Collapse Of Upper Airway Research Articles

Phenotyping Using Polysomnography Attributes Reduced Respiratory Events after CPAP Therapy to Improved Upper Airway Collapsibility.

Rationale: In patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP), the apnea hypopnea index (AHI) measured off CPAP may be decreased relative to baseline AHI preceding CPAP treatment. Semi-invasive "endo-phenotyping" sleep studies attribute this fall in AHI primarily to improved ventilatory control stability. Phenotyping Using Polysomnography (PUP) attempts to reproduce these studies using routine polysomnography (PSG). Objectives: To determine whether changes in AHI following CPAP associate primarily with changes in PUP-estimated ventilatory control stability (loop gain, LG1) or with changes in other PUP-estimated pathophysiologic mechanisms. Methods: PUP analyses were performed on existing PSGs in research participants who underwent baseline PSG, 4.4±2.2 months CPAP therapy, and CPAP withdrawal with repeat PSG on night 2 of withdrawal. Pre-CPAP PUP-estimated LG1, arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and compensation (Vcomp) were compared to corresponding values during CPAP withdrawal. Mixed effects models were constructed to determine which PUP estimate best explained changes in AHI. Results: PSG data were available for 35 participants (age 47±10.8 years; 12 female; BMI 38.5±8.6 kg/m2, AHI3A 58.8±33.1 events/hr, 9 mild/moderate OSA, 26 severe OSA). Following CPAP, AHI decreased, but the change was not statistically significant. However, a significant decrease was observed in those with severe OSA (pre-CPAP 68.2 [32.6-86.3] versus CPAP withdrawal 49.0 [36.1-74.4] events/hr). Across all participants, changes in PUP estimates did not exceed test-retest agreement limits. For those with severe OSA, decrease in LG1 (0.86 [0.61-1.13] pre-CPAP versus 0.71 [0.61-0.99] on CPAP withdrawal) and increase in Vpassive (64.8 [5.4-88.4] %Veupnea pre-CPAP versus 76.4 [20.7-92.7] %Veupnea on CPAP withdrawal) exceeded test-retest agreement limits. Increased Vpassive, decreased LG1, and decreased ArTH were predictors of decreased AHI in mixed effects models. Vpassive had the greatest estimated effect on AHI. After accounting for Vpassive, additional estimates did not improve model performance. However, Vpassive and LG1 were correlated, and post hoc analyses suggest these estimates may be influenced by both upper airway collapsibility and ventilatory control. Conclusions: According to PUP physiologic estimates, decreases in AHI following several months of CPAP therapy are primarily attributable to improved upper airway collapsibility.

The effect of cpap therapy on blood pressure in the mild obstructive sleep apnea population

This retrospective study uniquely focused on the effects of continuous positive airway pressure (CPAP) on blood pressure in patients with mild obstructive sleep apnea (OSA), a condition characterized by intermittent upper airway collapse. OSA is a well-established risk factor for hypertension, with positive airway pressure (PAP) therapy being the most common treatment. While substantial evidence supports PAP therapy in moderate and severe OSA, the impact of CPAP on mild OSA, which accounts for 50%-70% of all cases, remains underexplored. The primary objective of this study was to investigate whether CPAP therapy, particularly the degree of adherence to treatment, has a measurable impact on blood pressure regulation in patients with mild OSA. Specifically, this research aimed to evaluate whether consistent CPAP use could lower systolic and diastolic blood pressure and assess how varying levels of adherence influence these outcomes. Participants were stratified into two groups based on CPAP adherence: Group A (n = 45) included those who used CPAP for four or more hours per night on at least 70% of nights, while Group B (n = 15) consisted of those with less than four hours of CPAP use per night on 70% of nights. Interestingly, greater systolic and diastolic blood pressure reductions were observed in Group B, suggesting that lower CPAP adherence may still contribute to significant cardiovascular improvements. These findings offer new insights into the management of blood pressure in patients with mild OSA and the role of CPAP adherence.

Altered control of breathing in a rat model of allergic lower airway inflammation.

