OSA Patients Research Articles

Effects of multilevel OSA surgery on patients with poor cardiopulmonary performance: A prospective pilot study

ObjectiveMultilevel airway surgery for obstructive sleep apnea/hypopnea syndrome (OSA) has benefits in improving sleep quality, but its effect on polysomnography (PSG) and 6-minute walk test (6MWT) parameters, including walking distance and cardiopulmonary performance, in patients with poor pre-operative cardiopulmonary performance remains understudied, which should be further investigated. MethodsThis prospective pilot study enrolled 27 consecutive OSA patients with poor pre-operative 6MWT results. All patients received multilevel OSA surgery, and the alterations of sleep parameters and 6MWT profiles were studied. The pre- and post-operative values of polysomnographic data and 6MWT profiles were analyzed using the Wilcoxon signed-rank tests. The relationships among changes of the indices of PSG and 6MWT were further investigated with the Spearman's correlations. ResultsAfter surgery, the sleep parameters and certain cardiopulmonary indices improved. When analyzing the correlations among changes of the indices of PSG and 6MWT, the improvement of daytime sleepiness (with ESS) was found related to farther walking distance (ρ=-0.414, p = 0.032) and higher percentage of “distance/target distance” (ρ=-0.435, p = 0.023). Moreover, the change of maximal expiratory pressure was the only index associated with the changes of AHI (apnea/hypopnea index, /hr.; ρ=-0.407, p = 0.035) and AHI in REM (ρ=-0.502, p = 0.009) among the cardiopulmonary performance parameters. ConclusionThis pilot study showed that OSA patients with poor pre-operative cardiopulmonary status undergoing multilevel sleep surgery could experience improvement in the sleep study and 6MWT to some extent. The relatively better walking distance and cardiopulmonary performance after the operation might potentially result from the improvement of daytime sleepiness and better respiration.

Impact of Exclusive Mouth Route and lateral position on the efficacy of oronasal CPAP to treat Obstructive Sleep Apnea in Patients with Obstructive Sleep Apnea Adapted to Oronasal Mask

BackgroundOronasal masks are widely used for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP. Research QuestionWhat is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP? Study Design and MethodsPatients with OSA on oronasal CPAP underwent 2 CPAP polysomnography (PSG) titrations in random order using an oronasal mask with 2 independent sealed compartments connected to two separate pneumotachographs. One study was done with the nasal and oral compartments opened and the other study with only the oral compartment opened. CPAP titration was done in the supine and lateral position. Finally, the patients were offered a nasal mask. A third PSG was performed using nasal CPAP. ResultsTwenty OSA patients (baseline AHI: 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers on optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (2 (1 - 6.0) vs 12.5 (1.8 - 28.3); P = 0.003), despite a significantly higher CPAP level, (10 (9 - 10) vs 11 (10 - 12) cmH20; P = 0.003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue on nasal mask, which resulted in lower CPAP and better OSA control. InterpretationThe effectiveness of oronasal CPAP to abolish OSA is significantly decreased when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.

Kairos positive airway pressure (KPAP) equals continuous PAP in effectiveness, and offers superior comfort for obstructive sleep apnea treatment

Study objectivesA recent study challenged the prevailing clinical view that maintaining inspiratory positive airway pressure (IPAP) is necessary for upper airway patency, demonstrating no differences in apnea hypopnea index (AHI) between continuous PAP (CPAP) with and without a resistor to reduce IPAP. In this study, we assessed the effect of Kairos PAP (KPAP), a new algorithm which features multiple drops in IPAP, only returning to therapeutic pressure near the end expiration, on sleep apnea severity and subjective comfort. MethodsTwo randomized clinical trials were conducted. In the Efficacy trial, the effect of KPAP vs. CPAP on AHI in PAP-treated OSA patients was examined using a split-night design, adjusting for period, sequence and fraction of supine sleep (mixed models). Unintentional leak differences between treatments were also examined. Exploratory analyses assessed the effect of KPAP vs. CPAP on key polysomnography outcomes. In the Comfort trial, we tested subjective preference for KPAP vs. CPAP at 9 and 13 cmH2O in PAP-naïve OSA patients. ResultsIn the Efficacy trial (N = 48), KPAP reduced AHI more than CPAP (mean difference [95%CI]: −0.5 [−0.8, −0.2] events/h, P = 0.007). Unintentional leak was also reduced by over 50 % (−2.5 [−3.2, −1.7] L/min, P < 0.001). No significant change was observed in the exploratory variables assessed. In the Comfort trial (N = 150), 69 [61, 77] % and 84 [77, 89] % of participants preferred KPAP over CPAP at 9 and 13 cmH2O, respectively (P < 0.001). ConclusionsKPAP is as effective as CPAP in reducing respiratory events, but is more comfortable and potentially better tolerated.

