Obstructive sleep apnoea syndrome

An evaluation of cone beam computed tomography in verifying the level of collapse in obstructive sleep apnea patients

OBJECTIVE

To assess the accuracy of cone beam computed tomography (CBCT) in verifying the level of collapse in obstructive sleep apnea (OSA) patients.

METHODS

A prospective analysis of 30 patients with confirmed OSA was selected. Drug-induced sleep endoscopy (DISE) was performed for all cases to determine the level of collapse clinically. Two groups of patients were imaged with CBCT, one at end of expiration and the other at end of inspiration. Virtual endoscopy was performed on CBCT software. The level of collapse was recorded from both groups and compared to DISE findings.

RESULTS

No statistical difference was discovered in the level of collapse observed from DISE or CBCT in most cases. Virtual endoscopy was found to have no role in determining collapse at tongue and lateral wall levels.

CONCLUSION

Using CBCT helped predict the air blockage level in patients with sleep apnea, which helps in surgical treatment planning measures.

Efficacy and safety of pitolisant in residual excessive daytime sleepiness for patients with obstructive sleep apnea adhering to continuous positive airway pressure therapy in the HAROSA studies: An individual patient meta-analytical approach

PURPOSE

Obstructive sleep apnea (OSA) is typically treated with continuous positive airway pressure (CPAP) therapy. Some patients experience residual excessive daytime sleepiness (EDS) under CPAP. Pitolisant demonstrated effectiveness in reducing EDS. An individual patient meta-analysis was conducted assessing the efficacy and safety of pitolisant 20 mg and 40 mg versus placebo to treat EDS in patients with OSA using CPAP.

METHODS

A study-patient, hierarchical, random-effects model was used. Epworth Sleepiness Scale (ESS) and Oxford Sleep Resistance test (OSLER) were co-primary endpoints. Secondary endpoints included EDS-Z scores, fatigue, clinical global impression, and quality of life (QoL).

RESULTS

The searches identified three randomized controlled trials. Individual patient data were derived from 423 patients (placebo: n = 120, pitolisant 20 mg: n = 183, pitolisant 40 mg: n = 120). Treatment effects on ESS were -3.20 (95 % confidence interval [CI]: 4.37, -2.00; P < 0.001) and -3.57 (95 % CI: 4.87, -2.80); P < 0.001) for the 20 mg and 40 mg doses, with corresponding standardized mean differences (SMD) of -0.71 (95 % CI: 0.45, -0.97) and -0.79 (95 % CI: 0.51, -1.08). Treatment effects in minutes for OSLER were 1.24 (95 % CI: 0.60, 1.10, SMD = 0.61; P = 0.001) and 1.21 (95 % CI: 0.06, 1.38, SMD = 0.51; P = 0.006). Pitolisant 40 mg was superior to the 20-mg dose for older age (≥50 years) and higher baseline apnea-hypopnea index values (≥15). No significant differences were observed for safety outcomes.

CONCLUSION

Pitolisant 20 mg and 40 mg were significantly therapeutically superior to placebo in treating residual EDS in patients with OSA who received CPAP on the outcomes for ESS, OSLER, and QoL.

Comparison of the predictive value of TyG index and METS-IR for OSA combined with NAFLD: a retrospective observational study based on a physical examination population

BACKGROUND

Obstructive sleep apnoea (OSA), Non-alcoholic fatty liver disease (NAFLD) and insulin resistance (IR) are interlinked. The aim of our study was to investigate the predictive value of metabolic score for insulin resistance (METS-IR) and triglyceride-glucose(TyG) index in relation to OSA combined with NAFLD in physical examination population.

METHODS

This is a retrospective observational study. 329 physical examiners who attended the healthcare centre of the First Affiliated Hospital of Wenzhou Medical University for polysomnography and abdominal ultrasonography (or CT abdominal scanning) from September 2021 to July 2024. Subjects were categorized into two groups according to the presence or absence of combined NAFLD. Logistic regression analysis and restricted cubic spline model (RCS) were used to evaluate the relationship between TyG index and METS-IR and NAFLD. The predictive value of TyG index and METS-IR for NAFLD was determined by receiver operating characteristic curves (ROC curves).

RESULTS

A total of 329 subjects were analyzed. The prevalence of NAFLD increased with increasing TyG index (P for trend < 0.001), and METS-IR showed an increasing-decreasing-increasing trend with NAFLD risk (P for trend < 0.001). RCS analysis showed a dose-response relationship between NAFLD risk and METS-IR (p = 0.012) and a linear relationship with the TyG index (p = 0.078), with a significant increase in the risk of NAFLD when the METS-IR exceeded a threshold of 47.47 (OR = 1). Compared with TyG index (AUC = 0.775, 95% CI: 0.711-0.828), METS-IR (AUC = 0.778, 95% CI: 0.716-0.836) had a higher predictive value for NAFLD in the OSA physical examination population.

CONCLUSIONS

In the OSA population, TyG index and METS-IR had predictive value for the development of NAFLD, with METS-IR being superior to TyG index.

Upper airway and hyoid bone-related morphological parameters associated with the apnea-hypopnea index and lowest nocturnal oxygen saturation: a cephalometric analysis

BACKGROUND

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive complete or partial closure of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. Cephalogram is recognized as an effective diagnostic tool for predicting OSA risk in clinical practice. This study aims to assess and analyze the morphological characteristics of the upper airway and hyoid bone position associated with OSA using data from polysomnography studies and two-dimensional cephalometric analysis.

METHODS

The study included lateral cephalograms and polysomnography reports from the records of 105 adult (64 males & 41 females) patients who underwent comprehensive clinical examination. The severity of OSA was evaluated based on the apnea-hypopnea index (AHI) and lowest nocturnal oxygen saturation (LSaO2). The participants were divided into male and female groups to investigate the correlation between cephalometric parameters and OSA severity. Thirteen cephalometric parameters, including eleven linear measurements and two angular measurements, were analyzed. The significance level was set at P-value < 0.05.

RESULTS

The male group exhibited significantly higher severity of OSA compared to the female group, as indicated by higher AHI and lower LSaO2. There was an inverse association between AHI values with width of upper airway as well as distance between hyoid bone position relative to mandibular plane in both male and female groups. Additionally, only the male group showed a correlation between hyoid bone position relative to gonion/third-fourth vertebrae positions with AHI values. 4 out of 7 parameters associated with AHI in male group remained correlated with LSaO2, while in females only the distance between hyoid bone and line formed by ptergoid and pterygomaxillary fissure point showed correlation with LSaO2.

CONCLUSION

Correlation analysis revealed that a narrower upper airway was positively associated with increased AHI, while an inferiorly positioned hyoid bone in relation to mandible was negatively correlated with LSaO2. Our findings highlight the importance of several cephalometric parameters in predicting OSA severity based on AHI and LSaO2 levels; moreover, certain parameters exhibited significant gender-specific associations.

The impact of PAP therapy first impression on short-term treatment adherence

PURPOSE

Positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) is often burdened by lower adherence rates. Patients' perception and acceptance of PAP therapy play a crucial role in achieving acceptable adherence.

METHOD

We conducted a prospective cohort study to assess patients' initial impressions of PAP therapy using a six-item questionnaire. The questionnaire evaluated CPAP tolerance, interface comfort, titration pressure, likelihood of CPAP use, expected health benefits, and overall attitude toward PAP therapy. Patients underwent a baseline awake PAP therapy trial (T0) followed by titration with an automatic device (APAP). After one month of titration, a fixed CPAP value was set (T1). Follow-ups occurred at 1 (T2), 3 (T3), and 6 (T4) months after the start of treatment. Adherence to PAP therapy was considered sufficient if the mean device usage was ≥ 4 h/night at T4.

RESULTS

After six months, 77% of the enrolled patients achieved high PAP treatment adherence. Questionnaire scores generally improved from T0 to T4, particularly in CPAP tolerance, likelihood of treatment adherence, expected health benefits, and overall judgment of PAP therapy. Time-to-event analysis revealed that higher baseline scores in titration pressure comfort, likelihood of CPAP adherence, and overall judgment of PAP therapy were significantly associated with higher adherence likelihood.

CONCLUSION

Patients' first judgement on PAP therapy could significantly influence short-term adherence. Early identification and management of patients' complaints and discomforts could improve adherence rates and PAP perception over time.

