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Monitoring unintentional air leaks in continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) is essential for therapy success. While leaks are often attributed to improperly sealed masks, mouth openings may also cause them, requiring interventions. Recent studies demonstrated distinctive mandibular jaw movement (MJM) signal patterns during sleep related to respiratory events and sleep stages. Analysing MJM during CPAP treatment reveals air leak peaks coinciding with maximal MJM amplitude during obstructive events, and air leak decreases corresponding to arousals. Examining leaks with MJM offers valuable insights into their origins and might open new avenues for CPAP management.

We examined the relationship between subjective and objective sleep outcomes and loneliness in older women at risk for Alzheimer's disease (AD). Our sample consisted of 39 participants (aged 65+) with mild cognitive deficits who completed the UCLA Loneliness Scale, the Pittsburgh Sleep Quality Index (PSQI), and an at home sleep test, to determine presence of obstructive sleep apnea. Based on sleep quality scores, individuals categorized as "poor sleepers" had significantly higher loneliness scores than "good sleepers." However, total loneliness scores did not significantly differ between groups with or without sleep apnea. We found that higher loneliness was significantly associated to lower habitual sleep efficiency and sleep duration and was also influenced by use of sleep medication. Our findings suggest that increased loneliness relates to worse subjective sleep quality, but not to sleep apnea. These findings suggest that combined interventions targeting loneliness and sleep quality may be important for older women.

BACKGROUND: Obstructive sleep apnea (OSA) increases risk for cognitive decline and Alzheimers disease (AD). While the underlying mechanisms remain unclear, hypoxemia during OSA has been implicated in cognitive impairment. OSA during rapid eye movement (REM) sleep is usually more severe than in non-rapid eye movement (NREM) sleep, but the relative effect of oxyhemoglobin desaturation during REM versus NREM sleep on memory is not completely characterized. Here, we examined the impact of OSA, as well as the moderating effects of AD risk factors, on verbal memory in a sample of middle-aged and older adults with heightened AD risk. METHODS: Eighty-one adults (mean age:61.7 ± 6.0 years, 62% females, 32% apolipoprotein E ε4 allele (APOE4) carriers, and 70% with parental history of AD) underwent clinical polysomnography including assessment of OSA. OSA features were derived in total, NREM, and REM sleep. REM-NREM ratios of OSA features were also calculated. Verbal memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT). Multiple regression models evaluated the relationships between OSA features and RAVLT scores while adjusting for sex, age, time between assessments, education years, body mass index (BMI), and APOE4 status or parental history of AD. The significant main effects of OSA features on RAVLT performance and the moderating effects of AD risk factors (i.e., sex, age, APOE4 status, and parental history of AD) were examined. RESULTS: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxyhemoglobin desaturation index (ODI) during REM sleep were negatively associated with RAVLT total learning and long-delay recall. Further, greater REM-NREM ratios of AHI, RDI, and ODI (i.e., more events in REM than NREM) were related to worse total learning and recall. We found specifically that the negative association between REM ODI and total learning was driven by adults 60 + years old. In addition, the negative relationships between REM-NREM ODI ratio and total learning, and REM-NREM RDI ratio and long-delay recall were driven by APOE4 carriers. CONCLUSION: Greater OSA severity, particularly during REM sleep, negatively affects verbal memory, especially for people with greater AD risk. These findings underscore the potential importance of proactive screening and treatment of REM OSA even if overall AHI appears low.

BackgroundObstructive sleep apnea (OSA) contributes to the generation, recurrence, and perpetuation of atrial fibrillation, and it is associated with worse outcomes. Little is known about the economic impact of OSA therapy in atrial fibrillation. This retrospective cohort study assessed the impact of positive airway pressure (PAP) therapy adherence on health care resource use and costs in patients with OSA and atrial fibrillation.Methods and resultsInsurance claims data for ≥1 year before sleep testing and 2 years after device setup were linked with objective PAP therapy use data. PAP adherence was defined from an extension of the US Medicare 90-day definition. Inverse probability of treatment weighting was used to create covariate-balanced PAP adherence groups to mitigate confounding. Of 5867 patients (32% women; mean age, 62.7 years), 41% were adherent, 38% were intermediate, and 21% were nonadherent. Mean±SD number of all-cause emergency department visits (0.61±1.21 versus 0.77±1.55 [P=0.023] versus 0.95±1.90 [P

Rationale: Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. Objectives: To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. Methods: This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. Results: The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Conclusions: Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.

