Treatment Of Obstructive Sleep Apnea Research Articles

Opioid use in treated and untreated obstructive sleep apnoea: remifentanil pharmacokinetics and pharmacodynamics in adult volunteers.

Patients with obstructive sleep apnoea (OSA) are considered more sensitive to opioids and at increased risk of opioid-induced respiratory depression. Nonetheless, whether OSA treatment (continuous positive airway pressure, CPAP; or bilevel positive airway pressure, BIPAP) modifies this risk remains unknown. Greater opioid sensitivity can arise from altered pharmacokinetics or pharmacodynamics. This preplanned analysis of a previous cohort study of remifentanil clinical effects in OSA tested the null hypothesis that the pharmacokinetics, pharmacodynamics, or both of remifentanil, a representative μ-opioid agonist, are not altered in adults with treated or untreated OSA. A single-centre, prospective, open-label, cohort study administered a stepped-dose, target-controlled remifentanil infusion (target effect-site concentrations 0.5, 1, 2, 3, 4 ng ml-1) to awake adult volunteers (median age 52 yr, range 23-70) without OSA (n=20), with untreated OSA (n=33), or with treated OSA (n=21). Type III (in-home) polysomnography verified OSA. Remifentanil plasma concentrations, end-expired CO2, thermal heat tolerance, and pupil diameter (miosis) were assessed. Population pharmacokinetic (clearance, volume of distribution) and pharmacodynamic (miosis, thermal heat tolerance, end-expired CO2) models were developed. Remifentanil clearance (median) was 147, 143, and 155 L h-1 (P=0.472), and volume of distribution was 19.6, 15.5, and 17.7 L (P=0.473) for subjects without OSA, untreated OSA, or treated OSA, respectively. Total body weight was an influential covariate on both remifentanil clearance and central volume of distribution. There were no statistically or clinically significant differences between the three groups in miosis EC50 or Emax, or the slopes of thermal heat tolerance or end-expired CO2vs remifentanil concentration. At a plasma remifentanil concentration of 4 ng ml-1, in participants without OSA, with untreated OSA, or with treated OSA, respectively, model-estimated pupil area (12%, 13%, and 17% of baseline, P=0.086), thermal heat tolerance (50°C, 51°C, and 51°C, P=0.218), and end-expired CO2 (6.3 kPa, 6.4 kPa, and 6.7 kPa, P=0.257) were not statistically different between groups. OSA (untreated or treated) did not influence remifentanil pharmacokinetics or pharmacodynamics (miosis, analgesia, respiratory depression). Results support the null hypothesis that neither pharmacokinetics nor pharmacodynamics of remifentanil, a representative μ-opioid, are altered in adults with treated or untreated OSA. These findings provide a mechanistic explanation for the lack of influence of OSA or OSA treatment on the clinical miotic, sedative, analgesic, or respiratory depressant response to remifentanil in awake adults. The conventional notion that OSA alters sensitivity to the effects of opioids in awake adults is not supported by our findings, such that opioid dosing might not need adjustment for pharmacokinetic or pharmacodynamic considerations. ClinicalTrials.gov, NCT02898792, https://clinicaltrials.gov/ct2/show/NCT02898792. First Posted: September 13, 2016.

A novel machine learning model for screening the risk of obstructive sleep apnea using craniofacial photography with questionnaires.

Undiagnosed or untreated moderate to severe obstructive sleep apnea (OSA) increases cardiovascular risks and mortality. Early and efficient detection is critical, given its high prevalence. We aimed to develop a practical and efficient approach for obstructive sleep apnea screening, using simple facial photography and sleep questionnaires. We retrospectively included 748 participants who completed polysomnography, sleep questionnaires (STOP-BANG, SBQ), and facial photographs at a university hospital between 2012 and 2023. Owing to class imbalance, we randomly undersampled the participants, categorized into the moderate/severe or no/mild OSA group, based on an apnea-hypopnea index of 15 events/h. Using a validated convolutional neural network, we extracted the OSA probability scores from photographs, which were used as the input for the questionnaires. Four machine learning models were employed to classify the moderate/severe versus no/mild groups and evaluated in the test dataset. We analyzed 426 participants (213 each in the moderate/severe and no/mild groups). The mean (standard deviation) age was 44.6 (14.7) years; 80.8% were men. Logistic regression achieved the highest performance: the area under the receiver operator curve was 97.2%, and accuracy was 91.9%. Adding OSA probability, retrieved from facial photographs, to the questionnaires improved performance, compared with using questionnaires or photographs alone (area under the receiver operator curve: 97.2%, 64% and 79.1% for threshold SBQ 3 and 4, and 85.7%, respectively). Using simple facial photographs and sleep questionnaires, a two-stage approach (convolutional neural network + machine learning) accurately classified OSA into moderate/severe versus no/mild OSA groups. This method may facilitate optimal OSA treatment and avoid unnecessary costly evaluations.

