Severe Obstructive Sleep Apnea Syndrome Research Articles

The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control. Fifty diabeticand 42 non-diabetic patientsdiagnosed with OSAS at the Sleep Disorders Center ofSüreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated. No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity. The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

The dark side of apnea: altered 24-hour melatonin secretion in obstructive sleep apnea (OSAS) is disease severity dependent.

Melatonin aids in the synchronization of the circadian rhythm to the external environment. Few studies have tried to elucidate the relationship between melatonin and obstructive sleep apnea syndrome (OSAS). These often include few patients, do not differentiate between OSAS severity and/or do not analyse a 24-h melatonin profile. This study set out to investigate disease severity dependent differences in 24-h salivary melatonin secretion of OSAS patients compared to a reference population in a retrospective design. 24-h salivary melatonin profiles of 169 OSAS patients were analysed (55 light, 66 moderate, 48 severe) as well as 91 reference patients. Several aspects of the melatonin curve were analysed and stratified according to OSAS severity. Parameters included: dim light melatonin onset (DLMO), time of returning below DLMO (DLMOoff), peak melatonin concentration and time, and total melatonin exposure. Significant effects were corrected for confounding by age and sex using linear regression. Our analysis shows that, compared to reference and in a disease dependent manner, OSAS patients have a significantly lower 24-h melatonin curve, lower melatonin peak concentration, lower total melatonin exposure and a smaller proportion of patients reach DLMO. The differences in peak melatonin production and total melatonin exposure were resistant to confounding by age and/or sex. This study describes clear OSAS severity dependent abnormalities in melatonin production in OSAS patients, independent of sex and/or age. Future research should indicate whether oral melatonin supplementation has beneficial effects in OSAS patients with attenuated endogenous melatonin production.

Is there a relationship between the severity of obstructive sleep apnea syndrome and the systemic immune inflammation index?

Vascular dysfunction, oxidative stress and systemic inflammation are considered responsible for the pathophysiology of Obstructive sleep apnea syndrome (OSAS). It is thought that desaturation due to apnea-hypopnea attacks in OSAS patients activates inflammatory pathways. In this study, we aimed to reveal the relationship between inflammation parameters Systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratios (PLR) severity of OSAS in patients who underwent polysomnography in our hospital's sleep laboratory. We grouped our 171 patients who were followed up in our sleep laboratory with the diagnosis of OSAS according to their AHI values. We evaluated the correlation of SII, NLR, and PLR values obtained from the complete blood tests of our patients with OSAS diagnosis and OSAS severity. The mean NLR, PLR and SII values of patients with OSAS were statistically significantly higher than those without OSAS (p < 0.05). A positive correlation of 18% was found between the presence of OSAS and the SII value (p = 0.016). No statistically significant difference was found when comparing OSAS severity and NLR, PLR and SII values (p > 0.05). We observed that SII, NLR and PLR parameters, which are rapidly assessable systemic inflammation markers of this process, were independently associated in patients diagnosed with OSAS and that there was no change in SII, NLR, and PLR parameters with OSAS severity.

Treatment of Obstructive Sleep Apnea and Simple Snoring: Efficacy of a New Mandibular Advancement Device

The following prospective study has the aim of evaluating the efficiency of the F22 MAD (mandibular advancement device), a new oral device for the treatment of OSAS (Obstructive Sleep Apnea Syndrome) and snoring. Methods: AHI (apnea-hypopnea index), ODI (Oxygen Desaturation Index), snoring percentage, time spent in the supine position, and Epworth Sleepiness Scale score were evaluated in 19 patients with snoring, mild to moderate OSAS, or severe OSAS who declined CPAP (Continuous Positive Air Pressure) treatment, before and after the application of the F22 MAD. Results: The median value of AHI varied from 15.6 ± 10.7 to 5.7 ± 5.7; the median value of ODI varied from 13.4 ± 8.8 to 6.2 ± 5.2; the median value of the percentage of snoring varied from 30.7 ± 7 to 7.5 ± 10.8, except for the patient who has severe OSAS who increased their value. The value obtained by the self-completion of the ESS questionnaire (Epworth Sleepiness Scale) underwent a statistically significant variation, while clinically significant for 13\19 patients who obtained a reduction of the value &gt;/= of 2 points. Conclusions: It is possible to conclude that the F22 MAD is effective in the treatment of patients with mild and moderate OSAS or simple snoring, reducing the polysomnographic outcomes with statistically and clinically significant results in terms of reduction of AHI, ODI and percentage of snoring.

