Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend

Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in psychiatric patients

BACKGROUND

Obstructive sleep apnea (OSA) is prevalent among psychiatric patients and can exacerbate psychiatric conditions. Screening for OSA in this population is challenging due to overlapping symptoms and adherence issues. This study evaluated the diagnostic accuracy of the STOP-Bang, BOAH, GOAL, NoSAS, and No-Apnea screening questionnaires in psychiatric patients.

METHODS

In this observational cohort study, consecutive psychiatric patients admitted to a single tertiary care center between June 1, 2016 and December 31, 2022 were screened using the STOP-Bang questionnaire and additional data on parameters of the other questionnaires were collected. Polygraphy was performed using the Somnocheck micro CARDIO® system to record the Apnea-Hypopnea Index (AHI). Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve, sensitivity, and specificity analysis.

RESULTS

Among 128 patients (median age 61.5 [IQR, 52.3-73.0] years; 77 [60.2 %] men), the No-Apnea questionnaire achieved the highest sensitivity for any OSA (AHI ≤5) at 96.00 % (95 % CI, 89.35 %-98.58 %; AUC, 0.68), followed by GOAL at 92.00 % (95 % CI, 83.78 %-96.27 %; AUC, 0.59) and STOP-Bang at 90.67 % (95 % CI, 81.85 %-95.26 %; AUC, 0.66). The specificities of all questionnaires were low, ranging from 15.09 % (STOP-Bang; 95 % CI, 8.35 %-25.90 %) to 50.94 % (BOAH; 95 % CI, 38.65 %-63.13 %).

CONCLUSION

The STOP-Bang, GOAL, and No-Apnea questionnaires effectively identify psychiatric patients at risk for OSA, though their low specificity underscores the necessity for confirmatory diagnostics, such as polygraphy. The No-Apnea score, which relies only on objective variables, may offer particular benefits in psychiatric settings.

Chronic intermittent hypoxia modulates corneal fibrotic markers and inflammatory cytokine expression in a sex-dependent manner

Chronic intermittent hypoxia (CIH) is a commonly observed condition in patients suffering from obstructive sleep apnea (OSA). Previous studies link CIH to fibrosis, inflammation, and hormonal dysregulation across various tissues. Yet, the effect of CIH in the cornea is unknown. Moreover, women and men diagnosed with OSA present with diverse symptoms, suggesting sex-specific pathophysiology at play. Thus, we used a rat model to assess the impact of CIH and sex on protein expression of corneal fibrotic markers (α-SMA, COL III, cFN, TSP-1), proinflammatory cytokines (IL-1 α, IL-17, IL-18, and IFN-γ), and hormone receptors (ERα, ERβ, GPER, GnRH-R, and LH-R). Male and female Sprague Dawley rats were exposed to normoxic or CIH conditions during their sleep cycle for 14 days. Extracted corneal proteins were subjected to Western blot and multiplex magnetic bead analysis. Our results reveal sex differences in fibrotic and inflammatory markers in the cornea, whereby female corneas exhibit higher levels of fibrotic markers, while male corneas exhibit increased inflammatory cytokines. CIH exposure resulted in elevated levels of α-SMA and pro-inflammatory cytokines in female corneas, while there was no impact on fibrotic or inflammatory markers in male corneas. Additionally, CIH exposure reduced hormone receptors in male and female corneas in a sex-dependent manner. Correlation analyses identified associations of corneal hormone receptors with corneal fibrotic and pro-inflammatory markers that were dependent on sex, with female corneas demonstrating stronger correlations compared to male corneas. Altogether, our data suggests hormone-mediated signaling may contribute to CIH-mediated corneal fibrosis and inflammatory phenotypes, especially in females.

Construction and Validation of a Nomogram Model for Predicting Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Purpose

Pulmonary hypertension (PH) is a common cardiovascular complication of obstructive sleep apnea (OSA), posing a significant threat to the health and life of patients with OSA. However, no clinical prediction model is currently available to evaluate the risk of PH in OSA patients. This study aimed to develop and validate a nomogram for predicting PH risk in OSA patients.

Patients and Methods

We collected medical records of OSA patients diagnosed by polysomnography (PSG) from January 2016 to June 2024. Transthoracic echocardiography (TTE) was performed to evaluate PH. A total of 511 OSA patients were randomly divided into training and validation sets for model development and validation. Potential predictive factors were initially screened using univariate logistic regression and Lasso regression. Independent predictive factors for PH risk were identified via multivariate logistic regression, and a nomogram model was constructed. Model performance was assessed in terms of discrimination, calibration, and clinical applicability.

Results

Eight independent predictive factors were identified: age, recent pulmonary infection, coronary atherosclerotic heart disease (CHD), apnea-hypopnea index (AHI), mean arterial oxygen saturation (MSaO2), lowest arterial oxygen saturation (LSaO2), alpha-hydroxybutyrate dehydrogenase (α-HBDH), and fibrinogen (FIB). The nomogram model demonstrated good discriminative ability (AUC = 0.867 in the training set, AUC = 0.849 in the validation set). Calibration curves and decision curve analysis (DCA) also indicated good performance. Based on this model, a web-based nomogram tool was developed.

Conclusion

We developed and validated a stable and practical web-based nomogram for predicting the probability of PH in OSA patients, aiding clinicians in identifying high-risk patients for early diagnosis and treatment.

Increasing incidence and burden of obstructive sleep apnoea in the Finnish population: A cohort study from 2005 to 2019

BACKGROUND

Obstructive sleep apnoea (OSA) is a significant public health problem. We sought to characterize the typical features of patients with OSA and to study the burden and treatment of OSA in Finland from 2005 to 2019.

METHODS

Our data included adult patients with OSA (n = 50 317) treated in 2005-2019 in secondary care in the Hospital District of Helsinki and Uusimaa (HUS). We collected diagnosis and procedure codes and healthcare contacts from HUS data lake. Word search from patient records included body mass index (BMI), smoking status, Epworth Sleepiness scale (ESS), apnoea-hypopnea-index (AHI), continuous positive airway pressure (CPAP) treatment, and Mallampati score. ResMed Airview program was used to calculate the prevalence of CPAP treatment in 2018-2022.

FINDINGS

The annual incidence of OSA increased from 99 per 100 000 to 564 per 100 000 (+470 %) during 2005-2019. The most significant increase in healthcare contacts occurred in remote care and nurse visits from 336 to 35 959 per year (+10 602 %) and from 1051 to 23 609 per year (+2146 %), respectively. The prevalence of CPAP treatment increased from 0·74 % to 2·48 % during 2018-2022 (+235 %).

INTERPRETATION

As the prevalence of OSA is increasing, the need for more efficient treatment protocols was seen as a shift towards telemedicine and as an increase in nurse visits. Data lake offers an efficient way to analyse large data sets of OSA patient characteristics and treatment strategies.

[Can drug therapy for obstructive sleep apnea be expected after all?]

Obstructive sleep apnea (OSA) is a very common sleep disorder and is usually a chronic disease. Indications for treatment depend on the severity of the nocturnal breathing disorder; the specific symptoms, such as daytime sleepiness; and the comorbidities, which, together with the breathing disorder, constitute the risk of sleep apnea. Standard treatment is nocturnal positive airway pressure therapy or, especially for mild to moderate sleep apnea, a mandibular advancement device. Surgical measures are only carried out if indicated. A specific and effective sleep apnea medication does not yet exist. The first approved medication for obese OSA sufferers is tirzepatide, which leads to a reduction in nocturnal breathing disorders through effective weight reduction. Alternative and in some cases more specific medications are currently being researched. These include, for example, carbonic anhydrase inhibitors, anticholinergics, serotonin-noradrenaline reuptake inhibitors, sympathomimetics, and cannabinoids. Drug therapy for sleep apnea will enrich an individualized therapy in the future that is geared toward the phenotype of sleep apnea.

Spatiotemporal Trends in the Prevalence of Obstructive Sleep Apnoea Across China: A Multilevel Meta-Analysis Incorporating Geographic and Demographic Stratification (2000-2024)

Purpose

China bears the highest global burden of obstructive sleep apnea (OSA), yet its spatiotemporal and occupational patterns remain unclear. We quantified OSA prevalence across Chinese subpopulations, focusing on geographic disparities, temporal trends, and occupational risks.

Methods

Following PRISMA guidelines, we systematically searched six databases (2000-2024) for population-based OSA studies using polysomnography or validated portable monitoring. Two researchers independently screened studies with third-party adjudication of discrepancies. Risk of bias was assessed using Joanna Briggs Institute criteria. Random-effects models pooled prevalence estimates; meta-regression identified heterogeneity contributors. OSA diagnosis followed 2012 AASM criteria (AHI ≥5; pediatric studies: OAHI ≥1.5).

