Obstructive Sleep Apnea Outcomes Research Articles

Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRSDisease Burden.

Assess the impact of obstructive sleep apnea (OSA) on chronic rhinosinusitis (CRS) severeity. Retrospective database review. TriNetX US database. TriNetX US Collaborative Network database was queried for cohorts of patients with OSA, CRS, and CRS with comorbid OSA (CRS-OSA). Data included demographics, CRS severity was assessed via rates of endoscopic sinus surgery (ESS), antibiotic, and oral steroid use. Propensity score matching was performed to account for differences in demographics and clinical variables. The query identified 1,818,879 patients with CRS, 481144 with OSA, and 93,153 CRS-OSA patients. OSA-CRS patients had higher rates of hypertension, diabetes mellitus, obesity, and asthma than either CRS or OSA populations (P < 0.0001). CRS-OSA patients demonstrated higher rates of ESS (odds ratio [OR]: 1.91, 1.82-2.02, P < 0.0001), antibiotic (OR: 1.90, 1.81-1.96, P < 0.001), and oral steroid use (OR: 2.23, 2.16-2.28, P < 0.001) compared to CRS-only patients. CRS-OSA patients not on continuous positive airway pressure had higher utilization of antibiotics (OR: 3.24, 2.82-3.71, P < 0.0001) and steroids (OR: 2.28, 2.05-2.55, P < 0.0001) than nonutilizers. CRS-OSA patients with sleep-related surgical interventions required fewer antibiotic courses (OR: 1.93, 1.62-2.28, P < 0.0001). CRS-OSA patients experience higher rates of comorbidities associated with both diseases than those with CRS or OSA alone. OSA was associated with an increased risk of ESS, antibiotic, and steroid use in patients with CRS. There appears to be a correlation with treatment of OSA and CRS outcomes, however, further studies are required.

Cannabinoids for obstructive sleep apnea: A systematic review.

Cannabinoids have emerged as a potential treatment for obstructive sleep apnea (OSA). This systematic review aimed to summarize the efficacy and safety of cannabinoids to treat OSA. Databases including Ovid MEDLINE, EMBASE, Scopus, PsycINFO, and International Pharmaceutical Abstracts were searched; experimental and observational studies were eligible for inclusion. One-hundred seventy unique records were screened, and nine studies included: five full-text studies and four published abstracts. The five full-text studies were judged for quality appraisal: two studies deemed at low risk for bias, one study deemed to have some concerns for bias, and two studies deemed to have high risk for bias. Seven of nine total studies were experimental designs and evaluated dronabinol, and the other two studies were observational designs evaluating cannabis. The range of cannabinoid therapy duration spanned from 1 to 6 weeks, and the median duration was 3 weeks. Eight of nine total studies reported statistically significant, positive OSA outcomes due to cannabinoid therapy including reductions in the apnea hypopnea index and improvements in patient-reported daytime sleepiness scales. Between 70% and 80% of study participants reported neuropsychiatric and gastrointestinal adverse events attributable to cannabinoids. The American Academy of Sleep Medicine does not recommend using cannabinoids to treat OSA due to a lack of long-term safety and efficacy data. This systematic review found similar limitations, with the median cannabinoid treatment duration being only 3 weeks. Adequately powered experimental trials over longer time frames are necessary to more completely assess the long-term efficacy and safety of cannabinoids in the treatment of OSA and its effects on common comorbid conditions, such as obesity and cardiovascular disease.

Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Prospective Studies.

Obstructive sleep apnea (OSA) is a prevalent clinical disorder characterized by intermittent airway obstruction during sleep, resulting in hypoxemia and hypercapnia. Although OSA is associated with increased cardiovascular disease (CVD) risk, such as hypertension, the precise nature of this relationship remains uncertain. This systematic review and meta-analysis aim to evaluate the potential links between OSA and cardiovascular outcomes by synthesizing data from recent prospective studies. A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing electronic databases, including PubMed/MEDLINE, Scopus, and the Cochrane Library. The PICTS (patients, index test, comparator/reference test, target condition, study design) framework was used to structure the primary research question and define the investigation's scope. The Newcastle-Ottawa Scale (NOS) was employed for quality appraisal, and a meta-analysis was performed using Review Manager 5.4 software (Cochrane Collaboration, London, UK). The analysis included 12 studies, focusing on the association between OSA and various cardiovascular outcomes, including hypertension, coronary artery disease, congestive heart failure, cardiac arrhythmias, and cardiovascular events. The pooled relative risk (RR) from the random-effects model was 0.79 (95% CI: 0.56-1.03), indicating a non-significant reduction in cardiovascular risk associated with OSA. The results were heterogeneous, with individual studies showing both increased and decreased risk. Subgroup analyses based on study design, patient characteristics, and follow-up duration suggested that the observed associations were stable across different subsets of studies. However, the overall findings did not establish a definitive causal link between OSA and increased cardiovascular risk. This meta-analysis underscores the complex relationship between OSA and CVD, highlighting the need for further research to elucidate the underlying mechanisms and confirm the potential causal association. Despite the lack of significant findings, the high prevalence of OSA and its association with cardiovascular risk factors warrant routine screening and early intervention, particularly through continuous positive airway pressure (CPAP) therapy, which may mitigate the cardiovascular risks linked to OSA. Future studies should focus on high-quality prospective data and explore the impact of OSA management on cardiovascular outcomes.

