Breathing Disorders Research Articles

Targeted TGF-βR2 Silencing in the Retrotrapezoid Nucleus Mitigates Respiratory Dysfunction and Cognitive Decline in a Mouse Model of Cerebral Amyloid Angiopathy with and without Stroke.

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid-beta peptides within cerebral blood vessels, leading to neurovascular complications. Ischemic strokes result from acute disruptions in cerebral blood flow, triggering metabolic disturbances and neurodegeneration. Both conditions often co-occur and are associated with respiratory dysfunctions. The retrotrapezoid nucleus (RTN), which is crucial for CO2 sensing and breathing regulation in the brainstem, may play a key role in breathing disorders seen in these conditions. This study aims to investigate the role of Transforming Growth Factor Beta (TGF-β) signaling in the RTN on respiratory and cognitive functions in CAA, both with and without concurrent ischemic stroke.Adult male Tg-SwDI (CAA model) mice and C57BL/6 wild-type controls underwent stereotaxic injections of lentivirus targeting TGF-βR2 in the RTN. Stroke was induced by middle cerebral artery occlusion using a monofilament. Respiratory functions were assessed using whole-body plethysmography, while cognitive functions were evaluated through the Barnes Maze and Novel Object Recognition Test (NORT). Immunohistochemical analysis was conducted to measure TGF-βR2 and GFAP expressions in the RTN.CAA mice exhibited significant respiratory dysfunctions, including reduced respiratory rates and increased apnea frequency, as well as impaired cognitive performance. TGF-βR2 silencing in the RTN improved respiratory functions and cognitive outcomes in CAA mice. In CAA mice with concurrent stroke, TGF-βR2 silencing similarly enhanced respiratory and cognitive functions. Immunohistochemistry confirmed reduced TGF-βR2 and GFAP expressions in the RTN following silencing.Our findings demonstrate that increased TGF-β signaling and gliosis in the RTN contribute to respiratory and cognitive dysfunctions in CAA and CAA with stroke. Targeting TGF-βR2 signaling in the RTN offers a promising therapeutic strategy to mitigate these impairments. This study is the first to report a causal link between brainstem gliosis and both respiratory and cognitive dysfunctions in CAA and stroke models.

Association between narrow palate and respiratory function in children: a literature review

Changes in the airways and dentoalveolar system are one of the most challenging aspects of modern practical and theoretical dentistry. Nasal breathing is essential for the normal development of the maxillofacial area. During a child’s growth, the respiratory tract and facial skull development are closely linked. The main stage of dentoalveolar system development occurs during preschool and elementary school years. Nasal breathing disorders are currently widespread in this age group. Dental professionals are frequently the first to detect these disorders. A dental professional can then inform parents on the potential causes and consequences of habitual mouth breathing, justify the need for treatment and prevention of this pathology, and refer a child to an ENT specialist. The review examines the association between narrow palate and respiratory function in children. Domestic and international studies addressing the association between dentoalveolar system pathologies and respiratory patterns and functional parameters were analyzed. The studies present a variety of opinions: some authors confirm the association between narrow palate and mouth breathing, while others refute it. Moreover, changes in respiratory function parameters following rapid palatal expansion have been analyzed, emphasizing the importance of timely orthodontic treatment to improve breathing.

Association of edentulism and obstructive sleep apnea: A systematic review.

Sleep apnea is a common and underdiagnosed sleep-related breathing disorder. This systematic review aimed to evaluate the scientific evidence regarding the association between obstructive sleep apnea (OSA) and edentulism. An electronic search was conducted through PubMed (MEDLINE), Scopus, and Cochrane Library, up to January 2024. A systematic approach was followed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines. The literature search intended to retrieve all relevant clinical studies about any possible association between OSA and edentulism. Only publications in the English language were selected, and animal studies, in vitro studies, case reports, case series, technique presentation articles, and expert opinions were excluded. A total of 23 studies met the inclusion criteria and were included in this systematic review. They were published between 1999 and 2023 and were all clinical studies. These studies examined a possible association between OSA and edentulism and all of them agreed on their positive relation. Tooth loss favors anatomic alterations that deteriorate breathing. The severity of OSA was related to the extent and duration of edentulism. Mean Apnea-Hypopnea Index (AHI) scores in edentulous patients were found to be two to three times higher in comparison to dentate individuals, although the statistical data about it are scarce. No agreement was reached, however, about the use of dentures during sleep time, since the data are controversial. The findings suggest that there is a plausible association between edentulism and OSA. Tooth loss impairs significant anatomic alterations and increases the risk for OSA. However, clinical data are limited and heterogeneous so more clinical studies should be encouraged for more robust conclusions.