Results

From 62 studies (N=178,049), pooled OSA prevalence was 11.8% (95% CI:10.1-13.4%), rising from 8.1% (2000-2005) to 26.9% (2021-2024). Prevalence was higher in males vs females (11.1% vs 6.0%, P<0.001), with marked geographic disparities: Northwest China had the highest prevalence (17.8%, 16.3-19.3%) versus Southwest (6.9%, 3.7-10.9%). Drivers exhibited the highest occupational risk (15.3%). Low-quality studies overestimated prevalence (15.0% vs 7.6-10.2% in higher-quality studies), and two-step sampling yielded higher estimates than single-risk-group designs (13.6% vs 7.4%, P<0.001). Meta-regression identified survey period (β=0.036, P=0.025), male sex (β=-0.062, P=0.047), geographic area (β=0.268, P=0.035), occupation (β=0.254, P=0.047), and sampling strategy (β=-0.029, P=0.012) as key predictors of heterogeneity.

Conclusion

OSA prevalence in China has accelerated significantly. Standardized screening is urgently needed for aging populations, high-risk occupations (particularly drivers), and underserved regions. Policy priorities should address rural diagnostic inequities and integrate OSA surveillance into public health programs. Methodological harmonization is critical for tracking OSA's evolving burden.

Effectiveness of aerobic exercise training in patients with obstructive sleep apnea: a systematic review and meta-analysis

PURPOSE

Obstructive sleep apnea (OSA), a sleep-related disorder, reports significant clinical consequences, apart from its socioeconomic burden globally. Among the physiotherapeutic treatment options, exercise training is primarily preferred for these patients. In the current systematic review and meta-analysis, we hypothesize that aerobic exercise training could be beneficial in reducing the severity of OSA.

METHODS

A thorough literature search was carried out from Scopus, PubMed, CINAHL, Cochrane, and Embase databases following the PRISMA guidelines, and eight studies were included. The primary outcome was the apnea hypopnea index (AHI) and secondary outcomes were maximal oxygen consumption, oxygen desaturation index, mean oxygen saturation during sleep, Epworth sleepiness scale, body mass index, and neck circumference. RevMan version 5.4.1 was utilized for analysis.

RESULTS

Meta-analysis involved seven studies that showed that aerobic training significantly improved the AHI with a mean difference of -5.24 and an overall effect of p < 0.00001; and VO2max with a mean difference of 5.84 and an overall effect of p = 0.03. The other secondary outcomes reported improvement but were not significant.

CONCLUSION

The current review concludes that there is supporting evidence for the beneficial effects of aerobic exercise training in reducing the severity of obstructive sleep apnea.

PROSPERO REGISTRATION

CRD42023453316.

Prevalence and Misperception: Exploring the Gap Between Objective and Subjective Assessment of Sleep Apnea in a Population at Increased Risk for Dementia

Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer's disease, including amyloid-β accumulation, tau phosphorylation, and neuroinflammation. This underscores the need to optimize OSA diagnosis in individuals with an increased risk of dementia. Methods: This cross-sectional observational study enrolled adults aged 60-85 years with a CAIDE dementia risk score ≥6. Subjective sleep was evaluated using validated questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Oviedo Sleep Questionnaire), while objective sleep data were obtained through a single-night peripheral arterial tonometry (PAT)-based wearable device, complemented by a 7-day sleep diary. Participants also completed the STOP-BANG and Berlin questionnaires, with clinically relevant findings communicated to participants. Results: Among 322 participants (48.8% women; mean age 71.4 ± 6.4 years), moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15) was identified in 48.49%, despite the absence of prior diagnoses. Subjective screening tools frequently underestimated OSA severity compared to objective assessments. While no significant sex-based differences were noted, higher AHI values correlated strongly with increased body mass index and elevated dementia risk scores. Conclusions: A marked discrepancy between subjective and objective sleep measurements complicates the accurate diagnosis and management of most sleep disorders, including OSA. Sleep disorders remain significantly underdiagnosed in individuals at increased risk for dementia. Integrating wearable technologies and structured tools such as sleep diaries into routine assessments can enhance diagnostic precision, enabling timely interventions for these modifiable risk factors of dementia.

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.

Examining Sleep-Disordered Breathing Events Using Latent Profile Analysis

The clinical utility of the ratio of the apnea-hypopnea index (AHI) occurring during rapid eye movement (REM) and non-REM (NREM) sleep (AHIREM/AHINREM ratio) has been debated. We investigated the heterogeneity of REM and NREM sleep behaviors to identify unobserved distinct subtypes of sleep-disordered breathing (SDB) and examine their demographic and clinical features. The present study used a sample of 3626 adult patients who underwent diagnostic polysomnography evaluations at the Sleep Disorders Center of King Abdulaziz Medical City in Riyadh, Saudi Arabia. Latent profile analysis was performed to categorize subjects into distinct profiles of SDB based on AHIREM, AHINREM, and AHIREM/AHINREM ratio. A multinomial logistic model estimated the odds ratio of SDB profiles. Four distinct subtypes of SDB were identified: Class I (low AHIREM; 75.9%) included patients with normal SDB events during REM sleep, serving as the reference group; Class II (REM-OSA, 1.2%) included patients with high AHI during REM sleep but lowest AHI during NREM sleep, resulting in the largest AHIREM/AHINREM ratio; Class III (AHINREM < 30 events per hour, 17.4%); and Class IV (AHINREM ≥ 30 events per hour, 5.5%). Compared to Class I, factors related to Class IV included older age, high BMI, large neck circumference, hypertension, reduced total sleep time, reduced REM sleep, poor sleep efficiency, high desaturation index, low SpO2, high arousal index, and high Epworth Sleepiness Scale. As hypothesized, the study characterized several subtypes of SDB based on the AHIREM, AHINREM, and their ratio (AHIREM/AHINREM) in a large cohort and identified their demographic and clinical features. These subtypes might be clinically useful for defining SDB among adult patients referred to sleep clinics who may have varying responses to treatment depending on their subtype of the disease.

Comparative efficacy of non-pharmacological interventions for adults with sleep apnea: A systematic review and network meta-analysis

BACKGROUND

Sleep apnea is associated with cardiovascular risk, work productivity, occupational/traffic accidents, and quality-of-life (QoL); however uncertainty exists regarding optimal treatment. We performed a systematic review on the efficacy of non-pharmacological interventions for adults with sleep apnea.

METHOD

We searched MEDLINE, Scopus, Virtual-Health-Library and Web-of-Science through June 2023 for parallel/cross-over randomized trials on adults with sleep apnea (apnea-hypopnea-index>5 events/hour). Study selection, data extraction and risk-of-bias assessment were performed in duplicate, followed by frequentist network meta-analyses.

RESULTS

Ultimately, 197 unique trials were included (15,931 patients; mean age 51.4 years; 78.9 % male) assessing 25 treatments. Positive Airway Pressure (PAP) (alone or combined with health behaviour modification) consistently improved more apnea-hypopnea-index or daytime sleepiness and physical/mental QoL in obstructive sleep apnea (OSA) patients compared to all other interventions but was not always well-tolerated. Mandibular advancement devices (MAD) yielded the greatest improvement in depression, while also improving objective/subjective apnea-outcomes, and physical/mental QoL-albeit less than PAP and less for moderate/severe cases. Acupuncture, health behaviour modifications, surgical maxillomandibular advancement, minor oral surgery, oropharyngeal training, oxygen supplementation, or electrical neurostimulation might improve apnea-related outcomes, but weak evidence exists. Finally, electrical neurostimulation performed best for central sleep apnea and PAP performed best for positional OSA. Confidence in the network meta-analysis estimates was low due to non-adherence issues that was rarely directly assessed in included trials with objective measures.

CONCLUSION

PAP (alone or with co-interventions) performed best for the treatment of adult OSA patients regardless of disease severity. For patients not tolerating PAP, MADs might be a good alternative, but confer smaller improvements overall. However, adherence issues and the heterogenous response increase the complexity of OSA treatment.

