Apnea-hypopnea Index Research Articles

Coblation Versus Radiofrequency for Tongue Base Reduction in Obstructive Sleep Apnea: A Meta-analysis.

The objective of this study is to determine the effectiveness and safety profile of coblation tongue base reduction (CBTR) compared to radiofrequency base of tongue (RFBOT) reduction on sleep-related outcomes in patients with obstructive sleep apnea (OSA). PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews databases. Literature search by 2 independent authors was conducted using the abovementioned databases. Studies on CBTR and RFBOT as part of OSA treatment in adult patients with pre- and postoperative apnea-hypopnea index (AHI) were included. Direct meta-analysis and single-arm meta-analysis were conducted to compare sleep-related outcomes (AHI, apnea index [AI], surgical success rates, Epworth sleepiness score [ESS], SpO2, body mass index [BMI], and visual analog scale [VAS]) between both groups. A total of 40 studies with a total of 1940 patients were included, of which 1440 individuals who underwent tongue base reduction interventions (RF = 306, RF + UPPP = 656, and coblation + UPPP = 482) met inclusion criteria. Pooled analysis showed significant improvements in AHI (CBTR = -22.84, RFBOT = -11.14), AI (CBTR = 15.64, RFBOT = -5.26), ESS (CBTR = -7.59, RFBOT = -7.18), mean oxygen saturation (CBTR = 7.43, RFBOT = 4.25), mean BMI (CBTR = -0.69, RFBOT = -4.09), and snoring visual analog scale (CBTR = -16.20, RFBOT = -18.21). Surgical success rate (postoperative AHI < 20 and drop >50% from baselines) was 70% for CBTR and 43% for RFBOT. Both interventions decreased sleep-related outcomes in adult patients with OSA. Coblation appears to exhibit superiority over radiofrequency with a similar safety profile. However, further studies with direct comparisons between both interventions must be performed.

Sex differences in clinical and polysomnographic features of obstructive sleep apnea: The Turkish sleep apnea database (TURKAPNE) cohort.

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±5.6kg/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.

Assessment of sleep quality using cardiopulmonary coupling and its predictive value for delirium in ICU patients.

To assess sleep quality in intensive care unit (ICU) patients using cardiopulmonary coupling (CPC) analysis and explore its predictive value for delirium. ICU patients (n=135) were divided into the delirium group (n=44) and control group (n=91) based on the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). CPC analysis was used to evaluate the sleep quality of all participants. Intergroup comparisons showed that total sleep time, stable sleep time, and sleep efficiency were significantly lower in the delirium group than in the control group, whereas unstable sleep time, rapid eye movement sleep time, wake-up time, stable sleep latency, and apnea-hypopnea index (AHI) were significantly higher in the delirium group than in the control group. Logistic regression analysis showed that advanced age and AHI were risk factors for delirium, whereas stable sleep time was a protective factor for delirium. Receiver operating characteristic (ROC) analysis showed that stable sleep time and stable sleep latency had a certain predictive value for delirium; the area under the ROC curve (AUC) for stable sleep time was higher (0.888 vs. 0.704). The cut-off value for stable sleep time was 0.65h, with a sensitivity of 84.1% and specificity of 81.3%. ICU patients with delirium have poorer sleep quality than patients without delirium. Stable sleep time derived from the CPC has a high predictive value for delirium and may serve as an objective indicator for its diagnosis.

Detection of sleep apnea using only inertial measurement unit signals from apple watch: a pilot-study with machine learning approach

PurposeDespite increased awareness of sleep hygiene, over 80% of sleep apnea cases remain undiagnosed, underscoring the need for accessible screening methods. This study presents a method for detecting sleep apnea using data from the Apple Watch’s inertial measurement unit (IMU).MethodsAn algorithm was developed to extract seismocardiographic and respiratory signals from IMU data, analyzing features such as breathing and heart rate variability, respiratory dips, and body movements. In a cohort of 61 adults undergoing polysomnography, we analyzed 52,337 30-second epochs, with 12,373 (23.6%) identified as apnea/hypopnea episodes. Machine learning models using five classifiers (Logistic Regression, Random Forest, Gradient Boosting, k-Nearest Neighbors, and Multi-layer Perceptron) were trained on data from 41 subjects and validated on 20 subjects.ResultsThe Random Forest classifier performed best in per-epoch respiratory event detection, achieving an AUC of 0.827 and an F1 score of 0.572 in the training group, and an AUC of 0.831 and an F1 score of 0.602 in the test group. The model’s per-subject predictions strongly correlated with the apnea-hypopnea index (AHI) from polysomnography (r = 0.93) and identified subjects with AHI ≥ 15 with 100% sensitivity and 90% specificity.ConclusionUtilizing the widespread availability of the Apple Watch and the low power requirements of the IMU, this approach has the potential to significantly improve sleep apnea screening accessibility.

