Epidemiology of obstructive sleep apnea: a population health perspective

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.

Sex Hormones, Sex Hormone-Binding Globulin and Sleep Problems in Females With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVE

Sleep problems like obstructive sleep apnea (OSA) are common in polycystic ovary syndrome (PCOS), although the underlying mechanisms are not well understood. We aimed to determine the prevalence of sleep problems, synthesise and appraise studies analysing the associations between serum sex hormones, sex hormone-binding globulin (SHBG) and sleep problems in females with PCOS.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search using MEDLINE, Embase, PsycInfo, CINAHL, Scopus, and Google Scholar was performed till 3 August 2024. Studies that examined serum sex hormones, SHBG or hyperandrogenism with sleep disorders and/or sleep disturbances in PCOS were eligible. Random effects meta-analyses of sex hormones and SHBG among females with PCOS with compared to without OSA were conducted.

RESULTS

From 4487 screened studies, 24 were included, with nine suitable for meta-analyses. Among females with PCOS, 46.0% had OSA and 56.0% had other sleep disturbances. SHBG levels were significantly lower in women with PCOS and OSA compared to those without OSA (standardised mean difference = -0.62; 95% CI = -0.82 to -0.42; I2 = 0%; 179 participants; p < 0.00001), but no differences were seen in total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, and oestradiol. No significant associations between serum sex hormones, SHBG or hyperandrogenism with sleep disturbances in PCOS were observed.

CONCLUSION

SHBG, rather than hyperandrogenism, may play a more important mechanistic role for OSA in PCOS, while other sleep disturbances exhibit a less severe SHBG profile. These findings enhance comprehension of underlying pathophysiology of sleep problems in PCOS. Further validation across PCOS populations is warranted.

Evaluation of a Hub-And-Spoke Model of Care for the Delivery of Sleep Disorder Services to a Remote Australian Community Using the RE-AIM Framework: A Controlled Before-And-After Implementation Outcome Study

OBJECTIVES

To evaluate a Hub-and-Spoke design for providing sleep disorder services in a very remote community. The health service re-design aimed to provide unattended polysomnography at the Spoke site with access to attended laboratory studies at the Hub when clinically indicated.

METHODS

Summative evaluation using the RE-AIM Framework including all adult patients referred for diagnosis and management of a suspected sleep disorder from Remote Health Service to Metropolitan Health Service 2 years pre-implementation and 1 year post-implementation.

DESIGN

Controlled before-and-after implementation outcome study.

SETTING

Public hospital in metropolitan South-East Queensland with a comprehensive accredited sleep disorder service (Hub), networked to a Community Health Centre (Spoke), located in a very remote region defined by the Modified Monash Model in central Queensland.

MAIN OUTCOMES MEASURES

Referral numbers (Reach), travel avoidance and consumer satisfaction (Effectiveness), number of referrers (Adoption), unattended sleep study data quality, timeliness to testing, health service costs (Implementation), and referral numbers beyond initial 12-month pilot (Maintenance).

RESULTS

The Hub-and-Spoke model increased adoption five-fold by local referrers and resulted in a nine-fold increase in reach. Effectiveness was demonstrated through high levels of consumer satisfaction, and all implementation aims were met, including providing services at a lower cost. Sustainability was demonstrated through ongoing referrals and the transition of the model of care to business as usual.

CONCLUSION

Hub-and-Spoke designs for public sleep disorder services are effective at both the individual and organisational levels. Services can be delivered at a lower cost and, importantly, improve access to specialist services in remote and very remote communities.

Contrasting effects of acute versus chronic intermittent hypoxia on leptin secretion in differentiated human adipocytes - Implications for sleep apnea

Obstructive sleep apnea (OSA) is a common sleep disorder associated with repetitive episodes of nocturnal intermittent hypoxia (IH), obesity and elevated leptin. Newly diagnosed OSA patients have a history of significant recent weight gain. While IH is implicated in OSA pathophysiology, the factors contributing to weight gain in OSA are not completely understood. Leptin is an adipokine with a central role in energy homeostasis and appetite control. Increases in leptin suppress appetite, while decreases in leptin increase appetite and may consequently cause weight gain. Using an in vitro approach, we examined the role of acute and chronic IH exposure on leptin secretion in differentiated human white preadipocytes. We show that acute 24-h exposure to IH and sustained hypoxia both increased leptin secretion, compared to normoxic controls (p = 0.01). In contrast, chronic repetitive IH exposure for 7 days decreased leptin secretion, compared to normoxic controls (p = 0.02). The decrease in leptin secretion during chronic IH exposure suggests a mechanism which may contribute to increased appetite and thereby predispose patients with untreated OSA to weight gain and obesity in early stages. As obesity progresses, leptin levels likely rise secondary to the increase in body fat. Elevated leptin levels in patients with longstanding OSA may be indicative of increased fat mass and not a consequence of IH-mediated effects on adipocytes.

Prevalence of Sleep Apnea in Patients with Syncope of Unclear Cause: SINCOSAS Study

Background and Objectives: The association between syncope and sleep apnea (SA) has been scarcely investigated. Dysfunction of the autonomic nervous system (ANS) may represent a shared pathophysiological mechanism. This study aimed to determine the prevalence of SA in patients with syncope of unclear cause (SUC), identify potential associated factors, and evaluate nocturnal heart rate variability (HRV) as a marker of ANS function. Materials and Methods: A prospective cohort study was conducted in adult patients diagnosed with SUC. Nocturnal cardiorespiratory polygraphy was performed to detect the presence of SA. A range of variables potentially associated with SA was collected. Both SA diagnosis and HRV parameters were assessed using the Embletta® MPR polygraph system. Results: A total of 156 patients were enrolled (57% male), with a mean age of 64 years and a mean body mass index of 27.5 kg/m2 (range: 24.8-32.2). Hypertension was present in 46% of the cohort. The overall prevalence of SA was 78.2% (95% CI: 71.7-84.4%), with 28.7% classified as severe. Age (OR = 1.04; 95% CI: 1.01-1.07) and BMI (OR = 1.17; 95% CI: 1.06-1.28) were independent predictors of SA. Mean RR interval was significantly lower in patients with SA compared to those without (942 ms vs. 995 ms; p = 0.04). No significant differences in HRV parameters were observed between the two groups. Conclusions: This study found a high prevalence (nearly 78%) of SA among adult patients with SUC, particularly in individuals over 50 years of age and those who were overweight. However, this association could not be predicted based on clinical variables alone. No significant differences in nocturnal HRV were detected between patients with SUC with and without SA.

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.

Obesity and its associations with autonomic and cognitive functions in the general population

BACKGROUND

Obesity poses a significant global health burden. This study aimed to investigate the prevalence of obesity in Mongolia and its associations with autonomic and cognitive functions while considering potential psychosocial risk factors.

METHODS

This population-based, cross-sectional study included 382 participants who underwent physical examinations, completed health-related questionnaires, and participated in heart rate variability (HRV) testing for autonomic assessment and the mini-mental state examination for cognitive evaluation.

RESULTS

Obesity prevalence was 28.1% (age-sex adjusted). Individuals with obesity were more likely to be older, married, have lower education, and engage in less physical activity. They exhibited autonomic imbalance, decreased autonomic nervous system activity, lower cognitive function, and sleep disturbances compared to the individuals without obesity. Body mass index, and waist circumference inversely correlated with HRV indices. Female sex, lower education, apartment living, alcohol consumption, sleep disturbances, and autonomic dysfunction emerged as significant risk factors for obesity. Independent predictors of autonomic dysfunction included systolic blood pressure, physical activity, and neck circumference, while age, education, height, sleep apnea, and autonomic dysfunction predicted cognitive decline. Furthermore, generalized linear mediation models revealed a partial mediation effect of autonomic dysfunction on the association between obesity and cognitive decline.

CONCLUSION

This study highlights a high prevalence of obesity in the general population (28.1%) and identifies distinct characteristics associated with the condition. Furthermore, our findings suggest a potential indirect effect of obesity on cognitive function, mediated by autonomic dysfunction. Further research is needed to elucidate the causal relationships and develop targeted interventions for high-risk groups (females, individuals with lower education) and promotion initiatives of healthy lifestyles (less alcohol, exercise, and sleep hygiene) to address both obesity and its associated health complications, including autonomic dysfunction.