The prevalence of sleep disorders in Iranian adults - an epidemiological study.

Sleep disorders can be harmful to our health and treating them can also be expensive. Due to the widespread occurrence and impact of sleep disorders, it is valuable to investigate and study them from an epidemiological perspective. Therefore, this study aimed to determine the prevalence of sleep disorders among Iranian adults in 2022. This is a cross-sectional study that examines the prevalence of sleep disorders and problems in Iranian society. The participants were selected using a mixed sampling approach (utilizing virtual space and cluster sampling). A two-part package was used for evaluating participants sleep problems, which included a demographic profile form and the Holland Sleep Disorders Questionnaire. After collecting the data, appropriate statistical tests in SPSS version 25 were utilized for analysis. A total of 6013 questionnaires were fully filled out for this research, with participants answering the specific questions. The participants' score on sleep disorders was 1.94, which means 44.1% of them suffer from sleep disorders. The results indicated that the prevalence of sleep disorders in this study was as follows: insomnia (35%), parasomnia (35.3%), circadian rhythm sleep disorder (38.4%), hypersomnia and excessive daytime sleepiness (39%), restless leg syndrome and leg movements during sleep (43%), and breathing disorders related to sleep (38.4%). The prevalence of sleep disorders among the study participants demonstrated a significant relationship with most of their demographic variables (P < 0.001). The Pearson correlation coefficient also revealed an inverse and significant relationship between the prevalence of sleep disorders in the study participants and their age, monthly household income, and BMI (P < 0.001). Overall, the results depicted a relatively high prevalence of sleep disorders in the studied community. These findings emphasize the need for interventions to prevent and treat sleep disorders in society.

Avoid overstepping the bounds of evidence: the role of the orthodontist in managing pediatric Obstructive Sleep Apnea

IntroductionPediatric Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder often linked to distinct craniofacial features and malocclusions. While orthodontic treatments, particularly maxillary expansion and mandibular advancement, have been suggested for managing this condition, the results remain controversial and are based on low-quality evidence. This paper aims to summarize the ongoing debates on this topic by reviewing relevant literature and highlighting the role of the orthodontist in diagnosing and managing OSA in daily clinical practice.Discussion and conclusionsAccording to the present review, there is insufficient evidence to either confirm or deny the effectiveness of oral appliances for treating pediatric OSA due to significant methodological limitations, such as small sample sizes, inadequate control groups, short study durations, and a lack of long-term follow-up. Additionally, this condition cannot be diagnosed solely based on craniofacial morphology, but an interdisciplinary evaluation is strictly required. In addition, orthopedic treatment may be considered only as an adjunct therapy for children with craniofacial anomalies increasing the risk for OSA, and the combination of multiple therapeutic approaches may be necessary to achieve effective treatment outcomes.

Comparison of Supra-Alar Crease Deepening Following Septorhinoplasty in Two Techniques: Lateral Crura Steal Versus Lateral Crura Overlay.

Nasal tip correction is one of the most challenging parts of rhinoplasty. The objective of the study was to compare the prevalence of supra-alar crease deepening in lateral crura steal (LCS) and lateral crura overlay (LCO) techniques. In this prospective study, eligible patients referred to a university hospital for septorhinoplasty during 2022 were included. The study was conducted on 200 patients in two groups (100 patients in each group), 162 were women and 38 men with a mean age of 31.12±0.60 years. In the third month of follow-up, 36.5% of all studied patients had supra-alar crease deepening, of whom 13% were in the interrupt group and 23.5% were in the steal group (P=0.002); however, only 4% in the LCO and 9% in the LCS group had aesthetic or breathing disorders (P=0.25). Deepening of the alar crease was not significantly related to the skin thickness in the two techniques. According to the results, both LCO and LCS techniques are effective in achieving successful outcomes, although the problematic supra-alar crease deepening is less common in the LCO group; therefore, it seems to be a more suitable option in cases where there is a greater need to tip rotation, although this finding was not statistically significant. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A PhD completed. Issues related to indication, surgery, and outcome of maxillomandibular advancement in obstructive sleep apnea

