Treatment Of Obstructive Sleep Apnea Syndrome Research Articles

International expert consensus statement: surgical failure in obstructive sleep apnea

Abstract Purpose 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. Methods 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. Results 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. Conclusion 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.

Treatment of Obstructive Sleep Apnea and Simple Snoring: Efficacy of a New Mandibular Advancement Device

The following prospective study has the aim of evaluating the efficiency of the F22 MAD (mandibular advancement device), a new oral device for the treatment of OSAS (Obstructive Sleep Apnea Syndrome) and snoring. Methods: AHI (apnea-hypopnea index), ODI (Oxygen Desaturation Index), snoring percentage, time spent in the supine position, and Epworth Sleepiness Scale score were evaluated in 19 patients with snoring, mild to moderate OSAS, or severe OSAS who declined CPAP (Continuous Positive Air Pressure) treatment, before and after the application of the F22 MAD. Results: The median value of AHI varied from 15.6 ± 10.7 to 5.7 ± 5.7; the median value of ODI varied from 13.4 ± 8.8 to 6.2 ± 5.2; the median value of the percentage of snoring varied from 30.7 ± 7 to 7.5 ± 10.8, except for the patient who has severe OSAS who increased their value. The value obtained by the self-completion of the ESS questionnaire (Epworth Sleepiness Scale) underwent a statistically significant variation, while clinically significant for 13\19 patients who obtained a reduction of the value >/= of 2 points. Conclusions: It is possible to conclude that the F22 MAD is effective in the treatment of patients with mild and moderate OSAS or simple snoring, reducing the polysomnographic outcomes with statistically and clinically significant results in terms of reduction of AHI, ODI and percentage of snoring.

Airway stability in sleep apnea: Assessing continuous positive airway pressure efficiency

Obstructive Sleep Apnea Syndrome (OSAS) disrupts millions of lives with its burden of airway obstruction during sleep. Continuous Positive Airway Pressure (CPAP) therapy has been scrutinized for its biomechanical impact on the respiratory tract. This study leverages computational fluid dynamics to investigate CPAP's effects at 9 cm H2O (882.6 Pa) on the computed-tomography-based nasal-to-14-generation full respiratory tract model compared to ambient conditions, focusing on static pressure, airflow velocity, and shear stress. Our findings reveal that CPAP significantly increases static pressure, enhancing airway patency without adverse changes in airflow velocity or harmful shear stress on lung tissue, challenging prior concerns about its safety. Notably, the larynx experiences the highest shear stress due to its narrow anatomy, yet CPAP therapy overall supports airway walls against collapse. This investigation highlights CPAP's critical role in OSAS treatment, offering reassurance about its safety and efficacy. By clarifying CPAP therapy's physiological impacts, our study contributes vital insights for optimizing OSAS management strategies, affirming CPAP's benefit in maintaining open airways with minimal tissue strain.

Effects of obstructive sleep apnea syndrome on clinical and instrumental indicators in obese patients

