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OBJECTIVE: Central sleep apnea (CSA) is a rare condition in children; however, it can cause significant morbidity if not diagnosed early. We aimed to increase the knowledge about CSA in children by describing the clinical characteristics of children diagnosed with CSA at our sleep center. MATERIAL AND METHODS: We retrospectively reviewed 1263 polysomnographies (PSG) performed between 2012 and 2023 at our tertiary sleep center and evaluated the clinical characteristics of the patients with CSA. Underlying diseases, clinical symptoms, sleep parameters, and short-term management of the patients were recorded. RESULTS: Of the 1263 patients aged between 1 month and 18 years, 122 (9.65%) had CSA, with 54.9 % (n = 67) of them being female. Only 56.6% (n = 69) of the patients' parents had reported a symptom indicating sleep-disordered breathing. The most common underlying disease was genetic, including Down and Prader-Willi syndromes, followed by neurological diseases. Obstructive sleep apnea was detected in addition to CSA in 103 of the patients (84.4%). Bi-level positive airway pressure with a backup rate was the most common treatment modality. CONCLUSION: While CSA is a rare clinical condition in children, it occurs more commonly in those with an underlying disease. Awareness of the disease and timely referral of the patients for sleep studies are critical to prevent long-term sequelae. [ABSTRACT FROM AUTHOR]

Noninvasive respiratory support delivered through a face mask has become a cornerstone treatment for adults and children with acute or chronic respiratory failure. However, an imperfect mask fit by using commercially available interfaces is frequently encountered, which may result in patient discomfort and treatment inefficiency or failure. To overcome this challenge, over the past decade, increasing attention has been given to the development of personalized face masks, which are custom-made to address the specific facial dimensions of an individual patient. With this scoping review, we aim to provide a comprehensive overview of the current advances and gaps in knowledge with regard to the personalization masks for CPAP and NIV. We performed a systematic search of the literature and identified and summarized a total of 23 studies. Most studies included were involved in the development of nasal masks. Studies that targeted adult respiratory care mainly focused on chronic (home) ventilation and included some clinical testing in a relevant subject population. In contrast, pediatric studies focused mostly on respiratory support in the acute setting, whereas testing was limited to bench or case studies only. Most studies were positive with regard to the performance (ie, comfort, level of air leak, and mask pressure applied to the skin) of personalized masks in bench testing or in human, healthy or patient, subjects. Advances in the field of 3-dimensional scanning and soft material printing were identified, but important gaps in knowledge remain. In particular, more insight into cushion materials, headgear design, clinical feasibility, and cost-effectiveness is needed before definite recommendations can be made with regard to implementation of large-scale clinical programs that personalize noninvasive respiratory support masks for adults and children. [ABSTRACT FROM AUTHOR]

Genioglossus advancement is a surgical technique performed to treat obstructive sleep apnea. The genial tubercle, where the genioglossus muscle attaches, is not visible during dissection due to its location on the posterior mandible. Computer-aided design, particularly for the production of cutting guides, has arisen as a modern modification in the procedure to support accurate location of the tubercle. This study aims to demonstrate the utility of cutting guides designed by virtual surgical planning in a series of 7 genioglossus advancement cases. Computed Tomography (CT) data were preoperatively collected and rendered in three-dimension. The surgeon designed patient-specific cutting guides, registered to the occlusion, to ensure the genial tubercle was included in the osteotomy and stayed below the incisor tooth roots. These surgical guides were then 3D-printed. All the virtual surgical planning-designed guides fit appropriately, the genial tubercle was successfully included in the osteotomy in all cases, and no tooth roots were injured. We conclude that occlusal-based 3D printed cutting guides are a useful adjunct to help guide a genioglossus advancement procedure by accurately incorporating the genial tubercle. This provides a safe way to concurrently address correction of obstructive sleep apnea in patients undergoing other procedures. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the effects of two different mandibular advancement devices on the upper airway volume, polysomnographic parameters, and sleepiness scale scores in patients with obstructive sleep apnea and Temporomandibular disorders (TMD). Materials and methods: Monoblock and twinblock mandibular advancement devices were applied to patients with obstructive sleep apnea syndrome for 3 months separated by a wash-out period of 2 weeks. Research Diagnostic Criteria for TMD (RDC/TMD), Polysomnographic parameters and cone-beam computed tomography findings were recorded before and after the use of the mandibular advancement devices. A three-dimensional analysis of the airway was then performed. Results: The use of the monoblock device significantly increased the upper airway volume compared with the use of the twinblock device (p = 0.032). The polysomnographic parameters similarly improved with the use of the twin-block and monoblock devices. The significant reduction in TMD symptoms was observed. Conclusion: The use of the monoblock device increased the retropalatal airway volume. This volume increase may be attributed to the fact that the design of the monoblock device allows less mandibular movement than does that of the twinblock device. Indicates the potential benefits of MADS treatment in alleviating TMD-related issues. Clinical significance: Monoblock MADs have improved effects on respiratory parameters and upper airway dimensions in patients with OSA and mild to moderate TMD. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious and potentially life‐threatening disease. Mandibular advancement device (MAD) has the characteristics of non‐invasive, comfortable, portable and low‐cost, making it the preferred treatment for mild‐to‐moderate OSAHS. Our previous studies found that abnormal contractility and fibre type distribution of the genioglossus could be caused by OSAHS. However, whether the mitochondria participate in these tissue changes is unclear. The effect of MAD treatment on the mitochondria of the genioglossus in OSAHS is also uncertain. Objective: To examine the morphology and function of mitochondria from the genioglossus in a rabbit model of obstructive sleep apnea–hypopnea syndrome (OSAHS), as well as these factors after insertion of a mandibular advancement device (MAD). Methods: Thirty male New Zealand white rabbits were randomised into three groups: control, OSAHS and MAD, with 10 rabbits in each group. Animals in Group OSAHS and Group MAD were induced to develop OSAHS by injection of gel into the submucosal muscular layer of the soft palate. The rabbits in Group MAD were fitted with a MAD. The animals in the control group were not treated. Further, polysomnography (PSG) and cone‐beam computed tomography (CBCT) scan were used to measure MAD effectiveness. CBCT of the upper airway and PSG suggested that MAD was effective. Rabbits in the three groups were induced to sleep for 4–6 h per day for eight consecutive weeks. The genioglossus was harvested and detected by optical microscopy and transmission electron microscopy. The mitochondrial membrane potential was determined by laser confocal microscopy and flow cytometry. Mitochondrial complex I and IV activities were detected by mitochondrial complex assay kits. Results: OSAHS‐like symptoms were induced successfully in Group OSAHS and rescued by MAD treatment. The relative values of the mitochondrial membrane potential, mitochondrial complex I activity and complex IV activity were significantly lower in Group OSAHS than in the control group; however, there was no significant difference between Group MAD and the control group. The OSAHS‐induced injury and the dysfunctional mitochondria of the genioglossus muscle were reduced by MAD treatment. Conclusion: Damaged mitochondrial structure and function were induced by OSAHS and could be attenuated by MAD treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing evidence suggests an association between childhood obstructive sleep apnea (OSA) and metabolic syndrome, with more research available on the potential impacts of positive airway pressure (PAP) on metabolic markers in children. The purpose of this systematic review is to provide a systematic synthesis of the evidence on the effect of PAP use on metabolic markers in children with OSA. METHODS: A search strategy with terms for "OSA" and metabolic markers in pediatrics was run to systematically assess 5 databases until August 26, 2022. Two reviewers independently screened eligible articles, extracted data, and conducted quality appraisal. Meta-analysis was done using random-effects models. Body mass index (BMI), glycemic, lipid, cardiovascular, and other metabolic and inflammatory markers were reported. RESULTS: Sixteen studies (N = 1,213) were included, 15 observational studies and 1 randomized controlled trial (RCT); most reported outcomes in children with obesity. Meta-analysis of 4 studies found no changes in BMI at median average follow-up of 12 months after PAP initiation. A reduction in heart rate and blood pressure parameters was demonstrated in several studies in children with OSA with and without obesity at a median average follow-up of 4.9 months after PAP initiation. Research in echocardiographic outcomes is limited, including one RCT in children with Down syndrome and OSA showing no changes in heart rate variability parameters. Evidence of improvements in glycemic and/or lipid control, liver enzymes, and inflammatory markers with PAP therapy is even more limited and of limited clinical importance. Risk of bias was moderate to critical and outcome evidence very low. CONCLUSIONS: Although evidence on effects of PAP on metabolic markers in children with OSA is encouraging, available literature is limited. Longitudinal studies are still required to further assess the long-term influence of PAP on metabolic and inflammatory markers, particularly in children with obesity. [ABSTRACT FROM AUTHOR]