Obstructive sleep apnea is a common sleep-related breathing disorder. Although maxillomandibular advancement is widely recognized for its proven effectiveness, there are still uncertainties surrounding this procedure. This research therefore focused on the indication, surgical techniques, and outcomes of maxillomandibular advancement in patients with obstructive sleep apnea. A systematic review and meta-analysis showed that maxillomandibular advancement is more effective than multilevel surgery for the treatment of obstructive sleep apnea. Both maxillomandibular advancement and hypoglossal nerve stimulation were identified as effective and safe treatment methods for obstructive sleep apnea. Various retrospective studies also indicated that patients with hypopnea-dominant obstructive sleep apnea are better candidates for maxillomandibular advancement, in contrast to patients with cardiovascular diseases or a higher central apnea index. Furthermore, it was demonstrated that maxillomandibular advancement is effective in patients with a high percentage of central and mixed apneas, despite the potential surgical inaccuracies of maxillomandibular advancement, highlighting the broad applicability of this treatment method.

The Lehigh Valley Health Network narcolepsy cohort: clinical and polysomnographic analysis of 304 cases.

We aimed to characterize clinical features, comorbidities and polysomnographic characteristics of a large cohort of patients with narcolepsy. We undertook a retrospective chart and polysomnographic review of all patients with a diagnosis of narcolepsy type 1 (NT1) or narcolepsy type 2 (NT2) seen within the Lehigh Valley Health Network between 2000 and 2022. We found 304 cases with a diagnosis of narcolepsy (52 NT1, 252 NT2), based on International Classification of Sleep Disorders, third edition criteria. Compared to NT2, patients with NT1 had younger diagnosis age (24.5 versus 27.4 years, p=0.03), shorter diagnostic gap (3.0 versus 4.6 years, p=0.002), more frequent sleep paralysis (55.8% versus 19.4%, p<0.0001) and hypnagogic hallucinations (46.2% versus 25.4%, p=0.003), and higher Epworth Sleepiness Scale (ESS) scores (17.8 versus 16.7, p=0.02). The most common comorbid sleep disorders were breathing disorders (17.4%) and insomnia (15.5%). Migraine was the most common neurological disorder. Depression was more common in NT2 than NT1 [12 (23.1%) versus 94 (37.3%), p=0.05]. On the Multiple Sleep Latency Test, patients with NT1 had more sleep onset REM periods (SOREMPs) than patients with NT2 (≥3 SOREMPs in 59.2% versus 26.9%, p<0.0001). Only in NT2, hypnagogic hallucinations and higher ESS scores were associated with higher numbers of SOREMPs (p=0.0277 and p=0.0179 respectively). This is one of the largest monocentric studies to date of patients with narcolepsy and confirms the frequent comorbidities of narcolepsy. Specific clinical characteristics and comorbidities may help differentiate NT1 from NT2.

Dyspnea, dysfunctional breathing disorders, and the Bayesian brain hypothesis

Dyspnea, dysfunctional breathing disorders, and the Bayesian brain hypothesis

Efficacy of obstructive sleep apnea treatment in reducing fall risk in older adults: study protocol for a clinical trial

BackgroundFalls are a major cause of hospitalization fractures and functional decline in older adults. Obstructive sleep apnea (OSA), a highly prevalent sleep breathing disorder in older adults, has emerged as a potentially modifiable risk factor for falls. A small number of uncontrolled studies suggest OSA therapy by continuous positive airway pressure (CPAP) may reduce fall risk. We aim to describe the design of a randomized clinical trial that will evaluate if six months of CPAP intervention can significantly reduce fall risk markers in older adults with OSA. Methods140 adults aged ≥60 years at risk of falls with diagnosed and untreated OSA will be randomized to receive CPAP and usual care for fall risk or only usual care for fall risk. The primary outcome will be the difference in fall risk scores, derived from the physiological profile assessment, between the two arms six months post-randomization. Secondary outcomes will include differences in gait, quality of life, sleep quality (self-reported and objective home-based monitoring), psychological well-being, cognitive function, physical performance, muscle strength, and body composition at six months post-randomization. ResultsData will be analyzed on an intention-to-treat basis. Ethical approval was obtained from Southern Adelaide Clinical Human Research Ethics Committee in July 2023 (reference: 2023/HRE00081). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences. Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN) 12623000965606 ConclusionThe findings from this study will provide insight into the causal associations between OSA and fall risk and contribute to high quality evidence required to inform larger clinical trials and future guidelines for fall prevention

