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ObjectivesThis analysis characterized changes in weight in participants with obstructive sleep apnea (OSA) or narcolepsy treated with solriamfetol (Sunosi™) 37.5 (OSA only), 75, 150, or 300 mg/d.MethodsIn two 12-week, randomized, placebo-controlled trials and one 1-year open-label extension study, changes in weight were evaluated from baseline to end of study (week 12 or week 40 of the open-label extension [after up to 52 weeks of solriamfetol treatment]) in participants with OSA or narcolepsy.ResultsAfter 12 weeks of solriamfetol treatment, median percent change in weight from baseline across all solriamfetol doses was -0.84%, compared with 0.54% for placebo, in participants with OSA; and -0.07%, compared with 3.08% for placebo, in participants with narcolepsy. After up to 52 weeks of solriamfetol treatment, overall median percent change in weight from baseline was -1.76%, which showed a dose-dependent pattern (75 mg, 0.57%; 150 mg, -1.2%; 300 mg, -2.5%). Results were similar in subgroups of participants with OSA or narcolepsy, with overall median percent changes in weight of -2.2% and -1.1%, respectively. After up to 52 weeks of solriamfetol treatment, the percentage of participants with weight loss ≥5% relative to baseline was 25.7% overall and increased in a dose-dependent manner (75 mg, 4.5%; 150 mg, 17.3%; 300 mg, 32.4%). Results were similar among subgroups of participants with OSA or narcolepsy, with 26.4% and 24.2% of participants experiencing weight loss ≥5%, respectively. No weight-related treatment-emergent adverse events were serious.ConclusionsSolriamfetol treatment was associated with decreases in body weight in a dose-related manner.

Study objectivesWhile sleep apnea has been associated with cardiovascular disease (CVD) risk factors in white individuals in the U.S., these associations in Chinese and Korean Americans are less well-understood, particularly how these associations vary by age, gender, Asian origin, obesity, chronic conditions, and daytime sleepiness.MethodsWe used a sample of Chinese and Korean Americans ages 50-75 (n = 394) from the Baltimore-Washington DC Metropolitan Area to examine the associations of high risk (HR) sleep apnea with diagnoseable hypercholesterolemia and diabetes, as well as the following biomarkers: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio, triglycerides, and glucose (non-fasting). Poisson models included demographic factors, socioeconomic status, and body mass index (BMI). We tested for potential effect modifiers.ResultsHR-sleep apnea was associated with higher LDL-C level (β = 14.56, p < 0.05) and higher total cholesterol/HDL ratio (β = 0.64, p < 0.01). Younger respondents had higher levels of triglycerides associated with HR-sleep apnea than older respondents. For men, HR-sleep apnea was associated with higher total cholesterol, total cholesterol/HDL-C ratio, and triglycerides. Obese and overweight respondents had positive associations between HR-sleep apnea and total cholesterol, total cholesterol/HDL ratio, and triglycerides, while underweight/normal weight individuals did not. The interactions between snoring and daytime sleepiness were associated with hypercholesterolemia and diabetes.ConclusionsThis study demonstrates associations between sleep apnea risk and dyslipidemia among Chinese and Korean Americans. Associations were particularly pronounced among younger, male, overweight/obese, and sicker individuals. Future research should examine how to improve sleep health in Asian American populations to improve CVD risk.

BackgroundHigh loop gain (unstable ventilatory control) is an important-but difficult to measure-contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. Our objective was to develop and validate a clinical prediction tool of loop gain.MethodsA retrospective cohort of consecutive adults with OSA (apnea-hypopnea index, AHI > 5/hour) based on in-laboratory polysomnography 01/2017-12/2018 was randomly split into a training and test-set (3:1-ratio). Using a customized algorithm ("reference standard") loop gain was quantified from raw polysomnography signals on a continuous scale and additionally dichotomized (high > 0.7). Candidate predictors included general patient characteristics and routine polysomnography data. The model was developed (training-set) using linear regression with backward selection (tenfold cross-validated mean square errors); the predicted loop gain of the final linear regression model was used to predict loop gain class. More complex, alternative models including lasso regression or random forests were considered but did not meet pre-specified superiority-criteria. Final model performance was validated on the test-set.ResultsThe total cohort included 1055 patients (33% high loop gain). Based on the final model, higher AHI (beta = 0.0016; P

Summary Patients with obstructive sleep apnea (OSA) may present different symptoms. The clinical importance of symptom clustering is supported by the difference in the incidence of cardiovascular diseases between hypersomnolent and non‐hypersomnolent sleep apnea patients. The objective of this study was to determine if quality‐of‐life clusters could be identified from the Quebec Sleep Questionnaire (QSQ) in OSA patients. Latent class analysis was used to identify clusters in a multivariate analysis of dichotomic variables (presence or absence of symptoms) for each item the QSQ obtained from 147 patients who fulfilled the questionnaire during its validation and subsequent trials (75.5% males, age: 53 ± 11 years, body mass index (BMI): 30.4 ± 4.7 kg/m2, apnea/hypopnea index (AHI): 31.3 ± 14.8/h). Three clusters were identified. Quality of life was preserved in patients of cluster 1 (20.4% of patients). Patients of cluster 2 (32.6% of patients) had a moderately impaired quality of life, mainly due to daytime somnolence and poor sleep quality. Patients with impaired quality of life (cluster 3, 46.9% of patients) had an important impact in every domain of the QSQ with the highest sleepiness and daytime symptom impairments. Gender, BMI, and AHI did not differ between the three clusters. In conclusion, different quality‐of‐life clusters can be identified from the QSQ in sleep apnea patients. These clusters are similar to those reported previously. Further studies are needed to validate these clusters in larger and independent cohorts, to evaluate how they respond to OSA treatment, and their relationship with incident outcomes. [ABSTRACT FROM AUTHOR]

The rail industry in Australia screens workers for probable obstructive sleep apnea (OSA) due to known safety risks. However, existing criteria to trigger screening only identify a small proportion of workers with OSA. The current study sought to examine the relationship between OSA risk and rail incidents in real-world data from Australian train drivers, and conducted a proof of concept analysis to determine whether more conservative screening criteria are justified. Health assessment (2016–2018) and subsequent rail incident data (2016–2020) were collected from two passenger rail service providers. Predictors included OSA status (confirmed no OSA with a sleep study, controlled OSA, unknown OSA [no recorded sleep assessment data] and confirmed OSA with no indication of treatment); OSA risk according to the current Standard, and OSA risk according to more conservative clinical markers (BMI threshold and cardiometabolic burden). Coded rail safety incidents involving the train driver were included. Data were analysed using zero-inflated negative binomial models to account for over-dispersion with high 0 counts, and rail safety incidents are reported using Incidence Risk Ratios (IRRs). A total of 751 train drivers, typically middle-aged, overweight to obese and mostly men, were included in analyses. There were 43 (5.7%) drivers with confirmed OSA, 62 (8.2%) with controlled OSA, 13 (1.7%) with confirmed no OSA and 633 (84.4%) drivers with unknown OSA. Of the 633 train drivers with unknown OSA status, 21 (3.3%) met 'at risk' criteria for OSA according to the Standard, and incidents were 61% greater (IRR: 1.61, 95% Confidence Interval (CI) 1.02–2.56) in the years following their health assessment compared to drivers who did not meet 'at risk' criteria. A more conservative OSA risk status using lower BMI threshold and cardiometabolic burden identified an additional 30 'at risk' train drivers who had 46% greater incidents compared to drivers who did not meet risk criteria (IRR (95% CI) 1.46 (1.00–2.13)). Our more conservative OSA risk criteria identified more workers, with greater prospective incidents. These findings suggest that existing validated tools could be considered in future iterations of the Standard in order to more sensitively screen for OSA. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a chronic condition affecting up to 1 billion people, globally. Despite this spread, OSA is still thought to be underdiagnosed. Lack of diagnosis is largely attributed to the high cost, resource-intensive, and time-consuming nature of existing diagnostic technologies during sleep. As individuals with OSA do not show many symptoms other than daytime sleepiness, predicting OSA while the individual is awake (wakefulness) is quite challenging. However, research especially in the last decade has shown promising results for quick and accurate methodologies to predict OSA during wakefulness. Furthermore, advances in machine learning algorithms offer new ways to analyze the measured data with more precision. With a widening research outlook, the present review compares methodologies for OSA screening during wakefulness, and recommendations are made for avenues of future research and study designs. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea, a common form of sleep-disordered breathing, is characterized by intermittent cessations of breathing that reduce blood oxygen levels and contribute to the development of hypertension. Hypertension is a major complication of obstructive sleep apnea that elevates the risk of end-organ damage. Premenopausal women have a lower prevalence of obstructive sleep apnea and cardiovascular disease than men and postmenopausal women, suggesting that sex hormones play a role in the pathophysiology of sleep apnea-related hypertension. The lack of protection in men and postmenopausal women implicates estrogen and progesterone as protective agents but testosterone as a permissive agent in sleep apnea-induced hypertension. A better understanding of how sex hormones contribute to the pathophysiology of sleep apnea-induced hypertension is important for future research and possible hormone-based interventions. The effect of sex on the pathophysiology of sleep apnea and associated intermittent hypoxia-induced hypertension is of important consideration in the screening, diagnosis, and treatment of the disease and its cardiovascular complications. This review summarizes our current understanding of the impact of sex hormones on blood pressure regulation in sleep apnea with a focus on sex differences. [ABSTRACT FROM AUTHOR]

