The associations between anxiety, depression, and the prognosis of COPD remain uncertain. The present study aims to investigate the associations of anxiety and depression with 30-day readmission rates and acute exacerbations of COPD (AECOPD). Four databases were searched to identify relevant studies published before 13 March 2024. Studies that report on the impact of anxiety and depression on the prognosis of AECOPD were included. The pooled effect size and its 95% confidence interval (CI) were calculated using a random effects model. The primary outcomes were 30-day readmission and AECOPD within the first year after discharge in COPD patients. Of the 5,955 studies screened, 14 studies were included in the analysis. Patients with anxiety had a higher risk of AECOPD within the first year after discharge compared to those without anxiety (HR: 2.10, 95% CI: 1.28-3.45, p = 0.003). Patients with depression also had a higher risk of AECOPD within the first year after discharge (HR: 1.36, 95% CI: 1.10-1.69, p = 0.004). Similar results were observed in the associations of anxiety and depression with 30-day readmission. Our results suggested that anxiety and depression were associated with an increased risk of 30-day readmission and AECOPD in patients with COPD.

CDKL5 deficiency disorder is a rare genetic disease caused by mutations in the CDKL5 gene. Central apneas during wakefulness have been reported in patients with CDKL5 deficiency disorder. Studies on CDKL5-knockout mice, a CDKL5 deficiency disorder model, reported sleep apneas, but it is still unclear whether these events are central (central sleep apnea) or obstructive (obstructive sleep apnea) and may be related to alterations of brain circuits that modulate breathing rhythm. This study aimed to discriminate central sleep apnea and obstructive sleep apnea in CDKL5-knockout mice, and explore changes in the somatostatin neurons expressing high levels of neurokinin-1 receptors within the preBötzinger complex. Ten adult male wild-type and 12 CDKL5-knockout mice underwent electrode implantation for sleep stage discrimination and diaphragmatic activity recording, and were studied using whole-body plethysmography for 7 hr during the light (resting) period. Sleep apneas were categorised as central sleep apnea or obstructive sleep apnea based on the recorded signals. The number of somatostatin neurons in the preBötzinger complex and their neurokinin-1 receptors expression were assessed through immunohistochemistry in a sub-group of animals. CDKL5-knockout mice exhibited a higher apnea occurrence rate and a greater prevalence of obstructive sleep apnea during rapid eye movement sleep, compared with wild-type, whereas no significant difference was observed for central sleep apnea. Moreover, CDKL5-knockout mice showed a reduced number of somatostatin neurons in the preBötzinger complex, and these neurons expressed a lower level of neurokinin-1 receptors compared with wild-type controls. These findings underscore the pivotal role of CDKL5 in regulating normal breathing, suggesting its potential involvement in shaping preBötzinger complex neural circuitry and controlling respiratory muscles during sleep.

We sought to identify important issues regarding symptoms and impacts of obstructive sleep apnea (OSA), to explore fatigue and sleepiness, and evaluate the content, clarity, and relevance of specific patient reported outcome (PRO) measures.

Participants in the US with OSA and at least mild fatigue were studied. Individuals with positive airway pressure (PAP) therapy intolerance or current PAP refusal (non-PAP users) and those who initiated PAP within the past 12 months (PAP users) were identified and interviewed. Interviews included concept elicitation questions about symptoms and impacts of OSA. Participants then completed several PRO measures (the PRO Measurement Information System [PROMIS] Fatigue-8a, PROMIS Sleep-Related Impairment-8a, Epworth Sleepiness Scale [ESS], Patient-Global Impression of Severity of Fatigue [PGI-S Fatigue], and Patient Global Impression of Change in Fatigue [PGI-C Fatigue]) and were cognitively debriefed to evaluate their content, clarity, and relevance.

A total of 30 individuals with OSA (20 non-PAP and 10 PAP) were enrolled. In addition to fatigue (reported by 100%), sleepiness (75%), difficulty concentrating (85%), dry mouth/throat (60%), headaches (50%) and interrupted sleep (50%) were the most common symptoms reported by non-PAP users. Fifty-eight percent of non-PAP users rated fatigue as the most bothersome symptom; 5% rated sleepiness as the most bothersome. Among PAP users, the most common symptoms (prior to PAP use) in addition to fatigue (100%) were sleepiness (90%), difficulty concentrating (60%), dry mouth/throat (60%), headaches (50%), and interrupted sleep (50%). Fatigue was rated as most bothersome by 56% of PAP users; sleepiness was rated as the most bothersome by 22%. All participants mentioned fatigue and sleepiness separately, indicating they are considered distinct symptoms. In general, participants found the PRO measures to be relevant and clear, and results supported their content validity, clarity, and relevance.

Fatigue was the most bothersome symptom reported by non-PAP and PAP users. Participants described fatigue as a distinct and different concept from excessive daytime sleepiness. Participants reported that their OSA symptoms negatively impact daily activities, functioning, work, and relationships. The PRO measures are clear and relevant for individuals with OSA and appropriate for use in both clinical and research settings.