Identification of Overlapping Genetic Signatures Between Obstructive Sleep Apnea and Lung Cancer: Moving Beyond "One Drug, One Disease" Paradigm of Pharmaceutical Innovation

Traditional paradigms of pharmaceutical innovation have long relied on the "one drug, one disease" premise. However, a network mindset in unpacking disease mechanisms can be fruitful to move toward a "one drug, polydisease" paradigm of drug discovery and development. A case in point is obstructive sleep apnea (OSA) and lung cancer, which are two prevalent respiratory disorders that share common risk factors and may potentially exhibit overlapping molecular mechanisms. The putative mechanistic linkages between OSA and lung cancer remain underexplored; however, this study offers new evidence on overlapping genetic signatures between OSA and lung cancer with an in-silico approach. Bioinformatics analysis of the publicly available datasets (GSE135917 and GSE268175) identified 123 upregulated and 13 downregulated genes in OSA and 3175 upregulated and 2272 downregulated genes in lung cancer. A total of four genes (C1GALT1, TMEM106B, ZNF117, and ZNF486) were significantly upregulated with both disorders, highlighting potentially shared genetic and molecular mechanisms. Pathway and cell enrichment analysis indicated that mucin type O-glycan biosynthesis pathway and endothelial cells are strongly associated with these shared genes, lending support for their potential roles in both diseases. Moreover, hsa-miR-34a-5p, hsa-let-7g-5p, and hsa-miR-19a-3p were found to be associated with these common genes. Validation using the GEPIA2 tool confirmed the consistent expression patterns of these four genes in lung cancer. Machine learning analysis highlighted TMEM106B as the most significant biomarker candidate for distinguishing OSA and lung cancer from controls. In summary, this study supports the overarching concept that human diseases can have shared mechanistic pathways in the specific example of OSA and lung cancer. While these findings call for further research and validation, they invite rethinking the current pharmaceutical innovation paradigms to move beyond the "one drug, one disease" concept.

Unraveling the Molecular Mechanisms of OSA-Related Cardiovascular Event Recurrence: A Post Hoc Analysis From the ISAACC Study

RATIONALE

Although obstructive sleep apnea (OSA) is a prevalent condition among patients with acute coronary syndrome (ACS), the impact of OSA on cardiovascular event (CVE) recurrence is not homogeneous. We previously defined a specific phenotype of first-ACS patients without previous cardiovascular disease who are at increased risk of OSA-related CVE recurrence. However, the pathobiological mechanisms whereby OSA leads to adverse cardiovascular outcomes in this singular ACS phenotype remain to be investigated.

OBJECTIVE

To characterize the molecular pathways that relate OSA with CVE recurrence.

METHODS

This post hoc analysis of the ISAACC study (NCT01335087) included subjects without previous cardiovascular disease who were hospitalized for a first ACS and developed a recurrent CVE during the follow-up. Patients underwent respiratory polygraphy and fasting blood extraction during hospitalization. Two study groups were established on the basis of the apnea-hypopnea index (AHI): untreated severe OSA (AHI≥30events/h) and non-OSA (AHI<15events/h) groups. Proteomic profiling analysis included 276 cardiovascular and inflammatory-related plasma proteins via Olink® technology.

RESULTS

Proteomics was performed in 58 patients (77.6% male, median [p25;p75] age 58.0 [51.2;65.8] years, and median BMI 28.6 [25.8;31.2]kg/m2). Thirty patients had severe OSA, and 28 subjects were considered non-OSA controls. A total of 24 plasma proteins were differentially expressed between the groups. Among these proteins, 18 were significantly associated with OSA severity parameters derived from respiratory polygraphy. Further bioinformatic analyses of OSA-related proteins revealed their involvement in several molecular pathways, mostly related to immune function, cell signaling, and inflammatory processes.

CONCLUSION

A specific proteomic profile related to OSA presence and severity was identified in the plasma of ACS patients who developed recurrent CVEs. This analysis suggests the activation of key OSA-mediated molecular pathways with potential implications for cardiovascular prognosis.

Chronic Intermittent Hypoxia-Induced Neural Injury: Pathophysiology, Neurodegenerative Implications, and Therapeutic Insights

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep-related respiratory disorder that poses a global threat to human health. Chronic intermittent hypoxia (CIH) is its main pathological feature. With the advancements in medical research, the study of CIH-induced neural injury has gained increasing attention. Studies have shown that CIH can lead to or aggravate neuroinflammation and apoptosis by increasing blood-brain barrier (BBB) permeability, promoting oxidative stress, activating glial cells, and triggering multiple signaling pathways, ultimately resulting in neural injury. These processes contribute to the development of Alzheimer's disease, Parkinson's disease, and stroke. This review aims to summarize the progress in CIH-induced neural injury and explore various underlying mechanisms, with the goal of providing new insights for the development of therapeutic interventions targeting CIH-related neural damage.

Intermittent hypoxia increases lipid insulin resistance in healthy humans: A randomized crossover trial

Sympathetic overactivity caused by chronic intermittent hypoxia is a hallmark of obstructive sleep apnea. A high sympathetic tone elicits increases in plasma free fatty acid and insulin. Our objective was to assess the impact of 14 nights of chronic intermittent hypoxia exposure on sympathetic activity, glucose control, lipid profile and subcutaneous fat tissue remodelling in non-obese healthy humans. In this prospective, double-blinded crossover study, 12 healthy subjects were randomized, among them only nine underwent the two phases of exposures of 14 nights chronic intermittent hypoxia versus air. Sympathetic activity was measured by peroneal microneurography (muscle sympathetic nerve activity) before and after each exposure. Fasting glucose, insulin, C-peptide and free fatty acid were assessed at rest and during a multisampling oral glucose tolerance test. We assessed histological remodelling, adrenergic receptors, lipolysis and lipogenesis genes expression and functional changes of the adipose tissue. Two weeks of exposure of chronic intermittent hypoxia versus ambient air significantly increased sympathetic activity (p = 0.04). Muscle sympathetic nerve activity increased from 24.5 [18.9; 26.8] before to 21.7 [13.8; 25.7] after ambient air exposure, and from 20.6 [17.4; 23.9] before to 28.0 [24.4; 31.5] bursts per min after exposure to chronic intermittent hypoxia. After chronic intermittent hypoxia, post-oral glucose tolerance test circulating free fatty acid area under the curve increased (p = 0.05) and free fatty acid sensitivity to insulin decreased (p = 0.028). In adipocyte tissue, intermittent hypoxia increased expression of lipolysis genes (adipocyte triglyceride lipase and hormone-sensitive lipase) and lipogenesis genes (fatty acid synthase; p < 0.05). In this unique experimental setting in healthy humans, chronic intermittent hypoxia induced high sympathetic tone, lipolysis and decreased free fatty acid sensitivity to insulin. This might participate in the trajectory to systemic insulin resistance and diabetes for patients with obstructive sleep apnea.

Management options for excessive daytime sleepiness in patients with obstructive sleep apnea

INTRODUCTION

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) associated with the risk of accidents at work or while driving. OSA treatment decreases EDS, but some patients remain sleepy despite optimal control of OSA. Patients who do not tolerate or refuse OSA treatment may be symptomatically treated for EDS. Solriamfetol and pitolisant are wake-promoting agents (WPA) recently approved for use in sleepy OSA patients accepting or refusing OSA treatment.

AREAS COVERED

This narrative review provides updated information on: how to assess EDS in OSA patients, epidemiology, and management of residual EDS in treated OSA patients and the results of recent studies using new WPAs in patients accepting or refusing CPAP treatment. Literature was accessed from PubMed between 1 December 2024 and 6 January 2025.

EXPERT OPINION

The new WPAs are useful drugs with a favorable safety profile to be included as a possible therapeutic option for sleepy OSA patients. However, it is still uncertain which subgroups of patients should be treated for the symptom of EDS while maintaining a low-risk profile in terms of the consequences of OSA on health. Until such data is available, use of WPA in OSA patients should be managed by Sleep Specialists.

The mutual impacts of stem cells and sleep: opportunities for improved stem cell therapy

Sleep is an indispensable physiological function regulated by circadian rhythms, which influence the biological pathways and overall health of the body. Sleep is crucial for the maintenance and restoration of bodily systems, and disturbances can lead to various sleep disorders, which can impair both mental and physical health. Treatment options for these disorders encompass lifestyle modifications, psychotherapy, medications, and therapies such as light therapy and surgery. Not only sleep deprivation has a significant impact on essential organs, but it also influences various types of stem cells in the body. In this review, we explore the connection between sleep and various types of stem cells, highlighting how circadian rhythms regulate stem cell activities that are vital for tissue regeneration and homeostasis. Disruptions in sleep can hinder stem cell self-renewal, homing, proliferation, function, and differentiation, thereby affecting tissue regeneration and overall health. We also discuss how transplantation of stem cells and their products may help improve sleep disorders, how sleep quality affects stem cell behavior, and the implications for stem cell therapies. Notably, while certain stem cell transplantations can disrupt sleep, enhancing sleep quality may improve the efficacy of these therapies. Finally, stem cells can be utilized to model sleep disorders, offering valuable insights into their underlying mechanisms.

Further insights into influence factors of hypertension in older patients with obstructive sleep apnea syndrome: a model based on multiple centers

OBJECTIVE

To construct a novel model or a scoring system to predict hypertension comorbidity in older patients with obstructive sleep apnea syndrome (OSAS).

METHODS

A total of 1290 older patients with OSAS from six tertiary hospitals in China were enrolled. The sample was randomly divided into a modeling set (80%) and validation set (20%) using a bootstrap method. Binary logistic regression analysis was used to identify influencing factors. According to the regression coefficients, a vivid nomogram was drawn, and an intuitive score was determined. The model and score were evaluated for discrimination and calibration. The Z-test was utilized to compare the predictive ability between the model and scoring system.