Objective: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway collapse. As types of surgical modalities have been defined according to the level of airway obstruction, uvulopalatal flap and anterior palatoplasty are 2 of the main surgical options for patients with collapse in the soft palate and oropharynx region. The aim of our study is to show the effect of surgery on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume values in OSAS patients. Methods: The medical records of 125 patients with OSAS diagnosis in between January 2012 and December 2014 were evaluated retrospectively. Age, gender, body mass index, polysomnography results, Epworth Sleepiness scale (ESS), complete blood count values, and surgical results of the patients were evaluated. Results: A statistically significant decrease was observed in the mean apnea-hypopnea index, oxygen desaturation index, and ESS scores in the postoperative period (P < .001). Considering all patients, a statistically significant decrease was observed in th mean platelet volume (MPV) values in the postoperative period (P < .001) and no statistically significant change was observed in the mean neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values (P = .808 and P = .117). In patients whose anterior palatoplasty (78 patients) results were considered successful, a statistically significant decrease was observed in MPV and PLR values (P < .001 and P = .038), while no significant change was observed in NLR values (P = .185). In those with successful uvulopalatal flap (47 patients) results, a statistically significant decrease was observed in MPV values (P < .001), while no significant change was observed in NLR and PLR values (P = .809 and P = .154). Conclusion: While it was observed that MPV values were associated with OSAS, no clear relationship was found between NLR and PLR values. [ABSTRACT FROM AUTHOR]

Objective: To develop a novel mandibular advancement device (MAD) with high comfort, good compliance, and bidirectional fine-tuning capability for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the therapeutic efficacy of the new MAD. Methods: The MAD, featuring upper and lower dental splints with a fine-tuning mechanism for mandibular adjustment, incorporates improved design elements such as partial dental coverage, shortened baffles, and memory resin lining. The novel MAD was used to treat 30 OSAHS patients in the study, comparing pre- and post-treatment scores on the Epworth Sleepiness Scale (ESS), the Apnea-Hypopnea Index (AHI), and the lowest oxygen saturation (LSO2). Results: The novel MAD reduced size and side effects, enhancing comfort. All patients complied well, using it for an average of 95% over 30 days and ≥ 5 h nightly. After treatment, significant improvements were observed in ESS, AHI, and LSO2 (P < 0.05). Conclusions: This novel bidirectional adjustable MAD provides high comfort and compliance, improving treatment precision. It is an effective choice for mild to moderate OSAHS patients and an alternative for those intolerant to CPAP or averse to surgery. [ABSTRACT FROM AUTHOR]

Background: Non‐invasive ventilation (NIV) for sleep‐disordered breathing (SDB) in children and young people (CYP) can result in multiple health outcomes; however, adherence to NIV can be challenging. Suboptimally treated SDB may increase the risk of adverse consequences. Placing children's and parents' goals at the core of their SDB treatment may support adherence to NIV. To identify these health outcomes, it is necessary to gain a greater understanding of CYP's experiences of using NIV, whether they perceive any benefits from NIV use, as well as the outcomes that their parents and NIV staff identify as important. Methods: Semi‐structured qualitative interviews were conducted with nine CYP (aged 4–16 + years), 13 parents and nine healthcare professionals (HCPs); verbatim transcripts were analysed using Framework Analysis. Results: CYP predominantly reported an improvement in levels of energy, focus and ability to concentrate whereas parents also identified outcomes of mood and behaviour. The majority of children showed understanding of the reasons for being prescribed NIV. A subset of children did not notice their SDB. The health outcomes identified by HCPs and parents that could result from improved overnight gas exchange are subjective measures that rely on parent and child report. Measuring these health outcomes focussed on the impact of improved sleep rather than measuring improved sleep itself. Conclusions: It is important for HCPs administering NIV to ascertain whether CYP have noticed any of their sleep‐disordered breathing symptoms and any improvements from using NIV, including the relationship between benefits and side effects. Focussing on promoting understanding for CYP who are unable to link their wellbeing to their previous night's sleep may be futile and HCP strategies should concentrate on the process of tolerating the device. Parents, CYP and HCPs should collaborate to identify treatment goals specifically tailored for the child and monitor any progress against these goals. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to analyze the clinical data of patients with chronic obstructive pulmonary disease and obstructive sleep apnea overlap syndrome (OS) during hospitalization and to evaluate the risk factors of patients treated with Non-Invasive Ventilation (NIV). METHODS: Demographic and clinical data of patients with confirmed OS during hospitalization were retrospectively collected. The patients were divided into two groups according to whether noninvasive ventilator was used during hospitalization, including OS treated with NIV (244 cases) and OS without NIV (239 cases). The t-test, χ² test, and Kaplan--Meier curve were used to compare the two groups, and multiple logistic regression was used to analyze the risk factors of NIV in patients with OS. RESULTS: Compared with the OS group without NIV, the pulmonary hypertension, lymphocyte count, and left ventricular ejection fraction% of OS patients with NIV were lower, whereas PCO2, uric acid, C-reactive protein, procalcitonin, and N-terminal pro-B-type natriuretic peptide were higher, with statistical differences (P < 0.05). During hospitalization and follow-up, OS patients with NIV had a longer hospital stay (P < 0.001), and there was no significant difference in the rate of readmission within 28 days. The logistic regression analysis showed that the history of diuretic use, previous history of noninvasive ventilator use, and ischemic heart disease were independent risk factors for NIV treatment in OS patients during hospitalization. CONCLUSION: Patients with OS undergoing NIV during hospitalization exhibited more severe overall illness and had prolonged hospital stays compared to OS patients not receiving NIV. History of diuretic use, history of NIV use, and ischemic heart disease are independent risk factors for NIV treatment in OS patients during hospitalization. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of positional therapy and oral appliance therapy for the management of positional obstructive sleep apnea. Methods: We searched PubMed, Web of Science, Cochrane, and SCOPUS for relevant clinical trials. Quality assessment of the included trials was evaluated according to Cochrane's risk of bias tool. We included the following outcomes: The apnea-hypopnea index (AHI), AHI non-supine, AHI supine, sleep efficiency, percentage of supine sleep, Adherence (≥ 4 h/night, ≥ 5 days/week), Oxygen desaturation Index, Arousal Index, Epworth Sleepiness Scale score (ESS), Mean SpO2, and Functional Outcomes of Sleep Questionnaire. Results: The AHI non-supine and the ESS scores were significantly lower in the OAT cohort than in the PT cohort. The PT cohort was associated with a significantly decreased percentage of supine sleep than the OAT cohort (MD= -26.07 [-33.15, -19.00], P = 0.0001). There was no significant variation between PT cohort and OAT cohort regarding total AHI, AHI supine, ODI, sleep efficiency, arousal index, FOSQ, adherence, and mean SpO2. Conclusion: Both Positional Therapy and Oral Appliance Therapy effectively addressed Obstructive Sleep Apnea. However, Oral Appliance Therapy exhibited higher efficiency, leading to increased supine sleep percentage and more significant reductions in the Apnea Hypopnea Index during non-supine positions, as well as lower scores on the Epworth Sleepiness Scale. [ABSTRACT FROM AUTHOR]

Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) post-stroke is often problematic, despite potential benefits. This study aimed to evaluate CPAP adherence in patients with OSA post-stroke based on the Andersen behavioral model of health services utilization. A total of 227 eligible participants were recruited from a Chinese hospital. After baseline assessment, participants were followed for 6 months to determine short-term CPAP adherence. Those with good short-term adherence were followed for an additional 6 months to explore long-term adherence and influencing factors. Short-term CPAP adherence rate was 33%. Being married or living with a partner, having an associate degree or baccalaureate degree or higher, and stronger health beliefs independently predicted short-term CPAP adherence. Only 25% of participants from the adherent group showed good long-term adherence. The factor associated with long-term CPAP adherence was participants not using alcohol. Adherence to CPAP is suboptimal among patients having OSA post-stroke. Addressing unfavorable predisposing factors and modifying health beliefs are suggested. [ABSTRACT FROM AUTHOR]

• Persistent and symptomatic periodic breathing (PB) was observed after 1 month of life in infants born at term. • Persistent and symptomatic PB was observed with the presence of obstructive sleep apnea syndrome (OSAS) and/or central apnea syndrome (CAS), along with gastroesophageal reflux. • Persistent and symptomatic PB improved after temporary treatment with oxygen or ventilatory support. • Persistent and symptomatic PB decreased with age and disappeared during the first year of life. • Polysomnography recording and its interpretation by professionals trained in pediatric sleep is important for distinguishing between PB, OSAS, and CAS and for proposing an adapted treatment. Periodic breathing (PB) is considered physiological in the neonatal period and usually disappears in the first months of life. There are few data available on persistent PB after the neonatal period. The objective of this study was to characterize infants born at term with persistent PB after the age of 1 month through polysomnography (PSG) performed during symptoms. This retrospective case series included infants born at term between 2012 and 2021, without an underlying disease, who presented with symptoms of persistent PB during a PSG. Persistent PB was defined as more than 1 % of total sleep time (TST) of PB after 1 month of life, and PB was defined as a succession of at least three episodes of central apnea lasting more than 3 s and separated by less than 20 s of normal breathing. A total of 10 infants born at term were included. They underwent PSG for brief resolved unexplained events, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of TST spent with PB was 18.1 % before 3 months of age (n = 7), and 4.7 % between 3 and 6 months of age (n = 10). During the first PSG, ≥3 % of desaturation events were observed in 77–100 % of the PB episodes. At the first PSG, nine of the 10 infants had an obstructive apnea–hypopnea index of >10/h and five of 10 infants had a central apnea index of >5/h. Gastroesophageal reflux (GER) was suspected in eight infants. All infants showed improvement in the initial symptoms during the first year of life. This study presents cases of persistent and symptomatic PB after 1 month of life in infants born at term. The interesting finding was the presence of obstructive sleep apnea syndrome and/or central apnea syndrome in the majority of children, along with GER. [ABSTRACT FROM AUTHOR]

This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA). Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by an oral glucose tolerance test. Secondary outcomes: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p =.008), sleep systolic BP (- 16.2 mmHg, p =.0003), sleep diastolic BP (−9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p =.03) and sleepiness (Epworth Sleepiness Score −3.2, p =.0003). In addition, there were reductions in glucose area under the curve (−230 units, p =.009), total (−0.86 mmol/L, p = 0.006) and LDL cholesterol (−0.58 mmol/L, p = 0.007), triglycerides (−0.75 mmol/L, p = 0.004), fat mass (−7.6 kg, p <.0001) and abdominal fat (−310 cm3, p <.0001). Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity. [ABSTRACT FROM AUTHOR]

This commentary outlines a rationale for Model of Care redesign using implementation science methodology in an example service (Sleep Psychology within a Public Hospital multidisciplinary service) incorporating Stepped Care and "Direct to" Psychology pathways. Sleep disorders are common and costly to society, with insomnia being the most common sleep disorder. We can improve access to Psychological care for this highly prevalent condition within existing resources through strategic service model redesign. In our service, model of care redesign was necessitated by the escalating demand for Psychology services in the context of finite resourcing in our public hospital context (Queensland Health). However, redesign of Psychology models of care is necessary across the public and private sector Nationally, particularly with the ongoing impacts and aftermath of the COVID-19 pandemic. These pressures have necessitated rapid changes in Psychology service delivery, with implementation of systematised models of care, practicing at full scope, delegation to junior staff, and utilisation of time efficient (e.g., group delivery) and technological solutions designed to improve service efficiencies, effectiveness of care, and to maintain or improve patient reported experience and outcomes. Given the evidence-base for direct access and stepped care models, appropriately tailored to the individual service context, it is imperative that we disseminate and share processes and skills for service model redesign with our colleagues across service areas and service delivery contexts. Implementation of similar/comparable service models to improve efficient and effective Psychology service delivery is a matter of priority Nationwide. What is already known about this topic: Insomnia is a common condition with serious mental health and economic impacts for which Psychological intervention is the evidence-based treatment. Access to Psychology assessment and treatment nationally is increasingly impacted by high demand and under resourcing, further compounded by the COVID-19 pandemic. There is precedent for service model redesign in other health contexts and disciplines incorporating "Direct to" Allied Health and "Stepped Care" service delivery models to optimise care within existing resources. What this topic adds: Psychology services can utilise learnings from other services and disciplines to inform model of care redesign with the aim of improving service efficiencies – this commentary outlines a rationale and process for this in an example context (Sleep Psychology). "Direct to Psychology" pathways leverage Psychologist skill and training as first contact for mental health and appropriate physical health conditions, thus reducing burden on Medical and Psychiatric specialists, reducing wait times and improving access to appropriate care. "Stepped Care" pathways can improve access to care within existing resources by implementation of systematised models of care, delegation to junior staff, and utilisation of time efficient (e.g., group delivery) and digital therapies as first-line. [ABSTRACT FROM AUTHOR]