Obstructive sleep apnea subtyping based on apnea and hypopnea specific hypoxic burden is associated with brain aging and cardiometabolic syndrome.

Conventional metrics such as the apnea-hypopnea index (AHI) may not fully capture the diverse clinical manifestations of obstructive sleep apnea (OSA). This study aims to establish a novel OSA subtype classification based on the patterns of apneic and hypopneic hypoxic burden (HB), a potential biomarker that more accurately reflects the severity and duration of respiratory events. We further examined the associations of these HB-based subtypes with cardiometabolic risk and brain health outcomes. We retrospectively analyzed polysomnography data from 1000 participants including normal, mild, moderate, and severe OSA patients. We performed hierarchical clustering based on apneic and hypopneic HB to identify OSA subtypes. We then compared the prevalence of cardiometabolic syndrome (CMS) and brain health outcomes using the brain age index (BAI) among these subtypes. Five distinct subtypes were identified: 'good sleepers' (subtype 1), 'light hypopneic HB' (subtype 2), 'mild HB' (subtype 3), 'moderate HB' (subtype 4), and 'severe HB with marked apneic HB' (subtype 5). The prevalence of CMS (particularly hypertension) was significantly higher in subtypes 2-5 (p<0.001) compared to subtype 1. BAI was higher in subtypes 4 (3.2 years, p<0.0001) and 5 (11.1 years, p<0001) compared to subtype 1. Greater daytime sleepiness was observed in HB-based subtypes 2 and 5 compared to subtype 1 (p<0.001), whereas no significant differences were found among groups classified by OSA severity using AHI. Our study demonstrates that the HB-based subtypes of OSA are significantly associated with various clinical features and outcomes. These insights could be utilized to improve risk stratification and guide the design of future OSA studies.

Study of the occurrence of metabolic dysfunction-associated fatty liver disease in obstructive sleep apnea hypopnea syndrome and its risk factors

Objective: To analyze the occurrence of metabolic dysfunction-associated fatty liver disease (MAFLD) and related inflammatory indicators in obstructive sleep apnea hypopnea syndrome (OSAHS) and explore the risk factors of MAFLD. Methods: A cross-sectional study. From January 2022 to October 2024,172 patients with sleep disorders were enrolled in the First Affiliated Hospital of Soochow University,including 38 patients with non-OSAHS,53 patients with mild OSAHS,37 patients with moderate OSAHS,and 44 patients with severe OSAHS. The occurrence of MAFLD was comprehensively judged from three aspects: metabolic dysfunction-associated fatty liver (MAFL),elevated liver enzymes,and liver fibrosis. The situation of MAFLD and the level of related inflammatory markers were compared among the four groups. Binary logistic regression was used to analyze the risk factors for MAFLD in OSAHS. Results: There were significant differences in the prevalence of MAFL,the percentage of elevated liver enzymes,and interleukin-6 and tumor necrosis factor-alpha levels among the four groups (P<0.05). The differences of fibrosis-4 index and C-reactive protein among the four groups were not statistically significant (P>0.05). Binary logistic regression showed that BMI,triglycerides,longest time of sleep apnea and tumor necrosis factor-alpha were the risk factors for MAFL (P<0.05). BMI,glucose,and apnea-hypopnea index were the risk factors for elevated liver enzymes (P<0.05). Conclusions: OSAHS is strongly associated with MAFLD,and the involvement of OSAHS in the occurrence and development of MAFLD may be related to obesity,lipid metabolism disorders,insulin resistance,inflammatory responses,and intermittent hypoxia.

Age-Related Clinical and Polysomnographic Features of Severe Obstructive Sleep Apnea in Infants.

