Treatment Of Obstructive Sleep Apnea Research Articles

Synergic Integration of the miRNome, Machine Learning and Bioinformatics for the Identification of Potential Disease-Modifying Agents in Obstructive Sleep Apnea.

Understanding the diverse pathogenetic pathways in obstructive sleep apnea (OSA) is crucial for improving outcomes. microRNA (miRNA) profiling is a promising strategy for elucidating these mechanisms. To characterize the pathogenetic pathways linked to OSA through the integration of miRNA profiles, machine learning (ML) and bioinformatics. This multicenter study involved 525 patients with suspected OSA who underwent polysomnography. Plasma miRNAs were quantified via RNA sequencing in the discovery phase, with validation in two subsequent phases using RT-qPCR. Supervised ML feature selection methods and comprehensive bioinformatic analyses were employed. The associations among miRNA targets, OSA and OSA treatment were further explored using publicly available external datasets. Following the discovery and technical validation phases in a subset of patients with and without confirmed OSA (n=53), eleven miRNAs were identified as candidates for the subsequent feature selection process. These miRNAs were then quantified in the remaining population (n=472). Feature selection methods revealed that the miRNAs let-7d-5p, miR-15a-5p and miR-107 were the most informative of OSA. The predominant mechanisms linked to these miRNAs were closely related to cellular events such as cell death, cell differentiation, extracellular remodeling, autophagy and metabolism. One target of let-7d-5p and miR-15a-5p, the TFDP2 gene, exhibited significant differences in gene expression between subjects with and without OSA across three independent databases. Our study identified three plasma miRNAs that, in conjunction with their target genes, provide new insights into OSA pathogenesis and reveal novel regulators and potential drug targets.

The relationship between composite lipid indices and baveno classification in patients with obstructive sleep apnoea

Obstructive Sleep Apnoea (OSA) is associated with the development of cardiovascular disease (CVD); however, the risk is only weekly related to OSA severity traditionally determined by the apnoea-hypopnoea index. The Baveno classification was developed to improve patient selection who would benefit from OSA treatment in terms of symptoms improvement and CVD risk reduction. However, it is unclear how the classification relates to biomarkers of CVD risk. Composite lipid indices were evaluated in various populations and showed good predictive value for incident CVD. One thousand two hundred and forty-two patients with OSA were included in the study. Composite lipid indices, including the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP) and cardiometabolic index (CMI) were compared between different Baveno groups (A – minor symptoms, minor comorbidities, B – severe symptoms, minor comorbidities, C – minor symptoms, severe comorbidities, D – severe symptoms, severe comorbidities). All composite lipid indices were higher in group D versus groups A and C. Only LAP (86.93 /58.40–119.49/ vs. 75.73 /48.37–99.04/) and CMI (1.03 /0.69–1.42/ vs. 0.91 /0.63–1.12/) were significantly different between the minimally symptomatic groups (C vs. A), and solely LAP was significantly higher (110.69 /76.76–147.22/ vs. 82.32 /60.35–113.50/) when the highly symptomatic groups (D vs. B) were compared. The Baveno classification correlates with cardiovascular risk estimated with composite lipid indices. Composite lipid indices may help better stratifying cardiovascular risk in both minimally- and highly symptomatic patients.

Case reports of oral appliance therapy on three young adults with Down syndrome and OSA.

Patients with Down syndrome (DS) have a high incidence of obstructive sleep apnea (OSA) due to hypotonia, weight, underdeveloped midface, and relative macroglossia. This article presents three cases of young adults with DS, who were diagnosed with mild to severe OSA and unable to tolerate positive airway pressure therapy. These patients have been successfully treated with a custom-made mandibular advancement device (MAD) or dual treatment with MAD and bi-level positive airway pressure (PAP) therapy. The baseline apnea-hypopnea index (AHI) of the three patients were 15.5/h, 31.8/h, and 41.3/h. The follow-up AHI after the application of MAD in three patients was 25/h (13 months after), 6/h (ODI 4%, 57 months after), and 21.8/h (21 months after), respectively. The application of MAD to treat OSA in patients with DS is a reasonable alternative when patients refuse PAP therapy. Although MAD might be less effective than PAP therapy, significant symptomatic improvement could be found in patients with DS after oral appliance therapy. The combination of MAD and PAP can decrease the PAP pressure and therefore improve adherence. This is the first case report to show that young adult patients with DS can successfully benefit from oral appliance therapy for OSA treatment.