The aim of the present study was to explore age-related sleep alterations in normal subjects whose sleep had been recorded for the first time 40.4 ± 4.8 years ago. For the follow-up polysomnography (3 nights) 15 participants (5 female, 10 male, age 56-74 years) were recruited. Recording conditions and sleep scoring were adapted to the previous study. In all older participants, the amount of slow-wave sleep and REM sleep was decreased, while stage 1 and wakefulness were increased. There was no significant change in stage 2 or in any of the additional REM sleep parameters (REM density, latency, number and duration of REM cycles). Sleep stage transition analysis showed a markedly reduced stability of SWS from young to older age. While none of the single sleep parameters showed intra-individual stability with age, a pattern analysis, which combined seven sleep parameters (sleep stages, total sleep time and REM density), showed that the concordance rate of the combined sleep parameters correlated significantly with the age at follow-up. The results of this longitudinal study over a period of about 40 years are largely consistent with those of cross-sectional studies. While the lack of significant correlation of the individual sleep parameters between the younger and older age groups did not allow for the identification of any of them as trait markers, the result of the pattern analysis, which combined a set of sleep parameters, indicates that the stability of the sleep structure decreases significantly in the age range between the late 50s and early 70s.

Carbon dioxide (CO2) accumulation during prolonged painless colonoscopy procedures in patients with obstructive sleep apnea syndrome (OSAS) can lead to an increased incidence of various complications. The disposable end-expiratory CO2 device monitors the respiratory function and CO2 elimination of patients in real time, providing timely feedback to physicians. This enhances the safety and success of the procedure and improves the overall medical experience for the patient.

A total of 158 patients with OSAS underwent colonoscopy and were divided into two groups. The study group received end-expiratory CO2 monitoring, while the control group underwent routine monitoring. Perioperative interventions, patient satisfaction, and postoperative complications were compared between the two groups using a case-control method. All colonoscopic procedures were performed by surgeons.

The study group exhibited a lower incidence of hypoxemia and higher utilization of upper airway ventilation devices, resulting in greater postoperative satisfaction (P = 0.019, P = 0.002, P < 0.001, respectively). Conversely, the control group experienced a higher incidence of postoperative nausea and vomiting as well as abdominal pain and abdominal distension (P = 0.006, P = 0.038, P < 0.012).

Employing disposable end-expiratory CO2 monitoring during painless enteroscopic procedures in patients with OSAS reduces the incidence of hypoxemia, enhances postoperative satisfaction, and decreases the incidence of postoperative complications.

ChiCTR2400083702; Registration date: April 2024.

Sleep apnea syndrome (SAS) is potentially linked to life-threatening conditions. The decline in kidney function is involved in the development of various diseases; however, it remains unclear whether it is implicated in the onset of SAS. Therefore, this study aimed to investigate the relationship between kidney function and the incidence of SAS.

The association of estimated glomerular filtration rate (eGFR) with the incidence of SAS was assessed retrospectively using real-world administrative claims and health checkup data collected between April 2014 and November 2022. To strengthen robustness, three stratified analyses and four sensitivity analyses were conducted.

We assessed 1 589 259 individuals for the analysis. During a median (interquartile range) follow-up of 1167 (652-1699) days, 11 054 cases of SAS events were documented. Multivariable Cox regression analyses after adjusting for potential confounders, including age, sex, body mass index, hypertension, diabetes, dyslipidemia, cigarette smoking, alcohol drinking, and physical inactivity, demonstrated that the decrease in eGFR (eGFR ≥ 90, 60-89, 45-59, 30-44, and <30 mL/min/1.73 m2) was associated with a higher risk of SAS (hazard ratio [95% confidence intervals]; 1 [reference value], 1.13 [1.06-1.20], 1.22 [1.13-1.32], 1.34 [1.17-1.52], 1.82 [1.43-2.33]). In the restricted cubic spline regression model, the risk of developing SAS increased with the reduction in eGFR. The results of the sensitivity analyses were consistent with the primary findings.

Our analysis utilizing a large-scale population-based cohort concluded that reduced eGFR is associated with the risk of developing SAS in a dose-dependent manner.

All areas of medicine are focused on developing a personalized approach to diagnosis and treatment of specific conditions. This is based on the fundamental concept that all subjects with apparently the same disorder are different. There are multiple reasons for these differences. These include differences in the sequence of DNA, differences in the environment, differences in epigenetics, some of which may be driven by environmental differences and differences in the microbiome. These different factors will result in variations in multiple aspects of the phenotype. This includes different pathways to disease, different symptoms, different pattern of comorbidities and risk for adverse outcomes, and different physiological changes during sleep as a result of breathing episodes.

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.

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway collapse during sleep. Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an uncomfortable urge to move the legs, especially during inactivity and evenings. Both OSA and RLS are common with significant overlap: RLS is present in up to 36% of those with OSA. Treatment of OSA with continuous positive airway pressure (CPAP) therapy may influence RLS outcomes. We performed a systematic review to evaluate the impact of CPAP therapy on RLS symptoms and RLS medication usage in individuals with both OSA and RLS.

