Moderate Obstructive Sleep Apnea Research Articles

Cerebral perfusion is not impaired in persons with moderate obstructive sleep apnoea when awake.

It is well established that, together with a multitude of other adverse effects on health, severe obstructive sleep apnoea causes reduced cerebral perfusion and, in turn, reduced cerebral function. Less clear is the impact of moderate obstructive sleep apnoea (OSA). Our aim was to determine if cerebral blood flow is impaired in people diagnosed with moderate OSA. Twenty-four patients diagnosed with moderate OSA (15 ≤ apnoea-hypopnea index (AHI) < 30) were recruited (aged 32-72, median 59years, 10 female). Seven controls (aged 42-73years, median 62years, 4 female) with an AHI < 5 were also recruited. The OSA status of all participants was confirmed at baseline by unattended polysomnography and they had an MRI arterial-spin-labelling scan of cerebral perfusion. Neither global perfusion nor voxel-wise perfusion differed significantly between the moderate-OSA and control groups. We also compared the average perfusion across three regional clusters, which had been found in a previous study to have significant perfusion differences with moderate-severe OSA versus control, and found no significant difference in perfusion between the two groups. The perfusions were also very close, with means of 50.2 and 51.8mL/100g/min for the moderate-OSAs and controls, respectively, with a negligible effect size (Cohen's d = 0.10). We conclude that cerebral perfusion is not impaired in people with moderate OSA and that cerebral flow regulatory mechanisms can cope with the adverse effects which occur in moderate OSA. This is an important factor in clinical decisions for prescription of continuous positive airway pressure therapy (CPAP).

A study on pulmonary function in children with obstructive sleep apnea hypopnea syndrome.

To investigate the pulmonary function of children with obstructive sleep apnea syndrome. A total of 328 children aged 3 to 12 years old who were evaluated for a sleep disorder from January 2022 to June 2023 were selected as the observation group, classified into mild, moderate, and severe categories based on the apnea hypopnea index. The number of children with mild, moderate, and severe obstructive sleep apnea is 228, 62, and 28 respectively. Additionally, 126 healthy individuals aged 3 to 13 years old undergoing health examinations during the same period were selected as the control group. All subjects underwent sleep respiratory monitoring, pulmonary function tests, and impulse oscillometry. Comparative analysis was performed on pulmonary function indices (forced vital capacity, maximum ventilation, inspiratory capacity, total lung capacity, and inspiratory reserve volume), and respiratory impedance indices (resonant frequency, total respiratory impedance, viscous resistance at 5 Hz, 20 Hz, and 35 Hz). Pulmonary function indices were also compared among patients in the observation group with mild, moderate, and severe conditions. In the observation group, the FVC pre% of patients decreased by 10.5 ± 5.99 compared to the control group. The MVV of the control group decreased by 28.10 ± 2.22 compared to patients in the observation group. The IC of the control group decreased by 0.68 ± 0.44 compared to patients in the observation group. The TLC of the control group decreased by 1.354 ± 0.51 compared to patients in the observation group. The ERV of the control group decreased by 0.53 ± 0.30 compared to patients in the observation group. Additionally, the Fres, Zrs, R5, R20, and R35 of the observation group were higher than those of the control group by 10.73 ± 0.18, 1.78 ± 0.24, 0.11 ± 0.17, 0.86 ± 0.13, and 0.02 ± 0.21, respectively. In sum, the pulmonary function indices of the observation group were significantly lower than those of the control group, while the respiratory impedance indices were higher (P < 0.05). Within the observation group, the pulmonary function indices of severe patients were lower than those of moderate and mild patients, and moderate patients had lower pulmonary function indices than mild patients (P < 0.05). The pulmonary function of children with obstructive sleep apnea syndrome is impaired and varies in severity. There are significant differences in pulmonary function, underscoring the importance of monitoring pulmonary function in these children for clinical assessment and treatment prognosis.

Positional obstructive sleep apnea and periodic limb movement during sleep: A large multi-center study.

