Obstructive sleep apnea (OSA) in women is often underdiagnosed due to various and different symptoms, significant delay of referrals, sex-specific polysomnographic patterns that are usually not detected by standard severity indices from the home sleep apnea test, and limitations of current screening tools. Up to 75% of women with OSA remain undiagnosed, with relevant clinical and socioeconomic consequences. Women often report daytime fatigue, insomnia, depression, anxiety, and poor sleep quality rather than excessive daytime sleepiness or snoring, which may lead to fewer sleep clinic referrals. Additionally, the menstrual phase significantly influences symptom expression. Comorbidities also exhibit sex-based differences: OSA in premenopausal women is strongly linked to depression, metabolic syndrome, and polycystic ovary syndrome, while postmenopausal women with OSA reported hypertension and diabetes more frequently, leading to a greater cardiometabolic risk in postmenopausal women with OSA. The screening questionnaires showed numerous limitations in women due to the lack of items concerning symptoms. Women's typical polysomnographic pattern, especially in the premenopause period, is characterized by predominant hypopneas, mild OSA with prevalent rapid eye movement (REM)-OSA, respiratory effort-related arousals (RERAs), and low arousal threshold, highlighting the crucial role of sleep fragmentation evaluation, beyond the apnea-hypopnea index (AHI). New indices such as hypoxic burden, pulse wave amplitude drops index and arousal burden may provide more appropriate OSA severity classification and risk stratification in women.After a review of the literature, we proposed four women phenotypes, highlighting the heterogeneity of OSA in women and the key role of sex-tailored OSA management. From a therapeutic perspective, women differ in apnea-hypopnea index (PAP) compliance, required lower PAP levels for the same disease severity as men, and experience mask-related side effects. However, we have to mention that this is suspected to be biased due to significant lower number of women included in cohorts and even lower in randomized controlled trials (RCTs). Mandibular advancement devices (MADs) and endotype-based pharmacotherapy may be beneficial in women with mild OSA and low arousal threshold or low muscle responsiveness. Emerging evidence suggests that a sex-centered approach to screening, diagnosis, and treatment may reduce the clinical and socioeconomic burden of OSA in women in the future.

Polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA), but it poses significant barriers in resource-limited settings. The Belun Ring, a new home sleep apnea testing device utilising photoplethysmography and deep learning analysis, offers an alternative approach for diagnosing OSA. Herein, we present our initial experience with this device. Simultaneous in-lab PSG and Belun Ring assessments were conducted in six consecutive adults with suspected OSA undergoing PSG. Diagnostic performance was assessed by comparing the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) derived from both modalities. Belun Ring demonstrated a strong correlation with PSG AHI and ODI (Pearson's r = 0.98 for both; P < 0.001), but misclassified OSA severity in 50% of cases, mainly underestimating moderate disease. The device had a sensitivity of 83% for diagnosing OSA. This case series demonstrates the feasibility of Belun Ring use in an Indian population, but frequent severity misclassification is a concern, limiting its diagnostic applicability.

Brain death (BD) is defined as the irreversible loss of all brain functions resulting from non-recoverable brain injury. The aim of this study was to evaluate the knowledge, practices, and challenges encountered by pediatric neurology (PN) and pediatric intensive care (PIC) specialists in Turkey regarding BD diagnosis and related processes. Cross-sectional, descriptive study based on a structured online survey. Nationwide multicenter study involving hospitals across seven geographical regions of Turkey. A total of 100 specialists (54 PN and 46 PIC) participated in the study. An online survey comprising 41 questions on diagnostic procedures, organ donation processes, and family communication was administered to PN and PIC specialists. Eighty-six percent of respondents had previously declared BD. The median annual pediatric BD declaration was 5, with 67.4% of centers performing organ transplantation. However, 42.4% reported no organ donations in the past year. While 81.4% of PIC specialists considered their training adequate, only 53.5% of PN specialists agreed (p < 0.001). Multiple centers (69.8%) had transplant coordination services, but 25.6% of respondents reported insufficient support in this regard. The view that a single apnea test is sufficient for BD diagnosis was held by 83.7% of PIC and 65.1% of PN specialists (p = 0.045). When apnea testing was unfeasible, 88.4% of PIC and 65.1% of PN specialists considered cerebral blood flow studies adequate for BD confirmation (p = 0.011). Of the participants, 72.1% routinely used neuroimaging, with CT angiography being the most preferred method (77.9%). In patients designated as potential donors, 53.5% of PIC specialists refrained from initiating additional therapies. This is the first systematic comparison of expert opinions on the pediatric BD diagnostic process in Turkey. The findings underscore an urgent need for the development of multidisciplinary guidelines and nationwide standardization.