Mapping the comorbidome: A novel analysis of the associations between obstructive sleep apnea and its comorbidities in Colombia

IntroductionObstructive sleep apnea (OSA) is linked to a complex network of comorbidities, including cardiovascular, metabolic, neurological, and oncological diseases. The comorbidome visually maps disease associations, highlighting the interconnected comorbidities of OSA, whose incidence and severity are strongly correlated.MethodsA retrospective cohort study was conducted between 2005 and 2020 to identify the comorbidities most frequently associated with OSA through a comprehensive comorbidity map. The prevalence of each comorbidity was calculated as a percentage, and a detailed analysis was performed to examine the relationship between these comorbidities and the severity of OSA. This graphic represents all comorbidities with significant associations to OSA, where the size of each bubble is proportional to the prevalence of the disease within the cohort, and the proximity to the center reflects the strength of the association.ResultsA total of 3043 patients diagnosed with OSA were included, of whom 51.1% (1154/3043) had severe OSA, 29.2% (889/3043) had moderate OSA, and 19.7% (600/3043) had mild OSA. The average age was 57.6 years (SD ± 15.32), and 65.6% (1995/3043) were men. Among patients with mild OSA, hypertension was present in 48.0% (288/600), in moderate OSA in 53.0% (470/889), and in severe OSA in 58.5% (909/1554). Renal failure (OR: 9.39; 95% CI: 3.7-23.84), cardiovascular disease (OR: 7.73; 95% CI: 3.92-15.21), dementia (OR: 6.98; 95% CI: 2.85-17.11), hemiplegia/stroke sequelae (OR: 6.90; 95% CI: 2.02-23.51), smoking (OR: 5.54; 95% CI: 2.74-11.21), and diabetes (OR: 4.34; 95% CI: 2.02-9.35) were associated with mild OSA. Hemiplegia/stroke sequelae (OR: 10.11; 95% CI: 3.8-26.89), cardiovascular disease (OR: 9.77; 95% CI: 6.18-15.46), chronic pulmonary disease (OR: 7.48; 95% CI: 4.76-11.77), and dementia (OR: 6.80;95% CI: 3.37-13.71) were associated with moderate OSA. Dementia (OR: 10.59; 95% CI: 6.41-17.5), leukemia and lymphoma (OR: 7.49; 95% CI: 2-28.1), chronic pulmonary disease (OR: 7.24; 95% CI: 5.33-9.83), hemiplegia or stroke sequelae (OR: 6.33; 95% CI: 3.3-12.16), and renal failure (OR: 6.10; 95% CI: 3.97-9.36) were associated with severe OSA.ConclusionThe most prevalent comorbidities were hypertension, smoking, and cardiovascular disease, with a higher incidence in patients with severe OSA. Additionally, a significant association was observed between certain comorbidities and mortality, particularly conditions such as renal failure and dementia. Malignant or neoplastic diseases were related to severe OSA.

Association between nasal cross-sectional areas and obstructive sleep apnea identified using acoustic rhinometry and computed tomography

PURPOSE

Obstructive sleep apnea (OSA) is a prevalent disorder associated with severe comorbidities. Anatomical variations, including nasal diseases, have been identified as potential contributing factors. This study aimed to explore the relationship between nasal cross-sectional areas (CSAs) and OSA, using both acoustic rhinometry (AR) and computed tomography (CT).

METHODS

A retrospective analysis was conducted on 355 individuals who underwent polysomnography (PSG), paranasal sinus CT, and AR. Clinical characteristics were compared among the non-OSA, mild OSA, moderate OSA, and severe OSA patients. Multiple logistic regression was used to determine the influence of nasal cross-sectional areas (CSAs) on the risk of developing moderate or severe OSA, with adjustments for sex, age, and body mass index.

RESULTS

Significant associations between specific AR-measured CSA values of anterior nasal region and moderate-severe OSA were identified upon adjusting for confounders (p = 0.034, 0.010, and 0.025, respectively). The lower CSA measurements between the right and the left sides showed a stronger correlation with moderate-severe OSA than the summed values, suggesting the importance of the narrower nasal passage in OSA severity. No significant impact of CSA values on the development of severe OSA was observed.

CONCLUSION

Nasal CSA measured using AR appears to be a better method for verifying its association with OSA than CT. Nasal CSAs at the anterior region of the inferior turbinates play a crucial role in developing OSA, independent of other known risk factors.

Age-Related Changes in Sleep and Its Implications for Cognitive Decline in Aging Persons With Schizophrenia: A Critical Review

BACKGROUND AND HYPOTHESIS

Cognitive impairment is a core feature of schizophrenia that worsens with aging and interferes with quality of life. Recent work identifies sleep as an actionable target to alleviate cognitive deficits. Cardinal non-rapid eye movement (NREM) sleep oscillations such as sleep spindles and slow oscillations are critical for cognition. People living with schizophrenia (PLWS) and their first-degree relatives have a specific reduction in sleep spindles and an abnormality in their temporal coordination with slow oscillations that predict impaired memory consolidation. While NREM oscillatory activity is reduced in typical aging, it is not known how further disruption in these oscillations contributes to cognitive decline in older PLWS. Another understudied risk factor for cognitive deficits among older PLWS is obstructive sleep apnea (OSA) which may contribute to cognitive decline.

STUDY DESIGN

We conducted a narrative review to examine the published literature on aging, OSA, and NREM sleep oscillations in PLWS.

STUDY RESULTS

Spindles are propagated via thalamocortical feedback loops, and this circuitry shows abnormal hyperconnectivity in schizophrenia as revealed by structural and functional MRI studies. While the risk and severity of OSA increase with age, older PLWS are particularly vulnerable to OSA-related cognitive deficits because OSA is often underdiagnosed and undertreated, and OSA adds further damage to the circuitry that generates NREM sleep oscillations.

CONCLUSIONS

We highlight the critical need to study NREM sleep in older PWLS and propose that identifying and treating OSA in older PLWS will provide an avenue to potentially mitigate and prevent cognitive decline.

Association between periventricular white matter hyperintensity and moderate-to-severe patients with sleep apnea syndrome

PURPOSE

The association between sleep apnea syndrome (SAS) severity and white matter hyperintensities (WMHs) has been previously described. However, the associated anatomical details of WMHs remain unclear. The WMHs were divided into periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DWMH). PVH is characterized as a non-vascular entity, whereas DWMH is vascular in nature. This study aimed to clarify the association between SAS and the anatomical details of WMHs.

METHODS

Patients (n = 237) diagnosed with neurologically asymptomatic SAS (1999-2016) were enrolled. Any symptomatic SAS patients, whose MRI was conducted more than six months prior to SAS diagnosis, or whose data were incomplete were excluded. For patients with multiple MRI scans, the most recent imaging was employed. SAS diagnosis was defined as an apnea-hypopnea index (AHI) ≥ 5. PVH and DWMH were graded from 0 to IV according to severity. Age, sex, medical history, body mass index, AHI, estimated duration of SAS, and MRI findings were collected. Factors associated with PVH and DWMH grade ≥ I were analyzed.

RESULTS

PVH grade ≥ I was associated with the estimated duration of SAS (odds ratio, 1.01; 95% confidence interval, 1.00-1.02), DWMH grade ≥ I (102.04; 21.40-486.49), hypertension (4.05; 1.53-10.74), and cerebral atrophy (17.47; 1.36-225.28). Age (1.07; 1.03-1.12) and PVH grade ≥ I (88.73; 19.07-412.86) were significantly associated with DWMH grade ≥ I.

CONCLUSION

This study confirmed that PVH rather than DWMH is associated with SAS. This study may contribute to research on the mechanism of WMHs caused by SAS.

A possible important regulatory role of estrogen in obstructive sleep apnea hypoventilation syndrome

Obstructive sleep apnea-hypoventilation syndrome (OSAHS) is a prevalent clinical sleep breathing disorder that affects both pediatric and adult populations. If left untreated, OSAHS can induce or aggravate systemic dysfunction across multiple organ systems, with a particularly pronounced impact on cardiovascular health, thereby posing a substantial threat to overall human well-being. Notably, there exists a significant sex disparity in the prevalence and severity of OSAHS, with a higher incidence and greater severity observed in males. However, this disparity tends to diminish post-menopause. Research indicates that sex differences in OSAHS are associated with gonadal function, wherein estrogen exerts a protective effect by modulating pharyngeal muscle tone and mitigating oxidative stress. This regulatory role of estrogen partially reduces the incidence of OSAHS and attenuates its pathological impact. Conversely, OSAHS may adversely affect gonadal function, resulting in decreased estrogen levels, which can exacerbate the condition. This review examines the beneficial role of estrogen in the progression of OSAHS and explores the potential impact of OSAHS on estrogen levels.

