Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association

Gender-specific associations between sleep stages and cardiovascular risk factors

STUDY OBJECTIVES

Sleep characteristics are associated with cardiovascular disease (CVD) risk and both sleep and CVD risk vary by gender. Our objective was to examine associations between polysomnographic sleep characteristics and CVD risk after excluding moderate-severe sleep apnea, and whether gender modifies these associations.

METHODS

This was a cross-sectional study with at-home polysomnography in adults in Brazil (n = 1102 participants with apnea-hypopnea index (AHI) <15 events/hour). Primary exposures were N3, REM, wake after sleep onset (WASO), arousal index, and AHI, and outcomes were blood pressure (BP) and lipid levels.

RESULTS

Associations between sleep and BP varied by gender. In women, more N3 was associated with lower systolic BP (-0.40 mmHg per 10 minutes, 95% CI: -0.71, -0.09), lower diastolic BP (-0.29 mmHg per 10 minutes, 95% CI: -0.50, -0.07), and lower odds of hypertension (OR 0.94, 95% CI: 0.89, 0.98). In men, more WASO was associated with higher systolic BP (0.41 mmHg per 10 minutes, 95% CI: 0.08, 0.74) and higher odds of hypertension (OR 1.07, 95% CI: 1.01, 1.14). No interactions by gender were observed for lipids. More WASO was associated with lower total cholesterol (-0.71 per 10 minutes, 95% CI: -1.37, -0.05). Higher AHI was associated with higher total cholesterol (+0.97 per event/hour, 95% CI: 0.24, 1.70) and higher LDL (+0.84 per event/hour, 95% CI: 0.04, 1.64).

CONCLUSIONS

N3 is more strongly associated with BP in women, which is consistent with other studies demonstrating gender differences in BP control and CVD risk and adds a novel risk factor. Longitudinal and interventional studies are required to determine whether changes in N3 result in BP changes.

Association of obstructive sleep apnea with cardiovascular events in acute coronary syndrome patients with dual risk of remnant cholesterol and low-grade inflammation: a post-hoc analysis of the OSA-ACS study

PURPOSE

Obstructive sleep apnea (OSA) is a recognized cardiovascular risk factor, yet the benefits of intervention remain uncertain due to the heterogeneity among OSA patients. We aimed to explore the association of OSA with cardiovascular outcomes in acute coronary syndrome (ACS) patients with dual risk of elevated remnant cholesterol (RC) and low-grade inflammation indicated by high-sensitivity C-reactive protein (hs-CRP).

METHODS

This study is a post-hoc analysis of OSA-ACS project enrolled 1833 ACS patients from January 2015 to December 2019, who underwent a sleep study, categorized into four groups by median levels of RC and hs-CRP: RC and low-grade inflammation risk (RCIR), low-grade inflammation risk (LDIR), RC risk (RCR), and no residual risk. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or heart failure, and ischemia-driven revascularization. Cox proportional hazards models were used to assess the association between OSA and cardiovascular events.

RESULTS

After a median follow-up of 35.13 months, OSA significantly increased the risk of MACCE (adjusted hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.01-2.47; p = 0.045) and stroke (adjusted HR 5.23, 95% CI 1.19-22.99; p = 0.027) in the RCIR group. In the RCIR group, the log-transformed AHI (Log-AHI) and ODI (Log-ODI) were both significantly associated with an increased risk of MACCE, with adjusted hazard ratios of 1.711 (95% CI: 1.092-2.679; p = 0.019) and 1.813 (95% CI: 1.039-3.163; p = 0.036), respectively. Moreover, log-transformed nadir SaO2 (Log-Nadir SaO2) demonstrated a significant inverse association with MACCE risk (adjusted HR: 0.033; 95% CI: 0.001-0.769; p = 0.034).

CONCLUSIONS

OSA is prevalent and more severe in ACS patients with dual risk of elevated RC and low-grade inflammation, significantly increasing MACCE and stroke risk, highlighting the need for routine screening and comprehensive management to reduce cardiovascular risk.

Adherence to CPAP for patients with atrial fibrillation undergoing catheter ablation: A "real-world" analysis

BACKGROUND

The relationship between obstructive sleep apnea (OSA) and atrial fibrillation (AF) is well established, as the existing literature has concluded that sleep apnea creates a unique, complex, and dynamic substrate for AF with various pathophysiological mechanisms. Little is known about the role of continuous positive airway pressure (CPAP) therapy in reversing the risk of AF recurrence in patients with OSA. Awareness of the therapeutic effects of CPAP in preventing AF recurrence postablation will help create a multidisciplinary team of doctors to treat this complex population of patients.

OBJECTIVES

The goals of this study were to examine the effect of CPAP adherence on AF-free survival post-catheter ablation and to identify the indicated average CPAP use to maximize AF-free survival postablation.

METHODS

We selected 190 consecutive patients who underwent catheter ablation for AF at Lenox Hill Hospital in New York and who had a concurrent diagnosis of OSA. In this retrospective case-control study, 97 (51%) patients with OSA adherent to CPAP use were carefully matched with 93 (49%) patients who were not adherent to CPAP guidelines for patients with OSA.

RESULTS

The mean age of the population was 66.3 ± 9.4 years, and 78% were male. Patients in the adherent group had a recurrence rate of 24% until their last follow-up visit compared with 42% in the nonadherent group (P=.02). In a stepwise multivariate regression model, adherence to CPAP was independently associated with lower chances of composite AF recurrence with an odds ratio of 0.24 (CI 95% = 0.08-0.68; P = .007). Using the receiver operating characteristic curve, we identified the optimal average nightly CPAP duration required to observe a clinical benefit and reperformed the above analysis. With a new cutoff set at 287 minutes of CPAP per night, the adjusted odds ratio for AF recurrence was 0.17 (CI 95% = 0.12-0.71; P=.004). In a secondary analysis, patients who were not adherent to optimal CPAP use did not show any benefit compared with patients who did not use CPAP at all (56% vs 59%; P = .75).

CONCLUSION

Consistent nightly CPAP use offers a 3-year AF-free survival postablation in 1 of 5 patients with OSA who undergo ablation for AF. Inconsistent CPAP use, defined as <287 minutes per night, offers no benefit compared with no CPAP.

Sleep traits causally affect epigenetic age acceleration: a Mendelian randomization study

Sleep disorders (SDs) are a common issue in the elderly. Epigenetic clocks based on DNA methylation (DNAm) are now considered highly accurate predictors of the aging process and are associated with age-related diseases. This study aimed to investigate the causal relationship between sleep traits and the epigenetic clock using Mendelian randomization (MR) analysis. The genome-wide association study (GWAS) statistics for epigenetic clocks (HannumAge, intrinsic epigenetic age acceleration [IEAA], PhenoAge, and GrimAge) and sleep traits were obtained from the UK Biobank (UKB), 23andMe and Finngen. Moreover, crucial instrumental variables (IVs) were evaluated. Inverse variance weighted (IVW), MR-Egger, weighted median (WM), weighted mode, and simple mode methods were employed to assess the causal relationship between them. Multiple analyses were performed for quality control evaluation. Our study showed that self-reported insomnia may speed up the aging process by GrimAge clock, while GrimAge acceleration could faintly reduce self-reported insomnia. Epigenetic clocks mainly influence sleep traits by PhenoAge and GrimAge with weak effects. This may indicate that early interventions of SDs could be a breaking point for aging and age-related diseases. Further studies are required to elucidate the potential mechanisms involved.

APOE Polymorphism, Obstructive Sleep Apnea, and Cognitive Function

Objective  Obstructive sleep apnea (OSA) is associated with the apolipoprotein E ε4 polymorphic allele ( APOE ε4 ) and with worse cognitive function. However, the influence of APOE ε4 on cognitive function in patients with moderate-to-severe OSA is controversial. The present study evaluated the influence of APOE ε4 polymorphism and cognitive function in sedentary OSA patients with no other major comorbidities. Materials and Methods  In total, 55 middle-aged patients underwent conventional nocturnal polysomnography, APOE ε4 polymorphism genotyping, cognitive evaluation (attention, inhibitory control, frontal functions, processing speed, and episodic memory), and they filled out the International Physical Activity Questionnaire. Results  Overall, 13 patients had no or mild OSA, and 42 had moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events/h of sleep) and APOE ε4 was present in 7.7% and 21.4% of the patients in each group respectively. Among patients with moderate-to-severe OSA, the sleep parameters were similar in the groups of APOE ε4 carriers and noncarriers. Compared with patients with no or mild OSA, the cognitive parameters were worse for processing speed (Digit Symbol Test) and attention (Stroop Color Word Test, SCWT-Part 2) among the patients with moderate-to-severe OSA. The difference was present even after the exclusion of APOE ε4 carriers. Among patients with moderate-to-severe OSA, APOE ε4 carriers presented worse episodic memory, evaluated through the Rey Auditory Verbal Learning Test, than APOE ε4 noncarriers. Conclusion  Moderate-to-severe OSA is associated with poor cognitive function that is further impaired by the presence of APOE ε4 polymorphism.

Rising cardiovascular mortality among obstructive sleep apnea patients: United States epidemiological trends (1999-2019)

BACKGROUND

Obstructive sleep apnea (OSA) prevalence has risen significantly, affecting millions globally and posing a major healthcare burden. OSA is strongly associated with cardiovascular diseases (CVD) such as heart failure, stroke, and ischemic heart disease. However, trends in CVD-related mortality among individuals with OSA remain underexplored.