The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movement during sleep (PLMS) are unclear. We analyzed these relationships according to OSA severity and explored the underlying mechanisms. We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography in four clinical centers over a period of 5 years with eventsynchronized analysis. The PLMS index (PLMI) and periodic limb movements with arousal index (PLMAI) were evaluated. The effects of POSA on the PLMI, PLMAI, and PLMS were analyzed according to OSA severity. The mean PLMI and PLMAI, as well as PLMS prevalence, were significantly lower in those with severe OSA than in those with mild and moderate OSA. The mean PLMI was higher in mild OSA group than in control group. The mean PLMI (4.80 ± 12.71 vs. 2.59 ± 9.82 events/h, p < 0.001) and PLMAI (0.89 ± 3.66 vs. 0.53 ± 3.33 events/h, p < 0.001), and the prevalence of PLMS (11% vs. 5.3%, p < 0.001) were higher in patients with POSA than patients with non-POSA. This trend was particularly marked in severe OSA group (OR 1.55, 95%CI [1.07-2.27]) and less so in mild (OR 0.56, 95%CI [0.30-1.03]) and moderate (OR 1.82, 95%CI [0.99-3.34]) OSA groups. The POSA group tended to have a higher prevalence of PLMS, particularly in those with severe OSA. If PLMS is prominent, diagnosis and treatment of POSA and OSA may be considered.

DOES EXERCISE PRESERVE FAT FREE MASS DURING A VERY LOW ENERGY DIET IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA?

INTRODUCTION AND AIMS Obesity is a major comorbidity of Obstructive Sleep Apnea (OSA), contributing to 58% of moderate to severe cases in adults. Very low energy diets (VLED) are effective for rapidly reducing weight however are associated with a greater fat free mass reduction compared to other energy restricted diets. Exercise may protect against this and has been shown to improve apnoea hypopnea index (AHI) independently of weight loss. We aimed to assess the feasibility and tolerability of rapid weight loss induced by VLED with or without high-intensity functional exercise in overweight and obese men with OSA. METHODS This two-arm open-label pilot randomised trial included 20 participants with a BMI of ≥27kg/m2 and moderate to severe OSA. Patients were randomised to VLED-only (VO) or VLED plus exercise (VEX) for 12-weeks. Both groups followed a VLED providing &amp;lt;800kcal/day for 8 weeks, followed by a 4-week refeeding period. The VEX group also participated in supervised high-intensity functional exercise training consisting of resistance and aerobic training of up to 5 days per week. RESULTS A total weight loss of -14.5kg [95%CI -17.5 to -11.5] and -9.3kg FM [95%CI -11.0 to -7.6] was achieved (measured by DEXA). Fat-free mass (FFM) reduction occurred (-3.9kg [95%CI -5.5 to -2.3]), with a trend towards preservation in the VEX group. The VO group reduced AHI by 42.9%, moving from severe to moderate OSA. The VEX group’s AHI change (-32.6%) approached but did not reach the moderate category post-intervention. CONCLUSION The VLED, with or without exercise, proved feasible and well-tolerated and demonstrated positive outcomes in body composition and AHI. The VEX group suggested a potential trend in preserving FFM compared to the VO group. These results are promising, indicating the need for a larger, definitive trial to confirm these findings and explore the impact of exercise on FFM preservation in this population.

The Effect of Continuous Positive Airway Pressure (CPAP) Therapy on Serum Caspase-3 Level in Patients with Obstructive Sleep Apnea (OSA).

Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49 ± 12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 h per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r = -0.397, p = 0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 h per night increased (r = -0.411, p = 0.024). The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue.

Microstructural brain abnormalities and associated neurocognitive dysfunction in obstructive sleep apnea: a pilot study with diffusion kurtosis imaging.

To assess the possible brain abnormalities in adult patients with moderate and severe obstructive sleep apnea (OSA) using the mean kurtosis (MK) from diffusion kurtosis imaging (DKI) and analyze the correlation between MK and cognitive function. A total of 30 patients with moderate and severe OSA and 30 healthy controls (HCs) evaluated by the Montreal Cognitive Assessment (MoCA) scale were enrolled. All subjects underwent DKI and 3D T1-weighted imaging (T1WI) on a 3.0T MR scanner. The MK values of gray and white matter brain regions were compared. Partial correlation analysis was used to analyze the correlation between respiratory sleep parameters/cognitive score and MK values in different brain regions. Compared with the HCs, the MK of 20 brain regions (13 after false discovery rate (FDR) correction) and cognitive scores in the OSA group were significantly lower. In the OSA group, the apnea-hypopnea index (AHI) was negatively correlated with the MK in the white matter of the right occipital lobe; the LSpO2 was positively correlated with the MK in the bilateral parietal, precentral, and right postcentral cortex; the total score of MoCA scale was positively correlated with MK in the left hippocampus; the language function was positively correlated with MK in the white matter of left parietal lobe, and the delayed recall was positively correlated with the MK in right insula cortex and bilateral cingulate. After FDR correction, only the correlations of LSpO2 with right precentral gyrus cortex, and bilateral parietal cortex were significant. MK values of DKI imaging may provide valuable information in assessing the neurological impacts of obstructive sleep apnea.