Background: Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. Objectives: This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. Methods: Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea–hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM‐percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). Results: Patients had significantly higher respiratory scores than controls. AHI increased 4.6‐fold (p =.006), RDI 2.5‐fold (p =.008) and ODI 6.4‐fold (p <.001). Oropharyngeal volumes showed a 30% decrease (p =.003). dB, TST and REM showed no significant differences. AHI (r = −.51; p =.005), ODI (r = −.60; p <.001) and RDI (r = −.45; p =.016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = −.47; p =.010) and positively with AHI (r =.41; p =.03) and ODI (r =.49; p =.007). dB and TST (r = −.49; p =.008) and REM and RDI (r = −.43; p =.02) correlated negatively. UEQ‐KPI (2.17 ± 0.24) confirmed excellent usability of PAT. Conclusion: Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) impacts approximately 936 million individuals globally and is known to complicate post-surgical recovery, particularly after total hip arthroplasty (THA). While continuous positive airway pressure (CPAP) is commonly recommended for managing OSA, its effect on THA recovery remains uncertain. The study aimed to assess the impact of CPAP use on post-THA outcomes in patients with OSA, focusing on medical complications and periprosthetic joint infection (PJI) at 90 days and 1 year. A national, all-payer database was utilized to identify patients undergoing primary THA between 2010 and 2021. Patients with OSA were stratified based on CPAP use through propensity score matching. Three matched groups were formed: OSA without CPAP, OSA with CPAP, and no OSA. Medical and surgical complications were assessed at 90 days and 1 year post-THA. Patients with OSA using CPAP exhibited more baseline comorbidities than those without CPAP. CPAP use was associated with inferior outcomes, including higher odds of PJI, wound complications, and venous thromboembolism at 90 days and 1 year post-THA. These trends were consistent even after adjusting for confounders. CPAP use, indicative of severe OSA, was linked to worse post-THA outcomes, emphasizing the importance of recognizing OSA severity preoperatively. The study does not advocate for or against CPAP use but underscores the heightened risk in this patient population, guiding clinicians in tailoring perioperative strategies and counseling patients about potential risks. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) commonly coexists with lung disease. However, the association between OSA components and lung function remains unclear. This study estimated STOP-BANG scores according to lung function using nationwide Korean data. Materials and Methods: Three thousand and two hundred eighty adults with available STOP-BANG scores and spirometry data were analyzed. Multivariate regression models were applied to estimate STOP-BANG scores according to lung function. Results: Approximately 28% of participants had abnormal lung function, and the characteristics were diverse. The significant factors associated with abnormal lung function included the STOP-BANG score. In multivariate regression analyses, individuals with abnormal lung function had significantly higher STOP-BANG scores than those with normal lung function (odds ratio: 1.19; 95% confidence interval: 1.10-1.29; P < 0.001), and this difference was remarkable in men. Conclusion: Our results suggest that screening and management of OSA components are warranted to prevent impaired lung function. [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]

Introduction: The Hypoglossal Nerve Stimulator (HNS) is a novel therapy that has been extensively studied in adults and more recently, it has been incorporated in children with Down Syndrome (DS) with persistent obstructive sleep apnea after adenotonsillectomy and trial of continuous positive airway pressure treatment. This systematic review article aims to examine the existing literature on HNS use in children to explore the benefits, efficacy, and parental experiences. Methods: MEDLINE, Web of Science and EMBASE were searched to include all studies published up to March 2nd, 2023, on the topic of HNS use in pediatric population under 21 years old. Results: A total of 179 studies were initially identified from which 10 articles were consistent with the inclusion criteria. Nine articles addressed outcomes after implantation of the HNS device in children with DS and 1 article explored the parental experiences. Findings were similar across studies where after implantation of HNS, there was marked improvement in polysomnographic outcomes and quality of life scores with high level of compliance. Conclusions: HNS holds promise as an effective treatment option for pediatric patients with DS and persistent OSA after AT and CPAP trials. It significantly improves sleep-disordered breathing, quality of life, and neurocognitive measures, leading to substantial and sustained benefits for these children. While the findings are encouraging, further research is needed to explore the potential of HNS in other pediatric populations without DS and to raise awareness among healthcare providers about this treatment option. Overall, HNS may offer significant long-term benefits for the overall well-being and health of pediatric patients with DS and persistent OSA. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea (OSA) is a common disease in today's society and may affect even more of the population in the near future. Ailments and complications of OSA result from a decrease in the muscle tone of the soft palate, which causes shallow breathing or complete apnoea. The consequences of such episodes may be the development of arterial hypertension, the occurrence of cardiac arrhythmias, and also the deterioration of the quality of life. Diagnosis is based on polysomnography in people with suspected OSA. Continuous Positive Airway Pressure (CPAP) therapy is the most effective treatment for OSA. A case series is presented in which patients with OSA risk factors and nocturnal pauses in Holter ECG monitoring (HEM) were diagnosed due to suspected OSA. In the polysomnographic test, severe OSA was diagnosed and CPAP therapy was introduced. Follow-up HEM performed during treatment showed complete resolution or significant reduction in the number and length of nocturnal pauses. Based on the case series, current medical knowledge and guidelines for pacemaker implantation, it was concluded that in the event of pauses in the HEM, the diagnosis of OSA should be considered in each patient, especially if the pauses occur predominantly at night and the patient is at high risk of OSA. Such a procedure may protect the patient from serious complications related to the pacemaker implantation. It should be emphasized, however, that CPAP therapy requires close cooperation of the patient because it brings effects only when it is used for each sleep. [ABSTRACT FROM AUTHOR]

The role of a prosthodontist in the management of facial cleft patients is the restoration of feeding, respiration, facial harmony, dental harmony and phonation. This case report presents the fabrication of an appliance for a pediatric patient with congenital median facial cleft who had sleep apnea due to the absence of nasal septum, which is a rare condition, with a unique method that fulfilled the patient's needs and improved quality of life. The patient also had median cleft lip and premaxilla along with hypertelorism. [ABSTRACT FROM AUTHOR]

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO2 LASER, transoral robotic surgery, or the microdebrider. [ABSTRACT FROM AUTHOR]

