Obstructive sleep apnea is a common sleep disorder characterized by repeated airway obstructive during sleep, leading to breating pauses, reduced sleep quality and decreased blood oxygen levels. Polysomnographic data in Obstructive Sleep Apnea patients were analysed to explore correlations between Apnea Hypopnea Index, Mean Apnea hypopnea Duration, oxygen desaturation and sleep stages. Among 136 Obstructive Sleep Apnea patients, Mean Apnea hypopnea duration showed a mild correlation with Apnea Hypopnea Index but no association with age, weight and height. Patients with longer Mean Apnea hypopnea duration had association ( P < 0.05) with poorer oxygenation, lower average saturation, loss of sleep, Mean oxygen desaturation, shorter sleep latency, less Non Rapid Eye Movement 3, more Non Rapid Eye Movement 1 and higher arousal/desaturation. After adjusting Apnea Hypopnea Index, Mean Apnea hypopnea duration remained significantly associated with Epworth Sleep Scale, sleep latency, Non Rapid Eye Movement 1/3, arousal index and all oxygen metrics. These associations were stronger in severe Obstructive Sleep Apnea ( n = 90), while in mild-moderate cases ( n = 46), only Non Rapid Eye Movement 3 duration correlated negatively with Mean Apnea hypopnea duration ( r = -0.14, P = 0.02). Mean apnea hypopnea duration emerged as an independent marker of oxygen desaturation and sleep disruption in OSA, beyond the Apnea Hypopnea Index. Its critical relevance was more pronounced in severe cases suggesting added value in assessing disease burden. Incorporating event duration into routine evaluation may refine patient stratification and guide targeted management strategies.

Validation of an artificial intelligence-driven novel microphone-based wireless jaw movement and respiratory event detection system for home sleep apnea testing

Study DesignRetrospective multi-hospital cohort study.ObjectivesRetropharyngeal hematoma (RH) after anterior cervical spine surgery (ACSS) is an uncommon but potentially fatal complication due to rapid postoperative airway compromise. As outpatient ACSS increases and shorter postoperative observation periods are adopted, the safe monitoring window for RH remains unclear. We characterized the timing of symptom onset and operative intervention for clinically significant RH after ACSS to inform postoperative observation practices.MethodsFollowing institutional review board approval, all cervical spine procedures performed across eight hospitals (2013-2023) were reviewed. Patients undergoing ACSS who returned to the operating room within 72 hours were identified. Cases of clinically significant RH requiring operative evacuation were included. Timing of symptom onset and return to the operating room was abstracted from operative, anesthesia, and nursing documentation.ResultsTwenty-five patients developed postoperative RH, representing 0.29% of 8,609 anterior cervical spine procedures. Median time to symptom onset was 9 hours (IQR 4-15; range 1-34). Twenty-two patients (88%) developed symptoms within 24 hours, including four in the post-anesthesia care unit. Median time to return to the operating room was 11 hours (IQR 5-20). Oxygen desaturation occurred in 32%, and 20% required emergent bedside decompression. Three patients (12%) died during hospitalization, including two from anoxic brain injury following airway compromise.ConclusionsClinically significant RH after ACSS most commonly presents within the first 24 postoperative hours. These findings suggest that brief postoperative observation periods (4-8 hours) after ACDF may not capture the majority of severe airway events in this operative RH cohort.

Many patients with obstructive sleep apnea (OSA) are unable to tolerate long-term positive airway pressure (PAP) therapy, highlighting the need for alternative treatments. AD109 (investigational fixed-dose oral combination of aroxybutynin 2.5 mg/atomoxetine 75 mg) is designed to target neuromuscular dysfunction in OSA. To evaluate the efficacy/safety of AD109 over 6 months in a diverse OSA population unable to use PAP. SynAIRgy enrolled adults with mild-to-severe OSA who were intolerant to or refused PAP therapy into a randomized, double-blind, placebo-controlled, 26-week parallel-arm trial of AD109 vs placebo across 69 centers. The primary efficacy endpoint was change from baseline to week 26 in apnea-hypopnea index (AHI). Key secondary endpoints were oxygen desaturation index (ODI), Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue T-score, hypoxic burden (HB), PROMIS-Sleep Impairment T-score, and proportion of participants with ≥50% AHI reduction. A total of 646 eligible participants (median age 58 years, 49.3% female, median body mass index 32.4 kg/m2) were randomized. Median baseline AHI was 19.6 events/hour with 35% mild, 42% moderate, and 23% severe OSA. At week 26, mean AHI treatment difference was -4.0 events/hour (95% CI, -6.4 to -1.6; P = .001), representing a model-estimated 44.1% vs 17.6% decrease from baseline (P <.0001). AD109 demonstrated improvements in ODI and HB at week 26 vs placebo; however, no statistically significant difference was observed for PROMIS-Fatigue. Overall, 21.2% of participants on AD109 and 3.1% on placebo discontinued therapy due to adverse events. The most common adverse events with AD109 were dry mouth, nausea, insomnia, and urinary hesitation, with no serious treatment-related adverse events. AD109 significantly improved airway obstruction and oxygenation at 26 weeks across a broad range of patients unable to use PAP, suggesting that AD109 could become a potential treatment option for patients with OSA. www.clinicaltrials.gov (NCT05813275 [SynAIRgy]).

Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea-hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e' ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m2; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005-1.033) and ODI (OR 1.030, 95% CI 1.010-1.050) were significant predictors. HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors. The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige-Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).

Obesity hypoventilation syndrome (OHS) is a severe consequence of the global obesity epidemic. This study compared the patterns and severity of nocturnal oxygen desaturation in adults with OHS and obstructive sleep apnea (OSA). This case-control study conducted at King Abdulaziz University Hospital reviewed polysomnography (PSG) records (2016-2022) of patients with OHS and OSA. The data included demographics, BMI, and indices (apnea-hypopnea index [AHI], baseline/minimum SpO₂, percentage of total sleep time with SpO₂ < 90 percent [T90], total sleep time). GraphPad Prism was used for the analysis. Data were summarized as medians and interquartile ranges (IQR). Mann-Whitney U and Kruskal-Wallis tests with Dunn's test were used to compare groups. Fisher's exact test analyzed categorical variables (p < 0.05). The study was approved by the Ethics Committee. Of the 199 PSG studies, 15 patients met OHS criteria and 184 had OSA. The OHS group had a higher BMI (50.0 [47.0-55.0] kg m-2) than the OSA group (45.0 [32.0-48.8] kg m-2; p > 0.001). Baseline SpO₂ (89 [86-94] vs. 95 [93-97]%; p = 0.001), SpO₂ nadir (72 [63-81]% vs 82 [74-88]%; p = 0.007), average SpO₂ (87 [86-94]% vs. 94 [92-95]%; p = 0.003) and T90 (71 [3-93]% vs 2 [0-18]%; p = 0.001) were worse in OHS. Age and AHI were similar. Women were older than men in both groups. Women with OHS showed lowest baseline SpO₂ (88%), nadir SpO₂ (67%), and highest T90 (91%), differing from other groups (p < 0.05). AHI and sleep time remained similar. Despite similar AHI, OHS is associated with a greater hypoxemic burden than OSA, especially in females. These findings underscore the need to consider both diagnosis and sex in sleep-disordered breathing to develop sex-specific treatment approaches.

Optoacoustic imaging reveals preserved placental oxygen saturation in a mouse model of preeclampsia.

Relationship between changes in intestinal desulfovibrio levels and oxygen desaturation in patients with obstructive sleep apnea syndrome.

Emphysema and airway disease synergistically impair exercise tolerance in smokers: a CT-based study.

Inspiratory stridor in neonates is typically attributable to laryngomalacia, vocal cord paralysis, or subglottic stenosis. Less commonly, vascular anomalies can cause inspiratory stridor. A neonate developed progressive, position-dependent inspiratory stridor and episodic oxygen desaturation on the third day of life. Laryngomalacia was excluded on initial investigation. Imaging revealed a ductus arteriosus aneurysm that was likely compressing the left recurrent laryngeal nerve, resulting in left-sided vocal cord paralysis. Despite marked respiratory symptoms, the neonate improved spontaneously and was managed conservatively. This case underscores the importance of considering vascular anomalies - such as a ductus arteriosus aneurysm - in the differential diagnosis of neonatal stridor, particularly when symptoms are progressive or position-dependent. Timely recognition and targeted imaging facilitate accurate diagnosis, prevent unnecessary interventions and enable individualised management.

