Risk Of Sleep Apnea Research Articles

Correlation of Headache Frequency and Intensity with the Risk of Obstructive Sleep Apnea in Patients with Idiopathic Intracranial Hypertension (P10-12.007)

Correlation of Headache Frequency and Intensity with the Risk of Obstructive Sleep Apnea in Patients with Idiopathic Intracranial Hypertension (P10-12.007)

Evaluating Sleep Apnea Risk in Survivors of Intracerebral Hemorrhage in the REDUCE Cohort (P9-9.002)

Evaluating Sleep Apnea Risk in Survivors of Intracerebral Hemorrhage in the REDUCE Cohort (P9-9.002)

A Study on Improving Sleep Apnea Diagnoses Using Machine Learning Based on the STOP-BANG Questionnaire

Sleep apnea has emerged as a significant health issue in modern society, with self-diagnosis and effective management becoming increasingly important. Among the most renowned methods for self-diagnosis, the STOP-BANG questionnaire is widely recognized as a simple yet effective tool for diagnosing and assessing the risk of sleep apnea. However, its sensitivity and specificity have limitations, necessitating the need for tools with higher performance. Consequently, this study aimed to enhance the accuracy of sleep apnea diagnoses by integrating machine learning with the STOP-BANG questionnaire. Research through actual cases was conducted based on the data of 262 patients undergoing polysomnography, confirming sleep apnea with a STOP-BANG score of ≥3 and an Apnea–Hypopnea Index (AHI) of ≥5. The accuracy, sensitivity, and specificity were derived by comparing Apnea–Hypopnea Index scores with STOP-BANG scores. When applying machine learning models, four hyperparameter-tuned models were utilized: K-Nearest Neighbor (K-NN), Logistic Regression, Random Forest, and Support Vector Machine (SVM). Among them, the K-NN model with a K value of 11 demonstrated superior performance, achieving a sensitivity of 0.94, specificity of 0.85, and overall accuracy of 0.92. These results highlight the potential of combining traditional STOP-BANG diagnostic tools with machine learning technology, offering new directions for future research in self-diagnosis and the preliminary diagnosis of sleep-related disorders in clinical settings.

Prevalence of obstructive sleep apnoea risk and its association with anthropometric indices of cardiometabolic risks and cognition in young and middle-aged adults

Objectives: Obstructive sleep apnoea (OSA), an often underdiagnosed and undertreated sleep-related breathing disorder, is associated with an increased risk of cardiovascular morbidity and mortality. Hence, this study aimed to assess the prevalence of OSA risk and its association with anthropometric indices (AI) of cardiometabolic risks, domain-specific cognitive functions and quality of sleep in apparently healthy young and middle-aged adults. Materials and Methods: One hundred and eighty-nine apparently healthy individuals (123 males and 66 females) aged 19–45 years were included in this cross-sectional study. The participant’s current risk of OSA was assessed using the STOP-Bang questionnaire, and AI indicative of cardiometabolic risk (body mass index, waist-hip ratio [W/H ratio], waist-height ratio [WHtR], conicity index and a body shape index) was assessed using standard techniques. Domain-specific cognitive tests were performed to assess the cognitive status of the individual. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. The correlation between the OSA risk score and the study parameters was assessed using the Pearson or Spearman correlation coefficient test. Results: The prevalence of high current risk of moderate to severe OSA was found to be 12.7%. Significant positive correlations were observed between OSA risk score and W/H, WHtR and sleep quality scores. While a significant positive correlation was observed between OSA risk score and executive functioning, significant negative correlations were observed with the other cognitive tests (short-term memory, verbal fluency, visuospatial memory and sustained attention and response speed). Conclusion: A high risk of moderate to severe OSA is associated with obesity, cognitive decline and poor sleep quality in apparently healthy young and middle-aged adults.