ObjectivePrevious studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA.MethodsAdministrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models.Results37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p

The state-dependent noradrenergic activation of hypoglossal motoneurons plays an important role in the maintenance of upper airway patency and pathophysiology of obstructive sleep apnea (OSA). Chronic intermittent hypoxia (CIH), a major pathogenic factor of OSA, contributes to the risk for developing neurodegenerative disorders in OSA patients. Using anterograde tracer, channelrhodopsin-2, we mapped axonal projections from noradrenergic A7 and SubCoeruleus neurons to hypoglossal nucleus in DBH-cre mice and assessed the effect of CIH on these projections. We found that CIH significantly reduced the number of axonal projections from SubCoeruleus neurons to both dorsal (by 68%) and to ventral (by73%) subregions of the hypoglossal motor nucleus compared to sham-treated animals. The animals' body weight was also negatively affected by CIH. Both effects, the decrease in axonal projections and body weight, were more pronounced in male than female mice, which was likely caused by less sensitivity of female mice to CIH as compared to males. The A7 neurons appeared to have limited projections to the hypoglossal nucleus. Our findings suggest that CIH-induced reduction of noradrenergic innervation of hypoglossal motoneurons may exacerbate progression of OSA, especially in men.

ObjectiveDrug induced sleep endoscopy (DISE) is often performed for pediatric obstructive sleep apnea (OSA) when initial diagnostic studies do not provide adequate information for therapy. However, DISE scoring is subjective and with limitations. This proof-of-concept study demonstrates the use of a novel long-range optical coherence tomography (LR-OCT) system during DISE of two pediatric patients.MethodsLR-OCT was used to visualize the airway of pediatric patients during DISE. At the conclusion of DISE, the OCT probe was guided in the airway under endoscopic visual guidance, and cross-sectional images were acquired at the four VOTE locations. Data processing involved image resizing and alignment, followed by rendering of three-dimensional (3D) volumetric models of the airways.ResultsTwo patients were included in this study. Patient one had 18.4%, 20.9%, 72.3%, and 97.3% maximal obstruction at velum, oropharynx, tongue base, and epiglottis, while patient two had 40.2%, 41.4%, 8.0%, and 17.5% maximal obstruction at these regions, respectively. Three-dimensional reconstructions of patients' airways were also constructed from the OCT images.ConclusionThis proof-of-concept study demonstrates the successful evaluation of pediatric airway during DISE using LR-OCT, which accurately identified sites and degrees of obstruction with respective 3D airway reconstruction.

Longitudinal snoring changes can be captured using a mobile phone application. During hypoglossal nerve stimulator (HNS) therapy up-titration, increasing stimulation voltage was associated with reduced snoring frequency and intensity in this case series of six patients. Laryngoscope, 134:987-992, 2024.

OBJECTIVES: To examine the feasibility of individuals with spinal cord injury or disease (SCI/D) to perform combined oropharyngeal and respiratory muscle training (RMT) and determine its impact on their respiratory function. METHODS: A prospective study at a single Veterans Affairs (VA) Medical Center. Inclusion criteria included: 1) Veterans with chronic SCI/D (>6 months postinjury and American Spinal Injury Association (ASIA) classification A-D) and 2) evidence of OSA by apnea-hypopnea index (AHI ≥5 events/h). Eligible participants were randomly assigned to either an experimental (exercise) group that involved performing daily inspiratory, expiratory (using POWERbreathe and Expiratory Muscle Strength Trainer 150 devices, respectively), and tongue strengthening exercises or a control (sham) group that involved using a sham device, for a 3-month period. Spirometry, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), polysomnography, and sleep questionnaires were assessed at baseline and at 3 months. RESULTS: Twenty-four individuals were randomized (12 participants in each arm). A total of eight (67%) participants completed the exercise arm, and ten (83%) participants completed the sham arm. MIP was significantly increased (p

BackgroundContinuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality versus therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality.MethodsFrench national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time.ResultsOut of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption versus those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001).ConclusionThese data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit.

