Obstructive Sleep Apnea in Adults

Craniofacial, Dental, and Upper Airway Morphologic features of Severely Obese Adults with Obstructive Sleep Apnea

INTRODUCTION AND AIMS

Craniofacial and upper airway development are closely associated with obstructive sleep apnea (OSA). This study aimed to analyse craniofacial and upper airway characteristics in adults with severe obesity and OSA to better understand the disease.

METHODS

Ninety-four severely obese patients (BMI ≥ 35) underwent polysomnography (PSG) and lateral cephalograms to assess craniofacial and upper airway morphology. Cephalometric and airway measurements were analysed combined with PSG findings to evaluate craniofacial and airway features in severe OSA patients.

RESULTS

The study included 50 males and 44 females, with a mean age of 33.05 years and an average apnea-hypopnea index (AHI) of 52.22 events/h. Males had significantly higher AHI, neck circumference (NC), waist circumference, and arousal index, along with lower average and minimal oxygen saturation levels compared to females. Cephalometric analysis showed that males had greater mandibular ramus length and Sella-to-condyle vertical distance. Cross-correlation analysis indicated significant associations between AHI and both NC and the mandibular plane to Sella-Nasion line measurement. The Frankfurt horizontal plane to Nasion-Pogonion plane was correlated with BMI, NC, and waist circumference. Hyoid bone position was linked to tongue volume, Y-axis angle, pharyngeal airway space, facial height, and lip length. Tongue volume correlated with mandibular ramus length, upper anterior tooth angle, and upper lip length. Snoring index was associated with pharyngeal airway space and tongue height, while pharyngeal airway space width was related to oxygen saturation levels.

CONCLUSION

Severe obese individuals, particularly males, experience more severe OSA symptoms. A complex interplay exists between OSA, craniofacial morphology, and airway structure.

CLINICAL RELEVANCE

Craniofacial and dental features are consistent in severe obese OSA patients, suggesting that obesity-related fat accumulation has a greater impact on respiratory function than skeletal structure or dental alignment.

The association of the non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) with obstructive sleep apnea among adults aged ≥ 40 years: results from NHANES 2015-2018

BACKGROUND

The ratio of the non-HDL-cholesterol to HDL- cholesterol (NHHR) is a newly proposed lipid metric. Currently, few studies have explored the relationship between NHHR and obstructive sleep apnea (OSA) among middle-aged and elderly people. This study aims to investigate the potential association between NHHR and OSA.

METHODS

This study included participants from the NHANES 2015-2018 cycles, focusing exclusively on individuals aged 40 and above. OSA data were estimated based on questionnaire responses. NHHR was estimated as the ratio of non-HDL-C to HDL-C. Multivariable logistic regression, adjusted for covariates, subgroup analysis, and smoothing spline fittings were utilized to assess the link between NHHR and OSA.

RESULTS

A total of 5,858 participants were analyzed. Multivariable logistic regression highlighted a statistically significant positive relationship between NHHR and OSA [OR 1.06 (95% CI: 1.02, 1.11), p = 0.0053]. As NHHR increased by tertiles, the risk of OSA also showed an upward trend. Subgroup and interaction analyses confirmed the overall association was robust across most confounding factors except for gender and diabetes status. Further nonlinear analyses identified a significant inverted U-shaped curve (p-nonlinearity < 0.05) with peak risk at an NHHR of 5.3. This pattern was particularly evident in males (turning point = 3.97) and diabetics (turning point = 5.61).

CONCLUSION

From 2015 to 2018, among the NHANES population aged over 40, NHHR showed a significant and independent positive association with OSA risk. The consistency of this relationship across various subgroups suggests NHHR's potential as a complementary biomarker for metabolic risk assessment in OSA.

Apnea detection using wrist actigraphy in patients with heterogeneous sleep disorders

Obstructive sleep apnea (OSA) and related hypoxia are well-established cardiovascular and neurocognitive risk factors. Current multi-sensor diagnostic approaches are intrusive and prone to misdiagnosis when simplified. This study introduces an enhanced single-sensor-based OSA screening method, leveraging novel signal processing and machine learning to ensure accurate detection across diverse populations. Wrist actigraphy is a widely-used and energy-efficient tool for respiratory rate estimation. The main challenge in OSA pattern recognition is handling various disturbances in real-world applications. We developed a novel approach combining apex-centric tokenization with a Multi-Head Causal Attention (MHCA) mechanism. Apex-centric tokenization enhances sensitivity to OSA events, while MHCA refines predictions and increases specificity in detecting oxygen desaturation. Our study involved 58 participants, with overnight bilateral wrist actigraphy and concurrent polysomnography used as a reference for thorough analysis. By focusing on the physiological causal relationship of the events, the algorithm excelled in detecting moderate to severe oxygen desaturation, achieving a sensitivity of 85.7% and a specificity of 98.1%, even in the presence of disturbances such as restless leg movements and snoring. The estimated oxygen desaturation index correlated strongly with clinical standards (r = 0.89), and the correlation with the apnea-hypopnea index was 0.87. Both apex-centric tokenization and MHCA were crucial for this performance. Our approach shows potential for analyzing apnea patterns and related oxygen desaturation in a broader population using only wrist actigraphy, reducing measurement burdens and improving understanding of complex sleep disorders.

Association Between Obstructive Sleep Apnea and Regional Fat: A Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2015-2018

Purpose: The relationship between regional fat and obstructive sleep apnea (OSA) remains poorly understood. This study seeks to explore the link between regional fat and OSA, utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional analysis used NHANES 2015-2018 data. OSA symptoms were assessed through sleep questionnaires. Regional fat mass (FM) was measured using dual-energy X-ray absorptiometry, including trunk, arm, leg, android, gynoid, and abdominal FM. The fat mass index (FMI) was calculated by dividing FM by the square of height. Logistic regression evaluated the association between regional FMI and OSA, with univariate and stratified analyses to identify potential effect modifiers. Results: A total of 3,099 participants were included, with 1,595 classified into the OSA group. Significant associations were found between OSA and several regional FMIs, including trunk, arm, leg, android, gynoid, and abdomen. These associations were consistent in males, and in females, leg and gynoid FMI were not linked to OSA. Stratified analyses by race revealed significant associations between OSA and regional FMI indices (trunk, arm, leg, android, gynoid, and abdominal FMI) in non-Hispanic Whites and between OSA and trunk, android, and abdominal FMI in other Hispanics. No associations were observed in the Mexican American or non-Hispanic Black groups. Stratification by body mass index (BMI) indicated distinct profiles: obese individuals (BMI ≥30) showed associations limited to trunk, arm, android, and abdominal FMIs, while nonobese participants (BMI <30) displayed broader associations encompassing all regional FMIs. Both univariate and stratified analyses highlighted abdominal FMI as the strongest predictor of OSA. Conclusion: Higher regional FMI, particularly abdominal fat, is associated with an increased risk of OSA, with stronger associations observed in male, White, and nonobese populations.

Advanced Oxidation Protein Products in Obstructive Sleep Apnea Hypopnea Syndrome-A Systematic Review and Meta-Analysis

BACKGROUND

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a prevalent sleep-breathing disorder affecting both adults and children. Although previous studies have suggested a potential association between OSAHS and oxidative stress biomarkers, particularly advanced oxidation protein products (AOPP), their conclusive relationship remains unclear. This systematic review and meta-analysis aims to quantitatively synthesise existing evidence on the association between AOPP levels and OSAHS.

METHODS

We comprehensively searched PubMed, Wiley Online Library, Cochrane Library, CBM, and CNKI databases up to October 2023. Two independent researchers screened studies investigating AOPP-OSAHS correlations, followed by data extraction and quality assessment. Statistical analyses were performed using Stata, with standardised mean differences (SMDs) calculated for pooled estimates.