Comparative Efficacy of Continuous Positive Airway Pressure and Antihypertensive Medications in Obstructive Sleep Apnea-Related Hypertension: A Narrative Review

INTRODUCTION

Obstructive sleep apnea (OSA) presents a significant global health concern, affecting a substantial portion of the population, particularly among young and middle-aged adults.

AIM

This review aims to assess the efficacy of continuous positive airway pressure (CPAP) compared to antihypertensive medications in managing OSA-related hypertension.

METHODS

A comprehensive literature search was conducted across multiple databases, yielding studies published from 2000 to March 2024 that investigated CPAP, antihypertensives, or their combination therapy in OSA patients. Six definitive studies were analyzed, including two randomized controlled trials (RCTs), one randomized double-blind placebo-controlled crossover trial, one placebo-controlled trial, one open-label multicenter trial, and one longitudinal cohort study. These studies comprised 939 participants, with intervention durations ranging from four weeks to six months.

RESULTS

Analysis of CPAP monotherapy revealed variable efficacy, with some studies demonstrating significant reductions in 24-hour mean blood pressure and diastolic pressure, while others reported non-significant changes. CPAP therapy combined with antihypertensives showed additive effects, particularly in reducing office blood pressure measurements. Antihypertensive medications, such as valsartan, exhibited superior efficacy in reducing blood pressure compared to CPAP alone. Factors influencing therapy effectiveness included CPAP compliance, patient characteristics, and coexisting comorbidities. Patients with good CPAP adherence experienced greater reductions in blood pressure. The duration of exposure to OSA and the type of hypertension also impacted the therapy response.

CONCLUSION

While CPAP and antihypertensive medications offer significant benefits in managing hypertension among OSA patients, challenges such as CPAP intolerance and medication side effects exist. Personalized treatment considering individual patient factors is crucial for optimal management.

Knockdown of PLOD2 inhibits pulmonary artery smooth muscle cell glycolysis under chronic intermittent hypoxia via PI3K/AKT signal

OBJECTIVE

This study aimed to investigate the role and potential mechanism of procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2) in chronic intermittent hypoxia (CIH)-induced mice and pulmonary arterial smooth muscle cells (PASMCs).

METHODS

CIH mouse model was pre-injected with AAV-shPLOD2 by tail vein, and the pathological changes of lung was evaluated using hematoxylin-eosin (H&E) and α-SMA immunostaining. Enriched KEGG pathway analyses of PLOD2 targeted genes were performed using GSE11341 and GSE131425 datasets. Next, primary PASMCs were exposed to CIH environment, and then measured its proliferation, migration and glycolysis by CCK8, EdU assay, wound healing assay, Transwell and western blotting.

RESULTS

PLOD2 expression was increased in the lungs of CIH-induced mice and in PASMCs under CIH conditions. Moreover, glycolysis and PI3K/AKT pathway were regulated by PLOD2. Silencing of PLOD2 significantly inhibited the increase of RV/(LV + S) and RVSP, alleviated pathological changes of lung in CIH-induced mice and restrained the proliferation, migration, glycolysis and activation of PI3K/AKT in CIH-induced PASMCs. The inhibitory effects of PLOD2 silencing on PASMC proliferation and migration were accelerated by 2-DG (an inhibitor of glycolysis) and were reversed by lactate (the end product of glycolysis). In addition, the inhibitory effects of PLOD2 silencing on PASMC proliferation, migration and glycolysis were accelerated by PI3K/AKT inhibitor LY294002 and were reversed by the agonist 740Y-P.

CONCLUSIONS

Silencing of PLOD2 inhibits PI3K/AKT signaling to limit PASMC glycolysis which allows PASMC proliferation and migration in CIH-induced pulmonary arterial hypertension (PAH).

Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing

STUDY OBJECTIVES

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, whereas the criteria recommended by the American Academy of Sleep Medicine require either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these 2 definitions for men and women in a clinical setting.

METHODS

We reviewed polysomnography reports for all patients who completed a diagnostic polysomnography study at 1 sleep disorders center in 2019. Every polysomnography recording was scored using both sets of criteria to determine AHI-4 and AHI-3A.

RESULTS

Data from 279 women (64.7%) and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9 ± 27.3 and the mean AHI-3A was 34.7 ± 32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (P = .001) for women and 21.7% (P = .006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, and men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.

CONCLUSIONS

The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

CITATION

Haile K, Mungarwadi M, Ibrahim NA, et al. Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing. J Clin Sleep Med. 2025;21(3):543-548.

Phenome-wide associations of sleep characteristics in the Human Phenotype Project

Sleep tests commonly diagnose sleep disorders, but the diverse sleep-related biomarkers recorded by such tests can also provide broader health insights. In this study, we leveraged the uniquely comprehensive data from the Human Phenotype Project cohort, which includes 448 sleep characteristics collected from 16,812 nights of home sleep apnea test monitoring in 6,366 adults (3,043 male and 3,323 female participants), to study associations between sleep traits and body characteristics across 16 body systems. In this analysis, which identified thousands of significant associations, visceral adipose tissue (VAT) was the body characteristic that was most strongly correlated with the peripheral apnea-hypopnea index, as adjusted by sex, age and body mass index (BMI). Moreover, using sleep characteristics, we could predict over 15% of body characteristics, spanning 15 of the 16 body systems, in a held-out set of individuals. Notably, sleep characteristics contributed more to the prediction of certain insulin resistance, blood lipids (such as triglycerides) and cardiovascular measurements than to the characteristics of other body systems. This contribution was independent of VAT, as sleep characteristics outperformed age, BMI and VAT as predictors for these measurements in both male and female participants. Gut microbiome-related pathways and diet (especially for female participants) were notably predictive of clinical obstructive sleep apnea symptoms, particularly sleepiness, surpassing the prediction power of age, BMI and VAT on these symptoms. Together, lifestyle factors contributed to the prediction of over 50% of the sleep characteristics. This work lays the groundwork for exploring the associations of sleep traits with body characteristics and developing predictive models based on sleep monitoring.

Sleep disorders after cardiac arrest: Prevalence and relation with cognitive function

Background

Long term cognitive impairment affects about half of cardiac arrest survivors, typically attributed to postanoxic encephalopathy. Sleep disorders are common after acute brain injuries and may also impair cognition. We investigated the prevalence of sleep disorders in cardiac arrest survivors and their relation with cognitive function.

Method

Thirty survivors completed neuropsychological examination and questionnaires on mood (Hospital anxiety and depression scale), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index), and underwent polysomnography one year after cardiac arrest. Questionnaire outcomes and objective sleep parameters (sleep-apnea, leg movements, cyclicity) were correlated with performance on neuropsychological tests using Pearson R, Kruskal-Wallis, or Mann-Whitney U tests.

Results

Thirty-six percent of participants had moderate to severe obstructive sleep apnea, and 43% moderate to severe periodic limb movements during sleep according to polysomnography. Obstructive sleep apnea was correlated with poorer executive functioning (R = -0.38; p < 0.05) and memory (R = -0.50; p < 0.05). Fewer sleep cycles were correlated with poorer attention (R = 0.36, p = 0.05). Questionnaire outcomes (mood, daytime sleepiness, sleep quality) were not related to cognition. Participants with moderate/severe obstructive sleep apnea had worse executive functioning than those with no/mild obstructive sleep apnea (p = 0.02).

Conclusion

This explorative study shows moderate to severe sleep disorders are common in cardiac arrest survivors and that moderate to severe obstructive sleep apnea relates to poorer cognitive function. This implies that diagnosis and treatment of obstructive sleep apnea may offer a treatment target for cardiac arrest survivors with cognitive impairment.

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

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

Standardized List Evaluating Apnea (SLEAP): A Comprehensive Survey to Define the Quality of Life in OSA

OBJECTIVE

To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA).

STUDY DESIGN

A prospective cohort study.

SETTINGS

Tertiary referral center.

METHODS

We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach's α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient.

RESULTS

Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong.

CONCLUSIONS AND RELEVANCE

The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity.

LEVEL OF EVIDENCE

Level 4.

The impact of chronic intermittent hypoxia on enzymatic activity in memory-associated brain regions of male and female rats

BACKGROUND

Obstructive sleep apnea (OSA) is an intermittent hypoxia disorder associated with cognitive dysfunction, including learning and memory impairments. There is evidence that alterations in protease activity and neuronal activation are associated with cognitive dysfunction, are dependent on sex, and may be brain region-specific. However, the mechanisms mediating OSA-induced cognitive impairments are unclear. Therefore, we used a rat model of OSA, chronic intermittent hypoxia (CIH) to investigate protease activity (e.g., calpain and caspase-3) on spectrin, a cytoskeletal protein associated with neurotransmitter release, and neuronal activation (early growth response protein 1, EGR-1) in brain regions associated with learning and memory.