The future of big data: Remote monitoring of positive airway pressure treatment for obstructive sleep apnea - insights from adults and implications for pediatric care.

The advent of large expansive datasets has generated substantial interest as a means of developing and implementing unique algorithms that facilitate more precise and personalized interventions. This methodology has permeated the realm of sleep medicine and in the care of patients with sleep disorders. One of the large repositories of information consists of adherence and physiological datasets across long periods of time as derived from patients undergoing positive airway pressure (PAP) treatment for sleep-disordered breathing. Here, we evaluate the extant and yet scarce findings derived from big data in both adults and children receiving PAP for obstructive sleep apnea and suggest future directions towards more expansive utilization of such valuable approaches to improve therapeutic decisions and outcomes.

Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRSDisease Burden.

Assess the impact of obstructive sleep apnea (OSA) on chronic rhinosinusitis (CRS) severeity. Retrospective database review. TriNetX US database. TriNetX US Collaborative Network database was queried for cohorts of patients with OSA, CRS, and CRS with comorbid OSA (CRS-OSA). Data included demographics, CRS severity was assessed via rates of endoscopic sinus surgery (ESS), antibiotic, and oral steroid use. Propensity score matching was performed to account for differences in demographics and clinical variables. The query identified 1,818,879 patients with CRS, 481144 with OSA, and 93,153 CRS-OSA patients. OSA-CRS patients had higher rates of hypertension, diabetes mellitus, obesity, and asthma than either CRS or OSA populations (P < 0.0001). CRS-OSA patients demonstrated higher rates of ESS (odds ratio [OR]: 1.91, 1.82-2.02, P < 0.0001), antibiotic (OR: 1.90, 1.81-1.96, P < 0.001), and oral steroid use (OR: 2.23, 2.16-2.28, P < 0.001) compared to CRS-only patients. CRS-OSA patients not on continuous positive airway pressure had higher utilization of antibiotics (OR: 3.24, 2.82-3.71, P < 0.0001) and steroids (OR: 2.28, 2.05-2.55, P < 0.0001) than nonutilizers. CRS-OSA patients with sleep-related surgical interventions required fewer antibiotic courses (OR: 1.93, 1.62-2.28, P < 0.0001). CRS-OSA patients experience higher rates of comorbidities associated with both diseases than those with CRS or OSA alone. OSA was associated with an increased risk of ESS, antibiotic, and steroid use in patients with CRS. There appears to be a correlation with treatment of OSA and CRS outcomes, however, further studies are required.

Multicentre study conducted across centres in the USA, Europe and Australia to assess the safety and effectiveness of a bilateral hypoglossal nerve stimulation system for the treatment of obstructive sleep apnoea in adults: a protocol for a pivotal, multicentre, open-label, single-arm study

IntroductionObstructive sleep apnoea (OSA) is characterised by blood oxygen desaturations and sleep disruptions manifesting undesirable consequences. Existing treatments including oral appliances, positive airway pressure (PAP) therapy and surgically altering the...

Effects of Continuous Positive Airway Pressure Treatment on Sawtooth Waves During Rapid Eye Movement Sleep in Obstructive Sleep Apnea Patients.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by recurrent upper airway collapse and obstruction, leading to reduced or absent breathing during sleep, especially rapid eye movement (REM) sleep, and continuous positive airway pressure treatment (CPAP) is often used for treatment of OSA. Sawtooth waves (STWs) are a characteristic of REM sleep. To examine effects of CPAP treatment on STWs during REM sleep in the OSA patients. Polysomnographic recordings were performed on 20 moderate-to-severe OSA patients and 16 normal controls, and comparisons of STWs during REM sleep in the OSA patients with and without CPAP treatment (paired t-test or Wilcoxon signed-rank test wherever appropriate), and between OSA patients and normal controls (Student's t-test or Wilcoxon rank-sum test) were carried out. In addition, linear correlation analyses were used to estimate the relationship of STWs and REM sleep with duration of non-REM (NREM) sleep stage 3 (N3). The STWs were classified to be apnea/hypopnea associated and not associated (isolated), and the amplitude of the isolated STWs was significantly higher than that of the apnea/hypopnea associated. With CPAP treatment, the percentage of REM sleep with STWs and the amplitude of STWs were significantly increased to the levels, which were not significantly different from those in the normal controls, while the frequency of STWs was not significantly changed. In addition, the total duration of REM sleep and the duration of REM sleep with STWs were both positively correlated with the duration of N3 sleep in the normal controls and the OSA patients with CPAP treatment. Furthermore, CPAP treatment also caused a significant increase in the duration of rapid eye movements in REM sleep. These findings suggest that there are some interconnections between NREM and REM sleep, and STWs not only represent the quality of REM sleep but also are correlated with N3 sleep.