RESULTS

In the multivariate analysis, age, body mass index (BMI), apnea-hypopnea index (AHI), total bilirubin (TB), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG) were significant predictors of hypertension. The area under the receiver operating characteristic curve of the model in the modeling and validation sets was 0.714 and 0.662, respectively. The scoring system had predictive ability equivalent to that of the model. Moreover, the calibration curve showed that the risk predicted by the model and the score was in good agreement with the actual hypertension risk.

CONCLUSIONS

This accessible and practical correlation model and diagram can reliably identify older patients with OSAS at high risk of developing hypertension and facilitate solutions on modifying this risk most effectively.

Identifying and validating immunological biomarkers in obstructive sleep apnea through bioinformatics analysis

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by disrupted breathing patterns and dysfunctions in multiple organ systems. Although studies support a close correlation between OSA and immune function, the broader implications and specific manifestations remain unclear. Therefore, it is pressingly needed to identify potential immune-related markers and elucidate underlying immunological mechanisms of OSA. OSA-related datasets (GSE38792) and immune-related genes were downloaded from the GEO and ImmPort databases and intersected to obtain differentially expressed immune-related genes (DEIRGs). GO, KEGG, and GSEA were employed to explore the biological functions of DEIRGs. Immune cells and immune regulation were analyzed by CIBERSORT. The ROC curve was constructed to assess the accuracy of each DEIRG. The co-regulatory networks of transcription factors, microRNAs, and drugs were built using the NetworkAnalyst database and visualized by Cytoscape. The levels of DEIRGs in clinical samples were validated by RT-qPCR. GO, KEGG, and GSEA revealed that DEGs were mainly enriched in negative regulation of immune response and antigen processing and presentation in OSA. IL33, IL10RB, ANGPTL1, EIF2AK2, SEM1, IFNA16, SLC40A1, FCER1G, IL1R1, TNFRSF17, and ERAP2 were identified as DEIRGs among 175 differentially expressed genes in OSA. Memory B cells, mast cells resting, and dendritic cells resting were the predominant immune cells related to DEIRGs. The co-regulatory network contained 128 miRNAs, 40 transcription factors, and 172 drugs/compounds. Finally, IL33, EIF2AK2, IL10RB, and ANGPTL1 were also upregulated in clinical OSA samples. The present study identified potential immune-related biomarkers and systematically elucidated underlying immunological mechanisms of OSA. These findings provide novel insights into the diagnosis, mechanism research, and management strategies for future studies.

Causal associations between Sarcopenia-related traits and obstructive sleep apnea: a mendelian randomization study

BACKGROUND

Evidence for a causal relationship between sarcopenia and obstructive sleep apnea (OSA) is scarce. This study aimed to investigate the causal association between sarcopenia-related traits and OSA utilizing Mendelian randomization (MR) analyses.

METHODS

MR analyses were conducted using genetic instruments for sarcopenia-related traits, including hand grip strength, muscle mass, fat mass, water mass, and physical performance. Data from large-scale genome-wide association studies (GWAS) were utilized to identify genetic variants associated with these traits. Causal associations with OSA were assessed using various MR methods, including the inverse variance-weighted (IVW) method, MR-Egger, and weighted median approaches. Pleiotropy and heterogeneity were evaluated through MR-PRESSO and other sensitivity analyses.

RESULTS

Low hand grip strength in individuals aged 60 years and older exhibited a positive correlation with the risk of OSA (IVW, OR = 1.190, 95% CI = 1.003-1.413, p = 0.047), while no significant causal effects were observed for grip strength in the left and right hands. Muscle mass, fat mass, and water mass were significantly associated with OSA, even after adjusting for multiple testing. Notably, higher levels of body fat percentage, trunk fat percentage, and limb fat percentage were strongly correlated with increased risk of OSA. Physical performance indicators such as walking pace demonstrated an inverse association with OSA, while a higher risk of OSA was observed with increased log odds of falling risk and greater frequency of falls in the last year. Additionally, a causal effect was found between long-standing illness, disability, or infirmity and OSA.

CONCLUSIONS

This comprehensive MR analysis provides evidence of a significant causal relationship between characteristics associated with sarcopenia, including low hand grip strength, muscle mass, fat mass, and physical performance, and the risk of OSA. These findings underscore the importance of addressing sarcopenia-related factors in the management and prevention of OSA.

Cardiovascular effects of obstructive sleep apnoea and effects of continuous positive airway pressure therapy: evidence from different study models

Background

Cardiovascular consequences of obstructive sleep apnoea (OSA) and the effects of continuous positive airway pressure (CPAP) therapy on blood pressure, endothelial dysfunction and major adverse cardiovascular events (MACE) have been studied over decades using different study designs. However, clinical findings from different study models on cardiovascular outcomes are sometimes contradictory.

Methods

A literature search was conducted in PubMed for randomised controlled trials, meta-analyses, population-based epidemiological studies and OSA cohort studies up to September 2023 investigating the cardiovascular effects of OSA and CPAP in adults with OSA on the following cardiovascular end-points: blood pressure, arterial hypertension, endothelial function and MACE (myocardial infarction, stroke, transient ischaemic attack or cardiovascular death). The level of evidence for these outcomes was discussed on the basis of different study models.

Results and conclusions

There is high-level evidence of a causal relationship between OSA and arterial hypertension and endothelial dysfunction, as well as on higher MACE incidence among subgroups of patients with untreated OSA. The cardiovascular effects of OSA depend on the severity of OSA, symptoms, phenotype and comorbidities. The blood pressure-lowering effect of CPAP is mainly observed in uncontrolled and treatment-resistant hypertension. The MACE risk reduction in OSA depends on good long-term CPAP adherence. Younger, sleepy patients with more severe OSA, higher hypoxaemic burden and without overt cardiovascular end-organ disease may particularly benefit from CPAP treatment in terms of cardiovascular risk reduction. Randomised controlled trials of CPAP or other effective OSA treatments in primary cardiovascular prevention and in patients at highest risk are lacking.

Exploring phenotypes to improve long-term mortality risk stratification in obstructive sleep apnea through a machine learning approach: an observational cohort study

BACKGROUND

Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder for which the identification of phenotypes might help for risk stratification for long-term mortality. Thus, the aim of the study was to identify distinct phenotypes of OSA and to study the association of phenotypes features with long-term mortality by using machine learning.

METHODS

This retrospective study included patients diagnosed with OSA who completed a 15-year follow-up and were adherent to continuous positive airway pressure (CPAP) therapy. Multidimensional data were collected at baseline and were used to identify OSA phenotypes using the hierarchical approach. Associations between phenotypic features and long-term mortality were assessed using supervised analysis.

RESULTS

A total of 402 patients, predominantly male (70 %), were included. Clustering analysis identified three distinct phenotypes: Cluster 1 (middle-aged, severely obese, very severe OSA with nocturnal hypoxemia), Cluster 2 (young, overweight, moderate OSA with limited nocturnal hypoxemia), and Cluster 3 (elderly, obese, multimorbid, severe OSA with nocturnal hypoxemia). Mortality was significantly higher in Clusters 1 and 3 (p < 0.001). Supervised methods identified eight main features of these clusters, among which nocturnal hypoxemia was found to be the main risk factor for mortality even after confounding factors-adjustment (hazard ratio 2.63, 95 % confidence interval 1.09-6.36, p = 0.032).

CONCLUSIONS

This study demonstrated the interest of attributing OSA patients to distinct phenotypes including precise determination of nocturnal hypoxemia to improve mortality risk stratification.

Association between obstructive sleep apnea syndrome and type1/type2 diabetes mellitus: A systematic review and meta-analysis

INTRODUCTION

Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway, along with hypoxemia, microarousals, and sleep fragmentation. Compelling evidence has clarified a bidirectional correlation between OSA and diabetes mellitus (DM). This paper was to assess the link between OSA and DM via meta-analysis, consisting of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Four databases (PubMed, Cochrane Library, Embase, and CNKI) were screened from inception to March 2024 for observational studies of OSA and DM, including case-control studies and cohort studies. Bidirectional associations between OSA and DM were analyzed, consisting of T1DM and T2DM. Random-effect models were employed to determine the pooled odds ratio (OR) and 95% confidence intervals (CIs) to compare prevalence. Traditional subgroup analyses were implemented. Review Manager 5.3 and Stata 16.0 were utilized for data analyses.

RESULTS

Thirty-five studies were enrolled, including 12 prospective cohort studies, 4 retrospective cohort studies, and 19 case-control studies. DM prevalence was notably higher in OSA patients than in non-OSA patients (OR: 2.29, 95% CI: 1.93-2.72), and OSA prevalence was notably higher in DM patients than in non-DM patients (OR: 2.12, 95% CI: 1.73-2.60). Subgroup analysis uncovered that DM prevalence in the OSA population was more significant in the group <50 years (OR: 3.28, 95% CI: 2.20-4.89) and slightly decreased in the group >50 years (OR: 1.82, 95% CI: 1.38-2.40).