A comprehensive literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception to December 7, 2024. The outcomes of interest were the improvement in RLS symptom severity, as measured by standardized scales such as the International RLS Study Group RLS Severity Scale (IRLS), and changes in the usage of RLS medications. The review included clinical trials and observational studies. Inclusion criteria were: studies with a control group or comparison period before CPAP usage, adult participants diagnosed with OSA and RLS, measurements of RLS severity using standardized scales such as the IRLS, and reports on medication usage before and after CPAP therapy. Data extraction included study characteristics, participant demographics, exposure and outcome measurements, and adjusted effect estimates. Exclusion criteria included non-primary research articles such as reviews, editorials, commentaries, letters, studies without standardized assessments of RLS symptoms, and non-English articles. The quality of included studies was assessed using the Newcastle-Ottawa Quality Scale (NOS), and the risk of bias was evaluated using the ROBINS-I tool. The systematic review was registered in PROSPERO (ID: CRD42024550240).

The search identified 2,046 articles, with 291 undergoing full-text review, and three studies (3 observational, 0 RCTs) meeting the inclusion criteria, which included 479 patients. CPAP therapy was associated with improvements in RLS symptoms and a reduction in medication usage among patients with coexistent RLS and OSA. The magnitude of these effects varied, with some studies reporting significant improvements while others showed probable changes. The variability in results can be attributed to differences in study designs, sample sizes, and adjustments for confounding factors. These factors highlight the need for more rigorous research to evaluate the benefits of CPAP therapy in patients with coexistent RLS and OSA.

CPAP therapy appears beneficial for improving RLS symptoms and reducing medication usage in patients with coexistent OSA and RLS. However, further research with standardized diagnostic and treatment criteria, larger sample sizes, and robust adjustment for confounding factors is necessary to confirm these findings and better understand the underlying mechanisms.

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

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

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

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

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

The past of sleep medicine is rich with seminal discoveries, from the recognition of clinical syndromes to measurement of sleep itself to classic and novel therapeutics. Advances in neurobiology have mapped a number of sleep circuits, described the central and peripheral circadian system, and identified the cause of narcolepsy with cataplexy. Sleep apnea endotypes and phenotypes now have established clinical relevance, though treatment implications are a work in progress. Artificial intelligence will continue to change sleep medicine in a number of domains from aiding scoring to health outcome predictions. There is a large gap between the known science and clinical translational.

Obstructive Sleep Apnea (OSA) is usually caused by collapse of the base of tongue (BOT) and impacts patients' overall health. Despite current conventional therapies, some patients do not achieve satisfactory results. Reduction of BOT using Trans Oral Robotic Surgery (TORS) emerges as a promising treatment. We evaluated the patient reported and clinical outcomes of TORS for OSA.

We performed a retrospective cohort study of patients treated from 2018 to 2021 in a non-academic general hospital. Patients were eligible for TORS when apnea hypopnea index (AHI) was >5 in combination with obstruction at BOT level. Patients were included when 1-year follow up respiratory polygraphy was available. Changes in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-35), MD Anderson Dysphagia Inventory (MDADI) scores and postoperative complications were evaluated. Surgical success rates were obtained.

Out of 56 patients, 28 patients of which 22 (78.6%) males and 6 (21.4%) females, with OSA severity ranging from mild to severe and mean age of 49 (SD 11.8) with a median BMI of 28.1 (IQR 26.9-32.1) were included. ESS score declined from mean 5.9 (SD 3.8) to 2.2 (SD 2.0) (p<0.00). FOSQ-35 scores were all declined (p<0.05). MDADI scores were in normal range (80-100) and remained stable (p = 0.44). In 23 (82.1%) patients no postoperative complications were observed. Surgical success rates were 86%.

TORS demonstrate to be effective and safe in OSA patients, and it can be used in both patients who are unresponsive to conventional therapies or as a primary therapy.

Interventions leading to avoidance of supine position and thus reducing the likelihood of upper airway collapse during sleep are a treatment approach for positional obstructive sleep apnea (POSA). The aim of this randomized cross-over trial was to assess the effect of two actuated beds (trunk-elevation and sideward-tilting) on OSA severity and sleep fragmentation in POSA.

After baseline polysomnography, adult patients with POSA were randomly assigned to two nights of intervention in the intelligent sleep apnea bed ISABel1 and ISABel2. In the case of obstructive apnea or hypopnea, ISABel1 elevated the upper body by 50° and ISABel2 induced a unilateral bed tilt of 40°, with both interventions lasting 10 min. Sustained trunk elevations without sliding down (ISABel1) and position change from supine to non-supine (ISABel2) were defined as successful interventions.

Six adult men (57 ± 11 years, BMI 28 ± 4 kg/m2, AHI 39 ± 15/h) with POSA were included. Neither trunk elevation (ISABel1) nor side tilt (ISABel2) - approximately 10 interventions per night - significantly reduced apnea-hypopnea index (AHI), whereas trunk elevation showed a tendency to reduce supine AHI. Actuated beds had no effect on sleep efficiency and arousals. Only 13 % of side tilts in ISABel2 resulted in a successful shift to a non-supine position. The time to the next respiratory event after bed movement was longer in the trunk elevating bed than in the side-tilting bed.

Trunk elevating beds decrease supine AHI and both side-tilting and trunk elevating beds increase the time to the next obstructive apnea or hypopnea.

Sleep-disordered breathing (SDB) and the related clinical syndrome, sleep apnoea syndrome (SAS), are highly prevalent in patients with ischaemic heart disease and often remain undiagnosed. The AMI-Sleep study will describe its prevalence in patients with acute myocardial infarction (AMI) and assess the independent contribution of the type and severity of SDB/SAS to subsequent incident cardiovascular events and mortality.

