Plasma β-Endorphin and Neuropeptide Y as Candidate Biomarkers for Predicting Obstructive Sleep Apnea Syndrome: A Preliminary Study

To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity. One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups. The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001). In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.

Objectives: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. Methods: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age= yrs, AHI yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age= yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. Results: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were and ms (p=0.016), standard deviation of NN interval (SDNN) was and ms (p=0.022), SDNN index was and (p and (p=0.008), very low frequency (VLF) was and (p=0.035), low frequency (LF) was and (p=0.003). Conclusions: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.

To compare microstructural features of sleep in young and middle-aged adults with differing severities of obstructive sleep apnea syndrome (OSAS), and to investigate the relationship between sleep microstructural fragmentation and cognitive impairment, as well as daytime sleepiness, in these patients. A total of 134 adults with snoring (mean age, 37.54 ± 7.66years) were classified into four groups based on apnea-hypopnea index: primary snoring, mild OSAS, moderate OSAS, and severe OSAS. Overnight polysomnography was performed to assess respiratory, sleep macrostructure (N1, N2, N3, and R), and sleep microstructure (arousal, cyclic alternating pattern [CAP]) parameters. Cognitive function and daytime sleepiness were assessed using Montreal Cognitive Assessment (MoCA) and Epworth Sleepiness Scale (ESS). As OSAS severity increased, MoCA gradually decreased and ESS gradually increased. N1%, N2%, and N3% sleep were significantly different between the severe OSAS group and the primary snoring, mild OSAS, and moderate OSAS groups (all P < 0.05). Overall arousal index, respiratory-related arousal index, CAP time, CAP rate, phase A index, number of CAP cycles, and phase A average time differed significantly in the moderate and severe OSAS groups compared with the mild OSAS and primary snoring groups (all P < 0.05). The strongest correlations identified by stepwise multiple regression analysis were between phase A3 index and the MoCA and ESS scores. Sleep microstructure exhibited significant fragmentation in patients with moderate and severe OSAS, which was associated with decreased MoCA and increased ESS scores. This suggests that phase A3 index is a sensitive indicator of sleep fragmentation in OSAS.

OBJECTIVE: This study aimed to investigate the eustachian tube dysfunction (ETD) of patients with obstructive sleep apnea syndrome (OSAS) using the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). METHODS: The study included 96 patients (78 males, 18 females; mean age 39.4±12.2 years; range 18 to 64 years) diagnosed with OSAS by polysomnographic evaluation. All patients were administered the ETDQ-7. Age, sex, presence of septum deviation, Epworth Sleepiness Scale, apnea-hypopnea index (AHI), lowest oxygen saturation, and oxygen desaturation index parameters were recorded. The patients were divided into mild, moderate, and severe OSAS groups according to the AHI score. The parameters of the cases in each group were compared, and their correlation with the ETDQ-7 scores was evaluated. RESULTS: The fourth question score and the total score in the group with severe OSAS were significantly higher than the groups with mild and moderate OSAS (p&lt;0.05 for all). The fourth question score and the total score were significantly higher in the group with moderate OSAS than the group with mild OSAS (p&lt;0.05 for all). There was a significant positive correlation between the oxygen desaturation index and the scores of questions 1, 3, 4, 6, and 7 and the total score (p&lt;0.05 for all). CONCLUSION: Questionnaire scores were higher in patients with severe OSAS compared to mild to moderate OSAS patients. Based on this data, we would like to emphasize that OSAS cases may develop ETD and other related pathologies.