ABSTRACTBackgroundRespiratory failure is the main cause of death in Amyotrophic lateral sclerosis (ALS), in which the physiological sigh reflex is impaired due to inspiratory muscle weakness. Aim of this study is to assess the tolerability, safety, and effectiveness of adding a sigh cycle to non‐invasive mechanical ventilation (NIMV) settings in ALS patients.MethodsIn this randomized, blind‐controlled proof‐of concept study, 44 consecutive ALS patients with indication for NIMV were randomized to: Group I: NIMV with Sigh cycles; Group II: NIMV without Sigh. The primary outcome was the reduction in the Oxygen Desaturation Index (ODI); secondary outcomes included: Overnight Oximetry (OvOx), Arterial blood gas (ABG), and Visual Analog Scale (VAS; 0–10) scores to assess sleep quality, symptom intensity, mask interface, and NIMV tolerance. Assessments were conducted at baseline, after NIMV adaptation (T1) and at 1‐month follow‐up (T2).ResultsThe Sigh cycle was safe and well tolerated. No significant group differences were observed at T1 or T2 in the primary outcome ODI (median ΔODI: Group A:–4.2; Group B:–4.6: p = 0.54), as well as in the OvOx parameters and pO2 and pCO2 ABG values. At T2, secondary analysis showed a significant difference in HCO₃− in favor of the Sigh arm (ΔHCO3−: −1.60 vs. 1.35 mmol/L, p = 0.042). Exploratory Cox‐regression models suggested a potential independent effect of SIGH on survival.ConclusionsSigh is safe, well tolerated in ALS patients. Although this study did not reach the primary outcome, we also cannot rule out that sigh doesn't benefit the patient.

This study aimed to develop and validate an integrated neuroimaging-based model for identifying severe obstructive sleep apnea (OSA) with severe oxygen desaturation (ODI ≥ 30 events/hour) in young and middle-aged male. A key goal was to characterize the neuroimaging signatures associated with the hypoxic burden of OSA. Data from 111 patients were utilized. The initial feature set integrated 50Gy matter structural indices, seven dynamic functional connectivity (dFC) temporal metrics, and key demographic factors (age, BMI). A Random Forest algorithm was employed for feature selection based on variable importance measures (VIM), followed by Support Vector Machine (SVM) modeling to classify severe OSA patients (ODI ≥ 30 events/hour). The final model incorporated 28 features (2 demographic, 2 dFC, 24 structural). It achieved an accuracy of 70.91%, recall of 95.07%, precision of 72.25%, F1-score of 81.68%, and an AUC-ROC of 0.798. Feature selection at a VIM > 0.05 threshold (20 features) increased accuracy by 2.7% and achieved optimal recall (97.50%) and AUC (0.813). This study establishes a neuroimaging-based framework for identifying OSA patients with severe oxygen desaturation (ODI ≥ 30 events/hour), integrating gray matter structural and dynamic functional connectivity features. The features selected by the model overlap with brain regions and networks that support cognitive functions such as memory and attention, suggesting that the model captures neurobiologically meaningful patterns associated with the hypoxic burden of OSA.

Group III/IV muscle afferents play a prominent role in ensuring appropriate arterial oxygenation during exercise. Exercise in hypoxia poses a major cardiorespiratory challenge due to reduced inspired oxygen pressure (PIO2). Although humans adapt powerfully to hypoxia, the contribution of group III/IV afferents to ventilatory, pressor and metabolic responses to exercise in chronic hypoxia remains unknown. Fourteen healthy participants completed cycling trials with (placebo) and without (25 µg intrathecal fentanyl) intact group III/IV afferent feedback in three settings: (1) normoxia, PIO2=139 mmHg; (2) acute hypoxia, PIO2=90 mmHg; and (3) chronic hypoxia, after 7-9 days of acclimatisation to 3800 m, PIO2=90 mmHg. Participants completed three 3-min stages at matched absolute intensities corresponding to 45%, 60% and 75% sea-level maximal aerobic power. Ventilation, pulmonary gas exchange, arterial blood gases and blood pressure were measured. Fentanyl suppressed exercise hyperpnoea similarly across environments (P<0.001) but produced larger reductions in arterial oxygenation in hypoxia, lowering saturation by ∼3%-5% and content by ∼0.7-1.0 mldL-1 (condition×PIO2,P ≤ 0.016). Fentanyl also blunted the exercise-induced increase in mean arterial pressure, with a greater blood pressure-lowering effect of -10 to 13 mmHg observed in hypoxia (condition×PIO2,P=0.021). In contrast fentanyl increased circulating lactate and hydrogen ion concentration ([H+]) (P<0.001), an effect accentuated during acute hypoxia (lactate: +1-2 mmolL- 1, [H+]: +2-5 nmolL- 1) but attenuated after acclimatisation (interactions,P ≤ 0.034). Thus group III/IV afferent feedback becomes more consequential in hypoxia, as small perturbations in ventilatory control and perfusion pressure have amplified consequences for oxygen transport. KEY POINTS: Group III/IV muscle afferent feedback contributes to normal exercise hyperpnoea and blood pressure regulation; whether its functional contribution is altered by acute and chronic hypoxia is unknown. In a double-blind, placebo-controlled cross-over design, 14 participants completed steady-state cycling with intact (placebo) or attenuated (intrathecal fentanyl) group III/IV afferent feedback in normoxia, acute hypoxia and after 7-9 days of acclimatisation at 3800 m. Intrathecal fentanyl suppressed exercise hyperpnoea similarly across environments but caused exaggerated arterial oxygen desaturation during hypoxic exercise, reflecting operation on the steep portion of the oxygen-haemoglobin dissociation curve. The blood pressure-lowering effect of intrathecal fentanyl was greater during hypoxic exercise; effects on metabolic strain were greatest in acute hypoxia and largely normalised after acclimatisation. These findings highlight the functional importance of group III/IV muscle afferent feedback during hypoxic exercise, where small perturbations in ventilatory and pressor control have amplified consequences for oxygen transport.

