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Introduction: Oral submucous fibrosis (OSMF) alters the pharynx, which may affect airway size. MRI will be useful for diagnosing pharyngeal abnormalities. MRI is used to evaluate pharyngeal airway and soft palate changes in OSMF patients. Materials and methods: This study is a cross-sectional observational study that included a sample size of 42 patients. Group A consisted of 21 patients with OSMF, while Group B consisted of 21 volunteers without OSMF, who served as the control group. The patients with OSMF were classified into Stages I, II, and III according to the categorization established by Pindborg JJ in 1989, Stop-Bang questionnaire was employed to assess obstructive sleep apnoea. Magnetic Resonance Imaging (MRI) was utilized to acquire evaluations of the pharyngeal airway, encompassing measurements in the midsagittal, cross-sectional width, length planes, and cross-sectional area with volume, for all participants. The Shapiro-Wilk test determines distribution normality. We utilized one-way ANOVA to compare the means between groups. Results: The average age of OSMF patients was 45.9 ± 8.16, while the control group was 39.19 ± 4.21. Stage I of OSMF had the highest mean Stop Bang questionnaire score (2.75), followed by stage III (2.22), and stage II (1.75). Statistically significant differences (p

Abstract Background AcuPebble SA100 (‘AcuPebble’) is a novel wearable medical device to diagnose obstructive sleep apnoea (OSA). This paper investigates the potential economic impact of the technology in the UK through cost savings analysis, and the redirection of savings into further diagnoses. Methods A cost comparison study was conducted, comparing AcuPebble to the standard diagnostic approach of home respiratory polygraphy (HRP) and in-clinic polysomnography (PSG), estimating the net benefit value (NBV) and return on investment (ROI). Cohort size was varied to model the effects of volume discounted pricing and staff training costs. To demonstrate the potential for cost savings, data on the healthcare costs of undiagnosed OSA patients were used to quantify the benefit of increased OSA diagnosis rates, as facilitated by AcuPebble. Results For 500 uses of AcuPebble, the NBV in the diagnostic pathway over one year would be in excess of £101,169, increasing to £341,665 for 1,500 uses, £1,263,993 for 5,000 uses, and to £2,628,198 for 10,000 uses, with ROIs of 2.02, 3.03, 5.05, and 6.56, respectively. Given an initial cohort of 1,500 patients, 4,555 extra AcuPebble studies could be completed by redirecting resources from HRP/PSG. Direct cost savings to the NHS from resultant lower undiagnosed rates could be between £24,147 and £4,707,810, based on the cost per use and the percentage of tests that result in a positive diagnosis (varied from 25 to 75% positives). Conclusions AcuPebble presents an opportunity for substantial healthcare savings, enabling an increase in the number of people tested, diagnosed and treated for OSA.

Eduardo Tuta-Quintero,1 Alirio R Bastidas,1 Kamil Faizal-Gómez,1 Sergio Guillermo Torres-Riveros,2 Diego Alejandro Rodríguez-Barajas,2 Jonathan Alexander Guezguan,1 Laura D Muñoz,1 Ana Carolina Rojas,1 Katherine Hernández Calderón,1 Natalia Valentina Ardila Velasco,1 Paula Prieto,1 Juliana Cuestas,1 Julian Camacho-Osorio,1 Gabriela Bonilla,1 Estefania Collazos Bahamon,1 María Alejandra Guardiola,1 David Luna Salazar,1 Lina Paola Fajardo,1 Johan Rincón-Hernández1 1Facultad de Medicina, Universidad de La Sabana, Chía, Colombia; 2Residente de Medicina Interna, Facultad de Medicina, Universidad de La Sabana, Chía, ColombiaCorrespondence: Alirio R Bastidas, School of Medicine, Universidad de La Sabana, Km 7, Autonorte de Bogota, Chía, Cundinamarca, 250001, Colombia, Email alirio.bastidas@unisabana.edu.coBackground: Survival in patients with sleep apnoea (SA) can be reduced by variables such as age, sex, and comorbidities. However, survival data in patients with SA in Colombia remains scarce.Methods: This is a retrospective cohort study of patients diagnosed with SA between 2005 and 2022. Five-year survival was assessed using the Kaplan-Meier method, and survival curves were stratified by age, sex, and cardiovascular disease. Risk factors associated with survival were evaluated using Hazard Ratio (HR) by adjusting for confounding variables with a Cox regression model. A minimum sample size of 1537 patients were estimated to be necessary to estimate a survival incidence rate with a 5% precision.Results: The five-year survival rate in the general population was 94.6%, with lower survival in patients over 65 years (88.5% vs 97.9%; p < 0.001) and in patients with cardiovascular disease (89% vs 95.2%; p < 0.001) compared to the control group. In the Cox regression, age showed an HR of 1.05 (95% CI: 1.02– 1.07; p < 0.001). Male sex had an HR of 2.31 (95% CI: 1.25– 4.25; p = 0.007), congestive heart failure an HR of 4.00 (95% CI: 2.31– 6.94; p < 0.001), chronic obstructive pulmonary disease (COPD) an HR of 1.75 (95% CI: 1.04– 2.96; p = 0.035), chronic kidney disease (CKD) an HR of 2.23 (95% CI: 1.31– 3.78; p = 0.003), and metastatic cancer an HR of 4.96 (95% CI: 1.95– 12.60; p = 0.001).Conclusion: The study showed a high five-year survival rate in patients with SA. The risk factors associated with decreased overall five-year survival were age, male sex, cardiovascular disease, COPD, CKD, and metastatic cancer.Keywords: sleep apnoea, survival, risk factors

Background: Obstructive sleep apnoea (OSA) is part of a spectrum of sleep disorders causing snoring, gasping, and choking while sleeping. In children, OSA can also lead to behavioural issues, hyperactivity, and poor academic performance. Thus, early identification and management of OSA in children is crucial in preventing long-term health problems. The gold standard test for diagnosis is an overnight in-lab polysomnography (PSG). However, due to certain constraints associated with PSG, such as lack of accessibility, high expenses incurred, as well as the need for hospitalization, alternative diagnostic tools are needed. Cephalometry is a non-invasive, affordable diagnostic tool that may offer useful information in the evaluation of OSA. The present systematic review and meta-analysis aimed to evaluate the various cephalometric parameters associated with the diagnosis of OSA in children. Methods: A structured literature search was performed using the search engines PubMed, Scopus, Web of Science, Cochrane, and Google scholar from inception till July 2022. The weighted mean difference (z-test) was calculated using a random effects method (REM). Results: 16 studies were included in the review and meta-analysis was executed for each cephalometric parameter. The parameters of significance (p

Men have a significantly shorter life expectancy compared to women, with disparities further magnified among those from disadvantaged backgrounds. Non-communicable diseases (NCDs) constitute a large proportion of the health disparity between men and women. Up to 40% of the chronic disease burden in men could be mitigated through risk factor management or early intervention. This disparity is often attributed to the engagement with primary and preventive healthcare by men which is influenced by health literacy, accessibility of care and socio-economic status. The manuscript proposes that genitourinary symptoms, specifically erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), are sentinel indicators of chronic diseases or their risk factors in men. LUTS and ED share risk factors with major chronic disorders like cardiovascular disease, diabetes, and obesity, and are associated with depression and obstructive sleep apnea. Both ED and LUTS are meaningful to men and can motivate seeking care, providing healthcare providers an opportunity for preventative measures and early treatment. Such an approach also ameliorates the LUTS and ED symptoms and substantially improves quality of life. We advocate for a targeted approach that uses ED and nocturia as entry points for engaging men in healthcare. This involves public health education to raise awareness about the significance of these symptoms and encouraging healthcare providers to actively inquire about them during consultations. By addressing these symptoms, healthcare practitioners can better identify and treat underlying chronic conditions early, potentially reducing morbidity and mortality among men and helping to narrow the sex related health outcome disparities between genders.