To use clinical and polysomnographic (PSG) parameters to define the features of severe OSA in infants including PSG parameters, risk factors, and interventions. Retrospective comparison of PSG features in 207 infants (<12 months) referred for sleep-disordered breathing. Stepwise multivariate logistic regression was used to define risk factors for severe OSA including sleep stage-specific PSG parameters. Oxygenation was assessed as % of time with SpO2 < 90% nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage-specific O2 desaturation indexes. We found that 43% of the infants had an OAHI ≥10/h (90/207) with 152 analyzed due to lack of follow-up. Age is the strongest predictor for severe OSA with infants at or less than 3 months of age with 6.22 higher risk of severe OSA (95% CI, 3.16-12.27). Age-stratified analyses showed that infants ≤3 months had significantly higher total and OSA sleep stage-specific apnea hypopnea (OAHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI), arousal indexes, and more severe hypoxemia, both sustained and intermittent. The top risk factor in infants ≤3 months was craniofacial abnormality, which occurred in 57.9% of cases. No intervention was the most common management for each group (61.1% in ≤3 months and 56.6% in 4-12 months). The most common procedures in infants ≤3 months were mandibular distraction osteogenesis (MDO) and supraglottoplasty (SGP) while adenoidectomy was the most common in the 4- to 12- month group. Diagnosis ≤3 months is the strongest predictor for severe OSA, demonstrated across PSG parameters. No surgical intervention is the most common management. 3 Laryngoscope, 135:958-963, 2025.

Associations between objectively measured sleep characteristics and 6-minute walk distance in older adults: the Disparities in Sleep and Cognitive Outcomes (DISCO) study.

Decline in physical functioning in older adults has been associated with higher risk of chronic diseases. Subjective sleep disturbances have been associated with declines in physical functioning with aging. We examined the association between objectively measured sleep characteristics and 6-minute walk distance, a marker of functional capacity, in a sample of older adults. This analysis included 199 participants who were enrolled in the Disparities in Sleep and Cognitive Outcomes (DISCO) study, a longitudinal cohort of older adults aged ≥55 years. Exposures included: sleep duration, sleep percentage, sleep fragmentation, and sleep regularity index measured using 7 days of wrist actigraphy; sleep stages including non-REM stage 3 (N3) and REM, and apnea-hypopnea index (AHI) measured using an overnight type 2 home polysomnography. The primary outcome was the total distance walked in 6-minutes (6MWD). Multiple linear regression was used for analysis. Mean age of participants was 67.6 (SD=6.3) years (range 55-84 years), 69.3% were women, 62.3% were White and 84.4% were non-Hispanic. The average 6MWD was 476.0 (SD=95.6) meters. In adjusted models (B [95% CI]), higher sleep percentage (2.65 [0.22,5.08] percent) and greater sleep regularity (1.03 [0.0047, 2.05] units) were associated with higher 6MWD. Greater sleep fragmentation was associated with lower 6MWD (-2.56 [-4.02, -1.10] percent). Sleep duration, N3, REM, and AHI were not associated with 6MWD. Poorer objective sleep quality and irregular sleep were associated with poorer functional capacity in older adults. Future work should test whether improving sleep quality and regularity improves physical functioning and overall health in older adults.

Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances.

To investigate the effects of modified twin-block appliances (MTBA) on obstructive sleep apnea (OSA) and mandibular retrognathia and the changes in the upper airway, hyoid bone position, and hypoxia-related inflammatory marker levels in children with OSA. This study included children with OSA and mandibular retrognathia and those with class I without mandibular retrognathia (n = 35 each). The experimental group comprised children with OSA and mandibular retrognathia managed using MTBA. Postoperative and preoperative polysomnography, lateral cephalometric radiographs, and peripheral blood samples were collected. The control group comprised children with class I without mandibular retrognathia. Following MTBA management, the experimental group exhibited decreased apnea-hypopnea index and increased lowest arterial oxygen saturation level (P < 0.05). Sella- and subspinale-nasion-supramental angles significantly increased and decreased, respectively (P < 0.05). Posterior soft palatal-posterior pharyngeal wall distance, apical palatal-middle pharyngeal wall distance, posterior airway space, epiglottis valley-hypopharyngeal wall distance, hyoid-prevertebral plane distance, and distance from the superior anterior point of the hyoid bone to the inferior anterior point of the third cervical spine significantly increased, whereas distance from the superior anterior point of the hyoid bone to the mandibular plane decreased (P < 0.05). Children with OSA (n = 35) were managed using MTBA, which relieved the mandibular retrognathia deformity, widened the upper airway space, moved the hyoid bone forward and upward, and improved the sleep monitoring indicators. Thus, MTBA can achieve satisfactory therapeutic effect in children with OSA and mandibular retrognathia with mandibular advancement.