RESULTS

Nine studies comprising 608 patients and 770 controls were included. The meta-analysis demonstrated significantly elevated AOPP concentrations in OSAHS patients compared to controls (SMD = 1.66 , 95% CI = 1.02-2.29; I2 = 96%, p < 0.001). Meta-regression identified significant associations between effect sizes and publication year (β = 0.32, p = 0.016) as well as BMI (β = 0.25, p = 0.028), independent of geographic region, sample type, or analytical methods. Secondary analyses of oxidative stress markers revealed consistent elevations in SOD and MDA levels among OSAHS patients, whereas GSH showed no significant difference.

CONCLUSION

The meta-analysis confirmed a substantial increase in AOPP concentration in OSAHS patients compared to the control group, suggesting that the protein oxidation marker AOPP plays a role in the development of OSAHS and offering valuable insights for future clinical research.

Association between visceral adiposity index and sleep disorders among the U.S. adults: a cross-sectional study

Background

The visceral adiposity index (VAI) reliably measures body fat distribution and related dysfunctions. However, its association with sleep disorders among US adults remains unclear.

Methods

This study analyzed cross-sectional data from the 2005 to 2018 National Health and Nutrition Examination Survey (NHANES) for adults aged 18 and older. We used multivariable logistic regression to evaluate the association between VAI and sleep disorders and applied restricted cubic splines to assess potential non-linear relationships. Additionally, subgroup analyses by gender, age, and race were conducted to explore the VAI-sleep disorder association across different populations.

Results

This study included 14,021 adults aged 18 +. In Model 1, adjusted for gender and age, each unit increase in VAI was associated with a 5% higher risk of sleep disorders (OR = 1.05; 95% CI = 1.02-1.07). In Model 2, which adjusted for all potential confounders, each unit increase in VAI was linked to a 3% higher risk (OR = 1.03; 95% CI = 1.00-1.05). When treating VAI as a categorical variable, those in the highest quartile (Q4) had a 21% higher risk of sleep disorders compared to those in the lowest quartile (Q1) (OR = 1.21; 95% CI 1.03-1.41). Restricted cubic spline analysis revealed a positive linear relationship between VAI and sleep disorder prevalence. Subgroup analysis found stronger associations in males and non-Hispanic white individuals.

Conclusion

While causality cannot be confirmed, this cross-sectional study shows a significant positive linear association between higher VAI and the risk of sleep disorders among U.S. adults.

Osteoarthritis and the risk of sleep apnea: a general population-based cohort study

OBJECTIVE

Osteoarthritis (OA) is the most common joint disease, leading to pain and inflammation, two risk factors for sleep apnea (SA). We aimed to examine whether OA may increase the risk of incident SA, a common source of mortality and sudden death.

METHOD

Using data from the IQVIA Medical Research Database, we conducted three cohort studies (i.e., knee, hip, and hand cohort) among individuals aged 50 years or older. For each patient with incident OA, up to five non-OA individuals were matched by age, sex, entry-time, and BMI. We calculated the incidence rate of SA for the OA and non-OA cohorts, respectively, and examined the relation of OA to the risk of incident SA using a Cox proportional hazard model adjusting for potential confounders.

RESULTS

During the follow-up, 869 SA cases occurred in 58,674 patients with knee OA and 2,186 in 235,850 non-OA individuals (2.29 vs. 1.41/1000 person-years). Compared with the non-OA cohort, the multivariable-adjusted hazard ratio (HR) of SA in the knee OA cohort was 1.45 (95% confidence interval [CI]: 1.34-1.56). A higher risk of SA was also observed among patients with incident hip OA (adjusted HR: 1.45, 95%CI: 1.28-1.66) and hand OA (adjusted HR: 1.50, 95%CI: 1.26-1.78) than the matched non-OA individuals.

CONCLUSIONS

This general population-based study provides the first evidence that patients with knee, hip, and hand OA may have an increased risk of incident SA. Strategies aimed at screening, prevention, and treatment of SA could be developed to reduce the disease burden in OA patients.

The AutoStrain LV technique is a sensitive method for detecting subclinical left ventricular dysfunction in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is strongly associated with multiple cardiovascular diseases, however, early detection of subclinical myocardial damage is a challenge. We aimed to compare the sensitivity of AutoStrain LV technology versus conventional echocardiography for assessing left ventricular (LV) impairment in patients with subclinical OSAS and to identify sensitive echocardiographic indicators of LV injury. Classifying 126 qualified participants based on their apnea-hypopnea index (AHI), we formed control, mild, moderate, and severe OSAS categories. LV global longitudinal strain (LVGLS) was evaluated by AutoStrain LV technique. Conventional two-dimensional echocardiography was used to measure different factors including LV end-diastolic diameter, LV end-systolic diameter, interventricular septum diameter, LV posterior wall diameter, and LV functional shortening. LV ejection fraction was calculated by modified biplane Simpson method, and the Doppler ultrasound was used to measure the LV diastolic function indices E/A and E/E'. We calculated the correlations between these ultrasound parameters and the AHI. Although LV ejection fraction and LV functional shortening are normal, the LVGLS in the OSAS group decreased with the severity of the disease (P < .001). The values of E/A in the mild, moderate, and severe OSAS groups, as well as the values of E/E' in the mild and severe OSAS groups, showed significant differences compared to the control group, but no significant differences were found between different OSAS subgroups. The IVST and LVPWT values in the moderate and severe OSAS groups were higher than those in the control group and mild OSAS group, but there were no significant differences between the other groups. Conventional echocardiographic parameters did not change with the severity of the disease. Correlation analysis showed that LVGLS had the strongest correlation with AHI (r = -0.732, P < .001). Compared with conventional echocardiography, AutoStrain LV technology has a higher sensitivity for monitoring LV function impairment in patients with subclinical OSAS.

Echoes in the night: How sleep quality influences auditory health

The intricate relationship between sleep disorders and hearing loss emerges as a burgeoning field of scholarly inquiry. Numerous studies have illuminated a potential correlation between the two, affecting the quality of life and overall health of individuals. Hearing loss, or auditory impairment, serves as a critical indicator of physiological dysfunction, casting a pall over the daily existence and professional endeavors of those affected, potentially leading to irreversible deafness if left untreated. Sleep disorders may cause physical and psychological changes that further affect hearing, while auditory dysfunction may detrimentally impact sleep experienced by individuals. Although certain studies have failed to find a direct link between sleep duration and hearing loss, it is evident that sleep-related issues do increase the risk of hearing loss. Thus, understanding the relationship between sleep disorders and hearing loss, alongside the underlying mechanisms, will help establish interventions aimed at enhancing sleep quality and safeguarding auditory health. This systematic review endeavors to elucidate the correlation between sleep disorders and hearing loss, offering valuable insights and guidance for future basic research and clinical applications.

Knowledge, attitudes, and practices of physicians regarding multidisciplinary treatment of obstructive sleep apnea: a cross-sectional study

To investigate physicians' knowledge, attitudes, and practices (KAP) regarding the multidisciplinary treatment of Obstructive Sleep Apnea (OSA). A multicenter cross-sectional study was conducted in May 2024, enrolling physicians from southwestern China. The study collected demographic data and assessed KAP through self-administered questionnaires, with the respiratory and otolaryngology departments defined as relevant departments. A total of 329 valid questionnaires were collected. Of these respondents, 173 (52.6%) were female, and 114 (34.7%) had participated in multidisciplinary OSA-related training. The mean scores for knowledge and attitudes were 24.61 ± 8.27 (possible range: 0-34) and 39.99 ± 4.34 (possible range: 10-50), respectively. Practice scores of the physicians in departments directly and indirectly involved in OSA treatment averaged 24.28 ± 4.70 and 21.28 ± 4.24 (possible range: 6-30), respectively. Structural equation modeling results indicated that in departments directly related to OSA, knowledge had a significant positive effect on both attitudes (β = 5.53, P < 0.001) and practices (β = 5.8, P < 0.001). For departments indirectly related to OSA, knowledge had a significant positive effect on attitudes (β = 5.41, P < 0.001). Physicians showed adequate knowledge and attitudes toward OSA treatment; targeted education is recommended to enhance consistency in practices across departments.