Hypersomnolence is common in major depressive disorder (MDD), associated with more severe episodes, suicide and antidepressant resistance. Nevertheless, few studies used polysomnography (PSG) and multiple sleep latency test (MSLT) to characterize these patients. In this context, we compared patients visiting a sleep center for hypersomnolence complaint with MDD (HSC/MDD+) and without MDD (HSC/MDD-). HSC/MDD+ and HSC/MDD- groups were defined according to DSM-5 criteria and CES-D scale, and had a 30 h-PSG with ad libitum -sleep and PSG followed by MLST. HSC/MDD+ had an increased self-declared total sleep time (sTST) of about 10 h30 similar to HSC/MDD- (630.8 ± 17.3 min- vs -616.5 ± 18.1 min, respectively, p = 0.39). Nevertheless, their objective TST (oTST) on ad libitum PSG was significantly longer and about 10 h50 (648.6 ± 23.9 min- vs -587.4 ± 19.0 min, respectively, p = 0.038). HSC/MDD+ also significantly better estimated their sleep duration, with a lower difference between their sTST and oTST compared to HSC/MDD- (10.0 ± 1.7 %- vs -17.4 ± 2.1 %, respectively, p = 0.009) and confirmed significantly more frequently the hypersomnia diagnosis - i.e. oTST>10H- (82.6 ± 8.1 %- vs -54.6 ± 10.9 %, respectively, p = 0.046). Using the Kupfer index (KI), we confirmed a reduced REM sleep latency in patients MDD/HSC+ (15.2 ± 10.0 %- vs -2.3 ± 2.3 %, respectively, p = 0.039). Both groups had comparable increased diurnal sleepiness assessed with the Epworth scale (14.1 ± 1.1- vs -14.8 ± 1.1, respectively, p = 0.65). HSC/MDD+ had less MSLT sleep latency <8 min (9.1 ± 5.1 %- vs -27.3 ± 6.8 %, respectively, p = 0.048). Retrospective cross-sectional study. HSC/MDD+ accurately estimated their sleep duration, objectively confirmed hypersomnia and may specifically had a decreased Kupfer index. • HSC/MDD+ have an extended sTST and oTST. • HSC/MDD+ accurately estimate their sleep duration and it is essential to consider it during the medical interview. • HSC/MDD+ have a shortened REM latency using the Kupfer index. • HSC/MDD+ are complaining from excessive daytime sleepiness with normal sleep latencies on MLST. • Psychiatrists should also be aware that the prevalence of sleep apnea is increased in this at-risk population. [ABSTRACT FROM AUTHOR]

The effect of sleep apnea treatment on reducing cardiovascular disease risk remains inconclusive. This study aims to assess if the effective apnea hypopnea index (eAHI), a measure of residual sleep apnea burden post-treatment, is a factor in determining blood pressure (BP) response to continuous positive airway pressure therapy. The eAHI integrates time on therapy, residual apnea, and % of sleep time untreated. A secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a randomized, controlled, parallel group assessment of continuous positive airway pressure (CPAP), oxygen and sleep hygiene. The Delta-AHI (▲AHI) was defined as the difference between baseline AHI and effective AHI at 12 weeks. Logistic and linear regression models estimated the predictors for nocturnal systolic BP change following sleep apnea therapy. One hundred and sixty-nine subjects with a mean age of 62.82 ± 6.99 years were included in the final analysis. Fifty subjects had ▲AHI ≤8/hour of sleep and 119 subjects were higher. After adjustment, baseline mean nighttime systolic blood pressure (OR 1.036, 95% CI 1.015–1.058, p: 0.001) and ▲AHI ≥8/hour (OR 2.406 , 95% CI 1.116–5.185 , p :0.025) were independent predictors for mean nighttime systolic blood pressure change >3 mm Hg. The higher effective AHI was negatively related with BNP (β: −2.564 , SE: 1.167 , p: 0.029) and positively related with troponin change (β: 0.703 , SE: 0.256 , p: 0.007). The ▲AHI was an independent predictor of the blood pressure response to sleep apnea treatment. NCT01086800. • Effective AHI is a composite metric evaluating the residual sleep apnea burden on therapy. • Gap between effective and baseline AHI predicts the blood pressure response to treatment. • Baseline severity, efficacy and duration of treatment should be focused during follow up. [ABSTRACT FROM AUTHOR]

Summary: Sleep symptoms, including excessive sleepiness, are frequently reported by patients with functional motor disorders (FMD). We aimed to classify the comorbid sleep disorders in FMD, and to investigate the relationship between subjective sleepiness and objective measures of hypersomnia, comparing them with data from people with central hypersomnia. A total of 37 patients (mean [SD] age 46.4 [11.2] years) with clinically definite FMD, and 17 patients (mean [SD] age 41.1 [11.6] years) with central hypersomnia underwent structured medical and sleep history, neurological examination, polysomnography, multiple sleep latency test (MSLT), and questionnaires assessing sleepiness, fatigue, and depression. In all, 23 patients with FMD (62%) reported excessive daytime sleepiness. Evidence of specific sleep disorders was identified in our cohort, with 35% having restless legs syndrome; 49% obstructive sleep apnea; and 8% periodic limb movements in sleep; however, the presence of these disorders was not correlated with subjective sleepiness. Patients with FMD with self‐reported sleepiness reported higher fatigue (p = 0.002), depression (p = 0.002), and had longer sleep latencies in the MSLT (p < 0.001) compared to the patients with central hypersomnia. No correlation was found between subjective and objective sleepiness in either group. Fatigue positively correlated with self‐reported sleepiness in patients with FMD (p < 0.001). This study did not find objective correlates of increased sleepiness in patients with FMD. While sleep abnormalities were found to be common in FMD, they were not correlated with self‐reports of excessive sleepiness. Positive correlations between self‐reported sleepiness and fatigue support the current unified model of non‐motor symptoms in FMD. [ABSTRACT FROM AUTHOR]

Summary: Continuous positive airway pressure (CPAP) is the primary therapeutic modality for obstructive sleep apnea (OSA) management. However, despite efforts to encourage patients to comply with CPAP usage, long‐term adherence remains low. Consequently, surgical intervention for OSA is considered a secondary option for patients who exhibit non‐compliance with CPAP. Therefore, we conducted systematic review and meta‐analysis assessed the relative effectiveness of hypoglossal nerve stimulation (HNS) treatment and alternative surgical interventions for managing OSA. Five databases were searched. Studies were included if they measured polysomnography parameters and assessed sleep apnea‐related quality of life (Epworth Sleepiness Scale [ESS]) both before and after HNS, and compared these outcomes with control, CPAP, or airway surgery (uvulopalatopharyngoplasty, expansion sphincter pharyngoplasty, or tongue base surgery) groups. A total of 10 studies (2209 patients) met the inclusion criteria. Compared to other airway surgeries, the rates of post‐treatment apnea–hypopnea index (AHI) < 10 and < 15 events/h were significantly lower in the HNS group (odds ratio [OR] 5.33, 95% confidence interval [CI] 1.21–23.42; and 2.73, 95% CI 1.30–5.71, respectively). Additionally, postoperative AHI was significantly lower in the HNS group than in all other airway surgery groups (AHI: mean difference [MD] −8.00, 95% CI −12.03 to−3.97 events/h). However, there were no significant differences in the rate of post‐treatment AHI < 5 events/h (OR 1.93, 95% CI 0.74–5.06) or postoperative ESS score (MD 0.40, 95% CI−1.52 to 2.32) between the two groups. HNS is an effective option for selected patients with moderate‐to‐severe OSA and CPAP intolerance. [ABSTRACT FROM AUTHOR]