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated episodes of complete or partial obstructions of the upper airway during sleep, frequently followed by transient hypoxemia. Advanced oxidation protein products (AOPP) are a family of oxidized protein products, and oxidative stress has a substantial role in the morbidity of OSAS. The aim of this study was to investigate the serum levels of advanced oxidation protein products (AOPP) as a marker of oxidative stress, and their correlation with polysomnographic parameters in patients with obstructive sleep apnea syndrome (OSAS). Additionally, we investigated the effect of positive airway pressure (PAP) treatment on serum AOPP values and compared the levels before and after the treatment. The study enrolled a total of 125 subjects including 59 patients with severe OSAS, 34 patients with moderate OSAS, 32 patients with mild OSAS, and 40 healthy controls. Mean AOPP values were compared between OSAS groups and control groups. Correlations between AOPP and polysomnographic parameters were investigated. Mean AOPP values before and after 6-month PAP therapy were compared. Significantly elevated AOPP levels were found in severe and moderate OSAS groups in comparison with mild OSAS and control groups. AOPP was directly correlated with apnea-hypopnea index, percentage of total time spent with oxygen saturation below 90%, oxygen desaturation index, maximum obstructive apnea duration, arousal index, and number of obstructive apneas accompanying bradycardia but inversely correlated with average SPO2 (%), minimum SPO2, and percentage of non-REM stage 3 sleep. There was no statistically significant difference between AOPP values before and after PAP therapy. AOPP, which is an oxidative stress marker, was found to be high in OSAS patients. Especially, high levels in moderate and severe OSAS patients may be an indicator of increased morbidity. After 6months of PAP treatment, there was no statistically significant change in these levels.

To investigate whether sleep-disordered breathing and/or plasma adiponectin levels are associated with insulin resistance independent of obesity or fat distribution in obstructive sleep apnoea syndrome (OSAS). Cross-sectional clinical study. Two-hundred and thirteen Japanese patients with OSAS aged 27-80 years were divided into three groups: 30 with mild OSAS [apnoea-hypopnoea index (AHI) = 10.3 +/- 0.9 episodes/h, minimum oxygen saturation (min SpO2) = 87.3 +/- 0.9%], 98 with moderate OSAS (AHI = 28.9 +/- 0.6 episodes/h, min SpO2 = 82.1 +/- 0.7%), and 85 with severe OSAS (AHI = 68.1 +/- 2.8 episodes/h, min SpO2 = 72.3 +/- 1.6%). Twenty-one patients undergoing diabetic treatments (two mild, nine moderate and 10 severe) were excluded from the assessment of insulin resistance and plasma adiponectin measurements. Fat distribution [evaluated according to visceral (V) and subcutaneous (S) fat areas using computed tomography scanning at the umbilical level], blood pressure, metabolic parameters and hormones including insulin and adiponectin were measured. After full polysomnography, venous blood was collected between 0600 and 0700 h. Severe OSAS patients were more hypertensive than mild and moderate OSAS. Fasting plasma glucose (FPG) and fasting plasma insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels were all higher in severe OSAS than mild and moderate OSAS patients. HOMA-IR was correlated not only with obesity [body mass index (BMI), V and S areas] but also with apnoea (AHI, min SpO2 and desaturation time). Additionally, HOMA-IR was correlated positively with haemoglobin (Hb)A1c, systolic (SBP) and diastolic blood pressure (DBP), triglycerides and free fatty acids (FFA), and negatively with high density lipoprotein (HDL)-cholesterol, suggesting that insulin resistance is a key component of the metabolic syndrome in OSAS. Plasma adiponectin levels were not different between mild, moderate and severe OSAS groups. Plasma adiponectin levels were correlated with HOMA-IR and V area, but not AHI or min SpO2. Stepwise multiple regression analysis, however, revealed that BMI, AHI and plasma adiponectin were independently associated with HOMA-IR. Sleep-disordered breathing was associated with insulin resistance independent of obesity. Although plasma adiponectin was also an independent determinant of HOMA-IR in OSAS patients, plasma adiponectin was more closely related to obesity than to sleep apnoea. Although treatment of sleep-disordered breathing with nasal continuous positive airway pressure reportedly improves insulin sensitivity, our findings suggest that treatment of obesity is also essential in ameliorating insulin resistance at least through increased plasma adiponectin levels in OSAS.

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

Background: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality. We aimed to investigate the association between MHR and CVD in patients with OSAS, and relationship between severity of OSAS, polysomnographic parameters and MHR. Methods: This was a cohort study in which patients who had undergone a full night polysomnoraphy for diagnosis of OSAS were recruited. Included patients were grouped according to apnea–hypopnea index (AHI) as mild (5–15), moderate (15–30) and severe (>30) OSAS. Patients with AHI Results: A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65 and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, p Conclusion: MHR is strongly associated with CVD and the severity of OSAS. MHR might be used as a biomarker to predict CVD in OSAS patients.