To assess the association between personal temperature exposure and oxygen saturation (SpO2) during sleep in chronic obstructive pulmonary disease (COPD) patients, to analyze potential susceptibility factors and to provide a scientific basis for the adoption of effective measures to safeguard the health of susceptible populations. In this prospective panel study, 96 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 202 nights (from 20:00 to 08:00) of dynamic real-time SpO2 monitoring during sleep, simultaneously monitoring personal exposure level to temperature, alongside environmental humidity and other key air pollutant data. Based on previous clinical studies, SpO2 < 90% was defined as desaturation to assess the risk of hypoxic events occurring during sleep. Linear mixed-effects models and generalized linear mixed-effects models were used to analyze the association between personal temperature exposure and SpO2 during sleep, as well as the risk of oxygen desaturation. Interaction models were constructed to evaluate susceptibility factors. During the study, the average personal temperature exposure was (27.5± 2.6) ℃, with a temperature range from 16.5 ℃ to 40.0 ℃. Short-term exposure to personal temperature was associated with a decline in SpO2 and an increased risk of oxygen desaturation during sleep in the COPD patients. The effect of temperature exposure was strongest at lag 0-30 min, with a 0.24% (95%CI: -0.28%, -0.20%) decrease in SpO2, and with an odds ratio (OR) of oxygen desaturation was 1.26 (95% CI: 1.12, 1.42) for each interquartile range (IQR, 6.0 ℃) increase in temperature. Besides, the patients exposed to medium and high humidity levels were more likely to be affected by temperature exposure compared with the patients exposed to low humidity levels. Personal temperature exposure had a stronger effect on SpO2 during sleep in the patients with global initiative for chronic obstructive lung disease (GOLD) Ⅲ-Ⅳ compared with the patients with GOLD Ⅰ-Ⅱ (Pinteraction < 0.05). From 16.5 ℃ to 40.0 ℃, personal temperature exposure is associated with SpO2 decline during sleep in COPD patients. There was a significant synergistic amplification between temperature and humidity, patients were more susceptible to damage under high temperature and high humidity conditions. Moreover, patients with poorer lung function are more significantly affected by temperature.

Propofol is widely used for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP) due to its rapid onset and favorable recovery profile; however, it is associated with dose-dependent cardiopulmonary adverse effects, particularly hypoxia and hypotension. Significant heterogeneity persists in the definition, severity classification, and reporting of these adverse events, limiting comparability across studies and hindering reliable risk stratification. Therefore, the aim of this systematic review was to evaluate the incidence and clinical characteristics of propofol-associated hypoxia and hypotension in adult patients undergoing ERCP, and to assess variability in reporting practices across studies. A systematic review was conducted and reported in accordance with PRISMA guidelines. PubMed was searched for English-language studies published between 1995 and 2025 involving adult patients undergoing ERCP under propofol-based sedation. Across studies reporting extractable data, oxygen desaturation occurred in 16.9% of aggregated cases (1194/7049), whereas hypotension occurred in 13.0% (187/1440). These values represent descriptive estimates and should not be interpreted as meta-analytic pooled incidences. Both events were predominantly mild and transient, responding to standard supportive measures, whereas severe complications, including cardiopulmonary arrest, were exceptionally rare. Considerable variability in definitions, outcome reporting, and study design was observed across studies. Propofol sedation during ERCP is associated with frequent but generally manageable hypoxia and hypotension. Continuous respiratory and hemodynamic monitoring facilitates early recognition and prompt intervention. Standardization of outcome definitions and reporting, along with the development of structured risk stratification tools, may improve patient selection and enhance procedural safety.