Exploring Sleep-Related Breathing Disorders in Pediatric Obesity and Prader-Willi Syndrome

ObjectiveTo analyze the differences of clinical and diagnostic features of sleep related breathing disorders (SRBDs) between children with PWS and obese children, considering obesity as a unifying risk factor for sleep apnea. Study designThis retrospective cohort study included ≥2 years of age children who had obesity and genetically confirmed Prader-Willi syndrome (PWS) or were non-PWS obese children. Out of 267 children, 58 children met inclusion criteria. Clinical data and records of standard overnight polysomnography (PSG) were collected and compared between groups during the study. ResultsObstructive sleep apnea (OSA) was identified in 97.2% non-PWS obese children and 72.7% PWS children (p=0.072). Central sleep apnea (CSA) events were more commonly found in children with PWS (p=0.035, OR 4.35, CI 95% 1.05-18.03) as well as sleep-related hypoventilation (p=0.016, OR 4.66, CI 95% 1.26-17.34). Sleep efficiency was higher in PWS patients (p=0.038). Sleep fragmentation was significantly associated with higher AHI only in non-PWS obese children (p=0.027). In the PWS group patients, a moderate correlation was found between BMI and age (p=0.025, r=0.559, CI 95% 0.087-0.826) as well as AHI and age (p=0.003, r=0.686, CI 95% 0.232-0.895). ConclusionsNon-PWS obese children, similar to those with PWS, exhibit a high risk of SRBDs. Although CSA and sleep-related hypoventilation may occur more frequently in patients with PWS, OSA remains the predominant disorder. Both patient groups are advised to undergo PSG due to the significant risk of SRBDs, particularly during adolescence.

Breathlessness, but not breathing instability, varies with posttraumatic stress symptoms in university students.

Obstructive sleep apnea (OSA) is a chronic sleep-related breathing disorder that is highly prevalent in individuals with posttraumatic stress disorder (PTSD). The reason for this high prevalence remains unclear. We hypothesized that breathing instability, one of the key contributors to OSA, may be altered in PTSD and predispose OSA. Healthy participants (214 females, 98 males) aged 17 to 42 (M = 19.92; SD = 2.85) completed online questionnaires measuring PTSD symptomatology, sleep disturbances, and self-reported breathlessness. A subset of these participants (16 females, 14 males) aged 18 to 42 (M = 23.50; SD = 7.18) completed an in-lab breathing instability assessment, whereby they performed a series of 20-second and maximal duration breath-holds. PTSD severity positively predicted subjective perceptions of breathlessness (P < 0.001) but not objective measures of breathing instability, namely ventilation following 20-s breath-holds (P = 0.93) and maximal breath-hold duration (P = 0.41). These results suggest that breathing instability may not be the driving factor behind the high prevalence of OSA in PTSD. Instead, other factors such as a low arousal threshold, elevated ventilatory responses to arousal, or coexisting insomnia may explain the high rates of OSA in PTSD. One explanation for the discrepancy between subjective breathlessness and breathing stability measures relating to PTSD severity may be that hypervigilance and increased anxiety impacted self-perceptions of breathlessness while not altering breathing instability per se.NEW & NOTEWORTHY Obstructive sleep apnea (OSA) is more common in individuals with posttraumatic stress disorder (PTSD) than the general population for unknown reasons. This study assessed one of the key contributors to OSA, respiratory control instability, in young students with a range of posttraumatic stress symptoms. Although individuals with high PTSD symptoms reported increased subjective breathlessness, objectively measured breathing instability was not altered, suggesting respiratory instability is unlikely to increase the risk of OSA in PTSD.

Anthropometric Indices of Obstructive Sleep Apnea Patients in Mauritius.