OBJECTIVE

This study aims to assess the trends of OSA and CVD related mortality rates and variations in mortality based on demographics and regions in the US.

METHODS

Mortality data for adults aged ≥25 with OSA and CVD were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) with 95 % confidence intervals (CIs) were calculated, stratified by year, sex, race/ethnicity, age, urbanization, and Census regions.

RESULTS

Between 1999 and 2019, 168,111 OSA-related CVD deaths were recorded. Overall AAMRs rose significantly, particularly for hypertensive disease (1999-2006 APC: 13.2 %, 95 % CI: 11.6-15.7). Men consistently had higher AAMRs than women, and Black individuals showed the highest racial disparities. AAMRs varied geographically, with the Midwest recording the highest rates and rural areas showing notable increases. States like Oregon and Montana had rates three times higher than New York and Massachusetts.

CONCLUSIONS

OSA-related CVD mortality has risen substantially, with marked disparities by sex, race, and region. These findings emphasize the need for targeted public health interventions to reduce mortality in high-risk groups.

Nontraditional Factors Influencing Cardiovascular Disease Risk: Correlation Among Framingham Risk Score, Body Composition Index, and Sleep-Breathing Monitoring Index

To examine the correlation among body composition, sleep-breathing indicators, and Framingham risk score (FRS) to identify and amplify nontraditional factors that influence the risk of CVD in males, A total of 195 male participants underwent examinations for body composition and sleep-breathing monitoring. We compared the differences in individual factors across various FRS groups. We further conducted multiple linear regression analysis. A cutoff value of FRS ≥ 14 was utilized, and potential influencing factors were examined by logistic regression analysis. Statistical differences were observed in the levels of fasting blood glucose (FBG), CO2, serum ferritin, hemoglobin (HB), and ECT/TBW among the FRS tripartite groups. However, no significant differences were found in AHI and MSpO2. The multiple linear regression analysis revealed positive correlations between ECW/TBW and FBG with FRS (β = 0.324 and 0.324, p < 0.001), while HB and muscle/fat mass exhibited negative correlations with the score (β = -0.185 and - 0.169, p < 0.01). These five factors-ECW/TBW, FBG, HB, serum ferritin, and muscle/fat mass-collectively accounted for 28.6% of the variation in FRS. A higher ECW/TBW was significantly associated with FRS ≥ 14 (OR = 2.208, 95% CI: 1.503-3.244). Conversely, reduced levels of muscle/fat mass, HB, and basal metabolic rate (BMR) were significantly linked to moderate-to-high CVD risk (ORratio = 0.532, 95% CI: 0.284-0.996; ORHB = 0.961, 95% CI: 0.932-0.991; ORBMR = 0.997, 95% CI: 0.995-1.000). This study revealed correlations among ECW/TBW, HB, FBG, and muscle-to-fat mass ratio with the risk of CVD predicted using FRSs.

The expression changes endothelial and fibrinolytic biomarkers in acute ischemic stroke patients with OSA

OBJECTIVE

To assess the expression changes of serum fibrinogen, E-selectin, and tissue-type plasminogen activator (t-PA) in acute ischemic stroke (AIS) patients with varying degrees of obstructive sleep apnea syndrome (OSA), and evaluate their value in diagnosing AIS with OSA.

METHODS

Data were gathered from 80 patients with AIS who were admitted to the First Hospital of Jilin University between January 2023 and December 2023. Out of these, 60 patients completed the NIHSS Scale, ESS Scale, STOP-Bang Scale, and underwent polysomnography within a week of symptom onset. Based on the apnea-hypopnea index (AHI) score, patients were categorized into three groups: 15 in the non-exposed group (AHI < 5), 15 in the mildly exposed group (5 ≤ AHI ≤ 15), and 30 in the moderately to severely exposed group (AHI > 15). Serum levels of fibrinogen, E-selectin, and t-PA were determined using enzyme-linked immunosorbent assay.

RESULTS

Polysomnography results indicated AIS with OSA had an increased arousal index and oxygen desaturation index (P < 0.001). Additionally, serum levels of fibrinogen, E-selectin, and t-PA were markedly elevated in the moderately-severely exposed group compared to the non-exposed group (P < 0.001), and these levels positively correlated with the severity of OSA. ROC curves showed the sensitivities of serum of fibrinogen, E-selection, and t-PA was 84.4%, 80%, and 82.2%, respectively, and the specificities of 60%, 66.7%, and 66.7%, compared with that of PSG respectively.

CONCLUSION

The expression of serum fibrinogen, E-selectin, and t-PA is elevated in AIS with OSA and correlates with the severity of OSA.

Relationship between vascular aging and left ventricular geometry in patients with obstructive sleep apnea hypopnea syndrome-related hypertension

This study aimed to investigate the association of the vascular aging and left ventricular geometry in OSAHS-related hypertension population with good blood pressure control. A retrospective study was conducted at the Third Xiangya Hospital, collecting data from patients admitted between August 1, 2022, and January 1, 2024. Vascular aging parameters were collected, including ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), and carotid intima-media thickness (cIMT). Left ventricular mass index (LVMI), relative wall thickness (RWT), left ventricular hypertrophy (LVH), and left ventricular concentric geometry (LVCG) were collected to assess left ventricular geometry patterns. Spearman correlation analysis, generalized linear regression, and logistic regression were used to assess the associations of the vascular aging and left ventricular geometry. A total of 238 patients were included. Significant positive correlations were found between baPWV and LVMI (Rs = 0.26, P < 0.001), baPWV and RWT (Rs = 0.37, P < 0.001), cIMT and LVMI (Rs = 0.24, P < 0.001), and cIMT and RWT (Rs = 0.34, P < 0.001). Generalized linear regression model indicated that both baPWV (β = 0.84, P = 0.01 for LVMI; β = 0.005, P < 0.001 for RWT) and cIMT (β = 27.54, P = 0.01 for LVMI; β = 0.13, P < 0.001 for RWT) were associated with LVMI and RWT, respectively. Logistic regression revealed that baPWV (OR = 1.08, 95%CI 1.02-1.15) and cIMT (OR = 1.30, 95%CI 1.06-1.60) were associated with LVH. baPWV (OR = 1.44, 95%CI 1.28-1.65) and cIMT (OR = 1.54, 95%CI 1.21-1.96) also showed associations with LVCG. Subgroup analyses based on gender and BMI suggested that the results were robust. This study showed that vascular aging parameters may be used to assess changes in left ventricular geometry of patients with OSAHS-related hypertension.

AMI-Sleep: protocol for a prospective study of sleep-disordered breathing/sleep apnoea syndrome and incident cardiovascular events after acute myocardial infarction

INTRODUCTION

Sleep-disordered breathing (SDB) and the related clinical syndrome, sleep apnoea syndrome (SAS), are highly prevalent in patients with ischaemic heart disease and often remain undiagnosed. The AMI-Sleep study will describe its prevalence in patients with acute myocardial infarction (AMI) and assess the independent contribution of the type and severity of SDB/SAS to subsequent incident cardiovascular events and mortality.

METHODS AND ANALYSIS

This prospective study will include patients hospitalised for AMI enrolled in the multicentre nationwide prospective French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry. A nightly simplified polygraphy is performed before discharge from the index AMI admission, and participants complete two self-administered sleep questionnaires. Baseline data are obtained from the FRENCHIE registry. Each participant will be subsequently followed based on data from the National Health Data System (SNDS). Over a period of 4 years, the AMI-Sleep study is expected to recruit approximately 2000 participants. Assuming at least a 10% rate of incident cardiovascular events over 1 year, there would be an estimated 200 events during the first year of follow-up that would be sufficient in multivariable analysis. The primary objective is to describe the prevalence and severity of SDB in AMI and to analyse the association between the type and severity of SDB (based on the apnoea-hypopnoea index) and the occurrence of cardiovascular events (incident acute coronary syndrome, transient ischaemic attack, stroke) or all-cause death after AMI. Secondary objectives include determining the association between the presence of SAS and coronary artery disease severity, in-hospital mortality, morbidity events, healthcare consumption and related costs.

ETHICS AND DISSEMINATION

Eligible individuals are provided with information about the AMI-Sleep study and provided written informed consent. The protocol was approved by the regional Ethics Committee (CPP Ouest II - Angers, RCB N°2018-A00719-46) on 17 February 2019, is registered on ClinicalTrials.gov (NCT04064593) and started in January 2019 with the expected publication of primary outcome results in 2025.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT04064593.

Assessment of obstructive sleep apnea rate and associated factors among Lebanese adults: a cross-sectional study

Objectives

To estimate the rate of obstructive sleep apnea (OSA) and associated factors among Lebanese adults.

Methods

A cross-sectional study was conducted in February-April 2022; 1,202 Lebanese adults were enrolled. The sample was collected among several Lebanese governorates through an anonymous online self-reported questionnaire. The STOP-BANG questionnaire was used as a screening tool to estimate the OSA risk. "Low OSA risk" is established with 0-2 positive answers, "Intermediate OSA risk" is established by 3-4 positive answers while "High OSA risk" is established by 5-8 positive answers.

Results

This study showed that 743 (62.4%) of the sample had low risk for OSA, 357 (30.0%) had moderate, and 90 (7.6%) had high risk for OSA. Older age (aOR = 1.05) and having hypertension (aOR = 7.80) were associated with higher odds of moderate OSA. Female sex (aOR = 0.04) was significantly associated with lower odds of moderate OSA compared to males. Older age (OR = 1.17), higher BMI (OR = 1.14), hypertension (OR = 18.55), and having severe COVID-19 infection compared to mild (OR = 4.30) were significantly associated with higher odds of high OSA, whereas female sex (OR = 0.002) and being married compared to single (aOR = 0.23) were associated with lower odds of high OSA.