Due to the high prevalence of obstructive sleep apnea syndrome (OSAS), its diagnosis and treatment remains one of the urgent problems of medicine. Hypodiagnosis of OSAS is observed in everyday clinical practice. The early OSAS diagnosis and treatment, including the use of non‑invasive assisted ventilation of the lungs with constant positive pressure during sleep, could prevent the development and progression of cardiovascular diseases, and significantly improve the quality of life of a person.
 Objective — to assess OSAS impact on the clinical and instrumental indicators in obese patients, to establish correlation between the characteristics of cardiorespiratory sleep monitoring and indicators of carbohydrate and lipid metabolism in obese patients.
 Materials and methods. Observations involved 78 patients with I ‑ II degree obesity. According to the results of cardiorespiratory monitoring (CRM) of sleep, three groups of obese patients were formed. The first group included 26 patients with an apnea‑hypopnea index <30 episodes per hour (mild OSAS degree). The second group was consisted of 26 patients with apnea/hypopnea index (AHI) over 30 episodes per hour (severe OSAS degree). The groups matched by percentage of men and women, the mean age and body mass index.
 Results. An increase in body weight and body mass index (BMI) in obese patients was associated with an increase in the number and total duration of episodes of apnea/hypopnea, AHI, as well as a decrease in blood oxygen saturation (SpO2). Parameters of waist circumference (WC), hip circumference (HC), WC/HC positively correlated with the number and duration of episodes of apnea/hypopnea, AHI, and negatively correlated with SpO2. Positive values of the Spearman r coefficient ranged from 0.23 to 0.57, negative values — from –0.26 to –0.48 (р <0.05).
 Conclusions. In obese patients with OSAS, the parameters of cardiorespiratory sleep monitoring — apnea‑hypopnea index, total duration of apnea episodes, directly correlated with body mass index, waist circumference, blood pressure level, total cholesterol, blood triglycerides. An inverse correlation was found between oxygen saturation and fasting glycemia and the level of glycated hemoglobin.

Pharmacological interventions for the treatment of obstructive sleep apnea syndrome.

Obstructive Sleep Apnea Syndrome (OSAS) affects 13-33% of males and 6-9% of females globally and poses significant treatment challenges, including poor adherence to Continuous Positive Airway Pressure (CPAP) and residual excessive sleepiness (RES). This review aims to elucidate the emerging interest in pharmacological treatments for OSAS, focusing on recent advancements in this area. A thorough analysis of extensive clinical trials involving various drugs, including selective dopamine reuptake inhibitors, selective norepinephrine inhibitors, combined antimuscarinic agents, and orexin agonists, was conducted. These trials focused on ameliorating respiratory metrics and enhancing sleep quality in individuals affected by OSAS. The studied pharmacological agents showed potential in improving primary outcomes, notably the apnea-hypopnea index (AHI) and the Epworth sleepiness scale (ESS). These improvements suggest enhanced sleep quality and symptom management in OSAS patients. With a deeper understanding of OSAS, pharmacological interventions are emerging as a promising direction for its effective management. This review provides a comprehensive overview of the current state of drug research in OSAS, highlighting the potential of these treatments in addressing the disorder's complex challenges.

THE ROLE OF DENTISTRY IN THE DIAGNOSIS AND TREATMENT OF OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): literature review

Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive, disabling respiratory disorder with serious systemic repercussions; It is characterized by recurrent events of upper airway obstruction (UA) during sleep. In this way, it directly affects the individual's quality of life, since this occurrence causes daytime hypersomnolence, a feeling of suffocation when waking up, memory failure, sexual impotence, psychological changes such as anxiety and depression and, even, in more severe cases, acute heart attack. myocardial injury (AMI), cerebrovascular accident (CVA), as well as car accidents, which, therefore, constitute a public health problem. The objective of this literature review is to highlight the importance of the dentist's knowledge and conduct regarding the early diagnosis and treatment of OSAS, the request for appropriate complementary exams, their classifications and assertive therapeutic measures according to the individual's peculiarities. As a methodology, several searches were carried out in the SciELO, LILACS, PubMed, MEDLINE and Google Scholar databases from 1999 to 2023, with the following indexing terms: Sleep apnea syndrome, polysomnography, diagnosis, treatment, snoring, sleep. In this sense, it appears that Sleep Dentistry is a new field of activity for dental surgeons as a result of the possibility of conservative, effective and cost-effective treatments favorable to patients through clinically manufactured intraoral appliances (AIO). Therefore, it is expected that, in the medium term, the Federal Council of Dentistry (CFO) will recognize it as a dental specialty.