Background Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, affecting a significant number of individuals globally.It is associated with poor quality of life and an increased risk of all-cause mortality. It is estimated that most of the patients suffering from OSA are obese. Anthropometric indices can help guide doctors towardthe diagnosis. Objectives This study aimed to establish specific anthropometric thresholds associated with OSA risk, allowing clinicians to identify individuals more likely to have OSA and who may need further evaluation, such as polysomnography. This targeted screening approach would enable better resource allocation to those at higher risk, potentially enhancing the efficiency of OSA diagnosis and management. Methods We conducted a descriptive study using data from the sole private sleep clinic in Mauritius. We analyzed case files of consecutive patients diagnosed with OSA over a 3.5-year period from January 2015 to June 2018. Results The study population comprised 170 patients (79.4% males) diagnosed with OSA by a polygraphy test.The mean age of OSA diagnosis in men and women was 51.7 ± 14.0 years and 53.8 ± 12.5 years, respectively.The mean neck circumference (NC) for males and females was 41.9 ± 3.9 cm and 38.2 ± 3.9 cm, while the mean waist circumference (WC) was 105.6 ± 12.2 cm for men and 103.4 ± 14.5 cm for women. The body mass index (BMI) was 29.1± 5.0 kg/m2 and 31.4± 6.8 kg/m2 for males and females, respectively. The apnea-hypopnea index (AHI) averaged to 42.1 ± 19.7 events/hour for men and 33.3 ± 16.4 events/hour for women.In male patients, we found a positive significant correlation (p<0.001) between AHI and the following parameters: BMI (r=0.443), WC(r=0.337), WC-to-height ratio (WHr) (r=0.378), NC(r =0.274), and neck-to-height ratio (NHr) (r =0.321).In women, we observed a positive significant correlation between apnea severity and the following: BMI (r=0.396, p=0.029), WC (r=0.462, p=0.005), and WHr (r=0.494, p=0.003).No significant relationships were observed between AHI and the following parameters in women: NC (r=0.317, p=0.064) and NHr (r=0.311, p=0.069). A total of 83.5% of patients had a Mallampati score of 3-4. Conclusion This study represents a pioneering effort on the island. While further research is necessary to establish exact anthropometric cutoff values, the findings offer crucial insights for physicians to identify high-risk individuals. With just a scale, measuring tape, and calculator, healthcare professionals can detect important health markers that extend beyond diagnosing OSA. These simple measurements not only help in predicting OSA but also provide a broader view of an individual's overall health, identifying risks that go beyond sleep issues. This research sets an important foundation for future OSA studies within the Mauritian population.

Serum proteomic profiling reveals potential inflammatory biomarkers in long-COVID patients: a comparative analysis with healthy controls

Abstract Background Long-COVID (also known as post-acute sequelae of SARS-CoV-2 infection, PASC), is defined as the persistence, or the new onset, of symptoms after recovery from the acute phase of COVID-19. It consists of a multiorgan syndrome expressing itself with a wide variety of cardiovascular and non-cardiovascular symptoms such us chest pain, fatigue, shortness of breath, autonomic dysfunction, cognitive impairment and sleep disorders even in the absence of a clear evidence of organ dysfunction. Some previous studies have suggested the potential role of an abnormal inflammatory response after SARS-CoV-2 infection, however the specific underlying mechanisms remain unclear. In this study we performed a proteomic analysis of the serum of 80 long-COVID patients to identify potential biomarkers that may act as indicators or therapeutic targets for long COVID. Methods and results We compared the levels of the proteins in both long-COVID group and a control group using multivariate and univariate analysis. Both PLS-DA and PCA analysis showed a clear distinction between the two groups; clustering analysis also clearly separated control from long-COVID patients. Proteins were then filtered based on (a) statistical analysis, considering proteins with a VIP&amp;gt;1 (PLSDA) and p&amp;lt;0.05 (t-test); (b) coefficient of variation (CV), where only proteins with CV&amp;lt;10 were considered; (c) and fold change (FC), for which proteins with FC&amp;lt;0.67 or FC&amp;gt;1.5 were selected for further analysis. The selected proteins were then subjected to a ROC curve analysis to identify antithrombin as a potential biomarker with an area under the curve (AUC) near 1. Other proteins, displaying an AUC &amp;gt; 0.98, were also identified as potential biomarkers (Sirtuin 1, NatriureticPeptide B, Hemopexin Arachidonate 5-Lipoxygenase). In addition, a multivariate ROC method, using linear SVM as classification method, identified that a combination of ten proteins would also result in an AUC near 1. Finally, a correlation analysis between the proteins of interest and the clinical manifestations was performed. A positive correlation (above 0.5) was found between dyspnea and Glucocorticoid Receptor and between memory deficit and Antithrombin. Arachidonate 5-Lipoxygenase was negatively correlated (below -0.5) with tremors and hair loss, MannoseBinding Lectin 2 was found to be positively linked to asthenia, Antithrombin with concentration deficit and Endothelin-2 with muscles aches. Conclusions The identified biomarkers are associated with inflammatory processes, corroborating literature evidence that long-COVID patients develop an inflammatory state that damages many tissues. Further studies are needed to validate this data in larger cohorts to identify specific biomarkers, and guide future preventive strategies or treatments to address long COVID and its cardiovascular and non-cardiovascular sequelae.