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.

Prediction of non-responders to oral appliance treatment of obstructive sleep apnea: a pilot study

PURPOSE

Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.

METHODS

Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.

RESULTS

Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.

CONCLUSION

These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.

TRIAL REGISTRATION NUMBER

NCT05987618 (clinicaltrials.gov).

Serum sphingomyelin levels define oxyhemoglobin desaturation-related metabolic threshold in symptomatic obstructive sleep apnea

Hypoxia is a contributing factor for the morbidity and mortality in patients with obstructive sleep apnea (OSA). We aimed at identifying the percentage of sleep time with oxyhemoglobin desaturation below 90% (Tc90%) breakpoint from which the most significant changes occur in systemic metabolome of patients with OSA. In a prospective observational study on patients with polysomnography-confirmed symptomatic OSA, profiles of 186 metabolites including amino acids, biogenic amines, acylcarnitines (AC), lysophosphatidylcholines, phosphatidylcholines (PC) and sphingomyelins (SM) were analyzed with liquid chromatography-mass-spectrometry in peripheral blood, obtained at 3 time points that covered patients' night sleep. Comparisons of rank-transformed data with general linear model for repeated measures after dichotomizing the study group at different Tc90% levels were applied to define the best cut-off, hypoxic metabolic threshold (HMT), based on Cohen's f. Fifty-one subjects were recruited with their median Tc90% of 2.1. The mean Cohen's f over the metabolites was highest (0.165) at a Tc90% of 1.8 representing the HMT. Of the different classes of metabolites, the Cohen's f value at HMT was highest for SM (0.322). Compared to patients with Tc90% < HMT, concentrations of 2 PC, 1 AC and 7 SM were significantly higher in patients with Tc90% ≥HMT. The HMT for patients with OSA described in this report for the first time is located at a Tc90% level of 1.8 with SM levels contributing most to the size of this threshold.

Potential bidirectional communication between the liver and the central circadian clock in MASLD

Most aspects of physiology and behaviour fluctuate every 24 h in mammals. These circadian rhythms are orchestrated by an autonomous central clock located in the suprachiasmatic nuclei that coordinates the timing of cellular clocks in tissues throughout the body. The critical role of this circadian system is emphasized by increasing evidence associating disruption of circadian rhythms with diverse pathologies. Accordingly, mounting evidence suggests a bidirectional relationship where disruption of rhythms by circadian misalignment may contribute to liver diseases while liver diseases alter the central clock and circadian rhythms in other tissues. Therefore, liver pathophysiology may broadly impact the circadian system and may provide a mechanistic framework for understanding and targeting metabolic diseases and adjust metabolic setpoints.

The contributions of resting-state functional-MRI studies to our understanding of male patients with obstructive sleep apnea: a systematic review

Objectives

Obstructive sleep apnea (OSA) is a condition marked by the recurrent partial or complete obstruction of the upper airway during sleep. This leads to intermittent pauses in breathing, fragmented sleep, and frequent awakenings throughout the night. Many of these symptoms are believed to be linked to brain damage; however, the fundamental neurological processes underlying these impairments remain largely unknown. This study investigates resting-state functional MRI (rs-fMRI) findings in male patients with OSA to better understand the specific mechanisms associated with this condition in this demographic.

Methods

The search was conducted in the PubMed and Google Scholar databases, encompassing literature from their inception to July 2024. Studies were identified based on predetermined inclusion and exclusion criteria and were evaluated by two independent reviewers.

Results

A total of 16 eligible original rs-fMRI studies on male patients with OSA were included in this review. The findings indicate that patients with OSA exhibit alterations in resting-state brain activity. These neural changes may help explain the effects of OSA on emotion, cognition, and quality of life. Additionally, these findings could be used in the future to evaluate treatment outcomes.

Conclusion

This study highlights significant changes in local brain activities, interested region related functional connectivity, and whole-brain functional connectivity networks in patients with OSA. These findings offer valuable insights into the neural alterations at the core of OSA and may serve as potential biomarkers for diagnosis and intervention.

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

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

Altered brain dynamic functional connectivity in patients with obstructive sleep apnea and its association with cognitive performance

OBJECTIVES

Obstructive sleep apnea (OSA) is associated with potential disruptions in brain function and structure. The aim was to investigate alterations in dynamic functional connectivity (dFC) in OSA patients utilizing resting-state functional magnetic resonance imaging (rs-fMRI) and multiplication of temporal derivatives (MTD) to better understand the neurological implications of OSA.

METHODS

This cross-sectional study eventually recruited 111 patients, aged 25-65 years. We categorized participants based on the apnea-hypopnea index (AHI) assessed via polysomnography (PSG), 43 patients were groupAHI <15 and 68 patients were group AHI ≥15. Rs-fMRI and neuropsychological assessments were conducted to assess the brain function and visual-spatial memory, respectively. We evaluated the intergroup differences in dFC as well as its correlation with clinical parameters.

RESULTS

The dFC analysis identified five distinct connectivity states, comprising four hyperconnected states (State 1, 2, 3, and 5) and one hypoconnected state (State 4). Group AHI≥ 15 showed altered fraction time (FT) and mean dwell time (MDT) in States 1, 3, and 4. The partial correlation showed that the FT/MDT of State 1 negatively correlated with hypoxia parameters, while the FT/MDT of State 3 positively correlated with total sleep time in Group AHI≥ 15. Group AHI≥ 15 exhibited a negative association between FT of state 3 and Visuospatial/Executive score in MoCA (r = -0.297, p = 0.033).

CONCLUSIONS

Untreated male moderate to severe OSA patients exhibited altered in dFC, which significantly correlated with hypoxia parameters and cognitive performance, high lighting that dFC changes may be an indicator of the neurological consequence of OSA, especially moderate to severe OSA.

Impact of weight loss and lifestyle intervention on vitamin D in men with obstructive sleep apnea: The INTERAPNEA trial

INTRODUCTION

Vitamin D deficiency is commonly found among patients with obstructive sleep apnea (OSA). We aimed to determine the effect of an eight-week interdisciplinary weight loss and lifestyle intervention on circulating vitamin D levels in patients with moderate-to-severe OSA.

METHODS

89 men were assigned to a usual-care group (n = 49) or an 8-week interdisciplinary weight loss and lifestyle intervention combined with usual-care (n = 40). Evaluations were conducted at baseline, intervention endpoint (i.e., 8 weeks), and 6 months post-intervention. Serum 25-hydroxyvitamin D (25(OH)D) was determined using a chemiluminescence immunoassay. Sleep (i.e., sleep efficiency, apnea-hypopnea index [AHI], and oxygen desaturation index) and body weight and composition (i.e., fat mass, and visceral adipose tissue) variables were also determined.

RESULTS

Serum 25(OH)D concentrations showed an insufficient vitamin D status at baseline, which significantly increased (all p ≤ 0.034) at intervention endpoint (19 %) and at 6 months after intervention (45 %) in the intervention group to the point of potentially resolving vitamin D deficiency. Higher serum 25(OH)D concentrations were related to increased sleep efficiency and reduced AHI, oxygen desaturation index, and body weight and composition variables (all p < 0.001) from baseline to 6 months and from 8 weeks to 6 months after intervention. These results were also noted from baseline to 8 weeks, except for body composition (all p ≤ 0.007).

