Obstructive Sleep Apnea Outcomes Research Articles

Pediatric Obstructive Sleep Apnea: An Updated Review

Abstract Pediatric obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction during sleep, leading to disrupted breathing patterns and intermittent hypoxemia. This review synthesizes current literature on pediatric OSA, covering epidemiology, etiology, clinical presentation, diagnosis, and management. OSA affects 1%–5% of children, with adenotonsillar hypertrophy as a primary cause. The interplay of anatomical and neuromuscular factors contributes to OSA pathophysiology. Clinical manifestations include snoring, witnessed apneas, and daytime sleepiness, although diagnosis can be challenging due to varied symptoms. Diagnostic methods encompass clinical assessment and polysomnography, while management strategies range from adenotonsillectomy to continuous positive airway pressure therapy. Early recognition and intervention are crucial to prevent complications and optimize outcomes in pediatric OSA. Further research is needed to refine diagnostic approaches and enhance treatment efficacy for this significant pediatric health concern.

A Novel Method for Pre-selectivity of Oral Appliance Palliative Pharyngeal Airway Outcomes in Obstructive Sleep Apnea: A Pilot Study

A Novel Method for Pre-selectivity of Oral Appliance Palliative Pharyngeal Airway Outcomes in Obstructive Sleep Apnea: A Pilot Study

Hypoglossal Nerve Stimulation Therapy in a Belgian Cohort of Obstructive Sleep Apnea Patients.

Hypoglossal nerve stimulation (HGNS) has emerged as a widespread and innovative treatment option for selected moderate-to-severe obstructive sleep apnea (OSA) patients who cannot be treated effectively with traditional treatment modalities. In this observational cohort study, the objective and subjective outcomes of Belgian OSA patients treated with HGNS therapy were analyzed at 6 and 12 months post-implantation. Thirty-nine patients implanted with a respiration-synchronized HGNS device at the Antwerp University Hospital w ere included in this study. Patients underwent baseline in-laboratory polysomnography and a follow-up sleep study 6 and 12 months post-implantation. Questionnaires on patient experience and daytime sleepiness were filled out and data on objective therapy usage were collected. All 39 patients completed the 6-month follow-up and 21 patients (54%) completed the 12-month follow-up. Median AHI decreased from 33.8 [26.1;45.0] to 10.2 [4.8;16.4] at the 6-month follow-up, and to 9.6 [4.1;16.4] at the 12-month follow-up (p < 0.001). The surgical success rate, according to the Sher20 criteria, was 80% and 76% at the 6- and 12-month follow-ups, respectively. Median ESS improved from 12.0 [7.0;18.0] at baseline to 6.0 [2.5;11.0] at 6 months (p < 0.001) and to 6.5 [2.8;11.5] at 12 months (p = 0.012). Objective therapy usage was 7.4 [6.6;8.0] and 7.0 [5.9:8.2] h/night at the 6- and 12-month follow-ups, respectively. A high overall clinical effectiveness of HGNS therapy, as shown by a mean disease alleviation of 58%, was demonstrated at 12 months post-implantation. Overall, HGNS therapy using respiration-synchronized neurostimulation of the XII cranial nerve resulted in a significant improvement in both objective and subjective OSA outcomes, with a high level of patient satisfaction and high treatment adherence.

Association Between Healthy Behaviors and Health Care Resource Use With Subsequent Positive Airway Pressure Therapy Adherence in OSA

BackgroundThe healthy adherer effect (HAE) has gained increasing attention as potential source of bias in observational studies examining the association of positive airway pressure (PAP) adherence with health outcomes in obstructive sleep apnea (OSA). Research questionIs adherence to PAP associated with healthy behaviors and healthcare resource use prior to device prescription? MethodsData from the IRSR Pays de la Loire Sleep Cohort were linked to health administrative data to identify proxies of heathy behaviors (HB) including adherence to cardiovascular (CV) drugs (medication possession ratio, [MPR]), cancer screening tests, influenza vaccination, alcohol and smoking consumption, and drowsiness-related road accidents during the two years preceding PAP onset in OSA patients. Multivariable regression analyses were conducted to evaluate the association of HB with subsequent PAP adherence. Healthcare resource use was evaluated according to subsequent PAP adherence. FindingsWe included 2,836 patients who had started PAP therapy between 2012 and 2018 (65% of whom were PAP adherent with mean daily use ≥4h/night). Being adherent to CV active drugs (MPR≥80%) and non-smoker were associated with a higher likelihood of PAP adherence (odds ratio, OR [95% confidence interval]: 1.43 [1.15; 1.77] and 1.37 [1.10; 1.71] respectively). Patients with no history of drowsiness-related road accidents were more likely to continue PAP (OR: 1.39 [1.04; 1.87]). PAP adherent patients used less healthcare resources 2 years before PAP initiation, than non-adherents (mean number of outpatient consultations: 19.0 vs 17.2, P=.003; hospitalization days: 5.7 vs 5.0, P=.04; emergency room visit: 30.7 vs 24.0% P=.0002). InterpretationPatients who adhere to PAP therapy of OSA were more health seeking and less healthcare users prior to device initiation than non-adherent patients. Until the HAE associated with PAP adherence is better understood, caution is warranted when interpreting the association of PAP adherence with CV health outcomes and healthcare resource use in non-randomized cohorts.

0791 Polysomnographic Outcomes of Obstructive Sleep Apnea in Infants with Pierre-Robin Sequence

0791 Polysomnographic Outcomes of Obstructive Sleep Apnea in Infants with Pierre-Robin Sequence

Exploring the Prevalence and Characteristics of Obstructive Sleep Apnea Among Idiopathic Pulmonary Fibrosis Patients: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to scrutinize the prevalence, characteristics, and outcomes of obstructive sleep apnea (OSA) in individuals with ideopathic pulmonary fibrosis (IPF). We carried out this systematic review and meta-analysis in accordance with the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement (PRISMA). Two independent researchers systematically searched major databases, including MEDLINE/PubMed, EMBASE, and the Cochrane Library, from January 1, 2000, until December 31, 2023. We included all studies involving adult patients (age >18 years) with IPF that assessed the prevalence and characteristics of OSA in IPF patients. A total of seven studiesinvolving a pooled sample of 411 patientswere included in this meta-analysis. The pooled prevalence of OSA among individuals with IPF was found to be 70% (95% CI: 59 to 82%). Individuals with OSA exhibited a significantly higher mean body mass index (BMI) compared to their counterparts. While individuals with both IPF and OSA exhibited higher scores on the Epworth Sleepiness Scale (ESS) compared to those with IPF alone, the OSA group also showed lower oxygen saturation during sleep in comparison to non-OSA patients. In summary, OSA is a prevalent coexisting condition among individuals with IPF. This presence could worsen the nighttime oxygen saturation. Consequently, there is a need for more extensive studies involving more uniform participant groups.

Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review.

Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time. An exploratory longitudinal, retrospective, randomized chart review was done to assess clinical outcomes between patients with OSA who were defined as PAP therapy adherent (n=50) and non-adherent (n=50) during an eight-year observation period. No significant differences were shown between groups for mortality, hospitalizations, or development of co-morbidities during the observation period. However, logistic regression showed significantly higher odds of adherence in male patients compared to female patients (OR=8.519; 95%CI=1.301-55.756; p=0.025) and significantly lower odds of adherence in patients with higher normal (OR=0.039; 95%CI=0.005-0.392; p=0.003), mild excessive (OR=0.039; 95%CI=0.003-0.517; p=0.014), and severe excessive (OR=0.088; 95%CI=0.012-0.635; p=0.016) daytime sleepiness compared to patients with lower normal daytime sleepiness. An increasing number of hospitalizations also corresponded with a significant decrease in odds of being adherent (OR=0.741; 95%CI=0.551-0.995; p=0.046). The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful.

The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review.

Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a potential therapeutic, attributed to their durable effects in weight loss and glycaemic control in metabolic syndromes, such as obesity and type 2 diabetes mellitus. This has led to significant investment into companies that produce these medications and divestment from traditional gold standard methods of OSA management such as continuous positive airway pressure machines. Despite these sentiments, the impacts of these medications on OSA outcomes are poorly characterised, with no high-quality evidence at this stage to support this hypothesis. This scoping review therefore aims to address the research question of whether GLP-1RAs lead to a direct improvement in OSA and associated hypopnoea syndromes. A scoping review was performed following a computer-assisted search of Medline, Embase and Cochrane Central databases. Papers that evaluated the use of GLP-1RA medications related to sleep-disordered breathing, OSA or other sleep-related apnoeic or hypopnoeic syndromes were included. Literature search and evaluation identified 9 articles that were eligible for inclusion. Of these, 1 was a study protocol, 1 was a case report, 1 was an abstract of a randomised controlled trial (RCT), 1 was a non-randomised clinical trial and the remaining 5 were randomised clinical trials of variable rigour. All studies evaluated the outcomes of GLP-1RAs in patients with diagnosed OSA or symptoms suggestive of this condition. This scoping review identified early evidence to suggest that GLP-1RAs may improve OSA as defined by reduction in apnoea-hypopnoea index (AHI). This evidence is however conflicting due to contradicting results demonstrated from other studies. Overall, these medications were tolerated well, with minor gastrointestinal side-effects reported in some cases. Of all included studies, the quality of evidence was low, with short lengths of follow-up to identify durable effects of these medications on OSA outcomes and identify adverse events. More rigorous, RCTs with sufficient length of follow-up are required before consideration of formalising these medications into OSA treatment guidelines, frameworks and policies are warranted.

Assessment of Autonomic Nervous System Activity Using Spectral Analysis of Heart Rate Variability After Continuous Positive Airway Pressure (CPAP) Therapy in Patients With Sleep Apnea.

Heart rate variability (HRV) measurements have emerged as a valuable tool for understanding the functioning of the autonomic nervous system (ANS) and assessing the health outcomes of obstructive sleep apnea (OSA) in patients. Sleep and the ANS exert a mutual influence on each other. Sleep promotes relaxation and recovery of the ANS. Conversely, ANS activity plays a role in regulating the onset and maintenance of sleep. The impact of continuous positive airway pressure (CPAP) therapy on patient recovery levels was investigated by assessing the restoration of ANS activity using HRV indicators. The study included patients with OSA who had been on CPAP for at least eight weeks. The patients were divided into two groups, namely the experimental group (CPAP-compliant) and the control group (CPAP-non-compliant). The study included a total of 38 patients, with 20 in the CPAP-compliant group and 18 in the CPAP-non-compliant group. The HRV analysis included time- and frequency-domain measures. Data was collected in various resting conditions, including lying down, standing, regular breathing, and under physiological stress induced by deep breathing and the Valsalva maneuver. After CPAP treatment, there was an increase in the average values for SDNN for deep breathing and Valsalva maneuvers. The mean changes in SDNN for CPAP-non-compliant versus CPAP-compliant groups for normal breathing increased from 32.50±5.33 to 42.40±8.03, while the values for Valsalva increased from 20.16±2.47 to 25.45±3.03. Despite the observed variations in SDNN, there was no significant change in the average change in heart rate (∆ HR), except during the Valsalva maneuver. Post-CPAP values for the Valsalva ratio were significantly decreased in deep breathing. The E:I ratio for the CPAP-compliant group during normal breathing was 1.08±.16 compared to 1.55±.09; t (36) =-11.15, p <0.001 in the CPAP-non-compliant group. During deep breathing, the ratio was 1.36±.15 versus 1.59±.24; t (36) =-3.578, p <0.001. The high frequency (HF)nu mean values for deep breathing were 34.06±5.546 compared to 35.00±6.358; t (36) = -.485, p=.630. For the Valsalva maneuver, the values were 29.94±4.721 versus 26.95±6.621; t (36) =1.589, p=.060. The HF/low frequency (LF) ratio was found to be significant only in supine, standing, and normal breathing. The utilization of CPAP therapy was found to be effective in achieving and sustaining autonomic balance during tasks like standing and engaging in regular breathing patterns. During activities that involve intense physical effort, like the Valsalva maneuver, the HRV metrics did not indicate any significant balance between sympathetic and parasympathetic activity. However, using CPAP therapy for a prolonged period can be beneficial in consistently improving the sympathovagal balance in these patients.

Senolytic-facilitated Reversal of End-Organ Dysfunction in a Murine Model of Obstructive Sleep Apnea.

Rationale: Obstructive sleep apnea (OSA) is a highly prevalent condition that is associated with accelerated biological aging and multiple end-organ morbidities. Current treatments, such as continuous positive airway pressure (CPAP), have shown limited cognitive, metabolic, and cardiovascular beneficial outcomes despite adherence. Thus, adjunct therapies aiming to reduce OSA burden, such as senolytics, could improve OSA outcomes.Objectives: To assess if targeting senescence in addition to partial normoxia mimicking "good" CPAP adherence can improve physiological outcomes in mice exposed to chronic intermittent hypoxia.Methods: We compared the effects of 6 weeks of therapy with either partial normoxic recovery alone or combined with the senolytic navitoclax after 16 weeks of intermittent hypoxia exposures, a hallmark of OSA, on multiphenotypic cardiometabolic and neurocognitive parameters.Measurements and Main Results: Our findings indicate that only when combined with navitoclax, partial normoxic recovery significantly improved sleepiness (sleep in the dark phase: 34% ± 4% vs. 26% ± 3%; P < 0.01), cognition (preference score: 51% ± 19% vs. 70% ± 11%; P = 0.048), coronary artery function (response to acetylcholine [vasodilation]: 56% ± 13% vs. 72% ± 10%; P < 0.001), glucose, and lipid metabolism and reduced intestinal permeability and senescence in multiple organs.Conclusions: These findings indicate that the reversibility of end-organ morbidities induced by OSA is not only contingent on restoration of normal oxygenation patterns but can be further enhanced by targeting other OSA-mediated detrimental cellular processes, such as accelerated senescence.

Pharyngeal flap outcomes for velopharyngeal insufficiency: Evaluation of speech, obstructive sleep apnea, and velopharyngeal anatomy

The purpose of this study was to evaluate the speech outcomes, reveal postoperative rates of obstructive sleep apnea, and characterize changes in the pharyngeal flap and velopharyngeal anatomy following pharyngeal flap surgery for velopharyngeal insufficiency. A retrospective chart was reviewed for patients with clefts who underwent pharyngeal flap surgery between November 2020 and November 2021. The data collected included age, gender, cleft palate type, age at pharyngeal flap surgery, postoperative complications, age and type of primary palatoplasty, preoperative and postoperative speech assessments, magnetic resonance imaging findings, and obstructive sleep apnea outcomes. The authors included 72 nonsyndromic patients who underwent pharyngeal flap surgery following cleft palate repair. The mean age at pharyngeal flap surgery was 10.6 ± 6.2 years. There was a significant improvement in the Pittsburgh Weighted Speech Score Hypernasality Component and the nasalance scores of oral syllables (p < 0.001). The obstructive sleep apnea rate after pharyngeal flap surgery was 6.9%. Compared to preoperatively, the velar angle was more acute (p < 0.001), the velar length was longer (p < 0.001), the distance of the velum tip to the posterior pharyngeal wall was shorter (p < 0.001), the size of velopharyngeal gap was narrower (p < 0.001), and the pharyngeal flap atrophied (p < 0.001) at 6 months postoperatively. The pharyngeal flap improved speech outcomes in patients with velopharyngeal insufficiency with a relatively low incidence of obstructive sleep apnea (6.9%). The velum is positioned more superiorly and posteriorly, and the size of the velopharyngeal gap is substantially reduced after pharyngeal flap surgery. In addition, the pharyngeal flap partially atrophied over time.

Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography versus home-based efficacy sleep testing.

To evaluate whether laboratory or home-based hypoglossal nerve stimulation (HNS) management would have equivalent objective and subjective obstructive sleep apnea (OSA) outcomes 6 months after activation. Patients undergoing standard-of-care HNS implantation were randomized in a prospective, multicenter clinical trial to either a 3-month post-activation in-laboratory titration polysomnography (tPSG) or an efficacy home sleep study (eHST) with tPSG by exception for eHST non-responders at 5 months. Both arms underwent an eHST 6 months post-activation. Sixty patients were randomized. Patients experienced equivalent decreases in the apnea-hypopnea index (Mean difference: -0.01 events/hr [-8.75, 8.74]) across both arms with HNS; the selection of tPSG or eHST did not associate with therapy response rates (tPSG vs eHST: 63.2% vs 59.1%). The Epworth Sleepiness Scale (median of differences: 1 [-1, 3]) and device usage (median of differences: 0.0 h [-1.3, 1.3]) outcomes were similar but did not meet a priori statistical equivalence criteria. This prospective, multicenter, randomized clinical trial demonstrated that patients undergoing HNS implantation experienced statistically equivalent improvements in objective OSA outcomes and similar improvements in daytime sleepiness regardless of whether they underwent tPSG. HNS titration with tPSG may not be required for all postoperative patients. Registry: ClinicalTrials.gov; Identifier: NCT04416542.

O042 Healthy lifestyle is Associated with Reduced Cardiovascular Disease, Depression and Mortality in People at Elevated risk of Sleep Apnea

Abstract Background We evaluated 1) the independent and combined influence of obstructive sleep apnea (OSA) risk and a healthy lifestyle on typical OSA outcomes [excessive daytime sleepiness (EDS), depression, cardiovascular disease (CVD), and stroke]; and 2) the impact of a healthy lifestyle on survival in individuals presenting a heightened risk of OSA. Method We utilized data from 13,694 adults (median age 46 years; 50% men) for both cross-sectional and longitudinal analyses (15 years). A healthy lifestyle score ranging from 0 (most unhealthy) to 5 (most healthy) was computed based on diet, alcohol consumption, physical activity levels, smoking habits, and body mass index. Results A dose-response relationship was found between OSA risk and all examined chronic conditions and EDS (p for trend &amp;lt; 0.001). A healthy lifestyle was found to be inversely related to all chronic conditions (p for trend &amp;lt; 0.001), except EDS (p for trend = 0.379). A higher healthy lifestyle score correlated with lower odds of depression and CVD. An inverse relationship was found between healthy lifestyle score and depression (P for trend &amp;lt; 0.001), CVD (P for trend = 0.003), and stroke (P for trend = 0.025) in those with high OSA risk. An inverse relationship was observed between a healthy lifestyle and all-cause mortality in general, and in the moderate/high and high OSA risk groups (p for trend &amp;lt; 0.001). Discussion This study highlights the role of a healthy lifestyle in reducing chronic conditions and in enhancing survival rates in individuals with a heightened risk of OSA.

Obstructive sleep apnea is associated with the long-term prognosis of patients in acute coronary syndromes with prior myocardial infarction: Insights from OSA-ACS study

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to prior myocardial infarction (MI) remains unclear. We aimed to investigate the association between OSA and long-term cardiovascular outcomes in ACS patients with or without prior MI. MethodsWe prospectively recruited eligible 2160 ACS patients with portable sleep monitoring in Beijing Anzhen Hospital between June 2015 and January 2020. OSA was defined as an apnea hypopnea index (AHI) ≥15 events/hour. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. ResultsAmong 1927 patients enrolled, 1014 (52.6%) had OSA and 316 (16.4%) had prior MI. During 2.9 (1.5, 3.6) years of follow-up, multivariate analysis showed that OSA was associated with 1.7 times the risk of MACCE in patients with prior MI (50 events [28.2%] vs 24 events [17.3%]; adjusted HR = 1.74, 95%CI 1.04–2.90, P = 0.034), but not in patients without prior MI group (177 events [21.1%] vs 138 events [17.8%]; adjusted HR = 1.19, 95%CI 0.94–1.51, P = 0.15). There was no significant interaction between prior MI and OSA for MACCE (interaction P = 0.14). ConclusionsOSA was independently associated with an increased risk of MACCE among ACS patients, particularly among ACS patients with prior MI. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS characterized by prior MI are warranted.

Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review.

Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.

The Effects of Adenotonsillectomy for Obstructive Sleep Apnea on Growth Trajectory in Children With Obesity.

To analyze the growth trajectory of children with obesity before and after adenotonsillectomy (T&A). We hypothesize that T&A will not affect the growth trajectory but children in a multidisciplinary weight management program (MWMP) will have a healthier growth trajectory. Retrospective review. Tertiary Children's Hospital. Body mass index (BMI) trajectories of nonsyndromic children with obesity and obstructive sleep apnea (OSA) who underwent T&A were analyzed. A linear mixed effects model was fit to the BMI expressed as a percentage of the 95th percentile (%BMIp95 ) data. Covariates included demographic variables, pre- and postoperative participation in an MWMP, baseline obesity class, and time. We explored clinically meaningful interactions. BMI slope estimates before and after surgery were calculated and compared for baseline obesity classification and postoperative MWMP visits. A total of 177 patients, 58% male with a mean age of 9.7 years at the time of surgery, were studied. Higher baseline obesity class (II and III), time, the interaction between obesity class III and elapsed time relative to surgical date, and the interaction between obesity class III and the postsurgical period were all significantly associated with the outcome of %BMIp95 (P < .05). There was a significantly higher %BMIp95 trajectory following surgery in patients with baseline obesity class III who did not have any postoperative MWMP visits (P < .001). Preoperative obesity visits, however, were not significantly associated with postoperative growth. The association between T&A and weight trajectory depends upon obesity class and participation in a MWMP. Coordinated care of children with obesity between otolaryngologists and an MWMP may improve OSA and obesity outcomes. The level of evidence: 3.

Urological manifestations of obstructive sleep apnoea and their clinical utility in screening.

The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential to impact quality of life and patient outcomes. This article aims to strengthen the connection between OSA and urological complaints, summarise their response to CPAP treatment and discuss their clinical utility in OSA. Common urological complaints associated with OSA are nocturnal polyuria, overactive bladder symptoms and erectile dysfunction. Urinary symptoms are thought to be related to recurrent hypoxic episodes and have a significant impact on quality of life. Multiple studies report that urological symptoms and quality of life improve with CPAP treatment. However, current OSA screening questionnaires rely heavily on cardiorespiratory symptoms and specific risk factors that are not present in all OSA population subgroups. We review data that support clinicians incorporating urological symptoms when screening for OSA.

Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta-analysis is to determine the efficacy of OMT in OSA patients. PubMed/Medline, EMBASE, Cochrane, Web of Science. Using PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono-therapeutic OMT. The primary outcome of interest was apnea-hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep-related quality-of-life, and snoring frequency. Of the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD -10.2; 95% CI, -15.6, -4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD -5.66; 95% CI, -6.82, -4.5, p < 0.05), sleep-related quality-of-life (Pittsburgh Sleep Quality Index; MD -3.00; 95% CI, -4.52, -1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency. OMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long-term effects of OMT on OSA outcomes. 1 Laryngoscope, 134:480-495, 2024.

Reduced usage of upper airway stimulation therapy in patients with comorbid insomnia and obstructive sleep apnea.

Upper airway stimulation (UAS) is a hybrid surgical-medical device used to treat moderate-to-severe obstructive sleep apnea (OSA). Comorbid insomnia and OSA (COMISA) is present in ∼50% of these patients. Our aim was to study UAS outcomes and adherence in patients with COMISA. A retrospective review of 379 patients with OSA who underwent UAS implantation at a single institution between 2014 and 2021. Demographics, OSA severity metrics, and insomnia data were collected. Patients were categorized into OSA alone (OSAa) or COMISA. Objective adherence data were collected from device downloads during follow-up. Data were analyzed with using R Studio (R Foundation for Statistical Computing, Vienna, Austria) and Prism (Boston, MA, USA). Of the 274 patients included, 148 had COMISA (54.0%) and 126 OSAa (46.0%). Average follow-up time was 2.5 years and OSAa had more males than COMISA (P < .001). Patients with COMISA had higher insomnia severity index scores than OSAa preoperatively (16 vs 8.7; P = .003). All groups showed significant decreases in objective and self-reported OSA outcomes postoperatively, but there was no difference between COMISA and OSAa. Patient with COMISA had decreased device usage (4.9 vs 5.8 h/night; P = .015) and paused therapy more often than patients with OSAa (1.4 vs 0.4 pauses/night; P < .001). Multivariate linear regression, when controlling for sex as a covariate, showed insomnia to be an independent predictor of lower UAS hours/night and more pauses/night (P < .01). Patients with COMISA use UAS therapy for shorter durations and require more breaks from therapy when compared with those with OSAa. Future research is needed to explore the underlying mechanism and improve UAS treatment adherence in patients with COMISA. Kaffenberger TM, Chandna M, Kaki P, etal. Reduced usage of upper airway stimulation therapy in patients with comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med. 2023;19(12):1997-2004.

0444 Racial Differences in Positive Airway Pressure Requirements Amongst Obstructive Sleep Apnea Patients (The RACE-PAP Study)

Abstract Introduction Prior studies of patients with obstructive sleep apnea (OSA) show racial differences in clinical presentation. When compared with White patients, Black patients present with more severe OSA and greater sleepiness. Racial differences in upper airway collapsibility could explain these differences. Here, we investigated whether mean positive airway pressure (PAP) levels, a clinically accessible measure of upper airway collapsibility, differed by race in a cohort of patients adherent to PAP. Methods We conducted a retrospective analysis of White and Black adults with OSA who were prescribed auto-adjusting PAP (aPAP) therapy at a single academic center between January 2018 and January 2020. The analysis included adherent patients (usage on &amp;gt;70% of nights for ≥4 hours per night) with well-controlled OSA (defined as ≥50% reduction in apnea-hypopnea index [AHI] on aPAP and residual AHI&amp;lt; 10). Mean PAP level was compared between White and Black patients using linear regression controlled for age, gender, body mass index (BMI), AHI, O2 nadir, and mask type (full face, nasal, or unknown). Results Overall, 148 Black (56% women) and 230 White (36% women) patients were included. On average, Black patients were younger (50.7±14.6 vs. 53.8±12.7 years; p=0.037) with higher BMI (40.4±9.5 vs. 34.9±7.6 kg/m2; p&amp;lt; 0.0001). Black patients had less severe OSA on average, but this difference was not statistically significant (AHI of 33.9±25.5 vs 38.6±24.9 events/hour; p=0.077). After adjusting for covariates, Black patients had a 0.62 cm H2O (95% CI: 0.21 to 1.03) higher mean PAP level than White patients (p=0.003). There was a larger racial difference in mean PAP level among men (0.76 [0.16, 1.35] cm H2O; p=0.013) compared to a non-significant difference among women (0.34 [-0.23, 0.91] cm H2O; p=0.242). While statistically significant, differences were &amp;lt; 1 cm H2O and, thus, not clinically meaningful. Conclusion Black patients with OSA had a statistically significant but clinically insignificant difference in mean PAP level when compared with White patients. There was evidence of stronger differences in men than women. Further studies are needed to explore other potential mechanisms, including craniofacial anatomy, which may underlie racial differences in OSA presentation and outcomes. Support (if any) National Institutes of Health R01 1R01HL144859 (PIs: Schwartz, Dedhia)