Role of surfactant therapy in reducing oxygen requirement and mortality among neonates suffering from respiratory distress syndrome: A Prospective study at Al – Batool teaching hospital in Diyala province

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is a breathing disorder characterized by a deficiency or inactivity of surfactant in the lungs of preterm and term babies and if not treated, it leads to serious complications like pneumothorax, emphysema, bronchopulmonary dysplasia and death. Objective: To estimate the effect of surfactant therapy on oxygen requirement and neonatal mortality as well as the incidence of RDS in the special care neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala Governorate. Patients and Methods: A sample of 2000 patients with signs and symptoms of RDS at the time of presentation was prospectively collected from the 1st of July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy, and continuous positive airway pressure (CPAP) were taken into consideration in assessing the outcome of RDS neonates. Results: There was a significant relationship between surfactant administrations, the period of staying on CPAP, and oxygen demand as the p-value was &lt; 0.001 for both. Neonates who received surfactant had a lower mortality rate, with an incidence of 2.5%; the p-value was &lt; 0.001. Incidence of neonatal RDS was 694 (34.7%). Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy should be routine in neonatal special and intensive care units. Proper use of surfactant (proper timing and mode of administration) reduces oxygen demand, the need for CPAP, hospitalization, and mortality among those neonates.

Characteristics of clinical descriptive variables and polysomnographic findings of catathrenia.

Catathrenia has been classified as a sleep-related breathing disorder variant in the third edition of the International Classification of Sleep Disorders, but its validity remains unverified. We analyzed the clinical descriptive variables and polysomnographic findings of catathrenia and discussed the similarities and differences to those of obstructive sleep apnea (OSA), non-REM parasomnias, and sleep bruxism (SB). A retrospective analysis was conducted on 47 patients diagnosed with nocturnal groaning through polysomnography. We examined sex, body mass index, age at symptom onset, weekly symptom frequency, and presence/absence of comorbidities, including OSA, periodic limb movement disorder, non-REM parasomnia, and SB. The groaning event (GE) index was calculated according to sleep position and sleep stage. The distribution of patients with catathrenia did not show sex difference (male/female = 20:27), body mass index was 20.6 ± 3.0 kg/m2, and age of onset was 18.2 ± 7.4 years. The GE index was higher in stages N1 and R than in stage N3 and in the supine position than in the lateral position. There were no cases complicated with non-REM parasomnia, but the complication of SB was observed in 30% of the participants, and SB events appeared immediately before or during the interictal period of the GE episodes in these cases. Given the clinical background, posture- and sleep stage-dependent appearance of GEs, and the relatively high complication rate of SB, catathrenia pathogenesis may be heterogeneous or comprise elements of different sleep disorders.

The Impact of Lung Function on Sleep Monitoring in Obstructive Sleep Apnea Associated with Obstructive Lung Diseases: Insights from a Clinical Study.