Effectiveness Of Oropharyngeal Exercises For Obstructive Sleep Apnea In Sedentary 45-Year-Old Adult: A Case Report

Background: Obstructive sleep apnea (OSA) is a common condition characterized by repeated episodes of airway obstruction during sleep. Traditional treatments include CPAP and lifestyle modifications. This case report explores the effectiveness of Oropharyngeal exercises in a sedentary 45-year-old adult with OSA. Case Presentation: A 45-year-old sedentary male with moderate OSA underwent a regimen of Oropharyngeal exercises over a 12-week period. Intervention: The patient performed daily Oropharyngeal exercises designed to strengthen the upper airway muscles. Outcome Measures: Improvement was assessed using the Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and subjective sleep quality. Results: After 12 weeks, there was a significant reduction in AHI, improvement in ESS scores, and enhanced subjective sleep quality. Conclusion: Oropharyngeal exercises may be a viable adjunctive treatment for OSA, particularly in sedentary individuals. Further research with larger samples is needed to confirm these findings

Clinical Efficacy of a Position-Responding Mandibular Advancement Device in Patients With Obstructive Sleep Apnea.

Although mandibular advancement device (MAD) treatment is effective for obstructive sleep apnea (OSA), some concerns remain regarding its potential therapeutic impact and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. We conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Fourteen patients diagnosed with OSA participated in this study. Polysomnography (PSG) was performed at the beginning of the clinical trial, and after 3 months of treatment, PSG with AMAD in situ was conducted. The mean scores for the Epworth Sleepiness Scale (ESS) and STOP-Bang were 8.21±4.21 and 5.00±1.00, respectively. After 3 months of AMAD treatment, the STOP-Bang scores improved to 3.75±1.06; however, the ESS scores did not show a significant change. Additionally, we observed statistically significant improvements in several respiratory parameters in the PSG data following AMAD treatment. These included reductions in the apnea-hypopnea index (AHI) (from 32.85±21.71 to 12.93±10.70), supine AHI (from 45.91±23.58 to 15.59±12.76), and lateral AHI (from 13.94±10.95 to 5.49±7.40). Improvements were also noted in the lowest O2 saturation (from 79.71±6.22 to 84.00± 5.71), total arousal number (from 191.14±112.07 to 86.57±48.80), and arousal index (from 33.76±21.00 to 15.05± 8.42). However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, no major side effects were observed during treatment, specifically related to tooth or jaw pain. Our clinical trial found that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Glucagon-like peptide-1 receptor agonists for the treatment of obstructive sleep apnea: a meta-analysis

Abstract Study Objectives Obstructive sleep apnea (OSA) is characterized by disordered breathing during sleep and is associated with major cardiovascular complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an important treatment for obesity and diabetes mellitus show promising therapeutic prospects in OSA. We conducted a meta-analysis to evaluate the effect of GLP-1RA intervention in OSA individuals. Methods We searched the PubMed and Web of Science databases (published until July 1, 2024). The included studies evaluated the GLP-1RA in OSA individuals and the efficacy outcomes measured by the apnea-hypopnea index (AHI). Results Six studies with a total of 1067 participants enrolled. GLP-1RA significantly decreased AHI with an estimated treatment difference of −9.48 events per hour (95% confidence interval [CI] = −12.56 to − 6.40, I2 = 92%). The change in weight was −10.99 kg and body mass index (BMI) was –1.60 kg/m2. The mean difference in systolic blood pressure was –4.81 mmHg and in diastolic blood pressure was –0.32 mmHg. Tirzepatide significantly reduced AHI more than liraglutide with an estimated treatment difference of –21.86 events per hour (95% CI = –25.93 to –17.79) vs –5.10 events per hour (95% CI = –6.95 to –3.26). Obese individuals experienced a more significant decrease in AHI with an estimated treatment difference of –12.93 events per hour vs –4.31 events per hour. The application of continuous positive airway pressure and the duration of follow-up did not affect the therapeutic effect. Conclusions GLP-1RA could significantly reduce the severity of OSA, and also lead to weight loss and lower blood pressure. Further high-quality randomized controlled trials (RCTs) are needed to explore different GLP-1RA treatments and durations in OSA and identify participant subgroups that may benefit the most. Clinical Trial NA.