METHODS

Male and female Sprague Dawley rats were exposed to CIH or room air (normoxic) for 14 days. We quantified protease activity and cleaved spectrin products, along with EGR-1 protein expression in hippocampal subregions (CA1, CA3), cortical regions [entorhinal cortex (ETC), retrosplenial cortex (RSC), cerebellar cortex (CC)], and subcortical regions [raphe nucleus (RN), locus coeruleus (LC)] associated with learning and memory. Within each group, Pearson correlations of calpain activity, caspase-3 activity, and EGR-1 expression were performed between brain regions. Sex differences within normoxic and CIH correlations were examined.

RESULTS

CIH dysregulated calpain activity in male ETC, and female CA1 and RSC. CIH dysregulated caspase-3 activity in male RN, and female CA1 and RSC. CIH decreased calpain and caspase-3 cleavage products in male ETC. CIH decreased calpain-cleaved spectrin in male RSC but increased these products in female RSC. EGR-1 expression was decreased in male and female RN. Correlational analysis revealed CIH increased excitatory connections in males and increased inhibitory connections in females. EGR-1 expression in males shifted from negative to positive correlations.

CONCLUSIONS

Overall, these data indicate CIH dysregulates protease activity and impairs neuronal function in a brain region- and sex-dependent manner. This indicates that males and females exhibit sex-specific vulnerabilities to mild OSA. These findings concur with our previous behavioral studies that demonstrated memory impairment in CIH-exposed rats.

The effect of continuous positive airway pressure therapy on atrial fibrillation in patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) stands as an autonomous risk factor for a broad spectrum of cardiovascular diseases, particularly atrial fibrillation (AF), which is closely associated with heightened morbidity and mortality rates. The intricate pathophysiological pathways linking OSA to AF encompass chronic intermittent hypoxia, disruptions in the autonomic nervous system, inflammatory responses, and alterations in ion channel function. Continuous positive airway pressure (CPAP) therapy emerges as the frontline treatment for moderate to severe OSA, effectively alleviating symptomatic manifestations and potentially mitigating cardiovascular risks. However, the influence of CPAP on AF among OSA patients remains a subject of debate. Some investigations underscore its beneficial effects, including the reversal of atrial remodeling, enhanced atrial conduction, decreased AF incidence, and improved outcomes post-AF ablation in CPAP-treated individuals. Conversely, other studies reveal neutral or insignificant impacts. This review delves into the repercussions of CPAP therapy on AF in OSA patients, exploring potential explanations for the discrepancies observed across existing research endeavors. By consolidating current evidence and pinpointing areas ripe for further inquiry, this review aspires to inform clinical decision-making regarding the management of OSA-related AF.

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

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

Sex Differences in Obstructive Patterns on Drug-Induced Sleep Endoscopy

OBJECTIVE

To identify and characterize sex differences in collapse patterns on drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea (OSA).

STUDY DESIGN

Retrospective cohort analysis.

SETTING

An outpatient tertiary care academic medical center.

METHODS

A retrospective cohort study at a single tertiary care institution was performed from 2020 to 2023. All adult patients who underwent a DISE were included in this study. Univariate and multivariate analyses were used to compare differences between males and females on DISE.

RESULTS

117 patients who underwent DISE were included in this study, including 30% females (n = 35). The average age was 54.7 years (SD 15.2), mean BMI was 28.6 kg/m2 (SD 4.1), and mean apnea-hypopnea index (AHI) was 32.3 events per hour (SD 21.3). Most patients had severe OSA (48.7%). There was no difference in palatine or lingual tonsil size between sexes. On DISE, a significantly lower proportion of females demonstrated complete oropharyngeal lateral wall collapse (25.7% females vs 51.2% males, P = .008). Multivariate analysis revealed that male sex was independently associated with the presence of complete collapse at the oropharynx (odds ratio [OR] 2.55, 95% confidence interval [CI] [0.005-1.868], P = .048) but not at other levels. Additionally, higher BMI was associated with any collapse (partial or complete) at the oropharynx (OR 1.30, 95% CI [0.131-0.392], P < .001).

CONCLUSION

This study demonstrates that a lower proportion of females have complete oropharyngeal lateral wall collapse even when controlling for BMI and AHI. Additional studies are needed to better understand the differences in OSA physiology between the sexes.

Prevalence and association analysis of obstructive sleep apnea in India: Results from BLESS cohort

BACKGROUND

Despite having the largest population in the world with 1.4 billion inhabitants, there is only scarce data on the prevalence of OSA from India.

RESEARCH QUESTION

This study aimed to find the prevalence of Obstructive Sleep Apnea (OSA) using Polysomnography (PSG) and current scoring rules (AASM 2012) in population and investigate OSA associations for cardiovascular and metabolic comorbidities.

STUDY DESIGN

and Methods: Participants were randomly selected among the accompanying attendants of patients admitted to a hospital in Bhopal, India and underwent level I PSG. Anthropometric measurements, blood investigations were taken. The primary outcome was prevalence of OSA, assessed by the Apnoea-Hypopnoea Index (AHI).

RESULTS

Level I PSG was performed on 1015 adult participants from December 2019 to February 2023; after excluding 57 participants with sleep time <240 min, 958 participants (age range 18-80 years) were finally included in this study. Median (IQR) age was 40.0 years (31.0, 49.0) while median (IQR) BMI was 23.5 (20.7, 26.8) Kg/m2. Prevalence (95 % CI) of moderate-to-severe OSA (AHI ≥15) and severe OSA (AHI≥30) was 30.5 % (28-34 %) and 10.1 % (8.3-12), respectively. The upper quartile of the AHI (Q4 ≥17) was independently associated with the presence of Diabetes Mellitus [OR 2.14 (95 % CI 1.07-4.44)], Hypertension [OR1.98 (95 % CI 1.20-3.28)] and Metabolic Syndrome [OR 2.36 (95 % CI 1.37-4.09)] compared to the first quartile AHI.

INTERPRETATION

OSA prevalence was found to be significantly higher than previously estimated in Indian population. Association of OSA with diabetes, hypertension, and metabolic syndrome was observed.

Changes in the Spatial Structure of Synchronization Connections in EEG During Nocturnal Sleep Apnea

This study involved 72 volunteers divided into two groups according to the apnea-hypopnea index (AHI): AHI>15 episodes per hour (ep/h) (main group, n=39, including 28 men, median AHI 44.15, median age 47), 0≤AHI≤15ep/h (control group, n=33, including 12 men, median AHI 2, median age 28). Each participant underwent polysomnography with a recording of 19 EEG channels. Based on wavelet bicoherence (WB), the magnitude of connectivity between all pairs of EEG channels in six bands was estimated: Df1 0.25;1, Df2 1;4, Df3 4;8, Df4 8;12, Df5 12;20, Df6 20;30 Hz. In all six bands considered, we noted a significant decrease in symmetrical interhemispheric connections in OSA patients. Also, in the main group for slow oscillatory activity Df1 and Df2, we observe a decrease in connection values in the EEG channels associated with the central interhemispheric sulcus. In addition, patients with AHI>15 show an increase in intrahemispheric connectivity, in particular, forming a left hemisphere high-degree synchronization node (connections PzT3, PzF3, PzFp1) in the Df2 band. When considering high-frequency EEG oscillations, connectivity in OSA patients again shows a significant increase within the cerebral hemispheres. The revealed differences in functional connectivity in patients with different levels of AHI are quite stable, remaining when averaging the full nocturnal EEG recording, including both the entire sleep duration and night awakenings. The increase in the number of hypoxia episodes correlates with the violation of the symmetry of interhemispheric functional connections. Maximum absolute values of correlation between the apnea-hypopnea index, AHI, and the WB synchronization strength are observed for the Df2 band in symmetrical EEG channels C3C4 (-0.81) and P3P4 (-0.77). The conducted studies demonstrate the possibility of developing diagnostic systems for obstructive sleep apnea syndrome without using signals from the cardiovascular system and respiratory activity.