Associations between quantitative susceptibility mapping with male obstructive sleep apnea clinical and imaging markers

PurposeTo quantitatively measure and compare whole-brain iron deposition between OSA patients and a healthy control group, we initially utilized QSM and evaluated its correlation with PSG results and cognitive function. Materials and methodsA total of 28 OSA patients and 22 healthy control subjects matched in age, education level, and BMI were enrolled in our study. Each participant underwent scanning with 3D T1 and multi-echo GRE sequences. Additionally, PSG results were collected from OSA patients, and they underwent simple cognitive assessments. Finally, we analyzed the relationship between iron content in different brain regions, PSG results, and cognitive ability. ResultsIn OSA patients, iron content increased in the left temporal-pole-sup and right putamen, while it decreased in the left fusiform gyrus, left middle temporal gyrus, right inferior occipital gyrus, and right superior temporal gyrus. The correlation analysis between brain iron content and PSG results/cognitive scales is as follows: left fusiform gyrus and MMSE (r = −0.416, p = 0.028); right superior temporal gyrus and MMSE (r = 0.422, p = 0.025); left middle temporal gyrus and average oxygen saturation (r = −0.418, p = 0.027); left temporal-pole-sup and REM stage (rs = 0.466, p = 0.012); the right putamen and N1 stage (rs = 0.393. p = 0.039). Moreover, both MoCA (r = 0.598, p = 0.001) and MMSE (r = 0.456, p = 0.015) show a positive correlation with average oxygen saturation. ConclusionThis study is the first to use QSM technology to show abnormal brain iron levels in OSA. Correlations between brain iron content, PSG, and cognition in OSA may reveal neuropathological mechanisms, aiding OSA diagnosis.

Is it important to stabilize palatopharyngeus muscle to pterygomandibular raphe under vision during surgery for OSA?

Access the importance of visualizing the pterygomandibular raphae (PMR) while fixing palatopharyngeous (PPM) muscle to the pterygomandibular raphae (PMR). Randomized controlled trial. First group, forty-two OSA patients performed either Anterolateral advancement pharyngoplasty (ALA) or Barbed reposition pharyngoplasty (BRP) while visualizing the PMR according to the following criteria: age between 21 and 60 years, body mass index (BMI) < 35, and patients with lateral pharyngeal collapse diagnosed with drug induced sleep endoscopy (DISE). The results were compared to the second control group of 42 patients performed the same procedures without exposing the PMR. PMR was bilaterally present in 27 (64.28%) patients and bilaterally absent in 5 (11.8%) patients while unilateral in 10 (23.9%) patients. PSG findings in group 1: Apnea hypopnea index (AHI) decreased from 40.84 ± 26.93 to 14.81 ± 7.43 (P < 0.001), mean Lowest oxygen saturation (LOS) significantly increased from 79.25 ± 14.93 to 89.92 ± 10.7 (P < 0.001) and Epworth sleepiness scale (ESS) significantly dropped from 13.25 ± 4.65 to 6.1 ± 2.06 (P < 0.001). Group 2 results showed AHI decrease from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ 0.001), LOS increased from 81.86 ± 6.41 to 90.21 ± 3.70 and ESS dropped from 14.95 ± 3.72 to 7.91 ± 3.05. The difference between both groups was not statistically significant (P > 0.001). Fixation of PPM to the PMR under direct vision doesn't significantly affect the surgical outcomes but can increase the procedure efficiency and reduce complication rate keeping in mind that PMR may be absent in some patients.

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

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

Phase-Amplitude Coupling in Theta and Beta Bands: A Potential Electrophysiological Marker for Obstructive Sleep Apnea.

