Obstructive Sleep Apnea Symptoms Research Articles

Obstrüktif Uyku Apnede (OUA) Ortalama Trombosit Hacmi (OTH) ve OUA'da Sürekli Pozitif Hava Yolu Basıncı (CPAP) Tedavisinin OTH Üzerine Etkisi

Aims: In this study, our objective was to evaluate mean platelet volume (MPV), an indirect marker of platelet activation, in patients with obstructive sleep apnea (OSA), and assess the effect of OSA treatment with continuous positive airway pressure (CPAP) on MPV
 Methods: In this study, records of consecutive patients who underwent polysomnographic evaluation for OSA symptoms in the Sleep Disorders Laboratory during a one-year period were reviewed retrospectively. Patients who had both complete blood count and MPV measurements were included in the study.
 Results: A total of 158 patients, including 51 females (32.3%) and 107 males (67.7%), were included in the study. The mean age of the patients was 51±13 (min-18, max-82) years. OSA was detected in 74.1% (117/158) of the patients. It was determined that as the severity of OSA increased, hemoglobin and hematocrit values increased significantly. There was no significant difference in platelet count according to the presence and severity of OSA. The MPV was significantly lower in severe OSA cases compared to those without OSA and mild OSA cases. A negative correlation was observed between MPV and the apnea-hypopnea index, desaturation index, and the amount of oxygen saturation below 90% during sleep. There was no significant difference in median erythrocyte and thrombocyte counts, hematocrit percentage and hemoglobin values before and after treatment in OSA patients who used CPAP therapy. However, a significant decrease in MPV was observed after OSA treatment compared to pre-treatment. (p=0.021).
 Conclusions: The results of the study do not support an increase in MPV and hence platelet activation in severe OSA patients compared with those without OSA. However, the results suggest that one month of CPAP treatment reduces MPV and thus platelet activation in severe OSA patients. Further controlled, prospective studies including treatment outcomes are needed on this subject.

Item response theory analysis of daytime sleepiness as a symptom of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a sleep disorder which is linked to many health risks. The gold standard to evaluate OSA in clinical trials is the Apnea-Hypopnea Index (AHI). However, it is time-consuming, costly, and disregards aspects such as quality of life. Therefore, it is of interest to use patient-reported outcomes like the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, as surrogate end points. We investigate the link between AHI and ESS, via item response theory (IRT) modeling. Through the developed IRT model it was identified that AHI and ESS are not correlated to any high degree and probably not measuring the same sleepiness construct. No covariate relationships of clinical relevance were found. This suggests that ESS is a poor choice as an end point for clinical development if treatment is targeted at improving AHI, and especially so in a mild OSA patient group.

Evaluation of daytime sleepiness and insomnia symptoms in OSA patients with a characterization of symptom-defined phenotypes and their involvement in depression comorbidity-a cross-sectional clinical study.

Recent research highlights the significance of insomnia and sleepiness, shifting from obstructive sleep apnea (OSA) severity and sleep structure, in defining OSA phenotypes. This study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA. This cross-sectional, clinical study included 181 participants who underwent polysomnography (PSG) and filled out questionnaires, including the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Index (BDI). They were categorized into phenotypes: insomnia-sleepiness (I + S; ESS ≥ 11; ISI ≥ 15; n = 20), sleepiness (S; ESS ≥ 11; ISI < 15; n = 22), insomnia (I; ESS < 11; ISI ≥ 15), and asymptomatic (A; ESS < 11; ISI<15; n=55). A linear regression model for the BDI score (R2=0.357, p < 0.001) included ISI score and subjective-to-objective sleep latency ratio. The ISI score was a predictive factor for mild and moderate DS [OR = 1.23 (95% CI: 1.09-1.38), p < 0.001 and OR = 1.39 (95% CI: 1.13-1.72), p = 0.002]. The I and I + S phenotypes are characterized by higher BDI scores (p < 0.001 and p = 0.02), longer subjective sleep latency (p = 0.008 and p = 0.04), and shorter subjective total sleep time (TST; p = 0.049 and p = 0.006) compared to A. Furthermore, the I and I + S groups had shorter subjective TST than S (p = 0.03 and p = 0.047). The I and I + S had higher BDI scores than A (p < 0.001 and p = 0.02, respectively) and S (p < 0.001 and p = 0.02, respectively). The I phenotype was associated with the risk of mild and moderate DS (OR = 5.61 (95% CI: 1.91-16.53), p < 0.001 and OR = 9.55 (95% CI: 1.81-50.48), p = 0.008 respectively). Moreover, the I + S phenotype presented an even greater risk for mild DS (OR = 10.29 (95% CI: 2.95-35.85), p < 0.001). Using clinical features for OSA phenotyping holds promise for finding OSA individuals with increased risk for DS occurrence.

Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms?

Obstructive sleep apnea (OSA) is a heterogeneous condition covering many clinical phenotypes in terms of the diversity of symptoms. Patient-based OSA screening questionnaires used in routine practice contain significantly varying contents that can impact the reliability and validity of the screening. We investigated to what extent common patient-based OSA screening questionnaires differ or overlap in their item content by conducting a rigorous, methodical, and quantified content overlap analysis. We conducted an item content analysis of 11 OSA screening questionnaires validated in adult populations and characterized their overlap using a 4-step approach: (1) selection of OSA screening questionnaires, (2) item extraction and selection, (3) extraction of symptoms from items, and (4) assessment of content overlap with the Jaccard index (from 0, no overlap, to 1, full overlap). We extracted 72 items that provided 25 distinct symptoms from 11 selected OSA questionnaires. The overlap between them was weak (mean Jaccard index: 0.224; ranging from 0.138 to 0.329). All questionnaires contained symptoms of the "OSA symptom" dimension (eg, snoring or witnessed apneas). The STOP-BANG (0.329) and the Berlin (0.280) questionnaires exhibited the highest overlap content. Ten symptoms (40%) were investigated in only 1 questionnaire. The heterogeneity of content and the low overlap across these questionnaires reflect the challenges of screening OSA. The different OSA questionnaires potentially capture varying aspects of the disorder, with the risk of biased results in studies. Suggestions are made for better OSA screening and refinement of clinical OSA phenotypes. Gauld C, Baillieul S, Martin VP, etal. Symptom content analysis of OSA questionnaires: time to identify and improve relevance of diversity of OSA symptoms? J Clin Sleep Med. 2024;20(7):1105-1117.

Sex-specific differences in presenting symptoms of obstructive sleep apnea.

Scant data from India are available on the gender differences in presenting features of Obstructive Sleep Apnea (OSA) in India. This study aims to compare male and female patients with OSA for general characteristics and presenting symptoms. Retrospective study was done in OSA patients diagnosed in our sleep lab. History, biochemical reports, and polysomnography variables were retrieved from the sleep registry and were compared between males and females. Out of 514 patients of OSA (367 males; 147 females). Females were older (55.97 ± 9.73 v/s 50.2 + 12.70 years, P<0.001) and more obese (BMI 35.26 ± 7.17 v/s 29.58 ± 5.49 Kg/m2; P<0.001). Waist and hip circumference were significantly higher in the female patients (P = 0.009 and <0.001 respectively). Morning headache, nocturia, fatigability (P < 0.001), and depression (P = 0.005) was more common in females (P = 0.036). Hypersomnia was more commonly seen in males (P < 0.001). Mean diastolic blood pressure was significantly higher in males, although no difference was seen in Systolic BP. Females had higher mean Fasting Blood glucose (FBS) (P = 0.02). Apnea hypopnea index was significantly higher in females {P = 0.01}. Women with OSA are more obese, elderly, and with higher fasting blood glucose than males at the time of diagnosis. Females have a higher prevalence of symptoms like fatigability, depression, nocturia and early morning headache and had more severe AHI than males.

Intervention Programmes among Obstructive Sleep Apnea Patients: A Systematic Review

Aims: To assess the effectiveness of intervention programs to improve functional outcomes, continuous positive airway pressure (CPAP) adherence, daytime sleepiness, and knowledge among obstructive sleep apnea (OSA) patients. Background: Oxygen desaturations, awakenings, and snoring are symptoms of OSA. Design: Through five databases such as Google Scholar, Science Direct, Web of Science, Medline, and Research Gate. Conclusions: Patients improved their knowledge; CPAP compliance was higher in the intervention group compared to the control group. Regular CPAP utilization can improve functional outcomes and reduce daytime sleepiness. Implication for practice: researchers need to develop educational initiatives appropriate for OSA patients in Malaysia.