Glutamate stress in the caudal nucleus tractus solitarii (nTS): Impact on respiratory function and synaptic signaling in an Alzheimer's disease model

Respiratory dysfunction is a prevalent comorbidity in Alzheimer's disease (AD), yet its underlying mechanisms are poorly understood. Using the Streptozotocin (STZ) -induced rat model of AD, which replicates respiratory dysfunction and brain pathologies observed in human AD, we analyzed how these impairments relate to central neurological integration within the peripheral chemoreflex. Our focus was on glutamatergic signaling at the synapse between peripheral chemoafferents and second-order neurons in the nucleus tractus solitarii (nTS), a critical brainstem center for respiratory control. Activating the peripheral chemoreflex with potassium cyanide (KCN) increased respiratory frequency. Response magnitudes to repeated KCN injections typically decreased over time, which was exacerbated in the STZ-AD group. Similarly, repeated glutamate nanoinjections into the caudal/commissural nTS caused a pronounced reduction of respiratory frequency responses in STZ-AD. Electrophysiological analysis of nTS neurons within the peripheral chemoreflex revealed increased network activity, enhanced excitatory postsynaptic currents evoked by solitary tract stimulation (TS-EPSCs), and elevated asynchronous glutamate release following high-frequency stimulation (aEPSCs). These data were consistent with molecular evidence for astrogliosis (elevated GFAP expression), reduced astrocytic glutamate uptake (decreased EAAT2 expression), and presynaptic calcium dysregulation (increased TRPV1 expression). Additionally, presynaptic metabotropic glutamate receptors (mGluR3) were downregulated, while postsynaptic ionotropic receptor expression remained unchanged. With high-frequency solitary tract stimulation, STZ-AD rats had greater frequency-dependent TS-EPSC depression than controls, mirroring the diminished respiratory responses to KCN and glutamate nanoinjections. Our findings connect neurophysiological and molecular changes at the first nTS synapse of the peripheral chemoreflex with impaired respiratory responses to hypoxia in the STZ-AD model.

Immediate Postoperative Changes After Expansion Pharyngoplasty and Hypoglossal Nerve Stimulation

OBJECTIVE

Patients with obstructive sleep apnea (OSA) are at an increased risk for perioperative cardiopulmonary complications. Our objective was to assess the postoperative effects of hypoglossal nerve stimulation implantation (HGNS) and expansion pharyngoplasty (EP) on longitudinal sleep apnea measures as a surrogate for respiratory complications.

STUDY DESIGN

Prospective longitudinal cohort study of patients with OSA undergoing HGNS or EP.

METHODS

Sleep studies were performed with the NightOwl Mini peripheral arterial tonometry (PAT) device. Changes in apnea-hypopnea index (AHI) and oximetry time below 90% (T90) were assessed between two baseline PAT studies prior to surgery and nightly PAT studies for the first postoperative nights (PON) 1-7, 10, and 14.

RESULTS

Thirty patients were enrolled (19 HGNS, 11 EP). The mean age was 52.6 years, 76.7% were male, and the mean clinical baseline AHI was 29.8/h. There were no significant changes in the AHI or T90 following HGNS implantation. Following EP, there was a statistically significant mean increase in AHI of +19.2/h on PON1, +24.9/h on PON2, and + 20/h on PON3 compared to baseline. T90 was also elevated after EP on PON1, 4, and 5. The mean increase in T90 was +7.4% (95% CI 2.9, 11.9) on PON1 compared to baseline.

CONCLUSIONS

In the immediate postoperative period, there were no significant changes in AHI or hypoxemia after HGNS, suggesting that there is no need for routine overnight observation after HGNS. There were significant increases in AHI and hypoxemia after EP suggesting that postoperative disposition should be considered on a case-by-case basis.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:1836-1842, 2025.

Effect of multi-level upper airway surgery on obese patients with obstructive sleep apnea

PURPOSE

Obesity is a major risk factor in Obstructive sleep apnea (OSA), which is a prevalent disease that leads to significant morbidity. Multi-level Sleep Surgery (MLS) is a method of treatment for patients who cannot tolerate continuous positive airway pressure. Obesity has previously been identified as a risk factor that may decrease the success rate of MLS. The purpose of our study is to assess the success rates of MLS in obese patients.

METHODS

A retrospective cohort study in 109 adults that underwent MLS in our institution. All the participants completed pre-operative and post-operative level 1 polysomnography. They were divided into four groups as per their body mass index (BMI): Normal (BMI < 25), overweight (25-30), obese (30-35), morbid obese (> 35) and the variables were compared. We measured the surgical success as defined by Sher Criteria (AHI drop > 50% from preoperative baseline and AHI < 20) and cure rates (AHI < 5).

RESULTS

The average BMI was 30.9 pre-op and 30.4 post-op. The mean AHI was 29.8 pre-op and decreased to 10.1 (p < 0.001) and the Epworth Sleepiness Scale from 12.9 to 4.8 (p < 0.001). There were 13, 31, 43, and 22 patients in normal, overweight, obese and morbidly obese groups, respectively. The surgical success rate as defined by Sher's criteria was 84%, 84%, 72%, and 77% in the respective groups, with no statistical difference (p = 0.662). Moreover, the cure rate was 77%, 45%, 44%, and 45%, with no statistical difference (p = 0.192). The AHI reduction was 9.93, 19.73, 21.1 and 22.8 in the respective groups. A linear regression analysis revealed no significant difference in assessing the surgical success and cure rates as BMI increases.

CONCLUSION

Data regarding MLS success rates on obese patients is scarce. The current study demonstrates that MLS can offer positive outcomes for this population. However, further studies are warranted to investigate this relationship.

LEVEL OF EVIDENCE: 3

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults

Background

Obesity is a well-established risk factor for obstructive sleep apnea (OSA). We assessed the reciprocal prevalence of obesity and OSA and how it varies by age and sex.

Methods

Following a systematic review through March 27, 2025, the final sample included four community-based cohort studies in the US and Switzerland. OSA severity was quantified using the apnea-hypopnea index (AHI, all apneas plus hypopneas with ≥4% oxygen desaturation/hour). Random effects individual participant data (IPD) meta-analyses estimated prevalences. Logistic regression compared odds of OSA across weight groups.

Findings

Among 12,860 adults (mean ± SD age: 66.6 ± 7.3 years), 7222 (56.2%) had OSA (AHI ≥5 events/h) and 3309 (25.7%) had obesity (BMI ≥30 kg/m2). IPD meta-analysis showed 31.5% [95% CI: 16.8-48.5] of individuals with OSA had obesity and 44.4% [36.5-52.5] had overweight status (25 ≤ BMI < 30). Among subgroups of individuals with obesity and overweight, 74.3% [63.8-83.5] and 59.8% [46.5-75.7] had any OSA, respectively. Obesity was higher in females than males with OSA, and in younger (<65 years) vs. older individuals. Odds ratios for OSA in subgroups of individuals with overweight and obesity compared to BMI <25 kg/m2 were 2.18 [1.73-2.76] and 4.84 [3.09-6.00], respectively.

Interpretation

Our analyses show that most adults with OSA do not have obesity, with 44.4% having overweight and 23.5% having normal weight or underweight. Obesity was more prevalent among females compared to males and in younger individuals (<65 years) compared to older individuals with OSA. Recognizing OSA is not exclusive to obesity highlights the need for personalized treatment plans.

Funding

American Academy of Sleep Medicine, National Heart, Lung, and Blood Institute, and Apnimed.

Alterations in gut microbial community structure in obstructive sleep apnea /hypopnea syndrome (OSAHS): A systematic review and meta-analysis

OBJECTIVES

This systematic review investigates gut bacterial diversity and composition in patients with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and examines how these changes may contribute to cardiovascular complications.

METHODS

A comprehensive search was conducted in PubMed, Web of Science, and Scopus up to March 2025. After removing duplicates, titles and abstracts were screened by two reviewers, and full texts were assessed for inclusion. Data extraction on study characteristics and outcomes was performed. Methodological quality was evaluated using the Joanna Briggs Institute checklist. α-diversity was assessed using richness and diversity indices, while β-diversity examined community structure differences. Meta-analysis was conducted using standardized mean differences (SMD) and confidence intervals (CIs), and heterogeneity was assessed with the Cochrane I2 test.

RESULTS

The review included 18 studies (16 adults, 2 pediatrics) examining the gut microbiome in OSAHS. Meta-analysis revealed significant reductions in α-diversity indices (Shannon, Chao1, observed species, ACE) in OSAHS patients, while Simpson's index showed no difference. β-diversity analyses showed distinct gut microbiome differences in OSA. Key differential bacteria included Bacteroides, Proteobacteria, Faecalibacterium, Ruminococcaceae, Megamonas, Oscillibacter, Dialister, Roseburia, and Lachnospira. Study quality was medium to high.

CONCLUSION

OSAHS is associated with significant gut microbiome alterations, including a reduction in beneficial bacteria and an increase in LPS-producing bacteria, leading to intestinal barrier dysfunction. These changes may contribute to systemic inflammation and elevate the risk of cardiovascular diseases.

Community prevalence of positional obstructive sleep apnea

STUDY OBJECTIVES

The prevalence of positional obstructive sleep apnea (POSA) in community populations warrants further investigation. Further, more research is needed into the clinical characteristics of its subtypes such as supine predominant OSA (spOSA) and supine isolated OSA (siOSA).

METHODS

A cross-sectional analysis was performed on 1,870 Sleep Heart Health Study participants. OSA was defined by an apnea-hypopnea index (AHI) of ≥ 5 events/h of sleep. Participants with OSA were classified as POSA if the supine AHI was ≥ 2 times the nonsupine AHI. Participants with OSA who did not meet this threshold were classified as participants with nonpositional OSA. Demographics, polysomnographic data, comorbidities, and medications were all considered. The POSA subtypes spOSA and siOSA were also investigated.