Objective. Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder. Materials and Methods. A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study. Conclusions. CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnea (OSA) is linked to cognitive impairment. We aimed to investigate subjective cognitive complaints (SCCs) and objective cognitive scores and their relation to polysomnography (PSG) parameters in patients suspected of having OSA. Methods: A prospective cohort cross‐sectional study was conducted at Siriraj Hospital. Patients suspected of OSA who were scheduled for PSG were recruited. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT). The Memory Index Score (MIS) was calculated from the MoCA. Subjective cognitive complaint presence was assessed through direct questioning of patients and by employing the Cognitive Change Index rated by self or informants (CCI‐I). Patients with severe dementia were excluded. Results: Among 258 patients (mean age 61.46 ± 7.05 years, 51.2% female), the mean MoCA score was 23.89 ± 3.89. Based on PSG results, patients were categorized into groups as follows: those without OSA or with mild OSA (combined total of 20.1%), moderate OSA (28.3%), or severe OSA (51.6%). Cognitive Change Index rated by self and CCI‐I scores correlated significantly (r = 0.238, p = 0.019) but not with the MoCA score or CTT time. Objective cognitive scores were associated with PSG parameters: total sleep time (TST), sleep onset latency, wake after sleep onset, sleep stages, mean O2 saturation, and time spent with SaO2 below 90% (all p < 0.05). Subjective cognitive scores were not associated with PSG parameters, except CCI‐I with TST. Participants with objective cognitive impairment had lower education, higher body mass index, more comorbidities, and lower SCC percentage (all p < 0.05). Patients with moderate to severe OSA had a higher proportion of objective cognitive impairment (64.1%) but a lower incidence of SCC (38.3%) than patients with no OSA or mild OSA. Thirty patients with severe OSA and cognitive impairment received continuous positive airway pressure (CPAP) treatment for a mean of 12.2 months. These patients showed MoCA and MIS improvement, but no significant changes were observed in their CTT and Cognitive Change Index scores. Conclusions: Most patients with OSA had objective cognitive impairment, but SCC was less frequent in patients with more severe OSA. Several PSG parameters correlated with cognitive scores but not with subjective cognitive scores. Patients with severe OSA may benefit cognitively from CPAP treatment. Key points: Patients suspected of obstructive sleep apnea (OSA) had a high prevalence of subjective cognitive complaints (SCCs) and objective cognitive dysfunction.Unlike the Alzheimer's disease, SCCs are not well correlated with the objective cognitive scores in patients with OSA.Some specific polysomnography (PSG) parameters are correlated with objective cognitive impairment.Patients diagnosed with severe OSA and mild cognitive impairment may have measurable improvement in cognition following treatment with continuous positive airway pressure (CPAP). [ABSTRACT FROM AUTHOR]

Background: Children with neuromuscular weakness or central hypoventilation often require nocturnal ventilation. Children with these conditions are living longer and the numbers of children affected are increasing. The challenges associated with managing ventilation at home have been documented; however, there has been limited investigation into accessing wider experiences such as travel. Air travel, in particular, may be considered challenging for children with these conditions because oxygen levels are lower in airplane cabins than at sea levels. Objective: We sought to understand experiences of and attitudes towards travel amongst families of children using nocturnal ventilation for neuromuscular weakness or central hypoventilation. Methods: Two semi‐structured interviews were conducted amongst participants enrolled in a trial of a new pre‐flight assessment of their tolerance of reduced oxygen levels during flight (known as a hypoxic challenge test). Children participating in the trial were aged 19 months to 18 years. Parents were interviewed and provided proxy views for younger children, and older children were encouraged to present their own views during these interviews. One interview was conducted immediately after the assessment, and a second 3 months later. Data were analysed utilising the framework approach to thematic analysis. Results: Seventeen families participated in the first interview with 14 of these families completing the follow‐up interview. Three further families participated in the follow‐up interview only. Here, we report three themes relating to participant experience of travel and how this is impacted by their condition. The three themes and their sub‐themes were (1) insight into children's lives: hospital attendances, gaining knowledge and confidence, and child as a person; (2) travelling with your child: planes, trains and automobiles, rules of air travel, and uncertainty; and (3) the meaning of travel: normalisation, connection to extended family, expanded experiences, and freedom and equality. Conclusions: This population of children and their families aspire to travel but face challenges from clinical and social barriers. It is essential that we further our understanding of the physiological, social and cultural aspects of their experience to facilitate their access to broadened life experiences. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnoea (OSA) is a highly prevalent problem with significant consequences. Continuous positive airway pressure (CPAP) and oral mandibular advancement device (MAD) are considered the standard treatments for OSA. Patients may experience self‐reported oral moistening disorders (OMDs) (i.e. xerostomia or drooling) at the beginning, throughout and after treatment. This affects oral health, quality of life and treatment effectiveness. The exact nature of the associations between OSA and self‐reported OMD is still unknown. We aimed to provide an overview of the associations between self‐reported OMD on the one hand and OSA and its treatment (namely CPAP and MAD) on the other hand. In addition, we sought to determine whether OMD affects treatment adherence. Materials and Methods: A literature search in PubMed was performed up to 27 September 2022. Two researchers independently assessed studies for eligibility. Results: In total, 48 studies were included. Thirteen papers investigated the association between OSA and self‐reported OMD. They all suggested an association between OSA and xerostomia but not between OSA and drooling. The association between CPAP and OMD was addressed in 20 articles. The majority of studies have indicated xerostomia as a CPAP side effect; however, some have observed that xerostomia diminishes with CPAP therapy. In 15 papers, the association between MAD and OMD was investigated. In most publications, both xerostomia and drooling have been described as common side effects of MADs. These side effects are often mild and transient, and they improve as patients continue to use their appliance. Most studies found that these OMDs do not cause or are not a strong predictor of non‐compliance. Conclusion: Xerostomia is a common side effect of CPAP and MAD, as well as a significant symptom of OSA. It may be regarded as one of the indicators of sleep apnoea. Moreover, MAD therapy can be associated with OMD. However, it seems that OMD may be mitigated by being adherent to the therapy. [ABSTRACT FROM AUTHOR]

Periodontal therapy results in successful disease management for some patients, but patients whose periodontal disease cannot be managed with standard-of-care protocols are treated repeatedly without success. For this set of patients, a systemic rather than an oral origin is possible. This clinical study investigated the connection between unresolved periodontal disease and sleep-disordered breathing (SDB) in 71 patients (44 women and 27 men), aged 19 to 75 years (mean, 45 years), who were enrolled in periodontal maintenance therapy for Stage I or 11 periodontitis. The results of an at-home sleep testing device served as the basis for evaluating 4 SDB screening tools: Papillary Bleeding Index (PBI), Epworth Sleepiness Scale (ESS) questionnaire, STOP-Bang questionnaire, and salivary cortisol testing. At-home sleep testing indicated that 33 participants had an apnea-hypopnea index 2 5, signifying probable obstructive sleep apnea. A finding of unstable periodontaL disease (PBI 22) was able to identify 21 of these 33 participants, while the ESS and STOP-Bang questionnaires identified only 2 and 6 participants, respectively. The difference between the PBI and both the ESS and STOP-Bang questionnaires was statistically significant (P < 0.05; 2-sample proportion test). There was no relationship between participants' cortisol levels and the PBI findings. This clinical study found a link between unresolved periodontal disease and SDB. The results of this study suggested that the PBI is a reliable, objective means for general dentists to identify SDB in patients with unresolved periodontal disease. Once identified, these patients can be referred for treatment to address their SDB, which may positively impact management of their periodontal disease. [ABSTRACT FROM AUTHOR]

