Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management

Low-frequency, mild-gradient chronic intermittent hypoxia still induces liver fibrogenesis in mice on a high-fat diet

The fibrogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) may progress when complicated by obstructive sleep apnea (OSA). Studies using animal models have shown that high-frequency intermittent hypoxia (IH) exposure, which resembles human OSA, accelerates liver fibrosis in fatty liver. This study highlights that low-frequency, mild-gradient intermittent hypoxia (IH) can exacerbate fibrogenesis in fatty liver disease, even without significantly raising markers of liver injury or insulin resistance. Using a mice model on a high-fat diet (HFD), we found that while routine liver tests (e.g., ALT, AST) and cholesterol levels remained comparable between HFD mice exposed to room air (RA) versus those exposed to chronic intermittent hypoxia (CIH), indicators of liver fibrosis and oxidative stress were elevated in the latter group. This suggests that even low-frequency, mild-gradient IH can increase oxidative stress and fibrotic activity within the liver, primarily through the upregulation of specific markers like ICAM-1 and osteopontin (OPN), which may play a role CIH-induced liver inflammation and fibrosis in fatty liver. In conclusion. Our study further notes that these hypoxia-related changes occurred without significantly worsening systemic insulin resistance, focusing attention on localized liver impacts rather than global metabolic disruptions. The findings underscore the potential role of oxidative stress and specific cytokines in the progression of liver fibrosis in MASLD, especially when complicated by conditions that introduce IH.

Exploring differences in signaling pathways of the circadian clock and neuromodulators in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurring upper airway obstructions, leading to disrupted sleep and systemic complications. The complexity of OSA suggests intricate interactions between neuromodulators and circadian clock genes. This study aimed to explore the expression levels of circadian rhythm genes and neurotrophins (NTs) in OSA patients compared to controls. Participants (166 OSA patients, 64 controls) were enrolled. Blood samples collected post-polysomnography (PSG), underwent RNA extraction from peripheral blood lymphocytes and RT-PCR was performed for gene expression analysis. In the OSA group, the expression of BMAL1, CLOCK, CRY1, PER1, NPAS2, NR1D1, and HIF-1β was positively correlated with BDNF expression (p < 0.05 for all). Conversely, in the control group, only PER1 mRNA showed a correlation with BDNF expression (R = 0.280, p = 0.017). NF-κβ expression demonstrated a positive correlation with BMAL1, CLOCK, CRY1, PER1, NPAS2, NR1D1, HIF-1α, and HIF-1β expressions in both groups (p < 0.05 for all). HIF-1α and HIF1-β mRNA expressions were positively correlated with BMAL1, CLOCK, CRY1, PER1, NPAS2, and NR1D1 expressions regardless of the presence of OSA (p < 0.05 for all). The study underscores the intricate interactions among circadian rhythm genes, NTs, and transcription factors in OSA, providing a basis for potential targeted therapeutic interventions.

The Interaction of Hypertension and Obstructive Sleep Apnea Risk on Cognitive Function in Healthy Older Adults

PURPOSE

To preliminarily examine the individual and interaction effects of hypertension and obstructive sleep apnea (OSA) risk on cognitive functions (i.e., global cognition, memory, attention, and executive function).

METHOD

The current study was a secondary data analysis. Forty older adults were retrieved from a descriptive study. OSA risk was measured by the STOP-BANG questionnaire, and hypertension by self-report and medications used. Spearman rho correlation and two-way analysis of covariance were used in the data analysis.

RESULTS

After controlling for covariates (i.e., age, educational years, health conditions, body mass index, and depressive symptoms), older adults with hypertension had poorer memory and attention; older adults with high OSA risk had poorer memory and better executive function. This interaction effect of hypertension and OSA risk on executive function was significant.

CONCLUSION

The association between hypertension and memory and attention and between OSA risk and memory in older adults was supported. The interaction effect was found in executive function but unexpected. Future studies are needed to recruit older adults with hypertension and diagnosed OSA to explore these interaction effects. [Research in Gerontological Nursing, xx(x), xx-xx.].

Glucagon-like Peptide-1 receptor agonists for obstructive sleep apnea in patients with obesity and type 2 diabetes mellitus: a systematic review and meta-analysis

The systematic review was registered on the PROSPERO website (CRD42024558287). Our objective is to systematically summarise the clinical evidence of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for obstructive sleep apnea (OSA) in patients with Obesity or/and type 2 Diabetes Mellitus (T2DM). This analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. 10 databases and registers Web of Science, Scopus, PubMed, APA PsycInfo, Embase, Ovid, Cochrane Library, CINAHL, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) were retrieved from the establishment to July 14, 2024 for related randomized controlled trials (RCT) and non-RCTs. Data were extracted by two investigators separately, and only the RCTs were included in the quantitative synthesis. The outcome was operated by Review Manager 5.4 and Stata 15.0. Ten studies containing eight RCTs and two non-RCTs were included. The efficacy of the GLP-1 RA group in reducing apnea-hypopnea index (AHI) was superior to that of the control group in patients with T2DM (MD = -5.68, 95%CI [-7.97, -3.38], P < 0.00001, I2 = 0%). GLP-1 RAs also possessed a tendency to reduce AHI in patients with obesity but more evidence is needed to support the findings due to the inconsistency. In consideration of the enhanced metabolic parameters observed with GLP-1 RAs, they may be recommended as useful hypoglycaemic medication for the management of T2DM with OSA. Patients with obesity and OSA may consider GLP-1 RA as a potential treatment option if the adverse events are deemed tolerable.

The effects of incremental maxillomandibular advancement surgery on airway morphology: a cadaveric study

Evidence demonstrates efficacy of maxillomandibular advancement (MMA) treatment of obstructive sleep apnea (OSA) and airway expansion. Patient studies are limited to pre/post-surgery comparisons. This cadaveric study evaluated intra-individual relationships between magnitudes of MMA advancement and airway changes. MMA with distraction osteogenesis devices and incremental advancement of the maxillomandibular complex, was performed on cadavers (n = 5). Computed tomography at each 2-mm advancement was used to measure volume and dimension of the oropharyngeal airway. Three-dimensional shape analysis visualized magnitudes and locations of changes. Incremental advancements caused volume, anteroposterior, and lateral dimensions to increase progressively, while length decreased. Changes were significant at lower advancements. Comparisons of MMA indicate alterations in airway volume from 4 to 6 mm and 6 to 8 mm were relatively greater than the changes from 8 to 10 mm (P = 0.044, P = 0.028, respectively), 10 to 12 mm (P = 0.024, P = 0.023), and 12 to 14 mm (P = 0.021, P = 0.019). These results may expand MMA application suggesting 6-8 mm advancements provide substantial increases in airway volume. MMA may be an OSA treatment option when large advancements are not possible. Lower magnitudes of advancement decrease risks of unfavorable facial esthetics from excess protrusion.

Safety and efficacy of glucagon-like peptide-1 receptor agonists in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials

Background

Obstructive sleep apnea (OSA) is a common condition affecting around one billion people worldwide. Emerging evidence from recent studies suggests that Glucagon-like peptide 1 receptor (GLP-1) agonists may reduce OSA severity. Hence, this meta-analysis aims to evaluate the efficacy and safety of GLP-1 agonists in patients with OSA.

Methods

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to 24 June 2024. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). The protocol for this review has been registered and published in PROSPERO with the ID (CRD42024562853).

Results

The meta-analysis included three randomized controlled trials with 828 patients. Pooled analysis of patients administered GLP-1 agonists or tirzepatide showed improvement in Apnea/Hypopnea Index (MD -16.57 events per hour, 95% CI [-27.41, -5.73], p = 0.003), weight reduction (MD -12.71%, 95% CI [-21.38, -4.03], p = 0.004), and systolic blood pressure (MD -4.93 mmHg,95% CI [-7.67, -2.19], p = 0.0004). Tirzepatide showed a reduction in high-sensitivity C-reactive protein (MD -0.89 mg/dl, 95% CI [-1.25, -0.54], p < 0.0001) and sleep apnea-specific hypoxic burden (MD -66.21%/min, 95% CI [-81.75, -50.67], p < 0.0001). Despite the heterogeneity observed in the AHI and weight, it was resolved, and the results were consistent. GLP-1 agonists/tirzepatide showed comparable outcomes concerning diastolic blood pressure (MD -1.34 mmHg, 95% CI [-2.80, 0.12], p = 0.07). No significant serious adverse events were observed for GLP-1 agonists/tirzepatide, but it was associated with a higher incidence of gastrointestinal adverse events.