Validation of an artificial intelligence based single-channel photoplethysmography home sleep apnea test.

Recent studies have reported higher frequencies of overactive bladder (OAB) symptoms in both male and female patients diagnosed with obstructive sleep apnea (OSA) in sleep medicine centers. However, there is a paucity of data on the prevalence of OSA in female urogynecological patients with a primary diagnosis of OAB. The aims of the present study were: (i) to evaluate the prevalence of OSA among urogynecological patients diagnosed with OAB compared with a control group (non-OAB gynecological patients), (ii) to assess the correlation between the severity of OSA and OAB symptoms. All patients underwent the home sleep apnea test based on peripheral arterial tonometry (PAT). The analysis included the PAT Apnea Hypopnea Index (pAHI), PAT Respiratory Disturbance Index (pRDI), sleep time with desaturations < 90%, and blood oxygen saturation (%). The results of the present study can be summarized as follows: (i) both study groups carried a high risk of OSA (> 85%) as defined by the AHI cutoff score ≥ 5 but the OAB group showed a significantly higher risk of OSA as assessed by the Berlin Questionnaire, (ii) there was a higher prevalence of more severe forms of OSA (AHI scores ≥ 15) among OAB patients, (iii) there was no correlation between the severity of OSA and OAB symptoms in OAB patients. OAB diagnosis in female urogynecological patients may be associated with an altered distribution of AHI scores and more severe OSA symptoms as compared to other gynecological patients.

The Home Sleep Apnea Test (HSAT) has good diagnostic performance for patients with a high pretest probability of moderate to severe obstructive sleep apnea (OSA). However, the false negative rate has been reported as high as 17%. Therefore, the American Academy of Sleep Medicine (AASM) recommends polysomnography (PSG) after a nondiagnostic HSAT (apnea-hypopnea index (AHI) < 5/hr). Our objective was to improve the accuracy of HSATs by using hyperpneas as a surrogate for arousals. A retrospective analysis was conducted on patients with non-diagnostic Type 3 HSATs with subsequent PSG. HSATs were re-scored using the AASM recommended hypopnea scoring including using post-hypopnea hyperpneas without relative desaturations as a surrogate for cortical arousals. The new AHI was then compared with the gold-standard PSG. We identified 68 patients (80.9% male) with a non-diagnostic HSAT and subsequent PSG. 38 patients (55.9%) had an AHI ≥ 5 on PSG. By applying our modified HSAT criteria, 41 (60.2%) of the previously non-diagnostic HSATs had an AHI ≥ 5. The mean difference in AHI between the modified HSAT criteria and PSG was 3.7/hr, compared to 5.9/hr between the original HSAT and PSG. The overall concordance between the modified HSAT criteria and PSG for OSA diagnosis was 89.7% compared to only 44.1% of the original HSATs. Incorporating a surrogate indicator of a cortical arousal such as a hyperpnea can improve the diagnostic accuracy of the HSAT. Our modified HSAT scoring criteria improved AHI concordance with PSG with fewer false negatives (5%), thereby decreasing the need for repeat testing and saving costs.

Evaluation of an automated sleep apnea scoring algorithm via the Wesper Lab home sleep apnea test.

Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizumab and/or endoscopic sinus surgery (FESS) affect sleep quality and OSA in patients with severe uncontrolled CRSwNP. In a randomised trial with 58 patients, participants received mepolizumab alone or combined with FESS. Sleep quality was measured using FOSQ-10 and ESS, and OSA severity via AHI from home sleep apnea tests. At baseline, 70% of participants had OSA (AHI ≥5), with 34.6% having moderate-to-severe OSA. After six months, there were significant improvements in sleep quality (SNOT-22, FOSQ-10, ESS) in both groups but no significant change in objective OSA measures (AHI, ODI). Patients with OSA showed a reduction in severity, however non-significant. There were no severe adverse events (SAE) during the follow-up. Mepolizumab, with or without FESS, improved subjective sleep quality and reduced fatigue but did not significantly affect OSA severity. This suggests that while treatment eases sleep-related symptoms, it may not resolve underlying OSA, particularly in more severe cases.

Type IV sleep monitors offer a low-burden option for obstructive sleep apnea (OSA) screening, yet their accuracy is often limited by motion artifacts and variability in signal-processing methods. The PM50-B is a wrist-worn Type IV device that combines high-sampling-rate (200 Hz) photoplethysmography (PPG)-based oximetry with wrist actigraphy to reduce motion artifacts and employs an adaptive SpO2 waveform-based desaturation detection algorithm. This study aimed to validate the diagnostic performance of the PM50-B against reference sleep studies. In this prospective observational study, adults with suspected OSA underwent simultaneous overnight recording with the PM50-B and a reference test: in-laboratory polysomnography (Type I), unattended polysomnography (Type II), or Type III home sleep apnea testing (HSAT). Oximetry and actigraphy signals were processed using a standardized workflow incorporating motion-artifact attenuation, signal stabilization, and sleep-wake estimation. From the SpO2 signal, hypoxemia metrics were derived, including the oxygen desaturation index ODI2.5_5 (≥ 2.5% desaturation lasting ≥ 5 s/h of total sleep time), cumulative time with SpO2 < 90% and < 95% (CT90, CT95), and lowest SpO2. Agreement with the reference apnea-hypopnea index (AHI) was assessed using intraclass correlation coefficients, and diagnostic accuracy was evaluated at clinically relevant AHI thresholds. A total of 475 participants were analysed (Type I, n = 37; Type II, n = 32; Type III, n = 406). ODI2.5_5 showed moderate-to-good agreement with AHI (ICC = 0.710) and good discrimination for moderate-to-severe OSA (AHI ≥ 15 events/h), with an under the curve (AUC) of 0.925 (sensitivity 81.20%, specificity 91.00%). Diagnostic performance was consistent across reference modalities (AUC range, 0.928-0.983). The PM50-B provides clinically acceptable accuracy for OSA screening when combined with a standardized signal-processing approach, particularly in comparison with Type III HSAT. ODI2.5_5 emerged as the strongest diagnostic metric, while CT90, CT95, and lowest SpO2 provided complementary characterization of nocturnal hypoxemia.

Sex differences in low arousal threshold in obstructive sleep apnea.

Acceptability and results of home sleep apnoea testing in older adults with mild cognitive impairment and dementia and cognitively unimpaired older adults: Towards a multi-centre study of sleep apnoea prevalence in memory clinics

TELE-SLEEP OSA: A protocol for a hybrid type I randomized clinical trial of telemedicine for obstructive sleep apnea among military dependents and retirees.