The impact of chronic intermittent hypoxia on enzymatic activity in memory-associated brain regions of male and female rats

Background

Obstructive sleep apnea (OSA) is an intermittent hypoxia disorder associated with cognitive dysfunction, including learning and memory impairments. There is evidence that alterations in protease activity and neuronal activation as associated with cognitive dysfunction, are dependent on sex, and may be brain region-specific. However, the mechanisms mediating OSA-induced cognitive impairments are unclear. Therefore, we used a rat model of OSA, chronic intermittent hypoxia (CIH), to investigate protease activity (e.g., calpain and caspase-3) and neuronal activation (early growth response protein 1, EGR-1) in brain regions associated with learning and memory. We used a rat model of OSA known as chronic intermittent hypoxia (CIH) to investigate protease activity (calpain and caspase-3) and neuronal activation (early growth response protein 1, EGR-1) in brain regions associated with learning and memory.

Methods

Male and female Sprague Dawley rats were exposed to CIH or room air (normoxic) for 14 days. We quantified protease activity and cleaved spectrin products, along with EGR-1 protein expression in hippocampal subregions (CA1, CA3), cortical regions [entorhinal cortex (ETC), retrosplenial cortex (RSC), cerebellar cortex (CC)], and subcortical regions [raphe nucleus (RN), locus coeruleus (LC)] associated with learning and memory. Within each group, Pearson correlations of calpain activity, caspase-3 activity, and EGR-1 expression were performed between brain regions. Sex differences within normoxic and CIH correlations were examined.

Results

CIH dysregulated calpain activity in male ETC and female CA1 and RSC. CIH dysregulated caspase-3 activity in male RN and female CA1 and RSC. CIH decreased calpain and caspase-3 cleavage products in male ETC. CIH decreased calpain-cleaved spectrin in male RSC but increased these products in female RSC. EGR-1 expression was decreased in male and female RN. Correlational analysis revealed CIH increased excitatory connections in males and increased inhibitory connections in females. EGR-1 expression in males shifted from negative to positive correlations.

Conclusions

Overall, these data show that CIH dysregulates protease activity and impairs neuronal function in a brain region- and sex-dependent manner. This indicates that males and females exhibit sex-specific vulnerabilities to mild OSA. These findings concur with our previous behavioral studies that demonstrated memory impairment in CIH-exposed rats.

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 mediating effect of TyG and its derived indices in the association between OSAHS and atherosclerosis in patients with T2DM

OBJECTIVE

Triglyceride-glucose index (TyG) and its derived indices which better reflect metabolic disturbances on atherosclerosis has not been reliably compared in patients with type 2 diabetes mellitus (T2DM). Besides, obstructive sleep apnea hypopnea syndrome (OSAHS), a driver of atherosclerosis (AS), can exacerbate metabolic disturbances strongly. The aim of this study is to explore the mediating effect of glycolipid metabolism on the association between OSAHS and arterial stiffness in T2DM patients.

METHODS

154 T2DM patients were involved in this study and were split into two groups: T2DM and T2DM + AS. Logistic regression analysis determined the accurate effects of different factors on the AS of T2DM patients. The capacity of TyG and the indices it derives to predict AS was assessed using the receiver operating characteristic (ROC) curve. Mediation analysis was employed to investigate the mediating effect of TyG and its derived indices on the association between OSAHS and arterial stiffness in T2DM patients.

RESULTS

OSAHS, TyG, and its derived indices were independent risk factors for AS in T2DM patients. Stratified by age, the hazardous effects of TyG and its derived indices remained significant in T2DM patients aged ≥ 50 years, but not in those aged < 50 years. In T2DM patients aged ≥ 50 years, the novel indices have a high predictive value for AS, with TyG-BMI exhibiting the largest AUC(AUC:0.788;95% CI:0.647 ∼ 0.928; P < 0.001). The mediation analysis results indicated that in T2DM patients aged ≥ 50 years, TyG, TyG-BMI, TyG-WC, and TyG-WHtR acted as potential mediators in the association between OSAHS and AS, with mediation effects of 33.42%, 48.2%, 37.7%, and 40.21%, respectively. However, there was no significant mediating effect observed in the younger patients.

CONCLUSION

TyG and its derived indices are strongly correlated with AS in T2DM patients, of which TyG-BMI has the best predictive performance. Besides, OSAHS partially exerts its atherogenic effect through glucolipid metabolism disorder in the T2DM population aged ≥ 50 years, while it mainly exerts a direct atherogenic effect in patients aged < 50 years.

Mandibular device treatment in obstructive sleep apnea -A structured therapy adjustment considering night-to-night variability night-to-night variability in mandibular devices

BACKGROUND

Mandibular advancement devices (MAD) are a well-established treatment option for obstructive sleep apnea (OSA). MAD are considered preferably for patients with mild to moderate OSA presenting with a elevated night-to-night variability (NNV). This study aimed to determine the treatment effect of MAD on NNV considering different protrusion distances and patient related outcome (PRO).

METHODS

We conducted a prospective cohort analysis of patients before MAD with 60% and 80% of the maximum protrusion. OSA severity was assessed using a home-sleep test for two consecutive nights. PRO contained the Epworth Sleepiness Scale (ESS) and sleep related quality of life (FOSQ).

RESULTS

Twenty patients with a median overweight body-mass-index of 27.1 (interquartile range (IQR) 16.3 kg/m²), with a mainly mild to moderate OSA with an apnea -hypopnea index (AHI) of 18.3 / h (IQR 17.7) and elevated ESS of 12.5 (IQR 8.0) were included. As opposed to 80%, 60% protrusion significantly but not 80% relevantly reduced AHI (60%%: 11.2 (IQR 5.5)/h, p = 0.01; 80%: 12.9 (IQR18,0)/h, p = 0.32) and improved the ESS (60%: 8.0 (IQR 10,0); 80%: 10 (IQR 9.0)), with therapy settings. No correlation could be detected between NNV and ESS, and FOSQ changes. Higher baseline NNV was associated with severe OSA (p = 0.02) but not with gender, overweight, or status post-tonsillectomy.

CONCLUSIONS

OSA improvement is associated with lower NNV; both OSA and NNV are connected to the degree of protrusion. Therefore, higher NNV does not justify the exclusion of candidates for MAD treatment. PRO changes are not visibly affected by NNV but by general OSA changes. These findings may help to define and optimize future study designs for the primary outcome decision between objective OSA parameters and PRO.

Association Between Sleep Position, Obesity, and Obstructive Sleep Apnea Severity

BACKGROUND

This study examines the relationship between obstructive sleep apnea severity, sleep position, and body weight, particularly focusing on the negative impact of sleeping in a supine position combined with being overweight in a population-based sample.

METHODS

The Apnea-Hypopnea Index (AHI) was utilized as a marker of OSA severity and sleep position from a standardized overnight polysomnography. Participants were categorized by body mass index (BMI) (kg/m2) into normal weight/underweight (<25) and overweight (≥25).

RESULTS AND CONCLUSIONS

The results indicated a higher mean Apnea-Hypopnea Index for those sleeping in the supine position compared to other positions, with overweight individuals experiencing a proportionally greater impact from sleep position than their normal-weight counterparts.

Predictors and Prevalence of Severe Obstructive Sleep Apnea: A Cross-Sectional Study in Erbil, Kurdistan Region, Iraq

Background Obstructive sleep apnea (OSA) is a common sleep disorder that's characterized by episodes of a complete or partial collapse of the upper airway with an associated decrease in oxygen saturation or arousal from sleep. According to the American Academy of Sleep Medicine (AASM), OSA is categorized based on polysomnography findings into mild, moderate, and severe. Objectives This study aims at determining the prevalence of the severities of OSA in Erbil, Kurdistan Region of Iraq, as well as discovering the predictors for severe OSA. Methods This was a cross-sectional study that was carried out from December 2021 to July 2023 on patients displaying OSA symptoms in a sleep study section of a private clinic in Erbil, Kurdistan Region of Iraq. A detailed questionnaire was designed to collect the data, and IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze it. The polysomnography device used for the diagnosis of OSA was a Philips Respironics Alice NightOne home device, and Philips Respironics Sleepware G3 (Koninklijke Philips N.V., Amsterdam, Netherlands) was used to analyze the sleep data. Results A sample size of 328 OSA cases was analyzed. The results revealed a prevalence of 47% (155) for severe OSA. Apnea-hypopnea index (AHI) was negatively correlated with lowest and average oxygen saturation, while it was positively correlated with time spent with oxygen saturation under 89%, body mass index (BMI), and weight of the participants. Furthermore, stepwise multiple regression tests revealed BMI, age, gender, and heart failure as independent predictors for AHI. Conclusion This study highlights the links between OSA and various chronic health conditions. Furthermore, it underscores the importance of factors like age, obesity, and gender in influencing OSA severity. The identification of predictors for OSA severity can assist in risk assessment and personalized interventions.