Conclusion

This study showed that most Lebanese adults have low risk for OSA. It also confirmed that sex, age, obesity, hypertension, and severe COVID-19 were associated with high OSA risk. These associated factors call for future research exploring the causes including the potential effect of social, economic, and political instability, local customs, and environmental factors. Moreover, future health campaigns should be assigned to increase awareness among Lebanese population regarding the prevention of OSA through lifestyle modifications.

Optimizing Obstructive Sleep Apnea Risk Assessment in Hypertension: Development of a Predictive Nomogram in China

Purpose

Obstructive sleep apnea (OSA) is common in patients with hypertension. Our study aims to construct and validate an objective nomogram that can accurately predict the risk of OSA in patients with hypertension.

Patients and Methods

Retrospective data were collected from patients with hypertension who underwent polysomnography (PSG) at the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University, China. All participants were assigned to the training group (used to develop the predictive model). Similarly, data from patients with hypertension who underwent PSG at the Sleep Medicine Center of the Second Affiliated Hospital of Guangdong Medical University, China, were collected, and these participants were assigned to the validation group (used to test the model's performance). Logistic and LASSO regression analyses were used to identify factors and construct the nomogram. C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve analysis (CICA) were used to assess the model. Finally, nomogram validation was performed in the validation group.

Results

This study included a training group of 303 patients and a validation group of 217 patients. Based on LASSO and Logistic regression analyses and clinical practicality, we identified gender, age, BMI (body mass index), NC (neck circumference) and ESS (Epworth Sleepiness Scale) as predictors for the nomogram. The C-index is 0.840 in the training group and 0.808 in the validation group. The area under the curve (AUC) of the predictive model and STOP-Bang at the three diagnostic cut-off points of the Apnea-Hypopnea Index (AHI) ≥ 5, AHI ≥ 15 and AHI ≥ 30 were 0.840 vs 0.778, 0.754 vs 0.740, and 0.765 vs 0.751 respectively. The AUC at each intercept point was higher than that of STOP-Bang. DCA and CICA showed that the nomogram is clinically useful.

Conclusion

The nomogram predictive model consisting of the five indicators (gender, age, BMI, NC and ESS) can be useful in determining OSA risk in patients with hypertension.

Association of Serum Ferritin Levels With Obstructive Sleep Apnea in Overweight/Obese US Populations: A Population-Based Study From the NHANES

Objective

To investigate the relationship between serum ferritin levels and OSA in overweight/obese individuals and assess the association between ferritin levels and all-cause mortality in overweight/obese female OSA patients.

Methods

Cross-sectional (n = 4,809) and prospective (n = 832) data from overweight/obese adults from the 2005-2008, and 2015-March 2020 NHANES cycles were analyzed. Participants were categorized into quartiles (Q1-Q4) based on their ln-transformed serum ferritin levels. Multivariable logistic regression and restricted cubic spline regression (RCS) investigate associations. Kaplan-Meier survival analyses and Cox proportional hazards regression examined the relationship between ferritin levels and all-cause mortality in OSA patients.

Results

After adjusting for potential confounding factors, we found that ln-transformed ferritin levels were associated with an increased risk of OSA (Q4 vs Q2: OR = 1.07, 95% CI: 1.01-1.13, P = 0.020, P for trend = 0.010). A non-linear U-shaped association was observed between ferritin levels and OSA risk (P-non-linear = 0.029), with an inflection point at ln-transformed ferritin of 4.58 (corresponding to a serum ferritin concentration of 97.51 ng/mL). In female OSA patients, elevated ferritin levels were associated with increased all-cause mortality risk (Q4 vs Q2: HR: 5.46, 95% CI: 1.18-25.16, P = 0.029, P for trend = 0.032).

Conclusion

Ferritin levels in overweight/obese individuals show a U-shaped relationship with OSA risk, and elevated levels correlate with increased all-cause mortality in female overweight/obese OSA patients. In the future, further research is needed to explore the potential associations between ferritin, inflammation, obesity, and OSA.

Association of Obstructive Sleep Apnea and Nocturnal Hypoxemia With the Circadian Rhythm of Myocardial Infarction

BACKGROUND

The circadian rhythm of myocardial infarction (MI) in patients with obstructive sleep apnea (OSA) remains disputable and no studies have directly evaluated the relationship between nocturnal hypoxemia and the circadian rhythm of MI. The aim of the current study was to evaluate the association of OSA and nocturnal hypoxemia with MI onset during the night.

METHODS

Patients with MI in the OSA-acute coronary syndrome (ACS) project (NCT03362385) were recruited. The time of MI onset was identified by patient's report of the chest pain that prompted hospital admission. All patients underwent an overnight sleep study using a type III portable sleep monitoring device after clinical stabilization during hospitalization. The difference in circadian variation of MI onset was evaluated between patients with moderate/severe OSA and non/mild OSA and those with or without nocturnal hypoxemia. Nocturnal hypoxemia was evaluated using 3 variables, including oxygen desaturation index, minimum oxygen saturation, and total sleep time with saturation <90%.

RESULTS

Among 713 patients enrolled, 398 (55.8%) had moderate/severe OSA (apnea-hypopnea index ≥15 events·h - 1). Compared with the non/mild OSA group, the MI onset was significantly increased in the moderate/severe OSA group between midnight to 5:59 am in 6-hour epochs analysis (26.9% versus 18.4%, P=0.008). Only in patients with both moderate/severe OSA and nocturnal hypoxemia, including oxygen desaturation index ≥15, minimum oxygen saturation ≤86%, and total sleep time with saturation <90% ≥2%, the incidence of MI onset between midnight to 5:59 am was significantly increased. Moderate/severe OSA (adjusted odds ratio 1.66 [95% CI, 1.13-2.43]; P=0.01) and nocturnal hypoxemia (oxygen desaturation index ≥15 model, adjusted odds ratio 1.80, [95% CI, 1.21-2.66]; minimum oxygen saturation ≤86% model, adjusted odds ratio 1.70 [95% CI, 1.16-2.47]; P=0.006; total sleep time with saturation <90% ≥2% model, adjusted odds ratio 1.54 [95% CI, 1.04-2.27]; P=0.03) significantly predicted MI occurrence from midnight to 6:00 am.

CONCLUSIONS

A peak of incident MI onset between midnight to 5:59 am was observed in patients with moderate/severe OSA, especially in those presenting with nocturnal hypoxemia.

Time for bed: diet, sleep and obesity in children and adults

Sufficient sleep is necessary for optimal health, daytime performance and wellbeing and the amount required is age-dependent and decreases across the lifespan. Sleep duration is usually affected by age and several different cultural, social, psychological, behavioural, pathophysiological and environmental factors. This review considers how much sleep children and adults need, why this is important, what the consequences are of insufficient sleep and how we can improve sleep. A lack of the recommended amount of sleep for a given age group has been shown to be associated with detrimental effects on health including effects on metabolism, endocrine function, immune function and haemostatic pathways. Obesity has increased worldwide in the last few decades and the WHO has now declared it a global epidemic. A lack of sleep is associated with an increased risk of obesity in children and adults, which may lead to future poor health outcomes. Data from studies in both children and adults suggest that the relationship between sleep and obesity may be mediated by several different mechanisms including alterations in appetite and satiety, sleep timing, circadian rhythm and energy balance. Moreover, there is evidence to suggest that improvements in sleep, in both children and adults, can be beneficial for weight management and diet and certain foods might be important to promote sleep. In conclusion this review demonstrates that there is a wide body of evidence to suggest that sleep and obesity are causally related and recommends that further research is required to inform policy, and societal change.

Obstructive sleep apnea syndrome (OSAS) in women: A forgotten cardiovascular risk factor

Sleep-disordered breathing is a highly prevalent disorder with negative impact on healthcare systems worldwide. This condition has detrimental effects on cardiovascular health and quality of life, and is frequently associated with a variety of comorbidities, including cardiovascular disease, heart failure, diabetes and atrial fibrillation. Nevertheless, it remains frequently undiagnosed and undertreated, especially in specific populations. Studies on sleep-disordered breathing have been conducted mainly on male patients, and the prevalence and severity of this disorder in women are underestimated. Recently, some clinical and laboratory evidence has highlighted the epidemiological and pathophysiological differences between men and women with sleep-disordered breathing. In this review, we discuss sex-related mechanisms of sleep-disordered breathing in frequently associated disorders, to improve clinical understanding of this condition and to simplify the practical application of targeted interventions. The aim is to improve prognosis among female patients and guarantee a better quality of life and a reduction in healthcare costs.

Polysomnographic features of hypoglossal nerve stimulation efficacy: Looking deeper than the apnea-hypopnea index

Objectives

Hypoglossal nerve stimulation (HGNS) is a promising surgical option for patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure therapy (CPAP). Efficacy studies for HGNS stimulation largely focus on the apnea-hypopnea index and/or oxygen desaturation index. This study's objective was to show the physiological effects of HGNS stimulation on upper airway patency, airflow, and treatment effect during polysomnography (PSG) testing.

