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                 <jats:p>Moderate-severe obstructive sleep apnea (OSA) (apnea\u2013hypopnea index [AHI], &amp;gt;15 events\/h) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI &amp;lt;15 events\/h) also report sleepiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the hypothesis that sleepiness in the AHI &amp;lt;15 events\/h group is a consequence of substantial flow limitation in the absence of overt reductions in airflow (i.e., apnea\/hypopnea).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 1,886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram-recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by an Epworth Sleepiness Scale score \u2a7e11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI &amp;lt;15 events\/h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 772 individuals with an AHI &amp;lt;15 events\/h were included in the primary analysis. Flow limitation was associated with EDS (odds ratio, 2.04; 95% confidence interval, 1.17\u20133.54; per 2\u2013standard deviation increase in flow limitation frequency) after adjusting for age, sex, body mass index, race\/ethnicity, and sleep duration. This effect size did not appreciably change after also adjusting for AHI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In individuals with an AHI &amp;lt;15 events\/h, increasing flow limitation frequency by 2 standard deviations is associated with a twofold increase in the risk of EDS. Future studies should investigate addressing flow limitation in low-AHI individuals as a potential mechanism for ameliorating sleepiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.202308-710oc","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T12:26:57Z","timestamp":1711456017000},"page":"1186-1193","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":9,"title":["Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2499-5415","authenticated-orcid":false,"given":"Dwayne L.","family":"Mann","sequence":"first","affiliation":[{"name":"School of Electrical Engineering and Computer Science"},{"name":"Institute for Social Science Research, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8220-7368","authenticated-orcid":false,"given":"Eric","family":"Staykov","sequence":"additional","affiliation":[{"name":"School of Electrical Engineering and Computer Science"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7585-1481","authenticated-orcid":false,"given":"Thomas","family":"Georgeson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4986-4753","authenticated-orcid":false,"given":"Ali","family":"Azarbarzin","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2798-2115","authenticated-orcid":false,"given":"Samu","family":"Kainulainen","sequence":"additional","affiliation":[{"name":"Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; and"},{"name":"Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-1610","authenticated-orcid":false,"given":"Susan","family":"Redline","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3752-0328","authenticated-orcid":false,"given":"Scott A.","family":"Sands","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7649-0884","authenticated-orcid":false,"given":"Philip I.","family":"Terrill","sequence":"additional","affiliation":[{"name":"School of Electrical Engineering and Computer Science"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"2026041420325652500_bib1","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1183\/13993003.01148-2015","article-title":"Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms","volume":"47","author":"Arnardottir","year":"2016","journal-title":"Eur Respir J"},{"key":"2026041420325652500_bib2","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1007\/s11325-021-02473-2","article-title":"Prevalence of objective excessive daytime sleepiness in a cohort of patients with mild obstructive sleep apnea","volume":"26","author":"Landzberg","year":"2022","journal-title":"Sleep Breath"},{"key":"2026041420325652500_bib3","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1164\/rccm.202107-1761OC","article-title":"Multinight prevalence, variability, and diagnostic misclassification of obstructive sleep apnea","volume":"205","author":"Lechat","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"key":"2026041420325652500_bib4","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1378\/chest.104.3.781","article-title":"A cause of excessive daytime sleepiness. 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