Screening for obstructive sleep apnea in the memory clinic: A comparison of questionnaires, pulse oximetry, and polysomnography.

Obstructive sleep apnea (OSA) is highly prevalent among older adults and has been associated with cognitive decline and dementia risk. The suitability of screening tools for detecting OSA in memory clinic settings is unclear. To evaluate the utility and validity of the STOP-Bang questionnaire (SBQ) and pulse oximeter as a screening tool, compared to gold-standard polysomnography (PSG) in older adults attending a memory clinic. Participants aged over 50 with new onset cognitive/mood concerns attended a memory clinic, then completed the SBQ, oximetry, and PSG. The SBQ and oximetry's accuracy in detecting moderate-severe and severe OSA was evaluated using receiver operating curves. Intraclass correlation and Bland-Altman plots compared the oximeter's adjusted oxygen desaturation index (ODI-Ox) and PSG's apnea-hypopnea index (AHI-PSG). Of 194 participants (mean age = 65.6, 64 males) who completed PSG, 184 completed the SBQ, and 138 completed oximetry. SBQ demonstrated limited performance for moderate-severe OSA (sensitivity = 52%, specificity = 62%, AUC = 0.600) and severe OSA (sensitivity = 18%, specificity = 87%, AUC = 0.577). Oximetry was satisfactory for moderate-severe OSA (sensitivity = 67%, specificity = 73%, AUC = 0.769) and severe OSA (sensitivity = 50%, specificity = 88%, AUC = 0.730). The diagnostic performance was improved with new cut-offs at ODI-Ox ≥ 11 for AHI-PSG ≥ 15 and ODI-Ox ≥ 20 for AHI-PSG ≥ 30. Bland-Altman plots and intraclass correlation indicated acceptable agreement for oximetry. The findings suggest that while the SBQ may be unsuitable to detect moderate or severe OSA for older adults with cognitive impairment, oximetry may be a viable screening tool. Given OSA treatment can optimize sleep and may slow cognitive decline, routine screening for OSA should be part of memory clinic assessments.

No negative impact of a vibro-tactile supine-avoidance alarm on sleep onset latency following supine posture shifts during sleep.

It is unclear to what extent posture shifts during sleep are associated with prior arousal and full awakening, and if supine-avoidance alarms to discourage supine sleep promote more extended wake following supine alarms. Thus, this study sought to examine relationships between posture shifts, arousals and awakenings, and to establish if a vibro-tactile supine-avoidance alarm delays the return to sleep following supine posture shifts. Detailed posture shift and sleep data from a chest-worn device with an inactive or active supine-avoidance alarm, and in-home sleep study data were from 37 participants who completed a randomised controlled trial of supine-avoidance device treatment for supine-predominant obstructive sleep apnea. Posture shifts, sleep, arousal and awakening responses, and sleep onset latency following posture shifts were compared between baseline and supine-avoidance treatment nights. Compared to baseline, there was a marked reduction in overnight supine time with active supine-avoidance treatment. Around 90% of posture shifts were preceded by either wake, arousal or full awakening. Sleep onset latency was longer for posture shifts occurring from prior wake compared to those from prior sleep but was not different between baseline or supine-avoidance treatment nights or between shifts from non-supine to supine or vice-versa. Most overnight posture shifts are associated with either prior wake or brief arousal, which likely facilitates co-ordinated body movements needed for effective posture shifts. Thus, sleep is typically already interrupted around the time that supine-avoidance alarms are activated, and the alarm itself does not significantly delay the return to sleep.

Use of empagliflozin as an adjuvant treatment for obstructive sleep apnea for a patient who has not seen a physician in over 40 years

A clinical decision report using: Neeland IJ, Eliasson B, Kasai T, et al. The Impact of Empagliflozin on Obstructive Sleep Apnea and Cardiovascular and Renal Outcomes: An Exploratory Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care. 2020;43(12):3007-3015. https://doi.org/10.2337/dc20-1096 for a patient with obstructive sleep apnea who has not seen a physician in over 40 years.

Caregiver-implemented intervention to increase use of positive airway pressure for adults with Down syndrome and sleep apnea.