RESULTS

Participants with POSA were slightly older, less obese, and had higher systolic blood pressure than participants with nonpositional OSA, in addition to being more prevalent (62% and 38%, respectively). POSA exhibited higher supine and total AHI. The prevalence of comorbidities or prescription drugs did not differ. In the POSA cohort, spOSA was more prevalent than siOSA (56% vs 44%). When compared to siOSA, spOSA was associated with more fragmented sleep and higher AHI. Furthermore, when compared to the siOSA group, the spOSA group had a higher prevalence of hypertension and diabetes, as well as more frequently prescribed medications for these comorbidities.

CONCLUSIONS

In the Sleep Heart Health Study population the prevalence of POSA is greater than nonpositional OSA. The spOSA subtype is more prevalent and appears to have worse health consequences than siOSA.

CITATION

Duce BL, Kulkas AE, Leppänen TT, Oksenberg A, Töyräs J, Hukins CA. Community prevalence of positional obstructive sleep apnea. J Clin Sleep Med. 2025;21(5):875-882.

The Global Burden of Obstructive Sleep Apnea

This study reviewed the global prevalence, health and socioeconomic impact, and management approaches of obstructive sleep apnea. The narrative review examined three key dimensions: (1) worldwide OSA prevalence across different regions, accounting for variations in diagnostic standards; (2) OSA's effects on health outcomes and socioeconomic conditions across diverse populations and healthcare systems; and (3) current global approaches to OSA diagnosis, treatment, and public health management. Despite advances in diagnosis and treatment, a large proportion of OSA cases remain undiagnosed or inadequately managed. The findings show that untreated OSA significantly increases public safety risks, particularly regarding motor vehicle and occupational accidents, while also creating a substantial pool of patients at high risk for systemic complications with severe impacts on overall health. There is a critical need for increased public awareness, universal screening approaches, and integrated care strategies to address this global health challenge and reduce its considerable socioeconomic burden. Our review uniquely addresses global disparities in OSA prevalence, clarifies the health and socioeconomic impacts that remain underexplored in the current literature, and suggests concrete strategies for public health and clinical management improvement worldwide.

Prevalence and risk factors of obstructive sleep apnea in depression: an observational retrospective study

Background

A substantial number of previous studies have concentrated on the prevalence of depression among patients with obstructive sleep apnea (OSA). However, research regarding the prevalence of OSA among patients with depression remains relatively scarce. The aim of this study was to determine the prevalence of OSA among patients with depression and to identify the associated risk factors.

Method

A single-center retrospective chart review was conducted. The research focused on patients diagnosed with depression who were referred for a polysomnogram (PSG) during a one-year period. Patients were diagnosed with obstructive sleep apnea (OSA) if their apnea-hypopnea index (AHI) was ≥5. Using the PSG monitoring results, patients were classified into two distinct groups: the OSA group, consisting of 50 patients, and the non-OSA group, which included 109 patients. An in-depth analysis was subsequently conducted on the sleep architecture and factors associated with the risk of OSA.

Results

Among the 159 depression patients who met the subject criteria, 31.4% were diagnosed with OSA. Statistically significant differences were observed between the OSA group and the non-OSA group in terms of sex, body mass index (BMI), smoking status, and lipid levels (all p<0.05). The PSG monitoring results indicated that both the duration of non-rapid eye movement stage 3 (N3) sleep and the percentage of N3 sleep relative to total sleep time (N3/TST) were markedly lower in the OSA group than in the non-OSA group, with a statistically significant difference (p<0.01). Statistically significant differences were observed between the two groups regarding the number of awakenings, arousal index (ArI), mean oxygen saturation, oxygen saturation nadir, and oxygen desaturation index (all p<0.01). Multiple logistic regression analysis indicated that advanced age (odds ratio [OR]=1.034, 95% confidence interval [CI]: 1.004-1.065, p=0.024), female sex (OR=0.378, 95% CI: 0.171-0.837, p=0.016), low-density lipoprotein cholesterol (LDL-C) (OR=1.946, 95% CI: 1.026-3.692, p=0.041), and BMI≥25.0 kg/m² (OR=3.434, 95% CI: 1.411-8.360, p=0.007) were factors associated with OSA among patients with depression.

Conclusion

OSA was prevalent among patients with depression. Risk factors for OSA included male sex, advancing age, a BMI≥25.0 kg/m², and elevated LDL-C levels.

Splintless maxillomandibular advancement for edentulous sleep apnoea patients: surgical accuracy and efficacy

The primary aim of this study was to assess the accuracy and predictability of a splintless treatment protocol for edentulous patients with moderate to severe obstructive sleep apnoea (OSA) undergoing maxillomandibular advancement (MMA). Ten consecutive edentulous patients treated with MMA were enrolled in this retrospective study. All cases were virtually planned, followed by computer-aided design of individual osteotomy cutting guides and patient-specific implants. For the maxilla, the mean discrepancy between the planned and achieved right to left, posterior to anterior, and cranial to caudal translations was 0.3 ± 0.2 mm, 1.0 ± 0.6 mm, and 0.8 ± 0.6 mm, respectively. There was a mean discrepancy of 0.5° ± 0.5°, 2.5° ± 2.0°, and 0.3° ± 0.4° for roll, pitch, and yaw of the maxilla, respectively. The mean discrepancy of the mandible osteotomy gap was 1.2 ± 1.0 mm on the right side and 0.8 ± 0.5 mm on the left. Surgical success was achieved in nine patients, one of whom met the criteria for surgical cure. On average, the apnoea-hypopnea index was reduced by 72%. The results of this study indicate that the splintless treatment protocol for MMA applied in edentulous OSA patients is highly accurate, predictable, and effective in the treatment of OSA.

Obstructive sleep apnea syndrome in polycystic ovary syndrome: a systematic review and meta-analysis

Background

Polycystic ovary syndrome (PCOS) has been associated with a high prevalence of obstructive sleep apnea syndrome (OSAS). However, the impact of OSAS on the PCOS symptom profile remains unclear. This systematic review and meta-analysis, which informed the 2023 International Evidence-based PCOS Guideline, aims to assess the prevalence and related symptoms of OSAS among females with and without PCOS.

Methods

A systematic search using databases (MEDLINE, Embase, EBM Reviews, PsycInfo and CINAHL) was performed until 16th May 2024. Random-effects restricted maximum likelihood meta-analyses compared OSAS and related symptoms between PCOS and non-PCOS groups. OSAS outcomes were categorized as apnea-hypopnea index (AHI)≥5 only, AHI≥5 with symptoms, AHI≥10 with symptoms and composite OSA (i.e., all AHI cut-offs with and/or without symptoms). Subgroup analyses by body mass index (BMI), age, PCOS diagnostic criteria and ethnicity were performed. Risk of bias and certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were conducted.

Results

From 4438 records, 3205 titles/abstracts were screened and 40 were eligible for full-text screening. Eight cross-sectional studies met inclusion criteria and meta-analysis. The pooled prevalence of OSA was 37.0% in PCOS (29.0% adolescents; 40.0% adults) and 6.0% in non-PCOS. Compared with non-PCOS, those with PCOS showed higher risk for composite OSA (odds ratio (OR): 9.52; 95% CI: 3.90 to 23.26; I 2 = 54.5%; 8 studies, n=942; P<0.001) and more pronounced OSAS risk with increasing symptom severity in PCOS (AHI≥5 OR: 3.90; 95% CI: 1.63 to 9.34; AHI≥5 with symptoms OR: 17.95; 95% CI: 6.17 to 52.22; AHI≥10 with symptoms OR: 30.61; 95% CI: 7.99 to 117.25, all P ≤ 0.0023). Subgroup results showed significantly higher risk of OSAS overall in overweight/obesity, adults and white ethnicity compared with normal weight, adolescent and Asian subgroups, respectively (all P<0.001), but independent of PCOS diagnostic criteria.

Conclusion

The prevalence of OSA was higher in PCOS compared with non-PCOS groups, with the risk of OSAS increasing with worse symptom severity. Adults and those of higher BMI and of white ethnicity were at increased risk of OSAS. Hence, identifying and treating OSAS symptoms in PCOS may be beneficial, but further validation of findings is warranted.

Dentoskeletal changes of long-term oral appliance treatment in patients with obstructive sleep apnea: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the dental and skeletal effects of the long-term oral appliance (OA) treatment in patients with obstructive sleep apnea (OSA) and provide insights for clinicians in treatment planning and decision-making for OSA patients undergoing OA treatment.

MATERIALS AND METHODS

A comprehensive literature search was conducted in major databases up to April 2024. Studies were included if they assessed long-term OA treatment (≥6 months) in adults with OSA using any type of mandibular advancement device (MADs) or tongue retaining device (TRD). Dental and skeletal changes, measured by dental cast and cephalometric analysis, were the primary outcomes.

RESULTS

A total of 42 studies were included in the systematic review, with 23 included in the meta-analysis. Long-term OA treatment was associated with a significant decrease in overbite (0.87 mm, 95% CI: 0.69-1.05) and overjet (0.86 mm, 95% CI: 0.69-1.03). Subgroup analyses showed the decrease of overbite and overjet progressively changed over the years intervals. There was a significant retroclination of the upper incisors (U1-SN, 2.58°, 95% CI: 1.07-4.08) and proclination of the lower incisors (L1-MP, -2.67° (95% CI: -3.78-1.56). Skeletal changes were not significant.