Existence and pattern of sleep-related breathing disorders in patients diagnosed with bronchial asthma.

Asthma and obstructive sleep apnea (OSA) are commonly prevalent diseases, and both can co-exist to result in an alternate overlap syndrome, where a bidirectional relationship can adversely affect each other. This study aimed to determine the existence and pattern of sleep-related breathing disorders in subjects with bronchial asthma. It was prospectively conducted at the National Institute of Tuberculosis and Respiratory Diseases, New Delhi, in diagnosed cases of bronchial asthma. A subjective assessment of sleepiness was done using the Epworth sleepiness scale (ESS). All subjects underwent overnight polysomnography (PSG) in the Sleep Laboratory of the Institute. A total of 70 subjects were screened, and among them, finally, 30 were enrolled. The mean age of the subjects was 37.53±11.21 years, the mean body mass index (BMI) was 26.4±5.58 kg/m2, the mean ESS score was 3.1, and 80% of the subjects were male. After PSG, OSA (apnea hypopnea index >5/hour) was found in 63% (19/30) of the patients, of whom 43% had mild OSA, 10% had moderate OSA, and 10% had severe OSA. 10% (3/30) had nocturnal oxygen desaturation, while none had sleep hypoventilation. Patients with OSA compared to those without OSA had a higher BMI, more co-morbid allergic rhinitis, severe bronchial asthma, and a worse percentage of predicted forced expiratory volume in the first second. The study showed high detection rates of OSA in bronchial asthma patients. Hence, asthma patients should be evaluated for OSA.

0374 Dimensions of Sleep Health and Mood Disorders in Middle Eastern/North African Women

Abstract Introduction Insomnia symptoms are a common sleep disturbance during midlife. However, emerging evidence suggests that midlife women also experience increased risk of obstructive sleep apnea and short sleep duration. Cohorts of women in midlife have mostly included white women, despite suspected sleep health disparities among women from underrepresented racial and ethnic backgrounds. To address this gap, we conducted a pilot study that examined sleep health among women from Middle Eastern/North African (MENA) ancestry. Methods This pilot study enrolled 77 women aged 40-60y from MENA ancestry, recruited mostly from Michigan. Women provided demographic, lifestyle, sleep and health information through interviews with structured and validated questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire (PHQ-9). Risk for obstructive sleep apnea (OSA) was evaluated using the STOP questionnaire+BMI and a subset of the women was tested with Watch-PAT, a one-night home sleep apnea testing device (OSA diagnosis, apnea-hypopnea index pAHI3%&amp;gt;5/h). The menopause rating scale was used to collect data on psychological and physiological symptoms. Results Mean age of women was 48y±5 years and mean BMI was 27.6±5 kg/cm2. Anxiety, irritability, and depression symptoms were identified in 33%, 25% and 31% of women. Half reported trouble falling asleep within 30 minutes, and 73% experienced nocturnal and early morning awakenings three or more times per week. Most women (75%) were aware of adequate sleep recommendations, but 54% reported short sleep duration, &amp;lt; 6 hours, and 30% reported &amp;lt; 5 hours of sleep per night. A STOP+BMI score ≥3 was observed in 20% of women. Twenty women were tested for OSA and 75% had it (mean pAHI3%=12.6/h). Moderate and severe OSA was apparent among 20% and 10% of the 20 women. Concurrent OSA and insomnia symptoms were observed among 40% of women. The odds ratio of insomnia were 9-fold and 3-fold for women with depression and anxiety, respectively. Conclusion We found a high burden of poor sleep and sleep disorders among midlife women from MENA ancestry. Moreover, poor sleep was associated with symptoms of depression and anxiety, raising the possibility that efforts to improve sleep health could benefit the mental health of these women as well. Support (if any)

Burden of obstructive sleep apnea in patients with lung cancer and its effect on performance status.