Exploring the therapeutic potential of GLP-1 receptor agonists in the management of obstructive sleep apnea: a comprehensive review.

Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder marked by repeated episodes of partial or complete upper airway obstruction during sleep, which leads to intermittent hypoxia and fragmented sleep. These disruptions negatively impact cardiovascular health, metabolic function, and overall quality of life. Obesity is amajor modifiable risk factor for OSA, as it contributes toboth anatomical and physiological mechanisms that increase the likelihood of airway collapse during sleep. While continuous positive airway pressure (CPAP) therapy remains the gold standard for OSA treatment, its limitations- particularly issues with patient adherence- underscore the need for alternative oradjunct therapeutic options. One such option is the use ofglucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are widely recognized for their ability to reduce body weight and improve metabolic health. Emerging evidence suggests that GLP-1 RAs may offer therapeutic benefits in managing OSA, particularly by addressing obesity, a key contributor to the condition. This narrative review seeks to explore the role of GLP-1 RAs in the treatment of OSA, evaluating their efficacy in reducing OSA severity and discussing their broader clinical implications for future research and practice.

CPAP Therapy for OSA and Its Impact on Various Cardiovascular Disorders.

Obstructive sleep apnea (OSA), a highly prevalent and serious disorder with significant complications, causes considerable daytime and nighttime symptoms as well as long-term consequences and is yet an underdiagnosed and inadequately treated condition. Patients with OSA undergo frequent awakenings during the sleep cycle and find it impossible to get restorative sleep. Individuals are extremely fatigued, sleepy, and irritable throughout the day. Reduced exercise performance and physical activity contribute to a decrease in energy metabolism and weight gain. Those in this population may experience decreased motivation, which could result in depressive symptoms. The abrupt drops in oxygen levels during the sleep cycle result in profound spikes in blood pressure and strain the cardiovascular system. Given its close tie with major cardiovascular risk factors, OSA is linked with various cardiovascular diseases, including coronary artery disease, cardiac arrhythmia, poorly controlled blood pressure, heart failure, and stroke. Continuous positive airway pressure is an effective and tried-trusted approach for symptom relief and improving quality of life. Despite its benefits, patients struggle with compliance and often go untreated because of physical discomfort and perceived inconvenience of using these machines. One other explanation for this could be the lack of awareness, comprehensive data, and extensive research on its effects on long-term cardiovascular and metabolic complications caused by OSA. The current standard treatment for OSA, using adequate positive airway pressure, greatly reduces cardiovascular morbidity. Nevertheless, patients with cardiovascular disorders continue to be highly susceptible to OSA and its detrimental clinical consequences, even with effective therapy available. In summary, continuous positive airway pressure has an indirect potential to affect cardiovascular outcomes, but further studies should be done to address issues with patient compliance and adherence.

A randomized, crossover trial of one night of oxygen therapy for obstructive sleep apnea in patients with fibrotic interstitial lung disease.