Nocturnal wearing of complete dentures and obstructive sleep apnea: A meta-analysis

Statement of Problem: Improvement in outcomes of obstructive sleep apnea (OSA) could answer the question of whether nocturnal wearing of removable complete dentures is beneficial. Purpose: To evaluate the available literature that compares nocturnal wearing of removable complete dentures or overdentures in patients diagnosed with OSA on the Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), quality of sleep (Pittsburgh Sleep Quality Index [PSQI]) and other outcomes. Methods: Registration of the proposed protocol was done in an open-source registry. Databases (Medline, Embase, and Cochrane Central Register of Controlled Trials) were searched until August 2024. All the reports were screened by reading the abstracts and full texts by two independent reviewers and conflicts were resolved by the third reviewer in Covidence. Data extraction and risk of bias assessment as per the Risk of Bias 1.0 tool (RoB 1.0) were done in Covidence. Mean difference and risk ratios were used as effect measures for continuous and dichotomous outcomes. Statistical analysis was performed using a fixed effect model. The certainty of evidence was judged by the GRADE approach. Results: Out of 2428 available reports, three randomized controlled trials were included for statistical analyses involving a total of 123 participants. The pooled estimate for AHI showed no evidence of any difference with and without nocturnal wear of removable complete dentures (MD: 2.88; 95% confidence interval [CI]: 0.94 to 6.70; 246 participants). No evidence of any difference was found for PSQI (MD: 0.20; 95% CI: -0.97 to 1.37; 138 participants) and for ESS (MD: 0.20; 95% CI: -1.60 to 1.20; 138 participants). Conclusion: The review found insufficient evidence to judge that nocturnal wearing of removable complete dentures was effective in patients with OSA measured by Apnea Hypopnea Index, PSQI, and Epworth sleepiness scale.

Hypoxic burden - definitions, pathophysiological concepts, methods of evaluation, and clinical relevance.

Obstructive sleep apnea (OSA) is a common chronic condition that affects over a billion people worldwide and is associated with adverse cardio- and cerebrovascular consequences. Currently, the go-to clinical measure that determines the presence and severity of OSA is the apnea-hypopnea index (AHI). The AHI captures the frequency of respiratory events due to changes in ventilation that are associated with either oxygen desaturations or arousal from sleep. The AHI is poorly correlated to adverse outcomes in OSA with poor prognostic ability. To overcome the limitations of AHI and perhaps driven by the ease of acquisition, several studies have suggested characterizing nocturnal hypoxia in OSA, termed as "hypoxic burden". The purpose of this review is to focus on the hypoxic burden in OSA, its various definitions, and its utility in moving OSA diagnosis beyond the AHI. Several measures and definitions of hypoxic burden have been proposed and studied that show promise in overcoming limitations of AHI and also have a greater prognostic ability than AHI. More recently, area-based measures that attempt to characterize the depth and duration of oxygen desaturations, i.e., nocturnal hypoxia in OSA, have been shown to better relate to incident cardiovascular disease than AHI. In this review, we delve into the evidence for these novel area-based metrics and also delve into the pathophysiological concepts underlying nocturnal hypoxia while cautioning the reader on interpretation of the recent findings relating hypoxic burden to adverse outcomes in OSA. In this review on hypoxic burden, we focus on the need that has driven the sudden influx of studies assessing hypoxic burden for various outcomes of OSA, its underlying pathophysiology, the various definitions, and clinical relevance. We hope that the reader can appreciate the nuances underlying hypoxic burden in OSA and suggest the need for a cohesive framework for moving beyond the AHI with hypoxic burden.

Maxillomandibular Advancement for Obstructive Sleep Apnea in Patients With Obesity: A Meta-Analysis.

To systematically review polysomnographic and cephalometric data in obstructive sleep apnea (OSA) patients with obesity (body mass index [BMI] ≥30 kg/m2) treated with maxillomandibular advancement (MMA). Scopus, PubMed, CINAHL, and The COCHRANE Library. A search was performed from inception until April 3, 2024, in each database. A total of 14 studies (143 subjects) were included. The mean age was 44.3 years (range: 17-69), 80.2% males (95% CI: 72.5-86.5), mean BMI of 35.3 (95% CI: 33.1-37.5), and mean duration to follow-up post-MMA was 13.7 months (95% CI: 10.1-17.3). All objective outcomes improved significantly; overall, apnea-hypopnea index (AHI) decreased by -57.3 ([95% CI: -71.5 to -43.2], p < 0.0001) lowest oxygen saturation (LSAT) increased by 14.1% ([95% CI: 9.9 to 18.3], p < 0.0001), and Epworth Sleepiness Scale (ESS) decreased by -9.4 ([95% CI: -13.5 to -5.2], p < 0.0001). Surgical cure was 39.2% (95% CI: 20.3-60.0), and surgical success was 85.6% (95% CI: 77.8-91.5). Comparing percent reduction in class 3 obesity (-92.9%) as compared to class 1 (-85.5%) and class 2 (-83.6%) exhibited a significant difference (1 vs 3 p = 0.0012, 2 vs 3 p = 0.015). Our findings suggest that MMA significantly improves subjective and objective outcomes in OSA amongst patients with obesity with results comparable to the overall population. Success rates remained above 80% in studies with the highest mean BMI. In addition, patients with class 3 obesity yielded a significantly increased benefit based on percent reduction in AHI compared with class 1 and 2. 1 Laryngoscope, 2024.

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

Uncovering the effect of CPAP on cardiovascular outcomes in obstructive sleep apnea.

Uncovering the effect of CPAP on cardiovascular outcomes in obstructive sleep apnea.

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.

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.