Obstructive sleep apnea (OSA) is increasingly recognized as a major comorbidity in chronic respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). The coexistence of OSA with asthma or COPD significantly complicates the clinical course, leading to poorer disease control, more frequent exacerbations, reduced lung function, impaired sleep quality, and increased cardiovascular and overall mortality. In asthma, OSA exacerbates airway inflammation, enhances bronchial hyperresponsiveness, and decreases responsiveness to standard therapies. In COPD, the "overlap syndrome" is associated with profound nocturnal hypoxemia, chronic hypercapnia, pulmonary hypertension, and a markedly elevated risk of hospitalization and death. Underlying mechanisms include chronic airway inflammation, oxidative stress induced by intermittent hypoxia, instability of ventilatory control (high loop gain), structural upper-airway alterations, and the burden of obesity and metabolic dysfunction. These interactions highlight the urgent need for integrated and proactive management strategies. Thus, we propose an Asthma-COPD-OSA Outpatient Unit (ACOSOU)-a care-delivery model, not a disease entity-designed to integrate systematic screening, diagnosis, treatment initiation, and long-term follow-up of OSA in patients with asthma and COPD. Optimal care requires systematic screening in respiratory outpatient settings, appropriate diagnostic pathways using polysomnography or home sleep apnea testing, and individualized treatment approaches. Continuous positive airway pressure (CPAP) remains the cornerstone therapy for OSA-asthma and OSA-COPD overlap, improving gas exchange, reducing exacerbations, and enhancing disease control. Comprehensive management also includes optimization of inhaled therapies, pulmonary rehabilitation, weight reduction, sleep hygiene, and multidisciplinary collaboration. This review proposes an integrated ACOSOU model to streamline screening, diagnosis, CPAP titration, and long-term follow-up. However, implementation in low- and middle-income countries faces challenges including limited trained sleep-medicine personnel, unequal access to diagnostic tools, and high CPAP costs without insurance coverage. Strengthening infrastructure, training, and policy support will be essential to improve outcomes for patients with chronic respiratory diseases and OSA comorbidity.

Brain death (BD) is the irreversible loss of brain function, assessed through consciousness, brainstem reflexes and apnoea testing. Previous research indicates that experienced physicians perform better in BD determination, underscoring the need for structured education. This study evaluates the level of knowledge about BD amongst physicians in Saudi Arabia, comparing expertise across neurology, neurosurgery and intensive care and investigating knowledge gaps. Amongst 162 physicians surveyed, the majority were aged 25-35 years (61.7%) and male (65.4%). Most were Saudi nationals (84.6%) and worked in governmental hospitals (92.0%). Intensivists comprised the largest speciality group (45.1%). Despite 95.1% having encountered BD patients, 41.4% felt that criteria were not well understood in their medical community. Confidence in diagnosis was 49.4%, while 51.9% had formal training. A cross-sectional study was conducted using an online questionnaire, targeting neurologists, neurosurgeons and intensivists through snowball sampling. Data were analysed using the SPSS 29.0.0. Significant associations were found between knowledge levels and factors such as age (P < 0.001), nationality (P = 0.009), experience (P < 0.001), and confidence in diagnosis (P = 0.025). Multivariate analysis identified years of experience (P = 0.011, Exp (B) = 2.338, 95% confidence interval: 1.211-4.514) as the strongest predictor of high knowledge.. The findings highlight the variability in physicians' understanding of BD, emphasising the need for enhanced training programmes and refresher courses to improve competency in diagnosis and criteria adherence.

The effect of hyperoxia on disordered breathing during recovery from general anesthesia: A single-blinded, crossover, non-randomized -controlled, trial.

BackgroundDeveloping quantitative indicators of daily life that detect subtle cognitive decline is an important challenge in today's growing population of older adults worldwide. In this study, we aimed to explore novel candidates for indicators associated with subtle abnormalities in brief dementia screening test.MethodsIn this multifaceted cross-sectional study, data were collected from 35 older adults who had not been certified for long-term care or diagnosed with cognitive impairment using questionnaires, the Mini-Mental State Examination (MMSE), body composition measurements, sleep apnoea testing, activity monitoring, motor function assessments, blood tests, and nutrient analyses. Of the 89 factors examined in this study, several less invasive indicators for cognitive impairment were identified using Spearman’s correlation analysis, two-group comparison, and multiple linear regression model analysis.ResultsAn increased minimum pulse rate during sleep was found to be the most important non-invasive marker associated with both the correlation with MMSE scores and the risk classification of cognitive impairment (mild cognitive impairment or dementia).ConclusionsThe minimum pulse rate during sleep is easily detectable owing to recent developments and widespread use of wearable devices. The results of this study will not only provide opportunities for older adults and their families to recognise slight cognitive decline but will also contribute to the early detection of cognitive decline, as a guide for the development of research evaluating the detection sensitivity and specificity of these indicators.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06584-3.