Phase-amplitude coupling (PAC) between the phase of low-frequency signals and the amplitude of high-frequency activities plays many physiological roles and is involved in the pathological processed of various neurological disorders. However, how low-frequency and high-frequency neural oscillations or information synchronization activities change under chronic central hypoxia in OSA patients and whether these changes are closely associated with OSA remains largely unexplored. This study arm to elucidate the long-term consequences of OSA-related oxygen deprivation on central nervous system function. : We screened 521 patients who were clinically suspected of having OSA at our neurology and sleep centers. Through polysomnography (PSG) and other clinical examinations, 103 patients were ultimately included in the study and classified into mild, moderate, and severe OSA groups based on the severity of hypoxia determined by PSG. We utilized the phase-amplitude coupling (PAC) method to analyze the modulation index (MI) trends between different frequency bands during NREM (N1/N2/N3), REM, and wakefulness stages in OSA patients with varying severity levels. We also examined the correlation between the MI index and OSA hypoxia indices. Apart from reduced N2 sleep duration and increased microarousal index, the sleep architecture remained largely unchanged among OSA patients with varying severity levels. Compared to the mild OSA group, patients with moderate and severe OSA exhibited higher MI values of PAC in the low-frequency theta phase and high-frequency beta amplitude in the frontal and occipital regions during N1 sleep and wakefulness. No significant differences in the MI of phase-amplitude coupling were observed during N2/3 and REM sleep. Moreover, the MI of phase-amplitude coupling in theta and beta bands positively correlated with hypoxia-related indices, including the apnea-hypopnea index (AHI) and oxygenation desaturation index (ODI), and the percentage of oxygen saturation below 90% (SaO2<90%). OSA patients demonstrated increased MI values of theta phase and beta amplitude in the frontal and occipital regions during N1 sleep and wakefulness. This suggests that cortical coupling is prevalent and exhibits sleep-stage-specific patterns in OSA. Theta-beta PAC during N1 and wakefulness was positively correlated with hypoxia-related indices, suggesting a potential relationship between these neural oscillations and OSA severity. The present study provides new insights into the relationship between neural oscillations and respiratory hypoxia in OSA patients.

Abstract P322: Assessing the causal associations of obstructive sleep apnea syndrome and hypertension: a bidirectional two-sample Mendelian randomization study

Background: Obstructive sleep apnea syndrome (OSA) frequently coexists with hypertension, with 30% to 70% of OSA patients also having hypertension. Conversely, the incidence of OSA in hypertensive patients ranges from 30% to 50%. This study designs a bidirectional Mendelian randomization trial to explore the causal relationship between OSA and hypertension. Methods: The summary data for OSA were sourced from a recent large-scale genome-wide association study (GWAS) meta-analysis, which included 16,761 OSA patients and 201,194 European-ancestry controls from the Finnish biobank. Five SNPs were selected as instrumental variables (IVs) for OSA. The summary data for hypertension were obtained from the UK Biobank GWAS, which included 124,227 hypertension patients and 337,653 European-ancestry controls, making it the largest hypertension dataset in GWAS. From this dataset, 214 SNPs were selected as IVs for hypertension. Multiple MR methods, primarily the inverse variance weighted (IVW) method, were used for analysis. Sensitivity analyses of the MR results were performed using methods such as MR-Egger, and the F-statistic was used to evaluate the IVs. Results: OSA was associated with an increased risk of hypertension (OR=1.053, 95%CI 1.019-1.089, P&lt;0.01), and hypertension was significantly associated with an increased risk of OSA (OR=1.812, 95%CI 1.354-2.425, P&lt;0.001). There was heterogeneity in the bidirectional results (OSA → hypertension, P&lt;0.001; hypertension → OSA, P&lt;0.001), but no horizontal pleiotropy (OSA → hypertension, P=0.666; hypertension → OSA, P=0.556). The selected IVs for OSA and hypertension were strong (OSA-IVs F=14.695; hypertension-IVs F=39.624). Conclusion: This bidirectional MR analysis confirms the causal relationship between OSA and hypertension, with hypertension having a more pronounced effect on the incidence of OSA. OSA patients should regularly monitor their blood pressure and undergo routine physical examinations to detect hypertension early.

