{
  "abstract": "Background\n\nObstructive sleep apnea (OSA) is a heterogeneous disorder influenced by both anatomical collapsibility and non-anatomical factors, such as neuromuscular response. Identifying these traits through simplified clinical surrogates is crucial for personalized precision medicine.Methods\n\nThis exploratory retrospective study evaluated 207 home polygraphy recordings of Italian patients to assess sleep-stage-specific Apnea-Hypopnea Index (REM vs. NREM AHI) as a clinical surrogate indicator of the balance between anatomical collapsibility and neuromuscular compensation. Patients were stratified by severity into simple snorers (AHI < 5 events/h), mild OSA (AHI 5-15 events/h), and severe OSA (AHI > 30 events/h). REM and NREM AHI values were compared and correlated with Apnea Index (AI), Hypopnea Index (HI), body mass index (BMI), and cumulative nocturnal desaturation indices (CT < 90% and T < 90 min).Results\n\nIn non-severe patients (simple snorers and mild OSA), REM AHI was significantly higher than NREM AHI (REM/NREM ratio > 1), suggesting relative neuromuscular protection during NREM sleep. Conversely, in severe OSA patients, the REM/NREM ratio progressively decreased and approached unity, with NREM AHI prevailing. Furthermore, NREM predominance was significantly associated with a higher AI and a worse cumulative desaturation indicating a globally more severe disease.Conclusions\n\nA predominance of REM AHI characterizes milder OSA presentations with effective NREM muscular compensation, whereas NREM predominance aligns with an anatomically dominant, severe phenotype. Decomposing AHI into REM and NREM components provides a practical, readily available clinical surrogate to estimate the anatomy-neuromuscular balance and guide PALM-oriented personalized treatments.",
  "abstract_shown": true,
  "affiliations": [
    "GVM Care & Research, San Pier Damiano Hospital, Via Portisano 1, 48018 Faenza, Italy.",
    "Department of Sense Organs, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.",
    "Department of Otolaryngology, Kore University of Enna, 94100 Enna, Italy.",
    "MedicAir Healthcare, Via Monte Rosa 61, 20149 Milan, Italy.",
    "Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy.",
    "Department of Otolaryngology, University of Ferrara, 44121 Ferrara, Italy.",
    "Asia Sleep Centre, Paragon Medical Centre, 290 Orchard Road, #18-04, Singapore 238859, Singapore.",
    "Professional Master's Programme in Dental Sleep Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ruggero Campisi",
      "orcid": "0009-0000-1701-1097"
    },
    {
      "affs": [
        0
      ],
      "name": "Ilaria Falco"
    },
    {
      "affs": [
        1
      ],
      "name": "Giannicola Iannella",
      "orcid": "0000-0003-1781-2809"
    },
    {
      "affs": [
        2
      ],
      "name": "Antonio Maniaci",
      "orcid": "0000-0002-1251-0185"
    },
    {
      "affs": [
        3
      ],
      "name": "Miriam Nava"
    },
    {
      "affs": [
        3
      ],
      "name": "Gianluca Bronzetti"
    },
    {
      "affs": [
        3
      ],
      "name": "Davide Bianchi"
    },
    {
      "affs": [
        3
      ],
      "name": "Alice Cescutti"
    },
    {
      "affs": [
        4
      ],
      "name": "Manuele Casale"
    },
    {
      "affs": [
        4
      ],
      "name": "Antonio Moffa"
    },
    {
      "affs": [
        5
      ],
      "name": "Chiara Bianchini",
      "orcid": "0000-0002-5115-6107"
    },
    {
      "affs": [
        5
      ],
      "name": "Stefano Pelucchi"
    },
    {
      "affs": [
        5
      ],
      "name": "Pietro Bonzagni"
    },
    {
      "affs": [
        6
      ],
      "name": "Kenny Peter Pang",
      "orcid": "0000-0003-3799-1891"
    },
    {
      "affs": [
        7
      ],
      "name": "Mario Pierri"
    },
    {
      "affs": [
        0
      ],
      "name": "Claudio Vicini"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0dvy8ee7ftjz8.bib",
  "cited_by": 0,
  "doi": "10.3390/clockssleep8040065",
  "fulltext_url": "https://europepmc.org/articles/PMC13692476",
  "id": "0dvy8ee7ftjz8",
  "issns": [
    "2624-5175"
  ],
  "landing_url": "https://europepmc.org/article/MED/42924741",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2737|Obstructive Sleep Apnea Research"
    ]
  ],
  "openalex": "W7220844368",
  "pdf_url": "https://europepmc.org/articles/PMC13692476?pdf=render",
  "pmcid": "PMC13692476",
  "pmid": "42924741",
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0dvy8ee7ftjz8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:36Z",
      "native_id": "MED:42924741",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42924741"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Obstructive Sleep Apnea Research",
      "subfield": "physiology"
    }
  ],
  "title": "Muscular Response in Sleep-Disordered Breathing Patients: New Methods of Assessment and Measurement.",
  "title_text": "Muscular Response in Sleep-Disordered Breathing Patients: New Methods of Assessment and Measurement.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:36Z",
  "url": "https://research.draconitic.com/paper/0dvy8ee7ftjz8",
  "venue": "Clocks & sleep",
  "versions": []
}