Diabetes and severe obstructive sleep apnea syndrome: effect on right ventricle systolic function

Diabetes and severe obstructive sleep apnea syndrome: effect on right ventricle systolic function

Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk.

There is evidence for a particular relationship between low-grade inflammation (LGI) and intermittent hypoxia (IH) related to obstructive sleep apnoea syndrome (OSAS). However, despite the potential deleterious cardiovascular consequences associated with this LGI in hypertensive patients, few studies have investigated the impact of IH related to OSAS on CRP levels in this subpopulation. In total, 1404 hypertensive patients were selected retrospectively from the Sleep Laboratory database. CRP levels ≥3 mg/L but <10 mg/L were used as cut-offs to identify hypertensive patients with LGI. Logistic regressions were conducted to examine the risk of LGI associated with IH related to OSAS in hypertensive patients. LGI was frequent (33.8%) in hypertensive patients. After adjustment for confounders, multivariate logistic regressions revealed that only moderate to severe OSAS (apnoea-hypopnoea index ≥ 15/h) with high IH (oxygen desaturation index ≥ 15/h) [OR 1.51 (95% CI 1.06-2.14)] was significantly associated with LGI in hypertensive patients (p-value = 0.045). Consistent with our hypothesis, our results demonstrated the existence of a particular subtype of hypertensive patients at high cardiovascular risk characterised by the presence of LGI induced by IH hypoxia related to moderate to severe OSAS, which justifies the establishment of adequate management of this pathology to allow better cardiovascular prevention in this subpopulation.

Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome.

In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS. We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination. Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity. Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes.

Echocardiographic Assessment of Left Ventricular Functions in Females with Severe Obstructive Sleep Apnea Syndrome

Echocardiographic Assessment of Left Ventricular Functions in Females with Severe Obstructive Sleep Apnea Syndrome

Effects of obstructive sleep apnea syndrome on clinical and instrumental indicators in obese patients

Due to the high prevalence of obstructive sleep apnea syndrome (OSAS), its diagnosis and treatment remains one of the urgent problems of medicine. Hypodiagnosis of OSAS is observed in everyday clinical practice. The early OSAS diagnosis and treatment, including the use of non‑invasive assisted ventilation of the lungs with constant positive pressure during sleep, could prevent the development and progression of cardiovascular diseases, and significantly improve the quality of life of a person.&#x0D; Objective — to assess OSAS impact on the clinical and instrumental indicators in obese patients, to establish correlation between the characteristics of cardiorespiratory sleep monitoring and indicators of carbohydrate and lipid metabolism in obese patients.&#x0D; Materials and methods. Observations involved 78 patients with I ‑ II degree obesity. According to the results of cardiorespiratory monitoring (CRM) of sleep, three groups of obese patients were formed. The first group included 26 patients with an apnea‑hypopnea index &lt;30 episodes per hour (mild OSAS degree). The second group was consisted of 26 patients with apnea/hypopnea index (AHI) over 30 episodes per hour (severe OSAS degree). The groups matched by percentage of men and women, the mean age and body mass index.&#x0D; Results. An increase in body weight and body mass index (BMI) in obese patients was associated with an increase in the number and total duration of episodes of apnea/hypopnea, AHI, as well as a decrease in blood oxygen saturation (SpO2). Parameters of waist circumference (WC), hip circumference (HC), WC/HC positively correlated with the number and duration of episodes of apnea/hypopnea, AHI, and negatively correlated with SpO2. Positive values of the Spearman r coefficient ranged from 0.23 to 0.57, negative values — from –0.26 to –0.48 (р &lt;0.05).&#x0D; Conclusions. In obese patients with OSAS, the parameters of cardiorespiratory sleep monitoring — apnea‑hypopnea index, total duration of apnea episodes, directly correlated with body mass index, waist circumference, blood pressure level, total cholesterol, blood triglycerides. An inverse correlation was found between oxygen saturation and fasting glycemia and the level of glycated hemoglobin.