Relationships between hypertensive disorders in pregnancy and obstructive sleep apnea syndrome

Objective: To investigate the impact of obstructive sleep apnea syndrome (OSAS) on pregnancy outcomes, especially the relationship between OSAS and hypertensive disorders in pregnancy (HDP). Methods: A total of 228 pregnant women with high risk of OSAS who underwent sleep monitoring during pregnancy in Peking University People's Hospital from January 2021 to April 2022 were collected by reviewing their medical records for retrospective analysis. According to the diagnosis of OSAS, the pregnant women were divided into OSAS group (105 cases) and non-OSAS group (123 cases). The non-parametric Mann-Whitney U test, χ2 test or Fisher's exact test were used to compare the general data and maternal and fetal outcomes between the two groups, and the occurrence of each type of HDP was further compared. Results: (1) Compared with the non-OSAS group, the median pre-pregnancy body mass index (23.6 vs 27.6 kg/m2) and the proportion of snoring [28.9% (33/114) vs 59.2% (61/103)] in the OSAS group were higher, and the differences were both statistically significant (both P<0.001). (2) The incidence of HDP [67.6% (71/105) vs 39.0% (48/123)] and gestational diabetes mellitus [GDM; 40.0% (42/105) vs 26.8% (33/123)] of pregnant women in the OSAS group were higher than those in the non-OSAS group, and the median delivery week was shorter than that in the non-OSAS group (38.4 vs 39.0 weeks). The differences were all statistically significant (all P<0.05). Between-group differences for the delivery way, postpartum hemorrhage, the rate of intensive care unit admission, preterm birth, small for gestational age infants, neonatal asphyxia, the rate of neonatal intensive care unit admission, newborn birth weight and the proportion of umbilical artery blood pH<7.00 were not statistically significant (all P>0.05). (3) Compared with the non-OSAS group, the incidence of chronic hypertension [11.4% (14/123) vs 22.9% (24/105)] and chronic hypertension with superimposed pre-eclampsia [11.4% (14/123) vs 30.5% (32/105)] were higher in the OSAS group, and the differences were both statistically significant (both P<0.01). Conclusion: OSAS is related to HDP (especially chronic hypertension and chronic hypertension with superimposed pre-eclampsia) and GDM, which could provide a practical basis for the screening, diagnosis and treatment of OSAS in pregnant women at high risk.

Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions.

Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies. A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.

MT15 Adherence to Positive Airway Pressure Therapy in a Cohort of Colombian Patients with Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is an important risk factor for several cardiovascular diseases including stroke and coronary heart disease. Positive air pressure (PAP) devices are part of the treatment for OSAS. We describe adherence to the use of PAP devices in a cohort of patients with OSAS in Colombia, and their hospitalization rates and cardiovascular comorbidities.

CARDIOVASCULAR DISEASES AND OBSTRUCTIVE SLEEP APNEA SYNDROME. REVIEW

Background. Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality among adults worldwide. On another hand, obstructive sleep apnea syndrome (OSAS) is common in patients with CVD, and can worsen the patients prognosis due to late diagnosis. &#x0D; Aim: to analyze and summarize the published researches about interrelation between CVD and OSAS, its influence on CVD, and the effects of continuous airway pressure (CPAP) treatment of OSAS on CVD in order to pay attention to OSAS potential risks, improve the investigation of this syndrome and management.&#x0D; Materials and methods. Review of scientific literature in the international electronic scientometric databases PubMed, Google Scholar by key words for the period 2008-2023. The search was carried out by two independent authors. 150 sources were selected, 48 English–language articles of which met all the search criteria and were used for analysis.&#x0D; Results. OSAS is one of the widespread sleep disorders that frequently occurs in patients with CVD, impairs quality of life. Its increases cardiovascular and all-cause mortality and cardiovascular morbidity. OSAS is observed in patients with arterial hypertension in 30-83%, coronary heart disease in 38-65%, stroke in 57-65%, heart failure in 12-55%, heart rhythm disorders - in 20-50%. In addition, the relationship between OSAS and diabetes, metabolic syndrome, insulin resistance, depression, and cognitive impairment has been established. OSAS is often not diagnosed or not diagnosed in time. Thus, there are data that 86-95% OSAS, clinically manifestated, were missed diagnosis, that worsens the prognosis of such patients.&#x0D; Conclusions. OSAS is a common sleep breathing disorder in patients with CVD that is often diagnosed late. Most studies have shown that OSAS worsens the CVD course and outcomes. Therefore early diagnosis and timely appropriate treatment reduce morbidity and mortality.