Association of lipid-modifying therapy with risk of obstructive sleep apnea: A drug-target mendelian randomization study

BackgroundObstructive sleep apnea (OSA) is considered to be an important contributor of dyslipidemia. However, there lacks observational studies focusing on the potential effect of lipid management on OSA risk. Thus, we aimed to investigate the genetic association of lipid-modifying therapy with risk of OSA. MethodsA drug-target mendelian randomization (MR) study using both cis-variants and cis-expression quantitative trait loci (eQTLs) of lipid-modifying drug targets was performed. The MR analyses used summary-level data of genome wide association studies (GWAS). Primary MR analysis was conducted using inverse-variance-weighted (IVW) method. Sensitivity analysis was performed using weighted median (WM) and MR-pleiotropy residual sum and outlier (MR-PRESSO) methods. ResultsGenetically proxied low-density lipoprotein cholesterol (LDL-C)-lowering effect of cholesteryl ester transfer protein (CETP) was associated with reduced risk of OSA (odds ratio [OR] =0.75, 95% confidence interval [CI]: 0.60–0.94, false discovery rate [FDR] q value = 0.046). A significant MR association with risk of OSA was observed for CETP expression in subcutaneous adipose tissue (OR = 0.94, 95%CI: 0.89–1.00, FDR q value = 0.049), lung (OR = 0.94, 95%CI: 0.89–1.00, FDR q value = 0.049) and small intestine (OR = 0.96, 95%CI: 0.93–1.00, FDR q value = 0.049). No significant effects of high-density lipoprotein cholesterol (HDL-C)-raising effect of CETP inhibition, LDL-C-lowering and triglycerides-lowering effect of other drug targets on OSA risk were observed. ConclusionsThe present study presented genetic evidence supporting the association of LDL-C-lowering therapy by CETP inhibition with reduced risk of OSA. These findings provided novel insights into the role of lipid management in patients with OSA and encouraged further clinical validations and mechanistic investigations.

Treatment of Sleep Apnea and Reduction in Blood Pressure: The Role of Heart Rate Response and Hypoxic Burden.

Obstructive sleep apnea is associated with increased blood pressure (BP). Obstructive sleep apnea treatment reduces BP with substantial variability, not explained by the apnea-hypopnea index, partly due to inadequate characterization of obstructive sleep apnea's physiological consequences, such as oxygen desaturation, cardiac autonomic response, and suboptimal treatment efficacy. We sought to examine whether a high baseline heart rate response (ΔHR), a marker of high cardiovascular risk in obstructive sleep apnea, predicts a larger reduction in post-treatment systolic BP (SBP). Furthermore, we aimed to assess the extent to which a reduction in SBP is explained by a treatment-related reduction in hypoxic burden (HB). ΔHR and HB were measured from pretreatment and posttreatment polygraphy, followed by a 24-hour BP assessment in 168 participants treated with continuous positive airway pressure or nocturnal supplemental oxygen from the HeartBEAT study (Heart Biomarker Evaluation in Apnea Treatment). Multiple linear regression models assessed whether high versus mid (reference) ΔHR predicted a larger reduction in SBP (primary outcome) and whether there was an association between treatment-related reductions in SBP and HB. A high versus mid ΔHR predicted improvement in SBP (adjusted estimate, 5.8 [95% CI, 1.0-10.5] mm Hg). Independently, a greater treatment-related reduction in HB was significantly associated with larger reductions in SBP (4.2 [95% CI, 0.9-7.5] mm Hg per 2 SD treatment-related reduction in HB). Participants with substantial versus minimal treatment-related reductions in HB had a 6.5 (95% CI, 2.5-10.4) mm Hg drop in SBP. A high ΔHR predicted a more favorable BP response to therapy. Furthermore, the magnitude of the reduction in BP was partly explained by a greater reduction in HB.