Sleep health in Swiss elite athletes. An online survey

Introduction There is no doubt that high-quality sleep is essential for athletes’ health, regeneration, and performance (Vorster et al., 2022). Unfortunately, sleep problems are as widespread in professional sports as they are in the rest of the population: about 11% of athletes have problems falling asleep and staying asleep, 20% have serious problems with sleep during competition periods, 30% are taking sleeping pills during the season, 10% show symptoms of obstructive sleep apnoea, 5% show symptoms of restless leg syndrome, and 15% report anxiety dreams before competitions (Gupta et al., 2017; Tuomilehto et al., 2017; Walsh et al., 2021). Comparative work that systematically analyses and compares sleep problems across sports remains scarce, so these figures should be viewed with caution. Especially for Swiss elite athletes’ representative numbers about the main sleep disorders are missing. The aim of the study is therefore to examine the status of sleep health among elite Swiss athletes. Methods An online questionnaire was sent to all Swiss elite athletes. Over 1,000 athletes (data collection is still running) filled out the questionnaire on various symptoms of sleep problems. The questionnaire included at least one item to screen for the six main categories of sleep disorders. These items were taken from different validated sleep questionnaires (e.g., PSQI, ASBQ, SDS). Results The prevalence of symptoms associated with sleep disorders of the six main categories: ‘insomnias’ ‘sleep-related breathing disorders’, ‘central disorders of hypersomnolence’, ‘circadian rhythm sleep-wake disorders’, ‘parasomnias’, ‘sleep-related movement disorders’ will be presented. Discussion/Conclusion This online survey will provide representative data on the prevalence of sleep problems in Swiss elite athletes. The dataset will provide novel insides into the distribution of certain sleep problems over the various sports in Switzerland. Sleep problems in athletes certainly need to be taken seriously and treated. They are often not just concomitants of other illnesses and problems. Therefore, important practical implications will be discussed.

Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea: Results from the international Sleep Apnea Global Interdisciplinary Consortium (SAGIC).

Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among OSA patients. Sleepiness was assessed using the Epworth Sleepiness Scale (>10 points defined as "risk of dozing") and a measure of general sleepiness (feeling sleepy ≥3 times/week defined as "feeling sleepy"). Four sleepiness phenotypes were identified: "non-sleepy", "risk of dozing only", "feeling sleepy only" and "both at risk of dozing and feeling sleepy". Altogether, 2083 OSA patients (69% male) with an apnea-hypopnea index (AHI) ≥5 events/hour were studied; 46% were "non-sleepy", 26% at "risk of dozing only", 7% were "feeling sleepy only" and 21% reported both. The two phenotypes at "risk of dozing" had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO2], time spent <90% SpO2, and hypoxic burden) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than "non-sleepy" and "feeling sleepy only" phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders. In a large international group of OSA patients, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as "risk of dozing" or "non-sleepy", while "feeling sleepy only" did not differ from "non-sleepy" individuals.

Prevalence of obstructive sleep apnea among Southern Indian pregnant women attending antenatal care

Background: Physiological and hormonal changes during pregnancy can alter the sleep patterns of the pregnant women and were said to be precursor for the development of obstructive sleep apnea (OSA) and complication of pre-existing OSA. Developing country like India has no health cost distribution for the treatment, as this condition’s treatment trends absorbs 65–82% of all health cost. There is oblivious state among clinicians and patients, self-reporting of the symptoms are poor which, in turn, results to upshot underdiagnoses of OSA among southern Indian population. Aims and Objectives: The aim of the study is to screen the prevalence of OSA among the southern Indian pregnant women attending antenatal care and to evaluate its predisposing factors. Materials and Methods: We enrolled 305 pregnant women according to our study selection criteria, attended antenatal care at ACS medical college and hospitals from Chennai. On face-to-face basis, berlin questionnaire screening was done. With a brief interview, sociodemographic details, medical records and laboratory parameters were obtained. To cluster the risk of OSA prevalence, percentage was estimated using frequency distribution. Chi-square analysis was done to obtain significant relationship between contributing factors and OSA symptoms. Statistical testing was done with SPSS software version 21. Results: Among 305 pregnant women, 31.8% (97) were shown to have high-risk OSA and 68.2% (208) low-risk OSA. Across the trimester, high-risk OSA were noted among 8.2% (25), 11.1% (34), and 15.4% (48) at first, second, and third trimester, respectively. Age, body mass index, occupation, neck circumference, multiple pregnancy, and presence of conditions such as gestational hypertension, chronic hypertension, adenoids, mallampatti grade, nasal congestion, and family history of OSA can be the predisposing factors which could influence the OSA symptoms. Conclusion: The future investigations should rely on the analysis of the fetal outcomes after proper diagnosis of OSA. Furthermore, independent predictive values of physical signs, history, risk factors, and mechanisms behind the progression of OSA should be studied well. Region and area specific difference of risk of OSA to identify disparities and to promote decentralization of sleep care could be done.