There is no satisfactory treatment for obstructive sleep apnea (OSA) in patients with interstitial lung disease (ILD) because of poor tolerance of positive airway pressure (PAP) therapy. Supplemental oxygen therapy has been shown to reduce hypoxemia and is well tolerated in patients with ILD. However, little is known about the effect of nocturnal oxygen supplementation (NOS) on OSA in patients with ILD. In this study, we evaluated one night of oxygen therapy in ILD patients with OSA. Forty-one patients with fibrotic ILD and OSA were randomized to receive supplemental oxygen or air for one night each in a crossover design separated by a washout period of one week. Polysomnography was performed, and sleep-disordered breathing, nocturnal desaturation, sleep architecture, and cardiovascular reactions were monitored. During nights with sham oxygen, the median (interquartile range) apnea-hypopnea index (AHI) was 14.1/h (10.4/h-24.1/h). The percentage of patients in the N3 sleep stage (N3%) was 19.5% (14.0-31.2%). NOS significantly decreased the AHI by a median of 9.3/h (95% CI, 7.6/h-14.4/h; P < 0.001), increased N3% by 4.4% (95% CI, 0.3-10.1%; P = 0.049), and lowered the sleep stage change index by 1.6/h (95% CI, 0.0/h-4.8/h; P = 0.036). NOS improved the oxygen desaturation index (ODI) by -8.8/h (95% CI, -13.4/h to -5.9/h; P < 0.001) and the mean SpO2 by 3.0% (95% CI, 2.6-4.5%; P < 0.001). The mean heart rate during sleep was reduced with the NOS; however, total sleep time and nocturnal blood pressure did not change. In patients with OSA and ILD, one night of oxygen therapy significantly improved sleep-disordered breathing, sleep architecture, nocturnal oxygenation, and heart rate. NOS may be a therapeutic option for ILD patients with OSA.

Diagnosis and treatment of obstructive sleep apnea

Obstructive sleep apnoea (OSA) is a prevalent disorder characterized by repeated episodes of partial or complete upper airway collapse during sleep, resulting in intermittent hypoxia, hypercapnia, and sleep fragmentation. Common in middle-aged and older adults, its pathogenesis is multifactorial, encompassing obesity, craniofacial abnormalities, altered upper airway muscle function, pharyngeal neuropathy, and fluid redistribution to the neck. These episodes trigger sympathetic activation, oxidative stress, and systemic inflammation, contributing to daytime sleepiness, road traffic accidents, and a spectrum of cardiovascular and metabolic comorbidities such as hypertension, arrhythmias, coronary artery disease, stroke, and diabetes mellitus. The efficacy of therapy in reversing chronic sequelae remains uncertain. Continuous positive airway pressure (CPAP) is the first-line treatment in severe cases, although patient adherence varies between 60–70%. Alternative modalities, including bi-level positive airway pressure, adaptive servo-ventilation, oral appliances, and surgical interventions, may be employed. Weight reduction and combined treatment strategies hold promise but require validation in well-designed randomized controlled trials.

Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea

BackgroundThis study aimed to identify characteristics associated with cognitive impairment in older individuals with obstructive sleep apnoea (OSA) using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) that could aid in stratifying those at higher risk for impairment.MethodsWe analysed existing cross-sectional datasets that measured the performance of 89 adult patients (aged 50–85 years) with OSA on the ACE-R cognitive test. Receiver operating characteristic curves and logistic regression analysis were utilised to identify associations between impairment status and various factors, including demographic characteristics, self-reported sleepiness, cognitive complaints, and OSA severity.ResultsAccording to established thresholds (ACE-R ≤ 88), 36% of participants were cognitively impaired. When adjusted for age and education, the strongest factors associated with impairment status were prior measures of arousal index (cut-off: ≥28events/hr, OR: 5.67, p < 0.01), sleep mean SpO2 (cut-off: ≤92%, OR: 3.52, p < 0.05), 3% oxygen desaturation index (cut-off: ≥27events/hr, OR: 3.75, p < 0.05), and sleep time spent under 90% SpO2 (cut-off: ≥9%, OR: 3.16, p < 0.05). Combining these factors achieved a high sensitivity (≥ 93%) of detecting impairment within this cohort. Conversely, the apnoea-hypopnoea index, daytime sleepiness, and cognitive complaints were not associated with impairment status.ConclusionsThe ACE-R identified a significant proportion of patients with OSA as having cognitive impairment. Traditional indices of sleep fragmentation and hypoxaemia may allow clinicians to identify at-risk patients for cognitive evaluation, however further studies are needed to validate these findings and explore whether poor cognitive performance can be remediated via OSA treatment.