Increasing obstructive sleep apnea risk is associated with albuminuria in Korean adults: cross-sectional analysis

Several studies have shown an association between albuminuria and obstructive sleep apnea (OSA). However, studies on the relationship between the STOP-BANG questionnaire that can screen for OSA and microalbuminuria are still insufficient. Therefore, this study attempted to clarify the relationship between microalbuminuria and OSA risk using the STOP-BANG questionnaire in Korean adults. A total of 7478 participants (3289 men and 4189 women) aged over 40 were enrolled in the Korean National Health and Nutrition Examination Survey from 2019 to 2020. STOP-BANG questionnaire to screen OSA was obtained from subjects. The urinary albumin/creatinine ratio (ACR) and proteinuria were measured via a single dipstick to evaluate renal function. The high OSA risk group had a higher mean ACR value than the low OSA risk group (36.8 ± 172.2 vs 17.7 ± 82.5; P < 0.001). The proportion of subjects with values of 30 ≤ ACR < 300 mg/g (11.9% vs 6.1%; P < 0.001) and ACR > 300 mg/g (2.1% vs 0.7%; P < 0.001) was significantly higher in high OSA risk group. Multivariate logistic regression results confirmed that microalbuminuria (OR 1.279, 95% confidence interval (CI) 1.068–1.532, P = 0.008) was significantly correlated with high OSA risk. In addition, significant correlation with high OSA risk was also found in macroalbuminuria (OR 1.684, 95% CI 1.073–2.530, P = 0.022) and proteinuria (OR 1.355, 95% CI 1.030–1.783, P = 0.030). We confirmed a significant correlation between high OSA risk and albuminuria/proteinuria in Korean adults. Therefore, renal function evaluation is required in high OSA risk patients, and OSA diagnosis through PSG test and treatment is necessary.

Abstract P442: Secondhand Smoking Associated With Sleep Apnea Risk Score

Introduction: Approximately 18 million people have obstructive sleep apnea. While many people experience occasional nights of insufficient sleep, chronic sleep disorders are more serious and increase the risk of injury, morbidity, and mortality. While the association between smoking and sleep problems is well established, the relationship between secondhand smoke on sleep disordered breathing risk is less clear. Hypothesis: Sleep apnea risk increases with the presence of a smoker in the household. Methods: Data from N=9,232 adults were leveraged from the NHANES 2017-March 2020 dataset. The outcome/dependent variable of interest was sleep apnea risk score based on modified STOP-BANG criteria combined, as well as the presence/absence of snoring, tiredness, gasping, high blood pressure, BMI &gt; 35, age &gt; 50, and male gender. The exposure/independent variable was smoking status categorized as no smoker at home (reference) compared to whether there was an outside only smoker or someone who smoked indoors. Linear models estimated the association between smoking and overall risk, while logistic regression models estimated the association between smoking and individual risk factors. Results: Compared to no-smoking households, those with only outdoor smokers had a 0.187 point greater sleep apnea risk score ( p = 0.008), while those with an indoor smoker had a 0.211 point greater sleep apnea risk ( p = 0.018). Outdoor smoking was associated with greater likelihood of concurrent tiredness/sleepiness (OR 1.30, p = 0.014), gasping (OR 1.29, p = 0.024), and less likelihood of being over 50 (OR 0.52, p &lt; 0.001). Indoor smoking was associated with greater snoring (OR 1.33, p = 0.027) and tiredness (OR 1.29, p = 0.013). Indoor/outdoor smoking was not associated with high blood pressure, BMI, or male gender. Conclusion: Having a smoker in the home (Indoor and outdoor) wasere associated with greater apnea risk score. Location of smoking varied in association with individual apnea symptoms, but not in any consistent way. Although studies have shown that smoking worsens sleep apnea risk, future work should explore whether smoking cessation can improve health in other family members as well.

Abstract P519: Sleep as a Cardiometabolic Risk Factor Following Release From Carceral Facilities

Background: Approximately 2 million people are incarcerated, and 11 million cycle in and out of U.S. jails and prisons annually. Cardiovascular disease (CVD) morbidity and mortality are higher among people with a history of incarceration, especially in the weeks following release from prison. Sleep is an underexplored factor that may contribute to CVD disparities among people with a history of incarceration. Population-specific risk factors in the social and physical environment may contribute to poor sleep and CVD risk during imprisonment and after release from a carceral facility. Methods: The Sleep Justice study, an ancillary study to an ongoing prospective cohort recruiting individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, aimed to describe sleep and examine the connections between sleep and CVD risk factor control among people released from a carceral facility. Sleep was assessed using subjective and objective measures. The Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control were used, and wrist-worn actigraphy was used to measure sleep objectively in a subsample of 80 participants. We will examine sleep and its association with CVD in this sample of people recently released from a carceral facility. Results: Most participants were male (92%), non-Hispanic Black (51%) or Hispanic (27%), were incarcerated 2-5 times, and were living in transitional housing (78%) at baseline. All participants had a CVD risk factor as a requirement of the study inclusion criteria: hypertension (78%), hyperlipidemia (47%), obesity (59%), diabetes (29%), and history of CVD (19%). Most reported low (24%) or some control (35%) over their sleep. Participants were at increased risk for sleep apnea, with 47% at moderate risk and 23% at high risk. Most participants reported poor sleep quality (65%) on the PSQI. We conducted logistic regression examining the relationship between sleep and CVD risk and found that poor sleep quality was associated with HTN (p=0.02), even after adjusting for age, race and ethnicity, and gender (AOR 2.44, 95% CI 1.14-5.29). Discussion: Given the disproportionate incarceration of racial and ethnic minoritized groups, the impact of incarceration on sleep health and CVD are areas that urgently need to be examined. This study is the first to examine sleep after release from a carceral facility and highlights the need for interventions targeting sleep health and CVD in this population.

Association between the Risk of Obstructive Sleep Apnea and Lung Function: Korea National Health and Nutrition Examination Survey.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with various health issues. Although some studies have suggested an association between reduced lung function and OSA, this association remains unclear. Our study aimed to explore this relationship using data from a nationally representative population- based survey. We performed an analysis of data from the 2019 Korea National Health and Nutrition Examination Survey. Our study encompassed 3,675 participants aged 40 years and older. Risk of OSA was assessed using the STOP-Bang (Snoring, Tiredness during daytime, Observed apnea, and high blood Pressure-Body mass index, Age, Neck circumference, Gender) questionnaire and lung function tests were performed using a portable spirometer. Logistic regression analysis was applied to identify the risk factors associated with a high-risk of OSA, defined as a STOP-Bang score of ≥3. Of 3,675 participants, 600 (16.3%) were classified into high-risk OSA group. Participants in the high-risk OSA group were older, had a higher body mass index, and a higher proportion of males and ever-smokers. They also reported lower lung function and quality of life index in various domains along with increased respiratory symptoms. Univariate logistic regression analysis indicated a significant association between impaired lung function and a high-risk of OSA. However, in the multivariable analysis, only chronic cough (odds ratio [OR], 2.413; 95% confidence interval [CI], 1.383 to 4.213) and sputum production (OR, 1.868; 95% CI, 1.166 to 2.992) remained significantly associated with a high OSA risk. Our study suggested that, rather than baseline lung function, chronic cough, and sputum production are more significantly associated with OSA risk.

Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration.

Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness. The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration. This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Adults aged 40 years or older were included and divided into two groups using the STOP-Bang Questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates. Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hours demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high risk for OSA with a sleep duration of 5-9 hours. The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.

Prevalence of Obesity among Adults Visiting Otorhinolaryngology Clinics for Snoring

Abstract Introduction: This study aims to assess the prevalence of obesity and to estimate the risk of obstructive sleep apnea (OSA) among adults visiting otorhinolaryngology (ORL) clinics for snoring. Methods: We conducted a retrospective chart review of adult patients who visited ORL clinics at King Fahd Military Medical Complex for snoring in the period between October 2019 and March 2022. We utilized STOP and STOP-BANG screening tools to stratify OSA risk in the included subjects. Results: Eighty-five patients were included in this study. Most of the subjects were male (80%). Obesity was detected in 63 (74.1%) of the included subjects. Seventy-seven subjects (90.6%) were independently at risk of OSA based on the STOP-BANG questionnaire and STOP questionnaire. Conclusion: Obesity is common in adults visiting ORL clinics for snoring. The rate of OSA risk is high among adult patients visiting ORL clinics for snoring. Therefore, it is important for ORL practitioners to utilize OSA risk assessment tools and to have enough knowledge or access to sleep medicine clinics for diagnostic and therapeutic purposes.