Obstructive sleep apnea (OSA) is highly prevalent in patients with asthma. Asthma, dose-dependently to its duration, promotes incident OSA, suggesting that asthma plays a role in OSA pathogenesis. We hypothesized that asthma-related inflammation alters breathing control mechanisms, specifically the carotid chemoreflex. Accordingly, we measured hypoxic ventilatory responses (HVR) in awake, unrestrained, ovalbumin (OVA)-sensitized Brown Norway rats and compared them with responses in sham-sensitized (SALINE) controls. To differentiate the role of allergic inflammation from bronchoconstriction, we repeated hypoxic ventilatory response (HVR) after administration of formoterol, a long-acting bronchodilator. Blood and bronchoalveolar lavage (BAL) fluid were collected for quantification of inflammatory cytokines. The rise in ventilatory equivalent for O2 evoked by acute exposure to hypoxia was augmented following sensitization by OVA, whereas it remained stable after SALINE. This augmentation was driven by increased breathing frequency with no change in tidal volume. Tachypneic hyperventilation in normoxia was also observed with OVA. Neither the increased HVR nor excessive normoxic ventilation was affected by formoterol, suggesting that they were not secondary to lung mechanical constraints. Higher levels of inflammatory cytokines were observed in BAL fluid and serum of OVA versus SALINE. In OVA, serum interleukin-5 levels significantly correlated with change from baseline in ventilatory responses to severe hypoxia ([Formula: see text], 0.09). These observations are consistent with inflammation-induced enhancement of carotid chemoreflex function, i.e., increased controller gain, and they suggest a possible role for asthma-related allergic inflammation in the ventilatory instability known to promote upper airway collapse and sleep apnea in humans.NEW & NOTEWORTHY Asthma is a risk factor for obstructive sleep apnea (OSA); however, the mechanisms are incompletely understood. In a rat model of allergic inflammation associated with asthma, we found that ventilation in normoxia and ventilatory responses to hypoxia were markedly enhanced and related with systemic inflammation. These alterations indicating carotid chemoreflex sensitization, known to promote ventilatory instability during sleep in humans, may contribute to the increased OSA risk in asthma.

Motor control of the palatoglossus and genioglossus during changes in breathing route.

High activity of upper airway dilator muscles is thought to be critical in preventing sleep-related upper airway collapse. To date, most of the research regarding upper airway dilator muscles has focused on the genioglossus muscle, which protrudes the tongue and opens the retroglossal airway. However, collapse commonly occurs in the retropalatal region. We therefore aimed to examine the motor control of the palatoglossus muscle as well as investigate breathing route-related changes in genioglossus and palatoglossus motor units. Single motor unit recordings of the genioglossus and palatoglossus were made simultaneously in healthy individuals during wakefulness while breathing through the nose with the mouth closed (NMC), nose with mouth open (NMO) or orally (OMO). The palatoglossus was found to have all 5 motor unit firing patterns that have been observed in other upper airway dilator muscles, but during nasal breathing had a higher proportion of tonically active but inspiratory modulated motor units as compared to the genioglossus (67% vs 30%). When still breathing nasally but with the mouth open, the units with an expiratory firing pattern in genioglossus, and all firing patterns in palatoglossal, increased their firing rates compared to nasal breathing with the mouth closed (GG: 17.8±4.9 vs 23.1±4.8 Hz, PG: 17.0±4.0 vs 19.3±4.0 Hz). Finally, oral breathing resulted in dramatic reductions in the number of palatoglossal motor units that were firing (35 units vs 92 during nasal breathing). Palatoglossus activity may contribute importantly to airway collapsibility and may provide an alternate pathway for preventing sleep-related airway collapse.

Upper airway collapse during nasopharyngoscopy (Muller’s Maneuver) in Egyptian Adult patients with Obstructive Sleep Apnea

Upper airway collapse during nasopharyngoscopy (Muller’s Maneuver) in Egyptian Adult patients with Obstructive Sleep Apnea

International expert consensus statement: surgical failure in obstructive sleep apnea.

Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the 'Definition of Surgical Success/Failure after OSA Surgery'. Regarding the 'Predictive Factors of Surgical Failure in OSA Surgery', consensus was reached on 10 out of 13 statements. In the context of the 'Diagnostic Workup in OSA Surgery', consensus was achieved on 9 out of 13 statements. Lastly, in 'Treatment in Surgical Failure Cases', consensus was reached on 12 out of 24 statements. The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

Critical Closing Pressure (Pcrit) and Negative (Subatmospheric) Expiratory Pressure (NEP) for Diagnosis of Pharyngeal Collapsibility in Patients With Obstructive Sleep Apnea (OSA)

The determination of critical closing pressure (Pcrit) is the diagnostic gold standard for assessing the severity of pharyngeal instability. Pcrit measurements are typically performed during natural nocturnal sleep (NREM Stage 2) in combination with polysomnography. However, determining Pcrit during sleep is time-consuming and impractical for routine use. Alternatively, Pcrit measurements can also be done during drug-induced sleep. A disadvantage of this method is the varying doses of propofol needed to induce sleep, which can affect muscle tone differently. As an alternative to these methods, the application of negative pressure during wakefulness (NEP test) has proven effective. In this test, the patient is administered a subatmospheric pressure of -5 or -10 cmH2O via mask at the beginning of expiration, and the change in expiratory airflow in the pharynx is measured. NEP test can be performed in both sitting and lying position. According to current knowledge, the NEP test appears to be a diagnostic procedure comparable to critical closing pressure (Pcrit) for assessing upper airway collapsibility.

Effects of different masks on diaphragm motion in OSAS patients undergoing CPAP: results from an ultrasound-based proof of concept study.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway narrowing or collapse during sleep. Continuous positive airway pressure (CPAP) remains the preferred treatment in selected patients and masks' choice plays an important role for subsequent respiratory events' reduction. It is known that oronasal masks are not as effective at opening the upper airway compared to nasal ones. Thus, the objective of this study was to investigate differences in US-assessed diaphragmatic excursion (DE) using oronasal vs. nasal CPAP masks. This observational study included 50 OSA patients presenting a moderate to severe apnea-hypopneaindex and requiring CPAP treatment. All participants received US evaluations on diaphragm motion during their oronasal and nasal CPAP trial at equal positive end-expiratory pressure level. The difference of DE switching mask during CPAP was assessed by using the non-parametric Wilcoxon signed-rank test. A statistically significant increase in US- assessed DE was found when shifting from oronasal to nasal mask (p-value < 0.01). Linear regression models revealed that increased neck circumference and more severe AHI were associated with decreased DE when shifting to an oronasal mask. This study evaluated the acute impact on US-assessed DE after changing CPAP route from oronasal to nasal mask. Our results suggest that the nasal type should be the more suitable option for most patients with OSA, especially those with higher nasal circumference. Diaphragmatic motion throughout US may become a practical tool to help in the choice of the fittest mask in patients undergoing CPAP.

Obstructive Sleep Apnea and Serotoninergic Signalling Pathway: Pathomechanism and Therapeutic Potential.

Obstructive Sleep Apnea (OSA) is a disorder characterized by repeated upper airway collapse during sleep, leading to apneas and/or hypopneas, with associated symptoms like intermittent hypoxia and sleep fragmentation. One of the agents contributing to OSA occurrence and development seems to be serotonin (5-HT). Currently, the research focuses on establishing and interlinking OSA pathogenesis and the severity of the disease on the molecular neurotransmitter omnipresent in the human body-serotonin, its pathway, products, receptors, drugs affecting the levels of serotonin, or genetic predisposition. The 5-HT system is associated with numerous physiological processes such as digestion, circulation, sleep, respiration, and muscle tone-all of which are considered factors promoting and influencing the course of OSA because of correlations with comorbid conditions. Comorbidities include obesity, physiological and behavioral disorders as well as cardiovascular diseases. Additionally, both serotonin imbalance and OSA are connected with psychiatric comorbidities, such as depression, anxiety, or cognitive dysfunction. Pharmacological agents that target 5-HT receptors have shown varying degrees of efficacy in reducing the Apnea-Hypopnea Index and improving OSA symptoms. The potential role of the 5-HT signaling pathway in modulating OSA provides a promising avenue for new therapeutic interventions that could accompany the primary treatment of OSA-continuous positive airway pressure. Thus, this review aims to elucidate the complex role of 5-HT and its regulatory mechanisms in OSA pathophysiology, evaluating its potential as a therapeutic target. We also summarize the relationship between 5-HT signaling and various physiological functions, as well as its correlations with comorbid conditions.