Identification and validation of ferroptosis-related hub genes in obstructive sleep apnea syndrome.

By 2020, the prevalence of Obstructive Sleep Apnea Syndrome (OSAS) in the US has reached 26. 6-43.2% in men and 8.7-27.8% in women. OSAS promotes hypertension, diabetes, and tumor growth through unknown means. Chronic intermittent hypoxia (CIH), sleep fragmentation, and increased pleural pressure are central mechanisms of OSAS complications. CIH exacerbates ferroptosis, which is closely related to malignancies. The mechanism of ferroptosis in OSAS disease progression remains unknown. OSAS-related datasets (GSE135917 and GSE38792) were obtained from the GEO. Differentially expressed genes (DEGs) were screened using the R software and intersected with the ferroptosis database (FerrDb V2) to get ferroptosis-related DEGs (f-DEGs). GO, DO, KEGG, and GSEA enrichment were performed, a PPI network was constructed and hub genes were screened. The TCGA database was used to obtain the thyroid cancer (THCA) gene expression profile, and hub genes were analyzed for differential and survival analysis. The mechanism was investigated using GSEA and immune infiltration. The hub genes were validated with RT-qPCR, IHC, and other datasets. Sprague-Dawley rats were randomly separated into normoxia and CIH groups. ROS, MDA, and GSH methods were used to detect CIH-induced ferroptosis and oxidative stress. GSEA revealed a statistically significant difference in ferroptosis in OSAS (FDR < 0.05). HIF1A, ATM, HSPA5, MAPK8, MAPK14, TLR4, and CREB1 were identified as hub genes among 3,144 DEGs and 74 f-DEGs. HIF1A and ATM were the only two validated genes. F-DEGs were mainly enriched in THCA. HIF1A overexpression in THCA promotes its development. HIF1A is associated with CD8 T cells and macrophages, which may affect the immunological milieu. The result found CIH increased ROS and MDA while lowering GSH indicating that it could cause ferroptosis. In OSAS patients, non-invasive ventilation did not affect HIF1A and ATM expression. Carvedilol, hydralazine, and caffeine may be important in the treatment of OSAS since they suppress HIF1A and ATM. Our findings revealed that the genes HIF1A and ATM are highly expressed in OSAS, and can serve as biomarkers and targets for OSAS.

The Relationship of Desaturation, Oxidative Stress, Comorbid Diseases, and Conditions in Obstructive Sleep Apnea Syndrome

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is associated with clinical pictures ranging from morning headache to vascular diseases and sudden death. It negatively affects the quality of life by causing deterioration in sleep quality, a decrease in work and academic performance caused by excessive daytime sleepiness (EDS), social restriction, and an increase in work/traffic accidents and depression. OSAS may cause comorbidities and conditions by desaturation. We aimed to investigate the effect of desaturation and cellular level hypoxia in patients with OSAS on comorbid diseases and conditions and emphasize their importance. Subjects and Methods: The study design was cross-sectional. A total of 100 patients (73 males and 27 females) aged 18–70 years were included in the study. Demographic data, presence of comorbidities (diabetes mellitus [DM], hypertension [HT], coronary artery disease), and symptoms related to OSAS (nocturia, enuresis, and morning headache) were questioned. In addition, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Scale were administered, the results of polysomnographic data were evaluated, and lactic acid levels were measured as an indicator of hypoxia at the cell level. Results: The minimum oxyhemoglobin saturation level was found to be associated with body mass index (BMI) (P = 0.004), HT (P = 0.005), ESS scores (P = 0.022), sleep apnea severity, depression scale (P = 0.012), position-related sleep apnea (P = 0.005), and lactic acid levels (P = 0.002). No correlation was found between sex, DM, CAD, morning headache, nocturia and enuresis, PSQI, and repaid eye movement -related sleep apnea. Conclusion: Although hypoxemia was shown to be associated with BMI, HT, EDS, depression, sleep apnea severity, positional apnea, and lactic acid in our study, sufficient evidence could not be obtained to consider the minimum oxyhemoglobin saturation level in the OSAS treatment plan. In the clinical evaluation of OSAS, apnea-hypopnea index and these parameters should be taken into account by physicians in the prediction of comorbidities and risks.