Conclusion

GLP-1 agonists, including tirzepatide, improved Apnea/Hypopnea Index, weight, and systolic blood pressure in adults with moderate-to-severe OSA. However, the evidence remains limited to two published studies comprising three randomized controlled trials using different pharmacological agents. Consequently, further research is needed before firm conclusions can be drawn.

Nonlinear association between blood urea nitrogen to creatinine ratio and obstructive sleep apnea: a cross-sectional study from NHANES

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is closely associated with metabolic conditions. The Blood Urea Nitrogen to Creatinine Ratio(BUCR) is commonly utilized as a tool for evaluating renal function, particularly in cases where there are concerns about pre-renal or renal causes of azotemia. However, the connection between OSA and BUCR is not yet fully understood.

METHODS

This study examined the link between BUCR and OSA in adults over 20 using National Health and Nutrition Examination Surveys(NHANES) data from 2005-2008. Logistic regression models adjusted for multiple variables were used to analyze the relationship. The non-direct correspondence relationship were explored with a smooth curve and a two-part linear regression model, which revealed a threshold effect. Subgroup analyses were conducted to assess variations among different populations.

RESULTS

The survey, encompassing a total of 8826 participants, revealed that the median age of all respondents was 48 years, with a notable OSA prevalence of 51.3%. Upon adjusting for pertinent covariates using Model III(age, sex, marital status, education level, BMI, smoking status, drinking, hypertension, and diabetes), our findings indicated a significant association between OSA and BUCR, as evidenced by an odds ratio (OR) of 1.01 (95% CI: 1.00-1.02, P = 0.005). Furthermore, the risk association was found to be non-linear, featuring an inflection point for BUNR at 10.86. This non-linear relationship adds complexity to our understanding of the interplay between OSA and BUCR. In addition, a subgroup analysis underscored the influence of diabetes on the association between BUCR and OSA.

CONCLUSION

This study reveals a significant correlation between elevated BUCR levels and the incidence of OSA, particularly in the presence of diabetes. This discovery underscores the necessity for additional research to investigate the underlying mechanisms and ramifications of this connection within the diabetic context.

Platelet-activating cytokines potentially associated with MASLD-induced liver injury significantly decreased following CPAP therapy: A translational study using a fatty liver mouse model

BACKGROUND AND AIM

Patients with obstructive sleep apnea (OSA) and metabolic dysfunction associated steatotic liver disease (MASLD) frequently overlap due to the high prevalence of obesity. This translational study aimed to identify cytokines linking these conditions, beginning with an analysis of fatty liver in mice. Serum cytokine levels upregulated in the fatty liver mice were subsequently examined in human OSA serum samples.

METHODS

Mice were fed a high-fat diet to induce fatty liver. Liver proteins were analyzed using cytokine arrays. Serum samples from seventy (70) OSA patients (with 20 non-MASLD and 50 MASLD, pre- and 6-month post-continuous positive airway pressure [CPAP] therapy) were analyzed for the cytokines identified in the mouse experiment using enzyme-linked immunosorbent assays.

RESULTS

Four platelet-activation chemokines/cytokines (CCL5/RANTES, P-selectin, CXCL4/PF4, and CXCL5/LIX) were upregulated in mice with fatty liver. While serum levels of these factors were not significantly higher in MASLD-OSA compared to non-MASLD-OSA patients, their levels significantly decreased 6 months after the initiation of CPAP therapy, along with a reduction in mean platelet volume. CPAP compliance was significantly associated with a reduction in CCL5 levels. Additionally, a decrease in ALT levels following 6 months of CPAP therapy was significantly associated with CPAP compliance in MASLD-OSA patients.

CONCLUSIONS

While platelet-activation cytokines were not directly implicated in liver injury in MASLD-OSA patients, they decreased with CPAP therapy. CPAP compliance may play a key role in ALT reduction in MASLD-OSA patients independently of body weight changes. CCL5/RANTES may be indirectly associated with liver injury in MASLD-OSA, potentially induced through intermittent hypoxia.

Pregnancy-onset obstructive sleep apnea and ambulatory blood pressure

STUDY OBJECTIVE

Elevated nocturnal blood pressure (BP) increases the risk for hypertensive disorders of pregnancy (HDP). Though obstructive sleep apnea (OSA) increases the risk for HDP, data on OSA, and 24-hour ambulatory blood pressure monitoring (ABPM) in pregnancy are scarce. We aim to examine the BP profile of women with pregnancy-onset OSA.

METHODS

Pregnant women with overweight/obesity and snoring were recruited at <13 weeks gestation and underwent level III home sleep apnea testing and 24-hour ABPM at enrollment and at 31-34 weeks' gestation. Women with OSA at enrollment were excluded. Mean differences in nocturnal BP and 24-hour BP measurements, between women with pregnancy-onset OSA and women without OSA, were computed by multivariable linear regression.

RESULTS

Participants (40/101) had pregnancy-onset OSA (respiratory event index (REI) ≥5 events per hour) in the third trimester. Despite no significant differences in baseline BP, nocturnal systolic and diastolic BP were significantly higher in women with pregnancy-onset OSA compared to women without OSA, after adjusting for multiple covariates (mean difference 5.49 (1.45-9.52) and 3.89 (0.19-7.60), respectively). Differences in systolic BP persisted into the daytime in the OSA group. Lack of nocturnal dipping was highly prevalent in both groups, but the difference was not significant in the adjusted model.

CONCLUSIONS

Pregnancy-onset OSA in the 3rd trimester is associated with elevated nocturnal BP and daytime systolic BP. The lack of nocturnal dipping irrespective of REI cut-off in pregnant women at risk for SDB further demonstrates the limitations of REI in defining pathology in pregnancy.

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.

Enhancing Workplace Wellness: A Comprehensive Approach to Sleep Apnea Screening in Onsite Health

BACKGROUND

This quality improvement project aimed to increase the screening rate for OSA in individuals aged 18 and above with obesity (body mass index [BMI] ≥30).

METHODS

This quality improvement study occurred from March 2023 to August 2023 using a two-independent pre-implementation post-implementation design. The STOP-Bang Questionnaire (SBQ) was implemented during annual exams, chronic disease management visits, and Department of Transportation (DOT) physicals.

FINDINGS

There were 946 patients involved in the study, including 471 in the pre-implementation group and 475 in the post-implementation group. OSA screening increased from 14.1% to 71.6% after implementing the screening protocol in the general population and 26.7% to 90.4% in the commercial driver's license (CDL) holder population. Of the CDL holders screened in the pre-intervention group, 15 (65.2%) were at intermediate to high risk for OSA (SBQ ≥3), and in the post-intervention group, 33 (50%) had an SBQ score of ≥3.

CONCLUSIONS/APPLICATION TO PRACTICE

Standardized OSA screening is crucial because it is common but underdiagnosed. Screening for OSA during DOT exams promotes community safety. Earlier identification of at-risk patients leads to earlier diagnosis and treatment of OSA to prevent long-term complications, reduce healthcare costs, improve patient outcomes, and improve community safety.

Time-hybrid OSAformer (THO): A hybrid temporal sequence transformer for accurate detection of obstructive sleep apnea via single-lead ECG signals

BACKGROUND AND OBJECTIVE

Obstructive Sleep Apnea (OSA) is among the most sleep-related breathing disorders, capable of causing severe neurological and cardiovascular complications if left untreated. The conventional diagnosis of OSA relies on polysomnography, which involves multiple electrodes and expert supervision. A promising alternative is single-channel Electrocardiogram (ECG) based diagnosis due to its simplicity and relevance. However, extracting respiratory-related features from ECG is challenging since ECG signals do not directly reflect respiratory patterns. Consequently, the accuracy of most deep learning models that predict OSA using ECG data remains to be improved.

METHODS

In this study, we propose the Time-Hybrid OSA transformer (THO), a novel method that leverages single-lead ECG signals for accurate OSA detection. The THO enhances feature extraction using a hybrid architecture combining dilated convolution and Long Short-Term Memory (LSTM), along with a multi-scale feature fusion strategy. Additionally, THO integrates an embedded memory decay mechanism within a multi-head attention model to capture real-time characteristics of time series data. Finally, a voting mechanism is incorporated to enhance decision reliability.

