Role Of Obstructive Sleep Apnea Research Articles

Mediating role of obstructive sleep apnea in altering slow-wave activity and elevating Alzheimer’s disease risk: Pilot study from a northern Taiwan cohort

ObjectivesObstructive sleep apnea is associated with alterations in slow-wave activity during sleep, potentially increasing the risk of Alzheimer’s disease. This study investigated the associations between obstructive sleep apnea manifestations such as respiratory events, hypoxia, arousal, slow-wave patterns, and neurochemical biomarker levels. MethodsIndividuals with suspected obstructive sleep apnea underwent polysomnography. Sleep disorder indices, oxygen metrics, and slow-wave activity data were obtained from the polysomnography, and blood samples were taken the following morning to determine the plasma levels of total tau (T-Tau) and amyloid beta-peptide 42 (Aβ42) by using an ultrasensitive immunomagnetic reduction assay. Subsequently, the participants were categorized into groups with low and high Alzheimer’s disease risk on the basis of their computed product Aβ42 × T-Tau. Intergroup differences and the associations and mediation effects between sleep-related parameters and neurochemical biomarkers were analyzed. ResultsForty-two participants were enrolled, with 21 assigned to each of the low- and high-risk groups. High-risk individuals had a higher apnea–hypopnea index, oxygen desaturation index (≥3%, ODI-3%), fraction of total sleep time with oxygen desaturation (SpO2-90% TST), and arousal index and greater peak-to-peak amplitude and slope in slow-wave activity, with a correspondingly shorter duration, than did low-risk individuals. Furthermore, indices such as the apnea–hypopnea index, ODI-3% and SpO2-90% TST were found to indirectly affect slow-wave activity, thereby raising the Aβ42 × T-Tau level. ConclusionsObstructive sleep apnea manifestations, such as respiratory events and hypoxia, may influence slow-wave sleep activity (functioning as intermediaries) and may be linked to elevated neurochemical biomarker levels. However, a longitudinal study is necessary to determine causal relationships among these factors. Statement of significanceThis research aims to bridge gaps in understanding how obstructive sleep apnea is associated with an elevated risk of Alzheimer’s disease, providing valuable knowledge for sleep and cognitive health.

Analysis of the characteristics of intestinal microbiota in patients with different severity of obstructive sleep apnea

Intestinal microbiota imbalance plays an important role in the progression of obstructive sleep apnea (OSA), and is considered to be the main mediator that triggers metabolic comorbidities. Here, we analyzed the changes in intestinal microbiota in patients with different severities of OSA based on apnea hypopnea index (AHI) classification, and explored the role of intestinal microbiota in the severity of OSA. This study included 19 healthy volunteers and 45 patients with OSA [5 ≤ AHI < 15 (n = 14), 15 ≤ AHI < 30 (n = 13), AHI ≥ 30 (n = 18)]. Relevant sleep monitoring data and medical history data were collected, and microbial composition was analyzed using 16S rRNA high-throughput sequencing technology. The diversity analysis of intestinal microbiota among different groups of people was conducted, including alpha diversity, beta diversity, species diversity, and marker species as well as differential functional metabolic pathway prediction analysis. With the increase of AHI classification, the alpha diversity in patients with OSA significantly decreased. The results revealed that the severity of OSA is associated with differences in the structure and composition of the intestinal microbiota. The abundance of bacteria producing short-chain fatty acids (such as Bacteroides, Ruminococcacea, and Faecalibacterium) in severe OSA is significantly reduced and a higher ratio of Firmicutes to Bacteroidetes. Random forest analysis showed that Parabacteroides was a biomarker genus with important discriminatory significance. The differential metabolic pathway prediction function shows that the main function of maintaining intestinal microbiota homeostasis is biosynthetic function. Our results show that the differences in the composition of intestinal microbiota in patients with different severities of OSA are mainly related to short-chain fatty acid-producing bacteria. These changes may play a pathological role in OSA combined with metabolic comorbidities.