Many individuals with Down syndrome are diagnosed with obstructive sleep apnea (OSA), a medical condition that substantially affects health and quality of life. The most common treatment for OSA is positive airway pressure (PAP) therapy. Few studies have examined interventions to improve PAP therapy adherence for adults with developmental disabilities or have recruited the assistance of caregivers to improve adherence with this therapy in the home. This study evaluated the efficacy of a caregiver-implemented behavioral intervention to increase PAP use for four adults with Down syndrome and OSA. The experimenters trained caregivers via telehealth to implement the intervention in their homes. The intervention consisted of graduated exposure, noncontingent reinforcement, and differential positive and negative reinforcement without escape extinction. The intervention increased the duration of PAP use for all four participants. These results provide preliminary support for the efficacy of this intervention and service-delivery model.

A randomised dose finding study of combination dronabinol and acetazolamide for the treatment of obstructive sleep apnoea.

Current treatments for obstructive sleep apnoea (OSA) are ineffective or not tolerated in a proportion of patients. Other therapeutic options are needed and pharmaceuticals may provide an alternative. This randomised, double-blind, placebo-controlled, cross-over study examined the effect of combination acetazolamide and dronabinol (IHL-42X) at low, medium and high doses on OSA severity. Participants with OSA (apnoea-hypopnoea index; AHI≥15events/hr) received 1-week of IHL-42X at each of 3 doses, and placebo, each separated by 1-week washout. The change from baseline in AHI, oxygen desaturation index (ODI), Epworth sleepiness score (ESS), and mood (profile of mood states) on the final night of each treatment arm relative to the change from baseline to placebo were the major endpoints. Adverse events (AEs) were monitored throughout. Ten of 11 participants completed the final night of at least one treatment arm. IHL-42X demonstrated a greater reduction in AHI from baseline compared with placebo (low, -19.7±27.1; medium, -17.5±23.3; high, -16.4±23.8 versus placebo, -2.8±21.0 events/hr; all p<0.05). The change from baseline in ODI3% was greater for the medium IHL-42X dose when compared with placebo (-15.4±19.0 versus placebo, -2.8±21.0 events/hr; p<0.05) but not the low or high doses (low, -15.2±24.8; high, -8.3±13.2 events/hr). IHL-42X did not change ESS or mood. No serious AEs occurred however 35 mild-moderate possibly, probably or treatment related AEs occurred during IHL-42X dosing and 5 occurred during placebo. One week of nightly IHL-42X at low, medium, and high doses was well tolerated, safe and associated with significant reductions in OSA severity.

Consumer sleep technology use in individuals with obstructive sleep apnea: does it have a role in monitoring treatment response?

Consumer sleep technology (CST) has an emerging role in monitoring sleep, including screening or surveillance of sleep disorders; however, few data are available on CST in patients with obstructive sleep apnea (OSA). We analyzed attitudes towards CST and patterns of CST use among individuals with OSA. Among 251 respondents (mean age 57.5 years; 58.2% female), 66.5% reported CST use, and 92.0% indicated that monitoring OSA treatment response would be a useful feature of CST. Individuals with a household income < $30,000 (OR 0.26; p=0.008) or identifying as a minority/other race (OR 0.15; p=0.021) were less likely to use CST. Older age (beta-coefficient 0.05; p<0.001), Medicare insurance (beta-coefficient 1.26; p=0.006), and positive airway pressure use (beta-coefficient; p=0.008) were associated with increased nights/week of CST use. These findings demonstrate a high perceived value of CST for monitoring treatment response among individuals with OSA, but disparate use by sociodemographic and clinical factors.

P029 High-definition neurostimulation to enhance slow oscillations during sleep in obstructive sleep apnea: A randomised, single-blind, sham-controlled, crossover proof-of-concept protocol

Abstract Global and regional deficits in slow frequency EEG oscillations during non-rapid eye movement sleep, which have been reported in people with obstructive sleep apnea (OSA) may have detrimental consequences on cognitive performance. Current OSA treatments have variable effects on restoring slow waves and improving cognition, and some treatments are poorly tolerated. Previous studies using non-invasive transcranial direct current stimulation (tDCS) applied to frontal brain regions enhanced slow wave oscillations in healthy adults and may have utility in an OSA population. This protocol will assess the feasibility of using tDCS to enhance slow oscillations in middle to late aged people with OSA. A randomised, crossover design will test two active (maximum current density 0.522mA/cm2) and one sham (&amp;lt;0.1mA) slow oscillation tDCS conditions. In this proof-of-concept study, 5 participants aged 40-65 years with mild-moderate OSA will attend three in laboratory visits with high-density EEG, with a 1-week washout. Active or sham stimulation in frontal or parietal regions will be applied in 5 x 5-minute blocks during the first NREM period of a 90-minute nap. EEG data will be measured for 60 seconds after each stimulation block. Memory and attention tasks and a perception questionnaire will be completed before and after the nap. The primary outcome is technical feasibility. Secondary outcomes include protocol acceptability, blinding and perceived effectiveness and delta EEG power. Tertiary outcomes include visuo-spatial recognition, vigilance, sigma power, and sleep macro-architecture. Preliminary feasibility data on this novel intervention to target sleep and cognition in OSA will inform a larger clinical trial.