Pharyngeal Manometry and Upper Airway Collapse During Drug-Induced Sleep Endoscopy

Drug-induced sleep endoscopy (DISE) is used to guide therapeutic management of obstructive sleep apnea (OSA), depending on the levels and patterns of pharyngeal collapse. However, the collapsibility of specific pharyngeal sites remains unknown. To assess collapse sites in patients with OSA undergoing DISE and whether number and location are associated with differences in airway collapsibility; and to quantify differences in collapsibility between primary and secondary sites in multilevel collapse. This cohort study assessed adult patients (≥18 years) with OSA undergoing DISE with manometry and positive airway pressure (PAP) titration at a tertiary care center from November 2021 to November 2023. Patients with an AHI score greater than 5 were included; those with less than 1 apnea event during DISE or incorrect catheter placement were excluded. Data were analyzed from September 28, 2022, to March 31, 2024. DISE with manometry and PAP titration. Active pharyngeal critical pressure (Pcrit-A) and pharyngeal opening pressure (PhOP) were used to quantify airway collapsibility, adjusted for covariates (age, sex, race, and body mass index [BMI]). Of 94 screened, 66 patients (mean [SD] age, 57.4 [14.3] years; BMI, 29.2 [3.9]; 51 [77.3%] males) with a mean (SD) apnea-hypopnea index (AHI) of 31.6 (19.0) were included in the analysis. Forty-seven patients (71.2%) had multilevel collapse, 10 (15.2%) had single-level nasopalatal collapse, and 9 (13.6%) had single-level infrapalatal collapse. Groups did not differ in demographic characteristics or established measures of OSA severity. The single-level nasopalatal group had substantially elevated levels of airway collapsibility (Pcrit-A and PhOP covariate adjusted mean, 2.4; 95% CI, 1.1 to 3.8; and 8.2; 95% CI, 6.4 to 9.9 cmH2O) compared to the single-level infrapalatal group (-0.9; 95% CI, -2.4 to 0.5 cmH2O; and 4.9; 95% CI, 3.0 to 6.8 cmH2O, respectively) and similar to the level among the multilevel group (1.3; 95% CI, 0.7 to 2.0; and 8.5; 95% CI, 7.7 to 9.3 cmH2O). The multilevel group had more negative inspiratory pressure (-24.2; 95% CI, -28.1 to -20.2 cmH2O) compared to the single-level nasopalatal group (-9.8; 95% CI, -18.3 to -1.28 cmH2O). In patients with multilevel collapse, airway collapsibility was significantly higher at the primary nasopalatal compared to secondary infrapalatal site (mean difference, 13.7; 95% CI, 11.3 to 16.1 cmH2O). The findings of this cohort study suggest that intervention should target the primary site of pharyngeal collapse, and secondary sites only if they are nearly as collapsible as the primary site. Future work is needed to precisely define the difference in primary and secondary collapsibility that necessitates multilevel treatment.

The Association of Depression with Obstructive Sleep Apnea in Patients with Cystic and Non-Cystic Fibrosis Bronchiectasis.