Early illness diagnosis and prediction are important goals in healthcare in order to offer timely preventive measures. The best, least invasive, and most reliable way for identifying any neurological disorder is EEG analysis. If neurological disorders could somehow be predicted in advance, patients could be saved from their detrimental consequences. With promising new advancements in machine learning-based algorithms, Early and precise prediction might induce a radical shift. Here, we present a thorough analysis of cutting-edge AI methods for exploiting EEG data for Parkinson’s disease early warning symptoms detection, sleep apnoea, drowsiness, schizophrenia, motor imagery classification, and emotion recognition, among other conditions. All of the EEG signal analysis procedures used by different authors, such as hardware software data sets, channel, frequency, epoch, preprocessing, decomposition method, features, and classification, have been compared and analysed in detail. We will point out the difficulties, gaps and limitations in the current research and suggest future avenues of research.

Introduction This study aimed to examine the effects of moderate-intensity interval training (MIIT) on the quality of sleep and functional capacity in atrial fibrillation (AF) patients with different presentations of sleep apnoea after coronary artery bypass graft (CABG) surgery. Methods 18 participants with AF and sleep apnoea aged 45–65 years were assigned into two groups: AF with obstructive sleep apnoea group (group A, n 1 = 9) and AF with mixed sleep apnoea group (group B, n 2 = 9). Both groups received MIIT for ten weeks (3 sessions / week) and medical treatment (i.e., Continuous Positive Airway Pressure and drug therapy). Exclusion criteria were unstable cardiac comorbidities and neurological/musculoskeletal limitations to exercise intervention. Outcome measures included sleep parameters collected from the actigraphy, overall sleep quality rating domain of the Pittsburgh Sleep Quality Index (PSQI), and six-minute walk distance (6-MWD). Results Significant changes were present in the means of all outcomes in group A ( p < 0.05) and two outcomes (i.e., cut points & 6-MWD) in group B compared to baseline ( p < 0.05). Also, there were significant differences in the absolute mean changes from baseline (∆) between the two groups, in favour of group A, in sleep latency ( p < 0.001), total sleep duration ( p = 0.026), sleep efficiency ( p < 0.001), overall sleep quality rating item of the PSQI ( p = 0.001), and 6-MWD ( p = 0.008). Conclusions MIIT can be a supplementary therapeutic intervention that could contribute to greater positive changes in sleep quality and functional capacity in AF patients with obstructive sleep apnoea rather than in AF patients with mixed sleep apnoea post-CABG. MIIT could enhance the functional capacity independent of improving sleep quality in patients with AF and mixed sleep apnoea post-CABG.

Context: Obstructive sleep apnoea is less known and lesser practised in dentistry. Dentists often struggle to educate, diagnose or offer treatment to the patient. Hence, the disorder of the patient and the opportunity for the dentist both go unnoticed. Aim: To assess the knowledge, attitude and practice regarding aspects of obstructive sleep apnoea among dental practitioners, faculty and interns in India. Methods and Material: A self-constructed validated questionnaire was prepared and circulated online among dental interns and professionals in India. Responses received from 237 participants were evaluated and statistically analysed. Results: Only questions about diagnosis and symptoms of OSA were correctly answered by more than 50% of the participants. In all other questions, the knowledge was poor. Only 11.4% of respondents felt that they are well equipped to diagnose OSA. The general attitude of the participants was favourable but with poor practice. Only 5.1% of participants were ever involved in the treatment of OSA. Conclusions: Given the high prevalence of OSA among the population, along with widespread ignorance among dentists for the same as found in our study, there is an urgent need to spotlight OSA in the dental curriculum at an undergraduate level. To complement this, extensive training and motivation must also be provided so that dental graduates can identify, refer and participate in the treatment of OSA.

Abstract Aims Heart failure (HF) and sleep‐disordered breathing (SDB) frequently coexist. We aimed to compare the prognostic value of different nocturnal hypoxic burden metrics in hospitalized HF patients. Methods and results HF patients underwent polygraphy screening for SDB in this prospective cohort. Hypoxic burden metrics assessed using pulse oximetry included time 52.0 min (HR 1.56, 95% CI: 1.21–2.02, P = 0.001) had a greater risk of the composite outcome than those with T90 95%, meanSO2

Poor sleep is a major public health problem with implications for a wide range of critical health outcomes. Insomnia and sleep apnoea are the two most common causes of poor sleep, and recent studies have shown that these disorders frequently co-occur. Comorbid insomnia and sleep apnoea can substantially impair quality of life and increase the overall risk of mortality. However, the causal and physiological links between sleep apnoea and insomnia are unclear. It is also unknown whether having a higher risk for one condition can increase the risk of developing the other. Here, we investigated links between sleep apnoea and insomnia in a British population using a combination of self-reported questionnaires and causal inference. We found that 54.3% of the cohort had moderate insomnia, 9.4% had moderate sleep apnoea, and that 6.2% scored high for both conditions. Importantly, having a higher risk of sleep apnoea was associated with a higher risk of insomnia and vice versa. To determine the causal directionality between sleep apnoea and insomnia, we used Mendelian randomisation and found evidence that sleep apnoea could cause insomnia, but not the reverse. To elucidate how both sleep apnoea and insomnia were linked to each other, we looked at the behavioural markers of poor sleep. We found that feeling fatigued after sleeping and having noticeable sleep problems were linked to a higher burden of both sleep apnoea and insomnia. In conclusion, our results show that sleep apnoea increases the risk of developing insomnia, and both conditions can result in fatigue. We highlight the importance of considering and treating the symptoms of both conditions.

Abstract Introduction Many scales are designed to screen for obstructive sleep apnoea‐hypopnoea syndrome (OSAHS); however, there is a lack of an efficiently and easily diagnostic tool, especially for Chinese. Therefore, we conduct a cross‐sectional study in China to develop and validate an efficient and simple clinical diagnostic model to help screen patients at risk of OSAHS. Methods This study based on 782 high‐risk patients (aged >18 years) admitted to the Sleep Medicine department of the Sixth Affiliated Hospital, Sun Yat‐sen University from 2015 to 2021. Totally 34 potential predictors were evaluated. We divided all patients into training and validation dataset to develop diagnostic model. The univariable and multivariable logistic regression model were used to build model and nomogram was finally built. Results Among 602 high‐risk patients with median age of 46 (37, 56) years, 23.26% were women. After selecting using the univariate logistic model, 15 factors were identified. We further used the stepwise method to build the final model with five factors: age, BMI, total bilirubin levels, high Berlin score, and symptom of morning dry mouth or mouth breathing. The AUC was 0.780 (0.711, 0.848), with sensitivity of 0.848 (0.811, 0.885), specificity of 0.629 (0.509, 0.749), accuracy of 0.816 (0.779, 0.853). The discrimination ability had been verified in the validation dataset. Finally, we established a nomogram model base on the above final model. Conclusion We developed and validated a predictive model with five easily acquire factors to diagnose OSAHS patient in high‐risk population with well discriminant ability. Accordingly, we finally build the nomogram model.