COMISA, Cardiometabolic Risk, and Other Critical Reasons for Considering Insomnia in Obstructive Sleep Apnea Treatment With Mandibular Advancement Devices

COMISA, Cardiometabolic Risk, and Other Critical Reasons for Considering Insomnia in Obstructive Sleep Apnea Treatment With Mandibular Advancement Devices

Age matters when improving symptoms of anxiety, depression, and sleepiness in patients with obstructive sleep apnea treated with continuous positive airway pressure.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to significant daytime sleepiness and mood disturbances. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA, but its effects on mental health outcomes, are not well understood. This study aimed to evaluate the impact of CPAP on daytime sleepiness, depressive symptoms, and anxiety symptoms while assessing how improvements vary with age. A total of 98 participants diagnosed with OSA were included in this study. Pretreatment and posttreatment scores for daytime sleepiness [Epworth Sleepiness Scale (ESS)], depression [Patient Health Questionnaire (PHQ)], and anxiety [Generalized Anxiety Disorder (GAD)] were collected. Improvements were calculated as the difference between pretreatment and posttreatment scores. Age, sex, ethnicity, apnea-hypopnea index, and CPAP compliance, were analyzed. Significant improvements were observed across all age groups after CPAP treatment: ESS scores improved by a mean of 5.6 points (P < 0.001), PHQ scores improved by 6.3 points (P < 0.001), and GAD scores improved by 1.1 points (P = 0.002). CPAP therapy effectively reduced daytime sleepiness, depression, and anxiety in patients with OSA, with significant age-related differences in outcomes. Younger individuals benefited most from treatment.

Bidirectional interplay of sleep apnea syndrome and cardio-vascular disorders in diabetes.

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium-glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes.

Association Between Severities of Obstructive Sleep Apnea and COVID-19 Outcomes.

Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse resulting in episodes of apnea and hypopnea. Studies have shown worsenedcoronavirus disease 2019 (COVID-19) severity due to coexisting respiratory conditionsand suggest increased severity of COVID-19 in patients with or at high risk of OSA.However, the extent of this correlation is unclear. This retrospective study aimed to evaluate the association between OSA severity and COVID-19 severity and assess the impact of continuous positive airway pressure (CPAP) compliance. Methods This single-center retrospective study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary care center in Jeddah, Saudi Arabia. Data were collected from 62 adult patients with OSA who were diagnosed via polysomnography (PSG) and had a positive documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)polymerase chain reaction (PCR) test result. COVID-19 severity was categorized into mild, moderate, and severe. Results There was no significant correlation between OSA severity as measured by the apnea-hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), arousal index (AI), respiratory disturbance index (RDI), or the type of treatment used, including adherence to CPAP, and the outcomes of COVID-19. However, higher arousal with respiratory index (ARI) and a lower percentage of time with SpO2 < 90% (T90) values were linked to moderate COVID-19 severity with significant p-values of 0.046 and 0.007, respectively. Conclusion There was no significant correlation between the severity or types of OSA treatment and the severity of COVID-19. Further research including multicenter studies with bigger populations and extensive sleep study data is warranted. Understanding the OSA-COVID-19 link may improve risk stratification and patient management.

Classification of obstructive sleep apnea using bio-control feedback EEG biosensor device

Obstructive sleep apnea (OSA) is a common sleeping disorder that can result in shortness of breath due to the relaxation of upper respiratory tract muscles while the patient is asleep. This leads to low blood oxygen saturation and, hence, apnea. OSA is associated with higher risks of hypertension, coronary artery disease, arrhythmias, cardiac failure, and stroke, affecting 5% of the global human population. Thus, early detection and treatment of OSA are crucial. Nowadays, OSA is diagnosed by analyzing EEG signals. Electroencephalographic (EEG) signals are important for monitoring brain activity; this paper focuses on patients with OSA. Unfavorable spikes in the graph, such as head movements, electrical interferences, or even muscle spasms, may interfere with the general EEG frequencies being targeted. Our research was centered on designing a cost-effective electronic circuitry for this device that would efficiently acquire and process EEG signals. We used various methods to improve the device's functionality and accuracy, including rectifications in noise reduction, signal filtering, and structural correction through ICA decomposition. ⁤⁤Our system, theoretically, achieved a high accuracy rate of 97.14% using Support Vector Machines.

