.19","first-page":"528","article-title":"Upper airway closing pressures in snorers","volume":"57","author":"Issa","year":"1984","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"2024102103095413000_61.3.2201486.20","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(83)90032-2"},{"key":"2024102103095413000_61.3.2201486.21","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1152\/jappl.1988.64.4.1506","article-title":"Transient analysis of cardiopulmonary interactions. I. Diastolic events","volume":"64","author":"Peters","year":"1988","journal-title":"J Appl Physiol"},{"key":"2024102103095413000_61.3.2201486.22","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1152\/jappl.1988.64.4.1518","article-title":"Transient analysis of cardiopulmonary interactions. II. Systolic events","volume":"64","author":"Peters","year":"1988","journal-title":"J Appl Physiol"},{"key":"2024102103095413000_61.3.2201486.23","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.98.12061257"},{"key":"2024102103095413000_61.3.2201486.24","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.55.5.393"},{"key":"2024102103095413000_61.3.2201486.25","doi-asserted-by":"crossref","first-page":"S202","DOI":"10.1093\/sleep\/19.suppl_10.S202","article-title":"Snoring as part of a dose-response relationship between sleep-disordered breathing and blood pressure","volume":"19","author":"Young","year":"1996","journal-title":"Sleep"},{"key":"2024102103095413000_61.3.2201486.26","doi-asserted-by":"crossref","first-page":"353","DOI":"10.3389\/fneur.2017.00353","article-title":"Mandibular movements as accurate reporters of respiratory effort during sleep: validation against diaphragmatic electromyography","volume":"8","author":"Martinot","year":"2017","journal-title":"Front Neurol"},{"key":"2024102103095413000_61.3.2201486.27","doi-asserted-by":"crossref","first-page":"635","DOI":"10.2147\/NSS.S346229","article-title":"Mandibular movements are a reliable noninvasive alternative to esophageal pressure for measuring respiratory effort in patients with sleep apnea syndrome","volume":"14","author":"Pepin","year":"2022","journal-title":"Nat Sci Sleep"},{"key":"2024102103095413000_61.3.2201486.28","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.6576"},{"key":"2024102103095413000_61.3.2201486.29","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.2172"},{"key":"2024102103095413000_61.3.2201486.30","unstructured":"American Academy of Sleep Medicine . International Classification of Sleep Disorders. 3rd Edn. Darien, AASM, 2014."},{"key":"2024102103095413000_61.3.2201486.31","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1111\/resp.12929","article-title":"Mandibular position and movements: suitability for diagnosis of sleep apnoea","volume":"22","author":"Martinot","year":"2017","journal-title":"Respirology"},{"key":"2024102103095413000_61.3.2201486.32","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1164\/rccm.202103-0680LE","article-title":"Machine learning-based sleep staging in patients with sleep apnea using a single mandibular movement signal","volume":"204","author":"Le-Dong","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102103095413000_61.3.2201486.33","doi-asserted-by":"crossref","first-page":"e1919657","DOI":"10.1001\/jamanetworkopen.2019.19657","article-title":"Assessment of mandibular movement monitoring with machine learning analysis for the diagnosis of obstructive sleep apnea","volume":"3","author":"P\u00e9pin","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2024102103095413000_61.3.2201486.34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s42256-019-0138-9","article-title":"From local explanations to global understanding with explainable AI for trees","volume":"2","author":"Lundberg","year":"2020","journal-title":"Nat Mach Intell"},{"key":"2024102103095413000_61.3.2201486.35","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1093\/sleep\/20.2.168","article-title":"Assessment of respiratory effort by means of strain gauges and esophageal pressure swings: a comparative study","volume":"20","author":"Boudewyns","year":"1997","journal-title":"Sleep"},{"key":"2024102103095413000_61.3.2201486.36","first-page":"1076","article-title":"An official American Thoracic Society workshop report: noninvasive identification of inspiratory flow limitation in sleep studies","volume":"14","author":"Pamidi","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2024102103095413000_61.3.2201486.37","doi-asserted-by":"publisher","DOI":"10.1159\/000335839"},{"key":"2024102103095413000_61.3.2201486.38","doi-asserted-by":"publisher","DOI":"10.1007\/BF01377349"},{"key":"2024102103095413000_61.3.2201486.39","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.162.1.9905006"},{"key":"2024102103095413000_61.3.2201486.40","doi-asserted-by":"publisher","DOI":"10.1378\/chest.109.4.901"},{"key":"2024102103095413000_61.3.2201486.41","doi-asserted-by":"crossref","first-page":"731","DOI":"10.6061\/clinics\/2014(11)04","article-title":"An overlooked cause of resistant hypertension: upper airway resistance syndrome \u2013 preliminary results","volume":"69","author":"Asker","year":"2014","journal-title":"Clinics"},{"key":"2024102103095413000_61.3.2201486.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2005.03.007"},{"key":"2024102103095413000_61.3.2201486.43","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.98.11051121"},{"key":"2024102103095413000_61.3.2201486.44","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00029315"},{"key":"2024102103095413000_61.3.2201486.45","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/ajh\/hpac006","article-title":"Sleep apnea syndrome and large artery subclinical damage: targeting thoracic aortic dilatation","volume":"35","author":"Gherbesi","year":"2022","journal-title":"Am J Hypertens"},{"key":"2024102103095413000_61.3.2201486.46","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1164\/rccm.201411-2127LE","article-title":"Aortic expansion assessed by imaging follow-up after acute aortic syndrome: effect of sleep apnea","volume":"192","author":"Barone-Rochette","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102103095413000_61.3.2201486.47","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1186\/s12890-021-01778-y","article-title":"Influence of nocturnal hypoxemia on follow-up course after type B acute aortic syndrome","volume":"21","author":"Delsart","year":"2021","journal-title":"BMC Pulm Med"},{"key":"2024102103095413000_61.3.2201486.48","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s11325-018-1698-3","article-title":"Aortic root size is associated with nocturnal blood pressure in a population of hypertensive patients under treatment for obstructive sleep apnea","volume":"23","author":"Delsart","year":"2019","journal-title":"Sleep Breath"},{"key":"2024102103095413000_61.3.2201486.49","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01788-2021"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.01486-2022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T01:08:07Z","timestamp":1740359287000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.01486-2022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,1]]},"references-count":49,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,2]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1183\/13993003.01486-2022"],"URL":"https:\/\/doi.org\/10.1183\/13993003.01486-2022","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,1]]}}}