The association between lung cancer and obstructive sleep apnea has remained a matter of debate for years. Obstructive sleep apnea is thought to increase the incidence of lung cancer due to intermittent hypoxaemia and sleep fragmentation. The aim of this study is to assess the prevalence of obstructive sleep apnea in patients with lung cancer and its effect on those patients' performance status. This is a prevalence study that was conducted at Chest Diseases Department, Alexandria Main University Hospitals. We enrolled 153 patients with lung cancer. All patients underwent cardiorespiratory monitoring using a home sleep-testing device. Performance status was assessed using Karnofsky performance status scale. The study included 120 (78.4%) males and 33 (21.6%) females newly diagnosed with lung cancer. The mean age was 59.98 ± 11.11 years. Obstructive sleep apnea (apnea-hypopnea index ≥ 5) was present in 134 (87.6%) patients. Eighty-five (63.4%) patients had mild obstructive sleep apnea, 39 (29.1%) patients had moderate obstructive sleep apnea, and 10 (7.46%) patients had severe obstructive sleep apnea. Prolonged nocturnal oxygen desaturation as demonstrated by time of oxygen saturation spent below 90% (T90%) during total sleep time > 30% was present in 25 (16.3%) patients. There was a significant difference in the median value of Karnofsky performance status scale between patients with lung cancer and associated obstructive sleep apnea and those without obstructive sleep apnea. In conclusion, obstructive sleep apnea is highly prevalent among patients with lung cancer. Performance status is worse among patients with lung cancer in the presence of obstructive sleep apnea. Screening patients with lung cancer for obstructive sleep apnea is important regardless of the presence of classical symptoms of obstructive sleep apnea.

T266M variants of ANGPTL4 improve lipid metabolism by modifying their binding affinity to acetyl-CoA carboxylase in obstructive sleep apnea

Background Angiopoietin-like protein 4 (ANGPTL4) is recognized as a crucial regulator in lipid metabolism. Acetyl-CoA carboxylases (ACACAs) play a role in the β-oxidation of fatty acids. Yet, the functions of ANGPTL4 and ACACA in dyslipidemia of obstructive sleep apnea (OSA) remain unclear. Methods This study included 125 male OSA subjects from the Shanghai Sleep Health Study (SSHS) who were matched for age, body mass index (BMI), and lipid profile. Serum ANGPTL4 levels were measured via ELISA. The ANGPTL4 T266M variants of 4455 subjects along with their anthropometric, fasting biochemical, and standard polysomnographic parameters were collected. Linear regression was used to analyze the associations between quantitative traits and ANGPTL4 T266M. Molecular docking and molecular dynamic simulation were employed to compare the effects of the wild-type ANGPTL4 and its T266M mutation on ACACA. Results Serum ANGPTL4 levels significantly decreased with increasing OSA severity (non-OSA: 59.6 ± 17.4 ng/mL, mild OSA: 50.0 ± 17.5 ng/mL, moderate OSA: 46.3 ± 15.5 ng/mL, severe OSA: 19.9 ± 14.3 ng/mL, respectively, p = 6.02 × 10−16). No associations were found between T266M and clinical characteristics. Molecular docking indicated that mutant ANGTPL4 T266M had stronger binding affinity for the ACACA protein, compared with wild-type ANGPTL4. In terms of protein secondary structure, mutant ANGTPL4 T266M demonstrated greater stability than wild-type ANGPTL4. Conclusions Serum ANGTPL4 levels were significantly decreased in OSA patients, particularly among individuals with severe OSA. Although functional ANGTPL4 T266M variants were not associated with lipid levels in OSA, ANGTPL4 T266M could enhance binding affinity for the ACACA protein, potentially regulating lipid metabolism.

Cardiac autonomic dysfunction and structural remodeling: the potential mechanism to mediate the relationship between obstructive sleep apnea and cardiac arrhythmias.