Weight Status, Autonomic Function, and Systemic Inflammation in Children with Obstructive Sleep Apnea.

Children with obstructive sleep apnea (OSA) frequently experience chronic low-grade systemic inflammation, with the inflammasome playing a central role in OSA. This cross-sectional study evaluated the relationship between weight status, autonomic function, and systemic inflammation in a cohort of 55 children with OSA, predominantly boys (78%) with an average age of 7.4 ± 2.2 years and an apnea-hypopnea index of 14.12 ± 17.05 events/hour. Measurements were taken of body mass index (BMI), sleep heart-rate variability, morning circulatory levels of interleukin-1β, interleukin-1 receptor antagonist, and interleukin-6, and tumor necrosis factor-α, anthropometry, and polysomnography. Multiple linear regression modeling showed that an apnea-hypopnea index was significantly associated with BMI, the standard deviation of successive differences between normal-to-normal intervals during N3 sleep, and the proportion of normal-to-normal interval pairs differing by more than 50 ms during rapid-eye-movement sleep. A moderated mediation model revealed that interleukin-1 receptor antagonist levels mediated the association between BMI and interleukin-6 levels, with sympathovagal balance during N3 sleep and minimum blood oxygen saturation further moderating these relationships. This study highlights the complex relationships between BMI, polysomnographic parameters, sleep heart-rate-variability metrics, and inflammatory markers in children with OSA, underlining the importance of weight management in this context.

Daytime Sleep Problems Are Related to Fine Motor Function in Persons with Down Syndrome

ABSTRACT Given the high prevalence of sleep problems and fine motor deficits that have been reported in persons with Down syndrome (DS), this study was to investigate the effect of sleep-related problems occurring during the day on fine motor function (i.e. manual dexterity and handgrip strength) in persons with DS. We also tested the moderating role of obstructive sleep apnoea (OSA) in the link between sleep-related problems occurring during the day and fine motor function. It was hypothesised that subtle sleep-related problems occurring during the day would significantly predict fine motor performance. Fifty-two persons with DS, aged 13–54, participated and caregivers completed a sleep questionnaire for their children with DS. Hierarchical multiple regression analyses indicated a greater frequency of sleep-related problems occurring during the day significantly predicted greater manual dexterity deficits. Results also suggested that OSA was the moderator for the association between sleep-related problems occurring during the day and manual dexterity. This study has highlighted the importance of exploring sleep problems that might impair fine motor performance for the DS population in their everyday lives. Additional studies are needed to develop effective interventions to promote sleep hygiene and fine motor development in this population.

The role of obstructive sleep apnea and nocturnal hypoxia as predictors of mortality in cancer patients

BackgroundObstructive sleep apnea (OSA), due to its high prevalence, has been associated with a number of comorbidities, frequently impacting the overall course of these other diseases if left untreated. Recent studies highlight a potential association between OSA and cancer. This study investigates how OSA severity and hypoxia affect cancer prognosis, aiming to elucidate how they interplay. MethodsRetrospective study including patients with a diagnosis of OSA after any cancer type followed up in a tertiary center during a 10-year period. OSA was mainly diagnosed after level III polysomnographic studies. ResultsNocturnal hypoxia was significantly more prevalent in patients presenting lung cancer versus other malignancies and was associated with higher rates of oncologic disease progression. Overall survival was significantly lower in severe OSA patients and also in patients presenting nocturnal hypoxia. A composite hypoxia score considering both OSA severity and significant hypoxia was an independent predictor of mortality regardless of clinical cancer staging and treatment. Shorter time between cancer and OSA diagnosis was also associated with worse prognosis. ConclusionThis study suggests an association between OSA severity and nocturnal hypoxia and increased cancer mortality independently from possible confounding factors such as age, cancer clinical staging at diagnosis, treatment modality and also progression. Neoplastic patients with severe OSA and/or complex hypoxia seem to have lower overall survival rates than those with less severe OSA and nocturnal hypoxia.