Multi-diagnostic chest-worn patch to detect obstructive sleep apnea and cardiac arrhythmias.

Evaluate the performance of the SANSA device to simultaneously assess obstructive sleep apnea (OSA) and cardiac arrhythmias. Participants suspected or known to have OSA underwent polysomnography (PSG) while wearing SANSA. SANSA's algorithm was trained using 86 records and tested on 67 to evaluate training bias. SANSA performance was evaluated against ground truth PSG scored by the consensus of three technologists. PSG scoring from individual testing sites was also evaluated against consensus. Diagnostic performance was evaluated using standard apnea-hypopnea index (AHI) cutoffs. AHI and total sleep time (TST) agreement was analyzed using correlation and Bland-Altman plots. ECG was reviewed for presence of significant arrhythmias (frequent premature atrial/ventricular complexes and atrial fibrillation). SANSA's sensitivity and specificity to detect OSA ranged from 91-97% and 78-97%, respectively, across all severity levels. SANSA TST correlation with Consensus PSG TST was 0.83 with a mean difference of 3.8 minutes (limits of agreement: -91.1 to 98.7). Significant arrhythmias were detected in 32% of participants. These participants had a greater AHI (27.5 versus 15.8, P=0.003) and spent nearly twice as long at reduced oxygenation levels (47.5 versus 20.5 minutes under 88% SpO2, P = 0.009). SANSA is a promising tool for comprehensive OSA evaluation, offering the unique advantage of concurrent arrhythmia detection. This dual functionality may improve patient outcomes through early diagnosis and management of both conditions.

Obstructive sleep apnea in patients with bradyarrhythmias

Obstructive sleep apnea (OSA) is a common condition frequently associated with bradyarrhythmias. In some cases, treatment for such patients involves the implantation of a permanent endocardial pacemaker. Undiagnosed OSA may lead to an increased number of unnecessary pacemaker implantations, emphasizing the importance of timely diagnosis and treatment of this condition. This article presents clinical observations of seven patients with nocturnal bradyarrhythmias, which resolved following CPAP therapy (continuous positive airway pressure therapy). The use of CPAP therapy contributed to the improvement of cardiovascular parameters, including the reduction in the number and duration of heart rhythm pauses. Clinically significant bradyarrhythmias were resolved in patients, allowing them to avoid surgical intervention. In the described cases, patients demonstrated a high apnea-hypopnea index (AHI) ranging from 35 to 79.5 episodes per hour, significant oxygen desaturation (minimum SpO2 down to 50%), and pronounced heart rhythm disturbances during the night. The initiation of CPAP therapy led to a reduction in the apnea-hypopnea index (1.9–23.1 episodes per hour), normalization of minimum oxygen saturation (80–93%), and the elimination of prolonged rhythm pauses. The findings highlight the necessity of mandatory screening for OSA in patients with nocturnal bradyarrhythmias before planning pacemaker implantation. CPAP therapy effectively eliminates rhythm disturbances associated with sleep apnea and prevents unnecessary surgical procedures. This underscores the importance of a comprehensive approach to the diagnosis and treatment of this patient group, as well as the need for further large-scale studies to optimize the management strategies for such cases.

Preliminary evidence of immune infiltration and neutrophil degranulation in peripheral blood of non-obese OSA patients related to cognitive decline