Obstructive sleep apnea (OSA) and cystic fibrosis (CF) are chronic conditions that profoundly impact quality of life. OSA, characterized by repeated episodes of upper airway collapse, can exacerbate CF symptoms due to nocturnal airway obstruction. Recent studies highlight the prevalence of OSA in CF patients, especially in adults, and its detrimental effects on health and quality of life. From April 2019 to December 2021, we conducted a study with 104 bronchiectasis patients at Marmara University Pendik Training and Research Hospital. After exclusions, 70 participants (35 CF and 35 non-CF) were included. Sleep parameters were assessed with polysomnography, and depressive mood was evaluated using the Zung Self-Rating Depression Scale (SDS). Daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS). The statistical analyses included t-tests, chi-square tests, and logistic regression. Among the CF patients, depressive mood was significantly associated with female sex (OR: 4.28, 95% CI: 1.27-12.04) and anemia (OR: 7.87, 95% CI: 1.50-41.27). Higher ESS scores indicated greater daytime sleepiness in the depressive groups (p = 0.051). Depressive CF patients also had a significantly longer disease duration and more frequent annual exacerbations. No significant differences were found in total sleep time, sleep efficiency, or sleep stages between the depressive and non-depressive groups. A lower forced vital capacity (FVC) was observed in the depressive CF patients, although not significantly. Depression is prevalent among adult CF patients with OSA, with significant associations with female sex and anemia. These findings underscore the need for integrated care addressing both physical and mental health aspects, including interventions for respiratory symptoms, anemia management, and sleep quality enhancement to improve overall quality of life.

Personalized Treatment for Obstructive Sleep Apnea: Beyond CPAP.

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients.

Sex-specific Age-Related Worsening of Pathological Endotypic Traits in Patients with Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is more prevalent in men and older adults. Few studies have explored variations in pathological endotypic traits by age and sex using a large patient sample, offering insights into the development of the disease. Our study aims to examine how endotype characteristics of obstructive sleep apnea vary across age in different sex. A cross-sectional study was conducted, enrolling 2296 adult patients referred for in-laboratory diagnostic polysomnography at a single sleep center in Taiwan. Among them, 1374 had an apnea-hypopnea index ≥ 5. Using the "Phenotyping Using Polysomnography" method, we estimated four endotypic traits-arousal threshold, upper airway collapsibility, loop gain, and upper airway muscle compensation. Demographic and polysomnographic characteristics were compared between sexes and age groups. Generalized linear regression and generalized additive models were employed to explore the associations of sex and age with endotypic traits. Men with OSA exhibited higher collapsibility and lower compensation than women (difference: 4.32 %eupnea and 4.49 %eupnea, respectively). Younger patients with OSA had a higher prevalence of obesity, more snoring symptoms, and lower loop gain compared to older patients. For men, age was correlated with increased collapsibility, increased loop gain, and decreased arousal threshold after 37 years old. Whereas in women, endotypic traits were not associated with age, except for an increase in loop gain with advancing age. Personalized treatment options for OSA should take into consideration age and sex. Reducing loop gain could be a treatment objective for older patients with OSA.

TEMPORARY REMOVAL: Implications of maxillary expansion for the craniofacial phenotype in pediatric and adolescent obstructive sleep apnea

Obstructive Sleep Apnea (OSA) in growing children and adolescents is a multifaceted condition marked by recurrent episodes of breathing interruptions during sleep due to upper airway collapsibility. The pathophysiology of pediatric OSA includes neuromotor dysfunction, inflammation, and anatomical factors related to soft tissues and craniofacial morphology. The prevalence of OSA in children varies between 1-10%, and its impact can extend to behavioral, neurocognitive, cardiovascular, and metabolic issues. Adolescence poses unique diagnostic challenges due to significant physical and hormonal changes, necessitating age-appropriate criteria for OSA assessment.Maxillary transverse deficiency (MTD) is recognized as a critical craniofacial risk factor for pediatric OSA. Rapid Maxillary Expansion (RME) has garnered attention for its ability to open the midpalatal suture, expand the nasal and oropharyngeal airways, and reduce nasal resistance, thereby improving respiratory function. While RME is effective in many cases, microimplant-assisted RME is a promising alternative for severe cases or when conventional RME is insufficient. This technique offers enhanced skeletal expansion and airway improvement, though further research is needed to validate its functional benefits.Case reports highlight the successful application of RME and microimplant-assisted RME in treating pediatric OSA. These interventions resulted in significant improvements in airway dimensions, reduction in apnea-hypopnea index (AHI), and alleviation of symptoms such as snoring and daytime sleepiness.