This prospective study will include patients hospitalised for AMI enrolled in the multicentre nationwide prospective French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry. A nightly simplified polygraphy is performed before discharge from the index AMI admission, and participants complete two self-administered sleep questionnaires. Baseline data are obtained from the FRENCHIE registry. Each participant will be subsequently followed based on data from the National Health Data System (SNDS). Over a period of 4 years, the AMI-Sleep study is expected to recruit approximately 2000 participants. Assuming at least a 10% rate of incident cardiovascular events over 1 year, there would be an estimated 200 events during the first year of follow-up that would be sufficient in multivariable analysis. The primary objective is to describe the prevalence and severity of SDB in AMI and to analyse the association between the type and severity of SDB (based on the apnoea-hypopnoea index) and the occurrence of cardiovascular events (incident acute coronary syndrome, transient ischaemic attack, stroke) or all-cause death after AMI. Secondary objectives include determining the association between the presence of SAS and coronary artery disease severity, in-hospital mortality, morbidity events, healthcare consumption and related costs.

Eligible individuals are provided with information about the AMI-Sleep study and provided written informed consent. The protocol was approved by the regional Ethics Committee (CPP Ouest II - Angers, RCB N°2018-A00719-46) on 17 February 2019, is registered on ClinicalTrials.gov (NCT04064593) and started in January 2019 with the expected publication of primary outcome results in 2025.

ClinicalTrials.gov, NCT04064593.

To estimate the rate of obstructive sleep apnea (OSA) and associated factors among Lebanese adults.

A cross-sectional study was conducted in February-April 2022; 1,202 Lebanese adults were enrolled. The sample was collected among several Lebanese governorates through an anonymous online self-reported questionnaire. The STOP-BANG questionnaire was used as a screening tool to estimate the OSA risk. "Low OSA risk" is established with 0-2 positive answers, "Intermediate OSA risk" is established by 3-4 positive answers while "High OSA risk" is established by 5-8 positive answers.

This study showed that 743 (62.4%) of the sample had low risk for OSA, 357 (30.0%) had moderate, and 90 (7.6%) had high risk for OSA. Older age (aOR = 1.05) and having hypertension (aOR = 7.80) were associated with higher odds of moderate OSA. Female sex (aOR = 0.04) was significantly associated with lower odds of moderate OSA compared to males. Older age (OR = 1.17), higher BMI (OR = 1.14), hypertension (OR = 18.55), and having severe COVID-19 infection compared to mild (OR = 4.30) were significantly associated with higher odds of high OSA, whereas female sex (OR = 0.002) and being married compared to single (aOR = 0.23) were associated with lower odds of high OSA.

This study showed that most Lebanese adults have low risk for OSA. It also confirmed that sex, age, obesity, hypertension, and severe COVID-19 were associated with high OSA risk. These associated factors call for future research exploring the causes including the potential effect of social, economic, and political instability, local customs, and environmental factors. Moreover, future health campaigns should be assigned to increase awareness among Lebanese population regarding the prevention of OSA through lifestyle modifications.

Sleep Apnea (SA) affects an estimated 936 million adults globally, posing a significant public health concern. The gold standard for diagnosing SA, polysomnography, is costly and uncomfortable. Electroencephalogram (EEG)-based SA detection is promising due to its ability to capture distinctive sleep stage-related characteristics across different sub-band frequencies. This study aims to review and analyze research from the past decade on the potential of EEG signals in SA detection and classification focusing on various deep learning and machine learning techniques, including signal decomposition, feature extraction, feature selection, and classification methodologies.

A systematic literature review using the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) and PICO guidelines was conducted across 5 databases for publications from January 2010 to December 2024.

The review involved screening a total of 402 papers, with 63 selected for in-depth analysis to provide valuable insights into the application of EEG signals for SA detection. The findings underscore the potential of EEG-based methods in improving SA diagnosis.

This study provides valuable insights, showcasing significant advancements while identifying key areas for further exploration, thereby laying a strong foundation for future research in EEG-based SA detection.

Unrecognised obstructive sleep apnoea (OSA) has been associated with adverse cardiorespiratory perioperative outcomes. However, with changing anaesthetic and perioperative management, there is ongoing uncertainty about the importance of OSA as a risk factor for post-operative complications.

A cohort study involving subjects undergoing elective surgery was conducted. OSA was diagnosed with a limited channel sleep monitor. In subjects undergoing routine perioperative care, complications were identified based on the assessment of the attending clinical team. The primary outcome was a composite end-point of cardiorespiratory outcomes comprising myocardial infarction, atrial fibrillation, other arrhythmias, bradycardia, need for inotropic support, unplanned intensive care unit admission, pneumonia or respiratory failure.

Four hundred seventy-two subjects were recruited, with 356 being included in the analyses; 281 (79%) had OSA and 66 (19%) had severe OSA. Subjects with OSA did not have a significantly higher incidence of complications (5.7%) compared to those without (2.7%, adjusted relative risk 1.89 (0.23-15.67)). Additionally, complications were not increased in those with severe OSA.

