Positive Airway Pressure Therapy Research Articles

Obesity Hypoventilation (Pickwickian) Syndrome – ”The Tip of an Iceberg” in Morbidly Obese Patients

ABSTRACT Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is a combination of obesity (body mass index (BMI) >30 kg/m2), daytime hypercapnia (arterial carbon dioxide tension >45 mm Hg) and sleep-disordered breathing, after exclusion of other disorders that may cause alveolar hypoventilation. Management of OHS requires a multifaceted approach in the form of weight loss, treatment of existing co-illnesses, pulmonary rehabilitation, and Bi-level positive airway pressure (Bi-PAP) therapy. A 58-year-old lady with a BMI of 50 kg/m2 with symptoms of obstructive sleep apnea (OSA) and OHS presented to the hospital with respiratory distress. She gave a history of breathlessness, snoring, and sleep disturbances for the last 7 years. She was managed by a physician with a diagnosis of obstructive airway disease without further evaluation of sleep disturbance. On admission, she was started on non-invasive ventilation during her initial management. After 72 hours of admission, the patient became stable, and overnight polysomnography was performed to confirm the diagnosis of OHS. After confirmation of the diagnosis, she was started on Bi-PAP therapy along with other supportive therapy for 7 days. She was discharged after 10 days of admission with nocturnal Bi-PAP therapy at home and was enrolled in a comprehensive pulmonary rehabilitation program. Patient is on regular follow-up and has been doing well since then.

Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions.

Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA. An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs. The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics. Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient's clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient's adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD.

Effect of continuous positive airway pressure therapy on blood levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in obstructive sleep apnoea adults: A systematic review, meta-analysis and trial sequential analysis

Obstructive sleep apnoea (OSA) is a long-term disorder characterized by frequent blockages in the upper respiratory tract during sleep, often leading to abrupt awakenings, with or without a decrease in oxygen levels. The systematic review and meta-analysis aimed to assess the effect of continuous positive airway pressure therapy (CPAP) on blood interleukin (IL) levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in OSA adults. The published databases from PubMed, Scopus, Web of Science, and Cochrane Library were searched from 2003 to 2024, without any restrictions. The Review Manager software 5.3 was employed to compute effect sizes, which were presented as the standardized mean difference (SMD) along with a 95% confidence interval (CI). In total, 320 records were identified through database searching; ultimately, 42 articles were included in the qualitative synthesis and then the meta-analysis. The CPAP therapy significantly reduces IL-6 levels, as indicated SMD=0.64 [95% CI: 0.35, 0.93] and P<0.0001. CPAP therapy significantly reduced IL-18 and IL-1β levels in adults with OSA, but there is no significant difference in IL-10, IL-4, or IL-17 levels. Age, blood sample, body mass index, ethnicity, and treatment duration for IL-6 and apnoea-hypopnea index with IL-10 levels were effective factors in the pooled results. Experimentally, there was an interaction between IL-18 and IL-1β. CPAP therapy has a positive impact on inflammatory markers in OSA adults; remarkably, it reduces IL-6 and IL-1β levels. Nevertheless, more evidence (such as the role of ethnicity) and understanding of interactions are needed.

Remote monitoring system to support positive airway pressure therapy in patients with obstructive sleep apnea: a multi-center randomized controlled trial.

To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy. A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed. The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50min (0.8h) more than the actual amount of use. The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA. IRCT2017092236314N1; https://en.irct.ir/trial/27185.

Evaluating the impact and costs of conversional or revisional metabolic bariatric surgery on obstructive sleep apnea: Insights from a French nationwide cohort