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular disease (CVD). Although monocyte to high-density lipoprotein cholesterol ratio (MHR) is increasingly being implicated in cardiovascular morbidity and mortality, no study has attempted to determine the role of MHR in cardiovascular morbidity of patients with OSAS. We aimed to investigate the association between MHR and CVD in patients with OSAS and the relationship between severity of OSAS, polysomnographic parameters, and MHR. In this cohort study, patients who had undergone a full-night polysomnography for the diagnosis of OSAS were recruited. Included patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-15), moderate (15-30), and severe (>30) OSAS. Patients with AHI < 5 served as the control group. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD. A total of 1050 patients were included (131 controls, 222 mild, 228 moderate, and 469 severe OSAS). The severe group had higher MHR compared with the control and other OSAS groups (9.99, 12.11, 13.65, and 20.67 in control, mild, moderate, and severe OSAS groups, respectively, P < .001). The MHRs were significantly correlated with AHI, oxygen desaturation index, and minimum O2 saturation values ( P < .001). Values of MHR were significantly higher in patients with CVD compared with those without ( P < .001). Multiple regression analysis demonstrated that MHR is an independent predictor of CVD. The MHR is strongly associated with CVD and the severity of OSAS and might be used as a biomarker to predict CVD in patients with OSAS.

Obstructive sleep apnea syndrome (OSAS) might be a risk factor for the development of eye disorders. The aim of the study was to evaluate the effect of OSAS on central corneal thickness (CCT). A total of 195 patients were enrolled in the study, and underwent polysomnography. Patients were divided according to their apnea-hypopnea index (AHI) scores into control group (AHI<5), mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAS (AHI>30) groups. In ophthalmological examinations, CCT, auto refractometer measurement, tear break-up time, and Schrimer's test results were evaluated. Central corneal thickness was significantly decreased in patients with OSAS compared to the control group (542.14±31.21 vs. 569.92±13.46, p<0.001). As the severity of OSAS increased, CCT decreased (mild OSAS=567.48±23mm, moderate OSAS=530.21±30.2mm, and severe OSAS=557.97±16.52mm, respectively, p<0.001). The mean values of auto refractometer, tear break-up time, and Schrimer's test were similar between the groups (p>0.05). CCT was negatively correlated with AHI, oxygen desaturation index, desaturation percentages, and positively correlated with minimum oxygen saturation values (p<0.05). This study showed that central corneal thickness is inversely correlated with the severity of OSAS. OSAS affects all organ systems particularly cardiovascular and neurological mechanisms. Further studies are warranted to evaluate the effect of OSAS treatment on CCT.

Background and ObjectivesThis study aimed to assess the changes of RA function in patients with obstructive sleep apnea syndrome (OSAS) using velocity vector imaging (VVI) and to evaluate the application of VVI technology.MethodsAccording to the apnea–hypopnea index (AHI), 71 patients with OSAS were divided into three groups: mild, moderate, and severe. A total of 30 cases of healthy subjects were enrolled as the control group. Digital images of apex four-chamber views were acquired to measure the right atrium (RA) linear dimensions and volume parameters including RA longitudinal diameter (RAL), transverse diameter (RAT), RA maximum volume (Vmax), RA minimum volume (Vmin), right atrial volume before contraction (Vpre). Right atrial volume parameters were corrected by body surface area (VImax, VImin, VIpre). The total right atrial emptying fraction (RATEF), right atrial passive emptying fraction (RAPEF), right atrial active contraction emptying fraction (RAAEF) were calculated. The VVI data measuring right atrial global strain (RA-GLS), right atrial strain rate in ventricular systolic phase (RA-SRs), right atrial strain rate in ventricular early diastolic phase (RA-SRe), right atrial strain rate in ventricular late diastolic phase (RA-SRa).ResultsRA linear dimensions and volume parameters in severe OSAS were higher than those of control group. RAPEF in severe group was lower than control group and mild OSAS group (t = 2.681, P = 0.021; t = 2.985, P = 0.011; respectively). RAAEF in OSAS moderate group was higher than that of control group (t = 3.006, P = 0.02), and without statistical difference (P > 0.05) in the severe OSAS group and the control group.RA-GLS in moderate OSAS group was significantly lower than that of control group (t = 2.333, P = 0.040) and reduced more obvious in the severe OSAS group (vs control, t = 3.25, P = 0.008, vs mild; t = 3.011, P = 0.012; respectively). RA-SRe in moderate and severe OSAS groups were lower than control group (t = 2.466, P = 0.031; t = 3.547, P = 0.005; respectively). RA-SRs of OSAS in severe group was lower than that of control and mild groups (t = 3.665, P = 0.004; t = 3.204, P = 0.008; respectively). RA-SRa in severe OSAS group was lower than that of control group (t = 2.425, P = 0.034).Multivariate regression analysis showed that RA-GLS and RA-SRe were independently correlated with AHI (t = − 2.738, P = 0.010; t = − 2.191, P = 0.036; respectively).ConclusionRA function was impaired in patients with OSAS. On hemodynamics, the change of RA function performed increased of reserve function, reduced pipeline function and increased of contraction function. However, the strain and strain rate reduced in different degree. RA-GLS and RA-SRe decreased the earliest, which suggested that strain and strain rate were the parameters which can reflect myocardial function damage earliest. VVI can more earlier and accurately detect myocardial dysfunction of right atrium in patients with OSAS, which is expected to be a worthy technique for early clinical therapy in patients with OSAS.