Unrecognised OSA was not associated with an increase in clinically evident cardiorespiratory complications in this cohort. The lower complication rates compared with earlier studies suggest that increased use of less invasive surgical techniques, improved pain management and increased awareness of OSA have had an impact in reducing postoperative complications in this group. Further research is needed to clarify the impact of severe OSA on post-operative outcomes in different surgical cohorts with varying risk profiles in order to develop optimal perioperative pathways.

Obstructive sleep apnea (OSA) is a breathing disorder in which airway obstruction during sleep leads to periodic bouts of inadequate (hypopneic) or absent (apneic) ventilation despite neurorespiratory effort. Repetitive apneic and hypopneic exposures can induce intermittent hypoxemia and lead to a host of maladaptive behavioral and physiological outcomes. Intermittent hypoxia treatment (IH), which consists of alternating exposure to hypoxic and normal air, can induce a long-lasting increase in breathing motor outputs called long term facilitation (LTF). IH models key aspects of the hypoxemia experienced during OSA and LTF might serve to prevent OSA or ameliorate its severity by stimulating ventilatory output during or after apnea/hypopnea. Ethanol consumption prior to sleep exacerbates existing OSA, but it is unknown how ethanol affects LTF expression. Thus, we hypothesized that ethanol treatment would attenuate LTF expression and the magnitude of the ventilatory response during acute hypoxic exposure. We administered either low-dose (0.8 g/kg) or high-dose (3 g/kg) ethanol or saline to adult female Sprague-Dawley rats through intraperitoneal injection and then measured subjects' ventilatory output by whole-body plethysmography during baseline, a 5 by 3-minute moderate IH protocol (hypoxia: FiO2 = 0.11, Normoxia: room air), and for one hour following the end of IH. Results indicate that low-dose ethanol abolishes LTF of respiratory rate and minute ventilation and trends suggest that low-dose ethanol might attenuate respiratory rate and minute ventilation during acute hypoxic exposure. While high-dose ethanol significantly diminished subjects' respiratory rate and minute ventilation during hypoxia, LTF expression was not significantly different between high-dose ethanol and saline-treated subjects. Overall, data indicate that ethanol exposure dramatically attenuates LTF expression following IH treatment and impairs ventilatory responses to hypoxia in a dose-dependent manner. Such findings inspire further consideration of ethanol's negative effects upon endogenous compensatory mechanisms for repeated hypoxic exposure, both in the context of OSA and beyond.

Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women.

We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry.

Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) ≥5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively.

In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7 %), of whom 70.2 % were male and 29.8 % were female. In the OSA group, women were older (56.7 ± 11.9 vs. 49.5 ± 11.3 years; p < 0.001) and more obese (body mass index 34.3 ± 7.2 vs. 31.4 ± 5.6 kg/m2; p < 0.001) and had lower AHI (29.8 ± 24.1 vs. 36.8 ± 26.2 events/h; p < 0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p < 0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p < 0.05 for each).

Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI.

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

A prospective cohort study.

Tertiary referral center.

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

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

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

Level 4.

The resolution of obstructive sleep apneas syndrome (OSAS) following bariatric surgery appears to be promising for the majority of patients although this resolution does not necessarily exhibit a linear correlation with weight loss. Previous small-scale studies have pinpointed a younger age and preoperative weight under 100kg as predictive factors of OSAS improvement OBJECTIVES: The primary objective was to evaluate the evolution of OSAS in patients treated with continuous positive airway pressure (CPAP). Additionally, we tried to identify potential predictive factors for OSAS improvement postsurgery.

Brest Hospital, France, University Hospital.

In this retrospective, observational study we analyzed a cohort of 44 patients who underwent bariatric surgery, between January 2015 and December 2021. Each patient underwent respiratory polygraphy (RP) or polysomnography (PSG) before and after the surgical procedure. We collected CPAP data (including effective pressure and adherence) before and during the 6 months following the intervention.

Within the study population, 68.18% of patients exhibited improved OSAS, as defined as an apnea-hypopnea index of less than 15 per hour. A higher mean oxygen saturation prior to surgery emerged as the sole predictive factor for OSAS improvement. CPAP adherence and therapeutic pressure value, 2 rarely studied parameters, did not show significant difference between improved and nonimproved patients.

The rate of OSAS resolution after surgery is 68.18%, with only a higher mean oxygen saturation before surgery identified as a predictive factor for OSAS resolution.

The complicated association between sleep apnea and postpartum depression (PPD), two diseases that can have a major influence on a mother's health and well-being, is examined in this thorough review. An increasing number of people are realizing that sleep apnea, which is defined by repeated bouts of upper airway obstruction during sleep, may be a risk factor for PPD. The literature currently available on the frequency, common risk factors, and possible processes relating these two disorders is summarized in this study. We investigate the potential roles that sleep apnea-related hormone fluctuations, intermittent hypoxia, and fragmented sleep may play in the onset or aggravation of PPD. We also talk about the difficulties in identifying sleep apnea in the postpartum phase and how it can affect childcare and mother-infant attachment. The evaluation assesses the effectiveness of existing screening techniques, available treatments, and how well they manage both illnesses at the same time. Lastly, we identify research gaps and suggest future lines of inquiry to enhance maternal health outcomes.