Prevalence of Obstructive Sleep Apnea Among Atrial Fibrillation Patients: A Cross-Sectional Study from Jordan.

Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA. A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017-2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses. Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 -4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634-7.376, p=0.001). These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.

Effectiveness of Adenoidectomy as a Standalone Procedure in Improving the Quality of Life of Children with Obstructive Sleep Apnea.

Adenoid hypertrophy (AH) and its sequel like nasal obstruction, obstructive sleep apnoea (OSA), recurrent rhinitis and middle ear disorders are common diseases of pediatric age group, forming the major bulk of pediatric outpatient visits. The recommended approach to treating OSA in children is through adenotonsillectomy. Adenoidectomy is the surgical procedure of removal of hypertrophied adenoid tissues, which is the most common surgery performed by Ear, Nose, and Throat (ENT) surgeons. Given that adenoidectomy alone might lead to reduced instances of adverse outcomes, decreased risk of complications, and lower expenses, our objective was to explore the viability and suitability of adenoidectomy as a standalone treatment for pediatric OSA and to learn the significant effect of adenoidectomy on the quality of life (QOL) of children. Multicentric prospective study conducted in Department of ENT, Head and Neck Oncosurgery, Smita Memorial Hospital, Thodupuzha & Department of ENT, Head and Neck surgery, MCS Hospital, Muvattupuzha, Kerala, India from June 2022 to June 2023. Children between the age group of 5-10 years, who underwent adenoidectomy during the study period, satisfying the inclusion criteria were subjected for the study. Adenoidectomy was done for them using endoscope assisted coblation technique. Postoperative improvement in symptoms and change in quality of life were analyzed using obstructive sleep disorders-6 (OSD-6) questionnaire at the end of 3 months follow up. The surgeon observed a statistically significant improvement in all domains of OSD-6; and there by improvement in QOL in all patients, who underwent adenoidectomy in a course of three months. Adenoid hypertrophy is the most common cause of nasal obstruction in pediatric population and is creating a significant negative impact on the quality of life of children. Adenoidectomy is a safe and simple procedure which can provide significant improvement in quality of life of kids. Adenoidectomy in isolation could be a valid and recommended surgical choice for selected population of children displaying symptoms of pediatric OSA.

Cephalometrics in Obstructive Sleep Apnea Patients with Mixed Dentition

Distal occlusion is one of the most common dentoalveolar anomalies and can be the reason for the obstructive sleep apnea (OSA) syndrome development among children. The aim of the study was to investigate the relationship between cephalometric and OSA parameters in the pediatric population. Methods: The cohort study included 39 children with OSA symptoms. Orthodontic examination consisted of a cephalometric analysis of 39 linear and angular variables. Patients underwent a sleep diagnostic study. Statistical analysis was performed using SPSS 19.0.0. Results: Of the general sample, 53.8% were mouth breathers and 46.2% had a mixed type of breathing. Moreover, 30.8% of patients had bruxism. The mean apnea-hypopnea index and oxygen desaturation index were 4.6/h and 3.9/h, respectively. A 1.06 times increase in the SNA index indicated the anterior position of the upper jaw. The MnPLSN° exceeded the norm by 1.3 times, which indicated the posterior position of the lower jaw and vertical type of the growth. An increase in ANSPNSSPT° by 1.1 times indicated an inclination of the upper jaw in the posterior position and a narrowing of the nasal passages. Patients with pediatric OSA had a significantly smaller lower airway space and MPH parameter. Conclusion: Systematic orthodontic monitoring of children with pediatric OSA is important for diagnosis and timely treatment.

Management of Velopharyngeal Dysfunction (VPD) Following Cleft Palate Repair: A Comprehensive Decision-Making Process Based on Severity and Structural Deficiencies.