Aim: to analyze stabilometric parameters in the habitual standing posture in patients with moderate vascular cognitive impairment (VCI) concomitant with obstructive sleep apnea syndrome (OSAS) of varying severity, and to assess their changes during voluntary breath-holding. Materials and Methods: 83 patients with moderate VCI underwent cardiorespiratory monitoring. Based on the results, patients were stratified into three groups according to OSAS severity (as determined by the apnea-hypopnea index, AHI) and a control group without sleep-disordered breathing. To achieve the study objective, a series of stabilometric assessments was conducted to evaluate balance function, including postural control in the habitual stance with both eyes open and closed, as well as an Apnea test. Results: patients with VCI and severe OSAS ( AHI &amp;ge;30) demonstrated significantly higher velocity of the center of pressure (VCOP) and statokinesiogram (S) area, along with a significantly lower dynamic postural stability index (DPSI), compared to the control group (p&lt;0.001). In the moderate OSAS group, these parameters differed significantly from those with mild OSAS (p=0.007). Following the Apnea test, a significant increase in DPSI was observed in patients without OSAS and those with mild to moderate OSAS (p&lt;0.005), whereas in the severe OSAS group, DPSI decreased (p&lt;0.01), potentially reflecting reduced compensatory capacity of the central nervous system in the context of chronic hypoxia. Conclusion: OSAS exerts a detrimental effect on postural stability in patients with moderate VCI, with the greatest impairments observed in those with severe OSAS. The Apnea test improved balance in mild to moderate OSAS, but resulted in further deterioration of postural stability in patients with severe sleep-disordered breathing. Keywords: vascular cognitive impairment, obstructive sleep apnea syndrome, stabilometry, balance, postural stability. For citation: Punina A.A., Gribova N.P. Indicators of balance function in patients with moderate vascular cognitive impairment and obstructive sleep apnea syndrome before and after voluntary breath-holding. RMJ. 2025;4:3–7. DOI: 10.32364/2225-2282-2025-4-1

Obstructive sleep apnoea syndrome (OSAS) might be a cause of heart failure. The present study aimed to assess left ventricular mass and myocardial performance index (MPI) in OSAS patients. A total of 67 subjects without any cardiac or pulmonary disease, referred for evaluation of OSAS, had overnight polysomnography and echocardiography. According to apnoea-hypopnoea index (AHI), subjects were classified into three groups: mild OSAS (AHI: 5–14; n = 16), moderate OSAS (AHI: 15-29; n = 18), and severe OSAS (AHI: ≥30; n = 33). Thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode, along with left ventricular mass (LVM) and LVM index (LVMI). Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Döppler echocardiography. There were no differences in age or body mass index among the groups, but blood pressures were higher in severe OSAS compared with moderate and mild OSAS. In severe OSAS, thickness of IVS (11.2±1.1 mm), LVPW (11.4±0.9 mm), LVM (298.8±83.1 g) and LVMI (144.7±39.8 g·m⁻²) were higher than in moderate OSAS (10.9±1.3 mm; 10.8±0.9 mm; 287.3±74.6 g; 126.5±41.2 g·m⁻², respectively) and mild OSAS (9.9±0.9 mm; 9.8±0.8 mm; 225.6±84.3 g; 100.5±42.3 g·m⁻², respectively). In severe OSAS, MPI (0.64±0.14) was significantly higher than in mild OSAS (0.50±0.09), but not significantly higher than moderate OSAS (0.60±0.10). In conclusion, severe and moderate obstructive sleep apnoea syndrome patients had higher left ventricular mass and left ventricular mass index, and also left ventricular global dysfunction.