RESULTS

Evaluation of the THO model demonstrates superior performance with prediction accuracy (ACC) and area under the receiver operating characteristic curve (AUC) values of 95.03 % and 96.85 %, respectively, representing improvements of 11 % and 8 % over comparative models. Moreover, the ACC shows a 5 % enhancement relative to state-of-the-art models.

CONCLUSIONS

These results prove the THO model's efficacy in predicting OSA, offering a robust alternative to traditional diagnostic approaches.

Accessible moderate-to-severe obstructive sleep apnea screening tool using multidimensional obesity indicators as compact representations

Many obesity indicators have been linked to adiposity and its distribution. Utilizing a combination of multidimensional obesity indicators may yield different values to assess the risk of moderate-to-severe obstructive sleep apnea (OSA). We aimed to develop and validate the performances of automated machine-learning models for moderate-to-severe OSA, employing multidimensional obesity indicators as compact representations. We trained, validated, and tested models with logistic regression and other 5 machine learning algorithms on the clinical dataset and a community dataset. Light gradient boosting machine (LGB) had better performance of calibration and clinical utility than other algorithms in both clinical and community datasets. The model with the LGB algorithm demonstrated the feasibility of predicting moderate-to-severe OSA with considerable accuracy using 19 obesity indicators in clinical and community settings. The useable interface with deployment of the best performing model could scale-up well into real-word practice and help effectively detection for undiagnosed moderate-to-severe OSA.

Association between obstructive sleep apnea hypopnea syndrome and arteriosclerosis in patients with type 2 diabetes mellitus: mediating effect of blood pressure

Objective

This study aims to explore the relationship between Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) and arteriosclerosis in type 2 diabetes mellitus (T2DM) patients and to evaluate the mediating effect of blood pressure in this process.

Methods

A total of 411 T2DM patients admitted to the Third Affiliated Hospital of Soochow University from January 2021 to December 2023 were selected and divided into the arteriosclerosis group (n = 299) and the non-arteriosclerosis group (n = 112) based on brachial-ankle pulse wave velocity (ba-PWV). General clinical data, metabolic indicators, and sleep-related parameters were collected. The relationship between the apnea-hypopnea index (AHI) and arteriosclerosis was analyzed using univariable and multivariable logistic regression models, while a generalized additive model (GAM) was applied for curve fitting. A segmented regression model was used to explain nonlinearity, and subgroup analysis was conducted to assess interactions. Finally, a mediation effect model evaluated AHI's direct and indirect effects on arteriosclerosis.

Results

The AHI of the arteriosclerosis group was significantly higher than that of the non-arteriosclerosis group (P < 0.001). In the unadjusted, partially adjusted, and fully adjusted regression analyses, elevated AHI significantly increased the risk of arteriosclerosis (P < 0.05). Curve fitting indicated a near-linear positive correlation (P = 0.033). The segmented regression model showed that when AHI < 8.8 events/hour, the risk of arteriosclerosis significantly increased with higher AHI (P = 0.008), but the risk increase was not significant when AHI > 8.8 events/hour (P = 0.124). There was no significant interaction between AHI and blood pressure-related index subgroup indicators (P > 0.05). Mediation analysis revealed that systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) had significant mediating effects on the relationship between AHI and arteriosclerosis (P < 0.05), but the direct effect of AHI on arteriosclerosis was not significant (P > 0.05).

Conclusion

OSAHS severity elevates arteriosclerosis risk in T2DM patients. Blood pressure is a partial intermediary in this effect.

Development and Validation of a Screening Equation for Obstructive Sleep Apnea

Background: The high prevalence of obstructive sleep apnea (OSA), about 30% of people worldwide over 30 years old, underscores the crucial need for early screening. This study aimed to identify key predictive factors for OSA; use these factors to develop a screening equation for a population at high risk for OSA; and prospectively validate this equation's application. Methods: The study included two phases: a retrospective phase examining anthropometric data, the Epworth sleepiness scale (ESS), and the home sleep apnea test (HSAT) from 200 patients referred to the Respiratory Sleep Disorder Center at Policlinico Umberto I, Rome, Italy (January 2020-January 2023) to create a predictive equation for OSA using multivariate analysis (with the most predictive data according to scientific literature). A prospective phase testing this equation on 53 patients from May 2023 to September 2024. Results: In the retrospective phase, the most predictive variables for the apnea-hypopnea index (AHI) identified were neck circumference (NC) and the Epworth sleepiness scale (ESS). The predictive equation derived from the multivariate analysis was as follows: AHIp = [-70.498 + (2.196 × NC) + (0.809 × ESS)]. In the prospective phase of the study, we compared the AHI predicted by the equation (AHIp) with the AHI measured via the HSAT (AHIm) in 53 patients recruited. The results showed that AHIp had a sensitivity of 95%, a specificity of 28%, a positive predictive value (PPV) of 46%, and a negative predictive value (NPV) of 90%. Conclusions: This study identified NC and ESS as key predictors of OSA, forming a predictive equation. This equation, showing high sensitivity and high NPV, may be useful as a screening method to rule out OSA.

Development of a guide for continuous positive airway pressure use - A good fit: Making continuous positive airway pressure work for you

Background

Obstructive sleep apnea (OSA) is highly prevalent in veterans with mental illnesses such as post-traumatic stress disorder (PTSD). Untreated OSA reduces the effectiveness of the treatment of PTSD. Treatment of OSA has been shown to reduce daytime sleepiness and symptoms of PTSD and depression. Continuous positive airway pressure (CPAP) therapy is the most effective treatment for OSA. A large number of veterans cannot tolerate CPAP therapy due to anxiety and PTSD symptoms. Positive airway pressure (PAP) NAP, a daytime sleep study for patients with anxiety about starting CPAP and exposure-based cognitive behavioural interventions are the mainstay for the management of CPAP intolerance. However, these options are not readily available to veterans in rural areas, who constitute about 40% of veterans registered in the South Texas Veterans Health Care System (STVHCS).

Methods

After getting local IRB exemption, we surveyed thirty (30) veterans in the outpatient clinic setting who could not tolerate CPAP therapy to evaluate the need for a tool to improve CPAP adherence. We reviewed the literature and conducted focused group meetings with local and national experts. We also convened consumer groups and stakeholder meetings, including primary care, sleep medicine, and mental health providers.

Results

After a comprehensive evaluation process, we compiled a concise self-help guide combining principles of cognitive behavioural therapy using a behavioural hierarchy approach towards CPAP desensitization. This guide can be used by veterans independently at their homes to improve CPAP use. A printer-friendly version is available for download on the South Central Mental Illness, Research, Education and Clinical Center (SC MIRECC) and the South Texas Veterans Healthcare System (STVHCS) website. The guide will be provided to veterans during the initial CPAP setup and available in clinic waiting rooms throughout the system.

Conclusion

Our guide will serve as an effective self-help tool to improve CPAP adherence. It may result in the improvement of various medical and psychiatric conditions.

Evaluation of five questionnaires for obstructive sleep apnea screening in the elderly

Obstructive sleep apnea (OSA) often leads to complications in the elderly. This study compares the usefulness of five screening tools for OSA in elderly patients. Data from elderly patients diagnosed with OSA, collected from the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2017, is analyzed. The sensitivity, specificity, predictive values, area under the curve (AUC), and diagnostic odds ratio (DOR) of the five screening tools are computed and compared. 273 elderly patients with suspected OSA are included, of whom 189 are male (69.2%). The Berlin Questionnaire has an AUC of 0.670 (95%CI: 0.611-0.725) at different cut-off points. The sensitivity and specificity of the Berlin Questionnaire are noticeably high at 0.653 (0.587-0.719) and 0.608 (0.497-0.719), 0.699 (0.621-0.776) and 0.533 (0.449-0.616), and 0.803 (0.713-0.892) and 0.503 (0.433-0.572) when the AHI is 5, 15, and 30 times/hour, respectively. The GOAL Questionnaire has the highest DOR at AHI cut-off points of 5 and 15 times/hour, while Berlin has the highest DOR at an AHI cut-off point of 30 times/hour. Comprehensive use of these five screening questionnaires for suspected OSA in elderly patients aged 60 years and older is valuable and worth promoting among the elderly population.