CONCLUSION

The intervention improved and potentially resolved vitamin D deficiency. Together with the improvement of adverse sleep patterns and body composition parameters, it may be considered as a promising approach in the treatment of OSA.

CLINICAL TRIAL REGISTRATION

(ClinicalTrials.gov NCT03851653).

The Effect of Tongue Volume and Adipose Content on Obstructive Sleep Apnea: Meta-analysis & Systematic Review

Objective

Macroglossia is a risk factor for obstructive sleep apnea (OSA) and has been linked to an elevated apnea-hypopnea index (AHI). Obesity may contribute to macroglossia, but its exact relationship is unknown and likely multifactorial, and the degree to which increased adiposity of the tongue affects the development of OSA is not understood. The primary objective of this study was to evaluate how tongue fat and volume relate to the presence and severity of OSA.

Data Sources

Studies reporting the impact of tongue fat or volume were identified using predefined inclusion criteria from September 2002 to 2022.

Review Methods

All studies underwent a 2-stage blinded screening, extraction, and evaluation process. Primary outcomes were the effect of tongue fat and volume on OSA severity and evaluation of study quality. Secondary outcomes included the impact of obesity on tongue fat distribution and OSA severity.

Results

Out of 930 studies, 6 studies with 219 patients and 133 controls were included in meta-analysis. All 6 studies were case-control designs. Included studies showed low (4) and moderate (2) risks of bias. All studies compared tongue volume with an observed significant increase in tongue volume in OSA patients (P < .00001) with a weighted mean difference of 19.00 cm3 [15.53, 22.47]. Two studies compared tongue fat, and there was a significant increase in tongue fat in patients with OSA (P < .00001) with a weighted mean difference of 8.04 cm3 [4.25, 11.82].

Conclusion

This meta-analysis supports increased tongue volume and tongue adipose as important risk factors associated with OSA. Larger studies investigating tongue fat distribution and the effect of weight changes on tongue fat and volume and OSA severity are needed to characterize this relationship better.

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

Background

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

Methods

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

Results

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

Conclusion

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

Serum matrix metalloproteinase-9 as a potential biomarker for obstructive sleep apnea severity

PURPOSE

We aimed to investigate the associations between serum matrix metalloproteinase (MMP)-2 and MMP-9 levels and obstructive sleep apnea (OSA) severity with a focus on nocturnal hypoxemia.

METHODS

The OSA patients (n = 105) were recruited from a prospective sleep apnea cohort after polysomnography, with 27 healthy volunteers as the controls. OSA severity was assessed via the apnea-hypopnea index (AHI) and percent night time with SpO2 < 90% (T90).

RESULTS

The serum MMP-9 levels were significantly higher in the OSA patients (AHI ≥ 5/h, 68.8 ± 44.9 ng/mL) than the controls (49.0 ± 18.6 ng/mL, p < 0.001). The MMP-2 levels showed no significant differences. When grouped into T90 quartiles, the MMP-9 levels were higher in the OSA patients in the highest quartile compared to those in the lowest quartile or the controls (90.6 ± 56.3 ng/mL vs. 56.9 ± 31.9 ng/mL, p = 0.022; 90.6 ± 56.3 ng/mL vs. 49.0 ± 18.6 ng/mL, p = 0.002, respectively). The MMP-9 levels correlated with T90 and the AHI (r = 0.36, p < 0.001; r = 0.35, p < 0.001, respectively). Multiple linear regression confirmed a significant association between MMP-9 and T90 after adjusting for body mass index, smoking status, and comorbidities (β = 0.53, p = 0.013). A similar association was observed for the AHI (β = 0.48, p = 0.019).

CONCLUSION

We concluded that serum MMP-9 levels are independently associated with OSA severity, particularly with T90 and the AHI, which suggests that MMP-9 could be a biomarker for OSA severity.

Do positional and non-positional obstructive sleep apnoea differ clinically? A further comparison of supine-isolated and supine-predominant subgroups

INTRODUCTION

Obstructive Sleep Apnoea (OSA) is a heterogeneous disorder characterized by recurrent upper airway obstructions during sleep. Positional OSA (POSA) and non-positional OSA are major subgroups that differ in clinical, polysomnographic, and treatment aspects. Furthermore, POSA can be classified into supine-isolated POSA (siPOSA) and supine-predominant POSA (spPOSA), which exhibit distinct characteristics. This study compares POSA and non-POSA patients, as well as siPOSA and spPOSA subgroups, focusing on their clinical, demographic, and polysomnographic differences.

MATERIALS AND METHODS

This retrospective observational study included patients who underwent polysomnography (PSG) in a tertiary care hospital between 2007 and 2021 due to suspected sleep-breathing disorders. Patients were classified into POSA and non-POSA groups, with POSA further divided into siPOSA and spPOSA subgroups. POSA was defined as an AHI at least twice as high in the supine position compared to other positions. siPOSA included patients with a non-supine AHI < 5 events/h, whereas spPOSA included those with a non-supine AHI > 5 events/h. Demographic, anthropometric, and PSG parameters were compared.

RESULTS

Among 2390 OSA patients, 884 were siPOSA, 519 spPOSA, and 987 non-POSA. POSA patients were younger (50.7 vs. 52.9 years, p < 0.001), had lower BMI (30.6 vs. 34.8 kg/m², p < 0.001), and milder OSA severity compared to non-POSA. spPOSA patients showed higher AHI and more severe OSA than siPOSA (p < 0.001).

CONCLUSION

POSA represents a milder subgroup compared to non-POSA, and siPOSA is milder than spPOSA. Identifying these subgroups enables tailored, patient-specific treatment approaches, enhancing therapeutic outcomes.

Insomnia in ambulatory care: A clinical review

PURPOSE

One-third to one-half of ambulatory care patients report insomnia. The objective of this clinical review is to detail the many causes and evidence-based treatment options for insomnia in outpatients and to recommend screening and summarize evidence for the place in therapy of prescription and nonprescription treatments.

SUMMARY

This work provides an overview of the literature on insomnia regarding causes, patient assessment, and nonpharmacological and pharmacological treatments. Patients who present with insomnia should be assessed for sleep apnea, restless legs syndrome, narcolepsy, and all contributing medications as well as medical, psychiatric, and substance use disorder diagnoses. The type of insomnia, namely difficulty falling asleep, difficulty maintaining sleep, and early morning awakening with resulting functional impairment, should be documented in addition to whether insomnia is short term or persistent. Cognitive behavioral therapy for insomnia (CBT-I) or digital CBT-I is first-line treatment for all patients with insomnia irrespective of the cause or type. Nonprescription treatments such as antihistamines or melatonin are for select populations. Prescription hypnotics are best utilized on an as-needed basis or for nightly use for less than 6 weeks. Z-hypnotics are safe and effective for insomnia in persons with depression or an anxiety disorder but should be avoided in older individuals or if there is respiratory or cognitive impairment. Orexin receptor antagonists are effective for sleep initiation and maintenance in healthy persons or if there is mild cognitive impairment, but they require further study in individuals with psychiatric and medical diagnoses. Trazodone is the most prescribed off-label treatment due to its efficacy for sleep initiation and maintenance and its lack of abuse potential.

CONCLUSION

Insomnia treatment should be guided by patient age, diagnoses, and type of insomnia. Pharmacological treatments should be used at the lowest effective dose for the shortest duration of time.

Right Atrial Function and Right Ventricular Diastolic Function and Their Relation With Exercise Capacity in OSAS

BACKGROUND

Right ventricular (RV) diastolic function and right atrial (RA) function are poorly characterized in patients with obstructive sleep apnea syndrome (OSAS), but may influence exercise capacity. We aimed to evaluate RA function and RV diastolic function in OSAS and study their relationship with exercise capacity.