CONCLUSIONS

The meta-analysis reveals a bidirectional link between OSA and DM.

Unmasking the Complex Interplay of Obesity Hypoventilation Syndrome, Heart Failure, and Sleep Dysfunction: A Physiological and Psychological Perspective in a Digital Health World

Obesity hypoventilation syndrome (OHS) is a multifaceted condition characterized by significant respiratory, cardiovascular, and psychological consequences. Positive airway pressure (PAP) therapy remains the cornerstone treatment, improving respiratory function, neurocognition, and mental health disorders such as depression and anxiety. However, its long-term impact on quality of life, physical activity, and broader health outcomes is not fully understood. Challenges such as residual apnoea/hypopnea index, reduced physical activity, and impaired quality of life persist despite high adherence rates. Factors like hypercapnia and daytime respiratory symptoms play a pivotal role in patient outcomes, underscoring the need for strategies beyond adherence alone. This review explores the interplay between OHS, heart failure, and sleep dysfunction, advocating for personalized PAP settings, targeted management of residual respiratory events, and enhanced patient education. Digital health technologies, including remote monitoring and feedback systems, present promising tools to optimize care delivery and foster holistic management. By integrating physiological, psychological, and digital health perspectives, this narrative review aims to advance understanding and improve outcomes for patients with OHS and other complex sleep-disordered breathing conditions.

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.

Sex- and age-differences in supine positional obstructive sleep apnea in children and adults

AIM

To analyze sex differences in age trajectories of supine positional obstructive sleep apnea (POSA).

METHODS

We conducted retrospective analysis of polysomnography studies from 13,144 individuals aged from 2 to 103 years with at least 30 min of both supine and lateral sleep. We used generalized linear mixed-effects models to estimate position-specific mean apnea-hypopnea index (AHI) values and logistic regression to estimate the proportion with POSA or with exclusive POSA among individuals with obstructive sleep apnea (OSA). Predictors included sex, 5-y age group, sleep position, and their interactions.

RESULTS

Supine AHI was higher than lateral AHI regardless of age or sex except under age 5 y. The ratio of supine AHI to lateral AHI reliably exceeded 2 after age 30-35 in males and age 50-55 in females. For both sexes, the proportion with POSA among individuals with OSA increased rapidly with age until 30-35 and then stabilized. The proportion with POSA among individuals with OSA was significantly higher in males than females for each age group between 40 and 75 (p < 0.03). Among individuals with OSA in those 20 and older, the proportion with POSA was 64.6% (95% CI: 62.7%, 66.5%) in males and 55.8% (95% CI: 53.6%, 57.8%) in females. The proportion of individuals showing exclusive POSA also increased with age and peaked near 41% at age 15-20 in males and at age 20-25 in females.

CONCLUSION

POSA becomes more common with age in both sexes; in women, its prevalence is generally lower but continues to increase after age 65.

Exploring the pharmacological mechanisms for alleviating OSA: Adenosine A2A receptor downregulation of the PI3K/Akt/HIF‑1 pathway (Review)

Obstructive sleep apnea (OSA) is the most common type of sleep apnea, which leads to episodes of intermittent hypoxia due to obstruction of the upper airway. A key feature of OSA is the upregulation and stabilization of hypoxia-inducible factor 1 (HIF-1), a crucial metabolic regulator that facilitates rapid adaptation to changes in oxygen availability. Adenosine A2A receptor (A2AR), a major adenosine receptor, regulates HIF-1 under hypoxic conditions, exerting anti-inflammatory properties and affecting lipid metabolism. The present study explored the roles of A2AR in OSA regulation, specifically focusing on its effects via the PI3K/Akt/HIF-1 pathway. The findings enhance our understanding the pharmacological potential of A2AR in OSA management and suggest future research directions in exploring its clinical applications.

Obstructive sleep apnea illness perception relative to other common chronic conditions

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is a common chronic medical condition that results in impaired daytime functioning. While the link between OSA and cardiovascular disease is important, there has been increasing recognition of the impact of OSA on daytime functioning and experience. Better insight into illness perceptions can help better understand how to initiate and maintain treatment.

METHODS

Data from 2 OSA clinical trials were examined. The baseline respiratory event index was obtained from diagnostic sleep testing. The Brief Illness Perception Questionnaire assesses the cognitive and emotional representation of illness and was administered at baseline along with the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index.

RESULTS

A total of 523 patients diagnosed with OSA were studied. The sample had a mean age of 51.1 ± 16.6, mean respiratory event index of 28.6 ± 17.9 events/h, and mean body mass index of 32.8 ± 15.5 kg/m2. The mean Brief Illness Perception Questionnaire total score at baseline was 43.3 ± 11.3. Brief Illness Perception Questionnaire scores were significantly correlated with sleepiness and sleep quality but not with respiratory event index. Relative to other common chronic conditions with major comorbidities, Brief Illness Perception Questionnaire scores for patients with OSA were higher on consequences, identity, concern, and emotional representation dimensions.

CONCLUSIONS

The study shows that veterans with OSA report elevated illness perceptions across several dimensions at levels as high, or higher, than other common chronic conditions. Implications for clinical practice are that it is important to ask patients about their understanding of illness across several dimensions to appreciate better patient needs and preferences.

CITATION

Zamora T, Nokes B, Malhotra A, Stepnowsky C. Obstructive sleep apnea illness perception relative to other common chronic conditions. J Clin Sleep Med. 2025;21(2):229-235.

Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel

Central sleep apnea (CSA) is commonly encountered among patients with sleep-disordered breathing; however, its clinical consequences are less well-characterized. The senior author (A.M.) therefore convened an expert panel to discuss the common presentations of CSA, as well as challenges and knowledge gaps in the diagnosis and management of CSA. The panel identified several key research priorities essential for advancing our understanding of the disorder. Within the diagnostic realm, panel members discussed the utility of multinight assessments and importance of the development and validation of novel metrics and automated assessments for differentiating central vs obstructive hypopneas, such that their impact on clinical outcomes and management may be better evaluated. The panel also discussed the current therapeutic landscape for the management of CSA and agreed that therapies should primarily aim to alleviate sleep-related symptoms, after optimizing treatment to address the underlying cause. Most importantly, the panel concluded that there is a need to further investigate the clinical consequences of CSA, as well as the implications of therapy on clinical outcomes, particularly among those who are asymptomatic. Future research should focus on endo-phenotyping central events for a better mechanistic understanding of the disease, validating novel diagnostic methods for implementation in routine clinical practice, as well as the use of combination therapy and comparative effectiveness trials in elucidating the most efficacious interventions for managing CSA.

CITATION

Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med. 2025;21(2):405-416.

MiRNA expression affects survival in patients with obstructive sleep apnea and metastatic colorectal cancer

INTRODUCTION

The relationship between obstructive sleep apnea (OSA) and cancer has been recognized for some time now. However, little is known about the mechanisms by which sleep apnea promotes tumorigenesis and the impact of OSA on survival after cancer diagnosis. In the last few years, research has focused on the exploration of different biomarkers to understand the mechanisms underlying this relationship and miRNAs, non-coding single strands of about 22 nucleotides that post-transcriptionally regulate gene expression, have emerged as possible actors of this process.The aim of the study was to evaluate the impact of OSA on survival of metastatic colorectal cancer (mCRC) patients based on the expression of specific miRNAs.

METHODS

The expression of 6 miRNAs, respectively miR-21, miR-23b, miR-26a, miR-27b, miR-145 and miR-210, was analyzed by qRT-PCR in patients' sera. Response to first-line therapy, Kaplan-Meier curves of overall and progression-free survival were used to evaluate survival in mCRC patients with and without OSA stratified for the expression of miRNAs.

RESULTS

The expression of miR-21, miR-23b, miR-26a and miR-210 was significantly upregulated in mCRCs with OSA compared to no OSA. In mCRC patients with OSA and increasing expression of miR-21, miR-23b, miR-26a and miR-210 risk of progression after first-line therapy was higher and both overall and progression-free survival were significantly worst. Conversely, as miR-27b and miR-145 expression increased, the life expectancy of patients diagnosed with OSA and mCRC improved markedly.

CONCLUSIONS

This study highlights the relevance of specific miRNAs on OSA in mCRCs and their significance as non-invasive biomarkers in predicting the prognosis in patients with mCRC and OSA.

Evaluating the Benefit of Home Support Provider Services for Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for an Ambispective International Real-World Study

BACKGROUND

Adherence and persistence to positive airway pressure (PAP) therapy are key factors for positive health outcomes. Home support providers participate in the home implementation and follow-up of PAP therapy for patients with obstructive sleep apnea (OSA). In Europe, home support provider service levels are country (or area) specific, resulting in differences in content and frequency of patient interactions. However, no robust evaluation of the impact of these differences on clinical and patient outcomes has been performed.

OBJECTIVE

The AWAIR study aims to evaluate and compare the impact of different home support provider service levels on PAP adherence and persistence in 4 European countries.