Background: Achondroplasia is a genetic condition that results in several orofacial and physical manifestations that predispose patients to dental, breathing, and sleep issues. Case Description: This report details the case of a 2-year-old girl with achondroplasia, malocclusion, speech and breathing dysfunction, and obstructive sleep apnea (OSA). Treatment involved using a myofunctional device that required chewing twice per day, two simple tongue exercises, speech-language therapy, chiropractic therapy, and continuous positive airway pressure (CPAP) for 24 months. Throughout the treatment period, the patient demonstrated significant improvements in her sleep, breathing, dental occlusion, speech, and overall confidence. Conclusion: This case report highlights how pediatric patients with achondroplasia can improve their OSA symptoms and health with conservative myofunctional therapy interventions. [ABSTRACT FROM AUTHOR]

The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea–hypopnoea index >5 events·h−1 may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long‐term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. Methods: A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB‐2 was used to evaluate the methodological quality of the included studies. Results: A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ‐related parameters from baseline to follow‐up intervals. Temporary increases in TMJ‐related pain or symptoms at the beginning of the follow‐up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. Conclusion: The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ‐related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches. [ABSTRACT FROM AUTHOR]

In the landscape of sleep surgery, the Inspire® Upper Airway Stimulation (UAS) device has gained prominence as an increasingly popular treatment option for obstructive sleep apnea, prompting significant discourse across social media platforms. This study explores the social media narrative of the UAS device, particularly the nature of multimedia content, author demographics, and audience engagement on Instagram, Facebook, and TikTok. Our analysis encompassed 423 public posts, revealing images (67.4%) and videos (28.1%) as the dominant content types, with over a third of posts authored by physicians. A notable 40% of posts were advertisements, whereas patient experiences comprised 34.5%. TikTok, although presenting a smaller sample size, showed a substantially higher engagement rate, with posts averaging 152.9 likes, compared with Instagram and Facebook at 32.7 and 41.2 likes, respectively. The findings underscore the need for otolaryngologists and healthcare professionals to provide clear, evidence-based information on digital platforms. Given social media's expanding role in healthcare, medical professionals must foster digital literacy and safeguard the accuracy of health information online. In this study, we concluded that maintaining an evidence-based, transparent digital dialogue for medical innovations such as the UAS device necessitates collaborative efforts among physicians, health institutions, and technology companies. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a common chronic condition in which upper airway collapse interferes with breathing during sleep, reducing sleep quality. Untreated OSA can impair a patient's health and quality of life. The recommended first-line treatment for OSA in adults is positive airway pressure, but difficulty tolerating this device limits adherence to treatment for many patients. Treatment with an implanted hypoglossal nerve stimulation (HNS) device is a relatively new second-line option for these patients, and is gaining more widespread use. Clinicians who treat OSA or provide other healthcare services to patients with HNS implants should be familiar with these devices. This article reviews HNS technology and relevant OSA pathophysiology, along with device candidacy criteria, efficacy, risks, and considerations related to use of other medical technologies for patients with HNS implants. [ABSTRACT FROM AUTHOR]

The article focuses on interpreting sleep studies and perioperative considerations in children with sleep-disordered breathing. Topics include the diagnosis and management of pediatric sleep-disordered breathing, and perioperative considerations in children at risk for sleep-disordered breathing during surgeries and the authors, J.F. Lopes Vieira, A. Miskovic, and F. Abel, discuss these topics in the context of their expertise in pediatric anesthesia and sleep-disordered breathing.

BACKGROUND: Both nasal obstruction and sleep disturbance are common in patients with cystic fibrosis (CF). In patients with obstructive sleep apnea (OSA), studies suggest that these conditions are related and that nasal congestion improves with CPAP therapy. We hypothesized that subjects admitted to hospital for therapy of an exacerbation of CF would have both nasal symptoms and sleep disturbance and that these would improve with the initiation of nocturnal high-flow nasal cannula therapy (HFNC). METHODS: Twenty-five subjects with an exacerbation of CF were enrolled to randomly receive either 5 d of nocturnal HFNC at 20 L/min in the treatment group or 5 L/min of nocturnal nasal cannula air at ambient temperature and humidity in the low-flow group. On the first and last day of the study, the Sino-Nasal Outcome Test (SNOT-20) was administered to evaluate nasal symptoms, and sleep quality was measured using the Actiwatch 2. RESULTS: Fifteen subjects completed the study (6 HFNC, 9 low flow). We confirmed that subjects had significant sleep disturbance that did not improve over the 5 d of the study. Subjects also had disturbing nasal symptoms that significantly improved only in those receiving HFNC (pre 14 [20] vs post 6 [13], P 5 .027). CONCLUSIONS: Similar to what has been reported in older subjects with OSA, nocturnal HFNC improves sinonasal symptoms in subjects with an exacerbation of CF. There was no measurable effect on sleep quality, which may be due to the short duration of the study, or to subjects being evaluated while being treated in a hospital setting. [ABSTRACT FROM AUTHOR]

Background: Continuous positive airway pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). However, the low acceptance rate of CPAP remains a challenging clinical issue. This study aimed to determine the factors that influence the acceptance rate of CPAP. Methods: This retrospective cohort study was conducted at the sleep center of Shuang-Ho Hospital. Initially, 1186 OSA patients who received CPAP therapy between December 2013 and December 2017 were selected, and finally, 1016 patients were analyzed. All patients with OSA received CPAP therapy for at least 1 week, and their acceptance to treatment was subsequently recorded. Outcome measures included patients' demographic and clinical characteristics (sex, age, BMI, comorbidities, history of smoking, and the medical specialist who prescribed CPAP treatment), polysomnography (PSG) results, and OSA surgical records. Results: Patients with a lower CPAP acceptance rate were referred from otolaryngologists (acceptance rate of otolaryngology vs. others: 49.6% vs. 56.6%, p =.015), in addition to having a lower apnea–hypopnea index (AHI) (acceptance vs. non-acceptance: 55.83 vs. 40.79, p =.003), rapid eye movement AHI (REM-AHI) (acceptance vs. non-acceptance: 51.21 vs. 44.92, p =.014), and arousal index (acceptance vs. non-acceptance: 36.80 vs. 28.75, p =.011). The multiple logistic regression model showed that patients referred from otolaryngology had a lower CPAP acceptance rate (odds ratio 0.707, p =.0216) even after adjusting for age, sex, BMI, AHI, REM-AHI, arousal index, comorbidities, and smoking status. Conclusions: Before their initial consultation, patients may already have their preferred treatment of choice, which is strongly linked to the type of medical specialists they visit, and consequently, affects their rate of acceptance to CPAP therapy. Therefore, physicians should provide personalized care to patients by exploring and abiding by their preferred treatment choices. [ABSTRACT FROM AUTHOR]

Objective: Obesity is one of the most important risk factors and also consequences of obstructive sleep apnea (OSA). Weight loss and positive airway pressure therapy are the main approaches in the treatment of OSA. In this study, it was aimed to evaluate the prevalence of OSA in obesity patients scheduled for bariatric surgery. Methods: In the University Hospital Obesity Center, 141 consecutive patients who were candidates for bariatric surgery in 2015 were clinically evaluated preoperatively for sleep-related respiratory disorders. Preoperative polysomnographic examination was recommended to all cases. Results: Of 141 bariatric surgery candidates with a mean age of 37±10 years, and 103 (73%) were female. The mean body mass index of the cases was 46.9±6.4 kg/m2. Among the major symptoms of OSA, snoring was present in 119 (84.4%), daytime sleepiness in 63 (44.7%) and witnessed apnea in 49 (34.8%) patients. OSA was detected because AHI>5/hour was found in 75.7% (84/111) of the patients who accepted the polysomnographic evaluation. 24.3% (27/111) of the cases who underwent polysomnography had non OSA, 29.7% (33/111) mild OSA, 17.1% (19/111) moderate OSA, and 28.8% (32 /111), severe OSA was detected. AHI was positively correlated with age (p=0.003), neck and waist diameter (p<0.001), and negatively correlated with percent of the forced vital capacity (p<0.001). In polysomnographic controls performed an average of 9 months after bariatric surgery, an average of 41.2% improvement in AHI was observed, compared to an average of 22.8% decrease in BMI. Conclusions: OSA prevalence was found to be very high in bariatric surgery candidates. It was thought that polysomnographic examination should be performed before bariatric surgery not only in symptomatic cases but also in all cases. Bariatric surgery can help improve OSA. [ABSTRACT FROM AUTHOR]

This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA 1) in children. The recommendations are based on shared experience and published literature. OSA 1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA 1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA 1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial–myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists. [ABSTRACT FROM AUTHOR]

Positive Airway Pressure (PAP) adherence is vital in optimising the reduction of anxiety symptoms severity Previous research indicates that treatment of sleep apnoea with continuous positive airway pressure (CPAP) is associated with reduced post-traumatic stress disorder (PTSD) related nightmares and improved overall PTSD symptoms among veterans with PTSD and obstructive sleep apnoea (OSA) Improvement of PTSD symptoms in veterans with OSA was found to be more pronounced with prolonged use of CPAP The study included 397 veterans with a comorbid psychiatric disorder, 92 of whom participated in CPAP behavioural group treatment, and 305 with similar demographics and behavioural health profiles were retrospectively included as controls (92% were male; 64% were diagnosed with PTSD) Multivariable linear regression results showed that adherence to CPAP use within the past 30 days was significantly higher in the treatment group at 1 month, 3 months, 6 months and 1 year after treatment, compared to the control group (7 2, 11 8, 11 3 and 9 2 percentage points higher respectively, all p<0 001), after controlling for demographics and relevant disease history [ABSTRACT FROM AUTHOR]

Sleep disordered breathing (SDB) in children with neuromuscular disease (NMD) is more prevalent compared to the general population, and often manifests as sleep-related hypoventilation, sleep-related hypoxemia, obstructive sleep apnea, central sleep apnea, and/or disordered control of breathing. Other sleep problems include, sleep fragmentation, abnormal sleep architecture, and nocturnal seizures in certain neuromuscular diseases. The manifestation of sleep disordered breathing in children depends on the extent, type, and progression of neuromuscular weakness, and in some instances, may be the first sign of a neuromuscular weakness leading to diagnosis of an NMD. In-lab diagnostic polysomnography (PSG) remains the gold standard for the diagnosis of sleep disordered breathing in children, but poses several challenges, including access to many children with neuromuscular disease who are non-ambulatory. If SDB is untreated, it can result in significant morbidity and mortality. Hence, we aimed to perform a comprehensive review of the literature of SDB in children with NMD. This review includes pathophysiological changes during sleep, clinical evaluation, diagnosis, challenges in interpreting PSG data using American Academy of Sleep (AASM) diagnostic criteria, management of SDB, and suggests areas for future research. [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing is a significant problem affecting the pediatric population. These conditions can affect sleep quality and children's overall health and well-being. Difficulties in social interaction, communication, and repetitive behavioral patterns characterize autism spectrum disorder. Sleep disturbances are common in children with ASD. This literature review aims to gather and analyze available studies on the relationship between SDB and children with autism spectrum disorder. We comprehensively searched the literature using major search engines (PubMed, Scopus, and Web of Science). After removing duplicates, we extracted a total of 96 records. We selected 19 studies for inclusion after a thorough title and abstract screening process. Seven articles were ultimately incorporated into this analysis. The research findings presented herein emphasize the substantial influence of sleep-disordered breathing on pediatric individuals diagnosed with autism spectrum disorder (ASD). These findings reveal a high incidence of SDB in children with ASD, emphasizing the importance of early diagnosis and specialized treatment. Obesity in this population further complicates matters, requiring focused weight management strategies. Surgical interventions, such as adenotonsillectomy, have shown promise in improving behavioral issues in children with ASD affected by OSA, regardless of their obesity status. However, more comprehensive studies are necessary to investigate the benefits of A&T treatment, specifically in children with ASD and OSA. The complex relationship between ASD, SDB, and other factors, such as joint hypermobility and muscle hypotonia, suggests a need for multidisciplinary treatment approaches. Physiotherapy can play a critical role in addressing these intricate health issues. Early sleep assessments and tailored weight management strategies are essential for timely diagnosis and intervention in children with ASD. Policy initiatives should support these efforts to enhance the overall well-being of this population. Further research is crucial to understand the complex causes of sleep disturbances in children with ASD and to develop effective interventions considering the multifaceted nature of these conditions. [ABSTRACT FROM AUTHOR]

Symptoms of obstructive sleep apnea (OSA) often are overlooked or misinterpreted, but without treatment, patients are at increased risk for potentially life-threatening conditions including stroke and heart failure. Clinician awareness of the risk factors for and treatment of OSA can prevent the development or progression of these complications in patients. [ABSTRACT FROM AUTHOR]

This study aimed to obtain a comprehensive view of the risk of developing diabetes in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). We used local and the global-scale federated data research network TriNetX to obtain access to electronic medical records, including those for patients diagnosed with OSA, from health-care organizations (HCOs) worldwide. Using propensity score matching and the score-matched analyses of data for 5 years of follow-up, we found that patients who had undergone UAS had a lower risk of developing diabetes than those who used CPAP (risk ratio 0.415, 95% confidence interval (CI) 0.349–0.493). The risk for newly diagnosed diabetes patients showed a similar pattern (hazard ratio 0.382; 95% CI 0.317–0.459). Both therapies seem to protect against diabetes (Risk 0.081 after UAS vs. 0.195 after CPAP). Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that, in patients with OSA, UAS can prevent the development of diabetes better than CPAP. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O'Connor-Reina et al. recently published a paper titled "Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study." In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and outcomes of powered intracapsular tonsillotomy and adenoidectomy (PITA) for the treatment of sleep disordered breathing in infants up to 36 months of age compared to older children. Methods: This retrospective analysis included children who underwent PITA from 2013 to 2019 at a single tertiary care medical center. The patients were divided into 2 groups: up to 36 months, and 36 to 72 months. The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Post-operative complications, and short- and long-term outcomes were compared. Results: A total of 48 patients met the inclusion criteria for the main study group (up to 36 months of age). They were compared to 59 children 36 to 72 months of age. There were no differences in subjective outcomes between age groups (P =.65). There were no differences in the frequency of post-operative complications between age groups (P =.8) or in the number of hospitalization days (P =.91). Conclusion: The short- and long-term outcomes and safety of PITA for the treatment of sleep disordered breathing in infants up to 36 months of age are similar to those of older children. [ABSTRACT FROM AUTHOR]

Positive airway pressure (PAP) is the standard treatment for patients with moderate to severe obstructive sleep apnea, especially when a correctable anatomic obstacle is not identified. The PAP efficiency strongly depends on the appropriate use during sleep. Despite the recent advancements in PAP interface designs, overall adherence to therapy remains low. The main sources of discomfort consist of air leakage and mask overtightening leading to skin problems. However, these disadvantages have been partially reduced by new interfaces like nasal pillows that have the capacity to reduce the contact of the silicone cushion with the skin, reducing the chances of skin irritation. At the same time, assuring a better seal prevents air leakage and is particularly useful in patients with internal valve insufficiency. We present a case of a 57-year-old patient with severe sleep apnea syndrome whose efficient treatment was delayed by an inadequate PAP mask prescription at diagnosis. Due to low treatment compliance secondary to the perceived adverse effects of the oronasal mask, the patient decided to discontinue treatment for two years with subsequent aggravation of sleep apnea symptoms. The patient's sensitivity to the silicone mask cushion and treatment ineffectiveness due to internal valve collapse were the main causes of treatment failure. After changing of PAP interface, the patient achieved long-term compliance. Our case report reflects the importance of choosing the most suitable PAP interface in accordance with the patient's particularities. In the absence of this approach, appropriate treatment might be delayed with detrimental consequences, especially in severe cases. Considering PAP adherence following therapy initiation usually predicts long-term compliance, finding the best mask design from the beginning can predict therapeutic success. [ABSTRACT FROM AUTHOR]

Background: The RAM cannula® consists of nasal prongs that can be used to administer oxygen, continuous, and bilevel positive airway pressure therapies. Studies have reported the efficacy and utility of the RAM cannula in inpatients requiring noninvasive ventilation (NIV); however, there is limited literature on the use of the RAM cannula to provide NIV in the outpatient setting. Objectives: This study aimed to describe the clinical features and outcomes of children who used NIV via RAM cannula in the outpatient setting. Design: Retrospective review. Methods: We conducted a retrospective review of children treated with outpatient NIV via RAM cannula at our institution between January 2010 and March 2023. The analyzed data included age, diagnoses, indications for NIV, duration of RAM cannula use, complications, and outcomes at 6 months. Results: We identified 20 patients who used outpatient NIV via RAM cannula during the study period. The median age at initiation of NIV via RAM cannula was 5.8 months (IQR 2.4-9.9 months). Indications for NIV included sleep-related hypoventilation (15%), restrictive lung disease (25%), obstructive sleep apnea (45%), and chronic respiratory failure (50%), with 6 patients having ⩾2 indications for NIV. RAM cannula was utilized for inability to tolerate conventional NIV interfaces (80%), to alleviate dyspnea (60%), and to avoid tracheostomy (55%). Patients used NIV via RAM cannula for a median duration of 7.7 months (IQR 3.7-20.6 months). Patient outcomes included ongoing usage of RAM cannula (55%), changing to conventional NIV interfaces (15%) or oxygen (10%), weaning off respiratory support (5%), and death (15%). There were no complications related to using the RAM cannula. Conclusion: Our study demonstrates the utility of outpatient NIV via RAM cannula in children with a variety of diagnoses until clinical improvement or tolerance of conventional interfaces, and for avoidance of tracheostomy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation between obstructive sleep apnea (OSA) and temporomandibular joint (TMJ) morphology, tooth wear condition, orofacial pain through a follow-up program. Materials and methods: Seventy one OSA patients were divided into three groups according to their (apnea hypopnea index) AHI: mild group (n = 23), moderate group (n = 24), and severe group (n = 24). All patients had OSA therapies around six months after confirm the diagnosis of OSA. The tooth wear score and orofacial pain condition of all patients were recorded via clinical examination. Cone beam computed tomography (CBCT) images were also taken when confirm the diagnosis of OSA (T0), 6 months after the diagnosis (T1), and 6 months after the OSA treatment (T2). Parameters indicating the condylar morphology and joint space were evaluated. The differences of clinical symptoms and TMJ conditions among T0, T1 and T2 time point were detected in the three groups respectively. The changes in T1-T0 and T2-T1 of all descriptions among three groups were also compared. The correlations between AHI and clinical symptoms were detected with Spearman correlation analysis. Results: In mild group, there was no difference in all clinical symptoms and TMJ morphology among the three time points. Both in moderate and severe group, the condylar volume, superficial area, wear score, visual analogue scales (VAS), and R value (indicating condyle position) displayed significant differences among the three time points (P < 0.05). From T0 to T1, mild group displayed fewer decreases in the condylar volume and superficial area and fewer increases in wear score than that in moderate and severe group (P < 0.05). From T1 to T2, there was a greatest reduction in severe group for R value, and significant difference in the description of VAS and R value were found among the three groups. AHI was negatively correlated condylar volume and condylar superficial area, and was positively correlated with tooth wear score and VAS (P < 0.05). Conclusion: Moderate to severe OSA will aggravate orofacial pain and tooth wear, affect TMJ volume and superficial area, even change the location of condyles. Appropriate OSA therapies may be effective ways to alleviate these adverse effects in long-term. [ABSTRACT FROM AUTHOR]

In our previous studies, we offered older family medicine patients testing for obstructive sleep apnea (OSA) and discovered that 80% of patients who accepted, were later diagnosed with unsuspected OSA. In the present study, we followed such patients for 3 years of usual treatment. The goals were to (1) observe whether wider testing for OSA would increase case recognition and treatment uptake; (2) identify symptom and health characteristics associated with diagnosis and treatment efficacy. 101 women and 75 men (>45 years) recruited from family medicine clinics completed questionnaires, polysomnography and consented to chart review (Time 1). Participants with OSA were offered treatment and follow-up with a sleep medicine specialist. All were re-evaluated after 3 years (Time 2). At Time 1, 93% of participants received a diagnosis of OSA. Of these, 53 initiated treatment (46 PAP therapy); at Time 2, 24 PAP users met criteria for adherence. PAP-adherent participants had worse OSA and worse reported symptoms at Time 1 than non-adherent participants. At Time 2, PAP-adherent participants improved on insomnia and daytime symptoms compared to non-adherent participants who showed no change. Adherent and non-adherent participants showed no difference in health indices at Time 1 and no change at three-year follow-up. Benefits of treatment included improvements in co-morbid insomnia and daytime functioning; however, offering wider testing for OSA to older, family medicine patients yielded a high rate of diagnosis but low treatment adoption and adherence. Therefore, a cost-effective strategy would identify and support those likely to adopt and adhere to treatment. [ABSTRACT FROM AUTHOR]