CONCLUSION

Overbite and overjet gradually decreased in the long-term OA treatment, which might predominantly result from the retroclination of the upper incisors and the proclination of the lower incisors. The skeletal patterns in the anteroposterior and vertical direction might remain relatively stable over time. There was a tendency for the clockwise rotation of the mandible.

Association of edentulism and obstructive sleep apnea: A systematic review

PURPOSE

Sleep apnea is a common and underdiagnosed sleep-related breathing disorder. This systematic review aimed to evaluate the scientific evidence regarding the association between obstructive sleep apnea (OSA) and edentulism.

METHODS

An electronic search was conducted through PubMed (MEDLINE), Scopus, and Cochrane Library, up to January 2024. A systematic approach was followed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines. The literature search intended to retrieve all relevant clinical studies about any possible association between OSA and edentulism. Only publications in the English language were selected, and animal studies, in vitro studies, case reports, case series, technique presentation articles, and expert opinions were excluded.

RESULTS

A total of 23 studies met the inclusion criteria and were included in this systematic review. They were published between 1999 and 2023 and were all clinical studies. These studies examined a possible association between OSA and edentulism and all of them agreed on their positive relation. Tooth loss favors anatomic alterations that deteriorate breathing. The severity of OSA was related to the extent and duration of edentulism. Mean Apnea-Hypopnea Index (AHI) scores in edentulous patients were found to be two to three times higher in comparison to dentate individuals, although the statistical data about it are scarce. No agreement was reached, however, about the use of dentures during sleep time, since the data are controversial.

CONCLUSION

The findings suggest that there is a plausible association between edentulism and OSA. Tooth loss impairs significant anatomic alterations and increases the risk for OSA. However, clinical data are limited and heterogeneous so more clinical studies should be encouraged for more robust conclusions.

STOP-BANG Score versus Epworth Sleepiness Scale as a Screening Tool for Obstructive Sleep Apnea

Background

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder. OSA is becoming highly prevalent, which means that to detect and prevent various hazardous complications, it is imperative that there are easy yet accurate techniques available to identify people with OSA.

Objectives

The objective was to compare two questionnaires: The STOP-BANG score and the Epworth Sleepiness Scale (ESS), used to screen the patients suspected of OSA. Polysomnography (PSG), the gold standard investigation, was used to diagnose OSA.

Materials and Methods

Sixty-five suspected individuals were recruited as per inclusion/exclusion criteria. Detailed history taking, physical examination, and anthropometric examination were done in all patients. Suspects were subjected to filling up of the STOP-BANG and ESS questionnaires, following which they underwent an overnight PSG examination, which is considered the gold standard diagnostic investigation for OSA. Compiled data were used to compare the sensitivities, specificities, and positive and negative predictive values (NPVs) of the two screening scores.

Results

Of 65 screened patients, 57 (88%) had OSA. The sensitivity to predict OSA was the highest for the STOP-BANG questionnaire (91.23%), whereas ESS had a sensitivity of 70.18%. No difference in specificity (75%) of the two scores was noted. The positive predictive values of STOP-BANG and ESS questionnaires was 96.30% and 95.20%, respectively. NPV of STOP-BANG and ESS was 54.50% and 26.10%, respectively.

Conclusion

The present study was able to provide valuable insights into OSA screening. Out of the two studied OSA screening questionnaires, we found out that both had comparatively good predictive and diagnostic accuracy, with the STOP-BANG score surpassing the ESS score in the majority of measures. Considering the high global burden of undiagnosed OSA, there is a need to upregulate the screening for OSA followed by appropriate treatment measures. This would improve sleep quality and reduce the risk of complications and future adverse health outcomes.

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.

Synergistic effect of anemia and obstructive sleep apnea on hypertension: National Health and Nutrition Examination Survey 2015-2018

OBJECTIVE

Anemia, obstructive sleep apnea (OSA), and hypertension are common social health problems. They are interconnected. This study assessed the independent association of anemia and OSA with hypertension and the interaction between anemia and OSA on hypertension in the US population.

METHODS

Data used by this retrospective study were obtained from the National Health and Nutrition Examination Survey (NHANES) 2015-2018. The relative excess risk due to interaction (RERI), weighted logistic regression, and the attributable proportion due to interaction (AP) were used to investigate the interaction above. Its impact was also assessed via subgroup analysis by gender, age, race, diabetes, smoking, alcohol use, education, and marital status.

RESULTS

After covariate adjustment in 6949 eligible observers, it was found that compared with non-OSA patients, OSA patients were at higher risk of hypertension [odds ratio (OR) = 1.254, 95% confidence interval (CI) 1.099-1.432, P  < 0.001). Meanwhile, OSA and anemia had a potential synergistic effect on the incidence of the disease (OR = 1.705, 95% CI: 1.390-2.091, P  < 0.01): the RERI was 0.371, and the AP was 0.218. In addition, such effect was observed in the subgroup of other race (AP = 0.48), the nondrinking subgroup (AP = 2.50), the subgroup graduating from high school or above (AP = 0.28), the unmarried subgroup (AP = 0.4), the subgroup without diabetes (AP = 0.24), and the drinking subgroup (AP = 0.41).

CONCLUSION

Anemia and OSA had a potential synergistic effect on hypertension. Their relationship needs to be further elucidated by a further study.

Effects of obstructive sleep apnea on nocturnal changes in blood pressure - a retrospective study

To explore the effects of obstructive sleep apnea (OSA) on nocturnal changes in blood pressure (BP), we enrolled 2037 participants who underwent polysomnography (PSG) between 2019 and 2020 and examined BP changes before and after sleep. BP was measured in the evening and the following morning using an electronic wrist sphygmomanometer in the supine position. The severity of OSA was determined by PSG and graded based on the apnea/hypopnea index (AHI). Participants with OSA (AHI ≥ 5 events/h) had significantly higher morning systolic BP (SBP) and diastolic BP (DBP) compared to their evening measurements. BP values, whether measured in the evening or the morning, as well as the nocturnal changes (differences between morning and evening values), showed significant correlations with the AHI for both SBP and DBP, even after adjusting for confounders such as age, sex, body mass index, and the presence of comorbidities, including hypertension, heart failure, coronary artery disease, diabetes, renal disorder, and cerebrovascular attack. After standardization, the extent of nocturnal changes in DBP was greater than SBP, especially among participants with severe OSA. In a logistic regression model with serial multivariate adjustments, OSA was found to be independently associated with morning hypertension, particularly in individuals with moderate to severe OSA.

Nomogram for predicting olfactory disorder in obstructive sleep apnea: A retrospective study based on a multicenter database

OBJECTIVE

Obstructive sleep apnea (OSA) increases the risk of olfactory disorder (OD), which may serve as an early warning of adverse health consequences. In this study, we aimed to develop and validate a nomogram for early detection of OD in patients with OSA.

METHODS

We retrospectively analyzed 125 patients with OSA at Beijing Anzhen Hospital for the development and internal validation of the nomogram. For external validation, 30 patients with OSA were recruited from the Air Force Medical Center. The included participants completed polysomnography (PSG) and the Sniffin' Sticks test. Patients with OSA were divided into two groups: OSA with OD and OSA without OD.

RESULTS

The nomogram included age, sex, and time spent with oxygen saturation below 90%. The area under the receiver operating characteristic curve of the nomogram was 0.814 (95% confidence interval [CI]: 0.673-0.955) for the internal validation group, and 0.778 (95% CI: 0.601-0.955) for the external validation group. The nomogram exhibited excellent discrimination and calibration, showing substantial benefits in clinical applications.

CONCLUSION

The present nomogram developed based on clinical characteristics and PSG features can serve as a convenient tool for clinicians to detect OD in OSA, aiding in patient stratification and personalized treatment.

Non-linear association between weight-adjusted-waist index and obstructive sleep apnea: a cross-sectional study from the NHANES (2005-2008 to 2015-2020)

Background

The principal objective of the present investigation is to undertake an in-depth exploration of the relationship that exists between the newly introduced weight-adjusted waist index (WWI), employed as a surrogate way for corpulence, and obstructive sleep apnea (OSA).

Methods

Analysis using cross-sectional data from 11,545 NHANES participants across 2005-2008 and 2015-2020. Obesity via WWI (waist circumference over sqrt of body weight). OSA via 3 NHANES QnA items: monthly excessive sleepiness, weekly wheezing/snoring/breathing stoppage, weekly snoring. Relationships between WWI and OSA probed with weighted multivariate logistic regression and smoothed curve fitting. Also did subgroup, interaction tests and threshold effect analysis. Excluded those with incomplete WWI, OSA or hypertension data as they might have different health profiles. We excluded participants with incomplete data on WWI, OSA, or hypertation-related items, as those with missing data might have different health profiles.