Exploring the therapeutic potential of GLP-1 receptor agonists in the management of obstructive sleep apnea: a comprehensive review

Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder marked by repeated episodes of partial or complete upper airway obstruction during sleep, which leads to intermittent hypoxia and fragmented sleep. These disruptions negatively impact cardiovascular health, metabolic function, and overall quality of life. Obesity is a major modifiable risk factor for OSA, as it contributes to both anatomical and physiological mechanisms that increase the likelihood of airway collapse during sleep. While continuous positive airway pressure (CPAP) therapy remains the gold standard for OSA treatment, its limitations - particularly issues with patient adherence - underscore the need for alternative or adjunct therapeutic options. One such option is the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are widely recognized for their ability to reduce body weight and improve metabolic health. Emerging evidence suggests that GLP-1 RAs may offer therapeutic benefits in managing OSA, particularly by addressing obesity, a key contributor to the condition. This narrative review seeks to explore the role of GLP-1 RAs in the treatment of OSA, evaluating their efficacy in reducing OSA severity and discussing their broader clinical implications for future research and practice.

Preventive medicine in obstructive sleep apnea-a systematic review and a call to action

STUDY OBJECTIVES

The purpose of this systematic review is to evaluate the modifiable risk factors associated with obstructive sleep apnea (OSA) and analyze extant publications solely focused on prevention of the disease.

METHODS

Studies focused on prevention strategies for OSA and modifiable risk factors were eligible for inclusion. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed, and LILACS. The references cited in these articles were also crosschecked and a partial gray literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies.

RESULTS

Search resulted in 720 publications examining risk factors and prevention of OSA, as well as lifestyle modifications. Of these, a thorough assessment of the abstracts and content of each of these manuscripts led to the rejection of all but four papers, the latter being included in this systematic review. In contrast, a search regarding "Therapeutics" showed that 23 674 articles on OSA were published, clearly illustrating the imbalance between the efforts in prevention and those focused on therapeutics.

CONCLUSIONS

Notwithstanding the importance and benefits of technological advances in medicine, consideration of the needs of people with OSA and its consequences prompts advocacy for the prevention of the disease. Thus, despite the economic interests that focus only on diagnosis and treatment, strategies preferentially aimed at overall avoidance of OSA emerge as a major priority. Thus, public and healthcare provider education, multidimensional prevention, and early diagnosis of OSA should be encouraged worldwide.

Impact of the visceral adipose tissue on bone quality in patients with untreated mild-to-severe obstructive sleep apnea

Obstructive sleep apnea (OSA) predominantly affects patients who are obese and causes systemic organ damage. Little is known about the relationship between fat distribution and bone impairment in these patients. We aimed to evaluate the impact of the visceral adipose tissue (VAT) on the bone quality of patients with OSA. In our prospective study, 49 untreated patients with mild-to-severe OSA underwent dual-energy X-ray absorptiometry. Polygraphy data were also collected. According to the recent reference values for European adults, patients were divided by the sex-related threshold of the VAT index into two categories: VAT index within limits (normal VAT [nVAT]) and increased VAT (iVAT). In all, 63% of the patients were in the iVAT category. Compared to patients with nVAT, those with iVAT had a higher prevalence of arterial hypertension (52% versus 22%) and diabetes (32% versus 6%), and higher values of mean nocturnal desaturation. Patients with iVAT had, in comparison to those with nVAT, lower values of the lumbar spine trabecular bone score (TBS; mean 1.24 versus 1.39; p < 0.001), TBS T-score (mean -1.82 versus -0.52; p < 0.001) and TBS Z-score (mean -0.35 versus 0.75; p = 0.002). Moreover, a close association was present between the VAT index and TBS lumbar spine L1-L4 (r2 linear 0.573; p < 0.001), and altered values of the TBS Z-score were associated with the severity of vertebral fractures. Finally, in a linear regression-adjusted model, the VAT index predicted TBS lumbar spine L1-L4 (β -0.323; p < 0.001). In patients with OSA VAT impacts bone quality. In these patients, the role of VAT as a metabolically active tissue should be considered.

Cardiopulmonary coupling predictors of blood pressure response to positive airway pressure therapy

RATIONALE

The effect of continuous positive airway pressure (CPAP) treatment on reducing cardiovascular disease risk in sleep apnea subjects remains inconclusive. It is plausible that pathological respiratory chemoreflex activation (high loop gain) is a predictive signal biomarker.

OBJECTIVE

To determine whether narrow band (e-LFCNB%) metric derived from cardiopulmonary coupling analysis is related with blood pressure reduction after CPAP.

METHODS

A secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES). The elevated low frequency coupling - narrow band (e-LFCNB %) metric derived from cardiopulmonary coupling analysis detects periodic breathing (as a surrogate for high loop gain), and was estimated in baseline polysomnogram. Linear regression analysis was performed to identify the potential association between e-LFCNB% of total sleep time and the observed reduction in blood pressure following the specified treatment.

RESULTS

A total of 388 subjects received CPAP and had e-LFCNB % measurements. At 2 months, 90/322 subjects had e-LFCNB ≥ 4 % at baseline. At 6 months 137/313 subjects had e-LFCNB higher than 2 % at baseline. For morning systolic blood pressure, e-LFCNB ≥ 4 % [β: 2.534, standard error (SE): 1.198, p: 0.035] was positively related with the extent of systolic blood pressure reductions after 2 months CPAP treatment and e-LFCNB ≥ 2 % was marginally related with systolic blood pressure decrement after 6 months (β: 2.162, SE: 1.173, p: 0.066). For the morning diastolic blood pressure, e-LFCNB ≥ 2 % predicted reductions at 6 months of treatment (β: 1.883, SE: 0.888, p: 0.035).

CONCLUSION

e-LFCNB % (probable high loop gain) was positively related to systolic blood pressure reduction (short-term) and diastolic blood pressure reduction (longer-term), following CPAP.

Nocturia and obstructive sleep apnoea

Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes.

Sleep Apnea and Postoperative Medical Complications and Health Care Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Ankle Fractures

INTRODUCTION

Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures.

METHODS

A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch'st-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant.

RESULTS

There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001).

CONCLUSION

This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures.

LEVEL OF EVIDENCE

Therapeutic, Level IV: Retrospective.

Prevalence and regional distribution of obstructive sleep apnea in Canada: Analysis from the Canadian Longitudinal Study on Aging

OBJECTIVES

Obstructive sleep apnea (OSA) is a common chronic condition that is often undiagnosed or diagnosed after many years of symptoms and has an impact on quality of life and several health factors. We estimated the Canadian national prevalence of OSA using a validated questionnaire and physical measurements in participants in the Canadian Longitudinal Study on Aging (CLSA).

METHODS

The method used individual risk estimation based upon the validated STOP-BANG scale developed for OSA. This stratified population sample spans Canada to provide regional estimates.

RESULTS

In this sample of adults aged 45 to 85 years old, the overall prevalence in 2015 of combined moderate and severe OSA in the 51,337 participants was 28.1% (95% confidence intervals, 27.8‒28.4). The regional prevalence varied statistically between Atlantic Canada and Western Canada (p < 0.001), although clinically the variations were limited. The provincial prevalence for moderate and severe OSA ranged from 27.5% (New Brunswick and British Columbia) to 29.1% (Manitoba). Body mass index (BMI) was the dominant determinant of the variance between provinces (β = 0.33, p < 0.001). Only 1.2% of participants had a clinical diagnosis of OSA.

CONCLUSION

The great majority (92.9%) of the participants at high risk of OSA were unrecognized and had no clinical diagnosis of OSA.

Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea

OBJECTIVE

To examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA).

METHODS

This cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data.

RESULTS

With this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01.

CONCLUSIONS

The rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.

Effect of continuous positive airway pressure on cardiometabolic risk factors in patients with obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE

Cardiometabolic risk factors (CMRFs) play a crucial role in the occurrence and development of cardiovascular diseases. Obstructive sleep apnea (OSA) causes abnormalities of CMRFs. Continuous positive airway pressure (CPAP) is a widely used treatment for OSA. This systematic review and meta-analysis aimed to investigate the effect of CPAP on CMRFs in patients with OSA.