A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS.

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.

Investigation of the frequency of obstructive sleep apnoea syndrome in patients with subclinical hypothyroidism.

BackgroundThe aim of this study is to determine the frequency of obstructive sleep apnoea syndrome (OSAS) in a study group with the diagnosis of subclinical hypothyroidism and in a control group without the diagnosis of subclinical hypothyroidism. This study compares these two groups in terms of demographic characteristics, chronic diseases and especially polysomnographic data.MethodsA total of 120 patients were included in this study. They consisted of 60 patients with newly diagnosed subclinical hypothyroidism and a control group of 60 patients with normal thyroid functions. Demographic, anthropometric, polysomnography data and Epworth Sleepiness Scale scores of the patients were recorded and compared.ResultsAny significant difference in the frequency and severity of OSAS was not detected. A significant difference was found in the oxygen desaturation index (ODI), the apnoea–hypopnoea index (AHI) in rapid eye movement sleep, the AHI in supine sleep position and the arousal index of the group experiencing subclinical hypothyroidism with OSAS.ConclusionThis study showed that there was no increase in OSAS frequency in patients with subclinical hypothyroidism, but it demonstrated that the ODI and the arousal index were significantly increased in OSAS patients diagnosed with subclinical hypothyroidism. It is thought that the diagnosis and treatment of OSAS in these patients may be important in preventing cardiovascular complications.

The Automatic Algorithm of the Auto-CPAP Device as a Tool for the Assessment of the Treatment Efficacy of CPAP in Patients with Moderate and Severe Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder where precise treatment assessment is of high importance. We aimed to validate an automatic algorithm of the auto-CPAP device and reveal polygraph usefulness in the OSAS diagnosis and treatment of outpatients. One hundred patients with moderate OSAS, severe OSAS, and excessive daytime sleepiness qualified for CPAP treatment were included. The study was conducted in three stages. The first stage included a minimum 6-hour polysomnographic examination to select moderate and severe OSAS. The second stage involved an auto-CPAP treatment lasting at least 4 h with simultaneous polygraph recording. The third stage was a titration of at least 4 h with auto-CPAP. The Apnea–Hypopnea Index (AHI) and oxygen desaturation index (ODI) were calculated under auto-CPAP treatment, simultaneously using polygraph (stage two), and as a result of treatment with auto-CPAP (stage three). The mean AHI was 40.0 ± 20.9 for OSAS. Auto-CPAP treatment was effective in 97.5%. The mean residual AHI was 8.6 ± 4.8; there was no significant difference between the AHI CPAP, and the AHI polygraph values were assessed with an accuracy of 3.94/h. The sensitivity and specificity of calculated cut point 8.2 event/hour were: 55% and 82%, respectively. The calculated AUC for the AHI CPAP parameter was 0.633. Presented data confirmed that the automatic algorithm of auto-CPAP is a good tool for the assessment of the treatment efficacy of CPAP in patients, i.e., home setting, with a moderate or severe stage OSAS-presented high sleepiness.

Dynamics of Circulating CD14/CD16 Monocyte Subsets in Obstructive Sleep Apnea Syndrome Patients upon Hypoglossal Nerve Stimulation.