BackgroundHigher step width variability while walking is associated with poor physical function and falls. Sleep is an established modifiable risk factor for both gait and physical function impairments, but it remains to be examined whether sleep is also related to step width variability.ObjectiveThis study aimed to evaluate the cross-sectional associations between objectively measured sleep quality, using cardiopulmonary coupling spectrograms, and step width variability during a preferred walking condition among middle-aged and older adults.MethodsThis study included 72 adults (mean age 71, SD 8.3 y; n=37, 51% female; n=65, 90% non-Hispanic White) who had ≥2 nights of objectively measured sleep (cardiopulmonary coupling via SleepImage ring) and completed a 10-m walk at preferred speed while wearing inertial sensors (APDM Mobility Lab). Sleep measures included sleep duration, efficiency, fragmentation, stability, apnea-hypopnea index, percentage of time oxygen saturation level <90%, oxygen desaturation index, and respiratory disturbance index. Additional derived sleep variables were explored using least absolute shrinkage and selection operator models. Step width variability was defined by the asymmetry of lateral step variability and categorized as medial (≤−7.5 cm), minimal (within ±7.5 cm; reference), or lateral displacement (≥7.5 cm). Multinomial logistic regression models adjusted for age, sex, race, education, BMI, and usual gait speed evaluated cross-sectional associations between sleep and step width variability categories.ResultsWe found that a 1% higher sleep fragmentation was associated with a 6% higher probability of step width variability ≥7.5 cm (95% CI 1.01‐1.11), while a 1% higher sleep stability was associated with a 5% lower probability of variability ≥7.5 cm (95% CI 0.91‐0.99), compared to minimal variability. From the least absolute shrinkage and selection operator models, we found that a 1% higher sleep quality index, a 1% higher rapid eye movement sleep, a 1-second shorter apnea duration, and a 1-beat per minute slower mean heart rate were also associated with a lower probability of lateral compared to minimal displacement.ConclusionsPoor sleep quality was associated with higher step width variability among middle-aged and older adults. This suggests that sleep may be a modifiable risk factor for maintaining postural stability while walking among middle-aged and older adults. Future studies are needed to examine whether intervening in these sleep measures also lowers the risk of falls.

Sleep-wake disruption is common after stroke and may impede recovery. The Sleep Regularity Index (SRI) quantifies the probability that an individual is in the same sleep or wake state at the same clock time on consecutive days. This study evaluates SRI during poststroke recovery, estimating associations with stroke outcomes and characterizing transitions between SRI states over time. We analyzed data from 71 participants who were part of a larger ongoing study exploring the impact of nonobstructive sleep apnea sleep disorders post stroke. Data were collected at 10, 60, and 90 days post stroke. SRI was calculated from sleep-wake data that were collected from wrist-worn actigraphy. Covariates included time, sex, stroke location, modified Rankin Scale score, Stroke Impact Scale score, Patient Health Questionnaire 9 score, and oxygen desaturation index. Associations between SRI and covariates were estimated using generalized estimating equations models. A generalized estimating equations model was also used to assess which variables may be associated with SRI improvement. SRI was low at 10 days post stroke (32.68) and did not significantly change at 60 (34.01, P=0.41) or 90 (38.44, P=0.42) days post stroke. SRI was significantly associated with Patient Health Questionnaire 9 (P=0.05) and Stroke Impact Scale (P=0.04) scores. Only initial SRI was associated with improvement in SRI. This is the first study that we are aware of to investigate sleep regularity early after stroke. We found that sleep regularity was associated with depression and quality of life and that sleep regularity did not improve after discharge from the hospital. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05012605.