Abstract Background Obstructive sleep apnoea (OSA) involves repeated breathing pauses during sleep due to upper airway obstruction. It causes excessive daytime sleepiness and has other health impacts. Continuous positive airway pressure (CPAP) therapy is effective first line treatment for moderate to severe OSA. Unfortunately, many patients have difficulty tolerating CPAP and pressure intolerance is probably an important contributing factor. Mandibular advancement devices (MAD) are an alternative to CPAP. They are worn in the mouth during sleep to reduce airway obstruction. There is some evidence that, when used in combination with CPAP, MADs improve airway anatomy enough to reduce the CPAP pressure required to treat OSA and that this combination therapy could improve CPAP adherence. Methods Consecutive patients starting on CPAP for moderate to severe OSA will be recruited at a regional NHS sleep service. Patients with high CPAP pressure requirements after initial titration, who satisfy all entry criteria and consent to participate, will undertake a 2-arm randomised crossover trial. The arms will be (i) standalone CPAP and (ii) CPAP + MAD therapy. Each arm will last 12 weeks, including 2 weeks acclimatisation. CPAP machines will be auto-titrating and with facility for data download, so the impact of MAD on CPAP pressure requirements and CPAP adherence can be easily measured. The primary outcome will be CPAP adherence. Secondary outcomes will include measures of OSA severity, patient-reported outcome measures including subjective daytime sleepiness, quality of life, and treatment preference at the trial exit and health service use. Cost-effectiveness analyses will be undertaken. Discussion If the intervention is shown to be effective and cost-effective in improving adherence in this standard CPAP-eligible OSA patient population it would be relatively straightforward to introduce into existing OSA treatment pathways, within the wider NHS and more widely. Both MAD and CPAP are already used by sleep services so their combination would require only minor adjustments to existing clinical pathways. It would be straightforward to disseminate the results of the study through regional, national, and international respiratory meetings. The health economics analysis would provide cost-effectiveness data to inform service planning and clinical guidelines through policy briefing papers, including those by NICE and SIGN. Trial registration PAPMAT was registered with ISRCTN prior to recruitment beginning (ISRCTN Registry 2021): https://www.isrctn.com/ISRCTN33966032 . Registered on 17th November 2021.

Abstract Background Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a recommended diagnostic alternative for patients with an increased risk for OSA. In a large clinical cohort, we investigated concordance and predictors for discordance in diagnosing OSA using PAT and PSG, and three-year cardiovascular risk in patients with discordant OSA diagnosis. Methods Retrospective monocentric cohort study. Patients with a PAT AHI ≥ 5/h followed by an in-hospital PSG within three months were included. All patients with a PAT AHI ≥ 5/h but a PSG AHI

Timothy Howarth,1– 3 Helmi Ben Saad,4 Subash S Heraganahally1,5,6 1Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia; 2Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; 3College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia; 4Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de recherche “Insuffisance Cardiaque” (LR12SP09), Université de Sousse, Sousse, Tunisia; 5Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; 6College of Medicine and Public Health, Flinders University, Adelaide, South Australia, AustraliaCorrespondence: Subash S Heraganahally, Email hssubhashcmc@hotmail.com; Subash.heraganahally@nt.gov.auBackground: Sleep disorders such as obstructive sleep apnoea (OSA) are known to overlap significantly with airway diseases in various populations. This study assessed the relationship between lung function parameters against polysomnography (PSG) and continuous positive airway pressure (CPAP) adherence data amongst an Aboriginal Australian population.Methods: Patients who undertook both a diagnostic PSG and spirometry were included. Restrictive, obstructive, and mixed impairments were assessed via global lung function initiative (GLI-2012, ATS/ERS) criteria/guidelines. PSG and CPAP data were evaluated between patients with or without spirometry impairments.Results: Of the total 771 patients, 248 had PSG and spirometry data available (52% female, 44% remote residents, 78% obese). The majority (89%) had OSA (51% severe), 95 (38%) were observed to have a restrictive impairment, and 31 (13%) had an obstructive or mixed impairment on spirometry. Compared to patients with no spirometric impairment, those with restrictive or obstructive/mixed impairments demonstrated significantly lower sleep efficiency (median 84% vs 79% and 78%), higher apnoea-hypopnea index (AHI) during rapid eye movement (REM) sleep (median 32 vs 52 and 55 events/hour), reduced REM oxygen saturation (SpO2) (median 94.0% vs 92.0% and 92.5%) and reduced adherence to CPAP therapy (median 39% vs 22% and 17%). Differences in sleep efficiency, REM AHI, and NREM SpO2 held for patients with obstructive/mixed impairments in multivariate modelling.Conclusion: Aboriginal Australian patients with OSA have a higher concurrent lung function’ impairment. Spirometric impairment appears to negatively influence sleep efficiency, nocturnal SpO2 and CPAP adherence. This may have substantial implications for OSA management among Aboriginal Australians.Keywords: COPD, CPAP, first nations, OSA, sleep apnoea, spirometry

Abstract Background Achondroplasia is the most frequent FGFR3-related chondrodysplasia, leading to rhizomelic dwarfism, craniofacial anomalies, stenosis of the foramen magnum, and sleep apnea. Craniofacial growth and its correlation with obstructive sleep apnea syndrome has not been assessed in achondroplasia. In this study, we provide a multimodal analysis of craniofacial growth and anatomo-functional correlations between craniofacial features and the severity of obstructive sleep apnea syndrome. Methods A multimodal study was performed based on a paediatric cohort of 15 achondroplasia patients (mean age, 7.8 ± 3.3 years), including clinical and sleep study data, 2D cephalometrics, and 3D geometric morphometry analyses, based on CT-scans (mean age at CT-scan: patients, 4.9 ± 4.9 years; controls, 3.7 ± 4.2 years). Results Craniofacial phenotype was characterized by maxillo-zygomatic retrusion, deep nasal root, and prominent forehead. 2D cephalometric studies showed constant maxillo-mandibular retrusion, with excessive vertical dimensions of the lower third of the face, and modifications of cranial base angles. All patients with available CT-scan had premature fusion of skull base synchondroses. 3D morphometric analyses showed more severe craniofacial phenotypes associated with increasing patient age, predominantly regarding the midface—with increased maxillary retrusion in older patients—and the skull base—with closure of the spheno-occipital angle. At the mandibular level, both the corpus and ramus showed shape modifications with age, with shortened anteroposterior mandibular length, as well as ramus and condylar region lengths. We report a significant correlation between the severity of maxillo-mandibular retrusion and obstructive sleep apnea syndrome (p

IntroductionObstructive sleep apnoea (OSA) is more prevalent in men. Several studies suggested that higher testosterone levels were associated with a greater risk of OSA. We aimed to determine whether testosterone administration in transgender men would accentuate symptoms of OSA.MethodsThe study involved 94 adult people undergoing a female-to-male transition with testosterone administration. The participants answered the Berlin Questionnaire (BQ) and a separate question on snoring before starting testosterone treatment and after at least 1 year of being on testosterone treatment.ResultsA higher proportion of participants at the follow-up answered positively to the first category of BQ devoted to snoring. A lower proportion of participants at follow-up answered positively to the second category of BQ devoted to tiredness. The percentage of subjects with a high risk of sleep apnoea, according to BQ, and of those who answered the question on snoring positively did not change significantly.ConclusionAn increased number of transgender men who reported snoring in BQ after testosterone administration indicate a higher risk of OSA development.