To describe a comprehensive decision-making process for surgical correction of structural Velopharyngeal Dysfunction (VPD) following cleft palate repair and evaluate its efficacy. Retrospective study. Tertiary care hospital. 300 consecutive patients with unilateral or bilateral cleft lip and palate (CLP) or isolated cleft palate (CP) diagnosed with clinical VPD following cleft palate repair between 2009 and 2014. Of these 206 patients had structural VPD and underwent surgical correction. Surgical corrections were carried out according to the comprehensive two stage decision making process developed by the investigators. Step 1 of decision-making involved visualisation of the VP sphincter function by nasoendoscopy. This was followed by step 2 which involved per-operative identification of scarring, tissue loss, hypoplasia and other structural deficiencies in the soft palate and septal mucoperiosteum. The choice of operation was then made from a repertoire of interrelated and escalating surgical procedures consisting of palate revision and pharyngoplasties ranging from most anatomical to the least. Evidence of postoperative restoration of VP function on nasoendoscopy, evaluation of speech for hypernasality, understandability, acceptability and symptoms of obstructive sleep apnea. Complete VP closure was demonstrated in 94% of patients treated using this algorithm. There was significant improvement in all speech parameters (p < 0.00001). Our comprehensive decision-making process is designed to effectively correct structural VPD according to the severity of structural and functional deficiencies in the soft palate and avoid over treatment.

The Effectiveness of Training the Components of Compassion-Focused Therapy on Memory, Anxiety, and Sleep Quality in Patients with Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA) is a common and debilitating sleep disorder with both mental and physical complications. Although medical treatments may improve OSA symptoms, they may not affect its mental sequelae. Objectives: The aim of this study was to evaluate the effect of training the components of compassion-focused therapy (CFT) on sleep quality, anxiety, and memory in patients with OSA. Methods: This experimental study was performed on 37 patients (18 to 65 years old) with confirmed OSA diagnosed in the past year with a minimum apnea index score of 5 and no history of medical or psychiatric diseases. The study was conducted between 2022 and 2023. Exclusion criteria were being absent from more than two training sessions, experiencing stressful events, and refusing to continue the study. The intervention group (n = 19) received the training component of CFT in 8 sessions (once a week), while the control group received no psychological intervention. The Pittsburg sleep quality index (PSQI), Rey Auditory-Verbal Learning Test (RAVLT), Rey-Osterrieth complex figure (ROCF), and Beck Anxiety Inventory (BAI), as well as a demographic information questionnaire, were filled out by the participants at the baseline and after the intervention. Results: There was no significant difference between the groups in terms of demographic variables. The training component of CFT was effective in reducing anxiety and improving sleep quality, as well as the auditory-verbal and visual-spatial components of short-term memory in patients with OSA (P &lt; 0.05). Conclusions: The training component of CFT was efficient and beneficial in reducing anxiety and improving immediate memory and sleep quality in patients with OSA.

Machinelearning-Basedmodelforprediction of Narcolepsy Type 1 in Patients with Obstructive Sleep Apnea with Excessive Daytime Sleepiness.

Excessive daytime sleepiness (EDS) forms a prevalent symptom of obstructive sleep apnea (OSA) and narcolepsy type 1 (NT1), while the latter might always be overlooked. Machine learning (ML) models can enable the early detection of these conditions, which has never been applied for diagnosis of NT1. The study aimed to develop ML prediction models to help non-sleep specialist clinicians identify high probability of comorbid NT1 in patients with OSA early. Totally, clinical features of 246 patients with OSA in three sleep centers were collected and analyzed for the development of nine ML models. LASSO regression was used for feature selection. Various metrics such as the area under the receiver operating curve (AUC), calibration curve, and decision curve analysis (DCA) were employed to evaluate and compare the performance of these ML models. Model interpretability was demonstrated by Shapley Additive explanations (SHAP). Based on the analysis of AUC, DCA, and calibration curves, the Gradient Boosting Machine (GBM) model demonstrated superior performance compared to other machine learning (ML) models. The top five features used in the GBM model, ranked by feature importance, were age of onset, total limb movements index, sleep latency, non-REM (Rapid Eye Movement)sleepstage 2 and severity of OSA. The study yielded a simple and feasible screening ML-based model for the early identification of NT1 in patients with OSA, which warrants further verification in more extensive clinical practices.

Predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of obstructive sleep apnea in pediatric population.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in children. Determination of risk factors for the development of OSA is essential for early diagnosis and treatment of the disease and decreases the risk of negative consequences. This study aimed to investigate the predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of OSA in children. This prospective cross-sectional study included 114 children with OSA symptoms. All children were assessed by BMI z-score, Mallampati score, and tonsillar size and underwent overnight polysomnography. They were consecutively selected and assigned to 4 groups as follows: Group 1 included normal-weight with a low Mallampati score; Group 2 involved normal-weight with a high Mallampati score; Group 3 included obese with a low Mallampati score; and Group 4 involved obese with a high Mallampati score. Of the 114 included children, 58 were female and 56 were male, with a mean age of 13.1 ± 2.9 years. OSA frequency and apnea-hypopnea index were significantly higher in group 4 compared with other groups (p = 0.003 and p < 0.0001, respectively), whereas average and minimum spO2 were significantly lower (for both, p = 0.001). Mallampati score and BMI z-score were found to be significant for predicting OSA (odds ratio = 4.147, 95% CI: 1.440-11.944; p = 0.008 and odds ratio = 1.760, 95% CI: 1.039-2.980; p = 0.035, respectively). Among OSA patients, the Mallampati score, tonsillar size, and BMI z-score were found to be significant for predicting OSA severity (odds ratio = 4.520, 95% CI: 1.332-15.335, p = 0.015, odds ratio = 9.177, 95% CI: 2.513-33.514, p = 0.001, and odds ratio = 2.820, 95% CI: 1.444-5.508; p = 0.002, respectively). The coexistence of the Mallampati score and BMI z-score significantly increases the presence of OSA in children. Mallampati score, tonsillar size, and BMI z-score are promising parameters for predicting OSA severity.

Multiple Allergic Rhinitis Single Nucleotide Polymorphism Variants are Associated with Sleep-Breathing Parameters in Men with Obstructive Sleep Apnea: A Large-Scale Study.

Sleep-disordered breathing is more prevalent in individuals with allergic rhinitis (AR) than in those without AR. In addition to increased risk for sleep-disordered breathing, AR is associated with greater severity of obstructive sleep apnea (OSA) symptoms. The aim of this research study was to evaluate the association of multiple single nucleotide polymorphism (SNP) variations in AR with sleep- and breathing-related parameters in men with OSA. Men who had complained of snoring were consecutively enrolled in the Shanghai Sleep Health Study of Shanghai Sixth People's Hospital from 2007 to 2018. After rigorous screening, 5322 men were included in the analysis. Anthropometric, fasting biochemical, and polysomnographic parameters, along with 27 AR-associated SNPs were analyzed. The associations between AR-related genetic polymorphisms and OSA were determined via linear, binary, and multinomial logistic regression analyses. Rs12509403 had significantly positive associations with most sleep-breathing parameters. While the risk for OSA was increased by rs12509403, it was decreased by rs7717955 [odds ratio (OR) = 1.341, 95% confidence interval [CI] = 1.039-1.732, P = 0.024; OR = 0.829, 95% CI = 0.715-0.961, P = 0.013, respectively]. A graded increase in the risk of being in the highest quartile (Q4) vs the reference category (Q1) for sleep breathing indicators, especially REM-AHI and NREM-AHI, was identified by rs12509403 (OR = 1.496, 95% CI = 1.175-1.904, P = 0.001; OR = 1.471, 95% CI = 1.151-1.879, P < 0.001, respectively). The association of multiple AR SNPs with OSA-related hypoxia and sleep indices provides a genetic explanation for the higher AR susceptibility of OSA patients. Understanding the AR-related genetic underpinnings of OSA may lead to more personalized treatment approaches.

Risk Assessment of Obstructive Sleep Apnoea Symptoms and Its Correlation with Oral Manifestations: A Cross-sectional Study

Introduction: Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder seen in all age groups. The aetiology is multifactorial, including factors such as obesity, aging, stress, and a sedentary lifestyle. Poor knowledge about diagnostic options, management, and consequences of improper treatment may contribute to morbidity and mortality. Berlin Questionnaires (BQ) are simple, low-cost, non-invasive tools that can be used to assess the risk of OSA. Screening subjects using questionnaires and oral examinations for a multidisciplinary approach to treat OSA is essential. Aim: To assess the risk of OSA symptoms and their association with oral manifestations among students. Materials and Methods: This cross-sectional study was conducted among medical students aged between 18 and 24 years. Three hundred medical students (171 males, 129 females) willing to participate in the study were included. Responses to the Berlin and oral health questionnaires were collected, and oral examinations were performed. Statistical analysis was conducted using Epi Info software. Kruskal-Wallis H test and one-way Analysis Of Variance (ANOVA) were carried out to evaluate significance in different groups and to examine associations between OSA, oral health, and other variables. Results: The collected data were statistically analysed. In the present study, 35 subjects (11.67%) were classified as highrisk and 265 subjects (88.33%) as low-risk by the BQ. The prevalence of OSA in the present study was 12.87% in males and 10.08% in females. High-risk subjects were educated, motivated, and referred for confirmatory diagnostic tests and early treatment. Conclusion: The prevalence of OSA in the present study was 12.87% in males and 10.08% in females. Emphasis should be placed on highlighting the clinical aspects related to OSA and its relation to oral health. There is a great need to educate and motivate dental and medical students and professionals about OSA by conducting health education programs.

The effect of pharyngeal structures on the severity of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterized by complete or partial cessation of breathing during sleep. The tongue is suggested as a possible anatomical site causing airway obstruction. However, the role of other pharyngeal structures in the development of OSA remains unclear. We designed a study using both the apnea-hypopnea index (AHI) and the oxygen saturation measurements to assess the severity of OSA. We aimed to identify critical anatomical structures of the upper airway that correlate with the severity of OSA and toevaluate the utility of magnetic resonance imaging (MRI) markers to detect possible OSA inpatients without overt symptoms. The study included participants referred to the neurology outpatient clinic from the check-up unit. Participants were grouped as controls, mild, moderate, or severe OSA according to the AHI. A cranial MRI with a field of view (FOV) encompassing the upper airway structures was obtained from all participants. The areas of the tongue and the uvula were measured on the sagittal images by drawing the boundaries of the tissues manually. The posterior air space (PAS) area was evaluated from regions of interest in five parallel planes. Of 105 participants, 30 were controls, 27 had mild, 25 had moderate, and 23 had severe OSA.The moderate and severe OSA groups did not differ in oxygen saturation levels during sleep. Therefore, patients withmoderate and severe OSA were combined into one group (moderate/severe OSA). The area of the tongue was significantly larger in the moderate/severe OSA group compared to the control group. Both the tongue and the uvula areas showed a significant positive correlation with the AHI. Our findings suggest that the tongue and uvula have prominent roles in the severity of OSAS. It may be useful to measure these structures with MRI to screen for at-risk individuals without overt OSA symptoms.

Association of obstructive sleep apnea and sleep quality with cognitive function: a study of middle-aged and elderly persons in India.

Symptoms of obstructive sleep apnea (OSA) and poor sleep quality affect around one in ten people in India. We aimed to determine if OSA symptoms and poor sleep quality are independently associated with cognition in middle-aged and elderly urban Indian populations. We studied the cross-sectional association between OSA symptoms (by Berlin Questionnaire), poor sleep quality (by Pittsburgh Sleep Quality Index), and cognitive function in adults ≥ 50years. Using a standard neuropsychological battery for cognitive function, a G-factor was derived as the first rotated principal component assessing domains of information processing, memory, and executive function. The associations of exposures with cognitive measures were modeled using linear regression, adjusted for metabolic risk factors, lifestyle factors, and psychosocial problems, followed by stratified analysis by decadal age group. A total of 7505 adults were enrolled.Excluding those with MMSE < 26 (n 710), of 6795 individuals (49.2% women), mean (SD) age 64.2 (9.0) years, 38.3% had high risk of OSA symptoms, and 15.9% had poor sleep quality. OSA symptoms were negatively associated with cognitive domains of information processing (adjusted beta coefficient of z-score - 0.02, p-value 0.006), memory (- 0.03, 0.014), and G-factor (- 0.11, 0.014) in full-model. Stratified analysis by age group showed significant adverse effects of OSA symptoms on cognition for middle-aged people (50-60years) (- 0.26, 0.001), but not in later age groups. Poor sleep quality was also associated with lower cognitive scores for G-factor (- 0.48, < 0.001), memory (- 0.08, 0.005), and executive domains (- 0.12, < 0.001), but not with information domain. The findings suggest that both symptoms of OSA and poor sleep quality have a direct adverse impact on cognition in an Indian setting. A modest effect of age on the relationship of OSA and cognition was also observed.