BackgroundThis study assesses the effectiveness of 5 main conversional or revisional metabolic bariatric surgery sequences after sleeve gastrectomy, adjustable gastric banding and gastric bypass on reimbursement and cost of continuous positive airway pressure therapy, the first line treatment for obstructive sleep apnea, in France. MethodsThis nationwide observational population-based cohort study analyzed data from the French National Health Insurance database. It included all patients who had undergone primary metabolic bariatric surgery in France between January 1, 2012, and December 31, 2014, and followed until December 31, 2020. The study assessed continuous positive airway pressure therapy reimbursement discontinuation and costs of reimbursed continuous positive airway pressure therapy across 5 different conversional or revisional metabolic bariatric surgery sequences. ResultsDuring follow-up, 6,396 patients underwent the following sequences: sleeve gastrectomy–gastric bypass (n = 2,400), adjustable gastric banding–sleeve gastrectomy (n = 2,277), adjustable gastric banding–gastric bypass (n = 1,173), sleeve gastrectomy–sleeve gastrectomy (n = 546), and gastric bypass–others (n =332), with a rate of obstructive sleep apnea of 15.2%, 12.4%, 15.5% 12.8%, and 9.9% in the year before conversional or revisional metabolic bariatric surgery. The rates of patients who had a discontinuation of continuous positive airway pressure were at 2 and 4 years: 41.1%, 41.9%, 46.4%, 29.3%, and 33.3%; 62.3%, 57.0%, 78.2%; 57.5%, and 44.4%, respectively. At 4 years, the mean annual costs (euros) of obstructive sleep apnea treatment per patient were significantly lower (P < .01) than the costs in the year before conversional or revisional metabolic bariatric surgery for each sequence: 526.9 ± 414.4 vs 257.4 ± 349.7; 368.0 ± 247.5 vs 230.9 ± 288.4; 433.7 ± 326.0 vs 116.8 ± 238.3; 540.7 ± 275.3 vs 248.0 ± 308.4 and 501.2 ± 254.0 vs 281.1 ± 287.0, respectively. ConclusionsOur study underscore the effectiveness of conversional or revisional metabolic bariatric surgery in significantly reducing the need and associated costs of continuous positive airway pressure therapy for patients with obstructive sleep apnea postprimary metabolic bariatric surgery over a 4-year period.

Therapeutic adherence in patients with Obstructive Sleep Apnea Syndrome: a retrospective cohort study.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated episodes of partial or complete airway obstruction. Continuous Positive Airway Pressure therapy (CPAP) is effective in improving sleep quality and daytime sleepiness. The aim of the study was to evaluate therapeutic adherence in a sample of patients with OSAS from the Pneumology ward of the "Cardinal Massaia" Hospital in Asti. A sample of 221 patients with OSAS were collected and retrospectively analyzed from January 2019 to December 2021. Ventilation hours during device titration (T1), possible second titration (T2) and one-year control (T3) were considered. The use of the CPAP device equal to or greater than 4h/night was considered as therapeutic adherence. Age, gender, severity of OSAS, smoking, interface used and Epworth Sleepiness Scale (ESS) score were considered. The analysis data showed that the percentage of adhesion during T1 was 84%. Only 9% needed T2, with 84% adherence. At T3 the adherence was 86%. Correlation studies showed that only smoking had a positive correlation with adherence, while OSAS severity, gender, ESS score, interface used and age had no statistically significant correlation. It was important to understand that OSAS is a disease with prolonged treatment, which affects the life of the person and his family. Therefore, the concept of assistance network was born, which sees the healthcare operators, the person and his family as the main actors involved in a care process.

Longer-term impacts of the COVID-19 pandemic on obstructive sleep apnoea (OSA)-related healthcare: a province-based study

RationaleFollowing marked reductions in sleep medicine care early in the COVID-19 pandemic, there is limited information about the recovery of these services. We explored long-term trends in obstructive sleep apnoea...

Psychometric Properties of the Turkish Version of Self-Efficacy Measure for Sleep Apnea (SEMSA) Instrument.

Determining the self-efficacy perceptions of obstructive sleep apnea (OSA) patients has a key role in health care practices. With further evaluation, the Self-Efficacy Measure for Sleep Apnea (SEMSA) could serve as a useful scale to develop specific interventions to increase self-efficacy in patients with OSA during the acceptance and maintenance of continuous positive airway pressure (CPAP) therapy. The aim of this study is to translate the SEMSA into Turkish and to evaluate the psychometric properties of the translation. This cross-sectional study was carried out with a sample of patients recently diagnosed with CPAP-naïve OSA. Linguistic and content validity of the scale were evaluated, while exploratory factor analysis and 2-level confirmatory factor analysis were used for validity. Internal consistency and test-retest methods were used in reliability analyses. The mean (SD) age of the patients with OSA was 51.36 (11.29), and 68% were male. The item factor loads obtained as a result of the confirmatory factor analysis ranged from 0.44 to 0.94, confirming the three-factor structure of the instrument. The Cronbach's α coefficient of the scale was found to be 0.90. Measurements made within the scope of test-retest analysis were found to be related and consistent results were obtained in the intervening time (P < .01). In this study, the Turkish version of SEMSA was found to be a valid and reliable tool and it could be used to evaluate the adherence-related cognition in Turkish patients with OSA on CPAP therapy.

Factors predictive of extensive use of CPAP treatment in obstructive sleep apnoea.

In patients with obstructive sleep apnoea (OSA), the benefits of continuous positive airway pressure (CPAP) therapy are increased for every additional hour of daily CPAP usage. However, the data of predictors of extensive usage is scarce, if any. Therefore, we evaluated potential predictors affecting extensive treatment usage. In this retrospective study, we compiled an institutional cohort of consecutive patients diagnosed with who started CPAP therapy 1999-2022 and were included in a wireless telemonitoring system in May 2022 (N = 14,394). Patients using CPAP device ≥ 9h/d were stratified into a younger (< 65 years; N = 124) and an older group (≥ 65 years; N = 131). We found 255 patients (male 61%) eligible for our study, with a median age of 65 (interquartile range, IQR 55-73) years, and mean body mass index (BMI) of 36 ± 6.9kg/m2. Median CPAP use was 10h/d (IQR 10-11). BMI and depressive symptoms (DEPS) in the younger group were higher than in the older group (37.9 ± 7 vs. 34.6 ± 6.4kg/m2, p < 0.001 and 11 (IQR 5-20) vs. 7 (IQR 5-14), p = 0.01, respectively). During follow-up, the BMI of the younger group increased (39.9 ± 12.5kg/m2 vs. 37.9 ± 7kg/m2, p = 0.009). DEPS values decreased in the younger group and became comparable between the groups. In multivariate models, the baseline BMI independently predicted extensive CPAP use among the younger age group, and the mask leak among the older group. BMI at baseline in the younger and mask leak in the older group could be independent predictive factors for extensive use of CPAP.

A novel 3D-printed customized nasal mask for improving CPAP adherence and satisfaction for the treatment of obstructive sleep apnea.

To evaluate the performance of a novel 3D-printed customized nasal mask on patient satisfaction and compliance to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). Patients prescribed CPAP therapy with suboptimal CPAP compliance using a conventional CPAP mask (<70% of nights with ≥4 hours per night over 4 weeks) were recruited from the sleep investigation unit of a tertiary hospital. Patients underwent a 3D-facial mapping procedure to have a novel 3D-printed customized nasal mask fabricated which was trialed four weeks. CPAP compliance data download of the same period was conducted with their pre-existing conventional mask and customized mask. Questionnaires assessing symptoms of OSA and mask-related side-effects were administered before and after the trial of the customized mask. Thirty patients (twenty-two males and eight females, age 63.3 ± 12.5 years, BMI 31.7 ± 5.2 kg/m2, apnea-hypopnea index 37.3 ± 21.9 events/h [mean ± standard deviation]) were studied. CPAP was used in a greater proportion of nights with the customized mask (85.7 [66.1, 98.2]% versus 63.2 [13.1, 96.8]%, P=0.009) compared to the conventional mask. Hourly CPAP usage was higher with the customized mask (3.8 [2.7, 5.8] hours versus 2.4 [0.3, 5.0] hours, P=0.016) compared to a conventional mask. Patients preferred the customized mask (P=0.008) and reported less mask-related side effects. The novel 3D-printed customized mask improved CPAP usage in patients with suboptimal CPAP compliance. Customized CPAP masks may be a suitable option for patients experiencing poor CPAP compliance from mask-related side effects. Registry: ANZCTR; Title: Conventional vs custom made nasal Continuous Positive Airway Pressure (CPAP) mask for treatment of Obstructive Sleep Apnoea: Pilot study A; Identifier: ACTRN12621001301853; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382142.

Behavioral KSA Intervention Class to Boost Positive Airway Pressure Adherence Among Active Duty Military Personnel With Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class. The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class. PAP adherence was examined using Medicare standard at 30-, 60-, 90-, and 180 days post class. The analytic sample comprised 379 active duty patients (93% men; mean age 40.21 ± 8.06) categorized into 3 groups: KSA (n = 235), did not show (DNS; n = 61), and mandatory education class (MEC; n = 83). The MEC group comprised patients from an education class in a previous year. Baseline scores on the apnea hypopnea index, body mass index, sleepiness, insomnia severity, and age were non-significant among the 3 groups. At 30 days, significantly more patients in KSA (48%) and MEC (51%) were adherent than the DNS group (16%). At 60 days, the adherence rates for the KSA, DNS, and MEC were significantly different at 39%, 22%, and 27%, respectively. At 90- and 180 days, the adherence rates among the KSA, DNS, and MEC groups did not differ significantly at 34%, 17%, and 26% (90 days) and 34%, 27%, and 25% (180 days), respectively. Consistently, more patients in KSA were adherent than those in DNS and MEC, except at 30 days. Additionally, adherence rates for KSA intervention declined more gradually over the 6 month period. The mean PAP usage on nights used was 4.6 hours that computed to a 34% non-use rate based on an optimal 7-hour/night sleep time. KSA could be a behavioral intervention that enhances PAP adherence with a booster session implemented at the 90 days mark.

Transoral Robotic Surgery Versus Hypoglossal Nerve Stimulation for OSA: A Cost Analysis Study.

Transoral robotic surgery (TORS) lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) are effective surgical interventions for well-selected patients with obstructive sleep apnea (OSA) intolerant to continuous positive airway pressure (CPAP) therapy. Previous publications have demonstrated that HGNS patients have a lower postoperative apnea-hypopnea index (AHI) and length of hospital stay than TORS patients. No prior study has investigated the differences in costs between HGNS and TORS. This study aims to compare surgery-related costs in patients undergoing HGNS versus TORS lingual tonsillectomy for OSA intolerant to CPAP. A retrospective study on OSA patients intolerant to CPAP that underwent HGNS or TORS from 2015 to 2022 at a tertiary care center. Cost was defined as the dollar amount associated with providing a specific service prior to the application of insurance. This study included 395 patients (375 UAS and 20 TORS). Average total cost was significantly higher in the UAS group than the TORS group (UAS: $25,582.60; TORS: $5832.60; p < 0.001). Operating room costs were also significantly higher in the UAS group (UAS: $1978.20; TORS: $1490.90; p = 0.001). The TORS cohort averaged higher costs for pharmacy (UAS: $201.30; TORS: $416.60; p < 0.001) and anesthesia (UAS: $139.00; TORS: $307.60; p < 0.001). The total cost was significantly higher in the UAS group compared to the TORS group. When making management decisions, it is important to consider the cost of care provided as well as patient-centered outcomes to optimize the value of care. N/A Laryngoscope, 2024.

Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis

This systematic review and meta-analysis (SRMA) evaluates the efficacy and safety of Positive Airway Pressure (PAP) therapy in perioperative care for obese surgical patients. We reviewed 24 studies, encompassing data up to March 23, 2023, analyzing the impacts of Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BIPAP) on postoperative adverse outcomes, oxygenation, and pulmonary function. Our findings underscore the significant potential of PAP therapy in managing obese patients during the perioperative period, particularly those at substantial risk for postoperative respiratory complications. PAP therapy not only enhances oxygenation levels and lung function but also substantially reduces the incidence of atelectasis and shortens hospital stays, thereby affirming its vital role in improving perioperative outcomes for this patient population.

Impact of Continuous Positive Airway Pressure Termination on Permanent Work Disability in Obstructive Sleep Apnea: A French Nationwide ALASKA Database Analysis.

Rationale: Three-year continuous positive airway pressure (CPAP) therapy termination rates are up to 50%, and therapy termination is associated with higher all-cause mortality and incident cardiovascular event risk. Objectives: This study investigated the impact of CPAP therapy termination in the first year on long sick leave leading to permanent work disability in patients with obstructive sleep apnea based on data from the Nationwide Claims Data Lake for Sleep Apnoea (ALASKA). Methods: French national health insurance reimbursement system data were analyzed for all adults with OSA aged ≤62 years who started CPAP therapy in France in 2015 and 2016. CPAP therapy termination was defined as the cessation of CPAP reimbursements triggered by the respiratory physician or sleep specialist in charge of follow-up. Individuals who terminated therapy were compared with those who continued to use CPAP. The primary outcome was sick leave ultimately leading to permanent work disability. A multivariable Fine and Gray model, adjusted for age, sex, cardiovascular and metabolic comorbidities, depression, and CPAP prescriber clinical specialty was used to assess the risk of long-term sick leave leading to permanent work disability over 3 years' follow-up. Results: The analysis included 174,270 individuals (median age, 52.0 yr [interquartile range, 44.0-57.0 yr]; 67.5% male). The 1-year CPAP therapy termination rate was 22.3%. The proportion of individuals with long-term sick leave leading to permanent work disability was significantly higher in the CPAP termination versus continuation group (0.60% vs. 0.52%; P = 0.042). In an adjusted multivariable Cox model, CPAP termination was associated with an increased risk of permanent work disability (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41; P = 0.01), primarily in the subgroup aged >55 years (hazard ratio, 1.41; 95% CI, 1.06-1.87; P = 0.02). Conclusions: These real-world data from a comprehensive, unbiased database highlight the potential occupational impact of CPAP therapy termination.

Prognostic Factors Related to Sleep Quality in Patients With Obstructive Sleep Apnea After Positive Airway Pressure Therapy

Background and Objectives: This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy.Methods: In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment.Results: Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m&lt;sup&gt;2&lt;/sup&gt;) than in the persistent EDS group (27.13 kg/m&lt;sup&gt;2&lt;/sup&gt;; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p&lt;0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p&lt;0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p&lt;0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p&lt;0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p&lt;0.001) and multivariate (OR=0.973, p=0.019) analyses.Conclusion: Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient’s self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.

Blood Pressure in Patients Obstructive Sleep Apnea and Resistant Hypertension with Continuous Positive Airway Pressure (CPAP) Therapy: A Systematic Review and Meta-Analysis

Blood Pressure in Patients Obstructive Sleep Apnea and Resistant Hypertension with Continuous Positive Airway Pressure (CPAP) Therapy: A Systematic Review and Meta-Analysis

The impact of continuous positive airway pressure therapy on cardiovascular events in patients with obstructive sleep apnoea: an updated systematic review and meta-analysis.

Obstructive sleep apnoea (OSA) is positively associated with cardiovascular diseases, and continuous positive airway pressure (CPAP) is a common treatment for such patients. This study aimed to explore the impact of CPAP on cardiovascular outcomes and prognosis in patients with OSA. A search was conducted in the PubMed, Embase and CENTRAL databases for relevant studies published up to March 2024. Two independent reviewers screened the studies based on inclusion and exclusion criteria, and data were synthesised using RevMan 5.3 software. Heterogeneity was assessed using the Cochran Q test and the I2 statistic. A total of 10 randomised controlled trials and 3 observational studies, comprising 13,832 patients, were included. Compared with standard treatment, the use of CPAP did not significantly reduce the risk of major adverse cardiovascular events (MACE) (risk ratio [RR]: 0.73, 95% confidence interval [CI]: 0.52-1.03; p = 0.07; I2 = 66%), all-cause mortality (RR: 0.92, 95% CI: 0.72-1.16; p = 0.48; I2 = 0%), cardiovascular mortality (RR: 0.63, 95% CI: 0.33-1.19; p = 0.15; I2 = 70%) or non-cardiovascular mortality (RR: 0.81, 95% CI: 0.57-1.15; p = 0.23; I2 = 0%). Similarly, there were no significant differences in the incidence of myocardial infarction, stroke, hospitalisation due to unstable angina or heart failure or atrial fibrillation among those using CPAP. However, when CPAP adherence was ≥ 4h, CPAP significantly reduced the risk of MACE and cardiovascular mortality. Although CPAP's cardiovascular benefits in patients with OSA are not confirmed, it may be that bias risks, CPAP adherence and characteristics of the study population may attenuate the perceived benefits of CPAP. Further research is needed to optimise CPAP therapy.

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.

Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea

BackgroundFew data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups. Methods20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting. ResultsPropensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01). ConclusionThese are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.

The latest research progress on the relationship between obstructive sleep apnea–hypopnea syndrome and metabolic syndrome

AbstractObstructive sleep apnea–hypopnea syndrome (OSAHS) is the most common subtype of sleep‐disordered breathing, characterized by symptoms such as snoring, nocturnal sleep disturbances, and excessive daytime sleepiness. OSAHS is defined by recurrent upper airway collapses during sleep, leading to apneas or hypopneas. These episodes result in intermittent nocturnal hypoxia and sleep fragmentation, which provoke sympathetic activation, oxidative stress, and systemic inflammation, ultimately causing chronic damage across multiple bodily systems. OSAHS significantly increases the risk of various cardiovascular and metabolic disorders, including atherosclerosis, hypertension, obesity, insulin resistance, and dyslipidemia. In China, approximately 176 million individuals are estimated to have OSAHS, with about 60 million experiencing moderate to severe forms of the condition. This paper reviews the epidemiological characteristics of OSAHS, the evolution of diagnostic criteria, and the association between OSAHS and metabolic syndrome (MetS), emphasizing the high prevalence of MetS among OSAHS patients. Through cross‐sectional analysis, cohort studies, and interventional studies, the complex interactions between OSAHS and MetS are examined, proposing therapeutic strategies to improve these metabolic anomalies, including continuous positive airway pressure therapy and weight management.