Background/Objectives: Obstructive sleep apnea (OSA) and obstructive lung diseases (OLD) are common and interdependent respiratory disorders, where one condition may contribute to the development and worsening of the other (OLDOSA syndrome). The term OLDOSA syndrome includes two different conditions: Overlap syndrome (OVS: OSA + chronic obstructive pulmonary disease, COPD) and Alternative Overlap syndrome (aOVS: OSA + Asthma). Data on the interactions between lung function and respiratory monitoring during sleep in OLDOSA patients are few and controversial. Our study aims to evaluate the impact of lung function impairment on sleep breathing disorders, paying attention to the lack of literature about comparisons between OVS, aOVS, and the impact of small airways disease (SAD) in these patients. Methods: In total, 101 patients with a diagnosis of OSA and asthma or COPD underwent pulmonary function tests (PFTs) and nocturnal home sleep cardiorespiratory monitoring (HSCM). Exclusion criteria: Obesity hypoventilation syndrome (OHS) and other non-respiratory sleep disorders. Results: Sleep time with oxygen saturation below 90% (T90) was negatively correlated with forced expiratory volume in the first second, % of predicted (%FEV1), forced vital capacity, % of predicted (%FVC), forced expiratory flow at 25-75% of the pulmonary volume, % of predicted (%FEF25-75), and, after multivariable linear regression analysis, %FEF25-75 remained an independent factor for T90 with a negative correlation in mild and moderate OSA. Obstructive apnea index (oAI) and FEV1/FVC were negatively correlated in mild and moderate OSA. OVS presented with more severe OSA (higher AHI, oAI, and T90) and SAD (lower FEF25-75) compared to aOVS. Conclusions: This study highlights a possible interdependence between OLD and OSA; obstruction of the large and small airways at PFTs contributes to the worsening of these patients' nocturnal hypoxemia and obstructive events of the upper airway during sleep. Furthermore, this study shows that patients with OVS should be carefully monitored, as they present worse data at HSCM and have greater small airways involvement compared to aOVS.

Impact of asthma and allergic rhinitis control on sleep disordered breathing in pediatrics

AimThe aim of our study is to assess the quality of sleep in children with asthma and/or allergic rhinitis, as well as the impact of the control of allergic respiratory diseases on sleep disturbances. Materials and methodsIt is an observational cross-sectional study on children attending pediatric allergy appointments at a portuguese tertiary hospital (G1), and compared to a control population (G2). The asthma and rhinitis control was determined using the Control of Allergic Rhinitis and Asthma Test (CARAT/CARATKids) questionnaires. Sleep was evaluated using the Pediatric Sleep Questionnaire (PSQ). G1 included 61 patients and G2 included 100 children. ResultsAbout a third of the children in the study group had sleep-related breathing disorders (SDB), compared to 9 % on the control group (p-value <0.05). There was a significant positive correlation between uncontrolled asthma and allergic rhinitis, and SDB (p-value <0.05). ConclusionSDB is more prevalent among children with asthma and/or allergic rhinitis. The absence of control of the allergic respiratory diseases has a negative impact on sleep. We recommend large cross-sectional studies to better comprehend the exact relationship between the two conditions, as well as the use of objective diagnostic tools. We believe it is essential to implement early screening for sleep disorders in children with allergic respiratory diseases, through validated questionnaires.

Effect of septoplasty on physical performance

The nasal septum is a key component of the nasal structure, affecting proper airflow and providing support for the nasal structures. A deviated septum (DSN) can lead to breathing disorders, impaired nasal patency, recurrent nosebleeds, olfactory disorders and frequent upper respiratory tract infections. In competitive sports, where ventilation performance is critical, septal deviation can adversely affect athletic performance. The purpose of this study is to evaluate the effect of septoplasty on patients' physical performance. Methodes This article is based on the available literature found in the Google Scholar, PubMed database with the use of key words such as ,,septoplasty'', ,,nasal septal deviation'', ,,septoplasty quality of life'', ,,nasal septal deviation athletes'', ,,septoplasty sport'', ,,nasal obstruction sport''. Results Conducted studies show that surgical correction of a deviated nasal septum improves physical performance as well as respiratory and cardiovascular functions. Restoring proper airflow through the nose after surgery leads to a noticeable improvement in physical performance, highlighting the significance of septoplasty in enhancing patient comfort and improving athletic outcomes.

Sleep Problems in Adults With ADHD: Prevalences and Their Relationship With Psychiatric Comorbidity

Background: Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic. Methods: We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files. Results: Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder. Conclusion: Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems.