Sleep Apnea In Adults Research Articles

Association of Heart Rate Variability with Obstructive Sleep Apnea in Adults.

Background and Objectives: Heart rate variability (HRV) analysis is a noninvasive method used to examine autonomic system function, and the clinical applications of HRV analysis have been well documented. The aim of this study is to investigate the association between HRV and the apnea-hypopnea index (AHI) in patients referred for polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis. Materials and Methods: Patients underwent whole-night PSG. Data on nocturnal HRV and AHI were analyzed. We determined the correlation of time- and frequency-domain parameters of HRV with the AHI. Results: A total of 62 participants (50 men and 12 women) were enrolled. The mean age, body mass index (BMI), neck circumference, and AHI score of the patients were 44.4 ± 11.5 years, 28.7 ± 5.2, 40.2 ± 4.8 cm, and 32.1 ± 27.0, respectively. The log root mean square of successive differences between normal heartbeats (RMSSD) were negatively correlated with BMI (p = 0.034) and neck circumference (p = 0.003). The log absolute power of the low-frequency band over high-frequency band (LF/HF) ratio was positively correlated with the AHI (p = 0.006). A higher log LF/HF power ratio (β = 5.01, p = 0.029) and BMI (β = 2.20, p < 0.001) were associated with a higher AHI value in multiple linear regression analysis. Conclusions: A higher log LF/HF power ratio and BMI were positively and significantly associated with the AHI during whole-night PSG in adult patients.

Metabolomic approach for obstructive sleep apnea in adults: a systematic review.

Obstructive Sleep Apnea (OSA) corresponds to episodes of complete or partial upper airway obstruction during sleep. The gold standard for diagnosing OSA is polysomnography; however, metabolomics is an innovative and highly sensitive method that seeks to identify and quantify small molecules in biological systems. Identify the metabolites most frequently associated with obstructive sleep apnea in adults. The search for articles was conducted between October 2020 and August 2021, in electronic databases, such as MEDLINE/PubMed, Scielo, Embase, and Cochrane, through the combination of descriptors: obstructive sleep apnea, metabolomic, adult. This systematic review included all cross-sectional studies published, including human patients aged 18years or older, of both genders who underwent type I or II polysomnography and metabolomics study. The search strategy selected 3697 surveys, and 4 of them were selected to be a part of this systematic review. Based on the analyzed surveys, it was found that all of them were able to diagnose OSA, reaching a sensitivity of 75-97%, and specificity that ranged from 72 to 100%; besides differentiating patients with OSA (severe, moderate, and mild) from simple snorers with a mean sensitivity of 77.2% and specificity of 66.25%. These findings suggest that, in addition to being used as a screening and diagnostic strategy for OSA, metabolomics has the potential to be used for severity stratification and to monitor the disease's progression.

Osteoprotegerin, Chitinase 3-like Protein 1, and Cardiotrophin-1 as Potential Biomarkers of Obstructive Sleep Apnea in Adults-A Case-Control Study.

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered a risk factor for cardiovascular diseases, depression, accidents, and stroke. Recent clinical practice guidelines for OSA expressed the need for a new clinical tool that establishes the Apnea-Hypopnea Index (AHI) to determine the disease burden. The serum and plasma concentrations of Osteoprotegerin (OPG), Chitinase 3-like protein 1 (YKL-40), and Cardiotrophin-1 (CT-1) in 80 subjects-52 OSA patients, 27 moderate (15 ≤ AHI ˂ 30) and 25 severe (AHI ≥ 30), and 28 non-OSA controls (AHI 0-5)-were determined. Moreover, the Total Oxidative Status (TOS), Total Antioxidative Status (TAS), and Oxidative Stress Index (OSI) were assessed in the serum and plasma to evaluate whether the severity of OSA and the concentrations of OPG, YKL-40, and CT-1 correlate with the oxidative/reductive status. The serum and plasma concentrations of YKL-40 and CT-1 were higher in the OSA group, whereas the serum and plasma concentrations of OPG were lower compared to the control group. The concentrations of OPG, YKL-40, and CT-1 in the serum and plasma correlated with AHI; however, a better correlation of the concentrations was obtained for the above-mentioned proteins in the plasma. The concentrations of YKL-40 and CT-1 in the serum and OPG in the plasma show better diagnostic capabilities for moderate and severe OSA than the concentrations of YKL-40 and CT-1 in the plasma and the concentrations of OPG in the serum.

P-64685169-369 - Evaluating knowledge of obstructive sleep apnoea (OSA) in adults and children amongst health professionals and the general public in Australia.

P-64685169-369 - Evaluating knowledge of obstructive sleep apnoea (OSA) in adults and children amongst health professionals and the general public in Australia.

Clinical phenotype of obstructive sleep apnea in older adults: a hospital-based retrospective study in China.

The prevalence of obstructive sleep apnea (OSA) in older people (aged over 65years) is high. However, OSA in older populations has not received sufficient attention. This study examined the clinical phenotypic characteristics of older patients with newly diagnosed OSA. A total of 110 older patients (≥ 65years) and 220 younger patients (< 65years), matched by gender, body mass index (BMI), and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Clinical manifestations, comorbidities, and polysomnographic results were compared between the two groups, and correlations between age ≥ 65years and OSA comorbidities were explored. Nocturia was more common in older patients with OSA, as with lower sleep efficiency, longer wake after sleep onset, increased stage N1 sleep, and decreased stage N3 sleep and average SpO2. The proportions of older OSA patients who had comorbid hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease, and ischemic stroke were significantly higher than those of younger patients. The incidence of tonsillar enlargement and pharyngeal narrowing was lower in older patients. Age ≥ 65years was an independent risk factor for patients with OSA to have hypertension (OR: 1.89, 95% CI: 1.11-3.21), CAD (OR: 4.83, 95% CI: 2.29-10.21), and ischemic stroke (OR: 2.92, 95% CI: 1.02 to 8.38). The presence of OSA in older adults was associated with significant abnormalities of sleep architecture, aggravated nocturnal hypoxia and increased risks of hypertension, CAD, and stroke, which can be distinguished as a unique clinical phenotype.

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency-A Prospective Study.

The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose patency and CPAP adherence. Material and methods: A cohort of 450 consecutive patients suspected of having OSA were prospectively enrolled. For further analyses, 47 OSA patients undergoing CPAP treatment were selected (13 females and 34 males, average age, 65.3 years, BMI 34.1, apnea-hypopnea index. AHI 51.0). The patients were divided into two groups: patients with good CPAP adherence (n = 35) and patients who did not adhere to CPAP therapy (n = 12). The influence of nasal endoscopy and flow measurement on CPAP adherence was explored. Results: We found a statistical independence between adherence to CPAP and AHI (p = 0.124), T90 (p = 0.502), endoscopic findings (p = 0.588) and nasal patency measured by a flowmeter (p = 0.498). Conclusions: In our studied sample, endoscopic findings and nasal patency measured by a flowmeter were not predictors of CPAP non-adherence in the first year of the treatment. Our data show that while an endoscopic finding in the nasal cavity could indicate that a patient has a severe obstruction, compliance with CPAP therapy is not reduced in these patients and neither is it reduced with a decrease in nasal flow, according to our observation.

PATIENT-REPORTED OUTCOMES WHILE MANAGING OBSTRUCTIVE SLEEP APNEA WITH ORAL APPLIANCES: A SCOPING REVIEW

This scoping review aims to describe dental treatment-related patient-reported outcomes (dPROs) while using oral appliances (OAs) to manage obstructive sleep apnea (OSA) in children and adults. Available literature that assessed dPROs in children and adults with OSA managed through OAs. Any clinical studies were included without restrictions of year or country. The results were analyzed and reported using narrative text and tables accompanying a descriptive summary. The searches identified 1718 citations, and of these, forty-five studies were finally included. A total of 3498 adults were included in all 42 primary studies included in this review, in which all the studies presented adults as participants. The dPROs assessed were quality of life (QoL), reported side effects after OA usage, patient satisfaction, and experience with treatment, and subjective perception of occlusal changes after treatment. This scoping review suggests that dPROs are mostly investigated as a secondary outcome from major studies exploring the effects of OAs on OSA severity, and often, dPROs are not well discussed or displayed on their report. As no risk of bias or certainty level assessment was completed, findings need to be carefully considered. Although in general terms management with OAs among adults with OSA does not seem to be uncomfortable or causing major problems to their lives, some mild discomfort and endured occlusal disturbances was reported in some studies. QoL seems to improve but consistent agreement was elusive. Data does not include experiences among those that dropped OA use. No data seems to exist about dPROs in children.

Low levels of awareness of obstructive sleep apnoea amongst the Australian general public

Abstract Introduction: Despite the serious health implications associated with obstructive sleep apnoea, the condition remains under-diagnosed. This study aims to evaluate the awareness of the condition amongst the Australian community. Methods: A total of 2016 respondents recruited from a web-based panel completed an online questionnaire which assessed awareness and experience of obstructive sleep apnoea and sleep-disordered breathing. The association between the level of awareness and various socio-demographic variables was analysed using uni- and multivariate analyses. Results: The results of the questionnaire indicated that 50% and 70% of participants were unaware of adult and paediatric obstructive sleep apnoea. Socio-demographic variables including age, annual household income and education level significantly influenced a participant’s level of awareness. Approximately 8.3% of the participants had previously been diagnosed with obstructive sleep apnoea. However, 65% of participants exhibiting symptoms of daytime sleepiness had not sought health care. Paediatric sleep apnoea had been previously diagnosed in 7.1% of children residing in participant’s households but 49% of children with regular snoring had not been medically evaluated. Conclusion: A deficiency exists in the awareness of sleep apnoea amongst the Australian general public. This is reflected in the discrepancy between the number of participants exhibiting potential symptoms and those who sought medical advice.

Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis.

Introduction The aim of this systematic review and meta-analysis was to evaluate the effects of maxillary expansion on adults with obstructive sleep apnoea (OSA).Methods Electronic searches up to July 2021 in eight electronic databases were conducted. Study selection, data extraction, risk of bias evaluation using ROBINS-I, quality of evidence assessment using GRADE and meta-analyses were performed.Results The electronic searches yielded 1,007 studies. Following the application of the eligibility criteria, 15 articles were fully read and five studies were included. The studies evaluated the effects of surgically assisted rapid maxillary expansion in adults with OSA. The meta-analysis demonstrated an improvement in Apnoea-Hypopnea Index (AHI) (MD = -9.91, CI = -14.57 to -5.25), Oxygen Desaturation Index (ODI) (MD = -7.95, CI = -12.23 to -3.67), and Epworth Sleepiness Scale (ESS) (MD = -4.40, CI = -6.39 to -2.40). ROBINS-I indicated serious, no information and critical risk of bias for the included studies. The quality of the evidence was very low.Conclusion The findings herein suggest that maxillary expansion could improve OSA in adults in the short term.

Correlation between snoring sounds and obstructive sleep apnea in adults: a meta-regression analysis

Snoring is a dominant clinical symptom in patients with obstructive sleep apnea (OSA), and analyzing snoring sounds might be a potential alternative to polysomnography (PSG) for the assessment of OSA. This study aimed to systematically examine the correlation between the snoring sounds and the apnea-hypopnea index (AHI) as the measures of OSA severity. A comprehensive literature review using the MEDLINE, Embase, Cochrane Library, Scopus, and PubMed databases identified the published studies reporting the correlations between and severity of snoring and the AHI values by meta-regression analysis. In total, 13 studies involving 3,153 adult patients were included in this study. The pooled correlation coefficient for snoring sounds and AHI values was 0.71 (95%CI: 0.49, 0.85) from the random-effects meta-analysis with the Knapp and Hartung adjustment. The I 2 and chi-square Q test demonstrated significant heterogeneity (97.6% and p<0.001). After adjusting for the effects of the other covariates, the mean value of the Fisher's r-to-z transformed correlation coefficient would have 0.80 less by the snoring rate (95%CI = -1.02, -0.57), 1.46 less by the snoring index (95%CI = -1.85, -1.07), and 0.21 less in the mean body mass index (95%CI = -0.31, -0.11), but 0.15 more in the mean age (95%CI = 0.10, 0.20). It fitted the data very well (R 2=0.9641). A high correlation between the severity of snoring and the AHI was found in the studies with PSG. As compared to the snoring rate and the snoring index, the snoring intensity, the snoring frequency, and the snoring time interval index were more sensitive measures for the severity of snoring.

Obstructive sleep apnea in young Asian adults with sleep-related complaints

This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea–hypopnea index on average and experienced more hypoxemia during their sleep, both in terms of duration and the extent of desaturation. Even though the prevalence of comorbidities increased with age, hypertension in young male adults carried higher risks for OSA. Young adults with OSA have constituted a relatively constant portion of all confirmed OSA cases across time. The young adults with OSA were heavier, more symptomatic, and with more severe severity.Clinical trial: The Institutional Review Board of Taipei Veterans General Hospital approved the study (VGHIRB No. 2018-10-002CC). The study is registered with ClinicalTrials.gov, number NCT03885440.

Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence.

To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. Prospective, observational, and cross-sectional study. Tertiary reference hospital for the rehabilitation of craniofacial anomalies. Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

Screening for Obstructive Sleep Apnea in Adults

Screening for Obstructive Sleep Apnea in Adults

Safety of tongue base procedures for sleep apnoea in adults: A systematic review and metanalysis from the YO-IFOS study group

Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults. PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database. Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique. 20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample. The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation. La base de la lengua y la hipofaringe son los principales sitios de obstrucción en pacientes con AOS persistente tras una faringoplastia. En los últimos años se han desarrollado numerosas técnicas de cirugía mínimamente invasiva con el objetivo de tratar la obstrucción en este nivel. Sin embargo, el foco de los investigadores se ha situado habitualmente en la efectividad de la técnica para reducir el número de eventos obstructivos, más que en sus complicaciones. En esta revisión sistemática y metaanálisis se evalúa la incidencia de complicaciones de procedimientos mínimamente invasivos para la base de la lengua en pacientes adultos con AOS. PubMed (Medline), Cochrane Library, EMBASE, Scopus, SciELO y Trip Database. Las bases de datos fueron evaluadas por 3 autores del grupo de investigación en apnea YO-IFOS. Tres autores extrajeron la información. Los resultados principales se expresaron como porcentaje de complicación e intervalo de confianza al 95% para cada técnica quirúrgica. Veinte estudios (542 pacientes) cumplieron los criterios de inclusión. La incidencia media de complicaciones fue del 12,79%; un 4,65% fueron menores, un 6,42% moderadas y un 1,77% severas. La complicación más habitual fue infección en el 1,95% de los casos, seguida por alteración transitoria de la deglución en un 1,30%. La heterogeneidad de los artículos incluidos no permite obtener conclusiones firmes. La evidencia disponible muestra que la cirugía mínimamente invasiva de la base de la lengua presenta un intervalo amplio de complicaciones que varía entre el 4,4% en la radiofrecuencia de la base de la lengua y el 42,42% en la ablación de la base de la lengua.

Non-invasive positive pressure ventilation for central sleep apnoea in adults.

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Predictive factors for obstructive sleep apnea in adults with severe asthma receiving biologics: a single-center cross-sectional study.

To evaluate the prevalence and potential predictors of obstructive sleep apnea (OSA) in a cohort of adults with severe asthma. From March 2021 to December 2021, this cross-sectional study enrolled patients with severe asthma receiving biologics, who were consecutively referred for sleep evaluation irrespective of sleep-related symptoms. Clinical and functional data, including three OSA screening instruments (GOAL, STOP-Bang, and NoSAS) were recorded. All participants underwent a portable sleep test (ApneaLink Air™). OSA diagnosis was based on the respiratory disturbance index ≥ 5.0/h and subclassified according to severity thresholds. Data were subjected to logistic regression tests to identify possible predictors for OSA. Discrimination was estimated from the area under the curve (AUC). Overall, 56 outpatients were included (80% females): 54% with any OSA, 13% with moderate-to-severe OSA, and 4% with severe OSA. In the multivariate analysis, no parameter emerged as an independent predictor for OSA: age (p = 0.080), body mass index (p = 0.060), loud snoring (p = 0.130), and hypertension (p = 0.848). No screening instrument was useful to predict any OSA: GOAL (AUC: 0.714; 95% confidence interval (CI): 0.579-0.849), NoSAS (AUC: 0.645; 95% CI: 0.497-0.793), and STOP-Bang (AUC: 0.640; 95% CI: 0.493-0.788). Similarly, no screening tool was also useful for predicting moderate-to-severe OSA or severe OSA. Patients with evere asthma receiving biologics exhibit a high prevalence of OSA. However, no clinical, functional, or OSA screening instrument showed acceptable discriminatory ability to predict the presence of OSA in these patients withsevere asthma.

Association of Blood MCP-1 Levels with Risk of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