Obstructive sleep apnea (OSA) patients have varying degrees of cognitive impairment, but the specific pathogenic mechanism is still unclear. Meanwhile, poor compliance with continuous positive airway pressure (CPAP) in OSA prompts better solutions. This study aimed to identify differentially expressed genes between the non-obese OSA patients and healthy controls, and to explore potential biomarkers associated with cognitive impairment. Cohorts of healthy control (n = 20) and non-obese, treatment-naïve OSA patients (n = 20) were recruited. We collected their peripheral blood mononuclear cells and neutrophils, and their cognitive performances were evaluated by the Montreal Cognitive Assessment (MoCA). The differentially expressed genes were identified by bioinformatic analysis and confirmed by PCR. Imbalanced immune cell proportions were assessed by Cibersort. Biomarkers related to enriched cellular pathways were measured by ELISA. OSA patients showed a significant decline in overall cognitive function and were associated with higher daytime sleepiness scores. Multiple signaling pathways were enriched in the non-obese OSA cohort, including upregulation of neutrophil-degranulation. Increased monocyte proportion and decreased NK cell proportion were figured out. The relevant genes, including upregulated defensin alpha 4 (DEFA4), haptoglobin (HP), survivin (BIRC5), and suppressed interferon gamma (IFNG) expression were detected. The relative expression of DEFA4 was significantly correlated with the MoCA score and sleep parameters. Biomarkers such as myeloperoxidase (MPO), H2O2, and lipocalin-2, as representatives of neutrophils’ activation, elevated significantly in the OSA group. The data demonstrated a positive correlation between MPO and oxygen desaturation index (ODI) and a negative correlation between MPO and lowest oxygen saturation (LSaO2). The level of Lipocalin-2 was positively correlated with apnea-hypopnea index (AHI) and ODI and negatively correlated with LSaO2 and MoCA score. We also observed a negative correlation between H2O2 and mean oxygen saturation (MSaO2). Degranulation of neutrophils was activated in non-obese OSA patients without other complications. The process is related to OSA severity and cognitive impairment, implying its role in pathogenesis.

Treatment effect of head extension by cervical collar on moderate obstructive sleep apnea-A randomized controlled trial.

As available treatments in obstructive sleep apnea are all associated with side-effects or adherence problems, there is a need for alternative treatment options. In this randomized, open, parallel-group intervention study, the effect of head extension by cervical collar was evaluated in patients with moderate obstructive sleep apnea. One-hundred patients with moderate obstructive sleep apnea (apneas and hypopneas per estimated hours asleep = respiratory events index: 15-30) were randomized to either lifestyle intervention, or cervical collar in combination with lifestyle intervention. Both groups received lifestyle advice. In addition, the treatment group was treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks. A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. In the intention-to-treat analysis, the cervical collar in combination with lifestyle intervention group decreased their respiratory events index (p = 0.008) and oxygen desaturation index (p = 0.008) more than the lifestyle intervention group, with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p = 0.018) but not on non-supine apnea-hypopnea index (-2.3, p = 0.17). We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate obstructive sleep apnea. Cervical collar can be a second-line treatment option in this group, especially in positional obstructive sleep apnea.

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

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

Drug Induced Sleep Endoscopy-Directed Tongue Surgery to Treat Persistent Pediatric Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

To systematically review the literature for articles evaluating outcomes of drug-induced sleep endoscopy (DISE) directed tongue surgery in children with prior adenotonsillectomy and persistent or recurrent obstructive sleep apnea (OSA), and to perform a meta-analysis on the polysomnographic (PSG) data. Systematic review and metanalysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. Primary, post-operative apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT); Secondary, surgical response rate. Seven studies (283 patients) met criteria and reported PSG outcome data for the systematic review. The mean ± standard deviation surgical response rate was 70.0% ± 17.0% [95% CI 67.6, 71.6]. Six of the seven studies (270 patients) reported specific pre- and post-operative PSG data included in our meta-analysis. The pre- and post-operative AHI decreased from 9.5 ± 12.1 to 4.2 ± 6.9 events/h (p < 0.04) with a mean difference (MD) of -5.13 [95% CI -7.13, -3.13], Z-score 5.02 (p < 0.00001). LSAT improved from 87.8 ± 5.7 to 90.1% ± 5.1% (p < 0.02) with a MD of 2.71 [95% CI 1.53, 3.89], Z-score 4.51 (p < 0.0001). Existing literature demonstrates DISE-directed tongue surgery in children with persistent OSA can reduce AHI by approximately 50%, improve LSAT by nearly 3%, and have an overall positive response to surgery rate of 70%. There is collective evidence that DISE-directed tongue surgery is effective; limitations include heterogeneity in reported outcomes influenced by confounding factors.

Association of Obstructive Sleep Apnea and Nocturnal Hypoxemia With the Circadian Rhythm of Myocardial Infarction.