Methods

PSG tracings from patients implanted with an Inspire© HGNS device were reviewed for this study. Nasal pressure was utilized as a surrogate for respiratory flow and chin electromyography was used to detect HGNS stimulation, allowing for breath-to-breath analysis. Per our sleep laboratory protocol, the HGNS device was turned on and off at different periods of the night. Respiratory tracings during these periods were visually analyzed.

Results

Analysis of on-off periods of HGNS therapy during PSG allows for a concise assessment of HGNS efficacy. The presence of inspiratory flow limitation and subsequent apneas or hypopneas upon turning off HGNS stimulation with restoration of stable, unobstructed breathing upon resuming HGNS stimulation indicates a positive treatment effect related to HGNS therapy. Despite the respiratory-sensing capacity of the Inspire HGNS device, desynchrony of stimulation and inspiration is observed. Desynchrony yields partially captured inspiratory cycles, allowing for assessment of HGNS effect on an individual breath.

Conclusion

Night-to-night and intranight variability in OSA severity makes assessing the effect of HGNS complex. Strategic testing protocols during postoperative PSG can provide critical insight into the effect of this therapy on upper airway obstruction during sleep. On-off periods of stimulation provide a concise assessment of the effect of HGNS on preventing upper airway collapse and help to account for night-to-night and intranight variability. Respiratory desynchrony associated with HGNS therapy exists. Observing partially-stimulated inspiratory cycles allow for assessment of HGNS's effect on a single breath.

Level of Evidence

4.

The cumulative impact of type 2 diabetes and obstructive sleep apnoea on cardiovascular, liver, diabetes-related and cancer outcomes

AIM

A bidirectional relationship exists between obstructive sleep apnoea (OSA) and type 2 diabetes (T2D). We aimed to examine the cumulative impact of having both OSA and T2D on patient outcomes, relative to having either condition alone.

MATERIALS AND METHODS

Using TriNetX, a global federated research network (n = 128 million), we undertook two retrospective cohort studies, using time-to-event analysis. Analysis 1 compared OSA with T2D versus OSA alone; analysis 2 compared T2D with OSA versus T2D alone. Propensity score matching using greedy nearest neighbour (calliper 0.1) balanced the cohorts (1:1) for significant covariates. Primary outcomes were cardiovascular, liver, diabetes-related (microvascular) and cancer events over 1-5 years.

RESULTS

Analysis 1 (n = 179 688): A codiagnosis of T2D/OSA significantly increased risk of all-cause mortality (hazard ratio [HR] 1.52; confidence interval [CI]: 1.48, 1.57), dementia (HR 1.19; CI: 1.12, 1.26), liver (HR 2.20; CI: 1.77, 2.73), pancreatic (HR 1.62; CI: 1.35, 1.93), colon, renal and endometrial cancers; all cardiovascular, microvascular and liver related outcomes versus OSA alone over 1-5 5 years following OSA diagnosis. Analysis 2 (n = 240 094): A codiagnosis of OSA/T2D significantly increased the risk of peripheral (HR 1.39; CI: 1.36, 1.43) and autonomic (HR 1.63; CI: 1.51, 1.75) neuropathy; retinopathy (HR 1.13; CI: 1.09, 1.18), CKD (HR 1.21; CI: 1.18, 1.23); all cardiovascular and liver outcomes; all-cause mortality and several obesity related cancers versus T2D alone.

CONCLUSIONS

T2D significantly potentiates risk of cardiovascular, malignancy and liver-related outcomes in individuals with OSA. OSA, in individuals with T2D, significantly potentiates risk of cardiovascular disease, malignancy, death and several microvascular complications (retinopathy, CKD, peripheral/autonomic neuropathy).

Identification of quality-of-life clusters by the Quebec sleep questionnaire in sleep apnea patients

Patients with obstructive sleep apnea (OSA) may present different symptoms. The clinical importance of symptom clustering is supported by the difference in the incidence of cardiovascular diseases between hypersomnolent and non-hypersomnolent sleep apnea patients. The objective of this study was to determine if quality-of-life clusters could be identified from the Quebec Sleep Questionnaire (QSQ) in OSA patients. Latent class analysis was used to identify clusters in a multivariate analysis of dichotomic variables (presence or absence of symptoms) for each item the QSQ obtained from 147 patients who fulfilled the questionnaire during its validation and subsequent trials (75.5% males, age: 53 ± 11 years, body mass index (BMI): 30.4 ± 4.7 kg/m2, apnea/hypopnea index (AHI): 31.3 ± 14.8/h). Three clusters were identified. Quality of life was preserved in patients of cluster 1 (20.4% of patients). Patients of cluster 2 (32.6% of patients) had a moderately impaired quality of life, mainly due to daytime somnolence and poor sleep quality. Patients with impaired quality of life (cluster 3, 46.9% of patients) had an important impact in every domain of the QSQ with the highest sleepiness and daytime symptom impairments. Gender, BMI, and AHI did not differ between the three clusters. In conclusion, different quality-of-life clusters can be identified from the QSQ in sleep apnea patients. These clusters are similar to those reported previously. Further studies are needed to validate these clusters in larger and independent cohorts, to evaluate how they respond to OSA treatment, and their relationship with incident outcomes.

Sex differences in clinical and polysomnographic features of obstructive sleep apnea: The Turkish sleep apnea database (TURKAPNE) cohort

BACKGROUND

Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women.

OBJECTIVE

We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry.

METHODS

Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively.

RESULTS

In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7 %), of whom 70.2 % were male and 29.8 % were female. In the OSA group, women were older (56.7 ± 11.9 vs. 49.5 ± 11.3 years; p < 0.001) and more obese (body mass index 34.3 ± 7.2 vs. 31.4 ± 5.6 kg/m2; p < 0.001) and had lower AHI (29.8 ± 24.1 vs. 36.8 ± 26.2 events/h; p < 0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p < 0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p < 0.05 for each).

CONCLUSIONS

Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI.

Chinese consensus report on the assessment and management of obstructive sleep apnea in patients with cardiovascular disease: 2024 edition

As cardiovascular disease (CVD) incidence and mortality rates continue to rise in China, the importance of identifying and managing CVD risk factors grows. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder, affecting an estimated 936 million individuals aged 30-69 worldwide, with China leading globally with about 176 million affected. Increasing research indicates a close association between OSA and the onset and progression of various CVD, significantly affecting outcomes. However, OSA has long been underrecognized and undertreated in CVD clinical practice. To address this gap, a multidisciplinary expert panel developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and the Delphi process. This consensus provides 17 recommendations on core clinical issues such as screening, diagnosis, treatment, and follow-up of CVD patients with OSA, aiming to standardize care and improve patient outcomes. The recommendations were informed by current evidence-based research and extensive expert consensus discussions. This approach seeks to support clinical decision-making, improve the quality of care, and address the unique challenges of managing OSA in Chinese CVD patients.

Roles of vitamins and nutrition in obstructive sleep apnea

INTRODUCTION

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, with a prevalence that rises alongside with the increasing prevalence of obesity. OSA is characterized by a low-inflammatory state and is followed by cardiovascular and metabolic sequelae. Continuous positive airway pressure (CPAP) represents the cornerstone of treatment for severe OSA. However, poor compliance with CPAP treatment renders OSA treatment a challenging venture. Weight loss and exercise are recommended as adjunctive treatment options for OSA. Several diets have proven to facilitate weight loss, and to alleviate the inflammatory status in patients with OSA. Moreover, several vitamins exhibit antioxidant properties that beneficially affect OSA pathology and reduce the risk of cardiovascular complications.

AREA COVERED

This narrative review aims to summarize the current knowledge regarding the effect of nutrition and vitamin deficiencies on OSA. Included were publications, relevant to the topic, with different types of design (i.e. cross-sectional studies, cohort studies, clinical trials, systematic reviews, meta-analyses, etc.) and indexed in PubMed database until 31 March 2024.

EXPERT OPINION

In addition to weight loss, other food components, such as proteins, carbohydrates, anti-inflammatory agents, vitamins A, B, C, D, E, and sodium, may play a beneficial role in the incidence and severity of OSA.

Apnea-Specific Pulse-Rate Response is Associated With Early Subclinical Atherosclerosis in Obstructive Sleep Apnea

INTRODUCTION

In patients with obstructive sleep apnea (OSA), novel metrics such as hypoxic burden (HB) and sleep apnea-specific pulse-rate response (ΔHR) may better correlate with cardiovascular diseases (CVD) than the apnea-hypopnea index (AHI). This manuscript aims to assess the correlation between ΔHR and HB with subclinical atherosclerosis in patients with OSA, testing the hypothesis that elevated ΔHR and HB are associated with subclinical atherosclerosis development.

METHODS

In a prospective study, individuals aged 20-65 years with suspected OSA without known comorbidities were consecutively recruited and defined as OSA (AHI≥5events/h) or healthy controls. Using bilateral carotid ultrasonography, common carotid intima-media thickness (CIMT) was assessed and the identification of at least one atheromatous plaque defined the presence of subclinical atherosclerosis. ΔHR, and HB were derived from pulse-oximetry.

RESULTS

We studied 296 patients of age 45±10 years old, of whom 28% were women, and with a BMI of 30.3±5.3kg/m2. Overall, 245 had OSA and 51 were healthy controls. After controlling for confounding variables higher ΔHR but not HB, was associated with higher CIMT (p=0.006) and higher time spent with oxygen saturation below 90% (T90) was associated with an increase in carotid atheroma plaques (p=0.032). When stratifying OSA based on HB tertiles, we observed that within tertile 2 of HB, an increase in ΔHR was associated with larger CIMT (p=0.017).