Are noradrenergics combined with antimuscarinics the future pharmacologic treatment for obstructive sleep apnea? A systematic review and meta-analysis of randomized controlled trials.

Noradrenergics and antimuscarinics have been proposed as future pharmacotherapy for obstructive sleep apnea (OSA). However, the available randomized controlled trials (RCTs) showed heterogeneous results regarding the safety and efficacy of the combined regimen in OSA. Therefore, we performed this meta-analysis from the published RCTs to clarify this conflicting evidence. A systematic search of four electronic databases was done till December 2023. Thirteen RCTs (n = 345) were systematically reviewed and meta-analyzed. The combined regimen significantly reduced apnea-hypopnea index (AHI): AHI 3% [events/h; Mean difference (MD): - 6.30; 95% Confidence interval (CI) (- 9.74, - 2.87); P = 0.0003], AHI 4% [events/h; MD: - 6.50; 95% CI (- 8.74, - 4.26 events/h); P < 0.00001]. All gasometric measures significantly improved in the combined regimen group except mean SpO2. No difference was found in total sleep time between the treatment and placebo. However, compared to placebo, the combined regimen altered sleep architecture and decreased sleep efficiency. Regarding OSA endotypes, the combined regimen significantly improved loop gain, pharyngeal muscle compensation, pharyngeal muscle recruitment, and respiratory arousal threshold. The combined regimen effectively reduces AHI and OSA severity with improvement in almost all OSA endotypes. However, this regimen decreased sleep efficiency and altered sleep architecture. Short-term side effects can be confined to increased heart rate, dry mouth and urinary hesitancy. Therefore, noradrenergics and anti-muscarinics is a promising regimen for treating OSA, yet this optimism must be titrated by the lack of long-term effects of the regimen. Future RCTs with focus on the long-term efficacy of the regimen and cardiovascular outcomes is recommended.

Clinical study of two mandibular advancement devices in the treatment of Obstructive Sleep Apnea: a pilot randomized controlled trial

ObjectiveA preliminary clinical evaluation of the efficacy, comfort, and adverse reactions of two mandibular advancement devices (MADs) in the treatment of Obstructive Sleep Apnea (OSA).MethodsForty patients with mild-to-severe OSA were recruited and randomly divided into two groups. They were treated with Shark-fin or Silensor MAD, respectively. Treatment efficacy was evaluated by home sleep apnea tests, the snoring scale, Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A comfort scale questionnaire was applied. Cone beam computed tomography (CBCT), cephalometric radiography, and intraoral scanning were made before and after 3-month treatment to detect temporomandibular joints (TMJ), dental and skeletal changes. All data were assessed as normal distributed and analyzed by t test. The significance level was defined as α = 0.05.ResultsThe effective rate, defined as a decrease in Respiratory Event Index (REI) to less than 5 events per hour or a decrease of more than 50%, was 70% in the Shark-fin MAD group and 50% in the Silensor MAD group. REI, lowest oxygen saturation and maximum apnea and hypoventilation time were significantly improved in Shark-fin MAD group (P < 0.01), and the proportion of non-rapid eye movement (REM) sleep stage 3 was higher than before use (P < 0.05), while only REI and lowest oxygen saturation were significantly improved in Silensor MAD group (P < 0.05). The loudness of snoring was significantly decreased after one day using Shark-fin MAD (P < 0.05), and further decreased after one month (P < 0.01). Conversely, Silensor MAD exhibited inferior efficacy in mitigating snoring compared to Shark-fin MAD. Upon wearing the Shark-fin MAD, ESS were significantly improved after one month and three months (P < 0.05), and PSQI improved after three months (P < 0.05). Additionally, the Shark-fin MAD group had a significantly better comfort score compared to the Silensor MAD group (P < 0.05). There was no significant difference in TMJ, dental and skeletal structures in the two groups before and after treatment (P > 0.05).ConclusionBoth two MADs were effective in reducing REI and increasing lowest oxygen saturation on OSA patients, and Shark-fin MAD has better improvement effect and faster onset of action. In addition, Shark-fin MAD was superior to Silensor MAD in improving snoring loudness, daytime sleepiness, sleep quality and wearing comfort. There were no significant dental or skeletal changes, and no alterations in occlusion or temporomandibular joint function in the short term.Trial registrationClinical Trials.gov Registration ID ChiCTR2400086628. Registered 08/07/ 2024-Retrospectively registered, https://register.clinicaltrials.gov.

Alterations in Gut Microbiota Composition Are Associated with Changes in Emotional Distress in Children with Obstructive Sleep Apnea.

Emerging evidence underscores the pivotal role of the gut microbiota in regulating emotional and behavioral responses via the microbiota-gut-brain axis. This study explores associations between pediatric obstructive sleep apnea (OSA), emotional distress (ED), and gut microbiome alterations before and after OSA treatment. Sixty-six children diagnosed with OSA via polysomnography participated, undergoing adenotonsillectomy alongside routine educational sessions. ED was assessed using the OSA-18 questionnaire, categorizing participants into high ED (scores ≥ 11, 52%) and low ED (scores < 11, 48%) groups. Gut microbiome analysis revealed significant diversity differences, with high ED linked to a reduced Shannon index (p = 0.03) and increased beta diversity (p = 0.01). Three months post-treatment, significant improvements were observed in OSA symptoms, ED scores, and gut microbiome alpha diversity metrics among 55 participants (all p < 0.04). Moreover, changes in the relative abundances of Veillonella, Bifidobacterium, Flavonifractor, and Agathobacter, as well as ultra-low frequency power and low frequency power of sleep heart rate variability, were independently associated with ED score alterations. These findings underscore the gut microbiome's critical role in the emotional and behavioral symptoms associated with pediatric OSA, suggesting that microbiome-targeted interventions could complement traditional treatments for ED reduction and emphasizing the need for further research.

Demographic profile of surgical approaches to obstructive sleep apnea in the United States from 2004 to 2020: a descriptive study

ObjectivesThis study aims to evaluate the quantity, types, and trends of surgical procedures used to treat obstructive sleep apnea (OSA) within a diverse national population, utilizing a comprehensive proprietary healthcare database.MethodsThis descriptive observational study analyzed longitudinal data from the Optum Clinformatics® Data Mart databases, covering the period from January 2004 to December 2020. The study included patients aged 18 to 89 years, both male and female, with a confirmed diagnosis of OSA. These patients were either treated with continuous positive airway pressure (CPAP) or underwent surgical interventions.ResultsThroughout the study period, 1,250,273 individuals were diagnosed with OSA. The average age at diagnosis was 62 years (SD = 16), with a male predominance of 62.3%, and 75% of the patients were identified as Caucasian. The most frequently performed surgical procedure for OSA was Uvulopalatopharyngoplasty (UPPP). However, the implantable hypoglossal nerve stimulator was more commonly utilized among older patients.ConclusionsThis study provides essential insights into the prevalence and characteristics of surgical procedures used in OSA treatment across a diverse national population. The findings underscore the significance of understanding surgical intervention patterns and trends to enhance patient care and outcomes.

Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis.

Rationale: Low arousal threshold and poor muscle responsiveness are common determinants of obstructive sleep apnea (OSA). Hypnotics were hypothesized as an alternative OSA treatment via raising the arousal threshold and possibly genioglossus responsiveness. Objectives: To examine the effect of common hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. Methods: We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for randomized clinical trials, and we ran meta-analyses to determine the effect of oral hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. The Grades of Recommendation Assessment, Development and Evaluation was used to rate the quality of evidence (QoE). The association between post-treatment apnea-hypopnea index (AHI) and arousal threshold percentage reductions was explored in individual patient data meta-analyses (overall sample and low arousal threshold subgroups). Measurements and Main Results: On the basis of our analysis (27 studies; 25 for AHI, 11 for arousal threshold, 4 for genioglossus responsiveness), hypnotics minimally raised arousal threshold (mean difference [95% confidence interval], 2.7 [1.5, 3.8] cm H2O epiglottic pressure swings; moderate QoE) but did not change OSA severity (-1.4 [-3.5, 0.7] events/h; moderate QoE). Individual patient data meta-analysis (N = 114) showed no association between changes in arousal threshold and AHI, independent of arousal threshold subgrouping. However, people with very low arousal threshold or those who exhibited a 0-25% arousal threshold increase from placebo experienced the greatest, yet still modest, post-treatment AHI reductions (∼10%). Hypnotics did not affect genioglossus responsiveness (high QoE). Conclusions: Further research testing or clinical use of hypnotics as OSA alternative treatments should be discouraged, unless in the presence of comorbid insomnia or as part of combination therapy in individuals with very low arousal threshold.