Background: Obstructive sleep apnea syndrome (OSAS) is a widespread respiratory disease that is associated with recurrent breathing intermissions at night. The corresponding oxidative stress triggers a low-grade systemic inflammation which leads to alterations of different immune cells in the peripheral blood. The current standard treatment for OSAS is continuous positive airway pressure (CPAP), whereas hypoglossal nerve stimulation (HNS) has been established as a second-line treatment option for CPAP failure. The aim of the study was to investigate the influence of HNS for OSAS patients on the distribution and differentiation of circulating monocyte subsets in connection with the clinical parameters. Materials and Methods: Therefore, a detailed analysis of the distribution of CD14/CD16 characterized monocyte subsets in the peripheral blood of OSAS patients before and after HNS therapy was performed by flow cytometry. Furthermore, values of BMI (body mass index), ODI (oxygen desaturation index), and ESS (Epworth Sleepiness Scale) were measured. Results: These OSAS patients significantly improved AHI and ESS scores under HNS. In addition, HNS revealed the potential to ensure normal distributions of blood monocyte subsets and even improved the monocyte dynamics in selected OSAS patients, but there were no significant correlations with AHI, ODI, HNS usage, and daytime sleepiness. Conclusions: We conclude that HNS-related positive effects on the oxygenation of the peripheral blood as well as affect the distribution of circulating monocyte subsets, but clinical OSAS correlations are missing. Far more individual clinical, cellular and molecular factors are involved in this sensitive and complex regulatory network and have to be elucidated in further studies.

Low patient compliance to CPAP therapy as a new challenge in the management of patients with obstructive sleep apnea syndrome: social, demographic characteristics and the quality of life

Introduction: Obstructive sleep apnea syndrome (OSAS) is one of the most common sleep disorders. According to various studies, the prevalence of OSAS varies between 2-4% of men and 1-2% of women in the general population, with more than 90% of cases among men and 80% of women being undiagnosed. The "gold standard" for the treatment of OSAS is respiratory therapy using CPAP. At the same time, the results of patients' compliance to CPAP are controversial. Thus, the inability to use this method was noted by 45 to 80% of patients, therefore it is important to study this group of patients, who showed low compliance with CPAP. Aim: to determine the social and demographic characteristics of the group of patients with OSAS and low compliance with CPAP therapy, as well as the impact of the disease on the quality of life of patients. Materials and methods: The study included 80 patients with second stage OSAS who had previously demonstrated low compliance with CPAP. Overall demographic indicators were assessed, and patients were interviewed to assess their quality of life using The Assessment of Quality of Life (AQoL) instrument. Statist ical criteria included methods of descriptive statistics (mean, mode, median, minimum and maximum value, variance). In case of normal data distribution methods of parametric statistics were used, and in case of uneven distribution – non-parametric criteria. Results: The gender distribution in the group showed 67.5% of men and 32.5% of women. Average age was 39.35 (±9.49) years and 39.56 (±11.89) years, respectively. The average value of the biomass index in men was 28.3 (±2.9), in women – 28.1 (±3.9). Only three people in the group reached retirement age. The results of the survey of the quality of life showed a significant reduction in the level of "Relationships with others", "Social isolation", "Sleep" and "Anxiety and depression" (p &lt;0.05). Conclusions: The results of the study showed that the demographic characteristics of the group of patients with OSAS with low compliance to CPAP do not differ from the general patterns. In addition, a questionnaire using The Assessment of Quality of Life (AQoL) instrument showed a significant decrease in the quality of life of patients due to worsening of social isolation and reduced psychological wellbeing.

Prevalence of obstructive sleep apnea syndrome in hospitalized patients with type 2 diabetes in Beijing, China.