CONCLUSION

A higher ΔHR is associated with an increase in CIMT among adult patients with OSA. This study suggests that ΔHR could be a biomarker of risk for CVD in patients with OSA.

Development and Evaluation of a Hypertension Prediction Model for Community-Based Screening of Sleep-Disordered Breathing

Purpose

Approximately 30% of patients with sleep-disordered breathing (SDB) present with masked hypertension, primarily characterized by elevated nighttime blood pressure. This study aimed to develop a hypertension prediction model tailored for primary care physicians, utilizing simple, readily available predictors derived from type IV sleep monitoring devices.

Patients and Methods

Participants were recruited from communities in Guangdong Province, China, between April and May 2021. Data collection included demographic information, clinical indicators, and results from type IV sleep monitors, which recorded oxygen desaturation index (ODI), average nocturnal oxygen saturation (MeanSpO2), and lowest recorded oxygen saturation (MinSpO2). Hypertension was diagnosed using blood pressure monitoring or self-reported antihypertensive medication use. A nomogram was constructed using multivariate logistic regression after Least Absolute Shrinkage and Selection Operator (LASSO) regression identified six predictors: waist circumference, age, ODI, diabetes status, family history of hypertension, and apnea. Model performance was evaluated using area under the curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

The model, developed in a cohort of 680 participants and validated in 401 participants, achieved an AUC of 0.775 (95% CI: 0.730-0.820) in validation set. Calibration plots demonstrated excellent agreement between predictions and outcomes, while DCA confirmed significant clinical utility.

Conclusion

This hypertension prediction model leverages easily accessible indicators, including oximetry data from type IV sleep monitors, enabling effective screening during community-based SDB assessments. It provides a cost-effective and practical tool for prioritizing early intervention and management strategies in both primary care and clinical settings.

Sleep apnea screening through a news portal using the STOP-bang questionnaire

PURPOSE

Obstructive sleep apnea (OSA) affects up to 936 million adults globally and is linked to significant health risks, including neurocognitive impairment, cardiovascular diseases, and metabolic conditions. Despite its prevalence, OSA remains largely underdiagnosed. This study aimed to enhance OSA awareness and risk assessment using the STOP-Bang questionnaire in a telemedicine format.

METHODS

During a six-week campaign on a popular Latin American news portal, 5,966 adults completed the STOP-Bang questionnaire. Participants reporting moderate or severe OSA risk were advised to seek clinical evaluation.

RESULTS

Among respondents, 44.7% were identified as having a moderate-to-high risk for OSA. Key risk factors included snoring, witnessed apneas, hypertension, male gender, older age, high BMI, and larger neck circumference. Statistical analyses showed significant associations between these variables and OSA risk.

CONCLUSIONS

This study highlights the importance of increasing OSA visibility and early detection in the general population. Despite limitations such as selection bias and potential false negatives/positives with the STOP-Bang tool, the findings demonstrate the potential of media campaigns to raise awareness and prompt early medical consultation. Future efforts should include follow-up assessments to evaluate healthcare-seeking behavior and confirm OSA diagnoses, contributing to improved public health outcomes.

Evaluating the effectiveness of mandibular advancement devices in treating very severe obstructive sleep apnea: a retrospective cohort study

BACKGROUND

The repeated airway obstructions in the common disorder Obstructive Sleep Apnea (OSA) cause health risks. Continuous Positive Airway Pressure (CPAP), the standard treatment, faces adherence challenges. Mandibular Advancement Devices (MADs) have been used successfully for mild to moderate OSA, as a good alternative for these patients.

OBJECTIVE

to evaluate the effectiveness of MADs in reducing the Apnea-Hypopnea Index (AHI) and improving symptoms in patients with very severe OSA unable to tolerate CPAP.

METHODS

This retrospective study included 22 patients with very severe OSA (AHI ≥ 50) treated with MADs. Baseline characteristics, including: age, sex, BMI, and AHI, were recorded, and changes in AHI following treatment were assessed. Adherence was monitored using patient-reported data. Unlike previous studies, this research focuses exclusively on the efficacy of MADs in treating patients with very severe OSA, a population often excluded from similar inspections.

RESULTS

median AHI significantly decreased from 60.0 (IQR: 57.0-65.0) to 15.0 (IQR: 10.0-24.0) after treatment (P < 0.001), with a mean reduction of 72.5% (± 14.3). Notably, 95.5% of patients achieved at least a 50% reduction in AHI. Symptom improvements, including reduced snoring and daytime tiredness, were reported by 72.7% of patients. BMI positively correlated with baseline AHI, and significant AHI reductions were observed across overweight and obese categories, although some patients remained in the severe AHI range post-treatment. Adherence varied, with 63.6% continuing to use the device.

CONCLUSIONS

MADs are effective in managing very severe OSA, providing significant reductions in AHI and symptom improvements. MADs may be a viable alternative for patients unable to tolerate CPAP. Further investigations into the long-term efficacy and impact on quality of life are needed.

Association between cardiovascular health and metabolic dysfunction-associated steatotic liver disease: a nationwide cross-sectional study

PURPOSE

Evidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD.

METHODS

5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life's essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD.

RESULTS

Among 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37-0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13-0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61-0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings.

CONCLUSIONS

Higher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.

Sustained hypoxia but not intermittent hypoxia induces HIF-1α transcriptional response in human aortic endothelial cells

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxic environments at the cellular level and is an independent risk factor for the development of cardiovascular disease. Endothelial cell (EC) dysfunction precedes the development of cardiovascular disease; however, the mechanisms by which ECs respond to these intermittent hypoxic events are poorly understood. To better understand EC responses to hypoxia, we examined the effects of sustained hypoxia (SH) and intermittent hypoxia (IH) on the activation of HIF-1α in ECs. While SH stabilized HIF-1α and led to its nuclear localization, IH did not activate HIF-1α and the expression of its target genes. Using RNA-sequencing, we evaluated transcriptional responses of ECs to hypoxia. SH induced the expression of HIF-1α and hypoxia response genes, while IH affected cell-cycle regulation genes. A cytoscape protein-protein interaction network for EC response to hypoxia was created with differentially expressed genes. The network comprises cell-cycle regulation, inflammatory signaling via NF-κB and response to VEGF stimulus subnetworks on which SH and IH had distinct activities. As OSA is associated with elevated catecholamines, we investigated the effect of epinephrine on the EC response to SH and IH. Transcriptomic responses under IH and epinephrine revealed protein-protein interaction networks emphasizing distinct subnetworks, including cytokine-mediated TNFα signaling via NF-κB, Wnt/LRP/DKK signaling and cell cycle regulation. This study reveals differential transcriptomic responses under SH and IH characterised by HIF-1α transcriptional response induced only by SH, but not by IH. The study also features the potential molecular events that may occur at the vascular level in OSA.

Effects of continuous positive airway pressure treatment on arterial stiffness and inflammatory factors in patients with coronary heart disease complicated with obstructive sleep apnea

BACKGROUND

Continuous Positive Airway Pressure (CPAP) treatment brings more benefits than risks to most coronary heart disease (CHD) patients with obstructive sleep apnea (OSA). However, the pathophysiological mechanism by which CPAP treatment improves the prognosis of patients with CHD and OSA remains unclear. The purpose of this study was to clarify whether CPAP can improve arterial stiffness and inflammatory factor levels in CHD patients with OSA, and to further improve prognosis.

METHOD

59 patients with coronary heart disease complicated by moderate to severe sleep apnea were divided into a CPAP treatment group (CPAP + coronary heart disease standard treatment) and a control group (only coronary heart disease standard treatment). Peripheral blood test reports were collected and pulse wave velocity (PWV) measurements were performed for each patient at the beginning, 3 months, and 6 months of treatment.

RESULTS

After 6 months of treatment, the CPAP group showed more significant improvement in the levels of inflammatory factors such as white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and PWV than the control group.

CONCLUSION

After active treatment with CPAP, arterial stiffness and inflammatory cytokine levels in patients with coronary heart disease and OSA improved. This association should be given more attention in clinical practice, and sleep apnea should be actively treated.

Airway Analysis and Morphometric Assessment of Dental Arches in Obstructive Sleep Apnea Patients

Background: Obstructive sleep apnea is a sleep-related breathing disorder associated with craniofacial morphology and dental arches. The aim of this study was to evaluate the correlation between obstructive sleep apnea and the morphometry of dental arches and upper airways. Methods: Forty patients were enrolled in the study, and the polysomnographic parameters evaluated were the apnea hypopnea index (AHI) and the oxygen desaturation index (ODI). Dental measurements taken from the 3D models included anterior arch widths, posterior arch widths, maxillary and mandibular arch lengths, and palatal surface area. A cone beam computed tomography (CBCT) evaluation was also performed. Results: In patients with moderate OSA, posterior maxillary width was significantly correlated with both minimal airway area (rho = 0.65, p < 0.01) and its transverse diameter (rho = 0.68, p < 0.01). Similarly, in patients with severe OSA, posterior maxillary width showed a significant correlation with total airway volume (rho = 1, p < 0.01), minimal airway area (rho = 1, p < 0.01), and its transverse diameter (rho = 1, p < 0.01). Conclusions: Craniofacial morphology and malocclusion can contribute to obstructive sleep apnea syndrome.

Influence of sedentary behavior on sleep quality in postmenopausal women in high-altitude regions of China: a cross-sectional study

Objective

This study investigates the association between sedentary behavior and sleep quality among postmenopausal women residing in China's plateau regions. Particular attention is given to moderating effects of age, body mass index (BMI), and sleep environment. This study aims to identify modifiable risk factors influencing sleep quality in this high-altitude population.