Prevalence and Risk Factors for Secondary Hypertension in Young Adults

BACKGROUND

The prevalence of secondary causes of hypertension in young adults is unknown, and therefore, there is no consensus about the indication of screening of secondary hypertension (2HTN) in this population. The objective was to report the prevalence and the causes of 2HTN in young subjects.

METHODS

In this cross-sectional study, 2090 patients with confirmed hypertension aged 18 to 40 years with full workup for 2HTN screening were included. We assessed the prevalence of 2HTN and analyzed the factors associated.

RESULTS

Among 2090 patients, 619 (29.6%) had a 2HTN. The most frequent diagnoses of 2HTN in descending order were primary aldosteronism (n=339; 54.8%), renovascular hypertension (n=114; 18.4%), primary kidney disease (n=80; 12.9%), pheochromocytoma/functional paraganglioma (n=37; 5.9%), hypertension caused by drugs or substances (n=32; 6.0%), and other diagnoses (n=17; 2.7%). Patients with blood pressure <160/100 mm Hg did not have a lower prevalence of 2HTN regardless of the number of treatments. The prevalence of 2HTN was higher in the decade between 30 and 40 years of age than between 18 and 30 years of age (P=0.024). Female sex, hypokalemia, treatment with at least 2 medications, no familial history of hypertension, body mass index <25 kg/m², and diabetes were associated with a higher prevalence of 2HTN.

CONCLUSIONS

The prevalence of 2HTN is high among young patients with hypertension (29.6% in our cohort), regardless of age and blood pressure level. All patients with hypertension under 40 years of age should be screened for secondary causes.

Evaluation and Management of Perioperative Pulmonary Complications

Pulmonary complications are very common after noncardiac surgery and can be easily overlooked. If not properly screened for or evaluated these can in many instances lead to postoperative respiratory failure or even death. Decisions regarding ambulatory versus inpatient surgery, modality of anesthesia, protective ventilation and method of weaning, type of analgesia, and postoperative monitoring can be crucial to avoid such complications.

Tonsillectomy May Not Be the Answer in All OSA Cases

Tonsillectomy is considered the standard of care in patients with obstructive sleep apnea (OSA) and large tonsils; however, there are selected cases where this procedure should not be considered. We present two patients with tonsil grade 4 and severe OSA where tonsillectomy was not the solution for their problem and could be a superfluous procedure. In our experience, a preoperatory drug-induced sleep endoscopy (DISE) and proper patient phenotyping will prevent this type of surgical failure.

Stated patient preferences for overnight at-home diagnostic assessment of sleep disorders

PURPOSE

The diagnostic workup for assessment of sleep disorders commonly involves overnight testing to assess sleep patterns and pathological events. So far, little is known about preferences for provision of home sleep tests to patients with sleep disorders. This study aims to close this gap by eliciting preferences for home sleep testing using a discrete choice experiment (DCE).

METHODS

A DCE with seven attributes of at-home sleep testing and three levels per attribute was developed using a fractional factorial design. Patients with and without previous sleep testing experience were recruited from two large sleep centers in Germany. Coefficients for attribute levels were calculated using a conditional logit model to estimate their influence on choice decisions and calculate the relative importance of each attribute.

RESULTS

305 patients (54.5 ± 13,1 years, 65.3% male) were enrolled, and 288 surveys with complete data included for analysis. Attributes with greatest relevance were Waiting time to discuss sleep study results; Waiting time to conduct sleep study, and Sleep quality during measurement. Of lowest importance was Diagnostic accuracy of sleep study, followed by Effort to apply sleep study device. Significant heterogeneity in choice behavior was found, including differences by gender, willingness-to-pay for sleep studies, and previous experience with sleep studies. Preferred location for conducting sleep testing was at-home in 50.7% and in-lab in 46.9%.

CONCLUSIONS

Preferences and relative importance of home sleep test attributes vary among different subgroups. Considering those preferences can be important for clinicians and policymakers when designing care pathways and planning of testing policies for sleep disorders.

Disparities in polysomnography referral in a high-risk cardiac population

PURPOSE

Obstructive sleep apnea (OSA) is associated with metabolic, cardiovascular, and cerebrovascular comorbidities. Appropriate diagnosis and treatment of OSA might mitigate these comorbidities. This retrospective review sought to assess the impact of sex, age, race, ethnicity, and insurance status on polysomnography (PSG) referral rates.

METHODS

An institutional STOP-Bang database of 299,320 patients was filtered for patients admitted to the hospital with an acute cardiac diagnosis between 2015-2020. A cohort of 4,735 patients were risk stratified by STOP-Bang (SB) score and correlations were made between PSG referrals and demographic and clinical variables (sex, age, race, ethnicity, and insurance status).

RESULTS

Of the 25.3% of the cohort with high SB scores (5-8) only 21.3% were referred for PSG. Age and female sex were negatively associated with sleep study referrals (p < 0.001). No correlation was found between sleep study referral rates and race or ethnicity. No correlation was found between sleep study referrals and insurance provider. Admitting cardiac diagnosis significantly influenced sleep study referrals with diagnoses of arrhythmias and myocardial infarction being associated with an increased rate of PSG referrals compared to heart failure patients (p < 0.002).

CONCLUSIONS

Our study found no significant correlation between PSG referral rates and race, ethnicity, or insurance provider. However, we found low overall rates of PSG referral, with negative correlations between older age and female sex and a high-risk cardiac population. This represents a substantial missed opportunity to identify patients at risk for OSA, obtain a diagnosis, and provider adequate treatment.

Exploring the link between vitamin D deficiency and obstructive sleep apnea: A comprehensive review

Despite the high prevalence and significant health burden of obstructive sleep apnea (OSA), its underlying pathophysiology remains incompletely understood. This comprehensive review explores the emerging connection between vitamin D deficiency and OSA, discusses potential mechanisms underlying this association, and explores the therapeutic implications of these findings. Recent research has consistently highlighted the high incidence of vitamin D deficiency among patients with OSA, which often occurs independently of geographical location. This suggests that factors beyond lack of sunlight exposure may be involved. This review also discusses how reduced vitamin D may be associated with more severe manifestations of OSA. In addition, it explores the potentiality of using vitamin D supplements as a therapeutic strategy for OSA, noting that some studies have found improvements in sleep quality and a reduction in OSA severity. Potential mechanisms are proposed, including the role of vitamin D deficiency in promoting inflammation, oxidative stress, hypoxia, impairing immune function, muscle function, and gene polymorphism of vitamin D receptors, all of which could contribute to the pathogenesis of obstructive sleep apnea. The paper underscores the need for future research to validate these observations, to determine optimal vitamin D supplementation dosage and duration, to explore potential side effects and risks, and to investigate potential interactions with other treatments.

Undergraduate dental sleep medicine teaching at German university dental schools - a questionnaire-based survey

PURPOSE

Diagnosing and treating obstructive sleep apnea (OSA) requires fundamental understanding of sleep medicine, including training and clinical experience. So far, dental sleep medicine (DSM) has not yet become a mandatory part of dental education in Germany. This questionnaire-based survey for both lecturers and students aimed to evaluate DSM education among undergraduate students.

METHODS

A structured questionnaire was sent to the managing directors and student councils of all 30 German university dental schools. The questionnaire contained 13 questions on teaching quantity and content, lecturers' knowledge, and future interest in DSM. For each university dental school, only one questionnaire should be completed by the student council and the managing director. A scoring system assessed lecturers' knowledge based on clinical experience and qualifications. Descriptive data and correlation coefficients were calculated (P < 0.05).

RESULTS

The responses of 24 lecturers (80%) and 28 students (93.3%) could be evaluated. DSM was reported to be included in the curriculum by 14 lecturers (58.3%) and 4 students (14.3%). Mean teaching hours per semester were 1.4 ± 1.4 h (lecturers) and 0.2 ± 0.6 h (students) accordingly. Greater knowledge of lecturers in DSM was positively correlated with the inclusion of DSM in the curriculum (P = 0.022) and with the number of teaching hours per semester (P = 0.001).

CONCLUSION

Postgraduate education and incorporating DSM knowledge into undergraduate education ("Teach the Teacher") seems to play a key role in fundamentally training future dentists in this field.