Cardiac arrhythmias are very common in patients with obstructive sleep apnea (OSA), especially atrial fibrillation (AF) and nonsustained ventricular tachycardia (NVST). Cardiac autonomic dysfunction and structural remodeling caused by OSA provide the milieu for cardiac arrhythmia development. This study aimed to determine whether OSA is associated with various cardiac arrhythmias and investigate potential pathophysiologic pathways between them. The analysis covered 600 patients with clinical suspicion of OSA hospitalized in Renmin Hospital of Wuhan University between January 2020 and May 2023. After undergoing sleep apnea monitor, all subjects received laboratory tests, Holter electrocardiography, and Echocardiography. Compared with those without OSA and adjusting for potential confounders, subjects with moderate OSA had three times the odds of AF (odds ratio [OR] 3.055; 95% confidence interval [CI], 1.002-9.316; p = 0.048). Subjects with severe OSA had three times the odds of AF (OR 3.881; 95% CI, 1.306-11.534; p = 0.015) and NSVT (OR 3.690; 95% CI, 0.809-16.036; p = 0.046). There were significant linear trends for the association between OSA severity with AF and NVST (p < 0.05). And this association was mediated by cardiac structural changes including left atrial diameter, left ventricular diastolic diameter, right atrial diameter and right ventricular diameter. In addition, the ratio of low-frequency and high-frequency individually mediated the association between severe OSA and NVST. This study demonstrated that severe OSA was independently associated with AF and NSVT, and this association was mediated by autonomic nervous system changes and cardiac structural remodeling.

Anterior palatoplasty as a treatment for mild and moderate obstructive sleep apnea: our experience

Abstract BACKGROUND. Obstructive sleep apnea (OSA) is characterized by frequent episodes of breathing cessation during sleep, resulting in low oxygen and high carbon dioxide levels, leading to daytime sleepnes, cognitive issues, and increased cardiovascular risk. The objective of this study was to assess the effectiveness of the anterior palatoplasty (AP) procedure in the treatment of patients with mild and moderate obstructive sleep apnea. MATERIAL AND METHODS. Sixteen patients diagnosed with mild and moderate OSA underwent AP in our clinic between 2021-2023. All patients were &gt; 18 years old, body mass index &lt; 30, with an apnea-hypopnea index (AHI) from 10 to 40 and disfunction of the velopharyngeal or of the retropalatal space. Patients underwent a one-night polysomnography examination prior to the surgical procedure, as well as six months after the procedure. Additionally, patients were asked to complete the Epworth Sleepiness Scale (ESS) both prior to and six months following the surgery. The procedure was done under general anaesthesia and involved AP surgery with or without reducing of the uvula. RESULTS. The average of total AHI values decreased from 28.89 per hour prior to surgery to 11.14 per hour six months after surgery. The oxygen desaturation index decreased after surgery with 2.57%. ESS scores of patients also decreased from 10.40 to 7.80 and all patients felt less tired. CONCLUSION. We believe that AP is an effective technique in the treatment of mild and moderate OSA caused by a disfunction of the velopharyngeal or retropalatal space. Additionally, we consider that AP is linked with a lower incidence of post-surgical complications compared to other surgical options.

Association Between Obstructive Sleep Apnea (OSA) Severity and Optimal Continuous Positive Airway Pressure (CPAP); Do Severe OSA Patients Always Need High CPAP Pressure?

Objective: Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with an increased risk of cardiovascular disease. Severity of OSA is assessed using the apnea-hypopnea index (AHI), but the optimal continuous positive airway pressure (CPAP) does not always correlate proportionally with AHI. This study aims to identify factors leading to the need for high CPAP pressure despite low AHI or vice versa.Methods: The study includes 91 patients diagnosed with OSA through polysomnography. Participants undergoing CPAP titration were categorized in three groups based on AHI (30/h) and optimal CPAP pressure (10 cm H&lt;sub&gt;2&lt;/sub&gt;O); low AHI and high CPAP pressure group (LH group), high AHI and low CPAP pressure group (HL group), direct proportion group (DP group). The Kruskal–Wallis nonparametric statistical test is used to identify significant differences between the three groups.Results: Among the subjects, 78% were male, with no significant age or BMI differences between groups. There were 36 (39.6%) subjects with mild to moderate OSA and 55 (60.4%) subjects with severe OSA. The study revealed that patients requiring high CPAP pressure despite low AHI (LH group) had lower AHI, oxygen desaturation index, and various other parameters compared to other groups as expected. However, certain factors like the percentage of hypopnea in AHI, limb movement (LM) arousal index, and spontaneous arousal index were higher in the LH group.Conclusion: Patients with mild to moderate OSA requiring high CPAP pressure are more likely associated with specific aspects such as hypopnea in AHI, LM arousal, and spontaneous arousal index, presenting unpredictable outcomes.

Flow Limitation Is Associated with Excessive Daytime Sleepiness in Individuals without Moderate or Severe Obstructive Sleep Apnea.