Three-dimensional mean disease alleviation (3D-MDA): The next step in measuring sleep apnea treatment effectiveness

Mean disease alleviation measures the effectiveness of Obstructive Sleep Apnea (OSA) treatments. It combines a patient's adherence to treatment normalized to their total sleep time and the treatment's efficacy as determined by the change in the apnea-hypopnea index. This metric fails to capture the patient's OSA-related symptoms, which are a key component and, in some cases, the primary component, of determining response to treatment.We propose an enhanced metric called three-dimensional mean disease alleviation (3D-MDA), which incorporates the symptom response to better reflect the true treatment impact. ResultsThe proposed 3D-MDA metric aims to provide a more comprehensive assessment of OSA treatment effectiveness by integrating the subjective impact, therapy adherence, and objective efficacy. Further, 3D-MDA is adaptable over time as the optimal metrics for these categories continue to evolve.

The efficacy and safety of dual orexin receptor antagonists in obstructive sleep apnea: A systematic review and meta-analysis of randomised controlled trials.

Dual orexin receptor antagonists (DORAs) are indicated for the treatment of insomnia disorder. However, DORAs may change sleep parameters, thus having adverse effects on patients with obstructive sleep apnea (OSA). This meta-analysis clarified the impact of DORAs in OSA treatment on sleep architecture and respiratory parameters. We systematically searched PubMed, Embase, and Cochrane Central databases for randomised control trials published up to May 2024. The search focussed on studies discussing the effects of DORAs on sleep architecture in patients with OSA. Nonrandomised studies were excluded. A meta-analysis using a random-effects model was performed. The patients were categorised into subgroups based on the treatment protocol (single or multiple dosages). The Cochrane risk of bias tool for randomised trials assessed the risk of bias. Our meta-analysis included four randomised placebo-controlled trials, encompassing 126 patients with a mean age of 49.1 years. The effects of DORAs on sleep architecture and respiratory parameters were examined. The main findings were as follows: DORAs significantly increased the total sleep time and improved sleep efficiency. However, they did not affect rapid eye movement sleep. DORAs also showed a trend towards decreased wake after sleep onset and did not increase the apnea-hypopnea index. DORAs did not increase the percentage of total sleep time with oxygen saturation lower than 90% and 85% compared with placebo, respectively. Furthermore, DORAs were not associated with significantly higher adverse effects compared with placebo. This meta-analysis demonstrated that DORAs improve sleep and do not impair nighttime respiratory function in patients with OSA.

Relationship Between Obstructive Sleep Apnea and Sports-Systematic Review and Meta-Analysis.

The primary objective of this research is to analyze and compare the effects of physical activity on patients diagnosed with obstructive sleep apnea (OSA), a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and various health complications. Methods: A systematic and strategic search of 16 peer-reviewed articles was conducted to assess the impact of different types of physical exercise on the apnea-hypopnea index (AHI), a key metric used to quantify the severity of OSA. The selected studies focused on two main exercise modalities: aerobic exercise alone and a combination of aerobic and resistance training. These modalities were examined to determine their respective influences on the AHI among individuals with OSA. Results: The findings revealed that aerobic exercise alone did not significantly alter the apnea-hypopnea index (p = 0.15), suggesting limited effectiveness in reducing the severity of OSA when performed in isolation. However, in patients who engaged in combined physical activity-incorporating both aerobic and resistance exercises-a significant reduction in the AHI was observed (p < 0.01), indicating a more substantial therapeutic effect. Conclusions: This study concludes that a structured exercise program combining aerobic and resistance training produces a significant improvement in the apnea-hypopnea indices of patients with obstructive sleep apnea. These results highlight the potential of combined exercise regimens as a non-pharmacological intervention that could complement traditional OSA treatments, offering a viable approach to managing the condition and improving patient outcomes. Future research should aim to explore the optimal exercise intensity, duration, and frequency to maximize these benefits.