METHODS

A search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted to find randomized controlled trials up to December 3, 2023. The quality of the studies included was evaluated using the Cochrane Bias Risk Tool 2.0, and a meta-analysis was carried out using Stata15.1 software. The effect sizes for this meta-analysis were represented as the weighted mean difference (WMD) and 95 % confidence interval (CI).

RESULTS

A total of 52 studies with 10,104 participants were analyzed. The results showed that CPAP significantly lowered systolic blood pressure (WMD: -2.04 mmHg; 95%CI: -3.56 to -0.51), diastolic blood pressure (WMD: -1.40 mmHg; 95%CI: -2.36 to -0.44), total cholesterol (WMD: -0.27 mmol/L; 95%CI: -0.51 to -0.04), triglycerides (WMD: -0.02 mmol/L; 95%CI: -0.03 to -0.01), and fasting blood glucose (WMD: -0.15 mmol/L; 95%CI: -0.16 to -0.13) in patients with OSA. However, there was no significant change in low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, waist circumference, or body mass index after CPAP.

CONCLUSION

In summary, this meta-analysis demonstrated that CPAP effectively reduced certain CMRFs in patients with OSA, offering new insights for cardiovascular disease prevention.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42023456380.

Effectiveness of Continuous Positive Airway Pressure in Alleviating Hypoxemia and Improving Exertional Capacity at Altitude

Strickland, Brian, Elan Small, Mary Ryan, and Ryan Paterson. Effectiveness of continuous positive airway pressure in alleviating hypoxemia and improving exertional capacity at altitude. High Alt Med Biol. 25:319-325, 2024. Introduction: Decreased oxygen saturation and exercise tolerance are commonly experienced at high altitude. Continuous positive airway pressure (CPAP) devices have become increasingly portable and battery powered, providing a potentially unique new therapeutic modality for treatment of altitude-related illnesses. This study evaluated the potential use of CPAP devices to improve and maintain oxygen saturation at altitude, both at rest and with exertion, to evaluate the feasibility of using this device at altitude. Methods: Subjects were taken to Mount Blue Sky and monitored while they hiked to the summit (4,350 m), maintaining a consistent level of exertion. Subjects hiked for 0.7 km both with and without CPAP set to 10 cmH2O pressure. Continuous vital signs were collected during the hike and recovery period. Results: All subjects completed the hike wearing CPAP devices at a vigorous level of exertion. Mean oxygen saturation of the CPAP group (M = 83.8%, SD = 3.72) was significantly higher than that of the control group during exertion (M = 78.7%, SD = 2.97); p = 0.005. Recovery after exertion was quicker in the CPAP group than the control group. Three subjects experienced claustrophobia requiring a brief pause, but were able to complete their exercise trial without removing equipment or experiencing adverse events. When pauses from claustrophobia were excluded, there was no difference in completion time between the groups (p = 0.06). Conclusion: CPAP reliably improved oxygen saturation at rest and during vigorous exertion at high altitude. Its ability to correct hypoxemia, even with physical exertion, may prove useful after further study as a portable self-carried device to prevent and treat altitude-related illness, or to improve safety in high-altitude rescues.

Impact of intensive hypertension criteria on multimorbidity prevalence and patterns in a multi-ethnic Chinese population

Background

The impact of intensive hypertension criteria on multimorbidity prevalence and patterns remains understudied. We investigated the prevalence and patterns of multimorbidity using both the current (140/90 mmHg) and intensive (130/80 mmHg) hypertension criteria within a multi-ethnic Chinese population.

Methods

Data were obtained from the baseline survey of the Regional Ethnic Cohort Study in Northwest China, conducted from June 2018 to May 2019, which enrolled adults aged 35-74 years from five provinces. A total of 114,299 participants were included in this study. Multimorbidity was defined as the presence of at least two chronic diseases or conditions from a list of 26, ascertained through self-report and physical examination. Agglomerative hierarchical cluster analysis was employed to identify multimorbidity patterns. A hypertension-related multimorbidity pattern was identified and further analyzed. The prevalence of multimorbidity and hypertension-related pattern were analyzed in different subgroups, and subgroup cluster analyses were conducted stratified by sex, age, and ethnicity.

Results

Applying the intensive 130/80 mmHg hypertension criteria resulted in an increase in multimorbidity prevalence from 17.6% (20,128 participants) to 21.7% (24,805 participants) compared to the 140/90 mmHg criteria. Four distinct multimorbidity patterns were consistently identified: cardiometabolic, digestive-bone-kidney, respiratory, and mental-cancer. Hypertension consistently clustered within the cardiometabolic pattern alongside diabetes, acute myocardial infarction, angina, and stroke/TIA, with relatively stable proportions observed even under the 130/80 mmHg threshold.

Conclusion

The revision of hypertension criteria significantly expands the population identified as having multimorbidity, without altering the identified multimorbidity patterns. Hypertension commonly co-occurs within the cardiometabolic cluster. These findings highlight the need for improved treatment and management strategies specifically targeting cardiometabolic multimorbidity.

Diagnostic utility of obstructive sleep apnea screening questionnaires: a comprehensive meta-analysis

OBJECTIVES

The main objective of this meta-analysis was to assess the accuracy of the Sleep-Related Breathing Disorder (SRBD) Scale in the diagnosis of obstructive sleep apnea syndrome (OSAS).

METHODS

A comprehensive review and meta-analysis of observational studies evaluating the diagnostic utility of OSA screening questionnaires were performed. Analyses determined the summary receiver operator characteristic area under the curve (SROC), the pooled sensitivity (Se), and the specificity (Sp). Subgroup analysis investigated and compared the summary sensitivity, specificity, and diagnostic odds ratio (DOR) among the BQ, STOP, and ESS according to the severity of OSA.

RESULTS

34 studies were included. The Berlin questionnaire had a sensitivity of 0.80 and a specificity of 0.48, while the Epworth sleepiness scale had a sensitivity of 0.48 and a specificity of 0.73. The STOP-BANG scale had a sensitivity and specificity of 0.89 and 0.40, respectively. The diagnostic accuracy of BQ, ESS, NoSAS, and STOP was evaluated based on OSA severity. BQ and STOP had higher sensitivity and specificity, while ESS had lower specificity.

CONCLUSIONS

The current meta-analysis indicates that the SRBD scale has acceptable accuracy in detecting patients with OSAS. We propose that the STOP questionnaire could be used as an easy-to-use and accurate screening tool for the identification of patients at risk for OSAS in the general population. ESS had higher specificity, allowing healthcare professionals to prioritize interventions and tailor treatment plans based on OSA severity.

Mandibular Advancement Devices in OSA Patients: Impact on Occlusal Dynamics and Tooth Alignment Modifications-A Pilot Prospective and Retrospective Study

Background: The widespread prevalence of obstructive sleep apnea (OSA) underscores the necessity for effective therapies. Mandibular advancement devices (MADs) have emerged as valid treatment for mild to moderate cases, despite the associated dental side effects. Methods: This study evaluates the nature, onset, and long-term manifestation of these side effects. In the prospective group (n = 12), dental impressions were taken pre-MAD-insertion and at intervals of three, six, nine, and twelve months post-insertion to monitor occlusal alterations. In the retrospective group, participants (n = 8) wearing MADs for 7 years at average underwent lateral cephalogram assessments to compare with pre-treatment X-rays. All participants completed a specific questionnaire. Statistical analysis was performed via t-test and with p < 0.05 as the significance level. Results: The majority of participants in both groups consistently used MADs and reported significant sleep quality improvements, rating common symptoms like jaw tension as negligible. In both the prospective group and the retrospective group, significant reductions in overjet were observed at multiple time points, with the prospective group showing reductions at six months (p = 0.001), nine months (p > 0.001), and twelve months (p = 0.019), while the retrospective group indicated a notable decrease between baseline and follow-up assessments after a mean of seven years of device wear (p = 0.004). A slight overbite increase of 0.2 mm was prospectively observed after one year, whereas a trend towards a minimal decrease over the long term was observed in the retrospective sample (p = 0.003). Noteworthy changes in angle class or lower incisor inclination were absent. Cephalograms revealed significant IOK-NL angle alterations with a mean of 98.2° before and 95.2° upon long-term treatment (p = 0.020). Conclusions: These findings suggest that MADs are effective in treating OSA with minor adverse effects. This study advocates for moderate mandibular protrusion to balance therapeutic efficacy with dental health considerations, crucial for optimizing treatment outcomes. Nonetheless, the limited sample size warrants caution when generalizing these results to the broader population.

Nonpharmacologic Management of Hypertension in Older Adults

Hypertension is ubiquitous among older adults and leads to major adverse cardiovascular events. Nonpharmacologic lifestyle interventions represent important preventive and adjunct strategies in the treatment of hypertension and have benefits beyond cardiovascular disease in this population characterized by a high prevalence of frailty and comorbid conditions. In this review, the authors examine nonpharmacologic interventions with the strongest evidence to prevent cardiovascular disease with an emphasis on the older adults.

Insomnia and Chronic Pain Mediate the Relationship Between Traumatic Brain Injury and Reduced Positive Airway Pressure Adherence Among Veterans

OBJECTIVE

To examine whether co-morbid insomnia, post-traumatic stress disorder (PTSD), depression, and chronic pain mediate the relationship between traumatic brain injury (TBI) and positive airway pressure (PAP) treatment adherence.

SETTING

One Veterans Health Administration (VHA) sleep medicine site.

PARTICIPANTS

Veterans (n = 8836) who were prescribed a modem-enabled PAP device.

DESIGN

Secondary analysis of clinical data. We used path analysis to examine: (1) whether Veterans with a history of TBI were more likely to experience insomnia, PTSD, depression, and chronic pain; (2) in turn, whether Veterans with these co-morbid conditions exhibited lesser PAP adherence; and (3) whether Veterans with a history of TBI will exhibit lesser PAP adherence, even while accounting for such co-morbid conditions. Model estimates were adjusted for sociodemographic (eg, race/ethnicity) and clinical characteristics (eg, mask leakage).

MAIN MEASURES

Health conditions were abstracted from the VHA medical record. PAP adherence was measured using average nightly use (hours).

RESULTS

Among 8836 Veterans, 12% had a history of TBI. TBI history was not associated with PAP adherence when accounting for the presence of insomnia, PTSD, depression, and chronic pain. Indirect effect estimates indicated that a history of mild, moderate-severe, or unclassified TBI was associated with lesser PAP adherence, as mediated by the presence of co-morbid insomnia and chronic pain. Generally, TBI was associated with an increased likelihood of co-morbid insomnia, PTSD, depression, and chronic pain. In turn, insomnia and chronic pain, but not PTSD or depression, were associated with lesser PAP adherence.

CONCLUSIONS

Our study offers empirical support for insomnia and chronic pain as potential explanatory mechanisms underlying the relationship between TBI history and suboptimal PAP adherence. While additional research is needed to confirm causality, findings offer preliminary evidence that can inform the development of tailored PAP adherence interventions for Veterans with TBI and obstructive sleep apnea.

Association between obstructive sleep apnea severity and depression risk: a systematic review and dose-response meta-analysis

Obstructive sleep apnea (OSA) has received considerable attention as a potential risk factor for depressive symptoms. The systematic review was conducted to confirm the dose‒response connection between OSA severity and depression risk. A systematic literature search of English and Chinese articles published in PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and SinoMed databases from their inception to 28 August 2023 was conducted. An evaluation using the Newcastle‒Ottawa Scale was performed. A meta-analysis was used to evaluate the impact of OSA severity. A random-effects dose‒response model was conducted to evaluate the linear and nonlinear dose‒response connections. We evaluated publication bias by funnel plots, and symmetry by Egger's test. We identified 18 cross-sectional researches. 3143 participants which were involved in the dose‒response meta-analysis. Contrasted with mild OSA, individuals with severe OSA had a higher adjusted risk of depression (rate ratio: 1.34, 95% confidence interval = 1.05-1.70), with substantial heterogeneity (I2 = 70.9%, Pheterogeneity<0.001). There is a significant linear connection between OSA severity and depression risk. The depression risk increased by 0.4% for every 1 event per hour increase in the apnea-hypopnea index (AHI). The protocol for this unfunded research was drafted and registered at PROSPERO (ID CRD42023474097).

CPAP Treatment at Home after Acute Decompensated Heart Failure in Patients with Obstructive Sleep Apnea

Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results: From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel-Cox) p = 0.044). Conclusions: This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.

Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review

Objective  To perform a systematic review to determine if isolated nasal surgery has any impact on subjective or objective parameters in adult obstructive sleep apnea (OSA) patients. Materials and Methods  From December 2022 to March 2023, we conducted a search on the PubMed, Cochrane, Scopus, and Web of Science databases. Two independent investigators performed a study selection according to the established criteria, as well as data collection, including the study design, the subjective and objective parameters addressed, the type of intervention, and the outcomes, considering the methodological quality and risk of bias. Results  In total, 25 studies met the selection criteria, and they showed that there is a significant improvement in sleep quality, sleepiness, nasal resistance, and snoring after isolated nasal surgery. Still, there is no relevant modification of other polysomnographic parameters. It also reduces the required titration pressures of continuous positive airway pressure (CPAP) and increases the duration of its use. Conclusion  Isolated nasal surgery is not a primary treatment for OSA. Still, it improves the subjective parameters and can lead to CPAP therapy success by enhancing its effectiveness and long-term compliance.

Hypoxic indices for obstructive sleep apnoea severity and cardiovascular disease risk prediction: A comparison and application in a community population

BACKGROUND AND OBJECTIVE

The apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) encounter challenges in capturing the intricate relationship between obstructive sleep apnoea (OSA) and cardiovascular disease (CVD) risks. Although novel hypoxic indices have been proposed to tackle these limitations, there remains a gap in comprehensive validation and comparisons across a unified dataset.

METHODS

Samples were derived from the Sleep Heart Health Study (SHHS), involving 4485 participants aged over 40 years after data quality screening. The study compared several key indices, including AHI, ODI, the reconstructed hypoxic burden (rHB), the percentage of sleep time with the duration of respiratory events causing desaturation (pRED_3p) and the sleep breathing impairment index (SBII), in relation to CVD mortality and morbidity risks. Adjusted Cox proportional models were employed to calculate hazard ratios (HRs) for each index, and comparisons were performed.

RESULTS

SBII and pRED_3p exhibited significant correlations with both CVD mortality and morbidity, with SBII showing the highest adjusted HR (95% confidence interval) for mortality (2.04 [1.25, 3.34]) and pRED_3p for morbidity (1.43 [1.09-1.88]). In contrast, rHB was only significant in predicting CVD mortality (1.63 [1.05-2.53]), while AHI and ODI did not show significant correlations with CVD outcomes. The adjusted models based on SBII and pRED_3p exhibited optimal performance in the CVD mortality and morbidity datasets, respectively.

CONCLUSION

This study identified the optimal indices for OSA-related CVD risks prediction, SBII for mortality and pRED_3p for morbidity. The open-source online platform provides the computation of the indices.

Nasal turbinate lymphatic obstruction: a proposed new paradigm in the etiology of essential hypertension

Hypertension affects an estimated 1.3 billion people worldwide and is considered the number one contributor to mortality via stroke, heart failure, renal failure, and dementia. Although the physiologic mechanisms leading to the development of essential hypertension are poorly understood, the regulation of cerebral perfusion has been proposed as a primary cause. This article proposes a novel etiology for essential hypertension. Our hypothesis developed from a review of nuclear medicine scans, where the authors observed a significantly abnormal increase in nasal turbinate vasodilation in hypertensive patients using quantitative region of interest analysis. The authors propose that nasal turbinate vasodilation and resultant blood pooling obstruct the flow of cerebrospinal fluid passing through nasal turbinate lymphatics, thereby increasing intracranial pressure. The authors discuss the glymphatic/lymphatic clearance system which is impaired with age, and at which time hypertension also develops. The increased intracranial pressure leads to compensatory hypertension via Cushing's mechanism, i.e., the selfish brain hypothesis. The nasal turbinate vasodilation, due to increased parasympathetic activity, occurs simultaneously along with the well-established increased sympathetic activity of the cardiovascular system. The increased parasympathetic activity is likely due to an autonomic imbalance secondary to the increase in worldwide consumption of processed food. This hypothesis explains the rapid worldwide rise in essential hypertension in the last 50 years and offers a novel mechanism and a new paradigm for the etiology of essential hypertension. This new paradigm offers compelling evidence for the modulation of parasympathetic nervous system activity as a novel treatment strategy, specifically targeting nasal turbinate regulation, to treat diseases such as hypertension, idiopathic intracranial hypertension, and degenerative brain diseases. The proposed mechanism of essential hypertension presented in this paper is a working hypothesis and confirmatory studies will be needed.

Association between adherence to life's simple 7 metrics and risk of obstructive sleep apnea among adults in the United States

BACKGROUND

We aimed to explore the impact of adherence to Life's Simple 7 (LS7) metrics on risk of obstructive sleep apnea (OSA), and the impact of inflammation on the association, in adults in the United States.

METHODS

Data from 13,825 community-dwelling adults aged ≥ 20 years recruited in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008, 2015-2018 was analyzed. The LS7 score was calculated based on the AHA definition of LS7 metrics. The diagnosis of OSA was based on self-reported symptoms of sleep disturbance using a standard questionnaire. The Multivariable Apnea Prediction (MAP) Index score was also calculated to assess the risk of OSA. Log-binominal regression and negative binomial regression were performed to estimate the associations between LS7 and OSA and MAP index, with odds ratios (ORs) and prevalence ratios (PRs) and their 95% confidence intervals (CIs) calculated. Mediation analysis was performed to estimate the mediating effects of inflammatory indicators on the associations.

RESULTS

A total of 4473 participants (32.4%) had OSA, and the mean MAP index was 0.39. In fully adjusted log-binominal regression models, with total score < 6 as the reference, the ORs (95% CIs) for risk of OSA were 0.90 (0.73, 1.10), 0.76 (0.65, 0.89), 0.78 (0.64, 0.95), and 0.45 (0.38, 0.54) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). When LS7 score was analyzed as a continuous variable, each 1-point increase in LS7 score was associated with a 15% decrease in OSA risk (P < 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for the MAP index were 0.93 (0.90, 0.97), 0.87 (0.84, 0.91), 0.80 (0.77, 0.84), and 0.55 (0.53, 0.57) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). For each 1-point increase in LS7 score, the risk of OSA decreased by 13% (P < 0.001). Consistent results were observed in subgroup analysis. Mediation analysis indicated that inflammatory factors, including blood cell count, neutrophil count, and C-reactive protein, positively mediated the association of LS7 with OSA, with a mediation proportion of 0.022 (P = 0.04), 0.02 (P = 0.04), and 0.02 (P = 0.02), respectively.

CONCLUSIONS

In a nationally representative sample of US adults, adherence to LS7 metrics was independently associated with reduced OSA risk. Inflammation plays a mediating role in the association between LS7 and OSA.

Impact of High Risk of Obstructive Sleep Apnea on Health-Related Quality of Life: The Korean National Health and Nutrition Survey 2019-2021

Background/Objectives: Obstructive sleep apnea (OSA) impairs quality of life (QoL). However, its disease burden in the general population remains unknown. We aimed to investigate the association between OSA and health-related QoL in the general Korean population. Methods: This study analyzed cross-sectional datasets of adults (≥40 years) in the Korean National Health and Nutrition Examination Survey 2019-2021. QoL was assessed using the 3-level EuroQoL 5-dimension component (EQ-5D-3L). The high risk of OSA was determined using the STOP-Bang questionnaire (score ≥ 3). Demographic and clinical factors were included in linear regression analyses to identify the factors associated with EQ-5D-3L. Results: Of the 8966 total participants, 6792 (75.8%) and 2174 (24.2%) were classified as having a low risk and high risk of OSA, respectively. The high risk OSA group showed significantly lower QoL scores when compared with the low risk OSA group (0.939 ± 0.003 vs. 0.951 ± 0.002, p < 0.001). However, the mean difference was within the minimal clinically important difference (MCID) of EQ-5D-3L. Only females exceeded the MCID for the EQ-5D-3L. Elderly females with a high risk of OSA showed the lowest QoL. The regression coefficient of high risk OSA in the multivariate model was -0.018 (95% CI: -0.025--0.01, p < 0.001). Patient demographics and comorbidities also showed significant associations with the EQ-5D-3L. Their regression coefficient was higher than that of high risk OSA. Conclusions: The impact of high risk OSA on QoL manifested differently according to age and sex. The impact of comorbidities on QoL was greater than that of high risk OSA, highlighting the important role of comorbidities and the need for their adjustment in the assessment of QoL.

Prediction of non-dipper blood pressure pattern in Chinese patients with hypertension using a nomogram model

Non-dipper blood pressure has been shown to affect cardiovascular outcomes and cognitive function in patients with hypertension. Although some studies have explored the influencing factors of non-dipper blood pressure, there is still relatively little research on constructing a prediction model. This study aimed to develop and validate a simple and practical nomogram prediction model and explore relevant elements that could affect the dipper blood pressure relationship in patients with hypertension. A convenient sampling method was used to select 356 inpatients with hypertension who visited the Affiliated Hospital of Jining Medical College from January 2022 to September 2022. All patients were randomly assigned to the training cohort (75%, n = 267) and the validation cohort (25%, n = 89). Univariate and multivariate logistic regression were utilized to identify influencing factors. The nomogram was developed and evaluated based on the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and decision curve analyses. The optimal cutoff values for the prevalence of dipper blood pressure were estimated. The nomogram was established using six variables, including age, sex, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), ejection fraction (EF), and heart rate. The AUC was 0.860 in the training cohort. The cutoff values for optimally predicting the prevalence of dipper blood pressure were 41.50 years, 151.00 g/L, 117.53 mL/min/1.73 m2, 64.50%, and 75 beats per minute for age, Hb, eGFR, ejection fraction, and heart rate, respectively. In summary, our nomogram can be used as a simple, plausible, affordable, and widely implementable tool to predict the blood pressure pattern of Chinese patients with hypertension.

Gut microbiota and sleep: Interaction mechanisms and therapeutic prospects

Sleep is crucial for wellness, and emerging research reveals a profound connection to gut microbiota. This review explores the bidirectional relationship between gut microbiota and sleep, exploring the mechanisms involved and the therapeutic opportunities it presents. The gut-brain axis serves as a conduit for the crosstalk between gut microbiota and the central nervous system, with dysbiosis in the microbiota impairing sleep quality and vice versa. Diet, circadian rhythms, and immune modulation all play a part. Specific gut bacteria, like Lactobacillus and Bifidobacterium, enhance sleep through serotonin and gamma-aminobutyric acid production, exemplifying direct microbiome influence. Conversely, sleep deprivation reduces beneficial bacteria, exacerbating dysbiosis. Probiotics, prebiotics, postbiotics, and fecal transplants show therapeutic potential, backed by animal and human research, yet require further study on safety and long-term effects. Unraveling this intricate link paves the way for tailored sleep therapies, utilizing microbiome manipulation to improve sleep and health. Accelerated research is essential to fully tap into this promising field for sleep disorder management.

J-Shaped Relationship Between Weight-Adjusted-Waist Index and Cardiovascular Disease Risk in Hypertensive Patients with Obstructive Sleep Apnea: A Cohort Study

Background

A newly introduced obesity-related index, the weight-adjusted-waist index (WWI), emerges as a promising predictor of cardiovascular disease (CVD). Given the known synergistic effects of hypertension and obstructive sleep apnea (OSA) on cardiovascular risk, we aimed to explore the relationship between the WWI and CVD risk specifically within this high-risk cohort.

Methods

A total of 2265 participants with hypertension and OSA were included in the study. Multivariate Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events. The restricted cubic spline (RCS) was used to further evaluate the nonlinear dose-response relationship.

Results

During a median follow-up period of 6.8 years, 324 participants experienced a CVD event. Multivariate Cox regression analysis revealed that compared to the reference group, the HRs for the second, third, and fourth groups were 1.12 (95% CI, 0.79-1.59), 1.35 (95% CI, 0.96-1.89), and 1.58 (95% CI, 1.13-2.22), respectively. Moreover, RCS analysis illustrated a clear J-shaped relationship between the WWI and CVD risk, particularly notable when WWI exceeded 11.5 cm/√kg, signifying a significant increase in CVD risk.

Conclusion

There was a J-shaped relationship between WWI and CVD in hypertensive patients with OSA, especially when the WWI was greater than 11.5 cm/√kg, the risk of CVD was significantly increased.

Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea

Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.

Obstructive sleep apnea and cardiovascular risk

Patients with obstructive sleep apnea (OSA) experience repetitive episodes of upper airway obstruction due to recurrent collapse during sleep. This leads to intermittent hypoxia episodes, which, through complex pathophysiological mechanisms, trigger sympathetic overactivation, endothelial dysfunction, hypercoagulation, and metabolic dysregulation. Consequently, other cardiovascular risk factors such as hypertension, metabolic syndrome, and diabetes are induced. Furthermore, this enhances target organ damage, affecting the heart, arteries, and kidneys, leading to an increased risk of cardiovascular morbidity and mortality. Among the various treatments for OSA, Continuous Positive Airway Pressure (CPAP) has been extensively studied. To date, this treatment has shown mild benefits in reducing blood pressure, particularly noticeable in patients with resistant hypertension. Furthermore, CPAP treatment appears to reduce cardiovascular events, both in primary and secondary prevention, though this benefit is limited to individuals with good compliance (CPAP use ≥4h/night). Future research perspectives in OSA seem to focus on identifying patients in whom the condition significantly influences cardiovascular risk, thus determining those who would benefit the most from treatment in the reduction of cardiovascular risk.

The Effect of Surgical Therapy for Obstructive Sleep Apnea on Blood Pressure and Peripheral Arterial Tonometry

OBJECTIVE

To determine the effect of upper airway surgery on cardiovascular function in patients with obstructive sleep apnea (OSA).

STUDY DESIGN

A prospective, self-controlled study from 2018 to 2023.

SETTING

Two academic medical centers.

METHODS

Seventy-four patients underwent surgery for OSA, including: tonsillectomy, adenoidectomy, epiglottidectomy, modified uvulopalatopharyngoplasty, maxillary expansion, and maxillomandibular advancement. Twenty-four-hour ambulatory blood pressure (BP), peripheral arterial tonometry (PAT)-based home sleep study, and sleep-related patient-reported outcomes (PROs) were captured preoperatively and at 6 months postoperatively. Paired T-tests evaluated changes in outcomes after surgery.

RESULTS

Forty-one patients successfully completed preoperative and postoperative assessments. Patients were generally middle-aged (43.8 ± 12.5 years), obese (BMI 33.0 ± 5.8 kg/m2), male (68%), White (71%), and had severe OSA (apnea-hypopnea index [AHI] 33.9 ± 29.5 events/h). The 4% oxygen desaturation index (ODI) decreased from 30.7 ± 27.1 to 12.2 ± 13.6 events/h (P < .01) after surgery. There was no significant difference in 24-h BP following surgery, though clinically meaningful reductions in nocturnal systolic (-1.95 [-5.34, 1.45] mmHg) and nocturnal diastolic (-2.30 [-5.11, 0.52] mmHg) blood pressure were observed. Stratified analysis showed patients undergoing skeletal surgery (n = 17) demonstrated larger average reductions compared to those undergoing soft tissue surgery in nocturnal systolic (-4.12 [-7.72, -0.51] vs -0.10 [-5.78, 5.58] mmHg) and nocturnal diastolic (-3.94 [-7.90, 0.01] vs -0.90 [-5.11, 3.31] mmHg) pressures. No meaningful changes were observed in PAT Autonomic Index (PAI) measurements.

CONCLUSION

Surgical therapy for OSA did not demonstrate statistically significant improvements in 24-h BP. However, clinically meaningful reductions in nocturnal BP were observed, particularly in skeletal surgery patients, supporting the need for larger studies of cardiovascular outcomes following OSA surgery.

Effect of continuous positive airway pressure treatment on Th17/Treg imbalance in patients with obstructive sleep apnea and a preliminary study on its mechanism

BACKGROUND

Obstructive sleep apnea (OSA) can be considered a chronic inflammatory disease that impacts all bodily systems, including the immune system. This study aims to assess the Th17/Treg pattern in patients with OSA and the effect of continuous positive airway pressure (CPAP) treatment.

METHODS

OSA patients and healthy controls were recruited. OSA patients recommended for CPAP treatment were followed up for three months. Flow cytometry was employed to determine the proportion of Th17 and Treg cells. Real-time quantitative polymerase chain reaction (PCR) and western blotting were utilized to detect the mRNA and protein levels of receptor-related orphan receptor γt (RORγt) and forkhead/winged helix transcription factor (Foxp3), respectively, in peripheral blood mononuclear cells (PBMCs). Enzyme-linked immunosorbent assay (ELISA) was performed to measure the serum levels of interleukin-17 (IL-17), IL-6, transforming growth factor-β1 (TGF-β1), and hypoxia-induced factor-1α (HIF-1α).

RESULTS

A total of 56 OSA patients and 40 healthy controls were recruited. The proportion of Th17 cells, Th17/Treg ratio, mRNA and protein levels of RORγt, and serum IL-17, IL-6, and HIF-1α levels were higher in OSA patients. Conversely, the proportion of Treg cells, mRNA and protein levels of Foxp3, and serum TGF-β1 levels were decreased in OSA patients. The proportion of Th17 and Treg cells in OSA can be predicted by the apnea hypopnea index (AHI), IL-6, TGF-β1 and, HIF-1α. 30 moderate-to-severe OSA patients were adherent to three-month CPAP treatment, with improved Th17/Treg imbalance, IL-17, IL-6, TGF-β1, and HIF-1α levels compared to pre-treatment values.

CONCLUSION

There was a Th17/Treg imbalance in OSA patients. The prediction of Th17 and Treg cell proportions in OSA can be facilitated by AHI, as well as serum IL-6, TGF-β1, and HIF-1α levels. Furthermore, CPAP treatment can potentially improve the Th17/Treg imbalance and reduce proinflammatory cytokines in OSA patients.

Sleep apnea and ischemic stroke- a perspective for translational preclinical modelling

Obstructive sleep apnea (OSA) is associated with ischemic stroke. There is, however, a lack of knowledge on the exact cause-effect relationship, and preclinical models of OSA for experimental ischemic stroke investigations are not well characterized. In this review, we discuss sleep apnea and its relationship with stroke risk factors. We consider how OSA may lead to ischemic stroke and how OSA-induced metabolic syndrome and hypothalamic-pituitary axis (HPA) dysfunction could serve as therapeutic targets to prevent ischemic stroke. Further, we examine the translational potential of established preclinical models of OSA. We conclude that metabolic syndrome and HPA dysfunction, which are often overlooked in the context of experimental stroke and OSA studies, are crucial for experimental consideration to improve the body of knowledge as well as the translational potential of investigative efforts.

The effects of obstructive sleep apnea on blood pressure variability and load in patients with hypertension

BACKGROUND

Hypertension frequently coexists with obstructive sleep apnea (OSA), and their interplay substantially impacts the prognosis of affected individuals. Investigating the influence of OSA on blood pressure variability (BPV) and blood pressure load (BPL) in hypertensive patients has become a focal point of clinical research.

METHODS

This cross-sectional study recruited hypertensive patients (n = 265) without discrimination and classified them into four groups based on their apnea-hypopnea index (AHI): control group (n = 40), AHI < 5; mild group (n = 74), 5 ≤ AHI ≤ 15; moderate group (n = 68), 15 < AHI ≤ 30; severe group (n = 83), AHI > 30. All participants underwent comprehensive assessments, including polysomnography (PSG) monitoring, 24-h ambulatory blood pressure (ABP) monitoring, cardiac Doppler ultrasound, and additional examinations when indicated.

RESULTS

BPV and BPL exhibited significant elevations in the moderate and severe OSA groups compared to the control and mild OSA groups (P < 0.05). Moreover, interventricular septum thickness and left ventricular end-diastolic volume (LVEDV) demonstrated higher values in the moderate and severe OSA groups (P < 0.05). Multiple stepwise regression analysis identified noteworthy risk factors for elevated BPV in hypertensive patients with OSA, including AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea.

CONCLUSION

Hypertensive patients with moderate to severe OSA exhibited substantially increased BPV and BPL. Moreover, BPV was correlated with AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea in hypertensive patients with OSA.