Summary: Obstructive sleep apnea (OSA) has a heavy health‐related burden on patients and the healthcare system. Continuous positive airway pressure (CPAP) is effective in treating OSA, but adherence to it is often inadequate. A promising solution is to detect sleep apnea events in advance, and to adjust the pressure accordingly, which could improve the long‐term use of CPAP treatment. The use of CPAP titration data may reflect a similar response of patients to therapy at home. Our study aimed to develop a machine‐learning algorithm using retrospective electrocardiogram (ECG) data and CPAP titration to forecast sleep apnea events before they happen. We employed a support vector machine (SVM), k‐nearest neighbour (KNN), decision tree (DT), and linear discriminative analysis (LDA) to detect sleep apnea events 30–90 s in advance. Preprocessed 30 s segments were time–frequency transformed to spectrograms using continuous wavelet transform, followed by feature generation using the bag‐of‐features technique. Specific frequency bands of 0.5–50 Hz, 0.8–10 Hz, and 8–50 Hz were also extracted to detect the most detected band. Our results indicated that SVM outperformed KNN, LDA, and DT across frequency bands and leading time segments. The 8–50 Hz frequency band gave the best accuracy of 98.2%, and a F1‐score of 0.93. Segments 60 s before sleep events seemed to exhibit better performance than other pre‐OSA segments. Our findings demonstrate the feasibility of detecting sleep apnea events in advance using only a single‐lead ECG signal at CPAP titration, making our proposed framework a novel and promising approach to managing obstructive sleep apnea at home. [ABSTRACT FROM AUTHOR]

Background: Sleep apnea is a prevalent condition that disproportionately affects overweight individuals, with adolescents being an especially vulnerable subgroup due to the rising incidence of obesity in this age group. Understanding the prevalence and associated factors in this population is crucial for early intervention and management. Methods: This hospitalbased, cross-sectional study investigated the prevalence of sleep apnea in 200 overweight adolescents aged 12-18 years. Participants were selected using a stratified sampling technique from the outpatient department of a tertiary care center. Results: The study identified a significant correlation between overweight status and the incidence of sleep apnea in adolescents, with detailed results highlighting specific risk factors and comorbid conditions. Conclusion: Our findings underscore the urgent need for targeted screening and therapeutic strategies in overweight adolescents to mitigate the risk of sleep apnea and its complications. [ABSTRACT FROM AUTHOR]

Background and Objectives Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). Research Design and Methods A total of 5,822 participants (M age = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. Results In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b  = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b  = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b  = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b  = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. Discussion and Implications Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep. [ABSTRACT FROM AUTHOR]

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Purpose: Comorbid insomnia often occurs in patients with obstructive sleep apnea (OSA), referred to as COMISA. Cortical arousals manifest as a common feature in both OSA and insomnia, often accompanied by elevated heart rate (HR). Our objective was to evaluate the heart rate response to nocturnal cortical arousals in patients with COMISA and patients with OSA alone. Methods: We analyzed data from patients with COMISA and from patients with OSA matched for apnea-hypopnea index. Sleep staging and analysis of respiratory events and cortical arousals were performed using the Philips Somnolyzer automatic scoring system. Beat-by-beat HR was analyzed from the onset of the cortical arousal to 30 heartbeats afterwards. HR responses were divided into peak and recovery phases. Cortical arousals were separately evaluated according to subtype (related to respiratory events and spontaneous) and duration (3–6 s, 6–10 s, 10–15 s). Results: A total of 72 patients with COMISA and 72 patients with OSA were included in this study. There were no overall group differences in the number of cortical arousals with and without autonomic activation. No significant differences were found for spontaneous cortical arousals. The OSA group had more cortical arousals related to respiratory events (21.0 [14.8–30.0] vs 16.0 [9.0–27.0], p = 0.016). However, the COMISA group had longer cortical arousals (7.2 [6.4–7.8] vs 6.7 [6.2–7.7] s, p = 0.024) and the HR recovery phase was prolonged (52.5 [30.8–82.5] vs 40.0 [21.8–55.5] beats/min, p = 0.017). Both the peak and the recovery phase for longer cortical arousals with a duration of 10–15 s were significantly higher in patients with COMISA compared to patients with OSA (47.0 [27.0–97.5] vs 34.0 [21.0–71.0] beats/min, p = 0.032 and 87.0 [47.0–132.0] vs 71.0 [43.0–103.5] beats/min, p = 0.049, respectively). Conclusions: The HR recovery phase after cortical arousals related to respiratory events is prolonged in patients with COMISA compared to patients with OSA alone. This response could be indicative of the insomnia component in COMISA. [ABSTRACT FROM AUTHOR]

Background: Patients with obstructive or central sleep apnea are primarily treated with positive airway pressure treatment. There are novel implantable options targeting either obstructive sleep apnea using hypoglossal nerve stimulation (HNS) or central sleep apnea using phrenic nerve stimulation (PNS). Methods: Patients with sleep apnea were implanted with both HNS and PNS devices, and their response to each therapy was monitored using home sleep tests as well as Epworth Sleepiness scale (ESS). Results: We evaluated our concurrent neurostimulation approach in two patients. Both patients were implanted with two neuromodulation devices: The first case suffered from treatment emergent central sleep apnea after HNS activation for primarily obstructive sleep apnea (apnea–hypopnea index/AHI 54/h). The central portion resolved under PNS (AHI 23.7/h). The second case suffered from predominantly central sleep apnea (AHI 82/h). Here, the PNS device was implanted first, resulting in a subsequent reduction of the central portion. The residual obstructive sleep apnea was addressed using HNS (AHI 5.4/h). No interaction between the HNS and PNS systems was noticed in either of the two patients. Conclusions: In selected cases, a concurrent treatment with hypoglossal and phrenic nerve stimulation may lead to improvement of sleep apnea and patient satisfaction in a safe manner. [ABSTRACT FROM AUTHOR]

Since sleep problems, like sleep apnea, may pose a serious health concern, the quality of a person's sleep is a good indicator of overall wellbeing. It is then crucial to continuously monitor people when they are sleeping, especially if they have cardiac or respiratory conditions. The goal of the present paper is to show how to extract physiological parameters from accelerometric signal processing during sleep by applying a non-invasive technology. Using an accelerometric device located under the mattress, we demonstrated the possibility of extracting heart rate and respiratory rate, and then how to use the same signal to implement an automatic algorithm to recognize apneas and, more generally, different activities. The proposed automatic approach has shown good accuracy and dependability, and it may be a useful tool for preventing significant harm during sleep. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a highly prevalent sleep-disordered breathing. It is associated with adverse comorbidities, being the most scientific evidence of cardiovascular (CV) disease. Currently, OSA is measured through the apnea-hypopnea index (AHI), the total number of respiratory events per hour of sleep. However, different studies have questioned its utility in OSA management, highlighting the need to search for new parameters that better reflect the heterogeneity of the disease. Hypoxic burden (HB) has emerged as a novel biomarker that informs about the frequency, duration and depth of the desaturation related to the respiratory events. We conducted a systematic review in order to find publications about the heterogeneity of OSA measured by HB and its associations with future disease. Methods: Systematic review was conducted using PubMed and Web of Science. The terms "sleep apne" and "hypoxic burden" were used to look for publications from the date of inception to August 15, 2023. Inclusion criteria: articles in English published in peer-reviewed journals. Exclusion criteria: (1) not available publications; (2) duplicated articles; (3) letters, editorials, and congress communications; (4) articles not including information about HB as a specific biomarker of OSA. Results: 33 studies were included. The results were classified in 2 main sections: (1) HB implication in the CV sphere: HB showed to be a better predictor of CV risk in OSA patients than traditional measures such as AHI with possible clinical management implication in OSA. (2) HB response to OSA treatment: pharmacological and nonpharmacological treatments have demonstrated to be effective in improving hypoxia measured through the HB. Conclusions: HB could be a better and more effective parameter than traditional measurements in terms of diagnosis, risk prediction and therapeutic decisions in patients with OSA. This measure could be incorporated in sleep units and could play a role in OSA management, driving the clinic to a more personalized medicine. [ABSTRACT FROM AUTHOR]

Background: Postoperative de novo atrial fibrillation (POAF) is one of the most frequently encountered complications following cardiac surgery. Despite the identification of several risk factors, the link between sleep-disordered breathing (SDB) and POAF has barely been examined. The objective of this prospective observational study was to determine whether severe SDB is associated with POAF in patients after elective coronary artery bypass grafting (CABG) surgery. Study design and methods: The incidence and preoperative predictors of in-hospital POAF were assessed in 272 patients undergoing CABG surgery at the University Medical Center Regensburg (Germany). In-hospital POAF was detected by continuous telemetry-ECG monitoring and 12-lead resting ECGs within the first seven postoperative days. POAF that occurred after hospital discharge within 60 days post CABG surgery was classified as post-hospital POAF and was ascertained by standardized phone interviews together with the patients' medical files, including routinely performed Holter-ECG monitoring at 60 days post CABG surgery. The night before surgery, portable SDB monitoring was used to assess the presence and type of severe SDB, defined by an apnea–hypopnea index ≥ 30/h. Results: The incidence of in-hospital POAF was significantly higher in patients with severe SDB compared to those without severe SDB (30% vs. 15%, p = 0.009). Patients with severe SDB suffered significantly more often from POAF at 60 days post CABG surgery compared to patients without severe SDB (14% vs. 5%, p = 0.042). Multivariable logistic regression analysis showed that severe SDB (odds ratio, OR [95% confidence interval, CI]: 2.23 [1.08; 4.61], p = 0.030), age ≥ 65 years (2.17 [1.04; 4.53], p = 0.038), and diabetes mellitus (2.27 [1.15; 4.48], p = 0.018) were significantly associated with in-hospital POAF. After additional adjustment for heart failure, the association between sleep apnea and postoperative atrial fibrillation was attenuated (1.99 [0.92; 4.31], p = 0.081). Conclusions: Amongst established risk factors, severe SDB was significantly associated with in-hospital POAF in patients undergoing CABG surgery. Whether SDB contributes to POAF independently of heart failure and whether risk for POAF may be alleviated by proper treatment of SDB merits further investigation. [ABSTRACT FROM AUTHOR]

Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are the most common comorbidities in Heart Failure (HF) that are strongly associated with all-cause mortality. Several therapeutic approaches have been used to treat CSA and OSA, but none have been shown to significantly improve HF prognosis. Our study evaluated the effects of a 3-months treatment with sodium-glucose cotransporter type 2 inhibitor (SGLT2i) on polygraphic parameters in patients with sleep apnea (SA) and HF, across the spectrum of ejection fraction, not treated with continuous positive air pressure (CPAP). A group of 514 consecutive elderly outpatients with HF, type 2 diabetes mellitus (T2DM) and SA, eligible for treatment with SGLT2i, were included in the investigation before starting any CPAP therapy. The two groups were compared with the t-test and Mann–Whitney test for unpaired data when appropriate. Then, a simple logistic regression model was built using 50% reduction in AHI as the dependent variable and other variables as covariates. A multivariate stepwise logistic regression model was constructed using the variables that linked with the dependent variable to calculate the odds ratio (OR) for the independent predictors associated with the reduction of 50% in AHI. The treated group experienced significant improvements in polygraphic parameters between baseline values and follow-up with reduction in AHI (28.4 ± 12.9 e/h vs. 15.2 ± 6.5 e/h; p < 0.0001), ODI (15.4 ± 3.3 e/h vs. 11.1 ± 2.6 e/h; p < 0.0001), and TC90 (14.1 ± 4.2% vs. 8.2 ± 2.0%; p < 0.0001), while mean SpO2 improved (91. 3 ± 2.3 vs. 93.8 ± 2.5); p < 0.0001. These benefits were not seen in the untreated population. The use of SGLT2i in patients suffering from HF and mixed-type SA not on CPAP therapy significantly contributes to improving polygraphic parameters. [ABSTRACT FROM AUTHOR]

The American Heart Association recently included sleep health as one of eight factors that define cardiovascular health. Restorative sleep is a pillar of lifestyle medicine influenced by sleep duration, quality, and disorders. Short and long sleep duration are associated with greater risk of cardiovascular disease. Short sleep appears causally related to cardiovascular risk. Long sleep is more strongly predictive of cardiovascular risk, which may be due to comorbidities and other risk factors. Good-quality sleep appears to protect against the increased risk and is independently associated with risk of cardiovascular disease (CVD). Insomnia, particularly difficulty falling asleep and non-restorative sleep, is associated with an increase in cardiac events. Obstructive sleep apnea (OSA) is associated with cardiac risk and outcomes, which is typically observed in the context of contributing comorbidities. However, treating OSA with continuous positive airway pressure (CPAP) may not improve prognosis. Further research is needed to understand the causal mechanisms connecting sleep health with CVD and whether modifying sleep can improve outcomes. Sleep health should be considered as part of a holistic approach to improving cardiovascular health, as reflected in the scoring of LE8 and as one of the interrelated components of lifestyle medicine. [ABSTRACT FROM AUTHOR]

Summary Obstructive sleep apnea is associated with many co‐morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold‐standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea–hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea–hypopnea index > 10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a common disease spreading around the world. It is unavoidably linked to the increasing rate of obesity, particularly in Western societies. Associated higher prevalence of sleep disordered breathing has also been observed. There are many diseases that can lead to OSA and many that are a result of untreated OSA. From the widely known cardiovascular complications to indirectly related diseases, such as insomnia, Alzeihmer's disease or psoriasis. Overall, sleep-disordered breathing have been shown to negatively impact quality of life, including general health perception, physical functioning, social functioning, and vitality. That is why it is important to spread awareness about OSA, often asymptomatic, through medical staff and patients in the risk group. In this review we describe the illness, the ways to diagnose it and discuss comorbid diseases. [ABSTRACT FROM AUTHOR]

Rationale: Obstructive sleep apnea (OSA) is a highly prevalent condition that is associated with accelerated biological aging and multiple end-organ morbidities. Current treatments, such as continuous positive airway pressure (CPAP), have shown limited cognitive, metabolic, and cardiovascular beneficial outcomes despite adherence. Thus, adjunct therapies aiming to reduce OSA burden, such as senolytics, could improve OSA outcomes. Objectives: To assess if targeting senescence in addition to partial normoxia mimicking "good" CPAP adherence can improve physiological outcomes in mice exposed to chronic intermittent hypoxia. Methods: We compared the effects of 6 weeks of therapy with either partial normoxic recovery alone or combined with the senolytic navitoclax after 16 weeks of intermittent hypoxia exposures, a hallmark of OSA, on multiphenotypic cardiometabolic and neurocognitive parameters. Measurements and Main Results: Our findings indicate that only when combined with navitoclax, partial normoxic recovery significantly improved sleepiness (sleep in the dark phase: 34% ± 4% vs. 26% ± 3%; P < 0.01), cognition (preference score: 51% ± 19% vs. 70% ± 11%; P = 0.048), coronary artery function (response to acetylcholine [vasodilation]: 56% ± 13% vs. 72% ± 10%; P < 0.001), glucose, and lipid metabolism and reduced intestinal permeability and senescence in multiple organs. Conclusions: These findings indicate that the reversibility of end-organ morbidities induced by OSA is not only contingent on restoration of normal oxygenation patterns but can be further enhanced by targeting other OSA-mediated detrimental cellular processes, such as accelerated senescence. [ABSTRACT FROM AUTHOR]

Summary Obstructive sleep apnea (OSA) is common in sickle cell disease (SCD) despite the absence of overweight, suggesting a specific pathophysiology. We previously showed that otherwise healthy children with increased pharyngeal compliance, a main endotype of OSA, exhibited decreased sympathetic modulation. Our objective was to assess whether modifications of heart rate variability (HRV) and compliance are associated in SCD. Cases (children with SCD, African or Caribbean ethnicity) and controls (otherwise healthy children, same ethnicity), aged 4–18 years, were selected from our database of children referred for OSA and matched for sex, age, and obstructive apnea–hypopnoea index (OAHI) score. The children underwent polysomnography and acoustic pharyngometry (to compute compliance). HRV analyses were performed from 5 min ECG recordings in wakeful, NREM, and REM sleep states and from the whole night. Twenty‐one pairs were analysed (median age 10.5 years, 24 girls). Children with SCD had lower BMI z‐scores and more tonsil hypertrophy than control children. Children with SCD and OSA (OAHI ≥2/hour) were characterised by lower compliance than children with SCD without OSA. An inverse relationship between compliance and SD2 (HRV from whole night, inversely related to sympathetic modulation) was evidenced (negative relationship in SCD: R = −0.63, p = 0.002 vs. positive relationship in controls R = 0.59, p = 0.006). In conclusion, while the decrease in sympathetic modulation in control children may contribute to increasing pharyngeal compliance, its decrease seems protective in children with sickle cell disease, which underlines the specificity of OSAS pathophysiology in SCD that could be due to sickle cell disease related smooth muscle dystonia. [ABSTRACT FROM AUTHOR]

Background: Reaching consensus on decision-making in surgical management and peri-operative considerations regarding snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the management of patients with such conditions, where there is a large degree of variability. Methods: A set of statements was developed based on the literature and circulated among eight panel members of European experts, utilizing the Delphi method. Responses were provided as agree and disagree on each statement, and the comments were used to assess the level of consensus and develop a revised version. The new version, with the level of consensus and anonymized comments, was sent to each panel member as the second round. This was repeated for a total of five rounds. Results: The final set included a total of 71 statements: 29 stand-alone and 11 with 42 sub-statements. On the 33 statements regarding decision-making in surgical management, there was 60.6%, 27.3%, and 6.1% consensus among all eight, seven, and six panelists, respectively. On the 38 statements regarding the peri-operative considerations, there was 55.3%, 18.4%, and 15.8% consensus among all eight, seven, and six panelists, respectively. Conclusions: These results indicate the need for an expanded review of the literature and discussion to enhance consensus among the sleep surgeons that consider surgical management in patients with snoring and OSA. [ABSTRACT FROM AUTHOR]

• The respiratory arousal threshold does not differ between apneic patients with and without epilepsy. • The arousal related heart rate increase after obstructive apnea is less pronounced in patients with drug-resistant epilepsy. • Late post-arousal parasympathetic activation is increased in patients with drug-resistant epilepsy. Sudden and unexpected deaths in epilepsy (SUDEP) pathophysiology may involve an interaction between respiratory dysfunction and sleep/wake state regulation. We investigated whether patients with epilepsy exhibit impaired sleep apnea-related arousals. Patients with drug-resistant (N = 20) or drug-sensitive (N = 20) epilepsy and obstructive sleep apnea, as well as patients with sleep apnea but without epilepsy (controls, N = 20) were included. We explored (1) the respiratory arousal threshold based on nadir oxygen saturation, apnea-hypopnea index, and fraction of hypopnea among respiratory events; (2) the cardiac autonomic response to apnea/hypopnea quantified as percentages of changes from the baseline in RR intervals (RRI), high (HF) and low (LF) frequency powers, and LF/HF. The respiratory arousal threshold did not differ between groups. At arousal onset, RRI decreased (-9.42%) and LF power (179%) and LF/HF ratio (190%) increased. This was followed by an increase in HF power (118%), p < 0.05. The RRI decrease was lower in drug-resistant (-7.40%) than in drug-sensitive patients (-9.94%) and controls (-10.91%), p < 0.05. LF and HF power increases were higher in drug-resistant (188%/126%) than in drug-sensitive patients (172%/126%) and controls (177%/115%), p < 0.05. Cardiac reactivity following sleep apnea is impaired in drug-resistant epilepsy. This autonomic dysfunction might contribute to SUDEP pathophysiology. [ABSTRACT FROM AUTHOR]

This study examines associations between sleep apnea risk and hypertension in a sample of immigrant Chinese and Korean Americans. The dataset included Chinese and Korean patients ages 50–75 recruited from primary care physicians' offices from April 2018 to June 2020 in the Baltimore-Washington DC Metropolitan Area (n = 394). Hypertension risk was determined using a combination of blood pressure measurements, self-reported diagnosis of hypertension by a medical professional, and/or self-reported use of antihypertensive medications. Linear regression models examined the associations between sleep apnea risk and blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Poisson regression models examined associations sleep apnea risk and hypertension. Models controlled for body mass index (BMI), demographic, and socioeconomic risk factors. We further examined models for potential effect modification by age, gender, Asian subgroup, and obesity, as well as effect modification of daytime sleepiness on the association between snoring and hypertension risk. High risk of sleep apnea appeared to be associated positively with SBP (β = 6.77, 95% CI: 0.00–13.53), but not with DBP. The association was positive for hypertension, but it was not statistically significant (PR = 1.11, 95% CI: 0.87–1.41). We did not find effect modification of the associations between sleep apnea and hypertension risk, but we did find that daytime sleepiness moderated the effect of snoring on SBP. Snoring was associated with higher SBP, primarily in the presence of daytime sleepiness, such that predicted SBP was 133.27 mmHg (95% CI: 126.52, 140.02) for someone with both snoring and daytime sleepiness, compared to 123.37 mmHg (95% CI: 120.40, 126.34) for someone neither snoring nor daytime sleepiness. Chinese and Korean immigrants living in the U.S. who are at high risk of sleep apnea have higher SBP on average, even after accounting for sociodemographic characteristics and BMI. : NCT03481296, date of registration: 3/29/2018 [ABSTRACT FROM AUTHOR]

Purpose: This study explores the potential of the Chat-Generative Pre-Trained Transformer (Chat-GPT), a Large Language Model (LLM), in assisting healthcare professionals in the diagnosis of obstructive sleep apnea (OSA). It aims to assess the agreement between Chat-GPT's responses and those of expert otolaryngologists, shedding light on the role of AI-generated content in medical decision-making. Methods: A prospective, cross-sectional study was conducted, involving 350 otolaryngologists from 25 countries who responded to a specialized OSA survey. Chat-GPT was tasked with providing answers to the same survey questions. Responses were assessed by both super-experts and statistically analyzed for agreement. Results: The study revealed that Chat-GPT and expert responses shared a common answer in over 75% of cases for individual questions. However, the overall consensus was achieved in only four questions. Super-expert assessments showed a moderate agreement level, with Chat-GPT scoring slightly lower than experts. Statistically, Chat-GPT's responses differed significantly from experts' opinions (p = 0.0009). Sub-analysis revealed areas of improvement for Chat-GPT, particularly in questions where super-experts rated its responses lower than expert consensus. Conclusions: Chat-GPT demonstrates potential as a valuable resource for OSA diagnosis, especially where access to specialists is limited. The study emphasizes the importance of AI-human collaboration, with Chat-GPT serving as a complementary tool rather than a replacement for medical professionals. This research contributes to the discourse in otolaryngology and encourages further exploration of AI-driven healthcare applications. While Chat-GPT exhibits a commendable level of consensus with expert responses, ongoing refinements in AI-based healthcare tools hold significant promise for the future of medicine, addressing the underdiagnosis and undertreatment of OSA and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Cardiac remodeling is a life-long process in hypertrophic cardiomyopathy (HCM), and if uncontrolled, would cause substantial morbidity and mortality. Sleep apnea (SA) is a common comorbidity in HCM. This study aimed to investigate the relationship between SA and cardiac remodeling in a large series of patients with HCM. A total of 606 patients with HCM who underwent sleep evaluations at Fuwai Hospital were included. Parameters of cardiac remodeling were evaluated by echocardiographic studies. SA was present in 363 (59.9%) patients. Left ventricular (LV) end-diastolic diameter (P < 0.001), left atrial (LA) diameter (P = 0.024), ascending aortic diameter (P < 0.001) all increased and maximal end-diastolic wall thickness (P < 0.001) decreased with the severity of SA. After adjustment for sex, age, body mass index, hypertension, hyperlipidemia, diabetes, coronary artery disease and cigarette use, log (apnea-hypopnea index+1) was independently correlated with increasing LV end-diastolic diameter (β = 0.729, P = 0.003) and deceasing maximal end-diastolic wall thickness (β = −0.503, P = 0.009). Log (percentage of total sleep time spent with oxygen saturation<90% + 1) was independently correlated with increasing LV end-diastolic diameter (β = 0.609, P = 0.004) and LA diameter (β = 0.695, P = 0.006). Severity of SA (severe SA with odds ratio, 2.38; 95% CI, 1.20–4.70; P = 0.013), log (apnea-hypopnea index+1) (OR, 1.28; 95% CI, 1.01–1.63; P = 0.045) and log (percentage of total sleep time spent with oxygen saturation<90% + 1) (OR, 1.31; 95% CI, 1.08–1.59; P = 0.006) were also independently associated with LV enlargement. Severity of SA is independently associated with cardiac remodeling indicating a trend toward enlarged chamber size and thinned wall. Clinical trials are required to determine whether treatment of SA improves cardiac remodeling and long-term outcomes in patients with HCM. • Sleep apnea was quite common with a prevalence of 59.9% in patients with HCM. • Sleep apnea was associated with enlarged chamber size and thinned wall thickness in HCM. • Severity of sleep apnea was an independent risk factor for cardiac remodeling. [ABSTRACT FROM AUTHOR]

Summary: Obstructive sleep apnea (OSA) is commonly observed in children with Down syndrome (DS) and may affect their physical and psychological development. Currently, adenotonsillectomy is the first line treatment option for paediatric patients with OSA. However, surgical outcomes for such patients are not satisfactory. In this study, we analysed the efficacy and safety of adenotonsillectomy in the treatment of children with obstructive sleep apnea and Down syndrome. We systematically searched the PubMed, Web of Science, EMBASE, and the Cochrane databases and pooled data from nine relevant studies involving 384 participants. Subsequently, we analysed four outcomes in polysomnography, namely: net postoperative changes in the apnea–hypopnea index (AHI), the minimum oxygen saturation, sleep efficiency, and arousal index. Meta‐analysis of the AHI showed a decrease of 7.18 events/h [95% CI (−9.69, −4.67) events/h; p < 0.00001] and an increase in the minimum oxygen saturation of 3.14% [95% CI (1.44, 4.84) %; p = 0.0003]. There was no significant increase in sleep efficiency [MD 1.69%, 95% CI (−0.59, 3.98) %; p = 0.15], but the arousal index significantly decreased by −3.21 events/hour [95% CI (−6.04, −0.38) events/h; p < 0.03]. In addition, the overall success rate was 16% (95% CI, 12%–21%) for postoperative AHI < 1 and 57% (95% CI, 51%–63%) for postoperative AHI <5. The postoperative complications recorded included airway obstruction and bleeding. This study demonstrated the efficacy of adenotonsillectomy as a treatment option for OSA. However, it is important to note that residual OSA and potential postoperative complications require further attention in future studies. [ABSTRACT FROM AUTHOR]

In this study, it was aimed to find out whether electroencephalographic (EEG) frequency bands can be used to distinguish people with obstructive sleep apnea (OSA) from those who do not have it. 11842 different cases taken from 121 patients suffering from OSA were combined with the case study of 30-person control group without sleep apnea. Apneas were highlighted at the respiration-record channels and EEG records which are concurrent with abnormal respiration cases were extracted from C4-A1 and C3-A2. Following that, they were examined with Fourier and Wavelet Transforms using a new software that was developed by us. The percentage values of Delta (0, 5-4 Hz), Theta (4-8 Hz), Alpha (8-13 Hz) and Beta (13-30 Hz) frequency bands were evaluated with the help of t-test and ROC Analysis to differentiate between apneas. The C3-A2 Beta (%) frequency level gave the highest distinguishing asset (AUC=0.662; p<0.001); however, the C3-A2 Alpha (%) level yielded the lowest distinguishing (AUC=0.536; p<0.001). Similarly, the C4-A1 Alpha (%) level produced the lowest distinguishing asset (AUC=0.536; p<0.001) whereas the C4-A1 Beta (%) frequency level gave the highest distinguishing asset (AUC=0.658; p<0.001). The chief finding of this study suggests that the EEG rates of patients with OSA differ from those of patients without OSA and following the changes at these channels may give rise to detection of apneas, and the Beta (%) yielded the most meaningful result among four different frequency bands in the study. [ABSTRACT FROM AUTHOR]

To explore the correlation between blood pressure variability（BPV）and vascular endothelial function induced by nocturnal hypoxia events in obstructive sleep apnea（OSA）patients. Methods：Between February 2022 and April 2023，a total of 131 moderate to severe OSA patients were studied from the departments of Sleep Medicine Centers in three different hospitals， including the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University，etc. Continuous non-invasive blood pressure （BP）monitoring was performed simultaneously during polysomnography（PSG）to calculate BPV induced by hypoxic events，the gap between the peak value of systolio blood pressure（SBP）and the lowest SBP during a hypoxia event reflects the amplitude of BP fluctuation（ΔBP）；the number of times ΔBP≥10 mmHg per hour/oxygen desaturation index（ODI）indicates the percentage of hypoxia-induced BP fluctuation. Endothelial function was assessed by flow -mediated dilation（FMD），and patients were divided into normal endothelial function group（n=70）and endothelial dysfunction group（n=61）according to the FMD value. The study analyzed and compared the BPV parameters between the two groups，aiming to explore the factors associated with BPV. Results：There were no significant differences between the two groups of patients in age，sex distribution，body mass index，and OSA severity. Compared with the normal endothelial function group，the endothelial dysfunction group exhibited higher Bnocturnal systolic peak BP［（152.0±7.2） mmHg vs.（148.1±8.8）mmHg］，nocturnal diastolic peak BP［（89.8±5.7）mmHg vs.（87.5±6.6）mmHg］，ΔBP［（15.3±2.9）mmHg vs. （13.3±2.7）mmHg］，the percentage of BP fluctuation［（63.5±14.3）% vs.（44.8±10.7）%，all P < 0.05］，a n d endothelin-1［（50.7± 7.0）ng/L vs.（47.8 ± 8.5）ng/L，P < 0.05］. After adjusting the baseline data of patients，the line regression model showed that the nocturnal SBP peak，the percentage of BP fluctuation，and ΔBP were all positively correlated with FMD（all P < 0.05）. Conclusion：For moderate-to-severe OSA patients，the elevation of BPV induced by nocturnal hypoxia events is closely correlated to vascular endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well‐being, which potentially affect the quality of life. This study aimed to investigate the health‐related general, oral and orthognathic quality of life, jaw function and sleep‐disordered breathing at different stages of orthognathic surgical treatment. Methods: A total of 120 consecutive patients with DFD were recruited and grouped as pre‐orthodontic treatment (group 1), pre‐surgery (group 2), 4 months post‐surgery (group 3), 24 months post‐surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF‐36), Oral Health Impact (OHIP‐14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP‐Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal–Wallis test, Tukey post hoc test and structural equation modelling (SEM). Results: Results revealed SF‐36 (p =.814) and STOP‐Bang (p =.143) total scores did not differ between control and treatment groups. In contrast, OHIP‐14, OQLQ and JFLS total scores differed between groups (p =.001). Higher scores were observed in groups 1 (p =.001), 2 (p =.001) and 3 (p =.041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health‐related quality of life was better, and OHIP‐14 (p =.936) and JFLS (p =.572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p =.001) but higher than group 0 (p =.013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP‐14 with OQLQ; OHIP‐14 with SF‐36; and finally STOP‐Bang with SF‐36. Positive associations were observed between JFLS and OHIP‐14; OHIP‐14 and OQLQ. Conclusion: Oral health‐related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health‐related quality of life. [ABSTRACT FROM AUTHOR]

This systematic review aimed to investigate the factors that may contribute to the development of OSA after orthognathic surgery in patients with skeletal class III. Electronic searches of PubMed, Embase, Web of Science, and Cochrane databases were conducted up to December 10, 2022. In total, 277 studies were retrieved and screened according to the inclusion and exclusion criteria, and 14 were finally selected. All studies were of medium quality (moderate risk of bias). The occurrence of OSA after orthognathic surgery in patients with class III skeletal relationships depends on surgical factors and patient self-factors. Surgical factors include surgery type, amount of maxillary and mandibular movement, and the patient's postoperative swelling. Patient self-factors include weight, age, gender, and hypertrophy of the soft palate, tonsils, and tongue. According to information in the 14 selected articles, the incidences of OSA after Le Fort I impaction and BSSO setback, BSSO setback, and Le Fort I advancement and BSSO setback were 19.2%, 8.57%, and 0.7%, respectively, mostly accompanied with greater amounts of mandibular recession. However, no clear evidence exists to confirm that orthognathic surgery is a causative factor for postoperative sleep breathing disorders in patients with mandibular prognathism. The wider upper airway in patients with class III skeletal might be the reason for the rare occurrence of OSA after surgery. In addition, obesity and advanced age may lead to sleep apnea after orthognathic surgery. Obese patients should be advised to lose weight preoperatively. [ABSTRACT FROM AUTHOR]

Sleep apnea has emerged as a significant health issue in modern society, with self-diagnosis and effective management becoming increasingly important. Among the most renowned methods for self-diagnosis, the STOP-BANG questionnaire is widely recognized as a simple yet effective tool for diagnosing and assessing the risk of sleep apnea. However, its sensitivity and specificity have limitations, necessitating the need for tools with higher performance. Consequently, this study aimed to enhance the accuracy of sleep apnea diagnoses by integrating machine learning with the STOP-BANG questionnaire. Research through actual cases was conducted based on the data of 262 patients undergoing polysomnography, confirming sleep apnea with a STOP-BANG score of ≥3 and an Apnea–Hypopnea Index (AHI) of ≥5. The accuracy, sensitivity, and specificity were derived by comparing Apnea–Hypopnea Index scores with STOP-BANG scores. When applying machine learning models, four hyperparameter-tuned models were utilized: K-Nearest Neighbor (K-NN), Logistic Regression, Random Forest, and Support Vector Machine (SVM). Among them, the K-NN model with a K value of 11 demonstrated superior performance, achieving a sensitivity of 0.94, specificity of 0.85, and overall accuracy of 0.92. These results highlight the potential of combining traditional STOP-BANG diagnostic tools with machine learning technology, offering new directions for future research in self-diagnosis and the preliminary diagnosis of sleep-related disorders in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. Methods: A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. Results: Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p <.00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p >.05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p <.001). Conclusions: A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d [ABSTRACT FROM AUTHOR]

Study Objectives: The aim of this cross-sectional study is to explore the association between serum 25-hydroxyvitamin D [25(OH)D] levels, a marker of Vitamin D status, and excessive daytime sleepiness (EDS), expressed as increased scores of the Epworth Sleepiness Scale (ESS), in a group of prospectively enrolled patients with obstructive sleep apnea (OSA). Methods: Newly diagnosed patients with OSA, divided into two groups, those with EDS (ESS > 10) and those without EDS (ESS < 10). All patients underwent night polysomnography. Measurement of serum 25(OH)D vitamin was performed using a radioimmunoassay. Results: In total, 217 patients with OSA (197 males and 20 females) were included. Patients with EDS had higher AHI (p < 0.001) values and lower mean serum 25(OH)D levels, compared with those of non-somnolent patients [17.4 (12.2–25.7) versus 21.1 (15.3–28.8) ng/mL, respectively, p = 0.005]. In patients with EDS, serum 25(OH)D levels correlated with average oxyhemoglobin saturation during sleep (r = 0.194, p = 0.043), and negatively with ESS score (r = −0.285, p = 0.003), AHΙ (r = −0.197, p = 0.040) and arousal index (r = −0.256, p = 0.019). Binary regression analysis identified Vit D serum levels (β = −0.045, OR: 0.956, 95% CI: 0.916–0.997, p = 0.035), total sleep time (β = 0.011, OR: 1.011, 95% CI: 1.002–1.021, p = 0.016) and AHI (β = 0.022, OR: 1.022, 95% CI: 1.003–1.043, p = 0.026) as independent predictors of EDS in patients with OSA. In patients with EDS, multiple regression analysis indicated that ESS score was negatively associated with Vit D serum levels (β = −0.135, p = 0.014) and minimum oxyhemoglobin saturation during sleep (β = −0.137, p = 0.043). Conclusions: In the present study, EDS in patients with OSA is associated with low levels of Vitamin D, while sleep hypoxia may play a role in this process. [ABSTRACT FROM AUTHOR]

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

Background: Observational studies indicate that sleep apnea is associated with non‐alcoholic fatty liver disease (NAFLD) and its related metabolic features, independent of confounding factors including obesity. However, the causal relationships remain to be determined. Methods: Univariable and multivariable Mendelian randomization (MR) analyses were performed to investigate the causal relationship between sleep apnea and NAFLD, along with its typical features including liver function, glycemic traits and lipid profiles. Summary‐level data for sleep apnea were obtained from the Finngen consortium (33,423 cases and 307,648 controls). Summary‐level data for NAFLD were available from a GWAS meta‐analysis (8434 cases and 770,180 controls), and data for 12 NAFLD‐related features from corresponding published GWASs. The inverse variance weighted (IVW) analysis was employed as the primary statistical method. Bidirectional MR and CAUSE analysis were conducted to avoid reverse causality and false positive findings. Results: In univariable MR analyses, we found evidence to support a causal effect of genetically predicted sleep apnea on NAFLD (OR = 1.50, 95% CI = 1.18–1.91) and HDL‐C (β = −0.045, 95% CI = ‐0.090 to −0.001). In reverse MR, genetically predicted serum TG was associated with an increased risk of sleep apnea (OR = 1.07, 95% CI = 1.02–1.12), while genetically predicted HDL‐C was associated with a decreased risk of sleep apnea (OR = 0.93, 95% CI = 0.89–0.98). After adjusting body mass index or educational attainment, none of these causal associations were retained. However, CAUSE method and MR analyses focusing on lipoprotein subfractions supported a causal effect of sleep apnea on HDL‐C and HDL subfractions. Conclusion: This MR study indicated that sleep apnea has no direct causal association with NAFLD, elevated liver enzymes and insulin resistance. Our results showed suggestive inverse associations of genetically predicted sleep apnea on HDL‐C and HDL subfractions, indicating that both HDL‐C levels and HDL function may be causally implicated in sleep apnea. [ABSTRACT FROM AUTHOR]

Sleep apnea is probably the most common respiratory disorder; respiration and blood oxygen saturation (SpO2) are major concerns in sleep apnea and are also the two main parameters checked by polysomnography (PSG, the gold standard for diagnosing sleep apnea). In this study, we used a simple, non-invasive monitoring system based on photoplethysmography (PPG) to continuously monitor SpO2 and heart rate (HR) for individuals at home. Various breathing experiments were conducted to investigate the relationship between SpO2, HR, and apnea under different conditions, where two techniques (empirical formula and customized formula) for calculating SpO2 and two methods (resting HR and instantaneous HR) for assessing HR were compared. Various adaptive filters were implemented to compare the effectiveness in removing motion artifacts (MAs) during the tests. This study fills the gap in the literature by comparing the performance of different adaptive filters on estimating SpO2 and HR during apnea. The results showed that up-down finger motion introduced more MA than left-right motion, and the errors in SpO2 estimation were increased as the frequency of movement was increased; due to the low sampling frequency features of these tests, the insertion of adaptive filter increased the noise in the data instead of eliminating the MA for SpO2 estimation; the normal least mean squares (NLMS) filter is more effective in removing MA in HR estimation than other filters. [ABSTRACT FROM AUTHOR]

This study presents an innovative, non-invasive sleep monitoring system that employs force-sensing resistors (FSRs) embedded in a pillow sheet to analyze sleep quality and detect sleep-related breathing disorders (SDB), offering an alternative to conventional polysomnography (PSG). We employed a comprehensive methodology, integrating FSRs with a wireless network device and dedicated software for real-time, precise data analysis and storage. The FSRs, calibrated to measure biomechanical signals associated with body movement, are integrated with a wireless network device. The experiment involved twenty-seven subjects diagnosed with sleep apnea, and the results were compared with PSG recordings. The intelligent sleep application recorded various sleep metrics, including sleep efficiency (SE), and respiratory rhythm. A regression analysis revealed a strong correlation (R2 = 0.96) between the SE measured by the PSG device and the pillow-sheet sensor systems, confirming the reliability of the latter. The Bland-Altman plot further supported this consistency. In conclusion, the pillow-sheet embedded with FSR sensors is a promising tool for unobtrusive sleep monitoring and SDB detection. It offers comparable accuracy to PSG, with the added benefits of being user-friendly and nonrestrictive, making it suitable for clinical and home settings. The system's ability to provide insights into sleep patterns, detect apnea episodes, and analyze sleep postures presents a significant advancement in sleep research and medicine, with potential applications in personalized sleep health management. [ABSTRACT FROM AUTHOR]

D-transposition of the great arteries (d-TGA) is surgically repaired with the arterial switch operation (ASO) with excellent results, however short and long-term morbidities still develop including neurocognitive delay. Clinically significant central sleep apnea is uncommon in non-premature infants, but when present indicates immature autonomic control of respiration likely due to a neurologic disorder. We report the unanticipated finding of central sleep apnea in four-term neonates with d-TGA after uncomplicated ASO, with the short-term complication of delayed hospital discharge and long-term concerns regarding this early marker of brain immaturity and its hindrance to normal development. Within this report, we will review each patient's clinical course and then examine the literature on pediatric central sleep apnea, neurodevelopmental outcomes after ASO, and the important overlap of these entities in the care of patients going forward. [ABSTRACT FROM AUTHOR]