Methods

This cross-sectional study focused on postmenopausal women (aged ≥50 years, ≥12 months post-menopause) across four primary plateau regions in China: Qinghai-Tibet, Yunnan-Guizhou, Inner Mongolia, and the Loess Plateau. Sedentary behavior was evaluated with the Older Adults Sedentary Behavior Questionnaire, and sleep quality was assessed with the Pittsburgh Sleep Quality Index. Data analysis encompassed descriptive statistics, correlation analysis, multiple linear regression, and subgroup analyses.

Results

Among the 151 participants (mean age 58.5 years), sedentary behavior was positively correlated with poorer sleep quality (r = 0.36, p < 0.001). Improvements in the sleep environment were similarly associated with better sleep quality (r = 0.29, p < 0.001). Multiple linear regression identified sedentary behavior and sleep environment as significant predictors of sleep quality, while other variables showed no significant associations. Subgroup analysis revealed age-specific effects: sedentary behavior had a strong influence on sleep quality in women under 60 years (r = 0.36, p < 0.01) but demonstrated a weaker, non-significant association in those aged 60 years or older (p = 0.062).

Conclusion

Prolonged sedentary behavior is an independent risk factor for reduced sleep quality among postmenopausal women residing in high-altitude regions, while improvements in the sleep environment are positively associated with better sleep quality. The influence of sedentary behavior on sleep quality varies by age groups. These findings highlight the importance of tailored interventions and health policies to improving sleep quality in postmenopausal women living at high altitudes.

A flexible catheter-based sensor array for upper airway soft tissues pressure monitoring

Obstructive sleep apnea is a globally prevalent concern with significant health impacts, especially when coupled with comorbidities. Accurate detection and localization of airway obstructions are crucial for effective diagnosis and treatment, which remains a challenge for traditional sleep monitoring methods. Here, we report a catheter-based flexible pressure sensor array that continuously monitors soft tissue pressure in the upper airway and facilitates at the millimeter level. The sensor's design and versatile 3D femtosecond laser fabrication process enable adaptation to diverse materials and applications. In vitro testing demonstrates high sensitivity (38.1 Ω/mmHg) and excellent stability. The sensor array effectively monitors distributed airway pressure and accurately identifies obstructions in an obstructive sleep apnea animal model. In this work, we highlight the potential of this catheter-based sensor array for long-term, continuous upper airway pressure monitoring and its prospective applications in other medical devices for pressure measurement in human body cavities.

Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea

BACKGROUND

There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.

OBJECTIVE

This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.

METHODS

African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.

RESULTS

Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.

DISCUSSION

Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.

Unraveling Comorbidities Contribution to Cardiac Diastolic Dysfunction and Heart Failure

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a major public health problem characterized by multiple simultaneous comorbidities whose specific contribution is challenging to disentangle in humans, leading to a generalized therapeutic approach that may not account for the underlying pathology.

METHODS

We followed distinct mouse models of major HFpEF comorbidities for 2.5 years to unveil their specific contribution to the syndrome.

RESULTS

All comorbidities contributed to HFpEF through partially distinct routes. Aging alone resulted in HFpEF in old age, with delayed left ventricular relaxation and kidney fibrosis. Obesity induced a faster deterioration of relaxation associated with enlarged left ventricle and liver fibrosis. Hypertension caused delayed ventricular relaxation independent from structural changes that preceded left atrial dilatation linked to aortic stiffness and increased fibrosis in myocardium and kidney. Chronic intermittent hypoxia led to HFpEF and relaxation impairment associated with pulmonary hypertension. Hyperglycemia accelerated diastolic dysfunction and HFpEF onset associated with reduced arterial flow and left ventricular remodeling. Therefore, the pathological substrates contributing to HFpEF included cardiac and noncardiac alterations with differential features for each comorbidity. Critically, the characteristics linked to diastolic dysfunction and HFpEF across the various comorbidities agreed with phenogroups observed in human patients.

CONCLUSIONS

The identification of time-dependent pathological features provides a comprehensive picture of HFpEF progression associated with each comorbidity.

Association of ethylene oxide exposure and obstructive sleep apnea

BACKGROUND

Ethylene oxide (EO) is a widely utilized industrial compound known to pose health hazards. Although its carcinogenic characteristics have been thoroughly investigated, recent findings indicate possible links to respiratory disease. The correlation between EO exposure and the likelihood of developing obstructive sleep apnea (OSA) in individuals remains unclear. The study aimed to explore the association between EO exposure and OSA within the broader US population.

METHODS

From 2015 to 2020, 4355 participants were analyzed cross-sectionally in the National Health and Nutrition Examination Survey (NHANES). As the primary indicator of EO exposure, hemoglobin adducts of EO (HbEO) were used in this study. The relationship between EO exposure and OSA prevalence was assessed using weighted multivariable regression analysis and smoothing curve fitting. Using subgroup analysis and interaction tests, we investigated whether this association remained consistent across populations.

RESULTS

According to the study, higher HbEO level was positively correlated with a higher prevalence of OSA. Compared to the first HbEO quartile (Q1), participants within the highest quartile (Q4) presented a higher OSA prevalence in the fully model (OR = 1.32, 95% CI: 1.08-1.62, P = 0.01, P for trend = 0.001). This correlation was particularly evident among females and individuals who are insufficiently physically active.

CONCLUSIONS

This research found a positive relationship between the extent of exposure to EO and OSA prevalence among a representative sample of Americans.

Assessment of simulated snoring sounds with artificial intelligence for the diagnosis of obstructive sleep apnea

BACKGROUND

Performing simulated snoring (SS) is a commonly used method to evaluate the source of snoring in obstructive sleep apnea (OSA). SS sounds is considered as a potential biomarker for OSA. SS sounds can be easily recorded, which is a cost-effective method for prescreening purposes.

OBJECTIVE

This study aimed to validate the performance of artificial intelligence (AI) models using SS sounds for OSA diagnosis.

METHODS

All participants underwent full-night polysomnography (PSG) monitoring at the sleep center. SS sounds of the participants were recorded during the laryngoscopy procedure. The audio data were processed via Python, and relevant features were extracted. OSA diagnostic models were developed using three machine learning (ML) algorithms and one deep learning (DL) algorithm. The diagnostic performance was evaluated by multiple indicators.

RESULTS

A total of 465 participants were included. For the support vector machine algorithm, the accuracy values at apnea-hypopnea index (AHI) levels of 5, 15, and 30 per hour were 0.914, 0.887, and 0.807, respectively. For the K-nearest neighbor algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.896, 0.872, and 0.756, respectively. For the random forest algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.905, 0.881, and 0.804, respectively. For the audio spectrogram transformer algorithm, the accuracy values at AHI levels of 5, 15, and 30 per hour were 0.926, 0.887, and 0.830, respectively.

CONCLUSIONS

Our study demonstrates that DL models can effectively screen and identify OSA with commendable performance. In addition, the identification ability of the DL models was better than that of any of the ML models.

Transoral Robotic Surgery Versus Hypoglossal Nerve Stimulation for OSA: A Cost Analysis Study

BACKGROUND

Transoral robotic surgery (TORS) lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) are effective surgical interventions for well-selected patients with obstructive sleep apnea (OSA) intolerant to continuous positive airway pressure (CPAP) therapy. Previous publications have demonstrated that HGNS patients have a lower postoperative apnea-hypopnea index (AHI) and length of hospital stay than TORS patients. No prior study has investigated the differences in costs between HGNS and TORS.

OBJECTIVES

This study aims to compare surgery-related costs in patients undergoing HGNS versus TORS lingual tonsillectomy for OSA intolerant to CPAP.

METHODS

A retrospective study on OSA patients intolerant to CPAP that underwent HGNS or TORS from 2015 to 2022 at a tertiary care center. Cost was defined as the dollar amount associated with providing a specific service prior to the application of insurance.

RESULTS

This study included 395 patients (375 UAS and 20 TORS). Average total cost was significantly higher in the UAS group than the TORS group (UAS: $25,582.60; TORS: $5832.60; p < 0.001). Operating room costs were also significantly higher in the UAS group (UAS: $1978.20; TORS: $1490.90; p = 0.001). The TORS cohort averaged higher costs for pharmacy (UAS: $201.30; TORS: $416.60; p < 0.001) and anesthesia (UAS: $139.00; TORS: $307.60; p < 0.001).

DISCUSSION

The total cost was significantly higher in the UAS group compared to the TORS group. When making management decisions, it is important to consider the cost of care provided as well as patient-centered outcomes to optimize the value of care.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:457-462, 2025.

Unraveling the relationship between obstructive sleep apnea and osteoarthritis: A multivariate mendelian randomization highlighting the role of BMI as a confounding factor

BACKGROUND

Osteoarthritis (OA) and obstructive sleep apnea (OSA) are prevalent chronic conditions with emerging evidence suggesting a potential link. However, the causality of this association remains unclear, possibly influenced by confounders like high body mass index (BMI). This study aimed to explore causal relationships between OA and OSA using Mendelian randomization (MR).

METHODS

MR analysis was performed to assess causality between OA and OSA. Inverse variance weighting (IVW) was the primary MR method, complemented by sensitivity analyses, including MR steiger, MR-Egger, MR-PRESSO, weighted median, heterogeneity tests, and leave-one-out approaches to evaluate pleiotropy and confirm the robustness of the causal estimates. To exclude confounding effects of BMI, we also used a multivariate MR (MVMR).

