Obstructive Sleep Apnea Screening Research Articles

Abstract 4134668: Title: Mandibular advancement device versus CPAP on cardiovascular health and quality of life in OSA a pre-specified 12 months follow up of outcomes

Background: Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling. Method: In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI. Results: A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was - 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P < 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3). Conclusion: At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).

Abstract 4117927: Prevalence of Obstructive Sleep Apnea Among Consecutive Patients with Atrial Fibrillation Using WatchPAT Home Sleep Testing: A Prospective Cohort Study

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health system costs. Obstructive sleep apnea (OSA) is a highly prevalent condition affecting more than one third of the global adult population and, among patients with comorbid AF, contributes to poor AF related quality of life. However, the prevalence of undiagnosed OSA in the general AF population is unknown. Methods: In this pragmatic, phase IV prospective cohort study, we performed sleep testing on consecutively enrolled ambulatory AF patients for OSA using a cloud-based disposable home sleep test (the WatchPAT system). The primary outcome of our study was the prevalence of undiagnosed mild (5≤AHI<15) or moderate/severe (AHI≥15) OSA in the general AF population. A prespecified power analysis supports 80% power to detect a <5% difference in OSA prevalence compared to the general population (defined by AHI cut-offs of ≥5 or ≥15). Results: We performed sleep testing in 180 AF patients. Enrollment concluded early after a prespecified interim power analysis showed a larger than predicted difference of OSA prevalence between AF patients and the general population. Among the patients tested, 126 (70.4%) had paroxysmal AF, and 53 (29.6%) had persistent/long standing persistent AF. None had previous sleep testing. Our results show that the prevalence of OSA was 83.3% by AHI≥5 and 47.2% had moderate/severe OSA (AHI≥15). Patients with persistent or long standing persistent AF demonstrated even higher rates of OSA with 51 (96.3%) testing positive for OSA (AHI≥5) and 35 (64.2%) with moderate/severe OSA (AHI≥15). Conversely, standardized OSA screening instruments (Stop-BANG questionnaire or Epworth Sleepiness Scale) were poorly predictive of OSA in AF patients (AUC 0.66 and AUC 0.44, respectively). Conclusions: Undiagnosed OSA is highly prevalent in the general AF population. Our results demonstrate that OSA prevalence in AF patients exceeds that in the general population with a high degree of confidence. Widely used clinical prediction instruments cannot effectively be used to guide sleep testing decisions in AF patients. Our results suggest routine OSA testing should be performed in the comprehensive evaluation of all AF patients.

Prognostic Effect of Obstructive Sleep Apnea in Acute Coronary Syndrome Patients with Heart Failure

Acute coronary syndrome (ACS), heart failure (HF) and obstructive sleep apnea (OSA) often overlap and interact, the impact of OSA on ACS patients with HF remains unclear. The study sought to comprehensively evaluate the effects of the interaction between OSA and HF on long-term cardiovascular outcomes in ACS patients. Between June 2015 and January 2020, patients hospitalized for ACS were prospectively enrolled and underwent portable sleep monitoring after clinically stabilization. OSA was defined as an apnea hypopnea index ≥15 events/h. HF was defined using medical records. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina. Among all 1927 included patients, 214 (11.1%) had HF, and 1014 (52.6%) had OSA. For 2.9 years (1.5, 3.6 years) follow-up, OSA was independently associated with the risk of MACCE in HF patients (adjusted hazard ratio [HR], 2.11; 95%CI, 1.16-3.84; P=0.014), but not in those without HF (adjusted HR, 1.15; 95%CI, 0.92-1.45; P=0.228). Further analysis showed OSA exerted more prognostic effect in HF patients with preserved eject fraction (adjusted HR, 2.45; 95% CI, 1.11-5.41; P=0.027) than those with reduced eject fraction (adjusted HR, 1.62; 95% CI, 0.63-4.20; P=0.319). In the settings of ACS, OSA was independently associated with poor prognosis in patients with concomitant HF especially those with persevered ejection fraction. Screening and treatment for OSA are highly recommended in ACS patients with HF. URL: www.clinicaltrails.gov; Unique Identifier: NCT03362385.