Impact of lifestyle interventions targeting physical activity and healthy diet on treatment of Obstructive Sleep Apnea (OSA)

Introduction and purpose: Obstructive Sleep Apnea Syndrome (OSAS) is a worldwide prevalent sleep-related medical condition characterised by upper airway collapse, leading to hypoxia and hypercapnia. Excess body weight is the risk factor of OSAS. Lifestyle interventions, particularly targeting weight loss, have emerged as potential management strategies for OSAS. The purpose of this review is to compile the information about the effectiveness of different forms of lifestyle interventions in the treatment of OSA. Brief description of the state of knowledge: While CPAP remains the current “gold standard” treatment of Obstructive Sleep Apnea, it’s not always well-tolerated. Consequently, lifestyle interventions such as dietary modifications, exercise programs, and behavioural therapies have emerged as important components in the management of this disease. The research has shown that these strategies not only reduce the severity of OSA but also improve quality of life. Summary: Lifestyle interventions, including dietary modifications, exercise programs, and behavioral therapies targeting weight loss, have demonstrated promising results in reducing the severity of obstructive sleep apnea (OSA) and alleviating associated symptoms. However, further large-scale, long-term studies are necessary to validate their efficacy and understand their broader impact on OSA management.

Characteristic Pressure Waveforms Can Distinguish Airway Collapse Patterns in Sleep Apnea Patients: A Pilot Study.

To use pharyngeal pressure recordings to distinguish different upper airway collapse patterns in obstructive sleep apnea (OSA) patients, and to assess whether these pressure recordings correlate with candidacy assessment for hypoglossal nerve stimulator (HGNS) implantation. Prospective case series. Single tertiary-quaternary care academic center. Subjects with OSA prospectively underwent simultaneous drug-induced sleep endoscopy (DISE) and transnasal pharyngeal pressure recording with a pressure-transducing catheter. Pressure was recorded in the nasopharynx and oropharynx, and endoscopic collapse patterns were classified based on site, extent, and direction of collapse. Pressure recordings were classified categorically by waveform shape as well as numerically by inspiratory and expiratory amplitudes and slopes. Waveform shape, amplitude, and slope were then compared with the endoscopic findings. Twenty-five subjects with OSA were included. Nasopharyngeal waveform shape was associated with the extent of collapse at the level of the palate (P = .001). Oropharyngeal waveform shape was associated with anatomical site of collapse (P < .001) and direction of collapse (P = .019) below the level of the palate. Pressure amplitudes and slopes were also associated with the extent of collapse at various sites. Waveform shape was also associated with favorable collapse pattern on endoscopy for HGNS implantation (P = .043), as well as surgical candidacy for HGNS (P = .004). Characteristic pharyngeal pressure waveforms are associated with different airway collapse patterns. Pharyngeal pressure is a promising adjunct to DISE in the sleep surgery candidacy evaluation.

Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients.