RESULTS

After adjusting for BMI through MVMR, no significant causal relationship was identified between genetically predicted OSA and OA phenotypes, including knee (KOA) and hip osteoarthritis (HOA), suggesting that obesity largely drives the observed relationship between these conditions. Similarly, MR steiger doesn't support a causal effect from OA on OSA. Sensitivity analyses confirmed the robustness of these results, with no significant evidence of horizontal pleiotropy or heterogeneity affecting outcomes. The findings indicate that BMI acts as a critical confounder in the relationship between OSA and OA, rather than OSA directly contributing to OA development.

CONCLUSIONS

Our findings indicate that there is no significant causal relationship between genetically predicted OSA and OA after adjusting for BMI. These findings underscore obesity as the primary shared risk factor, highlighting the importance of weight management as a key strategy for mitigating the risks of both conditions. Future research should aim to validate these findings in diverse populations and explore other metabolic pathways that may contribute to these complex associations.

Comparing standard treatment of moderate to severe obstructive sleep apnoea to add-on acetazolamide treatment: An open-label randomised controlled trial

BACKGROUND AND OBJECTIVE

Obstructive sleep apnea (OSA) is a common condition, featured by repetitive upper airway collapse during sleep manifested with poor quality of life and co-morbidities. Although continuous positive airway pressure (CPAP) is the recommended therapy, lack of patient compliance and persistent symptoms often preclude its success. The present study evaluates the effect of acetazolamide in combination with CPAP, and compares this treatment strategy to single therapy using CPAP in moderate to severe OSA.

MATERIALS AND METHODS

A parallel-group, open-label randomized controlled trial consisted of 95 subjects diagnosed with moderate to severe OSA. Subjects were randomly allocated in a 1:1 ratio to CPAP plus acetazolamide (C+D) and CPAP alone (C). The baseline characteristics and the apnea-hypopnea index (AHI) metrics were comparable. Following four weeks of intervention, the outcomes measured involved changes in AHI (apnea hypopnoea index), sleep architecture, ODI (oxygen desaturation Index), and other sleep parameters.

RESULTS

The combination of CPAP and acetazolamide significantly reduced total AHI (34.69 ± 18.91 events/hour) compared to CPAP alone (45.47 ± 19.09 events/hour, p = 0.0044). AHI also observed significant improvements during non-REM sleep (p = 0.0014). Although no significant difference was found in AHI during REM sleep between the groups (p = 0.6284), the C+D group demonstrated a notable decrease in severe OSA cases and an increase in mild and moderate OSA classifications. Compliance-adjusted AHI was significantly lower in the C+D group (5.67 ± 3.45) compared to the C group (7.67 ± 3.41, p = 0.0034). The C+D group exhibited improved sleep architecture with lower percentages of N1 and N3 sleep stages, and a trend towards increased REM sleep percentage (p = 0.0704). Significant reductions in WASO (p = 0.0404) and ODI (p = 0.0301) were also observed. Both groups reported minimal and comparable side effects, indicating the safety and tolerability of the combination therapy.

CONCLUSION

The addition of acetazolamide to CPAP therapy improves efficacy in OSA treatment parameters among moderate-to-severe OSA, reduces total and NREM AHI as well as ODI without an increase in adverse effects. With added pharmacotherapy, the combination therapy represents a potential adjunctive treatment for managing OSA.

Respiratory Pathology and Cardiovascular Diseases: A Scoping Review

Respiratory diseases and cardiovascular diseases (CVDs) have high prevalence and share common risk factors. In some respiratory diseases such as sleep apnoea and COPD, the evidence of their negative impact on the prognosis of CVDs seems clear. However, in other diseases it is less evident whether there is any direct relationship. With this in mind, our objective was to provide information that may be helpful to better understand the relationship between respiratory pathology and CVDs. There are different reasons for this relationship, such as shared risk factors, common pathophysiological mechanisms, side effects of treatment and the direct effect in the heart and great vessels of respiratory diseases. Indeed, aging and smoking are risk factors for CVDs and also for respiratory diseases such as obstructive sleep apnea (OSA), COPD and interstitial lung diseases (ILD). Furthermore, there are common pathophysiological mechanisms that affect both respiratory diseases and CVDs, such as accelerated atherosclerosis, microvascular dysfunction, endothelial dysfunction, inflammation, hypoxemia and oxidative stress. Besides that, it is well known that lung cancer, sarcoidosis and amyloidosis may directly affect the heart and great vessels. Finally, side effects of drugs for respiratory diseases and the discontinuation of treatments that are necessary for CVDs, such as β-blockers and aspirin, may have a deleterious impact on the cardiovascular system. In conclusion, the coexistence of respiratory diseases and CVDs is very common. It makes modifying diagnostic and therapeutic management necessary and is also a relevant prognostic factor.

The chronobiology of human heart failure: clinical implications and therapeutic opportunities

Circadian variation in cardiovascular and metabolic dynamics arises from interactions between intrinsic rhythms and extrinsic cues. By anticipating and accommodating adaptation to awakening and activity, their synthesis maintains homeostasis and maximizes efficiency, flexibility, and resilience. The dyssynchrony of cardiovascular load and energetic capacity arising from attenuation or loss of such rhythms is strongly associated with incident heart failure (HF). Once established, molecular, neurohormonal, and metabolic rhythms are frequently misaligned with each other and with extrinsic cycles, contributing to HF progression and adverse outcomes. Realignment of biological rhythms via lifestyle interventions, chronotherapy, and time-tailored autonomic modulation represents an appealing potential strategy for improving HF-related morbidity and mortality.

Impact of Obstructive Sleep Apnea on In-Stent Restenosis in Coronary Heart Disease Patients after Elective Drug-Eluting Stenting

Background

Extensive research has established obstructive sleep apnea (OSA) as a contributing factor to numerous cardiovascular and cerebrovascular diseases. However, whether OSA affects in-stent restenosis (ISR) after elective drug-eluting stenting is unclear. Therefore, the objective of this study was to examine the impact of OSA on ISR in patients with coronary heart disease (CHD) who underwent successful elective drug-eluting stent (DES) implantation.

Methods

This study retrospectively analyzed CHD patients who successfully underwent elective coronary stent implantation and overnight sleep breathing monitoring and were readmitted for coronary angiography due to symptoms of CHD at 12 to 26 months after percutaneous coronary intervention (PCI). OSA was diagnosed when the apnea-hypopnea index (AHI) was ≥5 events/hour. ISR was defined as >50% restenosis of the vessel diameter in which the DES was implanted. To explore the association between OSA and ISR among patients with CHD, multivariate logistic regression models were developed and utilized.

Results

This study enrolled 206 individuals who were diagnosed with CHD, with a mean age of 62.01 ± 10.27 years, and males constituted 76.2% of the patient population. After a median follow-up period of 15 months following DES implantation, there was a significant increase in the incidence of ISR among patients with moderate to severe OSA, increasing from 10.9% to 31.3% (p < 0.001). According to the fully adjusted model, the occurrence of ISR was found to be independently associated with the presence of OSA (OR: 3.247, 95% CI: 1.373-7.677, p = 0.007).

Conclusions

In individuals who underwent elective drug-eluting stenting, OSA is an independent risk factor for ISR.

A meta-analysis of the correlation between obstructive sleep apnea syndrome and renal injury

OBJECTIVE

To conduct a meta-analysis on the correlation between obstructive sleep apnea syndrome (OSAS) and renal injury.

METHODS

Literature search was carried out in PubMed, Embase and Ovid-Medline databases between the date of database establishment and June 30th 2024. The keywords included obstructive sleep apnea hypopnea syndrome, sleep apnea hypopnea syndrome, renal injury, and correlation. Two researchers 1st independently screened the titles and abstracts based on the eligibility criteria, then extracted the data and evaluated the quality, and used Review Manager 5.3 for data processing. All analysis methods were based on PRISMA.

RESULTS

Finally, 8 studies that matched the inclusion criteria were included, and the relationship between obstructive sleep apnea syndrome and serum cystatin C was analyzed. The homogeneity test showed (P < 0.01, I2 = 98%), and from the meta-analysis results, it could be known that the level of serum cystatin C in sufferers with OSAS was obviously greater than the control one (OR = 1.12, 95% CI 0.96-1.28, P < 0.01). The relationship between OSAS and serum creatinine was analyzed, and homogeneity test showed (P < 0.01, I2 = 96%). From the meta analysis result, it could be known that the serum creatinine level of obstructive sleep apnea syndrome was obviously greater than the control one (OR = 1.01, 95% CI 0.85 ~ 1.17, P < 0.01). The relationship between obstructive sleep apnea syndrome with serum urea nitrogen was analyzed, and homogeneity test showed (P < 0.01, I2 = 91%). From the meta-analysis results, it could be known that serum urea nitrogen of OSAS was obviously greater than the control one (OR = 1.38, 95% CI 01.17 ~ 1.59, P < 0.01).

CONCLUSIONS

Eight articles have been included to determine the correlation between obstructive sleep apnea syndrome and renal injury, and it has been found that obstructive sleep apnea syndrome is closely related to renal injury, and the two may be risk factors for each other.

The impact of tonsillectomy and/or adenoidectomy on cognitive function and brain structure in pediatric patients with OSAHS

BACKGROUND

Tonsillectomy and/or adenoidectomy can treat children with obstructive sleep apnea/hypopnea syndrome (OSAHS).