Introduction Chronic mountain sickness (CMS) is a condition characterized by excessive erythrocytosis in response to chronic hypobaric hypoxia. CMS frequently triggers cardiorespiratory diseases such as pulmonary hypertension and right or left heart failure. Ambient hypoxia might be further amplified night-time by intermittent hypoxia related to sleep-disordered breathing (SDB) so that sleep disturbance may be an important feature of CMS. Our aim was to characterize in a cross-sectional study nocturnal hypoxaemia, SDB, blood pressure (BP), arterial stiffness and carotid intima-media thickness (CIMT) in highlanders living at extreme altitude.Methods Men aged 18 to 55 years were prospectively recruited. Home sleep apnoea test, questionnaires (short-form health survey; Montreal cognitive assessment; Pittsburgh Sleep Questionnaire Index and the Insomnia severity index), 24-h ambulatory BP monitoring, CIMT and arterial stiffness were evaluated in 3 groups: i) Andean lowlanders (sea-level); ii) highlanders living at 3,800 m and iii) highlanders living at 5,100 m. Analyses were conducted in sub-groups according to 1) CMS severity 2) healthy subjects living at the three different altitude.Results Ninety-two males were evaluated at their living altitudes. Among the 54 highlanders living at 5,100 m, subjects with CMS showed lower mean nocturnal oxygen saturation (SpO2), SpO2 nadir, lower pulse wave velocity and higher nocturnal BP variability than those with no-CMS. Lower nocturnal SpO2 nadir was associated with higher CMS severity (ß= −0.14, p=.009). Among the 55 healthy subjects, healthy highlanders at 5,100 m were characterized by lower scores on quality of life and sleep quality scales and lower mean SpO2 compared to lowlanders.Conclusions Lower nocturnal SpO2 and higher nocturnal BP variability are associated with CMS severity in individuals living permanently at high altitude. The role of lower SpO2 and higher nocturnal BP variability in the cardiovascular progression of CMS and in the overall prognosis of the disease need to be evaluated in further studies.

Tongue mobility is an obstructive sleep apnoea (OSA) marker and myofunctional therapy (MFT) target. For this reason, all paediatric patients with sleep-disordered breathing should require a combined functional assessment from an ear, nose, and throat (ENT) specialist and a phonoaudiologist to confirm or rule out the presence of ankyloglossia. To our knowledge, this is the first case of a 13-year-old girl diagnosed with severe OSA and a significant decrease of 94% in her apnoea index (AI), requiring frenotomy with an immediate postoperative change in the tongue position. A drug-induced sleep endoscopy (DISE) was performed before and immediately postfrenotomy, and the anatomical changes provoked by this surgery during sleep were confirmed for the first time.

Objective:Obesity, hypertension and diabetes, which increase the risk of developing severe Coronavirus disease-2019 (COVID-19) pneumonia, are also the most common comorbidities of obstructive sleep apnoea syndrome (OSAS). The in-hospital evaluation and testing of patients with OSAS were delayed due to the pandemic. We aimed to investigate the changes in Epworth sleepiness score (ESS), use of positive airway pressure (PAP) devices, sleep quality, weight change, COVID-19 related anxiety, anxiety at hospital admission, domestic contact and contraction of SARS-CoV-2 in OSA patients during the pandemic.Materials and Methods:In our sleep centre, patients (n=202) who were diagnosed with sleep apnoea were called by telephone and a survey related to COVID-19, anxiety levels, PAP use, weight change, sleep quality and OSA was conducted during the pandemic.Results:In the study, hypertension and diabetes were the most common comorbidities. Overall, some of the patients with OSA gained weight, stopped PAP treatment, and ESS scores increased compared to the prepandemic period. The anxiety of hospitalization due to COVID-19 was found to be higher than the anxiety for COVID-19. There was a positive correlation between the level of anxiety at admission to hospital due to the risk of COVID-19 and the ESS measured at diagnosis (r=0.203 p=0.004). Better sleep quality was seen in 77% of the participants during the pandemic.Conclusion:OSA patients with high ESS at diagnosis, PAP uses, COVID-19 positive or with domestic contact should be monitored closely by telemedicine. In future research should examine sleep quality and the effects of working from home in OSAS individuals.

Obstructive sleep apnoea (OSA) is a sleep disorder with repetitive collapse of the upper airway during sleep, which leads to intermittent hypoxic events overnight, adverse neurocognitive, metabolic complications, and ultimately an increased risk of cardiovascular disease (CVD). The standard diagnostic parameter for OSA, apnoea–hypopnoea index (AHI), is inadequate to predict CVD morbidity and mortality, because it focuses only on the frequency of apnoea and hypopnoea events, and fails to reveal other physiological information for the prediction of CVD events. Novel parameters have been introduced to compensate for the deficiencies of AHI. However, the calculation methods and criteria for these parameters are unclear, hindering their use in cross-study analysis and studies. This review aims to discuss novel parameters for predicting CVD events from oximetry signals and to summarise the corresponding computational methods.

Background: Electrical stimulation has recently been introduced to treat patients with Obstructive sleep apnoea There are, however, few data on the effects of transcutaneous submental electrical stimulation (TES) on the cardiovascular system. We studied the effect of TES on cardiorespiratory variables in healthy volunteers during head-down-tilt (HDT) induced baroreceptor loading.Method: Cardiorespiratory parameters (blood pressure, heart rate, respiratory rate, tidal volume, airflow/minute ventilation, oxygen saturation, and end-tidal CO2/O2 concentration) were recorded seated, supine, and during head-down-tilt (50) under normoxic, hypercapnic (FiCO2 5%) and poikilocapnic hypoxic (FiO2 12%) conditions. Blood pressure (BP) was measured non-invasively and continuously (Finapres). Gas conditions were applied in random order. All participants were studied twice on different days, once without and once with TES.Results: We studied 13 healthy subjects (age 29 (12) years, six female, body mass index (BMI) 23.23 (1.6) kg·m−2). A three-way ANOVA indicated that BP decreased significantly with TES (systolic: p = 4.93E-06, diastolic: p = 3.48E-09, mean: p = 3.88E-08). Change in gas condition (systolic: p = 0.0402, diastolic: p = 0.0033, mean: p = 0.0034) and different postures (systolic: 8.49E-08, diastolic: p = 6.91E-04, mean: p = 5.47E-05) similarly impacted on BP control. When tested for interaction, there were no significant associations between the three different factors electrical stimulation, gas condition, or posture, except for an effect on minute ventilation (gas condition/posture p = 0.0369).Conclusion: Transcutaneous electrical stimulation has a substantial impact on the blood pressure. Similarly, postural changes and variations in inspired gas impact on blood pressure control. Finally, there was an interaction between posture and inspired gases that affects minute ventilation. These observations have implications on our understanding of integrated cardiorespiratory control, and may prove beneficial for patients with SDB who are assessed for treatment with electrical stimulation.

Abstract Aims Sleep apnoea and congestive heart failure (CHF) commonly co‐exist, but their interaction is unclear. Metabolomics may clarify their interaction and relationships to outcome. Methods and results We assayed 372 circulating metabolites and lipids in 1919 and 1524 participants of the Framingham Heart Study (FHS) (mean age 54 ± 10 years, 53% women) and Women's Health Initiative (WHI) (mean age 67 ± 7 years), respectively. We used linear and Cox regression to relate plasma concentrations of metabolites and lipids to echocardiographic parameters; CHF and its subtypes heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF); and sleep indices. Adenine dinucleotide phosphate (ADP) associated with left ventricular (LV) fractional shortening; phosphocreatine with LV wall thickness; lysosomal storage molecule sphingomyelin 18:2 with LV mass; and nicotine metabolite cotinine with time spent with an oxygen saturation less than 90% (β = 2.3 min, P = 2.3 × 10−5). Pro‐hypertrophic metabolite hydroxyglutarate partly mediated the association between LV wall thickness and HFpEF. Central sleep apnoea was significantly associated with HFpEF (P = 0.03) but not HFrEF (P = 0.5). There were three significant metabolite canonical variates, one of which conferred protection from cardiovascular death [hazard ratio = 0.3 (0.11, 0.81), P = 0.02]. Conclusions Energetic metabolites were associated with cardiac function; energy‐ and lipid‐storage metabolites with LV wall thickness and mass; plasma levels of nicotine metabolite cotinine were associated with increased time spent with a sleep oxygen saturation less than 90%, a clinically significant marker of outcome, indicating a significant hazard for smokers who have sleep apnoea.