The circadian rhythm of myocardial infarction (MI) in patients with obstructive sleep apnea (OSA) remains disputable and no studies have directly evaluated the relationship between nocturnal hypoxemia and the circadian rhythm of MI. The aim of the current study was to evaluate the association of OSA and nocturnal hypoxemia with MI onset during the night. Patients with MI in the OSA-acute coronary syndrome (ACS) project (NCT03362385) were recruited. The time of MI onset was identified by patient's report of the chest pain that prompted hospital admission. All patients underwent an overnight sleep study using a type III portable sleep monitoring device after clinical stabilization during hospitalization. The difference in circadian variation of MI onset was evaluated between patients with moderate/severe OSA and non/mild OSA and those with or without nocturnal hypoxemia. Nocturnal hypoxemia was evaluated using 3 variables, including oxygen desaturation index, minimum oxygen saturation, and total sleep time with saturation <90%. Among 713 patients enrolled, 398 (55.8%) had moderate/severe OSA (apnea-hypopnea index ≥15 events·h - 1). Compared with the non/mild OSA group, the MI onset was significantly increased in the moderate/severe OSA group between midnight to 5:59 am in 6-hour epochs analysis (26.9% versus 18.4%, P=0.008). Only in patients with both moderate/severe OSA and nocturnal hypoxemia, including oxygen desaturation index ≥15, minimum oxygen saturation ≤86%, and total sleep time with saturation <90% ≥2%, the incidence of MI onset between midnight to 5:59 am was significantly increased. Moderate/severe OSA (adjusted odds ratio 1.66 [95% CI, 1.13-2.43]; P=0.01) and nocturnal hypoxemia (oxygen desaturation index ≥15 model, adjusted odds ratio 1.80, [95% CI, 1.21-2.66]; minimum oxygen saturation ≤86% model, adjusted odds ratio 1.70 [95% CI, 1.16-2.47]; P=0.006; total sleep time with saturation <90% ≥2% model, adjusted odds ratio 1.54 [95% CI, 1.04-2.27]; P=0.03) significantly predicted MI occurrence from midnight to 6:00 am. A peak of incident MI onset between midnight to 5:59 am was observed in patients with moderate/severe OSA, especially in those presenting with nocturnal hypoxemia.

Phenome-wide associations of sleep characteristics in the Human Phenotype Project.

Sleep tests commonly diagnose sleep disorders, but the diverse sleep-related biomarkers recorded by such tests can also provide broader health insights. In this study, we leveraged the uniquely comprehensive data from the Human Phenotype Project cohort, which includes 448 sleep characteristics collected from 16,812 nights of home sleep apnea test monitoring in 6,366 adults (3,043 male and 3,323 female participants), to study associations between sleep traits and body characteristics across 16 body systems. In this analysis, which identified thousands of significant associations, visceral adipose tissue (VAT) was the body characteristic that was most strongly correlated with the peripheral apnea-hypopnea index, as adjusted by sex, age and body mass index (BMI). Moreover, using sleep characteristics, we could predict over 15% of body characteristics, spanning 15 of the 16 body systems, in a held-out set of individuals. Notably, sleep characteristics contributed more to the prediction of certain insulin resistance, blood lipids (such as triglycerides) and cardiovascular measurements than to the characteristics of other body systems. This contribution was independent of VAT, as sleep characteristics outperformed age, BMI and VAT as predictors for these measurements in both male and female participants. Gut microbiome-related pathways and diet (especially for female participants) were notably predictive of clinical obstructive sleep apnea symptoms, particularly sleepiness, surpassing the prediction power of age, BMI and VAT on these symptoms. Together, lifestyle factors contributed to the prediction of over 50% of the sleep characteristics. This work lays the groundwork for exploring the associations of sleep traits with body characteristics and developing predictive models based on sleep monitoring.

Efficacy of Orthognathic Surgery in OSAS Patients: A Systematic Review and Meta-Analysis.