Rationale: Moderate-Severe Obstructive Sleep Apnea (OSA, AHI>15) disturbs sleep through frequent bouts of apnea and is associated with daytime sleepiness. However, many individuals without moderate-severe OSA (i.e., AHI<15) also report sleepiness. Objective: To test the hypothesis that sleepiness in the AHI<15 group is a consequence of substantial flow limitation, in the absence of overt reductions in airflow (i.e., apnea/hypopnea). Methods: N=1886 participants from the MESA sleep cohort were analyzed for frequency of flow limitation from polysomnogram recorded nasal airflow signal. Excessive daytime sleepiness (EDS) was defined by Epworth Sleepiness Scale ≥11. Covariate-adjusted logistic regression assessed the association between EDS (binary dependent variable) and frequency of flow limitation (continuous) in individuals with an AHI<15. Results: N=772 individuals with an AHI<15 were included in primary analysis. Flow limitation was associated with EDS (odds ratio of 2.04, CI95% [1.17-3.54], per 2 standard deviation (2SD) increase in flow limitation frequency) after adjusting for age, sex, BMI, race/ethnicity, and sleep duration. This effect size did not appreciably change after additionally adjusting for AHI. Conclusions: In individuals with an AHI<15, increasing flow limitation frequency by 2SD is associated with a 2-fold increase in risk of EDS. Future studies should investigate addressing flow limitation in low AHI individuals as a potential mechanism for ameliorating sleepiness.

Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness

ObjectiveTo determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA). MethodsSymptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire–9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted. ResultsIn 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men. ConclusionsRLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.

Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial.

The prevalence of obstructive sleep apnea (OSA) is high among the bariatric surgery candidates. Obesity is the most important individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux-en-Y gastric bypass (LRYGB) on OSA 5years after the surgery. In this prospective multicenter study, standard overnight cardiorespiratory recording was conducted to 150 patients at baseline prior to bariatric surgery. A total of 111 (73.3%) patients of those had OSA. Cardiorespiratory recordings at 5years after surgery were available for 70 OSA patients. The changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and waist and neck circumference were evaluated. Also, a quality of life (QoL) questionnaire 15D administered in a baseline was controlled at 5-year follow-up visit. At 5-year OSA was cured in 55% of patients, but moderate or severe OSA still persisted in 20% of patients after operation. Mean total AHI decreased from 27.8 events/h to 8.8 events/h (p < 0.001) at 5-year follow-up. A clinically significant difference in QoL was seen in mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity. The QoL total score improved more in OSA patient at 5-year follow-up. LRYGB is an effective treatment of OSA in obese patients and the achieved beneficial outcomes are maintained at 5-year follow-up.

Correlation between positive airway pressure and medication adherence: the healthy user effect.

Despite the efficacy of positive airway pressure (PAP) for the treatment of obstructive sleep apnea (OSA), adherence remains challenging and negatively impacts assessments of effectiveness. It is unclear if low adherence is due to intolerance of PAP, or if this reflects overall adherence with medical therapy. We sought to correlate PAP use with medication adherence to determine if poor adherence with PAP was specific to this treatment or represented global compliance with medical therapy. 600 consecutive OSA patients treated with PAP. Objective measures of PAP use were correlated with medication adherence. We included all chronically used medications, defined as medications used daily for at least ninety days prior to PAP initiation. Medication use was verified using an electronic health record. PAP adherence ("regular use") was defined as PAP use for ≥4 hours/night on ≥70% of nights. Medication adherence was defined as >70% of pills taken as prescribed. Complete records were available for 566 patients, 361 (63.8%) utilized chronic medications. The cohort was primarily men (90.3%, age 44.6±10.2 years), with moderate OSA (AHI 18.1±13.9 events/h). In patients on chronic medications, PAP was used 55.8% of nights and 37.7% were regular users. Patients who were adherent with medications used PAP more hours/night (5.4 vs. 4.6, p<0.001) and were more likely to have regular PAP use compared to those non-adherent with medications (p=0.04). Adherence with PAP correlated with adherence to chronic medications. Low PAP adherence may reflect an individual's global adherence to medical care. This association may lead to better identification of patients who benefit from targeted therapy to improve overall healthcare adherence.

Tandem Mass Tag-Labeled Quantitative Proteome Analyses Identify C1R and A2M as Novel Serum Biomarkers in Pregnant Women with Obstructive Sleep Apnea.

