{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T16:04:44Z","timestamp":1779552284237,"version":"3.53.1"},"posted":{"date-parts":[[2026,5,21]]},"group-title":"Respiratory Medicine","reference-count":34,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Rationale<\/jats:title>\n                  <jats:p>Conventional measures of obstructive sleep apnea severity, particularly the apnea-hypopnea index, do not adequately capture event-level neurophysiologic responses to respiratory events. Whether post-apnea\/hypopnea arousal dynamics provide prognostic information beyond established metrics remains unknown.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine whether post-apnea\/hypopnea arousal dynamics are associated with all-cause and cardiovascular mortality.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective analysis of in-home polysomnography data from 8,053 adults across four community-based cohorts. Peak time (PT; latency to maximal arousal probability), peak height (PH; maximal arousal probability), and area under the curve (AUC; cumulative arousal probability) were derived from peri-stimulus time histograms aligned to event termination. Associations with mortality were examined using multivariable Cox models and random-effects meta-analysis.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Measurements and Main Results<\/jats:title>\n                  <jats:p>PT, but not PH or AUC, was associated with mortality. In pooled analyses, each 1-second delay in PT was associated with higher all-cause mortality in males (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02\u20131.06) and females (HR, 1.03; 95% CI, 1.00\u20131.06). For cardiovascular mortality, each 1-second delay in PT was associated with higher risk in males (HR, 1.05; 95% CI, 1.02\u20131.08) but not females (HR, 1.04; 95% CI, 0.99\u20131.10). Associations were driven primarily by non-rapid eye movement sleep and remained materially unchanged after additional adjustment for apnea-hypopnea index, arousal index, and hypoxic burden.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Delayed arousal timing after apnea\/hypopnea termination was associated with increased mortality risk independent of conventional measures of obstructive sleep apnea severity. Event-level arousal timing may provide prognostic information beyond count-based and hypoxemia-based metrics.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.18.26353387","type":"posted-content","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T23:10:13Z","timestamp":1779405013000},"source":"Crossref","is-referenced-by-count":0,"title":["Delayed Arousal Response to Sleep Apnea Encodes Mortality"],"prefix":"10.64898","author":[{"given":"Jiahao","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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