Awareness about Orthodontists' Role in Treating Osa and Mouth Breathing among Otolaryngologists.

Orthodontic correction of dentofacial abnormalities is a crucial component of oral health because it enhances overall oral health-related quality of life, optimal function, periodontal health, and aesthetics. This study sought to determine whether otolaryngologists recommend patients to orthodontists, whether they are adequately knowledgeable about the fundamentals of orthodontics, and whether they check for orthodontic problems in their patients. We conducted a survey study of otolaryngologists in Gujarat, India. Questionnaires were completed by 47 out of 60 otolaryngologists (response rate 78%). In the assessment of the mouth breathers, a very low frequency of "always" examining the extra-oral features (18%) was found. Reasons otolaryngologists referred patients to orthodontists varied from mouth breathing 48% (23/47) to face or teeth asymmetry 87% (41/47). In the multivariable analyses for the effect of gender, work sector, or years of experience in the decision for orthodontic referral, we could not identify any significant predictors. A low frequency of awareness of orthodontists' role in obstructive sleep apnoea, 48% (23/47) was found. In conclusion, the survey of otolaryngologists in Gujarat, India, revealed areas for improvement in awareness and practices related to orthodontic issues, particularly in cases of mouth breathing. The study highlighted a low frequency of examination of extraoral features and variability in referral patterns, emphasizing potential gaps in knowledge. Additionally, a low awareness of orthodontists' role in treating obstructive sleep apnea was identified. Targeted educational interventions are recommended to enhance interdisciplinary communication and collaboration between otolaryngologists and orthodontists, ultimately fostering a more comprehensive approach to patient care for individuals with dentofacial deformities in Gujarat and potentially influencing practices on a broader scale.

Regional associations between inspiratory tongue dilatory movement and genioglossus activity during wakefulness in people with obstructive sleep apnoea.

Inspiratory tongue dilatory movement is believed to be mediated via changes in neural drive to genioglossus. However, this has not been studied during quiet breathing in humans. Therefore, this study investigated this relationship and its potential role in obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in nine controls [apnoea-hypopnea index (AHI) ≤5 events/h] and 37 people with untreated OSA (AHI >5 events/h). Measurements were obtained for 156 neuromuscular compartments (85%). Analysis was adjusted for nadir epiglottic pressure during inspiration. Only for 106 compartments (68%) was a larger anterior (dilatory) movement associated with a higher phasic EMG [mixed linear regression, beta=0.089, 95% CI [0.000, 0.178], t(99)=1.995, P=0.049, hereafter EMG↗/mvt↗]. For the remaining 50 (32%) compartments, a larger dilatory movement was associated with a lower phasic EMG [mixed linear regression, beta=-0.123, 95% CI [-0.224, -0.022], t(43)=-2.458, P=0.018, hereafter EMG↘/mvt↗]. OSA participants had a higher odds of having at least one decoupled EMG↘/mvt↗ compartment (binary logistic regression, odds ratio [95% CI]: 7.53 [1.19, 47.47] (P=0.032). Dilatory tongue movement was minimal (>1 mm) in nearly all participants with only EMG↗/mvt↗ compartments (86%, 18/21). These results demonstrate that upper airway dilatory mechanics cannot be predicted from genioglossus EMG, particularly in people with OSA. Tongue movement associated with minimal genioglossus activity suggests co-activation of other airway dilator muscles. KEY POINTS: Inspiratory tongue movement is thought to be mediated through changes in genioglossus activity. However, it is unknown if this relationship is altered by obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue movement, quantified with tagged magnetic resonance imaging (MRI), and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in four tongue compartments of people with and without OSA. Larger tongue anterior (dilatory) movement was associated with higher phasic genioglossus EMG for 68% of compartments. OSA participants had an ∼7-times higher odds of having at least one compartment for which a larger anterior tongue movement was not associated with a higher phasic EMG than controls. Therefore, higher genioglossus phasic EMG does not consistently translate into tongue dilatory movement, particularly in people with OSA. Large dilatory tongue movements can occur despite minimal genioglossus inspiratory activity, suggesting co-activation of other pharyngeal muscles.

Abstract 17346: The Causal Role of Obstructive Sleep Apnea (OSA) in Atrial Fibrillation (AF): A Systematic Review and Meta-Analysis of Mendelian Randomization Studies

Background: Atrial fibrillation (AF) causes significant morbidity and mortality. Obstructive sleep apnea (OSA) has been suggested as a risk factor for AF, but the causal relationship between the two is still being investigated. We performed a systematic review and meta-analysis of Mendelian Randomization (MR) studies to determine OSA's role in AF. Methods: We searched PubMed, Scopus, Embase, and Google Scholar databases for MR studies on the causal relationship between OSA and AF through June 2023. Our analysis included eligible studies. The pooled odds ratio and subgroup analysis were calculated using the random-effects model. The I2 statistic was used to assess study heterogeneity, and a leave-one-out sensitivity analysis was performed to determine how individual studies affected the overall estimate and analysis robustness. Results: 5 MR studies met our inclusion criteria until June 2023. In these studies, one used diverse datasets and included patient data of 5 cohorts with UK, Canada, Australia, USA, Finland ancestry while the remaining 4 included patient data of European ancestry. Genetic predisposition to OSA was found to cause AF in the pooled odds ratio analysis (OR 1.21, 95% CI 1.15-1.28, I2=0.00%, p &lt;0.01). The leave-one-out sensitivity analysis showed that the odds ratio marginally changed when specific studies were excluded, suggesting that their contribution to the estimate slightly differed. Conclusion: Our findings suggest a causal relationship between OSA and AF, suggesting that OSA may cause AF. The findings emphasize the need for early evaluation and treatment of AF patients with OSA. However, large-scale prospective studies are required to confirm these findings and determine their clinical practice implications.

The Role of Obstructive Sleep Apnea in Vision-Threatening Diabetic Retinopathy-A National Register-Based Study.

we investigated the association between OSA and vision-threatening diabetic retinopathy (VTDR). we used three nationwide registers to identify subjects with and without OSA and patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). The Danish Civil Registration System was used to link OSA with diabetes diagnosis. The primary outcome was the occurrence of VTDR in diabetic patients with and without OSA. The secondary outcome was the prevalence of diabetes mellitus in patients with and without OSA. we included 532,828 diabetic subjects comprising 13,279 patients with OSA (2.5%) and 519,549 without OSA (97.5%). Diabetic patients with OSA had a 57% lower risk of VTDR compared to diabetic patients without OSA (OR 0.43, 95% CI 0.38-0.50, p < 0.0001). our findings indicate that OSA is associated with a lower risk of VTDR. Since we did not adjust our outcomes for diabetes duration, hypertension control and hemoglobin A1c, future studies are needed to confirm our findings.

Obstructive Sleep Apnea as a Predictor of Inducible Atrial Flutter During Pulmonary Vein Isolation in Patients With Atrial Fibrillation: Clinical Significance and Follow-Up Outcomes.

Atrial fibrillation (AF) and atrial flutter (AFL) often coexist in patients and may lead to severe symptoms and complications. Despite their coexistence, prophylactic cavotricuspid isthmus (CTI) ablation has failed to reduce the incidence of recurrent AF or new onset AFL. In contrast, the presence of inducible AFL during pulmonary vein isolation (PVI) has been shown to be predictive of symptomatic AFL during follow-up. However, the potential role of obstructive sleep apnea (OSA) as a predictor of inducible AFL during PVI in patients with AF remains unclear. Therefore, this study aimed to examine the potential role of OSA as a predictor of inducible AFL during PVI in patients with AF and reexamine the clinical significance of inducible AFL during PVI in terms of recurrent AFL or AF during follow-up. We conducted a single-center, non-randomized retrospective study on patients who underwent PVI between October 2013 and December 2020. A total of 192 patients were included in the study after screening 257 patients for exclusion criteria, which included a previous history of AFL or previous PVI or Maze procedure. All patients underwent a transesophageal echocardiogram (TEE) prior to their ablation to rule out a left atrial appendage thrombus. The PVI was performed using both fluoroscopic and electroanatomic mapping derived from intracardiac echocardiography. After the confirmation of PVI, additional electrophysiology (EP) testing was performed. AFL was classified as typical or atypical based on the origin and activation pattern. Descriptive and frequency statistics were performed to describe the demographic and clinical characteristics of the sample, and Chi-square and Fisher's exact tests were used to compare independent groups on categorical outcomes. Logistic regression analysis was performed to adjust for confounding variables. The study was approved by the Institutional Review Board, and informed consent was waived given the retrospective nature of the study. Of the 192 patients included in the study, 52% (n = 100) had inducible AFL after PVI, with 43% (n = 82) having typical right AFL. Bivariate analysis showed statistically significant differences between the groups for OSA (P = 0.04) and persistent AF (P = 0.047) when examining the outcome of any inducible AFL. Similarly, only OSA (P = 0.04) and persistent AF (P = 0.043) were significant when examining the outcome of typical right AFL. Multivariate analysis showed that only OSA was significantly associated with any inducible AFL after controlling for other variables (adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI): 1.003 - 3.69, P = 0.049). Of the 100 patients with inducible AFL, 89 underwent additional ablation for AFL prior to completion of their procedure. At 1 year, the rates of recurrence for AF, AFL, and either AF or AFL were 31%, 10%, and 38%, respectively. There was no significant difference in the rates of recurrence of AF, AFL, or either AF/AFL at 1 year when accounting for the presence of inducible AFL or the efficacy of additional AFL ablation. In conclusion, our study found a high incidence of inducible AFL during PVI, particularly among patients with OSA. However, the clinical significance of inducible AFL in relation to the recurrence rates of AF or AFL at 1-year post-PVI remains unclear. Our findings suggest that successful ablation of inducible AFL during PVI may not provide clinical benefit in reducing AF or AFL recurrence. To establish the clinical significance of inducible AFL during PVI in various patient populations, further prospective studies with larger sample sizes and longer follow-up periods are necessary.

Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension.

The potential role of obstructive sleep apnea (OSA) in hypertension-mediated organ damage (HMOD) may be influenced by the presence of resistant hypertension (RH). Herein, we enrolled patients with hypertension from a tertiary center for clinical evaluation and performed a sleep study to identify OSA (apnea-hypopnea index ≥15 events/h) and a blinded analysis of four standard HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy, and nephropathy). RH was diagnosed based on uncontrolled blood pressure (BP) (≥140/90 mmHg) despite concurrent use of at least three antihypertensive drug classes or controlled BP with concurrent use of ≥4 antihypertensive drug classes at optimal doses. To avoid the white-coat effect, ambulatory BP monitoring was performed to confirm RH diagnosis. One-hundred patients were included in the analysis (mean age: 54 ± 8 years, 65% females, body mass index: 30.4 ± 4.5 kg/m²). OSA was detected in 52% of patients. Among patients with non-RH (n = 53), the presence of OSA (52.8%) was not associated with an increased frequency of HMOD. Conversely, among patients with RH, OSA (51.1%) was associated with a higher incidence of LVH (RH-OSA,61%; RH + OSA,87%; p = 0.049). Logistic regression analysis using the total sample revealed that RH (OR:7.89; 95% CI:2.18-28.52; p = 0.002), systolic BP (OR:1.04; 95% CI:1.00-1.07; p = 0.042) and OSA (OR:4.31; 95% CI:1.14-16.34; p = 0.032) were independently associated with LVH. No significant association was observed between OSA and arterial stiffness, retinopathy, or nephropathy. In conclusion, OSA is independently associated with LVH in RH, suggesting a potential role of OSA in RH prognosis.

Role of Obstructive Sleep Apnea in Idiopathic Intracranial Hypertension (P10-4.004)

<h3>Objective:</h3> It remains unclear if the presence or treatment of Obstructive Sleep Apnea (OSA) influences the severity or natural history of Idiopathic Intracranial Hypertension (IIH). Hence, we did retrospective analysis to investigate the correlation of OSA in IIH with regards to opening pressure and papilledema grading. <h3>Background:</h3> Retrospective review of all IIH patients seen between 2018–2020 in Neuro-Ophthalmology clinic at University of Kentucky. <h3>Design/Methods:</h3> 80 IIH patients were categorized into three groups. Group 1 had IIH and OSA (19 patients), group 2 had IIH, but no OSA (21 patients) and Group 3 had IIH with suspected OSA, but sleep study not completed (40 patients). Comparison of these three groups on demographic and clinical outcomes were done. <h3>Results:</h3> Chi-square tests were used to compare the three groups on categorical outcomes. One-way analysis of variance (ANOVA) or Wilcoxon rank-sum tests were used to compare the groups on continuous outcomes that were either normally or non-normally distributed, respectively. Patients in group 1 were significantly older than group 2 (p = .013). Group 1 weighed significantly more than group 2 and 3 (p = .004 and p &lt; .001, respectively). Group 1 had a significantly higher BMI than those on group 3 (p = .024), but their difference compared to group 2 did not reach significance (p = .061). When comparing the three groups on clinical outcomes, overall, there were no significance differences in opening pressure, or papilledema grading for either eye. <h3>Conclusions:</h3> In our study, there was no significant difference between the association of OSA on IIH in terms of opening pressure and the severity of papilledema. Larger, prospective and controlled studies are required to further evaluate the relationship between OSA and IIH, and the effect of OSA treatment on the clinical course of IIH. <b>Disclosure:</b> Dr. Thandampallayam Ajjeya has nothing to disclose. Dr. Sudhakar has nothing to disclose.

Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients

ObjectiveThis study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. Methods180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. ResultsThe prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. ConclusionsAcute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.

Nursing Professionals’ Role in the Comprehensive Management of Obstructive Sleep Apnoea: A Literature Review

Background: obstructive sleep apnoea is a common and burdensome condition, characterised by obstruction of the airway during sleep at the level of the pharynx, which may occur with symptoms or without any symptoms. The most common place for obstructive sleep apnoea management is in specialised sleep units. Aim: to identify what is known about nurses’ role in comprehensive management of obstructive sleep apnoea, and to determine the effectiveness of nurse-led interventions as well as the cost effectiveness of management of obstructive sleep apnoea in primary care settings. Methods: a scoping review was carried out by searching PubMed/Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ScienceDirect. The study findings were synthesised using a thematic analysis approach. Results: In this review, 12 articles were included, and three key themes emerged, namely the role of nurses in the diagnosis of obstructive sleep apnoea, role of nurses in the follow up and support of obstructive sleep apnoea patients, and role of nurses in the management of obstructive sleep apnoea in primary care and the cost-effectiveness. Conclusion: Nurses can play a critical role in obstructive sleep apnoea. There are many ways in which nurses can contribute, including screening, assessment, diagnosis, promotion of therapy adherence, and following up with patients, including monitoring for any side effects associated with the CPAP machine, such as irritation of the face. Additionally, nurses can provide patient education and coordinate with other health care providers. Nursing interventions such as patient education have been demonstrated to be highly effective in promoting adherence to PAP therapy in both sleep units and primary care settings. Based on the findings of this review, the primary care model is more cost-effective than the sleep unit model in the management of obstructive sleep apnoea patients. The role of nurses in managing Obstructive Sleep Apnoea in both paediatric and adult populations shares similarities, but also includes differences that should be carefully considered and explored. In this review, one article only explored the role of nurses in paediatric OSA care. Thus, there is a need to identify the potential role of nursing in the comprehensive management of paediatric obstructive sleep apnoea, as well as to explore alternative cost-effective approaches that include primary care settings.

Obstructive sleep apnea syndrome and cardiovascular risk factors in the antihypertensive therapy "escape" phenomenon

To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy "escape" phenomenon in patients with arterial hypertension (AH). The data of 75 patients with AH stage I-II, grades 1-3 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) - initially, in 1, 3 and 6 months after the inclusion - in order to confirm the initial therapy efficacy and to identify or exclude the "escape" phenomenon. In 36.0% of patients, the "escape" phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the "escape" phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.0±4.7 mmHg vs 126.0±8.5 mmHg; 129.0±2.3 mmHg vs 121.0±7.7 mmHg; 131.0±8.2 mmHg vs 121.5±6.2 mmHg resp.; р<0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO2≤85% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.6±10.4 mmHg vs 152.4±8.1 mmHg resp., р<0,05; 132.0±6.8 vs 127.1±8.9 mmHg resp.; р<0,05), and mean 24-hour systolic BP (125.7±5.9 vs 121.6±8.2 mmHg resp.; р<0,05) - compared with patients with a minimum SpO2>85%. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control.

Adipocytokines in obstructive sleep apnea: A systematic review and meta-analysis

Background and aimAdipocytokines play an important role in obstructive sleep apnea (OSA) by mediating inflammatory responses. Previous studies have reported that OSA is related to a change in the serum levels of adipocytokines; however, the results are still controversial. This meta-analysis aimed to assess the relationship between OSA and circulating level of adipocytokines in adults and children. MethodsA comprehensive search was conducted in databases of Medline/PubMed and Scopus for pertinent articles published since their inception to July 2022. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to assess the strength of the relationship between the concentrations of adipocytokines with OSA. ResultsIn the overall analysis, contrary to IL-10, which showed a significant reduction, IL-1β, IL-4, IL-8, IL-17, and IFN- gamma showed higher levels in OSA patients in comparison with control groups (p <0.05). For adults, IL-1β, IL-8, IL-17, IL-18, vaspin, visfatin, and chemerin were linked to a greater serum levels in patients with OSA, while, IL-5 and IL-10 were detected significantly lower in adults with OSA in comparison with healthy adults (p <0.05). In children with OSA, the serum levels of IL-4, IL-8, IL-12, IL-17, IL-23, and IFN-gamma were significantly higher than healthy children (p <0.05). ConclusionThe levels of inflammatory markers were found to be higher in OSA patients compared with control individuals, suggesting that adipocytokines may contribute to the pathology of OSA.

Neurotrophins in the Neuropathophysiology, Course, and Complications of Obstructive Sleep Apnea-A Narrative Review.

Obstructive sleep apnea (OSA) is a disorder characterized by chronic intermittent hypoxia and sleep fragmentation due to recurring airway collapse during sleep. It is highly prevalent in modern societies, and due to its pleiotropic influence on the organism and numerous sequelae, it burdens patients and physicians. Neurotrophins (NTs), proteins that modulate the functioning and development of the central nervous system, such as brain-derived neurotrophic factor (BDNF), have been associated with OSA, primarily due to their probable involvement in offsetting the decline in cognitive functions which accompanies OSA. However, NTs influence multiple aspects of biological functioning, such as immunity. Thus, extensive evaluation of their role in OSA might enlighten the mechanism behind some of its elusive features, such as the increased risk of developing an immune-mediated disease or the association of OSA with cardiovascular diseases. In this review, we examine the interactions between NTs and OSA and discuss their contribution to OSA pathophysiology, complications, as well as comorbidities.

Knowledge, attitude, and practice regarding different domains of pediatric obstructive sleep apnea among pediatric dentists from Kerala: A cross-sectional study.

Pediatric dentists should play an essential role in obstructive sleep apnea (OSA) screening, referral, and management of their child patients. However, few studies have investigated pediatric dentists' knowledge, attitude, and practice aspects regarding different domains of pediatric OSA. This cross-sectional survey aimed to assess the knowledge, attitude, and practice aspects of different domains of pediatric OSA among pediatric dentists from Kerala. This cross-sectional study was conducted in Kerala. The sample frame consisted of 163 dentists, and the minimum required was 115. Ethical approval was obtained before starting the study. An invitation E-mail explaining the purpose of the study with a survey link was sent to the pediatric dentists from Kerala (n = 163). Nonrespondents were contacted at timely intervals. Categorical and quantitative variables were expressed as frequency (percentage) and mean ± standard deviation, respectively. Chi-square test was used to find an association between categorical variables. Statistical analysis was performed using a statistical software package, SPSS, version 20.0. This cross-sectional study showed that pediatric dentists in Kerala have a moderate-to-good level of knowledge, along with a positive attitude toward different domains of pediatric OSA, but lag behind in the practice aspects. Hence, they are required to direct themselves toward continuing dental education programs in order to boost their routine practice. For this, steps must be taken to ensure proper networking of the practitioners and amendments in the dental billing system similar to the medical counterpart.

PS-C29-5: PULMONARY HYPERTENSION AND RIGHT VENTRICULAR REMODELING IN OBSTRUCTIVE SLEEP APNEA

Background and Objective: Acute pulmonary artery (PA) pressure changes during sleep have been extensively reported in obstructive sleep apnea (OSA). However, the role of OSA as an independent risk factor for the day-time pulmonary hypertension (PH) is not well known. The present study was conducted to examine whether OSA is associated with PH and right ventricular (RV) remodeling. Methods: 423 OSA patients without chronic obstructive pulmonary disease or left ventricular dysfunction {age: 55 ± 13 years old, mean apnea-hypopnea index (AHI): 41 ± 22 /h} were enrolled in this study. All patients were performed polysomnography, echocardiography and spirometry. Pulmonary artery systolic pressure (PASP) was determined by continuous-wave Doppler using the simplified Bernoulli equation. For this study, PH was defined as an estimated PASP of greater than 30 mmHg. Patients were divided into two groups: mild-moderate OSA group (n = 153) (AHI = 5–30 /h) and severe OSA group (n = 270)(AHI over 30/h). Results: The prevalence of PH among all OSA patients was 19%. No significant differences were found in PASP, tricuspid annular velocity and tricuspid annular plane systolic excursion (TAPSE) between mild-moderate OSA group and severe OSA group. However, RV diastolic diameter (28.7 ± 3.4 vs 27.7 ± 3.0 mm, respectively, P &lt; 0.01) and main PA diameter (26.2 ± 3.7 vs 24.8 ± 3.9 mm, respectively, P &lt; 0.05) were significantly higher in severe OSA group than those in mild-moderate OSA group. Conclusions: The severity of OSA was significantly associated with RV and PA diameters independently PASP. These results suggested that OSA may directly affects RV and PA remodeling independently PH.

Arterial bicarbonate is associated with hypoxic burden and uncontrolled hypertension in obstructive sleep apnea - The ESADA cohort

ObjectiveBlood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA. MethodsA cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively. ResultsThe [HCO3-] level was normal in most patients (average 24.0 ± 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, <0.001, <0.001, and <0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (β value [95%CI]: 1.21 [0.88–1.54], −0.16 [-0.20 to −0.11], −0.51 [-0.64 to −0.37], 1.76 [1.48–2.04], respectively, all p < 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01–1.08], p = 0.013). ConclusionWe first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA.