A New Technological Advancement of the Drug-Induced Sleep Endoscopy (DISE) Procedure: The "All in One Glance" Strategy

Artificial Intelligence-Assisted Drug and Biomarker Discovery for Glioblastoma: A Scoping Review of the Literature

Background: Artificial intelligence (AI) has emerged as a transformative tool in healthcare, particularly in drug and biomarker discovery, where it can enhance precision, streamline discovery processes, and optimize treatment strategies. Despite its potential, the application of AI in glioblastoma (GB) research, especially in identifying novel biomarkers and therapeutic targets, remains underexplored. The aim of this review is to map the existing literature on AI-driven approaches for biomarker and drug discovery in GB, highlighting key trends and gaps in current research. Design: Following a PRISMA methodology, this scoping review examined studies published between 2012 and 2024. Searches were conducted across multiple databases, including MEDLINE (PubMed), Scopus, the Cochrane Library, and Web of Science (WOS). Eligible studies were screened, and relevant data were extracted and synthesized to provide a comprehensive overview of AI applications in GB research. Results: A total of 224 records were identified, including 210 from PubMed, 104 from Scopus, 4 from WOS, and 6 from the Cochrane Library. After screening and applying eligibility criteria, 33 studies were included in the final review. These studies showcased diverse AI methodologies applied to both drug discovery and biomarker identification, focusing on various aspects of GB biology and treatment. Conclusions: This scoping review reveals an increasing interest in AI-driven strategies for biomarker and drug discovery in GB, with promising initial results. However, further large-scale, rigorous studies are needed to validate real-world applications of AI and the development of standardized protocols to enhance reproducibility and clinical translation.

The relationship between bi-spectral index and VOTE score in evaluation of drug-induced sleep endoscopy: A systematic meta-analysis

OBJECTIVE

The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level.

METHODS

In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed.

RESULTS

As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001).

CONCLUSION

It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during the night. The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population. Typical nocturnal symptoms are the persistent snoring and awakenings with dyspnea sensation. On the other hand, diurnal symptoms could be sleepiness, headaches, asthenia, neurological disorders, and impaired personal relationships. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls.

A review of the "OMICS" for management of patients with obstructive sleep apnoea

Obstructive sleep apnaea (OSA) syndrome is a condition characterised by the presence of complete or partial collapse of the upper airways during sleep, resulting in fragmentation of sleep associated with rapid episodes of intermittent hypoxia (IH), activation of the sympathetic nervous system and oxidative stress. OSA is associated with a broad spectrum of cardiovascular, metabolic and neurocognitive comorbidities that appear to be particularly evident in obese patients, while affecting both sexes in a different manner and varying in severity according to gender and age. In recent years, studies on OSA have increased considerably, but in clinical practice, it is still a highly underdiagnosed disease. To date, the gold standard for the diagnosis of OSA is nocturnal polysomnography (PSG). However, since it is not well suited for a large number of patients, the Home Sleep Test (HST) is also an accepted diagnostic method. Currently, the major aim of research is to identify non-invasive methods to achieve a highly predictive, non-invasive screening system for these subjects. The most recent reports indicate that research in this field has made significant progress in identifying possible biomarkers in OSA, using -OMIC approaches, particularly in the fields of proteomics and metabolomics. In this review, we analyse these OMIC biomarkers found in the literature.

The Use of Middle Latency Auditory Evoked Potentials (MLAEP) as Methodology for Evaluating Sedation Level in Propofol-Drug Induced Sleep Endoscopy (DISE) Procedure

To analyze the middle latency auditory evoked potential index (MLAEPi), compared to the standard bispectral index (BIS), as a method for evaluating the sedation level in drug-induced sleep endoscopy (DISE). In this controlled clinical study on a sample of 99 obstructive sleep apnea (OSA) or snoring patients, we compared the MLAEPi with the BIS after propofol infusion during the standard DISE technique in order to define the MLAEPi values within the observational window of the procedure. The DISE procedure was divided into eight steps, and we collected both MLAEPi and BIS data values from the same patient in every step. The MLAEPi showed a faster response than the BIS after propofol infusion during DISE. Therefore, the clinical use of the MLAEPi in evaluating the sedation level seems to be a good alternative to the current technological standards.