Comorbid insomnia and obstructive sleep apnea (COMISA) present significant clinical challenges, given their overlapping symptoms and detrimental effects on health. Only a few studies have explored sex differences in patients with obstructive sleep apnea (OSA) and COMISA. This retrospective study investigated sex differences in psychiatric symptoms and polysomnographic findings between patients with COMISA and those with OSA alone.

Patients who underwent polysomnography (PSG) and completed questionnaires at a single tertiary hospital sleep center were enrolled. Patients diagnosed with OSA using PSG (apnea-hypopnea index ≥ 5) were categorized based on the Insomnia Severity Index-Korean version (ISI) into OSA without insomnia (OSA-only group; ISI < 15) and OSA with insomnia (COMISA group; ISI ≥ 15).

This study included 1,096 adult patients diagnosed with OSA, of whom 426 (38.9%) were in the COMISA group. COMISA was more common in women than in men (50.7% vs. 34.5%, p < 0.001). The COMISA group reported more severe subjective psychiatric symptoms, including depression, anxiety, and daytime sleepiness in both men and women. The male COMISA group had lower sleep efficiency (p = 0.02) and longer sleep latency (p = 0.002) than those had by the OSA-only group. The male COMISA group had a higher apnea-hypopnea index (p = 0.04) and a lower mean oxygen saturation (p = 0.004) than those had by the OSA-only group.

These findings highlight the importance of considering sex-specific clinical and polysomnographic characteristics when managing patients with COMISA.

Background: Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by intermittent upper airway obstruction, leading to significant health consequences. Traditional diagnostic methods, such as polysomnography, are time-consuming and resource-intensive. Objectives: This study explores the potential of proton-transfer-reaction mass spectrometry (PTR-MS) in identifying volatile organic compound (VOC) biomarkers for the non-invasive detection of OSA. Methods: Breath samples from 89 participants, including 49 OSA patients and 40 controls, were analyzed using PTR-MS. Significance analysis was performed between OSA patients and controls to identify potential biomarkers for OSA. To as-sess the differences in VOC concentrations between OSA patients and control subjects, the Wilcoxon rank-sum test was employed. partial least squares discriminant analysis (PLS-DA) analysis and heatmap plot was conducted to visualize the differentiation between OSA patients and control subjects based on their VOC profiles.In order to further investigate the correlation between identified biomarkers and the severity of OSA measured by Apnea-Hypopnea Index (AHI), regression analysis was conducted between biomarkers and AHI Index. Results: The results identified specific VOCs, including m045 (acetaldehyde), m095.950, and m097.071, which showed significant differences between OSA patients and controls. Advanced statistical analyses, including PLS-DA and correlation mapping, highlighted the robustness of these biomarkers, with m045 (acetaldehyde) specifically emerging as a potential biomarker associated with the AHI Index. Conclusions: This study underscores the potential of VOCs as biomarkers for identifying patients with severe AHI levels. The analysis of VOCs using PTR-MS presents a rapid, non-invasive, and cost-effective method that could be seamlessly integrated into clinical practice, allowing clinicians to better stratify patients based on their need for polysomnography and prioritize those requiring earlier testing. Future studies are necessary to validate these findings in larger cohorts and to explore the integration of PTR-MS with other diagnostic modalities for improved accuracy and clinical utility.

To investigate the effect of nocturnal chronic hypoxia on the thickness changes of the corneal limbal epithelial area that provides regeneration of the corneal epithelium and ocular surface evaluation parameters in patients with obstructive sleep apnea (OSA).

All patients diagnosed with OSA and the control group underwent a complete ophthalmological examination, including slit-lamp examination and funduscopy. Tear break-up time, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and anterior segment optical coherence tomography were performed with fluorescein sterile strip for ocular surface evaluation.

Oxygenation levels of patients during night sleep were different between mild-severe and moderate-severe groups. The Ocular Surface Disease Index results were statistically significantly different between the severe OSA group and the mild OSA group, and between the control group and all other OSA groups (P < 0.05). The limbal epithelial thickness (LET) value was found to be lower in the moderate OSA group than in the mild OSA group and the control group and was statistically significantly higher than in the severe OSA group. In the severe OSA group, the LET value was found to be statistically significantly lower than all other groups (P < 0.05).

In the literature, there is no study evaluating the effect of prolonged hypoxia on limbus epithelium as in patients with OSA. In this study, LET was measured to be statistically significantly thinner as the severity of OSA increased. Considering these results, it can be concluded that the proliferation of limbal stem cells is reduced in prolonged hypoxia.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most common sleep-related breathing disorder. Longer term, repeated episodes of hypercapnia and hypoxemia during sleep are associated with inflammatory and atherosclerosis-related factors. The aim of this study was to explore the effect of continuous positive airway pressure (CPAP) therapy on cerebral vasoreactivity and early atherosclerosis in patients with severe OSAHS.

Forty-one patients with severe OSAHS were enrolled. The mean follow-up time was 39.8 ± 9.1 months. Cardiovascular risk factors were assessed, and laboratory tests, carotid artery intima-media thickness (CIMT) measurement and cerebrovascular reserve capacity (CRC) measurement were performed. After the baseline examination, 28 patients received CPAP therapy (treated group), which was not available for 13 patients (untreated group). Parameters were compared before and after treatment, between treated and untreated patients.

Cardiovascular risk factors, baseline polysomnographic parameters, laboratory values, CIMT and CRC of the two groups were similar at baseline. At the follow-up, CRC did not differ between the two groups, but CIMT was significantly lower in the treated group than in the untreated group (0.73 ± 0.11 mm vs. 0.84 ± 0.21 mm, p = 0.027). The CIMT of both groups increased significantly during the follow-up period (from 0.65 ± 0.11 mm to 0.73 ± 0.11 mm in the treated group, and from 0.69 ± 0.11 mm to 0.84 ± 0.21 mm in the untreated group), but the increase in the treated group was smaller than in the untreated group (0.09 ± 0.09 mm vs. 0.15 ± 0.15 mm).

In patients with severe OSAHS, CPAP treatment significantly reduced the progression of CIMT.

Obesity hypoventilation syndrome (OHS) is associated with high morbidity and mortality. There are few data on whether there are gender differences in outcomes.

Do women with OHS experience worse outcomes in ambulatory and hospitalized settings compared to men?

Post hoc analyses were performed on two separate OHS cohorts: (1) stable ambulatory patients from the two Pickwick randomized controlled trials; and (2) hospitalized patients with acute-on-chronic hypercapnic respiratory failure from a retrospective international cohort. We first conducted bivariate analyses of baseline characteristics and therapeutics between genders. Variables of interest from these analyses were then grouped into linear mixed effects models, Cox proportional hazards models, or logistic regression models to assess the association of gender on various clinical outcomes.

The ambulatory prospective cohort included 300 patients (64% self-identified as women), and the hospitalized retrospective cohort included 1,162 patients (58% self-identified as women). For both cohorts, women were significantly older and more obese than men. Compared with men, baseline Paco2 was similar in ambulatory patients but higher in hospitalized women. In the ambulatory cohort, in unadjusted analysis, women had increased risk of emergency department visits. However, gender was not associated with the composite outcome of emergency department visit, hospitalization, or all-cause mortality in the fully adjusted model. In the hospitalized cohort, prescription of positive airway pressure was less prevalent in women at discharge. In unadjusted analysis, hospitalized women had a higher mortality at 3, 6, and 12 months following hospital discharge compared with men. However, after adjusting for age, gender was not associated with mortality.

Our findings indicate that although the diagnosis of OHS is established at a more advanced age in women, gender is not independently associated with worse clinical outcomes after adjusting for age. Future studies are needed to examine gender-related health disparities in diagnosis and treatment of OHS.

Measurement of loop gain in patients with obstructive sleep apnea (OSA) is of great importance for determining the cause of OSA and realizing precision medicine. In this study, automatic measurement of loop gain is carried out during wakefulness based on the pseudorandom binary sequence (PRBS) CO2 stimulation method.

A respiratory data acquisition platform is designed and constructed to automate the processes of gas configuration, ventilatory stimulation with CO2 and data acquisition. The respiratory data are substituted into the model of the ventilatory control system for parameter identification, and the loop gain values are calculated and then compared with the apnea-hypopnea index (AHI) measured in a hypoxia chamber.

A positive correlation is found between loop gain and AHI measured in the hypoxia chamber, with the linear correlation coefficient of approximately 0.65.

The feasibility of automatic measurement of loop gain using the respiratory data acquisition platform based on the PRBS CO2 stimulation method is validated, and the measured loop gain values can be used to assess the stability of ventilatory control.

This study provides an automated, rapid, and instrumented solution for loop gain measurement, laying the foundation for wide-scale clinical application of the PRBS CO2 stimulation method.

Obstructive sleep apnea has been proven to have a great negative impact on patients, and the relationship between sleep apnea and dental caries is still inconclusive. Our study shows that patients with sleep apnea and those older than 45 y have a significant risk of dental caries.

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

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

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

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

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

Sleep disturbances are increasingly prevalent, significantly impacting physical and mental health. Recent research reveals a bidirectional relationship between gut microbiota and sleep, mediated through the microbiota-gut-brain axis. This review examines the role of gut microbiota in sleep physiology and explores how biotics, including probiotics, prebiotics, synbiotics, postbiotics, and fermented foods, can enhance sleep quality. Drawing from animal and human studies, we discuss neurobiological mechanisms by which biotics may influence sleep, including modulation of neurotransmitters, immune responses, and hormonal regulation. Key microbial metabolites, such as short-chain fatty acids, are highlighted for their role in supporting sleep-related neurochemical processes. Additionally, this review presents dietary strategies and food processing technologies, like fermentation, as innovative approaches for sleep enhancement. Although promising, the available research has limitations, including small sample sizes, variability in biotic strains and dosages, and reliance on subjective sleep assessments. This review underscores the need for standardized protocols, objective assessments such as polysomnography, and personalized biotic interventions. Emerging findings highlight the therapeutic potential of gut microbiota modulation for sleep improvement, though further large-scale human trials are essential to refine strain selection, dosage, and formulation. This interdisciplinary exploration seeks to advance food-based interventions and holistic strategies for managing sleep disorders and improving quality of life.

This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings - the "GPSS" tool - "General Practice Sleep Scale" and compared against common existing OSA screening tools.

A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA.

159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0-7), moderate (8-13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang.

The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings.

Traditionally, obstructive sleep apnea (OSA) management has focused on continuous positive airway pressure therapy, oral appliances, and in some cases, surgical interventions. However, these treatments do not directly address the underlying metabolic issues contributing to OSA. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for type 2 diabetes management, have demonstrated substantial efficacy in promoting weight.

This review aims to summarize the potential impact of liraglutide, semaglutide, and tirzepatide in managing obese patients with OSA.

The introduction of GLP-1 RAs has gained attention not only for their ability to produce significant and sustained weight loss but also for their potential to improve OSA symptoms by reducing fat deposition around the upper airway and decreasing systemic inflammation. Emerging clinical trials suggest that GLP-1 RAs may enhance traditional OSA treatments, offering an integrated approach targeting the root cause of obesity in OSA. Additionally, GLP-1 RAs may provide benefits for other obesity-related comorbidities, including hypertension and cardiovascular disease, which are commonly associated with OSA. The future integration of GLP-1 RAs into OSA treatment protocols could mark a paradigm shift toward more comprehensive management strategies, ultimately improving patient outcomes in this complex patient population.

This study aims to evaluate the quantity, types, and trends of surgical procedures used to treat obstructive sleep apnea (OSA) within a diverse national population, utilizing a comprehensive proprietary healthcare database.

This descriptive observational study analyzed longitudinal data from the Optum Clinformatics® Data Mart databases, covering the period from January 2004 to December 2020. The study included patients aged 18 to 89 years, both male and female, with a confirmed diagnosis of OSA. These patients were either treated with continuous positive airway pressure (CPAP) or underwent surgical interventions.

Throughout the study period, 1,250,273 individuals were diagnosed with OSA. The average age at diagnosis was 62 years (SD = 16), with a male predominance of 62.3%, and 75% of the patients were identified as Caucasian. The most frequently performed surgical procedure for OSA was Uvulopalatopharyngoplasty (UPPP). However, the implantable hypoglossal nerve stimulator was more commonly utilized among older patients.

This study provides essential insights into the prevalence and characteristics of surgical procedures used in OSA treatment across a diverse national population. The findings underscore the significance of understanding surgical intervention patterns and trends to enhance patient care and outcomes.

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.

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").

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

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.

We aimed to explore alterations in polysomnographic, cephalometric, and subjective outcomes amongst different ethnic/racial groups after MMA for OSA.

A meta-analysis was performed according to PRISMA reporting guidelines. The COCHRANE Library, CINAHL, PubMed, and Scopus were searched from inception to August 8, 2023. Each measure was weighted according to the number of patients affected. Heterogeneity among studies was assessed using χ2 and I2 statistics with fixed effects (I2 < 50%) and random effects (I2 ≥ 50%).

Twenty studies with a total of 469 patients (n = 257 Caucasians, n = 204 Asians, n = 8 Latinos) with a mean patient age of 40.0 years (range: 18-67; 95% CI: 38.0, 42.1). The mean difference for Caucasians were AHI: -39.6 (95% CI: -55.0, -24.1; p <.001), LSAT: 7.5 (95% CI: 5.7, 9.3; p <.0001), and ESS: -4.5 (95% CI: -5.6, -3.4; p <.0001). The mean difference for Asians were AHI: -42.7 (95% CI -49.3, -36.0; p <.0001), LSAT: 13.8 (95% CI: 10.0, 17.4; p <.0001), and ESS: -6.7 (95% CI: -9.9, -3.5; p <.0001). The mean difference for Latinos were AHI: -21.2 (95 CI%: -37.7, -4.6; p =.01), and ESS: -2.0 (-7.9, 3.9; p =.50). Greater reduction of AHI was seen in Asians vs. Caucasians and Asians vs. Latinos. Lastly, the reduction of ESS was significantly better for Asians vs. Caucasians.

The study highlights significant variations in MMA outcomes among different ethnic/racial groups. Asians tend to have more severe OSA preoperatively and experience greater postoperative improvements in AHI, LSAT, and ESS compared to Caucasians.

Patients with Down syndrome (DS) have a high incidence of obstructive sleep apnea (OSA) due to hypotonia, weight, underdeveloped midface, and relative macroglossia. This article presents three cases of young adults with DS, who were diagnosed with mild to severe OSA and unable to tolerate positive airway pressure therapy. These patients have been successfully treated with a custom-made mandibular advancement device (MAD) or dual treatment with MAD and bi-level positive airway pressure (PAP) therapy. The baseline apnea-hypopnea index (AHI) of the three patients were 15.5/h, 31.8/h, and 41.3/h. The follow-up AHI after the application of MAD in three patients was 25/h (13 months after), 6/h (ODI 4%, 57 months after), and 21.8/h (21 months after), respectively. The application of MAD to treat OSA in patients with DS is a reasonable alternative when patients refuse PAP therapy. Although MAD might be less effective than PAP therapy, significant symptomatic improvement could be found in patients with DS after oral appliance therapy. The combination of MAD and PAP can decrease the PAP pressure and therefore improve adherence. This is the first case report to show that young adult patients with DS can successfully benefit from oral appliance therapy for OSA treatment.

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

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

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

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

Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes.

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

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

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

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