Impact of Adaptive Servo-Ventilation in Heart Failure Patients

Objective: Sleep-related breathing disorders (SRBD) as obstructive apnea, central apnea, and Cheyne-Stokes respiration (CSR), can be seen in patients with chronic heart failure. SRBD can influence the prognosis of heart failure. We aim to reveal sleep-related breathing disorders in heart failure patients and display the effects of adaptive servo-ventilation (ASV) as a new therapeutic modality. Materials and Methods: In this prospective study, 32 patients with heart failure were included. One night polysomnography (PSG) was done. Results: According to the results of PSG, the SRBD ratio was 96.7%. Continuous positive airway pressure (CPAP) and ASV titrations were offered to all patients with an apnea-hypopnea index (AHI) &amp;gt; 5. Demographics, clinical properties, symptoms, PSG findings, Cheyne-Stokes respiration (CSR), and echocardiography results were recorded. Before and after ASV titration, pulmonary function tests and walking tests were performed, and concentrations of transferrin and pro-BNP were recorded. In the groups according to the AHI, severe obstructive sleep apnea syndrome (OSAS) in 18 of 30 patients, four moderate OSAS, five mild OSAS, and two central sleep apnea (CSA). PSG and, CPAP, ASV titrations were done in 7 male and one female patient that obstructive apnea, central apnea, AHI, arousal, and SpO2 min values had significant improvements (p=0,001, p=0,016, p=0,001, p=0,015 and p=0,008 respectively). We determined all CSRs were eliminated with ASV. After ASV titration pro-BNP, walking distance, and FVC values changed significantly (p=0,036, p=0,018, and p=0,018 respectively). Conclusion: As a result, we determined CSR and central apneas persisted with CPAP but were eliminated with a one-night ASV application. ASV also decreased pro-BNP and increased FVC and walking distance values significantly.

The relationship of complete blood parameters, high-density lipoprotein cholesterol, and bilirubin values with disease severity in obstructive sleep apnea syndrome

Objectives: This study aimed to compare total bilirubin levels with monocyte-to-high-density lipoprotein ratio (MHR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients diagnosed with obstructive sleep apnea syndrome (OSAS) according to the apnea-hypopnea index (AHI) values. Patients and methods: The files of patients who underwent polysomnography and had total bilirubin and complete blood count values were retrospectively reviewed. Patients were divided into three groups: AHI &lt;5, AHI =5-29.99, and AHI ≥30. All blood parameters and calculated ratios were compared between the groups, and the relationship between these parameters and OSAS severity was investigated. Results: The study included 240 patients (149 males, 91 females; mean age: 47.4±11.9 years; range, 21 to 82 years). High-density lipoprotein values were significantly lower and MHR was significantly higher in the group with AHI ≥30 compared to the other two groups (p&lt;0.001 and p=0.001, respectively). Apnea-hypopnea index was correlated with MHR (r=0.270, p&lt;0.001). The groups were similar in terms of MLR, NLR, PLR, and total bilirubin levels. Conclusion: Considering that these easily accessible blood parameters are affected by many factors, they can only be used as auxiliary parameters in assessing the severity and follow-up of diseases such as OSAS.

The Relationship between Leptin Levels and Continuous Positive Airway Pressure Treatment: A Cluster Analysis

Abstract Objective Leptin is an appetite-suppressing hormone released by adipose tissue that plays an important role in severe obstructive sleep apnea syndrome (OSAS). However, it is unclear whether leptin levels are a useful biomarker for this syndrome. The present study aimed to assess the effect of continuous positive airway pressure (CPAP) treatment on the syndrome according to leptin levels, using a cluster classification based on clinical features of the syndrome. Materials and Methods We performed a hierarchical cluster analysis of data from 97 OSAS patients diagnosed via polysomnography. We also evaluated the effect after 6 months of CPAP administration. Results Clusters 1 (49 patients; 50.5%) and 2 (6 patients; 6.2%) presented normal leptin levels, and clusters 3 (11 patients; 11.3%) and 4 (31 patients; 32%) presented high leptin levels. Clusters 3 and 4 presented different leptin levels, but the same degree of obesity. After treatment, the levels of excessive daytime sleepiness improved in all clusters. In Cluster 3, leptin levels were significantly reduced after treatment. Conclusion Using the conventional diagnostic method of the apnea-hypopnea index, it was not clear whether leptin is a useful biomarker for the CPAP treatment. However, it may be helpful for particular clusters, including obese women, and where particular populations require CPAP treatment.

The role of atypical deglutition in children and adolescents with moderate to severe obstructive sleep apnea syndrome.