There is No Increased Pulmonary Risk Following Total Hip Arthroplasty in Patients Who Have Obstructive Sleep Apnea Without Underlying Lung Disease

BackgroundObstructive sleep apnea (OSA) is a frequent comorbidity. The current study evaluated whether there is a difference in the perioperative outcome after total hip arthroplasty (THA) in patients who had a low to moderate risk for OSA and high risk for OSA, respectively. MethodsAfter excluding patients who had concomitant lung disease (chronic obstructive pulmonary disease, asthma, or lung fibrosis) and those missing a STOP-Bang Score, 1,141 THA patients who had OSA were included in this retrospective study. Patients at low to moderate risk for OSA (STOP-Bang Score 0 to 4) and patients at high risk for OSA (STOP-Bang Score 5 to 8) were compared, and SpO2 (oxygen saturation) drops < 90% as well as readmission rates were compared between patients who did and did not use continuous positive airway pressure (CPAP). ResultsThere was no difference in the risk of SpO2 drop below 90% (1 versus 0%, P = 0.398) and readmission rate (2 versus 2%, P = 0.662) between patients who had low to moderate OSA risk (327 THA) and high OSA risk (814 THAs). There was no difference in SpO2 (P > 0.999) and a decrease in oxygen flow rate from the postanesthesia care unit to the morning of the first postoperative day. A CPAP device was used by 41% (467 of 1,141) of patients. There were no differences in SpO2 drop < 90% (0 versus 0%, P = 0.731) and readmission rate (2 versus 2%, P = 0.612) between patients who did and did not use a CPAP machine. ConclusionsThe current study showed no difference in perioperative outcomes between OSA patients undergoing THA who had a low STOP-Bang Score and patients who had a high STOP-Bang Score, regardless of the use of a CPAP machine. These data suggest that an elevated Stop-Bang Score does not indicate an increased perioperative risk for OSA patients when deciding on outpatient discharge.

O57 NOCTURNAL BLOOD PRESSURE FLUCTUATION AND DIPPING PATTERNS IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNOEA

Background and Objective: Nighttime blood pressure (BP) is important for diagnosis of hypertension and for cardiovascular risk stratification. Remarkably, a reverse dipping pattern is a strong and independent predictor of overall mortality and major adverse cardiovascular events. Therefore, the further clarification of the underlying mechanisms of non- and reverse dipping is crucial to improve the treatment of patients with nighttime hypertension. Methods: We investigated 97 patients with suspected obstructive sleep apnoea (OSA, AHI &gt;30) using standard polysomnography and continuous BP measurement based on the pulse-transit-time method (SOMNOscreen Plus®, SOMNOmedics). Frequency and amplitude of fluctuations in systolic BP following sleep disturbances (OSA) were investigated. Results: Apnoeic events went along with transient increases of BP. In some cases, systolic BP did not reach the value before the apnoea but increased over time. We defined elevations of the systolic BP baseline by &gt;10 mmHg with a duration of &gt;10 min as BP superpositions. The superposition periods were also characterized by increased BP amplitudes with peak values of BP up to 220 mmHg. Superposition occurred in 48 patients. Further, 65% of the OSA patients were identified as non-dippers. However, nearly all the patients with superposition (98%) were identified to have non-dipper or reverse dipper patterns. Conclusions: Our study strongly suggests that non-dipping and reverse dipping in patients with severe OSA are causally linked to OSA related BP fluctuations. Further, continuous elevations in SBP baseline (superpositions) result in extreme BP values. This behaviour with high BP peaks may be contributing to the increased mortality in patients with reverse dipping. Therefore, identification and adequate treatment of patients with reverse dipping reduces the cardiovascular risk and may prolong their life.

The knowledge profile, attitudes, and perioperative management of Chinese anesthesiologists towards patients with obstructive sleep apnea: a cross-sectional survey.

Obstructive sleep apnea syndrome (OSA) is increasingly encountered by anesthesiologists in clinical practice. However, research on managing these patients among anesthesiologists in China is scarce. This study aims to investigate the knowledge, attitudes, and perioperative management strategies for OSA patients among Chinese anesthesiologists. In this cross-sectional study, anesthesiologists from various hospitals across China were invited to complete a thirty-eight-item online questionnaire survey between October 1 and November 1, 2022. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) scale was utilized to measure their knowledge and attitudes. A total of 470 valid participants were recruited for this research, resulting in a valid response rate of 73.3%. (1) While the majority of participants acknowledged the importance of identifying OSA during perioperative management, only 58.3% felt confident in managing OSA patients; (2) Anesthesiologists with higher professional titles and longer work experience exhibited greater confidence in managing OSA patients; (3) Just under half of the participants were familiar with the STOP-Bang and Berlin questionnaires. Anesthesiologists with over 20 years of work experience were more likely to use the STOP-Bang and Berlin questionnaires compared to those with less than 10 years of work experience (OR = 3.166, P < 0.001); (4) 71.1% of participants expressed approval regarding the preparation of sugammadex for muscle relaxation reversal, while only 32.8% approved the safety of opioid use for postoperative analgesia in OSA patients. The study displayed that Chinese anesthesiologists have inadequate knowledge and perioperative management of OSA than expected. However, they have positive attitudes towards the assessment and management of OSA. The study highlights the need for high-quality training to identify and manage OSA among Chinese anesthesiologists.