METHODS

This real-world, ambispective, cohort study-conducted in France, Belgium, Spain, and Portugal-will recruit adults with OSA who started PAP therapy between 2019 and 2023 and were followed by an Air Liquide Healthcare home support provider. Given the large number of eligible participants (around 150,000), the study will use a decentralized and digital approach. A patient video will present the study objectives and the participation process. A secure electronic solution will be used to manage patient information and consent, as well as to administer a web-based questionnaire. Retrospective data, collected during routine patient follow-up by home support providers, include the level of service and device data, notably PAP use. Prospective data collected using an electronic patient-reported outcome tool include health status, OSA-related factors, patient-reported outcomes including quality of life and symptoms, OSA and PAP literacy, patient-reported experience, and satisfaction with PAP therapy and service. Hierarchical models, adjusted for preidentified confounding factors, will be used to assess the net effect of home support provider services on PAP adherence and persistence while minimizing real-world study biases and considering the influence of country-level contextual factors. We hypothesize that higher levels of home support provider services will be positively associated with adherence and persistence to PAP therapy.

RESULTS

As of December 2024, the study has received approval in France, Portugal, and 2 regions of Spain. The study began enrollment in France in October 2024. Results are expected in the second quarter of 2025.

CONCLUSIONS

The AWAIR study has a unique design, leveraging an unprecedented number of eligible participants, decentralized technologies, and a real-world comparative methodology across multiple countries. This approach will highlight intercountry differences in terms of patient characteristics, PAP adherence, and persistence, as well as patient-reported outcomes, patient-reported experiences, and satisfaction with the home service provider. By assessing the added value of home support provider services, the results will support best practices for patient management and for decision-making by payers and authorities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/65840.

Prevalence and impact of comorbid mental disorders in hospitalized patients with obstructive sleep apnea (OSA): a nationwide study using administrative data

This study aimed to compare the prevalence of mental comorbidities between hospitalization episodes with and without obstructive sleep apnea (OSA), and to analyze the association of those mental comorbidities with modifiable risk factors that may potentiate OSA. An observational retrospective analysis was conducted using an administrative database of discharges from all Portuguese mainland public hospitals. All-cause adult hospitalizations occurring between 2008-2015 were dichotomized according to the existence of an OSA code (ICD-9-CM 327.23). Mental disorders were clustered into categories 650-670 of Clinical Classifications Software. Within the OSA group, binary logistic regressions were performed to analyze associations between mental comorbidities and modifiable OSA risk factors. Of 6 072 538 admissions, 36 385 had a primary or secondary diagnosis of OSA, which was associated with greater odds of comorbid anxiety disorders (adjusted odds ratio [aOR] = 1.84), bipolar disorders (aOR = 2.68), depressive disorders (aOR = 2.38), alcohol abuse (aOR = 1.29) and suicidal behaviors (aOR = 1.52) compared to those without OSA (all p < 0.05). Each of these mental comorbidities was associated with significantly greater odds of at least two of the four studied risk factors that may potentiate OSA (namely obesity, smoking, alcohol abuse and opioid/sedative abuse). These findings emphasize the complex interplay between OSA and mental disorders, suggesting relevant bidirectional relationships, and highlight the importance of comprehensive assessment and management of mental health in individuals with OSA.

CPAP Therapy for OSA and Its Impact on Various Cardiovascular Disorders

Obstructive sleep apnea (OSA), a highly prevalent and serious disorder with significant complications, causes considerable daytime and nighttime symptoms as well as long-term consequences and is yet an underdiagnosed and inadequately treated condition. Patients with OSA undergo frequent awakenings during the sleep cycle and find it impossible to get restorative sleep. Individuals are extremely fatigued, sleepy, and irritable throughout the day. Reduced exercise performance and physical activity contribute to a decrease in energy metabolism and weight gain. Those in this population may experience decreased motivation, which could result in depressive symptoms. The abrupt drops in oxygen levels during the sleep cycle result in profound spikes in blood pressure and strain the cardiovascular system. Given its close tie with major cardiovascular risk factors, OSA is linked with various cardiovascular diseases, including coronary artery disease, cardiac arrhythmia, poorly controlled blood pressure, heart failure, and stroke. Continuous positive airway pressure is an effective and tried-trusted approach for symptom relief and improving quality of life. Despite its benefits, patients struggle with compliance and often go untreated because of physical discomfort and perceived inconvenience of using these machines. One other explanation for this could be the lack of awareness, comprehensive data, and extensive research on its effects on long-term cardiovascular and metabolic complications caused by OSA. The current standard treatment for OSA, using adequate positive airway pressure, greatly reduces cardiovascular morbidity. Nevertheless, patients with cardiovascular disorders continue to be highly susceptible to OSA and its detrimental clinical consequences, even with effective therapy available. In summary, continuous positive airway pressure has an indirect potential to affect cardiovascular outcomes, but further studies should be done to address issues with patient compliance and adherence.

Screening of obstructive sleep apnea and diabetes mellitus -related biomarkers based on integrated bioinformatics analysis and machine learning

BACKGROUND

The pathophysiology of obstructive sleep apnea (OSA) and diabetes mellitus (DM) is still unknown, despite clinical reports linking the two conditions. After investigating potential roles for DM-related genes in the pathophysiology of OSA, our goal is to investigate the molecular significance of the condition. Machine learning is a useful approach to understanding complex gene expression data to find biomarkers for the diagnosis of OSA.

METHODS

Differentially expressed analysis for OSA and DM data sets obtained from GEO were carried out firstly. Then four machine algorithms were used to screen candidate biomarkers. The diagnostic model was constructed based on key genes, and the accuracy was verified by ROC curve, calibration curve and decision curve. Finally, the CIBERSORT algorithm was used to explore immune cell infiltration in OSA.

RESULTS

There were 32 important genes that were considered to be related both in OSA and DM datasets by differentially expressed analysis. Through enrichment analysis, the majority of these genes are enriched in immunological regulation, oxidative stress response, and nervous system control. When consensus characteristics from all four approaches were used to predict OSA diagnosis, STK17A was thought to have a high degree of accuracy. In addition, the diagnostic model demonstrated strong performance and predictive value. Finally, we explored the immune cells signatures of OSA, and STK17A was strongly linked to invasive immune cells.

CONCLUSION

STK17A has been discovered as a gene that can differentiate between individuals with OSA and DM based on four machine learning methods. In addition to offering possible treatment targets for DM-induced OSA, this diagnostic approach can identify high-risk DM patients who also have OSA.

Association of Craniofacial Skeletal and Soft Tissue Characteristics With Severe Obstructive Sleep Apnea in Age-specific and BMI-specific Patient Groups

PURPOSE

To identify the key craniofacial anatomic characteristics associated with the prevalence of severe obstructive sleep apnea (OSA) in patient cohorts stratified by age and body mass index (BMI).

METHODS

This prospective study was conducted at the Beijing Anzhen Hospital Center for Sleep Medicine and Science between December 2023 and March 2024. Patients suspected of having OSA underwent overnight polysomnography, along with computed tomography scans of the head and neck, to evaluate the skeletal and soft tissue characteristics. Multivariable analysis was conducted to explore the independent risk factors associated with the prevalence of severe OSA (apnea hypopnea index ≥30 events/h) after adjusting for age, sex, BMI, and neck circumference.

RESULTS

Among the 118 participants, 75 (63.6%) were diagnosed with severe OSA. Skeletal variables, such as vertical airway length, and soft tissue-related variables, like soft palate length, were independently correlated with the prevalence of severe OSA. Furthermore, subgroup analysis revealed that all skeletal variables and a few soft tissue parameters were associated with severe OSA in patients aged older than 40 years, whereas only a specific soft tissue variable was independently associated with the occurrence of severe OSA in those aged younger than or equal to 40 years. In addition, certain soft tissue-related variables were notably associated with severe OSA in obese patients (BMI >28 kg/m2), whereas only specific skeletal variables were acted independent risk factors for severe OSA in non-obese patients (BMI ≤28 kg/m2).

CONCLUSION

Craniofacial skeletal and soft tissue features play essential roles in the prevalence of severe OSA, with variations observed based on age and BMI.

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.

Sleep Health Disparities

Sleep is an important and potentially modifiable determinant of many severe health outcomes. Sleep health disparities exist and are exemplified by reported differential rates of prevalence, severity, and outcomes among minority groups and low-socioeconomic-status backgrounds. In this review we highlight the concept of sleep health, review the evidence for disparities in sleep health, examine risk factors and consequences of poor sleep health, and discuss policy implications.

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.

Test-Retest Reliability of Epworth Sleepiness Scale Score in Patients with Untreated Obstructive Sleep Apnea

Study Objectives

This study aimed to evaluate the test-retest reliability of the Epworth Sleepiness Scale (ESS) in patients with untreated obstructive sleep apnea (OSA) and investigate the effects of different follow-up techniques and various factors on ESS score discrepancies.