There are disparities between Black and White patients in the utilization of positive airway pressure (PAP) alternatives for obstructive sleep apnea (OSA). Given low utilization rates among Black patients, there is limited knowledge of PAP alternative outcomes in this group. Therapeutic PAP levels are clinically accessible measures that have been shown to predict PAP alternative outcomes. Herein, we examined differences in PAP requirements between Black and White patients in a large clinical sample. Cross-sectional. Academic sleep center. We included OSA patients prescribed autoadjusting PAP between January 2018 and 2020 with baseline apnea-hypopnea index (AHI) ≥ 10. Mean and 90th percentile PAP levels were compared between White and Black patients who used PAP for ≥1 hour daily using linear regression controlling for age, sex, body mass index (BMI), AHI, oxygen saturation nadir, and mask type. There were 157 Black and 234 White patients who were generally obese (BMI, 37.3 ± 8.7) with severe OSA (AHI, 36.9 ± 25.6). Black patients had a 0.68 cm higher (95% confidence interval [CI]: 0.36, 1.35) mean PAP level and 0.85 cm H2O higher (95% CI: 0.36, 1.35) 90th percentile PAP level than white patients. Although statistically significant, differences were small and not clinically meaningful. Black and White OSA patients had clinically insignificant differences in PAP requirements, suggesting comparable upper airway collapsibility. Considering the predictive value of therapeutic PAP levels, our findings suggest Black and White patients may have comparable PAP alternative responses from a collapsibility standpoint. Future studies should explore reasons for low utilization of PAP alternatives among Black patients.

Upper Airway Collapsibility during Sleep Endoscopy with a Titratable Mandibular Advancement Simulator in Obstructive Sleep Apnea Patients

Upper Airway Collapsibility during Sleep Endoscopy with a Titratable Mandibular Advancement Simulator in Obstructive Sleep Apnea Patients

Current Medical Treatment of Obstructive Sleep Apnoea: A Narrative Review

Background: Recurrent episodes of upper airway collapse during sleep cause obstructive sleep apnoea (OSA). Patients with OSA, a serious clinical condition, frequently halt or reduce their breathing while they are asleep. This results in non-restful, fragmented sleep, which exacerbates symptoms such as morning headaches and drowsiness during the day. Aims and objectives: This review article focuses only on the current medical treatment of OSA. It will also catalyse further study and better awareness of the current medical treatment of OSA. Materials and methods: A search was conducted for recent research articles on current medical treatment for OSA. We searched the PubMed, Scopus, Medline and Google Scholar online databases. Results: Heart arrhythmias, depression, hypertension and coronary artery disease are among the medical disorders linked to OSA. Clinical symptoms that are predictive include obesity, enlarged neck circumferences, gasping when sleeping and loud snoring. Those who are obese, hypertensive, frequent snorers and hyper-somnolent should be suspected of having OSA. An essential test for accurately diagnosing OSA is overnight polysomnography. Conclusion: As OSA is a chronic illness, a long-term, interdisciplinary strategy is required. The first step in managing OSA is patient education. For treatment of OSA, lifestyle changes including losing weight, switching to a different sleeping position, abstaining from alcohol and using certain drugs are crucial. When treating OSA, positive airway pressure is a crucial choice. Since OSA affects both the person and society as a whole, further investigation is needed to find novel treatment approaches for this morbid clinical condition.

The Association of Serum Uric Acid with Risk of Obstructive Sleep Apnea: The Korean National Health and Nutrition Examination Survey 2019-2021.

Upper airway collapse and apneas in obstructive sleep apnea (OSA) induce intermittent hypercapnia and hypoxia, eventually contributing to excessive uric acid production. This study aimed to evaluate the association between hyperuricemia and OSA in the general population via analysis of the eighth KNHANES dataset (2019-2021). OSA risk was identified via the STOP-Bang questionnaire, with a score ≥3 indicating high risk. Among 11,981 total participants, 4572 (38.2%) had a high OSA risk. Participants with a high OSA risk had higher uric acid levels compared to those with a low risk (5.5 ± 1.4 mg/dL vs. 4.8 ± 1.2 mg/dL, p < 0.001). Serum uric acid levels were positively correlated with STOP-Bang score (r: 0.317, p < 0.001). Multivariate analysis revealed that hyperuricemia was associated with a high OSA risk after adjusting for confounders (odds ratio: 1.30, 95%CI: 1.11-1.53, p = 0.001). Therefore, serum uric acid levels are significantly higher in those with a high OSA risk and correlate with the risk of OSA. Further, hyperuricemia is an independently associated risk factor for high OSA risk. More research is warranted to evaluate the long-term clinical outcomes of hyperuricemia in OSA and to determine whether treatment targeting hyperuricemia is effective in the clinical course of OSA.