Examining the impact of obstructive sleep apnea on cognitive function in severe COPD

PurposeThis study aimed to examine the association between obstructive sleep apnea (OSA) and cognitive function in patients with severe chronic obstructive pulmonary disease (COPD).MethodsPatients with severe COPD, who had not previously been diagnosed with OSA, were recruited between January 2021 and January 2023. To evaluate cognitive function, the Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT) and a driving simulator were used. OSA was identified using a CardioRespiratory Monitor (CRM). Cognitive tests were repeated for patients who were identified with and received treatment for OSA, to determine whether treatment improved cognitive function.ResultsIn total, 80 patients participated in the study and 50 patients (63%) were diagnosed with OSA, with or without nocturnal desaturation (ND), and six patients (8%) with ND only. Thirty-two patients (40%) had mild OSA and 18 (23%) had moderate/severe OSA. We found no statistically significant difference in the prevalence of cognitive impairment (CI) between patients with and without OSA and/or ND. However, a multiple regression analysis showed that patients with moderate/severe OSA had a significant lower CRT-index, indicating a decrease in attention and reaction time, compared to patients with mild OSA.ConclusionIn patients with COPD and OSA, the degree of CI may depend on the severity of OSA. The 23% prevalence of moderate/severe OSA emphasizes the importance of OSA screening in severe COPD.The study was registered at www.clinicaltrials.gov in March 2020, with the identification number NCT04458038.

Chinese herbal medicine for obstructive sleep apnoea: a systematic review with meta-analysis.

Chinese Herbal Medicine (CHM) may have a place in the treatment of obstructive sleep apnoea (OSA), but the evidence has not been systematically assessed. The objective of this study is to evaluate the evidence for the effectiveness of CHM for OSA. CENTRAL, EMBase, PubMed, CINAHL, CNKI, Wanfang and Chongqing VIP were searched from database inception to the 13th of August 2023. Randomised-controlled trials in which the effect of CHM on sleep variables was tested in the treatment of OSA were selected. The primary outcomes of this review and meta-analysis were the apnoea hypopnoea index (AHI) measured with polysomnography. A total of 58 studies, involving 4,590 participants, were included. The meta-analysis showed that CHM reduced AHI more significantly than placebo (mean difference = -7.10 events/hour, 95% CI = -11.95, -2.25, P < 0.01, 7 studies, 583 participants) and the combination of CHM and Continuous Positive Airway Pressure (CPAP) more effective than CPAP alone (mean difference = -4.71 events/hour, 95% CI = -5.62, -3.80, P < 0.001, 28 studies, 2,267 participants). CHM improved sleepiness, quality of life, body weight, oxidative biomarkers, inflammatory biomarkers, cognitive function, blood pressure and respiratory function. Our results suggest that CHM, alone and as an adjunct treatment, can improve various aspects of OSA and its comorbidities and is therefore a viable therapeutic option for OSA.

Optimal treatment of obstructive sleep apnea guided by physiological characteristics

Obstructive sleep apnea (OSA) is a common and heterogeneous disorder. Most patients can be successfully treated, but some have poor treatment outcomes. This review first presented four physiological OSA characteristics, including upper airway collapsibility, loop gain, airway muscle responsiveness, and arousal threshold, which are associated with the efficacy of OSA therapy. Then, we presented how to select the most effective therapy modality for each individual based on OSA characteristics, with the purpose of providing a basis for individualized treatment of OSA.