Preclinical and human physiological studies indicate that topical, selective TASK 1/3 K+ channel antagonism increases upper airway dilator muscle activity and reduces pharyngeal collapsibility during anesthesia and nasal breathing during sleep. The primary aim of this study was to determine the effects of BAY2586116 nasal spray on obstructive sleep apnea (OSA) severity and whether individual responses vary according to differences in physiological responses and route of breathing. Ten people (5 females) with OSA [apnea-hypopnea index (AHI) = 47 ± 26 events/h (means ± SD)] who completed previous sleep physiology studies with BAY2586116 were invited to return for three polysomnography studies to quantify OSA severity. In random order, participants received either placebo nasal spray (saline), BAY2586116 nasal spray (160 lg), or BAY2586116 nasal spray (160 µg) restricted to nasal breathing (chinstrap or mouth tape). Physiological responders were defined a priori as those who had improved upper airway collapsibility (critical closing pressure ≥2 cmH2O) with BAY2586116 nasal spray (NCT04236440). There was no systematic change in apnea-hypopnea index (AHI3) from placebo versus BAY2586116 with either unrestricted or nasal-only breathing versus placebo (47 ± 26 vs. 43 ± 27 vs. 53 ± 33 events/h, P = 0.15). However, BAY2586116 (unrestricted breathing) reduced OSA severity in physiological responders compared with placebo (e.g., AHI3 = 28 ± 11 vs. 36 ± 12 events/h, P = 0.03 and ODI3 = 18 ± 10 vs. 28 ± 12 events/h, P ¼ 0.02). Morning blood pressure was also lower in physiological responders after BAY2586116 versus placebo (e.g., systolic blood pressure = 137 ± 24 vs. 147 ± 21 mmHg, P < 0.01). In conclusion, BAY2586116 reduces OSA severity during sleep in people who demonstrate physiological improvement in upper airway collapsibility. These findings highlight the therapeutic potential of this novel pharmacotherapy target in selected individuals. [ABSTRACT FROM AUTHOR]

The levels of low-density lipoprotein (LDL) cholesterol in plasma are important risk factors for coronary heart disease. Several reports suggest that elevated plasma cholesterol is associated with cardiac arrhythmias. In a subsequent study investigating LDL cholesterol levels and the frequency of LDL cholesterol measurements, a positive correlation was observed between the severity of sleep apnea and visit-to-visit LDL cholesterol variability. Our objective was to assess the effects of hypercholesterolemia on cardiac autonomic activity, disordered sleep patterns, and increased incidence of arrhythmias in freely moving rats. Wireless transmission of polysomnographic recordings was performed in control and high cholesterol male rats during normal daytime sleep. Spectral analyses were conducted on the electroencephalogram and electromyogram (EMG) recordings to distinguish active waking, quiet sleep, and paradoxical sleep. Heart rate variability power spectrum analysis was used to measure cardiac autonomic activity. The high cholesterol group exhibited a higher low-frequency (LF)/high-frequency (HF) power ratio during all sleep stages compared to the control group. Additionally, the frequency of sleep interruptions was increased in the high cholesterol group compared to the control group. Our results show significant sleep fragmentation with sympathetic hyperactivity after exposure to high cholesterol. This indicates that high cholesterol may increase the risk of sleep apnea and poor sleep quality by disrupting autonomic homeostasis. • High cholesterol in rats increased sympathetic activity, especially during the QS stage, impacting the autonomic system. • This finding suggests that lowering cholesterol may improve sleep quality in patients with hypercholesterolemia. • In our study, this finding suggests that hypercholesterolemia may increase the risk for worsen sleep-related arrhythmia. [ABSTRACT FROM AUTHOR]

This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place. Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses. Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered cost-effective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results. CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country. • In Brazil, the lack of a national guideline to orientate the lines of care of obstructive sleep apnea promotes inequity and inefficiency. • This present cost-utility analysis demonstrates that continuous positive airway pressure (CPAP) therapy for moderate to severe obstructive sleep apnea is cost-effective in the public health system, if the modality for CPAP obtention is purchase, but not for the leasing modality. • Our findings should underpin the decision making related to the design of programs for the provision of CPAP therapy in the public health system in Brazil, to expand access to treatment in a more efficient way. [ABSTRACT FROM AUTHOR]

Sleep apnea is not easy to diagnose. Electrocardiography (ECG) signals are broadly used to identify and analyze different types of sleep disorders. For detection of sleep apnea, the multi-feature analysis is an encouraging means to assist recognize the characteristic nonoverlapping apnea and non-apnea events. This study consists of the following steps: 1) segmenting non-overlapping apnea and non-apnea events, (2) investigating beat by beat of ECG signal to identify and calculate RR interval, (3) feature extraction to deeply based time, frequency, and non-linear analysis approach, and (4) classifying apnea and non-apnea using the various kernel of support vector. To address this issue, we created an optimal SVM model classifier to investigate the utility of patterns in predicting apnea and non-apnea occurrences. Our system with RBF kernel function of SVM is achieved to have an area under the curve (AUC), the classification accuracy (CA), F1 score, precision, the recall of 0.836, 0.851, 0.85, 0.86, 0.851 respectively in labelling ECG signal into apnea or non-apnea events. [ABSTRACT FROM AUTHOR]

Clinical calculators can provide patient-personalized estimates of treatment risks and health outcomes. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) set out to create a publicly available tool to assess both short-term postoperative risk and long-term benefits for prospective adult patients eligible for 1 of 4 primary bariatric procedures. The calculator is comprised of multiple prediction elements: (1) 30-day postoperative risk, (2) 1-year body mass index projections, and (3) 1-year comorbidity remission. To assess the performance of the 1-year comorbidity remission prediction feature of the calculator. Not-for-profit organization clinical data registry. MBSAQIP data across 4.5 years from 240,227 total patients indicating at least 1 comorbidity of interest present preoperatively and who had a 1-year follow-up record documenting their comorbidity status were included. Six models were constructed, stratified by the presence of the respective preoperative comorbidity: hypertension, hyperlipidemia, gastroesophageal reflux disease, sleep apnea, non-insulin-dependent diabetes, and insulin-dependent diabetes. A multinomial logistic regression model was used to predict 1-year remission (total, partial, or no remission) of insulin-dependent diabetes. All other outcomes were binary (yes or no at 1 yr), and ordinary logistic regression models were used. All models showed adequate discrimination (C statistics ranging from.58 to.68). Plots of observed versus predicted remission (%) showed excellent calibration across all models. All remission models were well calibrated with sufficient discrimination. The MBSAQIP Bariatric Surgical Risk/Benefit Calculator is a publicly available tool intended for integration into clinical practice to enhance patient–clinician discussions and informed consent. • The Bariatric Surgical Risk/Benefit Calculator predicts 1-year comorbidity remission • 1-year predicted (%) and observed remission (%) aligned for all comorbidities • All remission models were well calibrated with adequate discrimination • This tool enhances evidence-based decision making and promotes informed consent [ABSTRACT FROM AUTHOR]

• Whether dapagliflozin is beneficial in patients with sleep apnea and heart failure, across the range of ejection fractions, is unknown. • In a pooled individual-level meta-analysis of DAPA-HF and DELIVER, investigator-reported sleep apnea was associated with a greater risk of worsening heart failure events. • Dapagliflozin, compared with placebo, reduced the risk of clinical outcomes and improved health-related quality of life in patients with and without sleep apnea. Sleep apnea is more common in patients with heart failure (HF) than in the general population, but little is known about its association with clinical outcomes in various HF phenotypes or how it might modify the effect of HF therapy. To examine the prevalence of sleep apnea, its association with outcomes and the effects of dapagliflozin in patients with HF with and without sleep apnea in a pooled analysis of 2 trials comparing dapagliflozin to placebo in HFrEF (DAPA-HF trial) and HFmrEF/HFpEF (DELIVER trial). A history of sleep apnea was investigator-reported. The primary outcome was a composite of worsening HF or cardiovascular death. The prevalence of sleep apnea was 5.7% and 7.8% in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome occurred at a rate of 16.0 in participants with sleep apnea compared to 10.6 per 100 person-years in those without (adjusted HR 1.29 [95%CI, 1.10–1.52]). Compared with placebo, dapagliflozin reduced the risk of the primary endpoint to the same extent in patients with (HR 0.78 [95% CI, 0.59–1.03]) and without sleep apnea (HR 0.79 [0.72–0.87]) [P interaction = 0.93]. The beneficial effects of dapagliflozin on other clinical outcomes and symptom burden, physical function, and quality of life were consistent in participants with and without sleep apnea. In DAPA-HF and DELIVER, the true prevalence of sleep apnea was likely underestimated. An investigator-reported history of sleep apnea was associated with higher rates of worsening HF events. The benefits of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea. Unique identifiers: NCT01920711 In a pooled analysis of the DAPA-HF and DELIVER trials of more than 11,000 patients with heart failure (HF) across the range of ejection fractions, an investigator-reported history of sleep apnea was associated with higher rates of worsening HF events but not mortality. The beneficial effects of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea. These findings provide further evidence for dapagliflozin as a new treatment option for patients with heart failure across the range of ejection fractions. [ABSTRACT FROM AUTHOR]