Ambulatory polygraphy as a screening tool for obstructive sleep apnea in combination with semi-continuous rhythm monitoring in patients with atrial fibrillation: a pilot study

Abstract Background Obstructive sleep apnea (OSA) is a common, yet underdiagnosed risk factor in atrial fibrillation (AF) patients. Polysomnography (PSG) is the gold standard for OSA diagnosis but is also costly, time-consuming, and labor-intensive. (Cardio)-respiratory polygraphy (PG) offers an ambulatory screening for OSA detection. Studying the impact of OSA diagnosis and treatment on AF recurrence will require scalable tools for semi-continuous heart rhythm monitoring. Purpose The NOXFib-AF pilot study assessed the feasibility of PG as an OSA screening tool in patients with AF. The study monitored AF recurrences using a Fitbit smartwatch for heart rhythm monitoring with the FibriCheck algorithm. This pilot assessed the feasibility and patient compliance. Methods Overnight OSA testing was performed with the Noxturnal T3 (NOX-T3s) PG device used at home by AF patients, followed by four weeks of heart rhythm monitoring. Both semi-continuous monitoring with the Fitbit Versa 2 smartwatch with FibriCheck algorithm, and spot-check measurements on a smartphone (twice daily and in case of symptoms) were used. Patients with OSA suspicion on PG (Apnea-Hypopnea Index (AHI) cut-off ≥ 11.1 based on previous studies) were referred for PSG confirmation. Patient satisfaction with the PG and Fitbit smartwatch was evaluated through questionnaires. Results Thirty symptomatic AF patients underwent an overnight PG-based OSA screening, achieving an overall success rate of 96.7% (29/30). Interim analysis of 19 patients who underwent PSG evaluation upon referral showed that 12 (63.2%) were correctly diagnosed with at least moderate OSA (i.e., AHI ≥ 15) and were eligible for reimbursed CPAP treatment. PG and PSG agreement for OSA classification was fair (Cohen’s kappa = 0.230), with 68.4% (13/19) correctly classified (normal-mild, moderate-severe). There was high patient adherence to wearing the smartwatch for four weeks, with median compliance (i.e., adherence to the expected number of measurements) of 96.9% (IQR: 94.3% – 97.6%). A median of 150 (IQR: 145 – 151) daily automatic measurements were performed. Spot-check measurements via the smartphone also showed high compliance (110%, IQR: 100.0% – 135.5%) and high patient motivation (i.e., consistency of performing measurements; 90.3%, IQR: 67.7% – 96.8%). Patients were positive for both PG screening (Figure 1A) and Fitbit-based FibriCheck monitoring (Figure 1B). Conclusions PG is a feasible approach as a home screening tool for OSA, positively perceived by patients. Also, the acceptance of semi-continuous Fitbit-based FibriCheck monitoring was high. In a follow-up study, both tools will be used to evaluate the impact of a structured OSA screening and treatment trajectory on AF burden.

Strategies to address common sleep disorders among middle-aged and older adults

Abstract Obstructive sleep apnea (OSA) is an underdiagnosed and prevalent condition in middle-aged and older adults, with a disproportionate burden of OSA in marginalized populations. Lack of appropriate and timely treatment puts many at risk of poor quality of life, comorbidity, motor vehicle crashes and increased health care utilization. Furthermore, social and environmental disparities were acknowledged as contributing to sleep health disparities, OSA health literacy and adherence to OSA treatment. This presentation will overview the social and environmental determinants of OSA prevalence and management. The presenter will also cover strategies to improve access and waiting time for OSA diagnosis and treatment in middle-aged and older adults, such as screening for OSA in general and marginalized populations, alternative at-home OSA detection solutions, involvement of alternative care providers in OSA care, alternative OSA targeted therapies, including accessible self-administered interventions, health equity interventions targeting OSA, and promotion of sleep-centered lifestyle approaches, including weight loss, diet and exercise.