Background/Objectives: Polysomnography (PSG) is the gold standard for diagnosing sleep-disordered breathing (SDB). However, in a hospital testing setting, it may produce the first-night effect, viz., prolonged sleep latency, lower sleep efficiency, and uncertain apnea–hypopnea index (AHI). Here, we aim to determine the influences of hypnotic agents and gender. Methods: In this retrospective study, we reviewed the post-PSG questionnaires and electronic medical records of patients aged ≥20 years receiving overnight PSG for the diagnosis of SDB at Taichung Veterans General Hospital in a period between April 2024 and March 2025. Results: We studied a total of 1053 patients, aged 47.0 ± 14.7 years old. Compared to sleeping at home, 42.2% of patients reported worse perceived sleep quality (PSQ) with hypnotic agents, and 53.0%, without, before PSG testing in the hospital. For those without taking hypnotic agents, men had an odds ratio (OR) of 1.570 (95% CI: 1.127–2.189) for worsening PSQ compared to women (p = 0.008). Also, per increasing 1 Epworth Sleepiness Scale (ESS) score, the risk of worsening PSQ was reduced by OR of 0.963 (95% CI: 0.933–0.994) (p = 0.021). Once male patients had ESS < 10, as many as 57.3% of them reported the worse PSQ. Conclusions: Our study suggests a potentially more patient-centric approach to diagnosing sleep-disordered breathing. In some male patients with ESS scores < 10, short-acting hypnotics might be considered during in-lab PSG to improve subjective comfort, thereby potentially enhancing study reliability. Meanwhile, home sleep apnea testing can serve as a practical initial tool for selected patients—offering convenience, mitigating the first-night effect, and potentially reducing long wait times. However, its use in individuals with comorbid insomnia requires careful clinical judgment to avoid false-negative results, often making in-lab assessment the preferred option in such cases.

Obstructive sleep apnea (OSA) is a prevalent but underdiagnosed condition linked to serious health risks. Due to the limited accessibility of polysomnography (PSG), AI (Artificial Intelligence)-based speech analysis has gained attention as a non-invasive screening tool. This Bayesian meta-analysis evaluates the diagnostic accuracy of AI models trained on awake speech and examines factors affecting performance. We systematically searched Medline/PubMed, Embase, Scopus, Web of Science, and IEEE Xplore databases. Eligible studies included adults with OSA diagnosis via in-lab polysomnography or home sleep apnea tests and evaluated AI models using speech recordings. Models evaluated using random-split test sets or k-fold cross-validation were included in a Bayesian bivariate meta-analysis and meta-regression. Publication bias was examined using a selection model approach, while risk of bias and evidence quality were assessed with QUADAS-2 and GRADE. From 6,254 screened articles, 8 studies comprising 24 AI models, trained and tested on 1,060 and 825 participants were included. All studies used professional microphone recordings in the controlled hospital settings. AI models analysing awake speech recordings demonstrated pooled sensitivity and specificity of 82.9% (95% CrI: 80.0-86.4%) and 83.3% (95% CrI: 80.7-86.1%), respectively. The diagnostic odds ratio was 24.3 (95% CrI: 18.2-35.0). Higher mean age improved sensitivity. No significant effects were seen for OSA severity, model type, OSA prevalence, or male percentage. Publication bias was not evident. AI models trained on awake speech recordings demonstrate good diagnostic accuracy for OSA and hold potential as a practical, scalable screening tool in both clinical and community-based settings.

Independent association between hourly apnea-hypopnea duration and prevalence of diabetes in male adults.

Feasibility of sleep assessment modalities in children with Lennox-Gastaut syndrome.