METHODS

Fifty-three patients with OSAS and thirty age- and gender-matched controls prospectively underwent echocardiography and cardiopulmonary exercise testing to investigate RV diastolic function, RA function, and exercise capacity.

RESULTS

Altered RV diastolic function in patients with severe OSAS was indicated by the increased tricuspid valve E/e' ratio (TV E/e'), isovolumic relaxation time (IVRT), and by the reduced RV TDI e' velocity. The TV E/e' correlated modestly with peak VO2 (r = -0.334, p < 0.01). Patients with severe OSAS exhibited impaired RA total emptying fraction, RA passive emptying fraction, and RA reservoir strain (RARS), with RARS being associated with peak oxygen uptake (VO2) (r = 0.451, p < 0.01 for reservoir function).

CONCLUSION

Altered RA function and RV diastolic function in patients with OSAS are associated with impaired exercise capacity. The correlation of RA function and RV diastolic function with exercise capacity suggests that it may be important to evaluate RA function and RV diastolic function in this population.

The pleiotropic effects of glucagon-like peptide-1 receptor agonists in patients with metabolic dysfunction-associated steatohepatitis: a review for gastroenterologists

INTRODUCTION

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dual GLP-1/glucose-dependent insulinotropic peptide (GIP) or glucagon receptor agonists have emerged as promising agents to treat metabolic dysfunction-associated steatotic liver disease (MASLD)/metabolic dysfunction-associated steatohepatitis (MASH). Although the beneficial effects of GLP-1RAs on glycemic control and weight are well-established, clinicians may be unfamiliar with other potential benefits of this class.

AREAS COVERED

We examined the pleiotropic effects of GLP-1RAs and how they relate to gastroenterologists for MASLD/MASH treatment. Our narrative review of English articles included four GLP-1RAs (subcutaneous semaglutide, liraglutide, dulaglutide, and efpeglenatide), a dual GLP-1/GIP agonist (tirzepatide), a dual GLP-1/glucagon receptor agonist (survodutide), MASLD/MASH, related disorders, clinical management, treatment outcomes and landscape.

EXPERT OPINION

In Phase I - III trials, GLP-1RAs are associated with clinically relevant hepatic improvements including MASH resolution, liver fat reduction, and preventing worsening fibrosis. Effects on cardiometabolic parameters align with type 2 diabetes/obesity Phase III data, comprising substantial improvements in glycemic, weight, and cardiovascular outcomes. Promising data also suggest benefits in common comorbidities, including obstructive sleep apnea, polycystic ovary syndrome, chronic kidney disease, and heart failure with preserved ejection fraction.GLP-1RAs represent a valuable pharmacotherapeutic option for gastroenterologists managing individuals with MASLD/MASH and cardiometabolic comorbid conditions.

Inhibition of NSUN6 protects against intermittent hypoxia-induced oxidative stress and inflammatory response in adipose tissue through suppressing macrophage ferroptosis and M1 polarization

AIMS

Accumulating studies have demonstrated obstructive sleep apnea (OSA) is strongly associated with metabolic syndrome (MetS) and inflammatory response in adipose tissue. Chronic intermittent hypoxia (CIH) has been proved leading to M1 macrophage polarization that contributes to adipose tissue inflammation, but the molecular mechanism remains unclear. Epigenetic regulation of RNA has been found playing crucial roles in incremental diseases.

MAIN METHODS

Based on mining the GEO database, we constructed an IH (8 weeks) C57/6 J mice model to investigate the changes and interactions of key gene expression, M1 macrophage infiltration, and inflammatory markers in white adipose tissue. We also used an IH-treated (24 h) RAW 264.7 cells to further explore the mechanisms of hypoxia-induced M1 polarization, oxidative stress, and inflammatory response.

KEY FINDINGS

According to the analysis of datasets, CIH increases the level of NSUN6 in adipose tissue and NSUN6 shows good diagnostic value of OSA. In the mice model, CIH exposure is also demonstrated to increases NSUN6 level and M1 macrophage infiltration in adipose tissue, which can be reversed by ferroptosis inhibitor. Studies show that CIH leads to ferroptosis and M1 macrophage polarization by promoting the expression of NSUN6 in vitro, thus resulting in inflammatory response.

SIGNIFICANCE

Our findings provide a better understanding of the mechanisms of CIH-induced inflammation in adipose tissue. NSUN6 is firstly suggested to participate in macrophages ferroptosis and M1 polarization. Inhibition of NSUN6 in macrophages could protects against CIH-induce oxidative stress and inflammatory response in adipose tissue, thus becoming a potential therapeutic target to OSA-associated MetS.

Effects of continuous positive airway pressure on renal function in adults with obstructive sleep apnea: a systematic review and meta-analysis

PURPOSE

Obstructive sleep apnea (OSA) is associated with increased risk of chronic kidney disease (CKD). OSA is highly prevalent among patients with CKD, suggesting a bidirectional link between the two conditions. Recent studies reported that continuous positive airway pressure (CPAP) may benefit renal function in OSA patients; however, uncertainties regarding their effects persist. Therefore, we examined the effects of CPAP treatment on renal function in adults with OSA.

METHODS

We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from their inception until January 2024. Pooled estimates for all outcomes were calculated using a random-effects model. Primary outcome measures were the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR).

RESULTS

Four randomized controlled trials (RCTs) and seven non-RCTs (NRCTs) (n = 2,660) were included. Compared with the control group, the CPAP group exhibited a significantly minimal alleviation in eGFR decline in NRCT (mean difference [MD] = 1.95, 95% confidence interval [CI] = 0.80 to 3.11, p < 0.001), but not in RCT (MD = 1.42, 95% CI = - 0.99 to 3.82, p = 0.25). No significant associations were found between CPAP therapy and UACR (MD = - 0.05, 95% CI = - 0.41 to 0.30, p = 0.77).

CONCLUSION

Current research provides a low to moderate certainty of evidence, suggesting that CPAP therapy has little to no effect on alleviating the decline in renal function. However, further RCTs with larger sample sizes and extended follow-up periods are required.

Nicotinamide Phosphoribosyltransferase Acetylation Mediating Muscle Dysfunction Contributes to Sleep Apnoea in Obesity

BACKGROUND

Obstructive sleep apnoea (OSA) occurs frequently among individuals with obesity, which is attributed to upper airway muscle dysfunction. Muscle function is regulated by the dynamic balance of the nicotinamide adenine dinucleotide (NAD+) and its reduced form (NADH), which is controlled by the enzyme nicotinamide phosphoribosyltransferase (NAMPT). Elevated NAMPT levels have been found in individuals with obesity. However, the role of NAMPT in obesity-induced muscle impairment has not been fully clarified.

METHODS

A total of 110 participants (70 moderate-to-severe OSA vs. 40 mild or no OSA) underwent electrical impedance mammography and polysomnography. C57BL/6J mice with high-fat diet-induced obesity (DIO) and control group were utilized for their characterizations, which included forced running wheel tests, glucose tolerance tests, haematoxylin and eosin staining, immunostaining, magnetic resonance imaging, whole-body plethysmography, electromyographic techniques, western blot, NAMPT enzymatic activity assays and NAD+/NADH ratio measurements.

RESULTS

Patients with moderate-severe OSA have a significant decrease in lean mass percentage of upper airway muscles compared with those in controls (p < 0.01). In vivo, a high-fat diet reduced the levels of NAD-dependent deacetylase sirtuin-1 (SIRT1) (p < 0.01), which plays a crucial role in the deacetylation of NAMPT. The reduction in SIRT1-mediated NAMPT deacetylation (p < 0.001) resulted in decreased NAMPT activity (p < 0.01), leading to a decrease in NAD+/NADH ratio (p < 0.05) and decreased the myosin heavy chain isoform (MyHC) I level (p < 0.05), thereby affecting the effectiveness of upper airway muscle and ultimately leading to upper airway collapse (101.0 vs. 81.7 pixels, p = 0.02). The introduction of estradiol mitigated high-fat diet-induced muscle dysfunction by enhancing expression of SIRT1 and inhibiting the acetylation of NAMPT, reducing upper airway collapse (81.7 vs. 96.7 pixels, p = 0.06).