Obstructive sleep apnea syndrome (OSAS) is a prevalent condition characterised by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and associated morbidities. Orthognathic surgery (OGS) has been proposed as a treatment option for OSAS, aimed at anatomically repositioning the maxillofacial structures to alleviate airway obstruction. This systematic review and meta-analysis aimed to evaluate the efficacy of OGS in reducing apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) scores among OSAS patients. We conducted a comprehensive literature search across multiple databases for studies assessing the outcomes of OGS in OSAS patients, focusing on changes in AHI and ESS scores. The inclusion criteria encompassed observational studies, cohort studies, and randomised control trials. Data extraction and quality assessment were performed independently by two reviewers. Random-effects meta-analysis was utilised to pool mean differences (MD) of AHI and ESS scores preoperatively and postoperatively, with 95% confidence intervals (CI) calculated. A total of 8 studies met the inclusion criteria, where OGS was shown to be slightly more effective in correcting OSAS than the other modalities assessed, primarily CPAP. The pooled MD for AHI demonstrated a significant reduction in scores post-OGS (MD = 29.84, 95% CI: 14.17-45.50, p < 0.0001) with substantial heterogeneity (I2 = 95%). For ESS, the pooled MD indicated a non-significant reduction (MD = 1.91, 95% CI: -1.29 to 5.12, p = 0.24) with high heterogeneity (I2 = 81%). Orthognathic surgery appears to be an effective intervention for reducing AHI in patients with OSAS, suggesting a potential to improve the objective measures of sleep apnea. However, the effect on subjective sleepiness scores, as evaluated by ESS, was not statistically significant. The high heterogeneity among studies warrants individualised patient assessment when considering OGS for OSAS. Further research is needed to identify factors contributing to the variability of outcomes and to assess the long-term benefits and risks associated with the procedure.

Individualised Therapy for Obstructive Sleep Apnoea: Predictive Models and Anatomical Phenotyping of Mandibular Advancement Devices Responses.

This non-randomised clinical study aimed to identify the phenotypic characteristics that distinguish responders from non-responders. Additionally, it sought to establish a predictive model for treatment response to obstructive sleep apnoea (OSA) using mandibular advancement devices (MAD), based on the analysed phenotypic characteristics. This study, registered under identifier NCT05596825, prospectively analysed MAD treatment over 6 years using two-piece adjustable appliances according to a standardised protocol. Two response definitions aligned with the latest International Consensus Statement on OSA severity were established. Logistic regression and CHAID models integrated baseline clinical, anthropometric, cephalometric anatomical, soft tissue characteristics and physiological upper airway variables. A total of 112 patients completed the study: 64 responders and 48 non-responders according to response definition 1, and 81 responders and 31 non-responders according to response definition 2. Responders to MAD treatment had lower body mass index (BMI), neck and waist circumference, Epworth Sleepiness Scale scores, apnoea-hypopnea index (AHI), snoring intensity on the Visual Analog Scale, CPAP pressure, and higher T90% and minSaO2. Patients exhibiting greater anatomical imbalance, smaller airway volume, smaller minimum cross-sectional area (CSAmin) and longer airway length demonstrated a poorer response to treatment. Airway length, initial T90% and anterior facial height collectively formed a highly predictive logistic regression model for response definition 1. Jarabak's ratio, gonial angle, CSAmin, airway length, initial BMI and baseline AHI constituted a highly predictive model for the second response definition. Furthermore, the CHAID regression tree established cutoff values for the variables that form the predictive models.

Evolution of sleep disordered breathing in infants with achondroplasia.

Children with achondroplasia (ACH) are at risk for sudden death in infancy due to sleep disordered breathing (SDB) and foramen magnum stenosis (FMS). Sleep studies and neuroimaging are performed in infants with ACH, but interpretation of infant studies is challenging. We sought to describe baseline data on polysomnography (PSG) indices in infants with achondroplasia as well as effects of age and surgery on these parameters. Retrospective data were abstracted from the multisite CLARITY ACH database from years 2008-2017. Both obstructive apnea hypopnea index (OAHI) and central apnea index (CAI) were extracted, and effects of age and surgical intervention (adenoidectomy [AD] or cervicomedullary decompression [CMD]) were analyzed. 172 PSGs from 86 infants were analyzed. In surgically naive children, OAHI decreased over the first year but then increased in the second year, while CAI was mostly stagnant over the first two years. There were no significant differences between age at first PSG or PSG indices for surgically naive infants versus those who underwent AD or CMD. OAHI decreased after AD and CAI decreased after CMD. Similar to average stature infants, our results demonstrate the need to interpret sleep study findings of children with ACH in the context of age, particularly for obstructive indices. Neither OAHI nor CAI differentiated those infants who subsequently underwent surgery, suggesting that there were other important clinical factors in the surgical decision-making process. Independent of age, AD resulted in improvement in OSA and CMD with improvement in central sleep apnea.