This cross-sectional study aimed to assess the prevalence of atypical deglutition (tongue thrust) in children diagnosed with moderate to severe obstructive sleep apnea syndrome (OSAS) and to explore its associations, particularly in relation to the type of dentition (mixed or permanent). The study was conducted over a 5 year period at a paediatric hospital in Paris, France. Children aged 6-18 years with moderate to severe OSAS (apnea-hypopnea index ≥5/h) underwent a comprehensive evaluation, including the recording of demographic data, symptoms of snoring and breathing issues, and otolaryngology examination. The swallowing pattern was assessed and orthodontic evaluations were performed. Cephalometric radiography and pharyngometry tests (pharyngeal collapsibility was computed) were conducted. The study found a high prevalence of atypical deglutition in children with mixed 74% [56-87] or permanent 38% [25-51] dentition. In children with mixed dentition and atypical deglutition, the pharyngeal compliance and lower facial dimensions were increased. In children with permanent dentition, atypical deglutition was associated with more severe OSAS and a lower hyoid bone position. Independent of the type of dentition, atypical deglutition was associated with an increase in the apnea-hypopnea index, an increase in the lower facial dimension, increased pharyngeal compliance, and a more caudal hyoid bone position. Atypical deglutition was strongly associated with increased pharyngeal collapsibility, more severe OSAS and altered facial measurements in children. The findings suggest that identifying atypical deglutition in children with OSAS could help to guide a personalised therapeutic approach, including myofunctional therapy.

Can the width of lower tongue base preoperative sonography measurements predict hypoxemia during esophagogastroduodenoscopy under sedation in ASA I-II patients?

The most common complication during esophagogastroduodenoscopy (EGD) under sedation is hypoxemia. There isa scarcity of indicators to predict the risk of hypoxemia during EGD under sedation accurately. The width of the lower tonguebase measured by ultrasound (US) is considered to be a significant predictor of the presence and severity of obstructive sleepapnea syndrome (OSAS), which develops hypoxemia by a similar mechanism to EGD under sedation. This study aimed toobserve its ability to predict hypoxemia during EGD under sedation.Material and methodsː Adult patients undergoing EGDunder sedation at our hospital after assessment in the anesthesia clinic were enrolled in the study. The width of the lower tonguebase was measured as the distance between the lingual arteries (DLA) on both sides of the inferior lateral margin of the tongueby US. The primary outcome was hypoxemia defined as the SpO2 <90% for longer than 10 seconds during EGD under sedation.ResultsːA total of 304 patients were successfully included, and hypoxemia was reported in 32 patients (10.5%). The DLAprediction criterion for hypoxemia was >31 mm. The DLA was correlated with hypoxemia (Spearman correlation coefficient,0.455; p<0.001) and owned the highest area under the receiver operating characteristic curve (0.927; 99% CI, 0.891 to 0.953,compared with that of the other predictors, p< 0.001) with hypoxemia.Conclusionsː The width of the lower tongue base,measured as the DLA by US examination can be used to effectively predict the risk of hypoxemia during EGD under sedation.

A Systematic Review and Meta-Analysis of Mean Platelet Volume and Platelet Distribution Width in Patients with Obstructive Sleep Apnoea Syndrome.

Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent yet underestimated disorder caused by the complete or partial obstruction of the upper airways. Although polysomnography is the gold standard for OSAS diagnosis, there is an active search for easily accessible biomarkers of disease presence and severity, particularly those reflecting morphological changes in specific blood cells. We investigated the associations between the presence and severity of OSAS, continuous positive airway pressure (CPAP) treatment, mean platelet volume (MPV), and platelet distribution width (PDW), routinely assessed as part of the complete blood count. From 262 retrieved records from PubMed, the Web of Science, Scopus, and Google Scholar, 31 manuscripts were selected for a final analysis, 30 investigating MPV and 15 investigating PDW. MPV was not statistically different between OSAS patients and healthy controls; however, it progressively increased with disease severity. By contrast, OSAS patients had significantly higher PDW values than controls (SMD = 0.40, 95% CI: 0.25 to 0.56; p ˂ 0.001), and the difference increased with disease severity. In a univariate meta-regression, there were significant associations between the MPV and publication year, the apnoea-hypopnea index, and diabetes mellitus, while no associations were observed with the PDW. No significant between-group differences were observed in the subgroup analyses. These data suggest that PDW, and to a lesser extent, MPV, are potential biomarkers of OSAS and require further research to ascertain their pathophysiological significance (PROSPERO, CRD42023459413).