Analysis of the difference of therapeutic effect and predictive factors between postural and non-postural OSA after modified uvulopalatopharyngoplasty

Objective:To analyze the factors influencing the outcome of uvulopalatopharyngoplasty in positional obstructive sleep apnea（POSA） and non-positional OSA（NPOSA） patients, and to explore the differences between the two groups. Methods:The data of 101 patients with obstructive sleep apnea who received treatment from November 2020 to November 2023 were retrospectively analyzed. Among them, 45 positional patients（POSA group） and 56 non-positional patients（NPOSA group）, who underwent overnight polysomnography were included. The upper airway（UA） anatomy was evaluated by three-dimensional computer tomography（3D-CT）. All patients received revised uvulopalatopharyngoplasty with uvula preservation and were followed using polysomnography for at least three months postoperatively. Results:The overall effective rate was 55.45%. The surgical success rate in POSA undergoing UPPP was higher than NPOSA（POSA 30/45, 66.7% versus NPOSA 26/56, 46.4%, P=0.042）. The H-UPPP effect of POSA was negatively correlated with the minimum lateral airway of the Velopharyngeal airway（r=-0.505, P<0.001）, the minimum lateral airway of the glossopharyngeal airway（r=-0.474, P=0.001） and the minimum cross-sectional area（r=-0.394, P=0.007）. Logistic analysis showed that minimal lateral airway of the glossopharynxgeum（mLAT）（OR 0.873; 95%CI 0.798-0.955, P=0.003） was a significant predictor for surgical outcomes among POSA patients. In NPOSA, age（OR 0.936; 95%CI 0.879-0.998, P=0.042） was a significant predictor for surgical outcomes. Conclusion:The effect of H-UPPP was higher in POSA than in NPOSA. The width of glossopharyngeal mLAT was an important predictor of POSA efficacy. Age was a predictor of NPOSA efficacy.

Retraction Note: Automatic detection of respiratory arrests in OSA patients using PPG and machine learning techniques

Retraction Note: Automatic detection of respiratory arrests in OSA patients using PPG and machine learning techniques

An analysis of the potential association between obstructive sleep apnea and osteoporosis from the perspective of transcriptomics and NHANES

BackgroundObstructive sleep apnea (OSA) and osteoporosis (OP) are prevalent diseases in the elderly. This study aims to reveal the clinical association between OSA and OP and explore potential crosstalk gene targets.MethodsParticipants diagnosed with OSA in the National Health and Nutrition Examination Survey (NHANES) database (2015–2020) were included, and OP was diagnosed based on bone mineral density (BMD). We explored the association between OSA and OP, and utilized multivariate logistic regression analysis and machine learning algorithms to explore the risk factors for OP in OSA patients. Overlapping genes of comorbidity were explored using differential expression analysis, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and Random Forest (RF) methods.ResultsIn the OSA population, the weighted prevalence of OP was 7.0%. The OP group had more females, lower body mass index (BMI), and more low/middle-income individuals compared to the non-OP group. Female gender and lower BMI were identified as independent risk factors for OP in OSA patients. Gene expression profiling revealed 8 overlapping differentially expressed genes in OP and OSA patients. KCNJ1, NPR3 and WT1-AS were identified as shared diagnostic biomarkers or OSA and OP, all of which are associated with immune cell infiltration.ConclusionThis study pinpointed female gender and lower BMI as OP risk factors in OSA patients, and uncovered three pivotal genes linked to OSA and OP comorbidity, offering fresh perspectives and research targets.