To estimate the prevalence, and patient clinical and demographic profile, as well as risk factors associated with obstructive sleep apnea syndrome (OSAS) in hospitalized patients with type 2 diabetes mellitus in Beijing, China. Hospitalized adult patients with type 2 diabetes mellitus were consecutively screened and invited for an overnight polysomnography from four hospitals in Beijing, China, from May 2016 to February 2017. We used the American Academy of Sleep Medicine 2012 polysomnography recording techniques and scoring criteria to identify the type of apnea and the severity of OSAS. The χ2 -test was used to evaluate differences between groups regarding the prevalence, and demographic and other clinical parameters. A total of 735 patients were found eligible for the study, of whom 309 patients completed the overnight polysomnography. The mean age of the patients was 58.2 ± 10.9 years, and most (67.3%) were men. The prevalence of overall (apnea hypopnea index ≥5/h), moderate-to-severe (apnea hypopnea index ≥15/h) and severe (apnea hypopnea index ≥30/h) OSAS was 66.3% (95% confidence interval 60.8-71.6%), 35.6% (95% confidence interval 30.3-41.2%) and 16.5% (95% confidence interval 12.5-21.1%), respectively. Central and mixed apnea contributed 12% to all sleep-disordered breathing. With the aggravation of OSAS, the combined prevalence for central, mixed and obstructive apnea increased from 57% to 70%. We found OSAS to be associated with older age, obesity, self-reported snoring and apnea, and diabetes complications. Guidelines on screening and treatment of OSAS among hospitalized patients with diabetes are needed to direct the routine practice for diabetes endocrinologists for optimal clinical care of such patients.

Progression of Obstructive Sleep Apnea Syndrome in Pediatric Patients with Prader-Willi Syndrome.

Obstructive sleep apnea syndrome (OSAS) is one of the most common comorbidities in patients with Prader–Willi syndrome (PWS) and causes significant consequences. This observational study was conducted to investigate the progression of OSAS in pediatric patients with PWS, who had not undergone upper airway surgery, through a longitudinal follow-up of their annual polysomnography results. Annual body mass index (BMI), BMI z-score, sleep efficiency and stages, central apnea index (CAI), obstructive apnea–hypopnea index (OAHI), and oxygen saturation nadir values were longitudinally analyzed. At enrollment, of 22 patients (10 boys and 12 girls) aged 11.7 ± 3.9 years, 20 had OSAS. During the 4-year follow-up, only two patients had a spontaneous resolution of OSAS. The average BMI and BMI z-score increased gradually, but CAI and OAHI showed no significant differences. After statistical adjustment for sex, age, genotype, growth hormone use, and BMI z-score, OAHI was associated with the BMI z-score and deletion genotype. In conclusion, OSAS is common in patients with PWS, and rarely resolved spontaneously. Watchful waiting may not be the best OSAS management strategy. Weight maintenance and careful selection of surgical candidates are important for OSAS treatment in patients with PWS.

Anti-Oxidant Treatment in Obstructive Sleep Apnoea Syndrome

To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n = 10) and NAC (n = 10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9 +/- 2.7 vs 42.3 +/- 4.2; p < 0.01) and sleep efficiency (90.8 +/- 1.3 vs 94.4 +/- 1.5; p < 0.05) improved considerably. The apnoea-hypopnoea index (61.2 +/- 8.5 vs 43.1 +/- 8.6; p < 0.05), apnoea related arousals (22.2 +/- 7.6 vs 11.6 +/- 4.7; p < 0.05), longest apnoeic episode duration (seconds) (54.9 +/- 7.1 vs 37.8 +/- 5.6; p < 0.01), oxygen desaturation events per hour (51.8 +/- 7.7 vs 37 +/- 7.8; p < 0.01) and epworth sleepiness score (16.6 +/- 0.8 vs 9.2 +/- 0.9; p < 0.001) decreased significantly. The relative snore time (%) (10.2 +/- 2.9 vs 4.9 +/- 1.9; p < 0.01), number of snore episodes (63.8 +/-23.9 vs 28.2 +/- 9.9; p < 0.05) and duration of longest snore episode (min) (2.5 +/- 0.7 vs 0.6 +/- 0.1; p < 0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.