Portable polygraphic device (Somnocheck micro CARDIO®) provides accurate diagnostic information in psychiatric patients at risk for obstructive sleep apnoea: an observational cohort study

BACKGROUND

Symptoms of obstructive sleep apnoea (OSA) overlap significantly with those of psychiatric disorders, making accurate diagnosis of OSA challenging within psychiatric settings. Diagnosing OSA in psychiatric patients is crucial because untreated OSA can exacerbate psychiatric symptoms, reduce treatment efficacy, and impair overall quality of life. This study aimed to determine the diagnostic accuracy of a readily accessible procedure for psychiatric patients in a real-world clinical setting by comparing the Somnocheck micro CARDIO® (SCm) portable cardiorespiratory polygraphy device with the gold standard polysomnography (PSG).

METHODS

This observational cohort study included consecutive psychiatric patients at intermediate to high risk for OSA based on screening with the STOP-Bang questionnaire, admitted to a single tertiary care centre between June 1, 2016 and December 31, 2022. The Apnoea-Hypopnoea-Index (AHI), Apnoea-Index (AI), Oxygen-Desaturation-Index (ODI), and minimum oxygen saturation were measured sequentially by SCm and PSG.

RESULTS

A total of 57 patients were analysed (median age 62.0 [Interquartile Range (IQR), 51.5-72.5] years; 34 [59.6%] men). Regarding AHI, no significant differences (AHI measured by PSG, median, 16.6 [IQR, 6.2-26.7] vs. AHI measured by SCm, median, 14.9 [IQR, 10.0-22.8]; p = 0.812; r = 0.71) were found between SCm and PSG. AI, ODI and minimum oxygen saturation differed significantly between SCm and PSG. Using optimised cut-off values (any OSA: AHISCm ≥ 9.25), SCm showed high sensitivity (0.894) and high specificity (0.800) for the diagnosis of OSA, with an area under the receiver operating characteristic curve of 0.877.

CONCLUSIONS

This study found that the SCm portable device was accurate in identifying psychiatric patients with OSA. AHI measurement by SCm provided reliable diagnostic performance in comparison with the gold standard polysomnography. These findings support the integration of polygraphic measurements into the routine sleep assessment of psychiatric patients. Early and accurate diagnosis of OSA in this population can significantly improve the management of both sleep disorders and psychiatric conditions, potentially enhancing overall treatment outcomes and quality of life for these patients.

Age modifies the association between severe sleep apnea and all-cause mortality

PURPOSE

While sleep apnea (SA) gets more prevalent with advancing age, the impact of age on the association between SA and health outcomes is not well known. We assessed the association between the severity of SA and all-cause mortality in different age groups using large longitudinal data.

METHOD

We applied a Natural Language Processing pipeline to extract the apnea-hypopnea index (AHI) from the physicians' interpretation of sleep studies performed at the Veteran Health Administration (FY 1999-2022). We categorized the participants as no SA (n-SA, AHI< 5) and severe SA (s-SA, AHI≥30). We grouped the cohort based on age: Young≤40; Middle-aged:40-65; and Older adults≥65; and calculated the odds ratio (aOR) of mortality adjusted for age, sex, race, ethnicity, BMI, and Charlson-Comorbidity Index (CCI) using n-SA as the reference.

RESULTS

We identified 146,148 participants (age 52.23 ± 15.02; BMI 32.11 ± 6.05; male 86.7 %; White 66 %). Prevalence of s-SA increased with age. All-cause mortality was lower in s-SA compared to n-SA in the entire cohort (aOR,0.56; 95%CI: 0.54,0.58). Comparing s-SA to n-SA, the all-cause mortality rates (Young 1.86 % vs 1.49 %; Middle-aged 12.07 % vs 13.34 %; and Older adults 26.35 % vs 40.18 %) and the aOR diminished as the age increased (Young: 1.11, 95%CI: 0.93-1.32; Middle-aged: 0.64, 95%CI: 0.61-0.67; and Older adults: 0.44, 95%CI: 0.41-0.46).

CONCLUSION

The prevalence of severe SA increased while the odds of all-cause mortality compared to n-SA diminished with age. SA may exert less harmful effects on the aged population. A causality analysis is warranted to assess the relationship between SA, aging, and all-cause mortality.

Sleep Disordered Breathing and Neurocognitive Disorders

Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders.

Association between triglyceride glucose-body mass index and obstructive sleep apnea: a study from NHANES 2015-2018

Background

The association between TyG-BMI index and the risk of obstructive sleep apnea (OSA), a recently identified biomarker indicating insulin resistance, has yet to be elucidated. Therefore, this study aimed to investigate the association between TyG-BMI index and the risk of OSA using the NHANES database.

Methods

Analyses were performed on NHANES data conducted between 2015 and 2018. Logistic regression, stratified analyses, curve-fitting analyses, and threshold effects analyses were utilized to assess the association between TyG-BMI index and the risk of OSA.

Results

The study included 4,588 participants. Multifactorial logistic regression analyses found a significant association between TyG-BMI and increased risk of OSA [OR: 1.54 (CI:1.39-1.70)]. In stratified analyses, age interacted with the association, with TyG-BMI being associated with increased risk of OSA only in a subgroup of subjects younger than 60 years [1.31 (1.14-1.50)], but gender, smoking status, and alcohol use, did not influence the association. The presence of diabetes, hypertension, and cardiovascular diseases also modified the association, but the number of the included subjects with such conditions was significantly lower, therefore the significance of associations was not observed in those subgroups. Additionally, the risk was non-linearly associated, with the inflection point of TyG-BMI at 12.09, after which the lower slope in the risk was observed.

Conclusion

This study demonstrates that elevated levels of the TyG-BMI index are correlated with risk for OSA, underscoring the significance of these findings in facilitating early prevention or timely intervention for OSA.

Evaluation of an OSA Risk Screening Smartphone App in a General, Non-Symptomatic Population Sample (ESOSA)

Background: Obstructive Sleep apnea (OSA) is a prevalent sleep disorder, risk factor for cardiovascular disease and imposes a substantial global socioeconomic and health burden. OSA is insufficiently diagnosed as it often presents with unspecific or no symptoms. This study compares the effectiveness of a smartphone-based screening method to polysomnography (PSG) in a general, non-symptomatic population sample. Methods: Adult subjects were recruited from the general population. Subjects reporting OSA-related symptoms suggesting an increased OSA risk were excluded. Included subjects underwent Type-II PSG and a parallel breathing sound analysis using the Snorefox M smartphone app. The PSG scores were compared with the results of the Snorefox M app for its ability to detect moderate to severe OSA (AHI ≥ 15). Results: 150 subjects were included. All subjects completed the diagnostic night, no adverse events occurred. A valid analysis result was obtained for 142 subjects. A total of 24% of subjects had moderate to severe OSA based on the PSG results. The Snorefox M software app showed a sensitivity of 0.91 (0.76, 0.98), specificity of 0.83, PPV of 0.63 (0.48, 0.77), and NPV of 0.97 (0.91, 0.99) to detect AHI ≥ 15 compared with the reference PSG (95% CI). Conclusions: This study compares for the first time, the performance of an app-based OSA screening tool with PSG in a non-symptomatic population sample. Easily accessible screening tools can play a role in complementing existing diagnostic possibilities, helping to increase the diagnosis rate, with a positive effect on cardiovascular health in a relevant population share.

Gender differences in oral appliance treatment of obstructive sleep apnea

PURPOSE

Although overall success rates for treating obstructive sleep apnea (OSA) with an oral appliance (OA) are high, they are significantly higher among females. To verify published data, the study's purpose was to evaluate a participant sample after one year of OA use. The primary outcome was treatment response, with responders defined as having an apnea-hypopnea index (AHI) < 10 at follow-up and/or reduced by ≥50% of baseline. Secondary measures were from standardized questionnaires.

METHODS

A sample of 314 participants, predominately with moderate-to-severe OSA, were enrolled and instructed to use an OA every night. At baseline and one-year follow-up, polygraphic recordings and questionnaires, including sleepiness (measured using the Epworth sleepiness scale) and quality-of-life (measured using the Functional Outcomes of Sleep Questionnaire), were collected.

RESULTS

Among the 314 participants, 192 completed the one-year evaluation: 51 females (27%) and 141 males (73%). Overall, OA treatment resulted in 78% and 77% responders among females and males, respectively. Neither the difference in improvement nor the absolute change in AHI differed significantly based on gender, at any OSA severity level. There were no significant gender differences in sleepiness or quality of life. Treatment-related adverse reactions were more common among females.

CONCLUSION

Both females and males with OSA respond well to OA therapy, with nonsignificant gender differences in outcomes. Thus, the hypothesis that females respond better to OA treatment is rejected.

Bed partner perception of CPAP therapy on relationship satisfaction and intimacy-A European perspective from the ESADA network

Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.