A new perspective on OSAS cases with the Baveno classification

ABSTRACT Objective/Background Since the apnea-hypopnea index (AHI), which is used in the diagnosis and grading of OSAS, does not adequately reflect the clinical perspective of the disease, the Baveno classification of OSA was developed, which allows multicomponent evaluation of OSAS patients. The aim of our study was to evaluate the application of the Baveno classification in clinical practice. Patients/Methods A prospective study was performed on patients diagnosed with OSAS between January 2021 and June 2022. Patients were divided into 4 groups according to Baveno classification (Groups A-D) and three groups as mild, moderate, and severe OSAS according to AHI. Results A total of 378 patients (70% male, mean age 48.68 ± 11.81 years) were included in the study. The patients had mild (n: 75; 20%), moderate (n: 88; 23%), and severe (n: 215; 57%) OSAS. According to Baveno classification, patients were included in Groups A (n: 90; 24%), B (n: 105 (28%), C (n: 65; 17%), and D (n: 118; 31%). The mean AHIs of the Baveno groups were similar (p = 0.116). Oxygen desaturation index (ODI) was higher in Groups B and D compared to Group A. The duration of T90 desaturation was longer in Groups C and D compared to Groups A and B (p < 0.05). Conclusions The Baveno classification divided our OSAS cases into equivalent groups. One out of every four patients with mild OSAS was in Group D. This data was noteworthy in that the Baveno classification allows for the identification of symptomatic and comorbid patients with mild OSAS according to AHI and for the application of more effective treatments to these patients. Patients with comorbidities experienced oxygen desaturation for a longer period of time at night, and oxygenation deteriorated in patients with prominent symptoms. Baveno classification was found to be a more reasonable and easily applicable approach in clinical practice.

The role of obstructive sleep apnea and nocturnal hypoxia as predictors of mortality in cancer patients

BackgroundObstructive sleep apnea (OSA), due to its high prevalence, has been associated with a number of comorbidities, frequently impacting the overall course of these other diseases if left untreated. Recent studies highlight a potential association between OSA and cancer. This study investigates how OSA severity and hypoxia affect cancer prognosis, aiming to elucidate how they interplay. MethodsRetrospective study including patients with a diagnosis of OSA after any cancer type followed up in a tertiary center during a 10-year period. OSA was mainly diagnosed after level III polysomnographic studies. ResultsNocturnal hypoxia was significantly more prevalent in patients presenting lung cancer versus other malignancies and was associated with higher rates of oncologic disease progression. Overall survival was significantly lower in severe OSA patients and also in patients presenting nocturnal hypoxia. A composite hypoxia score considering both OSA severity and significant hypoxia was an independent predictor of mortality regardless of clinical cancer staging and treatment. Shorter time between cancer and OSA diagnosis was also associated with worse prognosis. ConclusionThis study suggests an association between OSA severity and nocturnal hypoxia and increased cancer mortality independently from possible confounding factors such as age, cancer clinical staging at diagnosis, treatment modality and also progression. Neoplastic patients with severe OSA and/or complex hypoxia seem to have lower overall survival rates than those with less severe OSA and nocturnal hypoxia.

Correlation between arousal threshold and occurrence of hypertension in patients with obstructive sleep apnea hypopnea syndrome

Objective: To investigate the relationship between arousal threshold (ArTH) and hypertension in patients with obstructive sleep apnea hypopnea syndrome (OSA). Methods: This study recruited 648 patients diagnosed with OSA at the Sleep Center of the Second Affiliated Hospital of Soochow University from January 2020 to August 2021, including 569 males and 79 females, aged 42(35,52) years. The basic demographic information and clinical data of all patients were collected, including blood pressure measurement, and relevant questionnaire scores, and nocturnal polysomnography (PSG) parameters. A clinical predictive model based on sleep apnea hypopnea index (AHI), lowest pulse oxygen saturation (LSpaO2) and hypopnea ratio (FHypopneas) was used to access the arousal threshold of OSA patients. Patients were divided into OSA group and OSA with hypertension group according to whether they were combined with hypertension. The differences in the above indexes between the two groups were analyzed to explore the relationship between arousal threshold and hypertension in OSA patients, using a binary logistic stepwise regression analysis. Results: A total of 648 OSA patients were enrolled, including 415 in the OSA with hypertension group and 233 in the OSA group. Compared with OSA group, OSA with hypertension group had older age, higher body mass index (BMI), higher blood pressure at bedtime and at awakening, higher AHI and lower proportion of hypopnea (all P<0.05). There were no significant differences between other general data and PSG parameters (all P>0.05). The proportion of patients with low arousal threshold (AHI<30 events per hour, LSpO2>82.5%, Fhypopneas>58.3%) in OSA with hypertension group was lower, and the proportion of phenotypic patients with low arousal threshold was significantly lower (30.1% vs. 52.4% P<0.001). Binary logistic stepwise regression analysis showed that the high arousal threshold (OR=1.930, 95%CI:1.326-2.808, P=0.001) was an independent risk factor for OSA complicated with hypertension. Conclusion: The arousal threshold is associated with the development of hypertension in OSA patients, and OSA patients with a high arousal threshold have a higher risk of developing hypertension.