Introduction: Rising morbidty resulting from Obstructive Sleep Apnoea (OSA) is an emerging public health concern. The estimated prevalence of OSA in India has been investigated. STOP-Bang and Epworth Sleepiness Scale (ESS) have proven beneficial in identifying sleep breathing disorder. Validity of these questionnaire has been verified against polysomnography in many studies. Aim: To assess the predictive ability of STOP-Bang questionnaire and ESS in identifying OSA and comparing their efficacy with polysomnography. Materials and Methods: The cross-sectional study was conducted in the Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India, from January 2020 to June 2021, among 100 patients with symptoms of OSA. The STOP-Bang questionnaires were administered to the patients, and scoring was done, followed by overnight attended polysomnography. The normality of data was tested by Shapiro Wilk’s test. The values obtained were statistically analysed and to compare the parameters between groups and with in groups for normal data parametric test One-way Analysis of Variance (ANOVA) followed by Tukey’s HSD test, for intragroup Paired t-test. Results: Mean age of the study population was 49.46±6.523 years, 79 were males and 21 females. Total, 79% of the subjects were males, and 21% of the study subjects were females. Among the 100, 65% had OSA as per polysomnography. STOP-Bang questionnaire had a higher sensitivity as compared to ESS in predicting OSA (75.38% for STOP-Bang and 72.31% for ESS). Conversely, the specificity of ESS (82.8%) was found to be greater than STOP-Bang (45.71%). Similar results were obtained for positive predictive value, in which ESS scored 88.6% while STOP-Bang scored 50%. For negative predictive values, ESS again scored higher (65%) than STOP-Bang (61.7%). Similarly, the Likelihood Ratio for a positive result (LR+) of ESS was greater than STOP-Bang (4.2 and 1.3 respectively). The STOP-Bang questionnaire, however, had higher Likelihood Ratio for a negative test (LR-) as compared to ESS (0.5 and 0.3 respectively). Conclusion: Polysomnography is the gold standard to diagnose OSA. For screening OSA, patients with symptoms of sleep disordered breathing, this study found that STOP-Bang questionnaire is better in identifying OSA as compared to ESS.

Abstract Aims Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril–valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation. Methods and results The ENTRESTO‐SAS trial is a six‐centre, prospective, open‐label real‐life cohort study (NCT02916160). Ambulatory patients eligible for SV (i.e. HFrEF adults who remain symptomatic despite optimal treatment) were evaluated before and after 3 months of SV (including nocturnal ventilatory polygraphy); 118 patients were final analysed [median age was 66 (IQ25–75: 56–73) years, 81.4% male, 36.5% New York Heart Association III–IV, N‐terminal pro‐B‐type natriuretic peptide level of 1564 (701–3376) ng/L, left ventricular ejection fraction of 30 (25–34)%, 60.7% ischaemic HFrEF, 97.5% initially treated with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers, 83.9% with beta‐blockers, 64.4% with mineralocorticoid receptor antagonists, and 74.6% with diuretics]. Three groups were defined according to initial central/obstructive apnoea–hypopnoea indices (AHIs): G1 (n = 49, AHIcentral ≥ 5/h and AHIobstructive

Introduction: There is a wide variation in different dimensions of trachea in same age group as well as in different age groups in both sexes. Besides anthropometry, the study of these morphometric variations is of profound clinical importance as it may help the pulmonologists to understand the aetiology of several pulmonary diseases like bronchitis, emphysema, pulmonary fibrosis and tuberculosis. Aim: To determine the variations in the dimensions of human trachea in the cadavers of age group 20-70 years in Northern India. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, during March 2019 to December 2021. A total of 40 tracheas were obtained from adult human cadavers which were included in present study by convenience sampling. The trachea was dissected with the larynx and principal bronchi and measurements were taken. Data collected was saved on Microsoft excel and was analysed by calculating percentages, mean and Standard Deviation (SD). Results: Mean length of trachea was 109.25 mm, mean subcarinal angle was 75.45°. Mean anteroposterior diameter, transverse diameter, mean height and distance between posterior ends of rings was 16.70 mm and 18.10 mm, 4.53 mm and 12.15 mm respectively and mean of inter-ring distance between 1st-2nd, 5th-6th, 10th-11th, 15th-16th tracheal rings was 1.12 mm. Conclusion: The present study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters, mean height, intertracheal ring distance and the subcarinal angle. Accurate anatomical knowledge of the variations is essential for understanding the pathophysiology and management of different airway disorders and in reconstructive surgery of tracheobronchial tree.

Abstract Background Sleep apnoea, a common sleep-disordered breathing condition, is characterised by upper airway collapse during sleep resulting in transient hypoxia, hypoperfusion of the optic nerve, and spike in intracranial pressure. Previous studies have reported conflicting findings on the association of sleep apnoea with glaucoma, and there are limited reports on the link between sleep apnoea and age-related macular degeneration (AMD). Methods Middle-aged and older participants from the longitudinal United Kingdom (UK) Biobank (n = 502,505) and the Canadian Longitudinal Study on Aging (CLSA; n = 24,073) were included in this analysis. Participants in the UK Biobank and the CLSA were followed for 8 and 3 years, respectively. Participants with diagnosed glaucoma or AMD at baseline were excluded from the analysis. In the UK Biobank, sleep apnoea and incident cases of glaucoma and AMD were identified through hospital inpatient admission, primary care records, and self-reported data. Multivariable Cox proportional hazards models were used to explore associations of sleep apnoea with incidence of glaucoma or AMD. Results During the 8-year follow-up in the UK Biobank, glaucoma incidence rates per 1000 person-years were 2.46 and 1.59 for participants with and without sleep apnoea, and the AMD incidence rates per 1000 person-years were 2.27 and 1.42 for participants with and without sleep apnoea, respectively. Multivariable adjusted hazard ratios of glaucoma and AMD risk for sleep apnoea were 1.33 (95% confidence interval [CI] 1.10–1.60, P = 0.003) and 1.39 (95% CI 1.15–1.68, P

In this paper, we propose a sparse decomposition of the heart rate during sleep with an application to apnoea–RERA detection. We observed that the tachycardia following an apnoea event has a quasi-deterministic shape with a random amplitude. Accordingly, we model the apnoea-perturbed heart rate as a Bernoulli–Gaussian (BG) process convolved with a deterministic reference signal that allows the identification of tachycardia and bradycardia events. The problem of determining the BG series indicating the presence or absence of an event and estimating its amplitude is a deconvolution problem for which sparsity is imposed. This allows an almost syntactic representation of the heart rate on which simple detection algorithms are applied.

Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.

Background: Alar collapse is known to aggravate snoring-severity and possibly the severity of obstructive sleep apnoea. Various surgical techniques, implants and commercial mechanical/prosthetic nasal alar dilators are evident in literature. Material and methods: A malleable wire prosthesis at ‘no’ manufacturing cost is custom designed through computer modelling and animation and thereafter tested for its efficacy in 20 normal subjects as per visual analog scale along with its correlation with patient-profiles. Observations and results: All subjects reported improvement in their nasal patency ranging from 30% to 99% but no correlation was seen between the degree of improvement & patient variables. This improvement in normal subjects indicates even a better improvement in true alar collapse. Conclusion: Main advantages of this devise is its extremely low-cost, non-traumatic nature, adjustability to suit patient comfort and can be customised across all types of noses. However it seems cosmetically unacceptable during the daytime, as well as for small children. With no correlation with patient factors the acceptability of this devise is mainly dependent on a good customized design. With a constant use during bedtime in alar collapse this device may not only resolve snoring and improve the sleep-quality of spouse but also enhances oxygenation during sleep.

Objectives: (1) To assess the risk of Obstructive Sleep Apnea (OSA) using a pre-designed questionnaire; (2) To assess the periodontal parameters like pocket probing depth (PPD) and clinical attachment loss (CAL) in the study subjects and (3) To determine the association between the shared risk factors of OSA and periodontitis. Background of the Study: Periodontitis is a microbially associated, host-mediated inflammatory disease that results in the loss of periodontal attachment. It has multifactorial etiology and has been linked to an array of systemic diseases. Though both periodontitis and obstructive sleep apnoea (OSA) share some common risk factors, the insight into the hypothetical speculative link remains vague. This study intended to probe into the association between periodontitis and OSA. Methodology: A cross-sectional study was conducted on 250 subjects. The subjects were explained the nature of the study and written informed consent was obtained for participation in the study. The patients were administered a STOP-BANG questionnaire following which the periodontal parameters were recorded. The data obtained was analyzed by descriptive and inferential statistics. Results: A statistically significant increase in PPD and CAL scores were seen with the increase in OSA scores. A significant moderate positive correlation was found between OSA scores and PPD [r = 0.58, P < 0.001] and CAL [r = 0.55, P = 0.001]. Males were at increased risk for OSA and periodontitis. Age, hypertension and BMI which are the risk factors for periodontitis were also significantly higher in subjects at high risk for OSA. Conclusion: This study found a moderate positive association between periodontitis and OSA.

Summary: Background: In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods: National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings: The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200). Interpretation: The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding: The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.

BackgroundThe capacity to diagnose obstructive sleep apnoea (OSA) must be expanded to meet an estimated disease burden of nearly one billion people worldwide. Validated alternatives to the gold standard polysomnography (PSG) will improve access to testing and treatment. This study aimed to evaluate the diagnosis of OSA, using measurements of mandibular movement (MM) combined with automated machine learning analysis, compared to in-home PSG.Methods40 suspected OSA patients underwent single overnight in-home sleep testing with PSG (Nox A1, ResMed, Australia) and simultaneous MM monitoring (Sunrise, Sunrise SA, Belgium). PSG recordings were manually analysed by two expert sleep centres (Grenoble and London); MM analysis was automated. The Obstructive Respiratory Disturbance Index calculated from the MM monitoring (MM-ORDI) was compared to the PSG (PSG-ORDI) using intraclass correlation coefficient and Bland-Altman analysis. Receiver operating characteristic curves (ROC) were constructed to optimise the diagnostic performance of the MM monitor at different PSG-ORDI thresholds (5, 15, and 30 events/hour).Results31 patients were included in the analysis (58% men; mean (SD) age: 48 (15) years; BMI: 30.4 (7.6) kg/m2). Good agreement was observed between MM-ORDI and PSG-ORDI (median bias 0.00; 95% CI −23.25 to + 9.73 events/hour). However, for 15 patients with no or mild OSA, MM monitoring overestimated disease severity (PSG-ORDI < 5: MM-ORDI mean overestimation + 5.58 (95% CI + 2.03 to + 7.46) events/hour; PSG-ORDI > 5–15: MM-ORDI overestimation + 3.70 (95% CI −0.53 to + 18.32) events/hour). In 16 patients with moderate-severe OSA (n = 9 with PSG-ORDI 15–30 events/h and n = 7 with a PSG-ORD > 30 events/h), there was an underestimation (PSG-ORDI > 15: MM-ORDI underestimation −8.70 (95% CI −28.46 to + 4.01) events/hour). ROC optimal cut-off values for PSG-ORDI thresholds of 5, 15, 30 events/hour were: 9.53, 12.65 and 24.81 events/hour, respectively. These cut-off values yielded a sensitivity of 88, 100 and 79%, and a specificity of 100, 75, 96%. The positive predictive values were: 100, 80, 95% and the negative predictive values 89, 100, 82%, respectively.ConclusionThe diagnosis of OSA, using MM with machine learning analysis, is comparable to manually scored in-home PSG. Therefore, this novel monitor could be a convenient diagnostic tool that can easily be used in the patients’ own home.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT04262557

Sleep is responsible for proper metabolic balance. Disturbances in sleep causes insulin resistance, beta cell dysfunction and obesity through various pathways. Snoring is one of the important indicative symptoms of sleep apnoea that leads to disturbances in sleep. A 54-years old male patient was presented to Kayachikitsa casualty Government Ayurveda College Nagpur with complaints of snoring, difficulty in breathing while climbing stairs since 10 years. After evaluation he was diagnosed as obese with type 2 Diabetes mellitus (DM). Sleep study revealed presence of sleep apnoea. We treated this patient following the principle of Vyadhi Hetu Sankar (∼one cause for many diseases). In such a case treatment of Hetu (∼cause of disease) can be principle of treatment. Snoring was subsided in patient after one -month of treatment. Significant reduction in HbA1c, fasting and post prandial blood glucose level were observed along with reduction in Lipid levels and BMI in three months. Ayurveda concepts can bring major breakthrough in treatment of metabolic disorders. Various Ayurvedic concepts of gut, lung endocrinal pathways and Agni (∼metabolic power) can generate future studies in this direction.

Background: Obstructive sleep apnoea (OSA) and gut dysbiosis are known risk factors for atherosclerosis. However, only very few studies have been focused on the relationship between OSA, atherosclerosis, and the intestinal microbiome, all in animal models. Methods: Twenty-two patients with OSA, 16 with and 6 without carotid atherosclerosis were involved in the study. After a diagnostic sleep examination, the intima media thickness (IMT) was measured and plaques were found using carotid ultrasound. Blood was also drawn for metabolic profile, and a stool sample was provided for 16S ribosomal RNA microbiome investigation. Results: An increased maximal common carotid artery (CCA) IMT was significantly associated with decreased phylum-level diversity. The level of Peptostreptococcaceae was significantly lower in atherosclerotic subjects. Some other candidate microbes appeared in the two groups at the genus level as well: Bilophila, Romboutsia, Slackia, and Veillonella in the non-atherosclerotic group; and Escherichia-Shigella, Prevotella, and Ruminococcaceae in the atherosclerotic group. Conclusions: This is the first pilot research to analyze the association between the gut microbiome and atherosclerosis in adult patients with OSA with and without carotid atherosclerosis. Dysbiosis and individual bacteria may contribute to the development of carotid atherosclerosis in patients with OSA. Further investigations are necessary to reveal a more precise background in a larger sample.

ObjectiveObstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders. Continuous positive airway pressure (CPAP) is considered first-line treatment for OSA. In the present study, we assess the effect of CPAP on symptoms and prevalence of insomnia in patients with OSA. We hypothesized a decrease in insomnia symptoms from CPAP initiation to follow-up, and that this decrease would depend on CPAP adherence.Materials and methodsThe sample included 442 patients diagnosed with OSA [mean age 54.9 years (SD = 12.1), 74.4% males] who started treatment with CPAP at a university hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean apnea-hypopnea index (AHI) was 30.1 (SD = 21.1) at baseline. Insomnia was assessed prior to CPAP treatment (baseline) and at follow-up after a median of 19.9 weeks (range 6–52 weeks) with the Bergen Insomnia Scale (BIS). CPAP adherence was defined as an average use of ≥ 4 h per night, whereas non-adherence was defined as < 4 h per night.ResultsThere was a significant decrease in BIS scores from baseline (mean = 18.8, SD = 9.8) to follow-up (mean = 12.9, SD = 9.9), p < 0.001. Cohen’s d(0.65) indicated a moderate effect size. The reduction in BIS scores was depending on CPAP adherence (interaction effect F(1,440) = 12.4, p < 0.001), with larger reduction in the adherent group than in the non-adherent group. The proportion of patients with chronic insomnia was significantly reduced from 51.1% at baseline to 33.0% at follow-up (p < 0.001).ConclusionOverall, there was a significant reduction in insomnia symptoms from baseline to follow-up. The improvement was significant in both adherence groups, but the degree of improvement was larger among patients who were adherent to CPAP. Furthermore, there was a significant reduction in the prevalence of chronic insomnia at follow-up compared to baseline. This suggests that CPAP effectively reduces both the presence of insomnia and the severity of insomnia symptoms in some patients with OSA.

Obstructive breathing disorders in sleep are a common problem in children that can have serious cardiovascular, neurocognitive, and metabolic consequences. The most common disorder is obstructive sleep apnoea, which is characterised by partial or complete obstruction of the upper airway, with resultant hypoxia, hypercarbia, increased respiratory effort, pronounced intrathoracic pressure changes and sleep fragmentation. The pathogenesis is not yet clearly understood. The diagnostic method of choice is polysomnography. Mild forms of obstructive sleep apnoea can be treated medically (leukotriene receptor antagonists and nasal glucocorticoids). Adenotonsillectomy is a very efficacious surgical treatment method in children with obstructive sleep apnoea and adenotonsillar hypertrophy. Children with a high body mass index, high-grade obstruction or other associated conditions are more likely to have postoperative residual obstruction. These children are treated by the application of continuous positive airway pressure through a mask.

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen. Int J Occup Med Environ Health. 2019;32(5):735–45

Abstract Background Obstructive sleep apnoea (OSA) is one of the major sources of the excessive daily sleepiness, cognitive dysfunction, and it increases cardiovascular morbidity and mortality. Previous studies suggested a possible genetic influence, based on questionnaires but no objective genetic study was conducted to understand the exact variance underpinned by genetic factors. Methods Seventy-one Hungarian twin pairs involved from the Hungarian Twin Registry (48 monozygotic, MZ and 23 dizygotic, DZ pairs, mean age 51 ± 15 years) underwent overnight polysomnography (Somnoscreen Plus Tele PSG, Somnomedics GMBH, Germany). Apnoea hypopnea index (AHI), respiratory disturbance index (RDI) and oxygen desaturation index (ODI) were registered. Daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS). Bivariate heritability analysis was applied. Results The prevalence of OSA was 41% in our study population. The heritability of the AHI, ODI and RDI ranged between 69% and 83%, while the OSA, defined by an AHI ≥5/h, was itself 73% heritable. The unshared environmental component explained the rest of the variance between 17% and 31%. Daytime sleepiness was mostly determined by the environment, and the variance was influenced in 34% by the additive genetic factors. These associations were present after additional adjustment for body mass index. Conclusion OSA and the indices of OSA severity are heritable, while daytime sleepiness is mostly influenced by environmental factors. Further studies should elucidate whether close relatives of patients with OSA may benefit from early family risk based screening.

Background: Poor sleep quality is reported to be frequent in end-stage renal disease (ESRD) patients on haemodialysis. The aim of this study was to assess sleep quality and its predictors among haemodialysis patients. Methodology: This cross-sectional study included 70 consecutively recruited ESRD patients on haemodialysis, who were assessed for sleep quality and sleep disorders by administering Pittsburgh Sleep Quality Index, Berlin Questionnaire for sleep apnoea, and International Restless Legs Syndrome Study Group rating scale. Depression and anxiety were assessed using Beck Depression Inventory II and Hamilton Anxiety Rating Scale respectively. Sleep quality and its association with sleep disorders, psychological and sociodemographic factors were studied. Results: The mean age of the study sample was 46.2±9.42 years, most of the patients were males (65.7%), literate (55.8%), married (82.8%), Hindu by religion (82.8%), hypertensive (81.4%), and diabetic (30%). 65.7% of the sample were classified as poor sleepers. There was a statistically significant difference between poor sleepers and good sleepers in terms of severity of anxiety, increasing age, having comorbid anxiety and depression, and having a high risk of sleep apnoea. The severity of anxiety and increasing age were found to be independent predictors of poor sleep quality. Conclusion: Poor sleep quality was frequent among haemodialysis patients and it correlated with severity of anxiety and increasing age in the present study. Assessment of sleep quality in all patients undergoing haemodialysis is necessary as poor sleep quality is associated with greater psychopathology.

Background and Aims: Obstructive sleep apnoea (OSA) has an estimated prevalence of 2%–4% in adult population and is increasing. Most of these are detected late which is the cause for higher perioperative morbidity. This survey was aimed to seek the level of knowledge and attitude of Indian anaesthesiologists towards OSA. Methods: The OSA Knowledge and Attitude (OSAKA) questionnaire (23-statements) was distributed to the anaesthesiologists attending the difficult airway conference in December 2017. The first section has 18 statements pertaining to OSA knowledge. The second section consists of five statements to evaluate self-confidence in the management of OSA. Age, gender, professional title, type of hospital, years of experience, and bariatric experience were analysed. Results: 205 out of 350 participants responded. In all, 201 (57.4%) fully completed responses were analysed. The mean ± standard deviation knowledge and attitude scores were 12.01 ± 2.88 (66.72% ± 16%) and 18.16 ± 3.75 (72.64% ± 15%) respectively. On exclusion of junior residents (n = 56), knowledge and attitude scores of qualified anaesthesiologists were 12.7 ± 2.55 (70.55% ± 14.16%) and 18.78 ± 3.91 (75.12% ± 15.64%), respectively. Anaesthesiologists with bariatric experience had a significantly higher attitude score when compared with those who do not practice bariatric surgeries (P < 0.01). There is weak but significant, positive linear correlation between knowledge and attitude score (rs= 0.370, P < 0.01). Conclusion: Deficit of adequate knowledge about OSA exists among Indian anaesthesiologists. Experience of managing cases with OSA seems to improve knowledge and attitude towards OSA.

Background: The prevalence of obstructive sleep apnoea syndrome (OSAS) keeps on rising. Daytime sleepiness resulting from fragmented sleep is the prime symptom, and obesity the major risk factor for OSAS. Quality of life with OSAS is often affected by depressive symptoms and anxiety. Nasal continuous positive airway pressure (CPAP) therapy reduces daytime sleepiness, but the results on the effect on mood, physical activity, and weight are controversial especially on long-term therapy. Purpose of this study was to evaluate these factors and predictors of weight gain during long-term CPAP therapy. Methods: Consecutive patients (n = 223), referred to sleep study with suspected OSAS, were enrolled. Patients underwent a cardiorespiratory polygraphy at baseline and a battery of questionnaires was completed, both at baseline, and after three years of follow-up. Total of 149 (67%; M 65, F 84) patients completed the follow-up. Of the 149 patients, 76 (51.0%; M 32, F 44) used CPAP. Results: In this study, depressive symptoms, anxiety, and sleepiness were alleviated during CPAP therapy. However, therapy did not have an influence on cravings of different food categories, or exercise habits and exercise duration. From the various factors studied, solely higher adherence to CPAP therapy was associated with weight gain. Conclusions: This research provides further evidence that long-term CPAP therapy in patients with OSAS not only decreases sleepiness and improves sleep quality but could also alleviate depressive symptoms and anxiety. In addition, our study reinforces that CPAP therapy alone is not sufficient for weight management in patients with OSAS. Regardless of comprehensive battery of questionnaires, we were unable to establish markers predicting weight gain during therapy. We advise on life-style counselling and weight management program to all patients with obesity on CPAP therapy.

Background: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular disease. Alterations in the gut microbiome have been implicated in the development of cardiovascular disease and may potentially link OSA to its cardiovascular consequences. However, only one study to date has investigated gut microbiomes in adult patients with OSA. Methods: 19 patients with OSA and 20 non-OSA controls participated in the study. Following a diagnostic sleep study, blood was collected for metabolic profiling, and the subjects provided a stool sample for microbiome analysis. The gut microbiome was investigated using the 16S ribosomal RNA method. Results: Patients with OSA had a higher relative abundance of the Proteobacteria phylum (p = 0.03), Gammaproteobacteria class (p = 0.01), Lactobacillae family (p = 0.02), Lactobacillus (p = 0.03), and Roseburia genus (p = 0.03), and a lower abundance of the Actinobacteria phylum (p = 0.03). The abundance of Proteobacteria, Gammaproteobacteria, Lactobacillae, and Lactobacillus were related to disease severity and dyslipidaemia (all p < 0.05), whilst the abundance of Proteobacteria and Gammaproteobacteria was also related to hypertension and cardiovascular disease (all p < 0.05). However, following adjustment for relevant confounders only the association between OSA and Actinobacteria remained significant (p = 0.04). Conclusions: Obstructive sleep apnoea is associated with only subtle changes in gut microbiome. Further studies should investigate gut dysbiosis in OSA.

INTRODUCTION: Recently, sleeping disorders and snoring are being recognized as a public health concern with various risk factors and health consequences. The main objective of the present study was to determine the prevalence of snoring and sleep apnea among adults (20–60 years) in Sharjah (United Arab Emirates, UAE) and assess the major risk factors as well as the general knowledge among the population. METHODS: A self-administrated Questionnaire of five sections including both Berlin questionnaire (BQ) and the Epworth Sleepiness Scales (ESS) were given to a randomly selected population in Sharjah between the ages of 20–60 years. Data were analyzed using SPSS software version 22.0. RESULTS: Nearly 34.2% of the study population reported to be snorers, and 43.2% of snorers were at high risk of sleep apnea based on the BQ. Gender was significantly associated with snoring (P = 0.038), as 40.8% of males reported snoring compared to 28.7% of females. Elderlies (50–60 years) were at a higher risk, and obesity (body mass index >30) was considered to be a powerful risk factor as 46.8% of the obese participants reported snoring. Those who scored higher on the ESS were more likely to be snorers (P = 0.001) and were likely to fall into the high-risk category in the BQ (P = 0.007). In addition, smoking (P = 0.005), hypertension (P = 0.005), and nasal septal deviation (P = 0.024) were also considered as risk factors. CONCLUSION: Prevalence and major risk factors within the UAE are similar to those in other countries. Sleeping disorders and snoring campaigns and management facilities should be considered to raise the awareness about these issues and manage their risk factors.

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

The obstructive sleep apnoea syndrome (OSAS) is characterized by a collapse of the upper respiratory tract, resulting in a reduction of the blood oxygen- and an increase of the carbon dioxide (CO2) - concentration, which causes repeated sleep disruptions. The gold standard to treat the OSAS is the continuous positive airway pressure (CPAP) therapy. The continuous pressure keeps the upper airway open and prevents the collapse of the upper respiratory tract and the pharynx. Most of the available CPAP-devices cannot maintain the pressure reference [1]. In this work a model predictive control approach is provided. This control approach has the possibility to include the patient’s breathing effort into the calculation of the control variable. Therefore a patient-individualized control strategy can be developed.

Background: Selected adult patients with obstructive sleep apnoea-hypopnea syndrome (OSAHS) may benefit from surgical intervention. At present, the dominant technique for the diagnosis of the anatomical locus of upper airway obstruction during sleep is drug-induced sedation endoscopy (DISE). This technique is widespread, but has generated controversy related to its artificiality. Methodology: We present a technique for the acquisition of high-quality and consistent recordings of snoring sounds, suitable for advanced acoustic analysis and correlation with the findings of DISE. Results: Analysis of the generated recordings demonstrates distinct frequency-domain characteristics of snoring sounds generated by distinct anatomical subsites, for example the soft palate, or tongue base. Conclusions: Supplemental information may potentially be obtained from the waveform of snoring sounds produced by the patient; however, no robust quantitative “assay” has been developed or been clinically validated. This may in part be related to inconsistencies or insufficient quality of the sound data acquired. This novel technique may circumvent these difficulties and permit more advanced analysis techniques with potential clinical applicability.

Continuous positive airway pressure (CPAP) treatment for sleep apnoea can be challenging for patients to master. Given limited evidence on this topic, we used constructionist grounded theory methodology to explore experiences of living with CPAP from participants' perspectives. Adults (n=16) were recruited through a main-center respiratory service in New Zealand and participated in semi-structured interviews. Data were analyzed until theoretical saturation was achieved. In this article, we present the newly constructed grounded theory of bargaining and balancing life with CPAP, which explains how participants made a series of personal decisions about whether to use and how to master CPAP. To situate, support and provide explanatory power the new theory is discussed in the context of change and decision theories to illustrate the varying phases of readiness experienced by persons preparing to engage with CPAP and the decision-making process required for effective management of CPAP at home. This study provides valuable CPAP-user centered information for the development of interventions to optimize CPAP use. Acknowledging individuals' abilities to make reasoned healthcare decisions and providing clinical environments that support the active process of bargaining and balancing may increase uptake of CPAP, and potentially other long-term therapies.

Objective: To compare the effects of a self-help book for insomnia to that of sleep hygiene advice in a randomized controlled trial with follow-up after about 3 months among patients who were diagnosed with obstructive sleep apnea (OSA) and comorbid chronic insomnia, and who were concurrently initiating treatment with continuous positive airway pressure (CPAP).Methods: In all, 164 patients were included. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor. The self-help book focused on cognitive behavioral therapy for insomnia. The main outcome measure was insomnia severity assessed with the Bergen Insomnia Scale (BIS) and the Insomnia Severity Index (ISI).Results: The scores on the BIS improved significantly from pre-treatment to follow-up in the sleep hygiene advice group (26.8 vs. 21.8) and in the self-help book group (26.3 vs. 22.4). Similarly, the ISI scores were significantly improved in both conditions (sleep hygiene: 17.0 vs. 14.1; self-help book: 16.6 vs. 13.6). No time × condition interaction effects were detected, suggesting that the self-help book did not improve insomnia symptoms more than the sleep hygiene advice.Conclusion: In this randomized controlled trial among patients with OSA and comorbid insomnia who were initiating CPAP treatment, concurrently treating their insomnia with a self-help book did not improve sleep more than sleep hygiene advice. The statistically significant improved sleep at follow-up in both groups is most likely explained by the CPAP treatment.