The aim of this study was to identify serum diagnostic biomarkers associated with the severity of obstructive sleep apnea (OSA) during pregnancy. Differentially expressed proteins (DEPs) were identified in the control (C), mild (O), and moderate (MO) OSA groups (n = 3 in each group). Bioinformatics analysis was conducted to identify the underlying functions, pathways, and networks of the proteins. Receiver operating characteristic curves were used to assess the diagnostic value of the identified DEPs. The enzyme-linked immunoassay was performed to detect serum levels of the complement C1r subcomponent (C1R) and alpha-2-macroglobulin (A2M) in 79 pregnant women with OSA (mild OSA [n = 32]; moderate OSA [n = 29], and severe OSA [n = 18]) and 65 healthy pregnant women without OSA. Pearson's correlation analysis was conducted to analyze the correlation between C1R and A2M levels and OSA clinicopathological factors. In total, 141 DEPs, 29 DEPs, and 103 DEPs were identified in the three groups (i.e., the mild OSA vs control group, the moderate OSA vs mild apnea group, and the moderate OSA vs control group, respectively). C1R and A2M were identified as continuously up-regulated proteins, and the levels of C1R and A2M were associated with OSA severity. C1R and A2M were found to be correlated with body mass index, systolic blood pressure, apnea-hypopnea index, oxygen desaturation index, time with saturation below 90%, and lowest SaO2. Adverse maternal and neonatal outcomes were observed in pregnant women with OSA. C1R and A2M have been identified as diagnostic biomarkers and are associated with the severity of OSA during pregnancy.

Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta-analysis.

Oral appliances (OA) are the recommended first-line option for mild-to-moderate obstructive sleep apnea(OSA)-hypopnea. However, there is a lack of evidence to compare the effectiveness of OA in different severities of OSA. The purpose of this study was to investigate the therapeutic effects of preferred OA (tongue retention devices [TRD] and mandibular advancement device [MAD]) in different severities of OSA. PubMed/MEDLINE, The Cochrane Library, and Web of Science. Concentrating on the efficacy of OA, 2 authors searched 3databases up to November 10, 2022, independently and systematically, following the requirements and steps of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Ultimately, 42 studies with 2265 patients met the criteria for inclusion in OA. Overall, the apnea-hypopnea index improved by 48% (5.6), 67% (14.92), and 62% (32.1) in mild, moderate, and severe OSA, respectively. Subgroup analysis showed a significant difference between MAD and TRD efficacy in mild OSA (58% vs 21%). However, no significant difference was seen between MAD and TRD efficacy in moderate (67% vs 66%) and severe OSA (66% vs 51%). There was no significant difference across groups in the Epworth Sleepiness Scale, oxygen desaturation index (ODI), and lowest oxygen saturation (LSAT). Overall, both TRD and MAD are effective treatments for moderate and severe OSA. MAD is efficacious in mild OSA, while TRD requires further validation. Furthermore, mild-moderate and severe OSA received similar improvements in sleepiness, ODI, and LSAT. This study complements the evidence for the efficacy of OA.

The effects of obstructive sleep apnea on blood pressure variability and load in patients with hypertension.

Hypertension frequently coexists with obstructive sleep apnea (OSA), and their interplay substantially impacts the prognosis of affected individuals. Investigating the influence of OSA on blood pressure variability (BPV) and blood pressure load (BPL) in hypertensive patients has become a focal point of clinical research. This cross-sectional study recruited hypertensive patients (n = 265) without discrimination and classified them into four groups based on their apnea-hypopnea index (AHI): control group (n = 40), AHI < 5; mild group (n = 74), 5 ≤ AHI ≤ 15; moderate group (n = 68), 15 < AHI ≤ 30; severe group (n = 83), AHI > 30. All participants underwent comprehensive assessments, including polysomnography (PSG) monitoring, 24-h ambulatory blood pressure (ABP) monitoring, cardiac Doppler ultrasound, and additional examinations when indicated. BPV and BPL exhibited significant elevations in the moderate and severe OSA groups compared to the control and mild OSA groups (P < 0.05). Moreover, interventricular septum thickness and left ventricular end-diastolic volume (LVEDV) demonstrated higher values in the moderate and severe OSA groups (P < 0.05). Multiple stepwise regression analysis identified noteworthy risk factors for elevated BPV in hypertensive patients with OSA, including AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea. Hypertensive patients with moderate to severe OSA exhibited substantially increased BPV and BPL. Moreover, BPV was correlated with AHI, maximum apnea time, total times of oxygen reduction, and mean time of apnea in hypertensive patients with OSA.