An exploratory study evaluating the use of coping strategies while driving in obstructive sleep apnoea syndrome patients and controls.

Sleepiness while driving is potentially fatal, and it is recommended that a driver who starts to feel tired should stop and have a rest. However, some may use various countermeasures to try to stay alert. We devised a questionnaire that assessed various potential coping strategies that might be used against fatigue and compared them between obstructive sleep apnoea syndrome (OSAS) patients and controls and with sleepiness in general (Epworth Sleepiness Scale (ESS)), specifically while driving (Driving Sleepiness Scale (DSS)) and driving incidents. 119 untreated OSAS patients (male 82%, body mass index (BMI) 37±8 kg·m-2, ESS 14±5, DSS 3±2, oxygen desaturation index (ODI) 39±15) and 105 controls (male 70%, BMI 28±6 kg·m-2, ESS 4±3, DSS 7±6) matched for age and driving experience were recruited. All completed a questionnaire relating to their experience over the last year, which included sleepiness in general, sleepiness specifically while driving, 10 questions about various coping strategies they might adopt in order to avoid sleepiness and their history of incidents while driving. As compared to controls, nearly a third of OSAS patients (29.4%) used more than three coping strategies "frequently". OSAS patients who used more than three such strategies had worse ESS (17±4 versus 12±5, p<0.0001); were more likely to feel sleepy while driving (10±8 versus 5±7, p=0.0002) and had more reported accidents (22.85% versus 2.38%, p=0.0002) as compared to OSAS patients who used less than three strategies. There was no difference in patient demographics, severity of OSAS, driving experience or episodes of nodding at the wheel and reported near miss events. Untreated OSAS patients frequently use certain strategies which could be surrogate markers of sleepiness. Enquiring about such strategies in clinical practice may aid the clinician in identifying the patients who are at risk of driving incidents and to advise appropriately.

Связь системного воспаления с тяжестью обструктивного апноэ сна у мужчин пожилого возраста с хронической обструктивной болезнью легких

The combination of obstructive sleep apnea syndrome (OSA) and chronic obstructive pulmonary disease (COPD) is characterized by deep nocturnal hypoxemia and a higher risk of pulmonary hypertension. The study of the participation of blood cellular elements and indices of cellular reactivity in the inflammatory response in this comorbidity is relevant today. The purpose was to study the severity of systemic inflammation in elderly patients with chronic obstructive pulmonary disease depending on the obstructive sleep apnea syndrome severity. We examined 126 men (aged 67.3 ± 3.4 years) diagnosed with COPD 1–2 low risk of exacerbations. Depending on the presence of OSA, the patients were divided into 2 groups: group 1 — 32 people without OSA, group 2 — 94 people with OSA. Symptoms were assessed using the modified Medical Research Council (mMRC) dyspnea scale and the COPD assessment test (CAT). The severity of OSA syndrome was assessed by the frequency of respiratory events: mild – from 5 to 15 per hour; moderate — from 15 to 30 per hour; severe — more than 30 per hour. The indices were calculated: quantitative ratio of neutrophils (N) and lymphocytes (L) — NLR = N/L; ratio of platelets (P) to lymphocytes PLR = P/L, systemic inflammatory index (SII) = platelet × neutrophils / lymphocytes. It was found that as the severity of OSA increased, chronic systemic inflammation increased, which was determined by the ratio of neutrophils, lymphocytes, and platelets (NLR, PLR, SII).

Association between Cardiopulmonary Exercise Test and severity of obstructive sleep apnea syndrome