Obstructive sleep apnoea syndrome (OSAS) might be a cause of heart failure. The present study aimed to assess left ventricular mass and myocardial performance index (MPI) in OSAS patients. A total of 67 subjects without any cardiac or pulmonary disease, referred for evaluation of OSAS, had overnight polysomnography and echocardiography. According to apnoea-hypopnoea index (AHI), subjects were classified into three groups: mild OSAS (AHI: 5-14; n = 16), moderate OSAS (AHI: 15-29; n = 18), and severe OSAS (AHI: > or = 30; n = 33). Thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode, along with left ventricular mass (LVM) and LVM index (LVMI). Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Döppler echocardiography. There were no differences in age or body mass index among the groups, but blood pressures were higher in severe OSAS compared with moderate and mild OSAS. In severe OSAS, thickness of IVS (11.2+/-1.1 mm), LVPW (11.4+/-0.9 mm), LVM (298.8+/-83.1 g) and LVMI (144.7+/-39.8 g x m(-2)) were higher than in moderate OSAS (10.9+/-1.3 mm; 10.8+/-0.9 mm; 287.3+/-74.6 g; 126.5+/-41.2 g x m(-2), respectively) and mild OSAS (9.9+/-0.9 mm; 9.8+/-0.8 mm; 225.6+/-84.3 g; 100.5+/-42.3 g x m(-2), respectively). In severe OSAS, MPI (0.64+/-0.14) was significantly higher than in mild OSAS (0.50+/-0.09), but not significantly higher than moderate OSAS (0.60+/-0.10). In conclusion, severe and moderate obstructive sleep apnoea syndrome patients had higher left ventricular mass and left ventricular mass index, and also left ventricular global dysfunction.

Patients with obstructive sleep apnea syndrome (OSAS) have cognitive dysfunction in many aspects, however, these patients' decision-making function remains unclear. In this study, the Game of Dice Task (GDT) was used to investigate the function of decision making in patients with OSAS. 30 participants with moderate to severe OSAS and 27 participants with no or mild OSAS diagnosed by sleep breathing monitor were selected from June 2021 to March 2022. Risky decision making was tested through the GDT with known risk probability. General demographic information and background cognitive functions, such as the overall cognitive functioning and executive functioning, were tested to establish baseline data. There were no significant differences in gender, age, and years of education between the two groups. During the GDT, the moderate to severe OSAS group opted for the safety option at a statistically significant lower rate when compared to the no or mild OSAS group (7.53 ± 4.43 vs. 10.26 ± 4.26, p = 0.022). The moderate to severe OSAS group utilized the higher risk option than the group with no or mild OSAS (10.47 ± 4.43 vs. 7.74 ± 4.26, p = 0.022). The utilization rate of negative feedback in the moderate and severe OSAS group was lower than that in the no or mild OSAS group (7.50, 52.50 vs. 28.57, 100.00, p = 0.001). At the end of the GDT, the moderate and severe OSAS group was more likely to have negative total assets than the patients with no or mild OSAS (-1846.67 ± 2587.20 vs. 300.00 ± 1509.97, p < 0.001). Multiple linear regression analysis shows that there is a negative correlation between the selection of risk options and negative feedback utilization in the GDT. Patients with moderate and severe OSAS displayed impaired decision-making throughout the study. Impaired decision-making is related to executive processes and may be caused by diminished prefrontal cortex functioning. However, the functions of memory, attention, language, abstraction, and orientation are relatively retained.