Improving obstructive sleep apnea competency of primary care clinicians through online education

ABSTRACT Background: Obstructive sleep apnea (OSA) is an often overlooked, widespread disease and a public health concern. Evidence-based practice guidelines do not exist to guide primary care clinicians' OSA screening practices. Clinicians must be competent in OSA; however, clinicians lack competency about this disease. Local problem: Elevated rates of undiagnosed OSA potentially exist in two rural and one suburban counties in Kansas, as indicated by the increased weight and elevated chronic disease prevalence in these counties' populations. Methods: A one-cohort, pretest–posttest, quasi-experimental design was used for this quality-improvement project implemented over 11 weeks. Clinicians' competencies on OSA were measured before and after the intervention using the Obstructive Sleep Apnea Knowledge and Attitude Survey. Intervention: A brief educational video on OSA was developed for this project. Definition, risk factors and complications, screening methods, definitive diagnosis, and treatment options were covered in this video. Results: Participants (N = 14) showed improved OSA competency after watching the educational video. Participants improved OSA competency after watching the interventional video (M = 16.3, SE = 0.194) versus preintervention (M = 14.2, SE = 0.318). Participants also improved OSA attitude scores postintervention. Conclusion: Primary care clinician OSA competency scores improved after engaging in a brief educational video intervention when measured using the OSA knowledge and attitude survey. Practicing clinicians can benefit from participating in education about the disease.

A Novel Screening Tool for Severe Obstructive Sleep Apnea.

Purpose: Obstructive sleep apnea (OSA) is a prevalent condition with long waiting lists for the gold standard polysomnography (PSG) test. Screening tests are essential to identify and prioritize patients with severe OSA. Current questionnaires do not accurately detect severe cases. This study aims to develop an alternative screening tool based on anthropometric and morphological characteristics to determine the severity of OSA. Methods: The study included 149 patients with sleep apnea symptoms who did not have additional diseases. The obstructive sleep apnea morphologic scale (OSAMS) was created using 5 parameters: 3 internal parameters related to the upper respiratory tract (tonsil size, oropharyngeal passage, and hypopharyngeal-laryngeal examination) and 2 external parameters (neck circumference and body mass index). Each parameter was scored, and the total scores were correlated with the apnea-hypopnea index (AHI) of PSG to determine the severity of OSA. Results: A statistically significant moderate positive correlation was found between AHI and OSAMS scores (rho = .491; P < .001). A grand total score >4 provided 80.3% sensitivity and 53.9% specificity to identify patients with severe OSA. OSAMS demonstrated superior results compared to existing questionnaires for OSA screening in our study group. Conclusions: OSAMS is a potential alternative to existing questionnaires to screen patients with severe OSA, offering a practical approach based on morphology during physical examinations.

Public engagement with consumer sleep technology for obstructive sleep apnea screening: implications for equity, access, and practice.

To characterize public practices and perspectives on the use of consumer sleep technology (CST) and evaluate perspectives on using CST as a screening tool for obstructive sleep apnea (OSA). We designed a survey instrument incorporating content from validated instruments (STOP-BANG and the Epworth Sleepiness Scale) and hypothesis-generated questions. Survey development involved multidisciplinary collaboration among three board-certified sleep medicine experts, researchers, and consumers. The survey was disseminated across a national sample of adults living in the United States via an online platform. Among 897 respondents, the mean (SD) age was 47.5 (16.9) years; 73.1% were female, 81.8% were White, and 505 respondents (56.3%) reported having tracked sleep using CS. Factors associated with decreased odds of CST use included household income <$30,000 (OR 0.47, 95% CI 0.28-0.79; p=0.004), Medicaid insurance (OR 0.43, 95% CI 0.26-0.69; p=0.001), Medicare insurance (OR 0.59, 95% CI 0.41-0.84; p=0.004), and lack of a primary care physician (OR 0.55, 95% CI 0.33-0.91; p=0.021). Most respondents (91.1%) agreed or strongly agreed that screening for OSA would be a useful feature of CST, but respondents reporting an education of high school diploma or less (OR 0.48, 95% CI 0.29-0.79; p=0.004) were less likely to agree with this statement. Attitudes toward and use of CST differed based on demographic and socioeconomic factors. Further study is needed to understand and address barriers to CST adoption and to characterize implications for equitable access to care for sleep disorders.

Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study.

To explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA). This explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information-rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi-square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively. Three hundred eighty-one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care. Brazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.

Validation of the European Obstructive Sleep Apnea Screening (EUROSAS) in Professional Male Drivers.

(1) Background: The European Union Driver License Committee recently developed a questionnaire as a screening tool for obstructive sleep apnea (OSA), named the European Obstructive Sleep Apnea Screening (EUROSAS) questionnaire for drivers. The aim of the current study was to investigate the diagnostic performance of the EUROSAS to predict risk of OSA in professional male drivers. (2) Methods: Fifty-eight drivers were included in the current study. All participants were asked to fill out the EUROSAS before an overnight polysomnography (PSG) in the hospital. OSA was defined as an apnea-hypopnea index (AHI) 5 events/hour on the PSG. (3) Results: Out of 58 participants, the EUROSAS correctly identified 39 (67.2%) cases as having high-risk OSA and one patient as having low-risk OSA, using AHI ≥ 5 events/h. The results indicated that the EUROSAS has a sensitivity of 67.2%, a specificity of 33.3%, a positive predictive value of 94.8%, and a negative predictive value of 5.2%. Similar results were obtained using AHI cut-offs of 15 and 30 events/h. (4) Conclusions: The EUROSAS provides a moderate level of accuracy for the screening of OSA in the professional male drivers. It seems that the diagnostic performance of the EUROSAS is not promising as an alternative questionnaire to identify professional drivers with OSA, probably due to participant response bias. Despite its limited evidence, the EUROSAS might have potential as a clinical screening tool in the general population.

Polysomnographic insights into the attention-deficit/hyperactivity disorder and obstructive sleep apnea connection in children

IntroductionThere is a high prevalence of sleep disturbances and disorders such as obstructive sleep apnea (OSA) in children with attention-deficit hyperactivity disorder (ADHD), though this relationship remains poorly characterized by objective measures. Polysomnographic studies (PSGs) on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated vs. non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA.MethodsMedical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019 to 2022. ADHD diagnosis was determined by ICD code F90, and OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA alone, children with ADHD alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest.Results4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA alone (29.8%), 333 with ADHD alone (8.3%), and 111 with ADHD and OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD alone. However, they exhibited significantly better sleep efficiency (SE), than children with OSA alone, and SE did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. The above results held true even after correcting for stimulant prescription.ConclusionThe increased frequency of clinical insomnia diagnoses in children with ADHD is not associated with any traditional parameters on polysomnogram. Innovative subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with both ADHD and OSA, PSG results do not reveal any distinctive sleep disturbances which cannot be better explained by OSA alone. These findings underscore the importance of screening for OSA in patients with ADHD and clinically assessing for other sleep concerns.

Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome

Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA. Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram. OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers. A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.

Exploring the links between periodontal diseases and obstructive sleep apnoea: An overview for clinicians.

Both periodontal diseases (PDs) and obstructive sleep apnoea (OSA) are highly prevalent disorders with global impact, associated with a large burden at individual patient and health system levels. These disorders often co-exist, but there is growing evidence that the association between the disorders goes beyond an overlap between two highly prevalent diseases that have shared risk factors. Evidence suggests a potential causal relationship, although further research is required to verify this. Regardless of any causal relationship, the co-existence of these disorders is important to recognize since they may act in combination to heighten health risks, particularly cardiovascular risk. Thus, dentists have an important role in screening for OSA in patients presenting with PDs, and similarly, they need to evaluate periodontal health in patients requiring treatment for OSA. Here we provide a narrative review of the association between PDs and OSA to raise awareness among clinicians and promote multidisciplinary collaborations that aim at an evidence-based and effective management of such patients.

Two-stage screening for obstructive sleep apnea in the primary practice setting.

To evaluate the effectiveness of a two-stage screening model for obstructive sleep apnea (OSA) in primary care that combines the STOP-BANG questionnaire (SBQ) with an automated home sleep apnea test (HSAT). This cross-sectional study was conducted from August 2018 to August 2022 in four Slovenian primary care practices. It included 153 randomly selected patients aged 18 to 70years who visited the practice for any reason. Participants completed the SBQ and underwent HSAT with type III polygraphy on the same night. The HSAT recordings were scored automatically and by an experienced, accredited somnologist. There was a strong correlation between manual and automated HSAT scorings for the detection of OSA (Pearson's r = 0.93). Cohen's kappa was 0.80 for OSA (respiratory event index (REI) ≥ 5) and 0.77 for OSA severity categorization. The two-stage model demonstrated sensitivity of 64%, a specificity of 97.4%, a positive predictive value (PPV) of 96.0%, a negative predictive value (NPV) of 73.8% and an accuracy of 81.1% for any OSA (REI ≥ 5). For moderate to severe OSA (REI ≥ 15), the model showed 72.7% sensitivity, 96.7% specificity, 85.7% PPV, 92.8% NPV and 91.5% accuracy. The two-stage model for OSA screening combining the SBQ and automated HSAT was shown to be effective in primary care, especially for moderate and severe OSA. This method provides a practical and efficient approach for the early detection of OSA.

Obstructive sleep apnea risk and associated factors among patients with type 2 diabetes mellitus in Africa: systematic review and meta-analysis

BackgroundAlthough obstructive sleep apnea affects people all across the world, there is limited information about the conditions in developing countries, notably in Africa. This study was conducted to address the aforementioned gaps by assessing the prevalence and determinants of obstructive sleep apnea risk among patients with type 2 diabetes mellitus in Africa.MethodsTo strengthen the credibility and transparency of the study the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA—P 2015) guideline were utilized for the review. Two independent reviewers searched electronic databases such as PubMed, Science Direct, and African Journal Online. The researchers used Microsoft Excel for initial data import and STATA software for statistical analysis. Cochran’s Q test was used to assess the presence of significant statistical heterogeneity I² statistic also used to quantify the degree of heterogeneity.ResultsElectronic searches produced a total of 1072 papers. The study estimates that the pooled prevalence of OSA risk among patients with type 2 diabetes mellitus in Africa is 41.13% (95% CI: 17.95–54.30, I² = 89.4%). There was significant heterogeneity among the selected studies (Q test P < 0.001) and I² (I² = 89.4%). Hypertension (AOR = 4.07, 95%CI: 2.84, 5.81), being male (AOR = 3.06, 95%CI: 0.97, 9.62), body mass index of ≥ 30 kg/m² (AOR = 3.05, 95%CI: 0.86, 10.83) and neck circumference of 40 cm (AOR = 8.55, 95%CI: 4.83, 15.12) were factors associated with obstructive sleep apnea risk among patients with type 2 diabetes mellitus.ConclusionsThe study found a high prevalence of high-risk obstructive sleep apnea risk among patients with type 2 diabetes mellitus. Male gender, body mass index of ≥ 30 kg/m² (obesity), neck circumference of > 40 cm and comorbid hypertension were significantly associated with obstructive sleep apnea risk among the study participants. The study emphasizes the importance of integrating obstructive sleep apnea screening and evaluation procedures into routine follow-up care for patients with type 2 diabetes mellitus.

Primary screening of obstructive sleep apnea in patients with acute coronary syndrome

Primary screening of obstructive sleep apnea in patients with acute coronary syndrome

Performance of Wrist-Worn Pulse Oximeter for the Screening of Obstructive Sleep Apnea.

A sleep apnea monitor (BM2000A) is a wrist-worn device that measures oxygen saturation and pulse rate during sleep. This study aimed to evaluate the efficacy of the watch-like BM2000A for screening obstructive sleep apnea (OSA). 102 patients complaining of sleep breathing disorders were included; 81% were men and 19% were women. All participants underwent overnight simultaneous polysomnography (PSG) and BM2000A sleep monitoring. The number of apneas and hypopneas, apnea-hypopnea index (AHI), percentage of time spent with oxygen saturation under 90%, average oxygen saturation, lowest oxygen saturation, and duration of sleep were computed by the BM2000A and PSG. Then, these parameters were compared to validate the BM2000A. All parameters, measured with BM2000A, had a good correlation (r ≥ 0.6, p < 0.0001) with PSG-derived indexes, except for sleep time (r = 0.19, p = 0.061) and hypopnea index (r = 0.4, p < 0.0001). AHI had the strongest correlation (r = 0.87, p < 0.0001). The mean difference between AHI values calculated with PSG and wrist-worn pulse oximeter (WPO) was -17.66 events/h (95% CI: -50.39 to 15.06). In AHI ≥ 5, BM2000A had 90.7% sensitivity, 100% specificity, 91.2% accuracy, and 0.994 area under the curve. Using AHI ≥ 5, ≥ 15, and ≥30 as the screening criteria, optimal WPO-AHI cutoffs to improve the screening accuracy were 3.10, 8.92, and 13.05. BM2000A-derived results properly correlate with PSG and can provide OSA screening with good sensitivity and specificity.

Obstructive Sleep Apnea and Type 2 Diabetes

Obstructive sleep apnea (OSA) and type 2 diabetes (T2D) are commonly encountered diseases in clinical practice, and there appears to be a bidirectional relationship between these 2 diseases. The presence of OSA can increase the risk of developing T2D, increase the risk of micro- and macro-vascular complications, and increase the risk of mortality. Several management strategies are available that can positively impact the outcomes of patients living with co-existing T2D and OSA. Given this bidirectional relationship, the negative consequences of untreated OSA on outcomes in T2D, along with the currently available management strategies, screening for OSA in patients with T2D should be considered.

Estimating the severity of obstructive sleep apnea during wakefulness using speech: A review

Obstructive sleep apnea (OSA) is a chronic breathing disorder during sleep that affects 10-30% of adults in North America. The gold standard for diagnosing OSA is polysomnography (PSG). However, PSG has several drawbacks, for example, it is a cumbersome and expensive procedure, which can be quite inconvenient for patients. Additionally, patients often have to endure long waitlists before they can undergo PSG. As a result, other alternatives for screening OSA have gained attention. Speech, as an accessible modality, is generated by variations in the pharyngeal airway, vocal tract, and soft tissues in the pharynx, which shares similar anatomical structures that contribute to OSA. Consequently, in this study, we aim to provide a comprehensive review of the existing research on the use of speech for estimating the severity of OSA. In this regard, a total of 851 papers were initially identified from the PubMed database using a specified set of keywords defined by population, intervention, comparison and outcome (PICO) criteria, along with a concatenated graph of the 5 most cited papers in the field extracted from ConnectedPapers platform. Following a rigorous filtering process that considered the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, 32 papers were ultimately included in this review. Among these, 28 papers primarily focused on developing methodology, while the remaining 4 papers delved into the clinical perspective of the association between OSA and speech. In the next step, we investigate the physiological similarities between OSA and speech. Subsequently, we highlight the features extracted from speech, the employed feature selection techniques, and the details of the developed models to predict OSA severity. By thoroughly discussing the current findings and limitations of studies in the field, we provide valuable insights into the gaps that need to be addressed in future research directions.

A Survey Study of the 3D Facial Landmark Detection Techniques Used as a Screening Tool for Diagnosis of the Obstructive Sleep Apnea Syndrome.

Obstructive Sleep Apnea (OSA) is a common disorder affecting both adults and children. It is characterized by repeated episodes of apnea (stopped breathing) and hypopnea (reduced breathing), which result in intermittent hypoxia. We recognize pediatric and adult OSA, and this paper focuses on pediatric OSA. While adults often suffer from daytime sleepiness, children are more likely to develop behavioral abnormalities. Early diagnosis and treatment are important to prevent negative effects on children's development. Without the treatment, children may be at increased risk of developing high blood pressure or other heart problems. The gold standard for OSA diagnosis is the polysomnography (sleep study) PSG performed at a sleep center. Not only is it an expensive procedure, but it can also be very stressful, especially for children. Patients have to stay at the sleep center during the night. Therefore, screening tools are very important. Multiple studies have shown that OSA screening tools can be based on facial anatomical landmarks. Anatomical landmarks are landmarks located at specific anatomical locations. For the purpose of the screening tool, a specific list of anatomical locations needs to be identified. We are presenting a survey study of the automatic identification of these landmarks on 3D scans of the patient's head. We are considering and comparing both knowledge-based and AI-based identification techniques, with a focus on the development of the automatic OSA screening tool.