Results

The study, encompassing a cohort of 11,545 participants, revealed that 5,727 individuals were diagnosed with OSA. Upon conducting fully adjusted models, A positive relevance between WWI and OSA was established, with an odds ratio of 1.57 (95% CI: 1.44, 1.71), indicating a significant relationship. Notably, participants falling within the highest quartile of WWI exhibited a markedly heightened propensity for OSA, being 2.58 times more likely to suffer from it than those in the bottom quartile [OR: 2.58 (95% CI: 2.10, 3.17)]. Rigorous subgroup analyses and interaction tests further confirmed the robustness of this positive association across various subgroups, thereby affirming the consistency of the observed relationship. Additionally, a noteworthy non-linear association and saturation phenomenon were discerned between the WWI and OSA, demarcated by an inflection point at 11.70 cm/√kg.

Conclusion

Our research has clearly shown a significant positive correlation, along with a saturation effect, between WWI and OSA in the American population. However, the cross-sectional design limits causal inference, and the exclusion of certain participants may affect the generalizability of the findings. Future longitudinal studies are needed to explore causality and address potential biases associated with participant exclusion, ultimately improving the broader applicability of the results.

Non-obtrusive monitoring of obstructive sleep apnea syndrome based on ballistocardiography: a preliminary study

Introduction

Obstructive sleep apnea syndrome (OSAS) degrades sleep quality and is associated with serious health conditions. Instead of the gold-standard polysomnography requiring complex equipment and expertise, a non-obtrusive device such as ballistocardiography (BCG) is more suitable for home-based continuous monitoring of OSAS, which has shown promising results in previous studies. However, often due to the limited storage and computing resource, also preferred by venders, the high computational cost in many existing BCG-based methods would practically limit the deployment for home monitoring.

Methods

In this preliminary study, we propose an approach for OSAS monitoring using BCG signals. Applying fast change-point detection to first isolate apnea-suspected episodes would allow for processing only those suspected episodes for further feature extraction and OSAS severity classification. This can reduce both the data to be stored or transmitted and the computational load. Furthermore, our approach directly extracts features from BCG signals without employing a complex algorithm to derive respiratory and heart rate signals as often done in literature, further simplifying the algorithm pipeline. Apnea-hypopnea index (AHI) is then computed based on the detected apnea events (using a random forest classifier) from the identified apnea-suspected episodes. To deal with the expected underestimated AHI due to missing true apnea events during change-point detection, we apply boundary adjustment on AHI when classifying severity.

Results

Cross-validated on 32 subjects, the proposed approach achieved an accuracy of 71.9% for four-class severity classification and 87.5% for binary classification (AHI less than 15 or not).

Conclusion

These findings highlight the potential of our proposed BCG-based approach as an effective and accessible alternative for continuous OSAS monitoring.

Evaluating cystatin-C and monocyte-to-high-density lipoprotein cholesterol ratio as indicators of obstructive sleep apnea severity in male patients

Objectives

This study investigates the association between blood cystatin-C (Cys-C) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), both established inflammatory markers, with the severity of obstructive sleep apnea (OSA) in male patients.

Methods

A total of 117 male participants who underwent overnight polysomnography (PSG) between February 2019 and December 2022 were included. Based on the apnea-hypopnea index (AHI), participants were categorized into three groups: G1 (AHI < 5 events/hour, n = 9; control group), G2 (5 ≤ AHI < 30 events/hour, n = 32), and G3 (AHI ≥ 30 events/hour, n = 76). Serum Cys-C and MHR levels were measured and analyzed for their correlation with OSA severity. Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed their diagnostic value, while restricted cubic spline (RCS) analysis examined potential nonlinear relationships.

Results

Cys-C and MHR levels increased with OSA severity and showed significant positive correlations with AHI (Cys-C: r = 0.084, P < 0.05; MHR: r = 0.1286, P < 0.05). In multivariate regression, MHR remained an independent correlate of OSA severity (adjusted OR = 47.130, 95% CI: 1.014-6.692, P = 0.008), whereas Cys-C lost statistical significance after adjusting for confounders. RCS analysis found no significant nonlinear relationship (P > 0.05). ROC analysis showed that combining Cys-C and MHR modestly improved diagnostic accuracy (AUC = 0.6622, 95% CI: 0.554-0.77). Subgroup analysis indicated that severe OSA patients with hypertension had higher Cys-C and MHR levels compared to those without hypertension, though the differences were not statistically significant (P > 0.05).

Conclusions

Cys-C and MHR are positively associated with OSA severity, with MHR emerging as a stronger independent biomarker. Incorporating these markers into OSA risk stratification may enhance clinical assessment and targeted interventions. Future large-scale prospective studies are needed to validate their prognostic value and clinical utility.

Incidence of arrhythmias in chronic obstructive pulmonary disease, obstructive sleep apnea, and overlap syndrome: A retrospective cohort study

BACKGROUND

New-onset arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). However, scarce data exist regarding arrhythmia risk in overlap syndrome (OS), encompassing COPD and OSA.

OBJECTIVE

We compared the incidence of new-onset atrial and ventricular arrhythmias in patients with COPD, OSA, and OS.

METHODS

We conducted a retrospective cohort study using the TriNetX Network, comprising >140 million patients to identify patients with COPD, OSA, and OS. Patients with pre-existing arrhythmias were excluded. Propensity score matching (PSM) was used to adjust for demographics, comorbidities, and medications. Adjusted odds ratios (aORs) were estimated to compare incidence of arrhythmias across cohorts.

RESULTS

Between 2010 and 2020, a total of 2,438,454 patients with COPD only, 1,960,845 patients with OSA only, and 440,018 patients with OS (age ≥18 years) were identified. After PSM, we included 359,496 patients per cohort for the OS vs OSA-only comparison and 399,235 patients per cohort for the OS vs COPD-only comparison. Over a mean follow-up of 5.3 years, incidence of new-onset atrial fibrillation/flutter was 10.0% in OS vs 7.0% in COPD (aOR 1.472, 95% confidence interval [CI] 1.449-1.496) and 6.4% in OSA (aOR 1.568, 95% CI 1.541-1.595). Patients with OS had higher incidence of new-onset ventricular tachycardia and cardiac arrest than those with COPD (aOR 1.442 and 1.189, respectively) and OSA (aOR 1.645 and 1.777, respectively). Patients with COPD preceding OSA diagnosis had higher odds of new-onset arrhythmias.

CONCLUSION

Patients with OS have a higher incidence of new-onset atrial fibrillation/flutter, ventricular tachycardia, and cardiac arrest compared with those with OSA and COPD alone.

Leptin receptor downregulation in the carotid body treats obesity-induced hypertension

Obesity and comorbid sleep disordered breathing (SDB) lead to high cardiovascular morbidity and mortality via multiple mechanisms including hypertension. Obesity also leads to high levels of leptin, which is produced in adipocytes. Increased leptin levels have also been implicated in increased sympathetic activity and the pathogenesis of hypertension in obesity. However, mechanisms for the effects of leptin on blood pressure are unclear. The carotid bodies (CB) express leptin receptor (Leprb), and diet-induced obesity (DIO) increases Leprb expression levels, but the mechanisms and consequences of leptin action in CB are poorly understood. We hypothesize that leptin signaling in CB in obesity leads to hypertension, which can be treated by Leprb knockdown specifically in CB. DIO male and female mice and lean male C57BL/6J mice were implanted with telemetry in the left femoral artery for continuous blood pressure monitoring. The adenoviral vectors carrying antisense RNA, Ad-LepR shRNA or Ad-scrambled control shRNA, were administered locally to the CB region. Blood pressure measurements were performed at baseline and 9-11 days after CB infection with the adenoviral vector. DIO male mice showed increased blood pressure compared with lean males and DIO females. Ad-LepR shRNA induced a twofold decrease in Leprb mRNA level in CB and abolished obesity-induced hypertension. Leprb knockdown was particularly effective during the light phase, when animals were predominantly asleep, decreasing mean arterial pressure by 8.5 mmHg. Control shRNA had no effect on DIO-induced hypertension. We conclude that inhibition of Leprb in the carotid bodies abolished obesity-induced hypertension.NEW & NOTEWORTHY Obesity and comorbid sleep apnea are key predisposing factors to hypertension. Obesity increases circulating leptin levels and hyperleptinemia may contribute to hypertension but mechanisms are not clear. Here, we have shown that knockdown of the leptin receptor LepRb in the carotid body decreased blood pressure and treated hypertension in diet-induced obese mice. Thus, we identified a novel mechanism of obesity hypertension and a novel drug target, LepRb in the carotid body.

Identification of multiple hypoxia-independent triggers of upper airway long-term facilitation in a rat model of upper airway motor plasticity

The respiratory control system can exhibit neuronal plasticity following exposures to repetitive respiratory challenges. For example, repeated obstructive apneas can trigger a form of respiratory plasticity that results in the enhancement of inspiratory hypoglossal (XII) motoneuron activity. This increase in respiratory motor output is known as hypoglossal long-term facilitation (hLTF). In adult male Sprague-Dawley rats, we demonstrate that hLTF can also be triggered in the absence of repeated apneas by intermittent optogenetic stimulation of locus coeruleus (LC) neurons, or through pharmacological activation of adenosine-A2a-receptors at the level of brainstem XII motor pool. Both our pharmacological and optogenetic approaches that trigger hLTF require noradrenergic signaling through activation of α1-noradrenergic receptors on hypoglossal motoneurons. We also use optical LC inhibition to reaffirm the importance of the LC in mediating apnea-induced hLTF. These results demonstrate that hLTF can be triggered by multiple hypoxia-independent stimuli, and for the first time, identify the LC as a key brainstem source for noradrenaline necessary for the expression of hLTF.

Exploring the Effects of Tirzepatide on Obstructive Sleep Apnea: A Literature Review

Obstructive sleep apnea (OSA) is a sleep disorder commonly secondary to obesity that has detrimental effects on health and quality of life. Thus, weight loss is one of the mainstays of OSA treatment. Tirzepatide, a novel glucagon-like peptide-1 (GLP-1) and glucagon-dependent insulinotropic polypeptide (GIP) dual agonist, demonstrated significant glycemic control and weight loss. This literature review analyzes the current literature on tirzepatide's effects on OSA, mechanism of action, complications, and off-label uses/indications. Also, this review offers potential insights into how tirzepatide and other GLP-1 medications can be repurposed for other metabolic conditions and their associated sequelae.

Non-linear association of the metabolic score for insulin resistance with obstructive sleep apnea: a cross-sectional study from NHANES 2015-2018

Background

The relationship between the Metabolic Score for Insulin Resistance (METS-IR), a novel index integrating multiple metabolic parameters, and the risk of obstructive sleep apnea (OSA) remains under explored.

Methods

Analyses were conducted on data from 2,348 participants included in the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018. Logistic regression, stratified analyses, curve-fitting analyses, and threshold effects analyses were employed to evaluate the association between METS-IR and the risk of OSA.

Results

Multifactorial logistic regression analyses revealed a significant positive correlation between METS-IR and the risk of OSA [OR: 1.05 (95% CI: 1.04-1.06)]. Stratified analyses showed consistent associations across various subgroups, including sex, race, age, marital status, education level, poverty income ratio, physical activity, alcohol use, smoking status, diabetes mellitus, hypertension, and cardiovascular disease. Nonlinear analysis identified an inflection point at METS-IR 46.65. On the left of the inflection point, the risk of OSA increased significantly, with each unit increase in METS-IR associated with a 7% increase in risk [OR: 1.07 (95% CI: 1.05-1.08)]. On the right side of the inflection point, however, the rate of risk increase slowed to 1% [OR: 1.01 (95% CI: 1.00-1.02)].

Conclusion

This investigation reveals a significant and nonlinear relationship between METS-IR and OSA. Further investigation is needed to explore their association more comprehensively and to elucidate the underlying mechanisms.

Different Oral Appliance Designs Demonstrate Different Rates of Efficacy for the Treatment of Obstructive Sleep Apnea: A Review Article

Obstructive Sleep Apnea afflicts an estimated 1 billion people worldwide. Untreated, Obstructive Sleep Apnea is linked with elevated levels of mortality, decreased quality of life and increased economic costs. However, several large population studies demonstrate that the efficacy of Continuous Positive Airway Pressure therapy, the most frequently prescribed treatment for Obstructive Sleep Apnea, is compromised by frequent refusals and terminations. As a result, healthcare providers are evaluating non-CPAP treatment options. Oral Appliance Therapy has emerged as a leading non-CPAP treatment for patients with Obstructive Sleep Apnea. Historically, healthcare providers have questioned the efficacy of Oral Appliance Therapy. Dozens of Oral Appliances are available to healthcare providers, with many contemporary Oral Appliances featuring improved designs, materials and technologies. This review investigates whether Oral Appliance design matters; do different Oral Appliance designs demonstrate different rates of efficacy? To the best of the authors' knowledge, this is the first review to exclusively focus on scientific papers that report treatment success with Oral Appliances as a residual Apnea Hypopnea Index of less than 10 events per hour. Out of 272 source papers, the 27 papers included in this review encompass a pooled sample of 3799 patients treated with six distinctly different categories of Oral Appliance designs. Chi-squared and two-sided Fisher's exact tests indicate significant differences in efficacy amongst Oral Appliance designs. These findings suggest that certain Oral Appliance designs can enable highly efficacious treatment for patients with Obstructive Sleep Apnea. Given these findings, healthcare providers should consider design when selecting an oral device for patients diagnosed with Obstructive Sleep Apnea.

The median effective dose of ciprofol combined with a low-dose sufentanil for gastroscopy in obese or nonobese patients: a dose-finding study using Dixon's up-and-down method

Objectives

Understanding the different pharmacodynamic responses to narcotics in patients with or without obesity is particularly important for the safety of gastroscopy sedation. This study aimed to determine the median effective dose (ED50) of ciprofol combined with low-dose sufentanil to inhibit the response to gastroscope insertion in obese or nonobese patients.

Methods

A total of 27 obese patients (BMI 30-40 kg/m2) and 25 nonobese patients (BMI 18-25 kg/m2), aged between 18 and 65 years, with ASA physical status of 1-2, were included in this study. All patients underwent painless gastroscopy and received intravenous sufentanil at a dose of 0.1 μg/kg, followed by ciprofol administration. The initial dose of ciprofol for the first patient in both groups was 0.4 mg/kg, the subsequent dose was determined by the response of the previous patient to gastroscope insertion (cough, choking, body movement, etc.) using Dixon's up-and-down method. The dose was increased or decreased by 0.05 mg/kg depending on the observed responses. Data collection continued until 7 crossover points were obtained. Probit regression and bootstrapping methods were employed to calculate the median effective dose (ED50) and 95% confidence intervals (CIs). The ED50 values were then compared between the obese and nonobese patient groups.

Results

The ED50 of ciprofol combined with sufentanil inhibiting response to gastroscope insertion in patients with obesity was 0.186 mg/kg with 95% CI of 0.153∼0.209 mg/kg, was significantly lower than patients with nonobese was 0.237 mg/kg with 95% CI of 0.206∼0.253 mg/kg (p < 0.05).

Conclusion

The ED50 values of ciprofol combined with sufentanil inhibiting response to gastroscope insertion in patients with obesity was lower than in patients with normal weight.

Trial registration

https://www.chictr.org.cn/bin/project/edit?pid=202873, identifier ChiCTR2300074216.

Changes in the Upper Airway Dimension Following the Use of Functional Appliances in Children with Obstructive Sleep Apnea: A Systematic Review

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper airway dimensions. Objective: this systematic review evaluates the effectiveness of functional appliances in improving upper airway structures in children with OSAS. Materials and Methods: the study was conducted according to PRISMA guidelines, analyzing studies published between 2004 and 2024 on PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases. Inclusion criteria focused on growing patients (≤14 years) with OSAS and Class II skeletal malocclusions treated with FAs. Results: Of 1298 articles screened, four studies met the inclusion criteria. All studies reported a significant increase in upper airway dimensions of approximately 21% after treatment with FAs. Specifically, the cephalometric and tomographic evaluations revealed a clear enlargement of the superior posterior airway space of about 0.5 mm and a consequent improvement of the respiratory function. Discrepancies arose regarding changes in soft palate length and hyoid bone position, perhaps due to the measurement methods' variation. Conclusions: Functional appliances appear effective in improving upper airway dimensions and alleviating OSAS symptoms in children. However, the limited number of studies, small sample sizes, and short follow-up periods emphasize the need for further research to confirm long-term efficacy and standardize evaluation protocols.

The endothelin-1 system among high-risk pregnant women with obstructive sleep apnea

Obstructive sleep apnea is associated with gestational hypertension. Elevated endothelin-1 is a proposed factor in the pathogenesis of gestational hypertension. However, the association between endothelin-1 and obstructive sleep apnea complicating pregnancy is unknown. In a prospective cohort of 60 pregnant patients with obesity but without confounding comorbid conditions (i.e. cardiac/pulmonary disease), plasma and placental samples were collected at delivery in 30 women with obstructive sleep apnea and 30 without. Endothelin-1 concentrations were evaluated using Western blot, quantitative real-time polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay. Multivariable analyses were conducted comparing endothelin-1 levels between obstructive sleep apnea and non-obstructive sleep apnea groups. There was no significant difference in band intensity or quantitative densitometric evaluation when comparing obstructive sleep apnea-positive and -negative groups (p = 0.42). mRNA expression of endothelin-1 did not differ in placental tissues between groups (p = 0.73). There was no significant difference in endothelin-1 median plasma concentrations between groups (p = 0.95). However, there was a significant sixfold increase in the rate of endothelin-1 elevation > 90th percentile (adjusted odds ratio 5.9, 95% confidence interval 1.05-32.7) after adjusting for confounding by body mass index. Additionally, lower pre-pregnancy body mass index (< 32 kg m-2) was associated with plasma endothelin-1 > 11 at delivery (p < 0.01), and class 3 obesity appeared protective for having elevated plasma endothelin-1 > 90th percentile (p = 0.03). Overall, in this prospective cohort of high-risk pregnant patients, obstructive sleep apnea was associated with an increased rate of markedly elevated (> 90th percentile) endothelin-1 plasma levels. Lower pre-pregnancy body mass index among patients with obesity was associated with elevated endothelin-1 plasma levels. Obstructive sleep apnea screening questionnaires focused on high body mass index may result in underestimated risk.

Prediction of central Augmentation Index in healthy adults

BACKGROUND

Central Augmentation Index (AIx) is a surrogate marker of large artery stiffness that may provide valuable insight to cardiovascular health. The aim of this study was to evaluate the relationship between AIx and components of physical fitness.

METHODS

One hundred eighty-five healthy men and women (aged 20-79 years) underwent non-invasive assessment of arterial wave reflection to determine AIx, which was corrected to a heart rate of 75 beats per minute (AI×75). Body composition was evaluated using dual energy X-ray absorptiometry (DXA) and aerobic capacity (VO2max) was derived from expired gas analysis during a symptom limited exercise test on a treadmill.

RESULTS

A multiple linear regression revealed age and VO2max as significant predictors of AI×75 [AI×75=32.055 + (0.252×age) - (0.722×VO2max)]. Upon removal of VO2max from regression analysis, resting heart rate (RHR) and % body fat (BF%) were revealed to be significant predictors of AI×75: AI×75=-61.316 + (0.481×age) + (0.565×BF%) + (0.56×RHR).

CONCLUSIONS

Our findings demonstrate that central Augmentation Index can be reliably predicted in healthy adults who undergo a maximal exercise or body composition assessment. These prediction equations may be applied in non-medical settings to assist in creating comprehensive health and fitness profiles for healthy clientele.

Obstructive sleep apnea illness perception relative to other common chronic conditions

STUDY OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CITATION

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

Menopause and obstructive sleep apnea: revealing an independent mediating role of visceral fat beyond body mass index

BACKGROUND

Menopause is a significant phase in women's health, in which the incidence of obstructive sleep apnea (OSA) is significantly increased. Body fat distribution changes with age and hormone levels in postmenopausal women, but the extent to which changes in body fat distribution affect the occurrence of OSA is unclear.

METHODS

This research performed a cross-sectional analysis utilizing data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). Body fat distribution was quantified using dual-energy X-ray absorptiometry in kilograms. Menopausal status and OSA symptoms were determined by questionnaire. Weighted multivariable regression analysis was utilized to investigate the correlation between menopausal status and OSA symptoms and body fat composition. We did a mediation analysis to assess how much of the effect of menopausal status on OSA symptoms was mediated through in body fat composition.

RESULTS

The analysis comprised 1459 individuals from NHANES, consisting of 1188 premenopausal and 271 postmenopausal women. In the weighted sample, 36.01% of premenopausal women and 53.39% of postmenopausal women had OSA symptoms. After adjusting for body mass index (BMI) and other potential confounders, menopausal status was correlated with a higher prevalence of OSA symptoms (OR = 1.57; 95% CI: 1.16,2.13), and increased visceral fat mass (β = 0.12; 95% CI: 0.07, 0.17). In addition, visceral fat mass exhibited a significant correlation with OSA symptoms (OR = 3.79; 95% CI: 1.61, 8.94). Mediation analysis showed that 29.76% of the effect of menopausal status on OSA symptoms was mediated through visceral fat. In age-matched analysis, postmenopausal women had higher visceral fat mass (0.63 kg vs. 0.52 kg, P = 0.02) and a higher prevalence of OSA symptoms (68.3% vs. 45.7%, P = 0.02) compared with premenopausal women; however, there was no significant difference in BMI (P > 0.05).

CONCLUSION

Our results suggest that menopausal status is associated with increased visceral fat accumulation and OSA symptoms prevalence. Visceral fat accumulation appears to play an important role in the development of OSA in postmenopausal women, independent of BMI; this highlights the importance of further studying this relationship.

Exploring the Association Between Triglyceride-Glucose Indices and Their Derivatives With Obstructive Sleep Apnea: Insights From the National Health and Nutrition Examination Survey

Background

Simple and affordable methods for evaluating Insulin Resistance (IR) have been suggested, such as the Triglyceride-Glucose (TyG) index and its variants, including the TyG-Body Mass Index (TyG-BMI), TyG-Waist Circumference (TyG-WC), and TyG-Waist-to-Height Ratio (TyG-WHtR). The aim of this study is to investigate the relationship between these TyG-related indices, which measure IR, and Obstructive Sleep Apnea (OSA).

Methods

This study analyzed NHANES data from 2007-2008, 2015-2016, and 2017-2020. TyG and its derivatives were evaluated as continuous and categorical variables in relation to OSA using multivariable logistic regression models. Subgroup analyses, dose-response relationships, and threshold effects were explored, and the diagnostic performance of TyG-related indices was assessed using AUC curves.

Results

The study included 8,374 participants. The fully adjusted Model 3 analysis (Note: Body Mass Index was not adjusted for TyG-BMI) of continuous variables showed a positive correlation between OSA and all four indices. All four TyG-related indicators showed statistically significant relationships with OSA when grouped into quartiles (TyG: AOR = 1.448, 95% CI: 1.260-1.663; TyG-BMI: AOR = 3.785, 95% CI: 3.319-4.317; TyG-WC: AOR = 2.089, 95% CI: 1.629-2.677; TyG-WHtR: AOR = 1.913, 95% CI: 1.548-2.363). Subgroup analysis revealed a stronger association of TyG-WHtR with OSA in the 41-59 age group (AOR = 1.459, 95% CI: 1.254-1.698) and the low-income group (AOR = 1.451, 95% CI: 1.241-1.698). TyG showed a linear relationship with OSA, while TyG-BMI, TyG-WC, and TyG-WHtR exhibited nonlinear relationships. The diagnostic capability was highest for TyG-WC, with an AUC of 0.647.

Conclusion

The study confirms strong associations between OSA and the TyG indices, particularly TyG-WC, which demonstrates significant predictive power for OSA risk. Future longitudinal studies are recommended to further investigate these associations and enhance OSA management in resource-constrained environments.

Sex-specific age-related worsening of pathological endotypic traits in patients with obstructive sleep apnea

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is more prevalent in men and older adults. Few studies have explored variations in pathological endotypic traits by age and sex using a large patient sample, offering insights into the development of the disease. Our study aims to examine how endotype characteristics of OSA vary across ages in different sex.

METHODS

A cross-sectional study was conducted, enrolling 2296 adult patients referred for in-laboratory diagnostic polysomnography at a single sleep center in Taiwan. Among them, 1374 had an apnea-hypopnea index ≥5. Using the "Phenotyping Using Polysomnography" method, we estimated four endotypic traits-arousal threshold, upper airway collapsibility, loop gain, and upper airway muscle compensation. Demographic and polysomnographic characteristics were compared between sexes and age groups. Generalized linear regression and generalized additive models were employed to explore the associations of sex and age with endotypic traits.

RESULTS

Men with OSA exhibited higher collapsibility and lower compensation than women (difference: 4.32 %eupnea and 4.49 %eupnea, respectively). Younger patients with OSA had a higher prevalence of obesity, more snoring symptoms, and lower loop gain compared to older patients. For men, age was correlated with increased collapsibility, increased loop gain, and decreased arousal threshold after 37 years old. Whereas in women, endotypic traits were not associated with age, except for an increase in loop gain with advancing age.

CONCLUSIONS

Personalized treatment options for OSA should take into consideration age and sex. Reducing loop gain could be a treatment objective for older patients with OSA.

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.

Soft palate angle and basihyoid depth increase with tongue size and with body condition score in horses

BACKGROUND

Obesity has been associated with human obstructive sleep apnoea and canine brachycephalic obstructive airway syndrome. The effect of body condition score (BCS) on structures of the oropharynx, nasopharynx and upper airway of the horse has not been investigated.

OBJECTIVES

To investigate the effect of BCS on tongue measurements, soft palate angle and basihyoid depth in horses.

STUDY DESIGN

Retrospective, analytical, cross-sectional.

METHODS

Computed tomographic (CT) images of the head of 58 horses were assessed. DICOM viewing software was used to measure head length, basihyoid-skin depth, soft palate angle (SPA), midline tongue area, dorsoventral height (DVH) of the tongue in two locations and head angle. BCS were assigned during CT examinations. Associations between measurements were tested and following initial calculations, further associations with tongue measurements as a ratio of head length were assessed.

RESULTS

For initial measurements, 44 horses met the inclusion criteria. Addition of head length ratios to tongue measurements resulted in 24 of 44 horses meeting the inclusion criteria for the second set of calculations. Increased BCS led to an increased mean SPA (mean difference = 2.56° $$ {}^{{}^{\circ}} $$ ; p = 0.02) and increased median basihyoid depth (mean difference = 0.246 cm; p = 0.006). Following adjustments made for the effect of head length on tongue measures, significant correlation was identified between SPA and tongue area (Spearman's r = 0.544; p = 0.007); SPA and DVH of the tongue at the level of the hard palate (Spearman's r = 0.562; p = 0.004) and SPA and DVH of the tongue at the lingual process of the basihyoid bone (Spearman's r = 0.690; p < 0.001). No significant correlation was identified between variables and sex.

MAIN LIMITATIONS

The sample size was small and the effect of breed on measures was not studied. Measurements were acquired on a single sagittal CT plane. The investigator collecting CT measures was not blinded to BCS. All horses were sedated for the CT procedure which may have affected measures obtained.

CONCLUSIONS

Increased BCS increases SPA and basihyoid bone depth. Increases in tongue size measurements increase SPA. Results from this study warrant further investigation into the clinical significance of the effects of BCS on the upper airways of the horse.

Sleep apnea is a common and dangerous cardiovascular risk factor

Sleep apnea involves almost one billion individuals throughout the world, including 40 million Americans. Of major medical concern is the fact that the prevalence of sleep apnea is significantly increasing due to the epidemic of obesity, physical inactivity, and diabetes mellitus which are important risk factors for the development and persistence of sleep apnea in individuals. Sleep apnea is characterized by multiple episodes of apnea or hypopnea during sleep, which cause nocturnal arousals, gasping for breath during the night, daytime sleepiness, irritability, forgetfulness, fatigue and recurrent headaches. Obstructive sleep apnea occurs when upper airway obstruction occurs in an individual during sleep with absent or markedly reduced airflow in the presence of continued activity of inspiratory thoracic and diaphragmatic muscles. Central sleep apnea is defined as the absence or the significant reduction of naso-oral airflow due to the withdrawal during sleep of ponto-medullary respiratory center stimulation of the nerves of the inspiratory thoracic and diaphragmatic muscles and absence of contraction of these muscles during apnea. Complex sleep apnea occurs when an individual exhibits characteristics of both obstructive and central sleep apnea. The severity of sleep apnea is measured by polysomnography and the apnea hypopnea index (AHI), which is the average number of apneas and hypopneas per hour of sleep measured by polysomnography. Sleep apnea is mild if the AHI is 5-14/h with no or mild symptoms, moderate if the AHI is 15 to 30/h with occasional daytime sleepiness, and severe if the AHI is >30/h with frequent daytime sleepiness that interferes with the normal activities of daily life. Chronic sleep apneas and hypopneas followed by compensatory hyperpneas are associated with significant adverse cardiovascular consequences including: 1) recurrent hypoxemia and hypercarbia; 2) Increased sympathetic nerve activity and decreased parasympathetic nerve activity; 3) oxidative stress and vascular endothelial dysfunction; and 4) cardiac remodeling and cardiovascular disease. Moderate or severe sleep apnea significantly increases the risk of coronary artery disease, congestive heart failure, cerebral vascular events (strokes), and cardiac dysrhythmias, and also increase the morbidity and mortality of these diseases. Nevertheless, sleep apnea is currently underdiagnosed and untreated in many individuals due to the challenges in the prediction and detection of sleep apnea and a lack of well-defined optimal treatment guidelines. Chronic continuous positive airway pressure for ≥4 h/night for >70% of nights is beneficial in the treatment of patients with sleep apnea. CPAP Improves sleep quality, reduces the AHI, augments cardiac output and increases oxygen delivery to brain and heart, reduces resistant hypertension, decreases cardiac dysrhythmias, and reduces daytime sleepiness. The present article discusses the diagnosis of obstructive sleep apnea, central sleep apnea, and complex apnea. Thereafter the important pathophysiologic mechanisms in sleep apnea and the relationship of these pathophysiologic mechanics to atherosclerotic vascular disease are reviewed. Guidelines are then provided for the treatment of mild, moderate and severe sleep apnea. In order to reduce the cardiovascular morbidity and mortality caused by sleep apnea and facilitate the diagnosis and the long-term, effective treatment of sleep apnea in patients, the close cooperation is necessary of cardiovascular specialists, pulmonary specialists, and respiratory therapy/rehabilitation specialists.

Do the effects of sleep problems on cognitive function differ according to age in daytime workers?

To examine whether the effects of low sleep quality, sleep deprivation, and chronotype on daytime cognitive function varied by age group. All data were collected online. We obtained the data from 366 employed people in their 20s, 40s, or 60s. The participants were required to fill out a questionnaire comprising of the Pittsburgh Sleep Quality Index, an Ultra-Short Version of the Munich ChronoType Questionnaire, and Karolinska Sleepiness Scale, and perform the online Stroop task through the web browser on their own PC. The results of analyses of variance showed that people in their 20s had more of an evening chronotype, while those in their 20s and 40s experienced more sleep loss than those in their 60s. Stroop interference, reflecting decline in selective attention, was greater in people in their 60s. The results of structural equation modeling showed that sleep loss tended to relate to lower Stroop interference in people in their 20s. Additionally, people in their 60s exhibited a significant relationship between lower sleep quality and lower Stroop interference in the reaction time. At least in this study, interindividual differences in sleep loss, chronotype, and sleep quality did not have a strong effect on cognitive function measured using the online Stroop task in the 40s age group. However, people in their 20s with sleep loss and those in their 60s with lower sleep quality showed higher selective attention, the mechanism of which requires further research.

IPCT-Net: Parallel information bottleneck modality fusion network for obstructive sleep apnea diagnosis

Obstructive sleep apnea (OSA) is a common sleep breathing disorder and timely diagnosis helps to avoid the serious medical expenses caused by related complications. Existing deep learning (DL)-based methods primarily focus on single-modal models, which cannot fully mine task-related representations. This paper develops a modality fusion representation enhancement (MFRE) framework adaptable to flexible modality fusion types with the objective of improving OSA diagnostic performance, and providing quantitative evidence for clinical diagnostic modality selection. The proposed parallel information bottleneck modality fusion network (IPCT-Net) can extract local-global multi-view representations and eliminate redundant information in modality fusion representations through branch sharing mechanisms. We utilize large-scale real-world home sleep apnea test (HSAT) multimodal data to comprehensively evaluate relevant modality fusion types. Extensive experiments demonstrate that the proposed method significantly outperforms existing methods in terms of participant numbers and OSA diagnostic performance. The proposed MFRE framework delves into modality fusion in OSA diagnosis and contributes to enhancing the screening performance of artificial intelligence (AI)-assisted diagnosis for OSA.

The Impact of Comorbid Sleep-Disordered Breathing on Hospitalization Risk Related to Diabetes and Atherosclerotic Disease: A Retrospective Cohort Analysis

Objective: To determine the relationship between comorbid sleep-disordered breathing (SDB) and hospitalization rates related to diabetes mellitus (DM) and atherosclerotic disease (AD). Methods: This study used a retrospective cohort design from a large medical claims database with 5 years of data between 2018 and 2022. The presences of SDB, DM, and AD were identified using International Classification of Diseases (ICD-10) and relevant Current Procedural Terminology (CPT) codes. Hospitalizations related to DM and AD were identified primarily using Place of Service (POS) code 21. Propensity-score matching was first used on data from the entire 5-year period to select matched controls (unadjusted n = 883,910, adjusted n = 888,619) compared to those diagnosed with SDB (n = 519,818) on hospitalization rates during the concurrent 5-year period. A second analysis used propensity-score matching on data from year 1 only to select matched controls (unadjusted n = 248,848, adjusted n = 260,298) compared to those diagnosed with SDB in year 1 (n = 193,671) on hospitalization outcomes in the subsequent 4-year period. Results: Odds ratios (ORs) revealed a significant association between SDB diagnosis and hospitalizations related to DM (OR 1.23-1.71), AD (OR: 1.08-1.34), and either condition (OR 1.17-1.49) in both analyses. Post hoc analysis revealed sex differences in the relationship between SDB and future hospitalizations, with females showing a pattern of significantly elevated risk across all future hospitalization outcomes (OR: 1.25-1.44), whereas males were found to have a significant relationship between SDB diagnosis and future DM hospitalization only (OR 1.10). Conclusions: These findings provide real-world evidence that comorbid SDB increases the risk for hospitalizations related to chronic cardiometabolic conditions. Sex is a potential moderator of this relationship and should be further explored.

Surgical Management of Pediatric Obstructive Sleep Apnea: Efficacy, Outcomes, and Alternatives-A Systematic Review

AIM

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive the most appropriate treatment for their specific condition.

MATERIAL AND METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered at PROSPERO under the ID CRD42024593760. A search on PubMed, Scopus, and Web of Science was performed to find papers that matched the topic, using the following Boolean keywords: ("obstructive sleep apnea" OR "OSA" OR "sleep apnea, obstructive") AND ("surgery" OR "surgical" OR "surgical techniques" OR "surgical treatment" OR "operative" OR "surgical procedures") AND ("treatment" OR "therapy" OR "management").

RESULT

The electronic database search found 20337 publications. After the screening and eligibility phase, 15 papers were chosen for the qualitative analysis.

CONCLUSIONS

Adenotonsillectomy (AT) significantly improves secondary outcomes like behavioral issues and quality of life, compared to watchful waiting with supportive care (WWSC). Alternative approaches such as tonsillotomy and adenopharyngoplasty (APP) offer promising results, with less postoperative discomfort and lower complication rates. However, further large-scale studies are needed to refine surgical techniques, assess long-term outcomes, and optimize individualized treatment strategies for OSA.