Methods

This study prospectively enrolled participants diagnosed with OSA at West China Hospital of Sichuan University from October 2022 to May 2023. Each participant completed a polysomnography (PSG) and the Chinese version of the ESS. Initial ESS evaluations were performed before the PSG and were reassessed either face-to-face or on telephone within a week. Analysis involved Bland-Altman plots, the intraclass correlation coefficient (ICC), and calculation of mean differences.

Results

We included 382 patients with untreated OSA, averaging 43.52 years old, with a mean body mass index (BMI) of 26.54 kg/m2 and an average apnea-hypopnea index (AHI) of 47.93 events/hour. The ICC was recorded at 0.820. The signed difference in ESS scores from baseline to follow-up was 1.68 ± 2.93 overall. In OSA patients with a BMI > 28, the difference was 2.39 ± 3.46, while in those with an AHI ≥ 30, it was 1.77 ± 3.27.

Conclusion

This study underscores the significance of repeated ESS testing to improve the reliability of sleepiness evaluations in patients with OSA. Further studies should aim to confirm these findings in a broader demographic and develop refined methods for more precise sleepiness assessments among different OSA groups.

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.

Deep Learning-Based Quantification of Adenoid Hypertrophy and Its Correlation with Apnea-Hypopnea Index in Pediatric Obstructive Sleep Apnea

Purpose

This study aims to develop a deep learning methodology for quantitative assessing adenoid hypertrophy in nasopharyngoscopy images and to investigate its correlation with the apnea-hypopnea index (AHI) in pediatric patients with obstructive sleep apnea (OSA).

Patients and Methods

A total of 1642 nasopharyngoscopy images were collected from pediatric patients aged 3 to 12 years. After excluding images with obscured secretions, incomplete adenoid exposure, 1500 images were retained for analysis. The adenoid-to-nasopharyngeal (A/N) ratio was manually annotated by two experienced otolaryngologists using MATLAB's imfreehand tool. Inter-annotator agreement was assessed using the Mann-Whitney U-test. Deep learning segmentation models were developed with the MMSegmentation framework, incorporating transfer learning and ensemble learning techniques. Model performance was evaluated using precision, recall, mean intersection over union (MIoU), overall accuracy, Cohen's Kappa, confusion matrices, and receiver operating characteristic (ROC) curves. The correlation between the A/N ratio and AHI, derived from polysomnography, was analyzed to evaluate clinical relevance.

Results

Manual evaluation of adenoid hypertrophy by otolaryngologists (p=0.8507) and MATLAB calibration (p=0.679) demonstrated high consistency, with no significant differences. Among the deep learning models, the ensemble learning-based SUMNet outperformed others, achieving the highest precision (0.9616), MIoU (0.8046), overall accuracy (0.9182), and Kappa (0.87). SUMNet also exhibited superior consistency in classifying adenoid sizes. ROC analysis revealed that SUMNet (AUC=0.85) outperformed expert evaluations (AUC=0.74). A strong positive correlation was observed between the A/N ratio and AHI, with the correlation coefficients for SUMNet-derived ratios ranging from r=0.9052 (tonsils size+1) to r=0.4452 (tonsils size+3) and for expert-derived ratios ranging from r=0.4590 (tonsils size+1) to r=0.2681 (tonsils size+3).

Conclusion

This study introduces a precise and reliable deep learning-based method for quantifying adenoid hypertrophy and addresses the challenge posed limited sample sizes in deep learning applications. The significant correlation between adenoid hypertrophy and AHI underscores the clinical utility of this method in pediatric OSA diagnosis.

A comparative study of Twin-Block and van Beek Headgear-Activator on the three-dimensional morphology of the upper airway in growing children with mandibular retraction in skeletal class II malocclusion

OBJECTIVES

To compare the variations in the upper airway of children with skeletal Class II mandibular retrognathism treated with van Beek Headgear-Activator (vBHGA) and Twin-Block (TB) appliances.

MATERIALS AND METHODS

40 children were involved in this retrospective study and divided into two intervention groups: the vBHGA group and the TB group, each comprising 20 individuals with an average age of 11.13 years. Employing Cone Beam Computed Tomography and Geometric Morphometric analysis, a comprehensive assessment of the upper airway's volume, minimum cross-sectional area (m-CSA), and 3D shape characteristics was conducted pre-and post-treatment.

RESULTS

The total volume, oropharynx volume, oropharynx m-CSA, and hypopharynx m-CSA significantly increased in both the vBHGA and TB groups (p < 0.05). The sole discrepancy between the two groups was observed in comparing the nasopharynx m-CSA (p < 0.05). A morphological difference was observed in the vBHGA group before and after treatment (p < 0.05), characterized by a wider and shorter airway, positioning of the posterior nasal spine closer to the anterior inferior area, and a more posterior nasopharyngeal wall. However, there were no significant shape differences between the two groups or before and after treatment within the TB group.

CONCLUSION

It appears that both vBHGA and TB interventions contribute positively to alleviating upper airway constriction. Nonetheless, the vBHGA group exhibits more alterations in the configuration of the nasopharynx.

CLINICAL RELEVANCE

Both orthodontic appliances have a positive impact on the upper airway but still have differences, emphasizing the need for individualized consideration when selecting orthodontic interventions.

CLINICAL TRIAL REGISTRATION

This study was also registered with the Chinese Clinical Trial Registry with registration number ChiCTR2400086867.

Dizziness and unstable gait in the older adults are associated with vestibular hypofunction, muscle dysfunction and sleep disturbance: impact on prevention of accidental falls

BACKGROUND

Dizziness and unstable gait with resultant falls are common symptoms among the older adults. Most of studies have focused on statistical analysis regarding single factor related to dizziness and unstable gait. On the other hand, there are very few comprehensive studies using a large number of patients except several review papers.

METHODS

We retrospectively analyzed a total of 164 aged patients with dizziness and unstable gait. The patients underwent description of the Japanese version of the Dizziness Handicap Inventory (DHI), measurements of vestibular function, handgrip muscle strength, physical performance, height-adjusted appendicular skeletal muscle mass, and vitamin B1 and B12, a full-night polysomnography study, cognition test and visual test.

RESULTS

Average age was 80.5 ± 6.1 years and ranged from 59 to 91 years. Forty-eight were males and 116 females. Three causative factors, namely vestibular hypofunction, muscle dysfunction and sleep disturbance, were independently and combinedly associated with dizziness and unstable gait in over 93% of the patients. Patients with higher scores defined by these three causative factors had higher scores of DHI. 23% of the patients showed vitamin B1 and/or B12 deficiency, which was highly associated with sarcopenia/frailty. Cognitive and visual impairment were recognized in 4.9% and 5.0%, respectively.

CONCLUSION

Dizziness and unstable gait were mainly associated with vestibular hypofunction, muscle dysfunction and sleep disturbance. In addition, vitamin B1 and B12 deficiency, and cognitive and visual impairment secondarily contribute to dizziness and unstable gait. Appropriate selection of treatment according to the underlying causes would prevent accidental falls among the older adults.

New management pathways for follow-up of CPAP-treated sleep apnoea patients including digital medicine and multimodal telemonitoring

BACKGROUND

The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional contacts. Focusing on the reshaping of the management of care pathways of CPAP-treated patients, with a specific focus on telemonitoring platforms, we aimed to review the evidence on how digital medicine and artificial intelligence (AI) tools are facilitating patient phenotyping and triage, risk stratification and the allocation of resources between the various healthcare professionals for an optimal follow-up of CPAP-treated patients.

PHENOTYPING

OSA is a heterogeneous condition with diverse phenotypes differing in symptoms, comorbidities, demographics, lifestyle and socioeconomic context. Different phenotypes are associated with different CPAP adherence patterns and differing long-term prognosis. This diversity demands greater plurality in management pathways with different types and levels of support to ensure treatment adherence and risk reduction for patients while easing the burden on health services. In multidimensional phenotyping, we discuss alternatives to the apnoea hypopnoea index (AHI) as a measure of OSA severity. Then we consider risk stratification taking advantage of the wealth of CPAP monitoring data already available in databases that can now be exploited using AI and machine learning to direct (stratify) patients into appropriate follow-up management pathways.

INTEGRATED CARE CLINICS FOR HIGH-RISK PATIENTS

We look at the role of integrated OSA care clinics particularly for the management of high-risk patients with low adherence and progression of comorbidities. Here, multidisciplinary teams might propose comorbidity management, and the use of connected wearable devices for long-term monitoring of physical activity, along with remote CPAP monitoring.

REMOTE MANAGEMENT PATHWAYS

The pros and cons of remote management pathways to replace in-person follow-up visits are considered, including the need to re-evaluate CPAP-device reimbursement policies in some countries. While remote CPAP monitoring has become the cornerstone of follow-up providing information on adherence and efficacy, the processing of alerts needs to be improved, particularly regarding mask changes and early detection of CPAP failures.

CHALLENGES

The implementation of CPAP monitoring alone, as well as its extension to multimodal monitoring, can present challenges that remain to be addressed (eg, access to digital care). The extent and components of remote follow-up must be adapted to each specific OSA phenotype. Finally, we give examples of certain patient phenotypes (eg, comorbid insomnia with OSA) with specific follow-up requirements, for which remote (even multimodal) monitoring alone has limitations and the intervention of both sleep specialists and/or their colleagues from other disciplines is needed.

CONCLUSION

Appropriately tailored combined digital and in-person CPAP follow-up pathways would present advantages both for patients with OSA and healthcare services.

The association between cardiovascular health and obstructive sleep apnea symptoms: findings from NHANES

Objective

To investigate the association between cardiovascular health (CVH) and obstructive sleep apnea (OSA) within the U.S. population.

Methods

This study enrolled 12,540 participants aged 20 years and older from the 2007-2008 and 2015-2018 cycles of the National Health and Nutrition Examination Surveys (NHANES). Weighted univariate and multivariate logistic regression were utilized to examine the relationship between CVH and OSA symptoms. Life's Essential 8 (LE 8) metrics was employed to evaluate the CVH status of participants. Identification of OSA symptoms was determined based on a sleep questionnaire. They include (1) how often you snore; (2) how often you snort/stop breathing; or (3) how often you feel overly sleepy during day. Individuals who answered that they snore 3 or more per week; snort/stop breathing 3 or more per week and feel overly sleepy during day 16-30 times per month were classified as having OSA symptoms.

Results

Significant inverse associations were observed between LE8 scores and symptoms of OSA after adjusting for covariates. The 95% CI was 0.750 (0.630,0.893) for the moderate CVH group and 0.573 (0.454,0.723) for the high CVH group. Subgroup analyses, stratified by age and gender, highlighted a significant interaction between LE8 scores and OSA symptoms with age (P < 0.0001). Participants under 60 years old in the high CVH group exhibited a reduced likelihood OSA symptoms (OR: 0.470; 95% CI: 0.345,0.641). Restricted cubic splines (RCS) in a multivariate regression analysis showed a non-linear relationship between LE8 score and OSA. Our finding demonstrates a substantial decrease in OSA symptom prevalence with increased LE 8 scores.

Conclusion

The results demonstrate a strong inverse correlation between LE8 scores and OSA symptoms. Participants with higher LE8 scores showed a reduced likelihood of experiencing OSA symptoms.

Body mass index mediates the association between plasma lipid concentrations and the prevalence of obstructive sleep apnea among US adults: a cross-sectional study

Background

The association between obstructive sleep apnea (OSA) and plasma lipid concentrations is not consistent. This study aimed to investigate the association of plasma lipid concentrations with the prevalence of OSA among US adults, with an additional examination of the mediating effect of body mass index (BMI).

Methods

This cross-sectional study included 8,086 individuals who participated in the National Health and Nutrition Examination Survey (NHANES), conducted from 2005 to 2008 and 2015-2018. Multivariable logistic regression analysis was conducted to compute the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between plasma lipid concentrations and the prevalence of OSA. Additionally, subgroup analysis was used to explore the potential interactions. Generalized additive models (GAM) were constructed to evaluate the nonlinear relationships between lipid concentrations and OSA. Furthermore, mediation analysis was performed to assess the potential mediating role of BMI.

Results

In the fully adjusted model, when comparing the lowest quartile, the ORs for the prevalence of OSA among participants in the highest quartile were 1.367 (95% CI, 1.107-1.688) for triglyceride and 1.212 (95% CI, 1.004-1.462) for low-density lipoprotein cholesterol (LDL-C). However, total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were not associated with OSA. Notably, the relationship between triglyceride and OSA differed in the subgroups of gender, race, and body mass index (BMI) (P for interaction <0.05). Furthermore, we discovered an inverted U-shaped association between triglyceride and OSA (inflection point: 0.813 mmol/L). Causal mediation analysis revealed that BMI significantly mediated the relationship between triglyceride and the prevalence of OSA.

Conclusions

This study revealed that an elevated level of triglyceride increased the prevalence of OSA, and this effect was potentially mediated through BMI. Lowering triglyceride concentration may help to reduce the prevalence of OSA.

Comorbidity of obstructive sleep apnea and narcolepsy: A challenging diagnosis and complex management

Introduction

Narcolepsy and obstructive sleep apnea syndrome (OSA) are relevant causes of excessive daytime sleepiness (EDS); although different for etiopathogenesis and symptoms, differential diagnosis is sometimes difficult, and guidelines are lacking concerning their management when coexisting in a same patient.

Methods

A narrative review of the literature was realized including PubMed, Scopus and Embase, aimed to regroup studies and case reports evaluating epidemiology, clinical and instrumental features and treatment of patients presenting comorbid NT1 and OSA. Moreover, a snowball search on the pathophysiology underpinnings of the association of the two disorder was realized.

Results

For adults, the prevalence of OSA in NT1 ranged from 24.8 % to 51.4 %. No studies were found concerning the treatment of EDS in double-diagnosis patients, but only case reports; these latter and the experience on patients with either NT or OSA suggest that modafinil, methylphenidate, pitolisant and solriamfetol are effective.

Discussion

Adults with NT1 showed a higher prevalence of OSA compared to the general population, but the reach of the results reviewed here is limited by the retrospective design of most of the studies and by the inhomogeneous utilization of diagnostic criteria. The association with OSA is likely to be explained by the involvement of orexin in hypercapnic-hypoxic responses: a deficit of orexin may promote obstructive events during sleep. Open questions warrant further investigation, especially orexin's involvement in other sleep disorders associated with EDS, and the more appropriate treatment for the OSA-narcolepsy comorbidity.

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.

Gut microbiota has important roles in the obstructive sleep apnea-induced inflammation and consequent neurocognitive impairment

Obstructive sleep apnea (OSA) is a state of sleep disorder, characterized by repetitive episodes of apnea and chronic intermittent hypoxia. OSA has an extremely high prevalence worldwide and represents a serious challenge to public health, yet its severity is frequently underestimated. It is now well established that neurocognitive dysfunction, manifested as deficits in attention, memory, and executive functions, is a common complication observed in patients with OSA, whereas the specific pathogenesis remains poorly understood, despite the likelihood of involvement of inflammation. Here, we provide an overview of the current state of the art, demonstrating the intimacy of OSA with inflammation and cognitive impairment. Subsequently, we present the recent findings on the investigation of gut microbiota alteration in the OSA conditions, based on both patients-based clinical studies and animal models of OSA. We present an insightful discussion on the role of changes in the abundance of specific gut microbial members, including short-chain fatty acid (SCFA)-producers and/or microbes with pathogenic potential, in the pathogenesis of inflammation and further cognitive dysfunction. The transplantation of fecal microbiota from the mouse model of OSA can elicit inflammation and neurobehavioral disorders in naïve mice, thereby validating the causal relationship to inflammation and cognitive abnormality. This work calls for greater attention on OSA and the associated inflammation, which require timely and effective therapy to protect the brain from irreversible damage. This work also suggests that modification of the gut microbiota using prebiotics, probiotics or fecal microbiota transplantation may represent a potential adjuvant therapy for OSA.

The impact of comprehensive healthy lifestyles on obstructive sleep apnea and the mediating role of BMI: insights from NHANES 2005-2008 and 2015-2018

OBJECTIVE

In this study, the associations between healthy lifestyles and obstructive sleep apnea (OSA) in middle-aged and elderly adults were investigated via data from the National Health and Nutrition Examination Survey (NHANES) for the periods of 2005-2008 and 2015-2018.

METHODS

A total of 6,406 participants aged 40 years and older were included in the analysis. Healthy lifestyle behaviors were assessed through diet quality, physical activity, sleep duration, alcohol consumption, smoking status, and body mass index (BMI). A composite healthy lifestyle score (ranging from 0 to 6) was created and categorized into insufficient (0-2), intermediate (3-4), and optimal (5-6) health groups. Weighted logistic regression models were used to examine the association between these lifestyle scores and OSA, adjusting for some demographic, socioeconomic, and clinical covariates. Additionally, mediation analysis was conducted to evaluate the role of BMI as a mediator in the relationship between the composite healthy lifestyle score and OSA, determining the proportion of the total effect mediated by BMI.

RESULTS

Participants were classified into insufficient (17.81%), intermediate (56.82%), and optimal (25.37%) lifestyle groups. Higher dietary quality (OR: 0.81, 95% CI: 0.66-0.99) and adequate weight (OR: 0.09, 95% CI: 0.07-0.11) were statistically associated with reduced OSA odds after adjustments, whereas the variables were not. Each one-point increase in the healthy lifestyle score was linked to a 33% reduction in OSA odds (OR: 0.67, 95% CI: 0.63-0.71). A significant linear trend was observed, with better adherence to healthy lifestyle correlating with lower odds of OSA (p for trend < 0.001). Compared with insufficient lifestyle, intermediate lifestyle was linked to a 27% reduction in OSA (OR: 0.73, 95% CI: 0.58-0.91), whereas optimal lifestyle was associated with a 74% reduction (OR: 0.26, 95% CI: 0.21-0.33). Mediation analysis revealed that BMI significantly mediated the relationship between healthy lifestyle score and OSA, accounting for approximately 59.2% of the total effect (P < 0.001). The direct effect of the healthy lifestyle score on OSA remained significant even when controlling for BMI (P < 0.001). Subgroup analyses confirmed consistent benefits across different demographic groups.