Background and objective: Among the broad variety of chemokines, monocyte chemoattractant protein-1 (MCP-1) is considered to be one of the most important chemokines. Among others, MCP-1 activates monocytes and other immune cells highly involved in inflammation. In the present systematic review and meta-analysis, we evaluated the relationship between serum/plasma MCP-1 levels and the risk of obstructive sleep apnea (OSA) in adults as a disease related to inflammation. Materials and methods: Four databases were systematically investigated until 12 July 2022. We used the Review Manager 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) to extract and calculate the standardized mean difference (SMD) and its 95% confidence interval (CI) of plasma/serum levels of MCP-1 between adults with and without OSA. Results: Eight articles including eleven studies in adults were entered into the meta-analysis. The serum/plasma MCP-1 levels in adults with OSA were higher than that in the controls (SMD = 0.81; p = 0.0007) and as well as for adults with severe OSA compared to those with mild and moderate OSA (SMD = 0.42; p < 0.0001). The subgroup analysis showed that ethnicity was an effective factor in the pooled analysis of blood MCP-1 levels in adults with OSA compared to the controls (Asians: (p < 0.0001), mixed ethnicity: (p = 0.04), and Caucasians: (p = 0.89)). The meta-regression showed increasing serum/plasma MCP-1 levels in adults with OSA versus the controls, publication year, age of controls, body mass index (BMI) of controls, and sample size reduced, and also BMI and the apnea–hypopnea index of adults with OSA increased. Conclusions: The meta-analysis showed that compared to the controls, serum/plasma levels of MCP-1 in adults with OSA were significantly more, as well as adults with severe OSA having more serum/plasma MCP-1 levels compared to the adults with mild to moderate OSA. Therefore, MCP-1 can be used as a diagnostic and therapeutic factor in adults with OSA.

A Narrative Review of the Association between Obstructive Sleep Apnea and Glaucoma in Adults.

Background: Obstructive sleep apnea (OSA) is a sleep disorder, primarily of the upper airway, which not only has a significant impact on quality of life but is also associated with various systemic diseases. Several ophthalmological diseases are also associated with OSA, especially glaucoma. The purpose of this review is to take a closer look at the causality and mutual influence. Methods: A systematic literature search was conducted using PubMed. A total of 19 studies with 316,178 adult participants were included. Results: Eleven of the sixteen studies concentrating on the prevalence of glaucoma in patients with OSA showed an association of both entities. One paper found a higher risk for progression of glaucoma in OSA patients. Five of the sixteen included studies failed to show a correlation between OSA and glaucoma. One study out of three surveying specific ophthalmological parameters showed an influence of OSA therapy on retinal nerve fiber layer (RNFL) thinning and vision. One study showed a rise in intraocular pressure (IOP), while two other studies showed no increase under continuous positive airway pressure (CPAP). Conclusions: Our findings suggest an association between OSA and glaucoma and, especially, between OSA and thinning of RNFL. CPAP therapy appears to be also suitable for patients with comorbid glaucoma.

Non-CPAP therapy for obstructive sleep apnoea.

To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse.

Nasomaxillary Expansion by Endoscopically-Assisted Surgical Expansion (EASE): An airway centric approach

The aim of this study was to analyze the skeletal, dental and airway changes with endoscopically assisted surgical expansion (EASE) to widen the nasomaxillary complex for the treatment of sleep apnea in adults. One hundred and five consecutive patients underwent EASE. Cone beam computed tomography (CBCT) was conducted preoperatively and within four weeks after the completion of the expansion process. Computational fluid dynamic (CFD) analysis was performed on 20 randomly selected patients to assess airway flow changes. One hundred patients (67 males) with the mean age of 35.0±13.5 years (17-64 years) had completed pre- and post-expansion imaging. Ninety-six patients (96%) had successful expansion defined as separation of the midpalatal suture at least 1 mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal cavity expansion was 3.12±1.11 mm at ANS, 3.64±1.06 mm at first molar and 2.39±1.15 mm at PNS. The zygoma expansion was 2.17±1.11 mm. The ratio of dental expansion to skeletal expansion was 1.23:1 (3.83 mm:3.12 mm) at canine and 1.31:1 (4.77 mm:3.64 mm) at first molar. CFD airway simulation showed a dynamic change following expansion throughout the airway. The mean negative pressure improved in the nasal airway (from -395.5±721.0 to -32.7±19.2 Pa), nasopharyngal airway (from -394.2±719.4 to -33.6±18.5 Pa), oropharyngeal airway (from -405.9±710.8 to -39.4±19.3 Pa) and hypopharyngeal airway (from -422.6±704.9 to -55.1±33.7 Pa). The mean airflow velocity within the nasal airway decreased from 18.8±15.9 to 7.6±2.0 m/s and the oropharyngeal airway decreased from 4.2±2.9 to 3.2±1.2 m/s. The velocity did not change significantly in the nasopharyngeal and hypopharyngeal regions. EASE results in expansion of the midpalatal suture from the ANS to PNS with a nearly pure skeletal movement of minimal dental effect. The expansion of the nasomaxillary complex resulted in the widening of the nasal sidewall throughout the nasal cavity. The improved air flow dynamics was demonstrated by CFD simulation.