CONCLUSIONS

These findings highlight the crucial role of SIRT1-mediated NAMPT deacetylation on obesity-induced muscle dysfunction, suggesting targeting NAMPT has the potential to reverse the obesity induced muscle dysfunction and provide effective treatment options for OSA.

Managing sleep issues in Parkinson's disease: an up-to-date review

INTRODUCTION

In Parkinson's disease (PD), sleep-wake problems are disease-related symptoms that occur throughout the day and have a negative impact on patients' quality of life to an extent that is equal to or greater than that of typical motor symptoms.

AREAS COVERED

Insomnia due to fragmented sleep and excessive daytime sleepiness (EDS) worsen as PD progresses. Nighttime wearing-off and early morning-off should be considered first when fragmented sleep is reported in PD patients. If the main complaint of patients with insomnia is difficulty falling asleep, restless legs syndrome should be differentiated first. Obstructive sleep apnea causes sleep quality deterioration and fragmented sleep. For rapid eye movement sleep behavior disorder (RBD), preventative measures against sleep-related trauma are necessary. RBD has also attracted attention as a PD precursor state and as a disease progression marker that is associated with specific PD clinical subtypes. In PD patients, the sleep-wake phase may advance/delay or become irregular due to circadian dysfunction.

EXPERT OPINION

Importantly, sleep-wake problems are core symptoms related to the pathogenesis and progression of PD, and addressing a wide range of these symptoms will improve patients' quality of life.

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

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

Incidence and risk factors of nocturnal penetrations and aspirations in patients with obstructive sleep apnea during drug-induced sedation endoscopy

Obstructive sleep apnea has been linked to an increased risk of pneumonia, possibly due to higher rates of nighttime aspirations. Few studies have directly investigated such aspirations in individuals with sleep apnea. This retrospective study included 142 adult patients with obstructive sleep apnea who underwent drug-induced sedation endoscopy between 2017 and 2020. The incidence of penetrations and aspirations during the procedure was assessed, along with potential associated factors. The results showed that 28.1% of the patients experienced penetrations, 48.5% had aspirations, and 23.2% had neither. Male gender and epiglottic collapse were significantly associated with both penetrations and aspirations, while oropharyngeal collapse was more common in those without these events. This study highlights a high rate of aspirations during the procedure in individuals with sleep apnea, with epiglottic collapse and male gender identified as potential risk factors. These findings underscore the need for further research to understand the mechanisms of nighttime aspirations in sleep apnea and to develop targeted strategies to reduce pneumonia risk in this population.

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis

STUDY OBJECTIVES

Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire.

METHODS

The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semiannual basis to survey participants with MG. Patients aged ≥ 18 years, living in the United States, and answering "yes" to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG-quality of life-15 revised, MG-activities of daily living instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS. Multivariable logistic regression models explored the association between RLS and MG variables of interest.

RESULTS

A total of 630 eligible participants with MG (age: 62.8 ± 13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-activities of daily living, MG-quality of life-15 revised, and depression scores. History of "thymic tumor with thymectomy" and "continuous positive airway pressure therapy" were also independent predictors of RLS.

CONCLUSIONS

RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS.

CITATION

AlGaeed M, McPherson T, Lee I, et al. Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis. J Clin Sleep Med. 2025;21(2):269-276.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Association between weight-adjusted waist index and obstructive sleep apnea among adults in the United States: data from NHANES (2005-2008 and 2015-2018)

OBJECTIVE

We aimed to examine the relationship between the weight-adjusted waist index (WWI) and obstructive sleep apnea (OSA), a condition often caused by obesity, which remains unclear.

METHODS

In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey among adults in the United States (US) aged 20 to 65 years, covering the periods 2005 to 2008 and 2015 to 2018. The study included 8278 participants; we used multivariate logistic regression, restricted cubic splines, and subgroup analyses to explore the relationship between WWI and OSA.

RESULTS

After adjusting for all covariates, each unit increase in WWI was associated with a 30% increase in OSA prevalence (odds ratio = 1.30, 95% confidence interval: 1.20-1.40).

CONCLUSIONS

These findings suggest that WWI, an index reflecting abdominal obesity, can provide important insights into OSA risk assessment. Its strong association with OSA highlights its potential utility in predicting OSA prevalence, particularly among diverse subpopulations. The WWI was associated with a higher prevalence of OSA among US adults and may serve as a valuable tool for risk assessment, early screening, and intervention strategies in clinical practice.

Postnatal Growth Trajectories and Risk of Obstructive Sleep Apnea in Middle Age: A Cohort Study

STUDY OBJECTIVES

Rapid growth in childhood predisposes to obesity and cardiometabolic diseases in adulthood. While obstructive sleep apnea (OSA) is bidirectionally linked to obesity, its developmental origins are sparsely studied. We examined associations between postnatal growth and the risk of OSA in adulthood.

METHODS

We included adults whose childhood anthropometric data was collected in the New Delhi Birth Cohort study. The risk of OSA was defined by the Berlin Questionnaire (BQ) with and without the obesity criterion. Using logistic regression, we studied associations of OSA risk with conditional growth parameters, which are statistically independent measures of gain in height, weight, and body mass index (BMI), during infancy (0-2 years), early childhood (2-5 years), and late childhood (5-11 years).

RESULTS

Among 521 subjects (58.9% males) with a mean (SD) age of 40.9 (1.7) years, 30.9% had a high risk of OSA. On multivariate analysis, a high risk of OSA was associated with a higher conditional BMI in infancy (odds ratio: 1.25; 95% confidence interval: 1.00-1.57; p = 0.048) and early childhood (1.35; 1.07-1.69; p = 0.011). Higher risk of OSA was associated with greater conditional weight in early childhood (1.34; 1.06-1.68; p = 0.013). Using the modified BQ definition without obesity, adult risk of OSA was significantly associated with a higher adult BMI instead of childhood conditional BMIs.

CONCLUSIONS

Greater gain in conditional BMI or weight in early childhood is associated with a high risk of OSA in middle age, which is mediated by a higher attained adult BMI.

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.

Impact of Sleep Fragmentation and Arousal on Nonalcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea: A Cross-Sectional Study

Purpose

Obstructive sleep apnea (OSA) is a contributing factor to nonalcoholic fatty liver disease (NAFLD). This study aimed to investigate the clinical and polysomnographic characteristics of OSA patients with and without NAFLD, focusing on the relationships between sleep fragmentation, arousal and NAFLD.

Materials and Methods

We consecutively enrolled patients who underwent polysomnography, anthropometry, blood sampling, and abdominal ultrasonography. Patients were categorized into NAFLD and non-NAFLD groups. A comparative analysis of clinical and polysomnographic profiles was conducted, followed by multivariate binary logistic regression to explore the relationship between sleep disturbance indices and NAFLD.

Results

A total of 403 subjects were included, including 92 patients with NAFLD and 311 with non-NAFLD. NAFLD patients exhibited a greater apnea-hypopnea index (AHI) (51.19/h vs 33.60/h, p = 0.002) and oxygen desaturation index (ODI) (37.90/h vs 21.40/h, p=0.034) compared to non-NAFLD patients. Specifically, NAFLD patients had a higher rapid eye movement (REM)-AHI (53.70/h vs 43.60/h, p=0.001) and greater arousal index (AI) (32 vs 25, p = 0.009). Additionally, sleep latency (SL) was significantly lower in the NAFLD group (p < 0.05). Multivariate logistic regression analysis confirmed that REM-AHI (OR=1.023, p = 0.024), AI (OR=1.140, p = 0.01), and SL (OR=0.956, p = 0.035) were significantly associated with NAFLD in OSA patients.

Conclusion

This study revealed that sleep disturbance indices, especially AI, REM-AHI and SL, were closely related to NAFLD. When evaluating whether OSA patients are complicated with NAFLD, more attention should be given to sleep fragmentation and arousal.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

An Alternative In-Home Protocol to Diagnose and Treat Obstructive Sleep Apnea

Objective  Obstructive sleep apnea (OSA) is a major public health problem of pandemic proportions. In-laboratory OSA diagnosis and continuous positive airway pressure (CPAP) titration are insufficient, considering the number of patients affected. Finding alternative ways to diagnose and treat OSA is mandatory, especially in this era of the coronavirus disease 2019 (COVID-19) pandemic. The present study aims to describe an alternative in-home protocol to diagnose and treat OSA. Materials and Methods  We enrolled consecutive patients aged ≥ 18 years with moderate/severe OSA, who underwent in-home type-III polysomnography and home-based titration with automatic CPAP, coupled with an oximetry sensor for 3 consecutive nights. Patients were remotely monitored for 90 days to evaluate CPAP compliance and the use of an engagement tool was encouraged. Results  We included 86 participants. The median time until the diagnosis was of one day. The mean time from the baseline visit until the acquisition and initiation of the CPAP therapy was of 33 (range: 17 to 52) days. Telemonitoring ensured good compliance in the first 30 (79.2%), 60 (76.3%) and 90 (74.3%) days, with an average daily use of 6.2 ± 1.4 h, 6.0 ± 1.4 h, and 6.0 ± 1.3 h respectively. About 1/3 of the patients used the engagement tool, and CPAP compliance was significantly higher among these patients compared with those who did not used the tool: 89.9% versus 73.5% ( p  < 0.002), 87.9% versus 70% ( p  < 0.003), and 86.6% versus 67.6% ( p  < 0.001) at 30, 60, and 90 days respectively. Conclusion  We demonstrated that an alternative in-home protocol to diagnose and treat OSA is effective, ensuring good CPAP compliance after 90 days. Telemonitoring and engagement tools could be strategies to improve CPAP compliance.

Prevalence and impact of obstructive sleep apnea in type 2 diabetes mellitus: A descriptive cross-sectional study

Background

Obstructive sleep apnea (OSA) has been reported to have a high prevalence in patients with type 2 diabetes mellitus. There is scarcity of literature on relationship between OSA and diabetes in Indian population.

Methods

A cross-sectional observational study was conducted at a tertiary care hospital and 80 consecutive and consenting patients with diabetes were enrolled over 24 months from 01 Sep 2014 to 31 Aug 2016. After a detailed history and clinical examination, all patients were subjected to a level I polysomnography (PSG), and their blood sample was drawn for the assessment of diabetes control, insulin resistance, and microvascular complications.

Results

Out of 80 patients with diabetes, 30 (37.5%) patients had a high-risk score on Berlin questionnaire and 59 (73.8%) patients had evidence of OSA by PSG. The prevalence of OSA in diabetics with normal body mass index, waist circumference, and neck circumference was 65.5%, 64.2%, and 67.2%, respectively. Patients with OSA had a significantly higher mean glycosylated hemoglobin (correlation coefficient 0.53) and higher insulin resistance (correlation coefficient 0.78). Patients with microvascular complications had a higher prevalence of OSA than those without. This included neuropathy (100% versus 62.5%), retinopathy (100% versus 69.6%) and diabetic kidney disease (DKD) (90.9% versus 52.8%). Patients with any microvascular complication were significantly more likely to have OSA (odds ratio 13.66, 95% confidence interval 3.94-47.37, p < 0.001).

Conclusion

Indian patients with diabetes have a high prevalence of OSA, regardless of obesity. Patients with diabetes and OSA have poorer diabetes control, more insulin resistance, and higher prevalence of microvascular complications like nephropathy, neuropathy, and retinopathy.

The bidirectional relationship between obstructive sleep apnea and atrial fibrillation: Pathophysiology, diagnostic challenges, and strategies - A narrative review

Atrial fibrillation (AF), is an irregular heart rhythm disorder that increases the risk of stroke, heart failure, and death. Obstructive sleep apnea is typified by intermittent airway blockages which results in low oxygen levels and disrupted sleep. These two conditions often coexist, with each worsening the other. Understanding this connection is critical to improve diagnosis and treatment. The relationship between atrial fibrillation and obstructive sleep apnea appears bidirectional. Obstructive sleep apnea increases the risk of atrial fibrillation through various mechanisms which are arrhythmogenic. Conversely, patients with atrial fibrillation are more likely to have undiagnosed obstructive sleep apnea, complicating their treatment. Screening modalities for obstructive sleep apnea are often inadequate. Polysomnography remains the most reliable tool but is costly and not practical for routine screening of all patients which limits early diagnosis and management. Continuous positive airway pressure (CPAP) therapy is the primary treatment for obstructive sleep apnea and can reduce atrial fibrillation recurrence by decreasing oxygen deprivation and sympathetic activity. However, adherence to continuous positive airway pressure is often low due to patient discomfort. Alternative therapies, such as mandibular advancement devices and hypoglossal nerve stimulation, offer promising options for patients who cannot tolerate continuous positive airway pressure. The interplay between atrial fibrillation and obstructive sleep apnea requires an integrated approach to diagnosis and treatment. Improving screening tools, enhancing treatment adherence, and evaluating alternative therapies are critical steps to reducing the impact of these conditions and improving patient outcomes.

Melatonin mediates intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients

BACKGROUND

Intestinal barrier dysfunction and systemic inflammation are common in obstructive sleep apnoea (OSA). We aimed to investigate the role of melatonin, an anti-inflammatory mediator, in mediating the relationships between OSA, intestinal barrier dysfunction and systemic inflammation.

METHODS

Two hundred and thirty-five male participants who complained with sleep problems and underwent whole night polysomnography at our sleep centre between 2017 and 2018 were enrolled. Polysomnographic data, anthropometric measurements and biochemical indicators were collected. Serum melatonin, intestinal barrier function biomarker zonula occludens-1 (ZO-1) and inflammatory biomarkers C-reactive protein (CRP) with lipopolysaccharide (LPS) were detected. Spearman's correlation analysis assessed the correlations between sleep parameters, melatonin and biomarkers (ZO-1, LPS and CRP). Mediation analysis explored the effect of OSA on intestinal barrier dysfunction and systemic inflammation in moderate-severe OSA patients.

RESULTS

As OSA severity increased, serum melatonin decreased, whereas ZO-1, LPS and CRP increased. Spearman's correlation analysis showed that serum melatonin was significantly negatively correlated with ZO-1 (r = -0.19, p < .05) and LPS (r = -0.20, p < .05) in the moderate-OSA group; serum melatonin was significantly negatively correlated with ZO-1 (r = -0.46, p < .01), LPS (r = -0.35, p < .01) and CPR (r = -0.30, p < .05) in the severe-OSA group. Mediation analyses showed melatonin explain 36.12% and 35.38% of the effect of apnoea-hypopnea index (AHI) on ZO-1 and LPS in moderate to severe OSA patients.

CONCLUSIONS

Our study revealed that melatonin may be involved in mediating intestinal barrier dysfunction and systemic inflammation in moderate-to-severe OSA patients.

The effect of hypoxia on interoception in patient with obstructive sleep apnea

PURPOSE

Obstructive Sleep Apnea (OSA) is the most common sleep-related disorder. Interoception is the collection of sensory and cognitive processes that involve receiving and interpreting physiological signals from internal body structures and conveying the perception of inner sensations. In this study, it was hypothesized that the impairment in cognitive functions associated with chronic hypoxemia and the insular effects due to OSA would negatively affect interoceptive functions. The aim of this study was to evaluate whether interoception in OSA changes consistent with the hypothesis.

METHODS

A total of 102 patients diagnosed with OSA were included in this study. All participants were divided into groups based on their T90 values: desaturated OSA (T90 ≥ 20%) and non-desaturated OSA (T90 < 20%). The Heartbeat Counting Task was used to assess interoceptive accuracy, while the Interoceptive Sense Questionnaire (ISQ) was employed to identify subjective challenges in evaluating interoception.

RESULTS

Interoceptive accuracy was lower in the desaturated OSA group than in the non-desaturated OSA group (Z = -2.463; p = 0.014). Interoceptive accuracy was negatively correlated with the body mass index (r = -0.228; p = 0.021), T90 (r = -0.269; p = 0.006), and positively correlated with the average SaO2 (r = 0.377; p < 0.001) and SaO2 nadir (r = 0.243; p = 0.014).

CONCLUSION

This study examined interoceptive functions in patients with OSA. It was concluded that interoceptive accuracy is affected by the severity of hypoxia as hypothesized.

Impact of comorbid sleep-disordered breathing on escitalopram treatment in patients newly diagnosed with generalized anxiety disorder: A 12-week prospective observational study

We aimed to evaluate the presence of sleep-disordered breathing (SDB) in generalized anxiety disorder (GAD) patients and its impacts after 12-week of escitalopram treatment. In this prospective observational study, GAD patients were followed up to determine whether comorbid SDB affects their treatment response. They underwent a home sleep apnea test (HSAT), and oxygen desaturation index ≥5 was considered indicative of SDB. All participants were treated with escitalopram 5 mg in the first 2 weeks and 10 mg in the remaining 10 weeks. They underwent assessments of heart rate variability and completed questionnaires for sleep, mood, attention, and daytime sleepiness on the day of enrollment, and 2 weeks, 4 weeks, and 12 weeks later. A total of 45 GAD participants (mean age, 56.2 years) were included in the study. Of these, 53.3% had comorbid SDB. Participants with GAD and SDB had higher baseline Beck Anxiety Inventory (BAI) and STOP-BANG scores. Both groups of participants with GAD showed overall improvement in anxiety, depression, and insomnia symptoms after 12 weeks of escitalopram treatment. Additionally, there were no statistically significant differences in the changes in BAI, Beck Depression Inventory, and Epworth Sleepiness Scale scores between the two groups at the Week 2, Week 4, and Week 12 assessments compared to baseline. However, the GAD group with comorbid SDB seemed to have a lower tendency for improvement in depressive symptoms than the group with non-comorbid SDB. Compared with the GAD group without comorbid SDB, the GAD group with comorbid SDB exhibited more severe anxiety symptoms at baseline and tended to show less improvement in depressive symptoms after 12 weeks of escitalopram treatment.

Long Term Cardiovascular Outcomes Between Sleep Surgery and Continuous Positive Airway Pressure

OBJECTIVES

Individuals with obstructive sleep apnea (OSA) suffer from a multitude of concurrent morbidities including cardiovascular disease (CVD). Limited data exists comparing long term cardiovascular disease (CVD) clinical outcomes for patients treated with surgical intervention versus continuous positive airway pressure (CPAP). The purpose of this study was to compare CVD outcomes at multiple time points comparing those treated with sleep surgery versus CPAP alone.

METHODS

A research database was used to assess outcomes: death, myocardial infarction, atrial fibrillation, heart failure, essential hypertension, and pulmonary hypertension at 5, 8, and 20 years for patients with OSA treated with surgical interventions (upper airway stimulation [UAS], uvulopalatopharyngoplasty [UPPP], and tonsillectomy) or CPAP alone. Subjects were identified using ICD and CPT codes and analyses were conducted with and without propensity score matching for age, sex, race, BMI, myocardial infarction (MI), essential hypertension, pulmonary hypertension, atrial fibrillation, and heart failure.

RESULTS

All surgical interventions demonstrated benefit over CPAP alone at most time points for most surgical interventions. At 8 years, for all sleep surgeries (UAS or UPPP or tonsillectomy) (n = 6627) versus treatment with CPAP alone (n = 6627), matched subjects demonstrated decreased risk (odds ratios) and superior survival (hazard ratios and log ranks tests) for death (OR = 0.49 [0.39, 0.62] P ≤ .0001, HR = 0.29 [0.23, 0.37], χ2 = 109.58 P ≤ .0001), myocardial infarction (OR = 0.67 [0.54, 0.84] P = .0005*, HR = 0.48 [0.38, 0.60], χ2 = 42.40 P ≤ .0001), atrial fibrillation (OR = 0.70 [0.59, 0.83] P ≤ .0001, HR = 0.54 [0.45, 0.64], χ2 = 51.53 P ≤ .0001), heart failure (OR = 0.55 [0.47, 0.64] P ≤ .0001, HR = 0.41 [0.35, 0.47], χ2 = 137.416 P ≤ .0001), essential hypertension (OR = 0.88 [0.82, 0.94] P = .0002, HR = 0.78 [0.74, 0.82], χ2 = 76.38 P ≤ .0001), and pulmonary hypertension (OR = 0.51 [0.40, 0.65] P ≤ .0001, HR = 0.38 [0.29, 0.48], χ2 = 60.67 P ≤ .0001) where P ≤ .00037 indicated statistical significance*.

CONCLUSION

This investigation suggests surgical management of obstructive sleep apnea may contribute to the mitigation of long-term clinical CVD morbidity.

Simple Subjective Sleep Quality and Blood Pressure in Individuals With Optimal Sleep Duration: A Cross-Sectional Study

Background

An individual's simple subjective feeling of having poor sleep quality usually occurs in combination with short sleep duration. Previous studies have mainly investigated the association between simple subjective sleep quality and blood pressure in a general population without considering the complicated issue regarding poor sleep quality and short sleep duration. The aim of this study was therefore to investigate whether poor sleep quality was associated with increased blood pressure in individuals with optimal sleep duration.

Methods

A cross-sectional study was conducted on 169 residents aged ≥ 18 years who lived in a remote island of Okinawa, Japan. The participants had a sleep duration of 6 - 7.9 h/day on weekdays and were not taking either sleep medication or antihypertensive medication. Analysis of covariance was used to compare systolic and diastolic blood pressures in the participants grouped according to simple subjective sleep quality.

Results

Of the 169 participants, 51 (30.2%) reported that their sleep quality was poor. After adjustment for age, sex, and other potential confounders including sleep duration within optimal levels, the participants aged ≤ 49 years had mean (95% confidence interval) systolic and diastolic blood pressures (mm Hg) of 121.0 (114.7 - 127.3) and 68.7 (63.8 - 73.6) in the good sleep quality group, and 127.8 (120.7 - 134.9) and 71.8 (66.2 - 77.3) in the poor sleep quality group (P = 0.01 and P = 0.14, respectively). However, in those aged ≥ 50 years, the corresponding means were 130.6 (121.3 - 139.8) and 79.1 (73.5 - 84.7) in the good-quality group and 126.9 (114.6 - 139.2) and 78.0 (70.5 - 85.4) in the poor-quality group (P = 0.43 and P = 0.68, respectively). There was a statistically significant interaction between simple subjective sleep quality and age for systolic blood pressure (P value for interaction = 0.04).

Conclusions

This study showed that an individual's simple subjective feeling of poor sleep quality was associated with increased systolic blood pressure in participants aged ≤ 49 years with optimal sleep duration. These findings highlight the importance of easily assessing simple subjective sleep quality in clinical settings even in individuals with optimal sleep duration, in order to prevent and manage hypertension.