OBJECTIVE

This study investigated the effects of tonsillectomy and/or adenoidectomy on cognitive function and brain structure in children with OSAHS.

METHODS

This study included 40 obstructive sleep apnea/hypopnea syndrome children and 40 healthy children. The cognitive function and brain structure changes of OSAHS children before and after surgery and 40 healthy children were evaluated by the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) and the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), as well as brain resting-state fMRI functional magnetic resonance imaging (rs-fMRI).

RESULTS

Children with OSAHS showed higher Swanson, Nolan, and Pelham Rating Scale and lower Integrated Visual and Auditory Continuous Performance Test scores than healthy peers, indicating cognitive impairment. Post-surgery, there was a significant improvement in cognitive function, evidenced by decreased Swanson, Nolan, and Pelham Rating Scale and increased Integrated Visual and Auditory Continuous Performance Test scores. Compared to healthy children, OSAHS children displayed altered ReHo values in certain brain regions, such as decreased values in the right angular gyrus, right precuneus, left parahippocampal gyrus, and left middle frontal gyrus, but increased values in the right posterior cerebellum. After surgery, ReHo values increased in regions like the right precuneus, right temporal lobe, right posterior cingulate gyrus, and left limbic lobe, suggesting neurological changes associated with treatment.

CONCLUSIONS

Children with obstructive sleep apnea/hypopnea syndrome had cognitive impairment and abnormal changes in multiple brain regions. Tonsillectomy and/or adenoidectomy could improve cognitive function and contribute to the reconstruction of brain function and structure in children with obstructive sleep apnea/hypopnea syndrome.

Association Between Nocturnal Hypoxemia Parameters and Coronary Microvascular Dysfunction: A Cross-Sectional Study

Objective

There is a connection between obstructive sleep apnea (OSA) and coronary microvascular dysfunction (CMD), but the underlying mechanisms remain unclear. This study aims to evaluate the correlation between OSA-related nocturnal hypoxemia parameters and CMD.

Methods

This is an observational, single-center study that included patients who underwent polysomnography and coronary angiography during hospitalization. The presence of CMD was determined by angio-based index of microcirculatory resistance (AccuIMR). Categorical variables were compared using chi-square test or Fisher exact test. The t-test and Mann-Whitney U-test were used to compare normally and non-normally distributed continuous variables, respectively. Univariate and multivariable logistic regression analyses were performed to evaluate the relationship between nocturnal hypoxemia parameters and CMD.

Results

A total of 133 patients were included in this study, of whom 72 (54.14%) had evidence of CMD. Patients with CMD exhibited a higher prevalence of OSA and experienced more severe nocturnal hypoxia. After adjusting for potential confounding factors, minimum oxygen saturation (minSpO2) ≤90% (OR 5.89; 95% CI 1.73-19.99; P=0.004) and the percentage of time spent with oxygen saturation below 90% (T90) ≥5% (OR 3.13; 95% CI 1.05-9.38; P=0.041) were independently associated with CMD. However, no significant association was observed between apnea-hypopnea index (AHI) and CMD.

Conclusion

Parameters of nocturnal hypoxemia are associated with CMD. Hypoxemia parameters may more sensitively reflect the correlation between OSA and CMD than AHI.

Self-Reported Symptoms of Obstructive Sleep Apnea are Associated with Increased Risk of Kidney Stones: A Cross-Sectional Study from NHANES 2015-2020

Objective

To investigate whether self-reported symptoms of obstructive sleep apnea (OSA), including snoring, snorting/stopping breathing, and sleepiness, are associated with increased risk of kidney stones.

Methods

This cross-sectional study was conducted based on the 2015-2020 National Health and Nutrition Examination Survey (NHANES). Self-reported symptoms of OSA and history of kidney stones were diagnosed via questionnaires. Multivariable logistic regression was used to determine the associations between self-reported symptoms of OSA and kidney stones. Subgroup analyses and interaction tests were performed to address this issue further.

Results

A total of 9,973 participants were enrolled, and the prevalence of kidney stones was 10.76%. Although no significant association was observed between frequent snoring and kidney stones after covariate adjustments (OR 1.033, 95% CI 0.726, 1.469 p = 0.850), frequent snorting/stopping breathing was associated with a greater risk of kidney stones after covariate adjustments (OR 1.655, 95% CI 1.262, 2.172, p = 0.002). Participants who often or almost always felt sleepy also had a greater risk of kidney stones after covariate adjustment (OR 1.651, 95% CI 1.222, 2.229; p = 0.004). The interaction tests suggested that marital status (p = 0.015) and smoking status (p < 0.001) significantly interacted with the association between snorting/stopping breathing and kidney stones.

Conclusion

Self-reported frequent snorting/stopping breathing and sleepiness may be associated with increased risk of kidney stones. Although these findings may emphasize prevention of kidney stones in these people, further research was still needed to verify our results.

Associations of TyG index with coronary heart disease risk and coronary artery sclerosis severity in OSA

BACKGROUND

Insulin resistance (IR) is involved in the pathogenesis and progression of obstructive sleep apnea (OSA) and coronary heart disease (CHD). The triglyceride glucose(TyG) index, an alternative indicator of IR with high reliability, is linked to CHD development and severity. However, the association of TyG index with CHD in OSA cases remains undefined. This study explores the association of TyG index with CHD risk and coronary artery sclerosis severity in the OSA population.

METHODS

OSA cases with suspected CHD, enrolled at the Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University between February 2020 and June 2024, were assigned to the OSA and OSA + CHD groups, followed by TyG index assessment. The t-test, Mann-Whitney U-test and one-way analysis of variance were utilized to compare continuous data, while comparisons of categorical data utilized the chi-square test or Fisher's exact test. Logistic regression analysis was conducted to determine factors independently predicting OSA with CHD and Gensini scores. Restrictive cubic spline (RCS) was used to assess potential non-linear associations of TyG index with CHD risk and Gensini score in OSA patients.

RESULTS

Totally 1059 OSA patients were included, with 514 diagnosed with CHD (48.54%). Multivariable logistic regression analysis upon adjustment for age, gender, hypertension, diabetes, and smoking history revealed TyG index as a risk factor for CHD in OSA cases. CHD risk in the high-TyG index group was 1.977 fold higher versus the low-TyG index group (OR = 1.977, 95% CI 1.424-2.800, P < 0.001). In addition, TyG index had a linear relationship with CHD (P for nonlinearity = 0.0709). In moderate to severe OSA cases, the high-TyG index group had a significantly higher CHD risk (OR = 2.430, 95% CI 1.601-3.690, P < 0.001). Gensini score and TyG index (P for non-linearity = 0.0033) had a non-linear relationship, while high TyG index was a risk factor for high Gensini score.

CONCLUSION

TyG index is a risk factor for CHD in OSA cases and reflects the severity of coronary atherosclerosis. TyG, a surrogate indicator for IR evaluation, may help predict CHD in OSA cases, especially in moderate to severe OSA.

Effects of Continuous Positive Airway Pressure Treatment on Sawtooth Waves During Rapid Eye Movement Sleep in Obstructive Sleep Apnea Patients

Background

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by recurrent upper airway collapse and obstruction, leading to reduced or absent breathing during sleep, especially rapid eye movement (REM) sleep, and continuous positive airway pressure treatment (CPAP) is often used for treatment of OSA. Sawtooth waves (STWs) are a characteristic of REM sleep.

Objective

To examine effects of CPAP treatment on STWs during REM sleep in the OSA patients.

Methods

Polysomnographic recordings were performed on 20 moderate-to-severe OSA patients and 16 normal controls, and comparisons of STWs during REM sleep in the OSA patients with and without CPAP treatment (paired t-test or Wilcoxon signed-rank test wherever appropriate), and between OSA patients and normal controls (Student's t-test or Wilcoxon rank-sum test) were carried out. In addition, linear correlation analyses were used to estimate the relationship of STWs and REM sleep with duration of non-REM (NREM) sleep stage 3 (N3).

Results

The STWs were classified to be apnea/hypopnea associated and not associated (isolated), and the amplitude of the isolated STWs was significantly higher than that of the apnea/hypopnea associated. With CPAP treatment, the percentage of REM sleep with STWs and the amplitude of STWs were significantly increased to the levels, which were not significantly different from those in the normal controls, while the frequency of STWs was not significantly changed. In addition, the total duration of REM sleep and the duration of REM sleep with STWs were both positively correlated with the duration of N3 sleep in the normal controls and the OSA patients with CPAP treatment. Furthermore, CPAP treatment also caused a significant increase in the duration of rapid eye movements in REM sleep.

Conclusion

These findings suggest that there are some interconnections between NREM and REM sleep, and STWs not only represent the quality of REM sleep but also are correlated with N3 sleep.

Update on the aetiopathogenesis of obstructive sleep apnea: Role of inflammatory and immune mediated mechanisms

Obstructive sleep apnea (OSA) is often a lifestyle disease associated with obesity, which is rapidly evolving as a major health concern with diverse multisystemic implications. To prevent and mitigate its adverse effects and reduce its burden on society, its aetiopathogeneses must be precisely understood. Numerous studies focusing on the range of diverse anatomic, functional, and lifestyle factors have already been carried out to determine the possible contributory roles of these factors in OSA. Recently, evidence to validate the role of inflammatory pathways and immune mechanisms in the aetiopathogeneses of OSA is being developed. This allows for further research and translation of such knowledge for targeted therapeutic and preventive interventions in patients with or who are at risk of developing OSA.