Review Association between Cardiopulmonary Exercise Test and Severity of Obstructive Sleep Apnea Syndrome Jianyu Wang 1,2, * , Shishi Zhang 2, Luying Jiang 3, Chunran Zhang 3, and Houjuan Zuo 2 1 Tianyou Hospital, Wuhan University of Science and TechnologyWuhan430064China 2 Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan430030China 3 The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi UniversityShihezi832008China * Correspondence: Wangjianyu1003@163.com Received: 17 April 2023 Accepted: 6 June 2023 Published: 27 December 2023 Abstract: Obstructive sleep apnea syndrome (OSAS) is becoming widespread, especially in people with obesity. As it is usually measured by polysomnography (PSG), the role of cardiopulmonary exercise test (CPET), a new exercise capacity test, has not attracted enough attention in OSAS research. In this article, we explore the relationship between CPET results and patients with OSAS. 68 individuals were recruited and divided into three groups: negative/mild group (n = 22, apnea hypopnea index (AHI) &lt; 15), moderate group (n = 22, 15 ≤ AHI &lt; 30) and severe group (n = 24, AHI ≥ 30). Clinical parameters, cardiopulmonary exercise test (CPET) indexes, and apnea hypopnea index (AHI) were compared among the three groups. A multivariate analysis was carried out to assess which factors determine the index of AHI. The ANOVA analyses were used to evaluate the difference among the three groups. Receiver operating characteristic analyses were chosen to detect the prediction efficiency of the CPET index for AHI. The predictive power of using the CPET index (VO2/kg peak) combined with the body mass index (BMI) of patients in the detection of AHI was significantly better when compared with using the CPET index only. There was a notable correlation between VO2 and the index of AHI (r = 0.249, P = 0.04). Also, the CPET data (VO2/kg peak) combined with the BMI of patients has powerful predictive value for the severity of OSAS in patients. It is expected to be a promising way to predict the severity of OSAS in the future. Our study provides a new strategy for predicting whether a patient is in the early phase OSAS.

The Baveno Classification as a Predictor of CPAP Titration Pressure in Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a clinical condition characterised by repeated periods of partial or full obstruction of airflow throughout sleep, with impairment of the quality of life and increased mortality with socioeconomic impacts. CPAP therapy is a simple and effective treatment option for OSAS patients. To overcome the clinical and prognostic limitations of AHI-as a sole index of OSAS-the Baveno classification was recently set out and introduced into clinical practice. This study aims to analyse the effect of the Baveno classification on the optimum CPAP titration pressure. A retrospective analysis of the records of sleep studies in two centres between 2018 and 2021 was carried out. Patients diagnosed with OSAS and recruited for CPAP titration were included. Based on the Baveno classification, the patients were categorised into four groups (A, B, C, and D). Consequently, 700 patients were analysed and 427 patients were included. A significant positive correlation was detected between the CPAP optimum titration pressure and OSAS severity, neck circumference, the oxygen desaturation index (ODI), mean oxygen saturation, the AHI, the BMI, and cumulative sleep time when the SpO2 was <90% (T90) on the other side (p: <0.0001). A non-significant correlation was seen between the Epworth Sleepiness Scale (ESS), symptom severity, end organ impact, and Baveno classification of the CPAP optimum titration pressure (p: 0.8, 0.4, 0.5, and 0.7, respectively). The Baveno classification is not useful in the prediction of CPAP optimum titration pressure. However, the ODI and neck circumference were significant independent predictors of a higher CPAP titration pressure.

Prevalence of Obstructive Sleep Apnea Using Home Sleep Test in Taiwan During the Coronavirus Disease Pandemic.

Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with serious sequelae. The current gold standard diagnostic method, polysomnography, is costly and time consuming and requires patients to stay overnight at a facility. This study aimed to reveal the prevalence of OSAS in general adult population using a home sleep test (HST) during the coronavirus disease 2019 (COVID-19) pandemic. This prospective cohort study was conducted by the Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan, between January 2020 and December 2021. A total of 1372 patients aged 30-70 years completed an HST using a Type 3 portable sleep monitor (PM). The apnea-hypopnea index (AHI) was analyzed to assess the association of OSAS with age, body mass index (BMI), sex, Epworth Sleepiness Scale (ESS) and the Sleep Apnea Risk Assessment questionnaire (STOP-Bang questionnaire) rating. The mean age of the patients (782 men, 57%; 590 women, 43%) was 49.24 ± 11.04 years. OSAS was detected in 954 (69.5%) patients with 399 (29.1%) mild OSAS; 246 (17.9%) moderate OSAS; and 309 (22.5%) severe OSAS. Among these, the prevalence of moderate-to-severe OSAS was 143 (10.4%) in women and 412 (30.0%) in men. The mean age was the highest (51.29 ± 11.29) in the mild OSAS group and lowest (47.08 ± 10.87) in the healthy group. OSAS severity was greater with increasing BMI, 23.39 ± 3.44 in the healthy group and 29.29 ± 5.01 in the severe OSAS group. A positive correlation was also noted between the ESS/STOP-Bang questionnaire rating and OSAS severity. The prevalence of OSAS in Taiwan was 69.5% in our study. It showed strong evidence that OSAS has important public health consequences and PMs are simple, fast, feasible, and cost-effective tools for OSAS screening in the home environment, especially during the COVID-19 pandemic.