BackgroundObstructive sleep apnea (OSA) is associated with cardiovascular disease. The endothelial glycocalyx (eGCX) is a shear-sensitive intravascular barrier. The relevance of OSA and intermittent hypoxia (IH) for eGCX perturbation and cardiovascular disease in humans remains unclear.MethodsIn a prospectively recruited observational cohort with cross-sectional biomarker analysis in men (n = 60), polysomnography quantified apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and hypoxic burden (HB). Using single-time-point plasma sampling, eGCX glycosaminoglycans hyaluronan (HA) and heparan sulfate (HS) and the proteoglycan syndecan-1 (SDC-1) were related to OSA severity and repetitive hypoxemia, including multivariable adjustment for cardiometabolic, inflammatory, and renal determinants. Plasma proteomics defined pathways associated with OSA and HA/HS. Shear-matured primary human endothelial cells were exposed to OSA-characteristic IH cycles under arterial flow to assess eGCX structure, oxidative stress, nitric oxide (NO) signaling, thromboinflammatory status, and antioxidant treatment with N-acetylcysteine.ResultsPlasma HA and HS were higher in OSA than in non-OSA individuals and increased stepwise with disease severity, tracking AHI, ODI, and HB. These associations persisted in multivariable analyses adjusting for age, BMI, hypertension, hs-CRP, fasting glucose, and eGFR. Plasma SDC-1 did not differ between groups and remained non-associated in adjusted analyses. Proteomics revealed enrichment of inflammatory, coagulation, and oxidative stress-related pathways that strengthened with increasing OSA burden and higher HA/HS levels. Experimentally, IH caused loss of endothelial surface HA/HS with increased shedding, increased reactive oxygen species, reduced redox capacity, impaired NOS3/eNOS signaling and reduced NO bioavailability. IH or enzymatic eGCX digestion each enhanced monocyte and platelet adhesion, tissue factor expression, and fibrin deposition under shear, while N-acetylcysteine attenuated oxidative stress and partially restored surface HA expression.ConclusionsIntegrated patient and IH-model data show that OSA severity and repetitive hypoxemia are associated with circulating markers consistent with eGCX perturbation, while the endothelial IH model supports induction of oxidative-inflammatory stress and a proadhesive, prothrombotic phenotype by intermittent hypoxia. Together, circulating HA and HS emerge as candidate biomarkers associated with OSA-related eGCX perturbation, warranting further evaluation in longitudinal and interventional studies of eGCX-stabilizing adjunct therapies. These findings derive from an all-male cohort and require validation in women and more diverse populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12967-026-08409-2.

BACKGROUNDSeveral studies have reported sex differences in resuscitation outcomes in critically ill adults, but whether these differences are associated with endotracheal intubation practices is not known.AIMTo investigate sex differences in serious outcomes among critically ill adults undergoing endotracheal intubation in the emergency department.METHODSIn this observational study, we enrolled all critically ill adult patients who underwent endotracheal intubation in the emergency department from 2016 to 2020. The serious outcomes were defined as mortality within 1 hour post endotracheal intubation, cardiac arrest within 1 hour post intubation, worsening hypotension (systolic blood pressure < 90 mmHg) and oxygen desaturation (< 92%). Variables known or suspected to be associated with serious outcomes were examined with univariate logistic regression. Furthermore, we conducted sensitivity analysis on the patient cohort, incorporating propensity score matching with nearest neighbor methods at a ratio of 1:1 to address baseline variations between male and female participants, using R program software version 4.1.3 with a library (MatchIT).RESULTSA total of 1021 patients were enrolled in our study, with a median age of 52.2 years (± 17.5). The mean age of the females was 52.2 (± 17.8) years, and that of the males was 52.1 (± 17.3) years. Endotracheal intubation was most frequently observed in males (634; 62%). The frequency of cardiac arrest was 118 (18.6%) males and 77 (19.9%) females, with a P value of 0.612. Similarly, the frequency of hypotension (systolic blood pressure < 90 mmHg) was 225 (35.5%) in males and 154 (39.8%) in females (P = 0.167). This was followed by hypoxia (< 92%), with 85 (13.4%) males and 46 (11.9%) females, with a P value of 0.481. In total, 263 (41.5%) males died in the hospital, whereas 135 (39.1%) females died, P = 0.036. Severe outcomes were observed in 702 (68.8%) patients, 271 (70%) of whom were females, whereas 431 (68%) of whom were men (P = 0.494). After propensity score matching, postintubation hypotension was the most frequent serious event, observed in 304 (39.3%) patients, of whom 154 (39.8%) were females, whereas 150 (39.8%) were males (P = 0.001).CONCLUSIONThe study revealed that females were at greater risk of serious outcomes in critically ill adults post endotracheal intubation than males were in the emergency department.

Efficacy and safety of atomoxetine combination therapy for obstructive sleep apnea: A meta-analysis of randomized placebo-controlled trials.