Association between dietary patterns and the risk of all-cause mortality among old adults with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) was associated with the increased cardiovascular events and all-cause mortality. And anti-inflammatory dietary has potential to improve the prognosis of OSA. This study aimed to investigate the association of anti-inflammatory dietary patterns with all-cause mortality among individuals with OSA.MethodsThis retrospective cohort study involved 1522 older adults with OSA from 2005 to 2008 in the National Health and Nutrition Examinations Survey (NHANES). Mortality status was determined by routine follow-up through December 31, 2019, using the National Death Index. Anti-inflammatory dietary patterns included Alternate Mediterranean Diet Score (aMED), Healthy Eating Index-2015 (HEI-2015), and Alternate Healthy Eating Index-2010 (AHEI-2010). Weighted Cox proportional hazard regression models were performed to investigate the association between anti-inflammatory dietary pattern and all-cause mortality.ResultsAfter a median follow-up of 131 months, 604 participants were recorded all-cause mortality. The mean age of OSA patients was 68.99 years old, of whom 859 were male (52.34%). Higher adherence of aMED (HR = 0.61, 95%CI: 0.48 to 0.78) and HEI-2015 (HR = 0.75, 95%CI: 0.60 to 0.95) were associated with lower all-cause mortality risk in the elderly with OSA. Conversely, no association was found between AHEI-2010 dietary pattern and all-cause mortality in individuals with OSA. In the component analysis of aMED, it was found that a higher intake of vegetables and olive oil potentially contributes to the reduction all-cause mortality risk in the elderly with OSA (HR = 0.60, 95%CI: 0.48 to 0.76; HR = 0.67, 95%CI: 0.63 to 0.71).ConclusionHigher adherence to the aMED and the HEI-2015 was associated with a lower risk of all-cause mortality in OSA. Future interventions in the elderly with OSA should considering adopting anti-inflammatory dietary patterns.

Increased Risk of Postoperative Complications in Patients Who Have Obstructive Sleep Apnea Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundObstructive sleep apnea (OSA) has been linked to multiple adverse health outcomes and postoperative complications. Despite the high prevalence of OSA in patients undergoing total joint arthroplasty (TJA), few studies have evaluated the postoperative course of OSA patients after joint arthroplasty surgery. MethodsPubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610). ResultsThere were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P < .001; I2 = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P < .001; I2 = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P = .005; I2 = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P = .001; I2 = 0%). ConclusionsA significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA.

A Novel Continuous Sleep State Artificial Neural Network Model Based on Multi-Feature Fusion of Polysomnographic Data.

Sleep structure is crucial in sleep research, characterized by its dynamic nature and temporal progression. Traditional 30-second epochs falter in capturing the intricate subtleties of various micro-sleep states. This paper introduces an innovative artificial neural network model to generate continuous sleep depth value (SDV), utilizing a novel multi-feature fusion approach with EEG data, seamlessly integrating temporal consistency. The study involved 50 normal and 100 obstructive sleep apnea-hypopnea syndrome (OSAHS) participants. After segmenting the sleep data into 3-second intervals, a diverse array of 38 feature values were meticulously extracted, including power, spectrum entropy, frequency band duration and so on. The ensemble random forest model calculated the timing fitness value for all the features, from which the top 7 time-correlated features were selected to create detailed sleep sample values ranging from 0 to 1. Subsequently, an artificial neural network (ANN) model was trained to delineate sleep continuity details, unravel concealed patterns, and far surpassed the traditional 5-stage categorization (W, N1, N2, N3, and REM). The SDV changes from wakeful stage (mean 0.7021, standard deviation 0.2702) to stage N3 (mean 0.0396, standard deviation 0.0969). During the arousal epochs, the SDV increases from the range (0.1 to 0.3) to the range around 0.7, and decreases below 0.3. When in the deep sleep (≤0.1), the probability of arousal of normal individuals is less than 10%, while the average arousal probability of OSA patients is close to 30%. A sleep continuity model is proposed based on multi-feature fusion, which generates SDV ranging from 0 to 1 (representing deep sleep to wakefulness). It can capture the nuances of the traditional five stages and subtle differences in microstates of sleep, considered as a complement or even an alternative to traditional sleep analysis.