CONCLUSIONS

This study revealed that adherence to healthy lifestyles significantly reduces the odds of OSA, with optimal lifestyles leading to a marked decrease in the odds of OSA. Notably, BMI plays a critical mediating role in this relationship. These findings emphasize the importance of promoting healthy lifestyle interventions as a key strategy for the prevention and management of OSA.

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.

T266M variants of ANGPTL4 improve lipid metabolism by modifying their binding affinity to acetyl-CoA carboxylase in obstructive sleep apnea

BACKGROUND

Angiopoietin-like protein 4 (ANGPTL4) is recognized as a crucial regulator in lipid metabolism. Acetyl-CoA carboxylases (ACACAs) play a role in the β-oxidation of fatty acids. Yet, the functions of ANGPTL4 and ACACA in dyslipidemia of obstructive sleep apnea (OSA) remain unclear.

METHODS

This study included 125 male OSA subjects from the Shanghai Sleep Health Study (SSHS) who were matched for age, body mass index (BMI), and lipid profile. Serum ANGPTL4 levels were measured via ELISA. The ANGPTL4 T266M variants of 4455 subjects along with their anthropometric, fasting biochemical, and standard polysomnographic parameters were collected. Linear regression was used to analyze the associations between quantitative traits and ANGPTL4 T266M. Molecular docking and molecular dynamic simulation were employed to compare the effects of the wild-type ANGPTL4 and its T266M mutation on ACACA.

RESULTS

Serum ANGPTL4 levels significantly decreased with increasing OSA severity (non-OSA: 59.6 ± 17.4 ng/mL, mild OSA: 50.0 ± 17.5 ng/mL, moderate OSA: 46.3 ± 15.5 ng/mL, severe OSA: 19.9 ± 14.3 ng/mL, respectively, p = 6.02 × 10-16). No associations were found between T266M and clinical characteristics. Molecular docking indicated that mutant ANGTPL4 T266M had stronger binding affinity for the ACACA protein, compared with wild-type ANGPTL4. In terms of protein secondary structure, mutant ANGTPL4 T266M demonstrated greater stability than wild-type ANGPTL4.

CONCLUSIONS

Serum ANGTPL4 levels were significantly decreased in OSA patients, particularly among individuals with severe OSA. Although functional ANGTPL4 T266M variants were not associated with lipid levels in OSA, ANGTPL4 T266M could enhance binding affinity for the ACACA protein, potentially regulating lipid metabolism.

Gefapixant as a P2X3 receptor antagonist treatment for obstructive sleep apnea: a randomized controlled trial

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is a highly prevalent disorder with serious health consequences but limited therapeutic options. For a subset of those with OSA, a key underlying mechanism is hypersensitive chemoreflex control of breathing. There is no approved therapy that targets this endotypic trait. Here we determine whether the P2X3 receptor antagonist gefapixant, which is predicted to attenuate hypersensitive carotid chemoreflexes, reduces OSA severity in patients with chemoreflex-dependent OSA.

METHODS

In a randomized placebo-controlled crossover study, 24 patients with moderate-to-severe OSA (aged 39-68 years, non-continuous positive airway pressure users) whose disorder was partially responsive to supplemental oxygen (chemoreflex-dependent OSA) were treated with gefapixant 180 mg (or placebo) administered as tablets taken orally before bedtime for 7 days and assessed via overnight polysomnography. The primary analysis examined whether gefapixant treatment resulted in a greater reduction in the apnea-hypopnea index from baseline than placebo.

RESULTS

Gefapixant did not lower the apnea-hypopnea index significantly more than placebo; the estimated ratio of the apnea-hypopnea index on gefapixant vs placebo was 0.92 (90% confidence interval: 0.73, 1.17). Notably, nocturnal hypoxemia was increased (ratio of total sleep time with saturated peripheral oxygen < 90% on gefapixant vs placebo = 2.08 [90% confidence interval: 1.53, 2.82]), consistent with reduced chemoreflex output. Commonly reported adverse events with gefapixant included ageusia, dysgeusia, oral hypoaesthesia, nausea, somnolence, and taste disorders.

CONCLUSIONS

Gefapixant, while generally well tolerated, did not reduce OSA severity in patients with chemoreflex-dependent OSA. P2X3 receptor antagonism is unlikely to provide an avenue for therapeutic intervention in OSA.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Safety and Tolerability of Gefapixant (MK-7264) in Participants with Obstructive Sleep Apnea (MK-7264-039); URL: https://clinicaltrials.gov/study/NCT03882801; Identifier: NCT03882801.

CITATION

Robbins JA, Sands S, Maganti L, et al. Gefapixant as a P2X3 receptor antagonist treatment for obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2024;20(12):1905-1913.

Altered cervical proprioception and biomechanics in obstructive sleep apnea: a case-control study

PURPOSE

This study aimed to compare cervical proprioception and related biomechanical factors among patients with Obstructive Sleep Apnea (OSA) and asymptomatic controls.

METHODS

In this case-control study, polysomnography scores (apnea-hypopnea index-AHI) were examined to determine the disease severity of the OSA group. Also, we evaluated cervical proprioception by using a laser pointer to detect joint repositioning error sense in cervical rotational movements. Comparison statistics were also conducted for the cervical musculoskeletal variables such as range of motion (ROM) with bubble inclinometer, cranio-cervical (CVA), and thoracic posture (TKA) through photometric analysis, neck flexor muscle endurance test, and pain pressure thresholds of trapezius (PPT).

RESULTS

This case-control study included 59 male participants: patients with OSA (n = 29; mean age = 49.10 years; mean BMI = 28.41 kg/m2) and asymptomatic controls (n = 30; mean age = 49.73 years; mean BMI = 26.89 ± 3.60 kg/m2). The mean AHI score was 26.06 events/hour, categorizing the severity of OSA as mild (31.03%), moderate (31.03%), and severe (37.94%). Patients with OSA demonstrated significantly poorer cervical proprioception compared to controls for both sides of cervical rotation with larger effect sizes (d:1.36-1.45; p < 0.05). Also, cervical ROM, CVA, TKA, neck flexor muscle endurance test, and PPT values were altered in the OSA group compared to the control group (p < 0.05).

CONCLUSION

Impaired cervical proprioception may be a previously unrecognized factor associated with OSA. This finding has implications for understanding the mechanisms underlying cervical musculoskeletal changes in OSA and for developing potential new interventions or exercise designs targeting postural control.

Exploring the role of aging in the relationship between obstructive sleep apnea syndrome and osteoarthritis: Insights from NHANES data

Background

Osteoarthritis (OA) is characterized by high morbidity and disability. While studies have demonstrated that OA is correlated with age-related diseases, few have shown the potential relationship between OA and obstructive sleep apnea syndrome (OSAS). OSAS is characterized by intermittent hypoxia and hypercapnia. We hypothesize that these stressors induce aging and increase the prevalence of OA.

Methods

The study included 10,641 participants drawn from the National Health and Nutrition Examination Survey (NHANES) dataset during 2005-2008 and 2015-2018. The correlation between OSAS and OA was analyzed using multivariable logistic regression, aging-related biomarkers were calculated, and the role of aging was explored through mediation analysis.

Results

OSAS was associated with an elevated risk of OA (for quartile 4 vs. quartile 1, odds ratio (OR) 2.31, 95% confidence interval (CI) 1.34 to 3.99; p-value for the trend = 0.004) after adjusting covariates. In the 20-59 years and > 60 years subgroup, the OSAS patients showed a similar trend (for quartile 4 vs. quartile 1, OR 5.69, 95% CI 2.75 to 11.8; p-value for the trend <0.001; OR 2.42, 95% CI 1.23 to 4.76; p-value for the trend = 0.004, respectively). Further mediation analysis revealed that aging acted as a mediator between OA and OSAS. The mediation proportions for biological age (BA) and phenotypic age (PA) were 13.82 and 52.94%, respectively, both with p < 0.001.

Conclusion

These findings suggest that individuals with OSAS may have an increased prevalence of OA, with aging also being involved in the association.

[Screening for sleep disorders in internal medicine as potential comorbidities of systemic autoimmune diseases and improving patients' quality of life]

Sleep medicine and internal medicine share a global and transdisciplinary vision of human physiology and illnesses, with an approach guided by the complaint and semiology. In France, approximately 13 to 18 million individuals suffer from a sleep disorder: these disorders therefore represent a public health problem. Their comorbidities with systemic autoimmune diseases are frequent. As such, this article suggests an approach to screening for sleep disorders in daily clinical practice of internal medicine leading, when appropriate, to request specialized diagnostic and/or therapeutic care in sleep medicine to substantially improve patients' quality of life.