Association of the combination of obstructive sleep apnea risk and sleep duration with ideal cardiovascular health metrics in patients undergoing hemodialysis

BackgroundThe purpose of this study was to explore the separate and combined associations of obstructive sleep apnea (OSA) risk and sleep duration with ideal cardiovascular health metrics in hemodialysis (HD) patients.Methods470 HD participants (average: 59.48 ± 12.89 y, 281 men) were included in this study. Sleep duration was measured as self-reported average sleep time during the previous month. The OSA risk was assessed using the STOP-BANG questionnaire. Participants were divided into three groups based on the number of ideal cardiovascular health (CVH) metrics: 0–2,3–4, and 5–7. Ordinal logistic regression was conducted to model the associations of CVH metrics with sleep duration, OSA risk, and their combined effects by adjusting for specific covariates.ResultsAfter adjusting for covariates, short sleep duration (< 7 h) (OR = 0.53; 95% CI [ 0.30, 0.92]) and OSA risk (OR = 0.58; 95% CI [0.32, 0.83]) were negatively associated with better CVH (ideal vs. intermediate; intermediate vs. poor), respectively. For HD patients with both short sleep duration and OSA risk, the odds of ideal CVH metrics were reduced by 72% (odds ratio 0.28 [95% CI 0.13, 0.60]).ConclusionsShort sleep duration and OSA risk are separately and jointly associated with poor CVH in hemodialysis patients. Suitable interventions for sleep may minimize the risk of developing cardiovascular disease.

Evaluation of a Pre-operative clinic's sleep apnea screening

BackgroundThis quality improvement (QI) project aimed to evaluate the process and outcomes of utilizing the STOP-BANG questionnaire (SBQ) to screen patients for sleep apnea in a pre-operative clinic. Studies outside the United States show that there is a greater risk for obstructive sleep apnea (OSA) among Asian ethnicity compared to Whites; thus, this project also aimed to describe the SBQ scores of a subset of Asian Americans not referred for a sleep study and determine the number of potential referrals if the body mass index (BMI) threshold in their SBQ scores is modified. MethodsA retrospective medical records review identified patients referred for a sleep study at the pre-operative clinic, described the sleep study outcome results, and identified gaps in the referral process that future QI projects can address. The records review also identified SBQ scores of Asian Americans not referred for a sleep study. Their scores were recalculated using a lower BMI threshold to determine the proportion of those who could have been referred. ResultsThere were 72,413 patient encounters at the pre-operative clinics from January 2019 to December 2021; 279 patients were referred for a sleep study. Only 103 (36.92 %) completed the test. There were 34 (33.01 %) confirmed to have severe sleep apnea, 28 (27.18 %) with moderate sleep apnea, 29 (28.16 %) with mild sleep apnea, and 12 (11.65 %) with no sleep apnea. Of the 176 (63.08 %) sleep study referrals not completed, the most common reasons for non-completion were issues with timely scheduling, educating patients to encourage study completion, and handling insurance denials. The mean BMI of the 1,560 Asian Americans not referred for a sleep study was 25.42 kg/m2, and only 2.31 % had a BMI > 35 kg/m2. Among the 162 Asian Americans with a history of sleep apnea, only 14.81 % had a BMI > 35 kg/m2. Adjusting the BMI threshold of SBQ increased the number of Asian Americans who could be referred for a sleep study by 1.35 % and 2.12 % if using a cut-off of > 30 kg/m2 and > 28 kg/m2, respectively. ConclusionsScreening of OSA using the SBQ in a pre-operative clinic effectively identified patients at high risk for sleep apnea. The low completion rate of sleep study referrals shows a gap in the referral process that requires improvement. Asian Americans with sleep apnea have lower BMIs. Attention to BMI thresholds would increase the identification of sleep apnea in this vulnerable population.

The effect of tongue reduction for preventing adverse effects in patients undergoing class III orthognathic surgery: a three-dimensional comparative analysis.

This study aims to evaluate the potential benefits of combining tongue reduction with mandibular setback surgery in patients undergoing class III orthognathic surgery. Specifically, we investigated whether this combined approach reduced the risk of surgical relapse, condylar resorption, and airway space reduction by mitigating tongue pressure on the mandible. The study retrospectively enrolled patients who had undergone bilateral sagittal split ramus osteotomy (BSSRO) with at least 5 mm of setback and met the criteria of a body mass index > 20 kg/m2 and tongue volume > 100 mm3. The study included 20 patients with 10 in the tongue reduction group (TR, n = 10) and 10 in the BSSRO only group (SO, n = 10). The volumetric changes of the total airway space were significantly different between the TR and SO groups (p = 0.028). However, no significant differences were observed in the condylar resorption and postoperative relapse between the groups (p = 0.927 and 0.913, respectively). The difference between the resorption of the anterior and posterior segments of the condyle was also statistically insignificant (p = 0.826). Postoperative counterclockwise rotation of the proximal segment only demonstrated a significant correlation with postoperative relapse (p = 0.048). The reduction in tongue volume demonstrated a preventive effect on the reduction of the airway space after mandibular setback, although it did not yield statistical significance concerning surgical relapse and condylar volume. The counterclockwise rotation of the proximal segment might be responsible for the forward displacement of the distal segment and postoperative relapse. However, the clinical implications of this finding should be interpreted with caution owing to the limited sample size CLINICAL RELEVANCE: Tongue reduction could potentially serve as a preventive measure in preserving the airway space and might be beneficial in mitigating the risk of obstructive sleep apnea in patients with class III deformity.

Association between risk of obstructive sleep apnea severity and risk of severe COVID-19 symptoms: insights from salivary and serum cytokines.

Obstructive sleep apnea (OSA) can adversely affect the immune response through clinical factors such as hypoxia, inflammation, and sleep disturbance. Since SARS-CoV-2 heavily relies on local and systemic host immune responses, this study aims to examine the links between the severity of OSA risk, cytokine levels, and the severity of symptoms associated with SARS-CoV-2 infection. Saliva and blood samples from 50 COVID-19 patients and 30 non-infected hospital staff members were collected. Using Luminex multiplex analysis, 65 blood and salivary cytokines were examined from the collected samples. Ordinal logistic regression analysis was utilized to examine the association between the self-reported risk of OSA, assessed through the STOP-Bang questionnaire, and the likelihood of experiencing severe symptoms of COVID-19. Mann-Whitney test was then performed to compare the cytokine levels between individuals with moderate to severe risk of OSA to those with a mild risk of OSA. Ordinal logistic regression analysis revealed that individuals with a moderate to severe risk of OSA were 7.60 times more likely to experience more severe symptoms of COVID-19 compared to those with a mild risk of OSA (OR = 7.60, 95%CI: 3.03, 19.06, p < 0.001). Moreover, among COVID-19-positive patients with a moderate to severe risk of OSA, there was a statistically significant negative correlation with serum IL-6 (p < 0.05), Eotaxin (CCL11) (p = 0.04), and salivary MIP-3α/CCL20 (p = 0.04). In contrast, individuals without COVID-19 who had a moderate to severe risk of OSA exhibited a significant positive correlation with serum IL-6 (p = 0.04). Individuals with moderate to severe risk of OSA were more likely to experience severe COVID-19 symptoms than those with mild risk for OSA. Additional analysis from the present studies revealed distinct patterns of oral and systemic immune responses between individuals with mild and moderate to severe risk of OSA. Findings from the present study underscores the importance of early detection and management of OSA to improve clinical outcomes, particularly when faced with the subsequent superimposed infection such as COVID-19.

Plant-based and vegetarian diets are associated with reduced obstructive sleep apnoea risk.

Obstructive sleep apnoea (OSA) and obesity commonly coexist. Weight loss and exercise are recommended management options for OSA. However, most of the current evidence on diet and OSA is focused on calorie restriction rather than diet quality. The aim of the present study was to determine the association of plant-based dietary indices (PDI) with OSA risk. Cross-sectional data from 14 210 participants of the National Health and Nutrition Examination Survey who provided dietary information using the 24-hour recall method were used. PDI - including healthy (hPDI), unhealthy (uPDI) and pro-vegetarian diet index (PVDI) - were determined. OSA risk was determined using the STOP-BANG questionnaire. Logistic regression was used to determine the relationship between dietary indices and OSA risk. Higher adherence to PDI (odds ratio (OR)Q5 versus Q1=0.81; 95% confidence interval (CI): 0.66-1.00), hPDI (OR=0.83; 95% CI: 0.69-1.01) and PVDI (OR=0.84; 95% CI: 0.68-1.05) was inversely associated with OSA risk, whereas higher consumption of an unhealthy plant-based diet (OR=1.22; 95% CI: 1.00-1.49) was positively associated with OSA. Sex differences in estimates were observed for PDI in males (OR=0.71; 95% CI: 0.56-0.90) versus females (OR=0.93; 95% CI: 0.68-1.28), hPDI in males (OR=0.90; 95% CI: 0.68-1.18) versus females (OR=0.77; 95% CI: 0.54-1.09) and uPDI in males (OR=1.13; 95% CI: 0.89-1.44) versus females (OR=1.42; 95% CI: 1.03-1.97) but not for PVDI. Higher adherence to a healthy plant-based diet is associated with reduced OSA risk, while an unhealthy plant-based diet has a positive association. The magnitude of these associations differs by sex. Further longitudinal studies are warranted.

The Correlation between Fatigue, Obstructive Sleep Apnea Syndrome and Depression in a Sample of Patients at the Hassan II University Hospital Center – Department of Pulmonology – Sleep Unit, Fes-Morocco

The study aims to monitor the correlational relationship between fatigue, obstructive sleep apnea syndrome (OSAS) and depression in a sample of patients visiting the Hassan II University Hospital Center in Fes. Study tools included the Epworth Sleepi-ness Scale, the Berlin Questionnaire for assessing the risk of sleep apnea, and Beck Depression Inventory. The scales have been translated into Arabic after ensuring their validity and reliability. Participants' ages ranged from 18 to 65+ years, with a male proportion of 34.4% (52) and a female proportion of 65.6% (99). The study results revealed a statistically significant positive correlation (p &lt; 0.01) between fatigue and OSAS, with a correlation coefficient of 0.261. Similarly, a statistically sig-nificant positive correlation (p &lt; 0.01) was found between fatigue and depression, with a correlation coefficient of 0.561.

Quality of Life in Metabolic Syndrome Patients Based on the Risk of Obstructive Sleep Apnea.

Despite the impact of metabolic syndrome (MetS) and obstructive sleep apnea (OSA) on a sizeable proportion of the global population, the difference in the quality of life (QoL) between a group without risk factors for OSA and a group with risk factors for OSA among individuals with MetS is currently unclear. This study aimed to identify the determinants of QoL in patients with MetS with and without OSA risk factors and to analyze differences between these two groups. Data were extracted from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES). The Rao-Scott χ2 test was performed to evaluate differences in baseline characteristics based on OSA risk factors. A t-test was performed to evaluate differences in the baseline QoL, and linear regression analysis was performed to identify the effect on the QoL of the two groups. The factors affecting QoL in the low-risk group included age, education level, and depression. The factors affecting QoL in the high-risk group were physical activity and depression. These results suggest that nursing interventions should be devised according to patients' characteristics to help improve their QoL.

Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study

Objectives: Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. Methods: A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. Results: Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001). Conclusions: A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d