AIM: The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS: A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation and the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

The effects of electromagnetic interference have been hiding in plain sight for millennia and are now being applied to the non-invasive stimulation of deep tissues. In the article by Missey et al., the effect of non-invasive stimulation of the hypoglossal nerve by an interference envelope of interfering carrier waves is examined in mice and participants with sleep apnea. This stimulation is capable of activating the nerve and reducing apnea-hypopnea events. Temporally interfering electric fields have potential applications far beyond hypoglossal stimulation and may represent a revolutionary new approach to treating illness and understanding the functional organization of the nervous system.

BackgroundWhile obstructive sleep apnea (OSA) and insomnia symptoms in neurotypical populations are associated with Alzheimer's disease (AD), their association with dementia in adults with Down syndrome (DS) remains less clear, even though these symptoms are prevalent and treatable in DS. Understanding their associations with AD-related dementia status, cognitive impairment, and functional deterioration may lead to interventions to slow decline or disease progression in adults with DS.ObjectiveTo characterize differences in OSA and insomnia symptom expression by dementia status, and to determine which sleep factors support dementia diagnosis.MethodsMultimodal consensus conference was used to determine dementia status in 52 adults with DS (52.2 ± 6.4 years, 21 women). Cognitive impairment, adaptive behavior skills, and symptoms of OSA and insomnia were quantified using validated assessments for adults with DS and their primary informants.ResultsA sex by dementia status interaction demonstrated that older women with DS and dementia had more severe terminal insomnia but not OSA symptoms relative to older women with DS who were cognitively stable (CS). Greater insomnia symptom severity was associated with greater functional impairments in social and self-care domains adjusting for age, sex, premorbid intellectual impairment, and dementia status.ConclusionsInsomnia symptoms are more severe in women with DS with dementia than in women with DS and no dementia, and regardless of dementia status or sex, more severe insomnia symptoms are associated with greater impairment in activities of daily living. These findings underscore the potential importance of early insomnia symptom evaluation and treatment in women with DS at risk of developing AD.

ObjectiveThe purpose of this study was to evaluate long-term outcomes of sphincter pharyngoplasties, including speech outcomes, revision surgeries, and postoperative incidence of obstructive sleep apnea (OSA).DesignRetrospective matched-cohort study SETTING: Two craniofacial centers in Los Angeles, CA PATIENTS: Patients (n = 166) with cleft lip and palate (CLP) or isolated cleft palate (iCP) who underwent sphincter pharyngoplasty from 1992 to 2022 were identified. An age- and diagnosis-matched control group of 67 patients with CLP/iCP without velopharyngeal insufficiency (VPI) was also identified.InterventionsThe pharyngoplasty group underwent sphincter pharyngoplasty, whereas the non-VPI group had no history of VPI surgery or sphincter pharyngoplasty.Main outcome measuresPostoperative speech outcomes, revision surgeries, and incidence of OSA were evaluated. Multivariable regression was used to evaluate independent predictors of OSA.ResultsAmong the patients in the pharyngoplasty cohort, 63.9% demonstrated improved and sustained speech outcomes after a single pharyngoplasty, with a median postoperative follow-up of 8.8 years (interquartile range [IQR], 3.6-12.0 years). One-third of the patients who underwent pharyngoplasty required a revision surgery, with a median time to primary revision of 3.9 years (IQR, 1.9-7.0 years). OSA rates increased significantly among the pharyngoplasty cohort, from 3% before surgery to 14.5% after surgery (p

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Overlap Syndrome (OS), the co-occurrence of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Clustering of patients in subgroups with similar pre-clinical manifestations (ie, endothelial dysfunction) may identify relevant therapeutic phenotype categories for patients with OS who are at high risk of CVD. We therefore conducted a cross-sectional pilot study of endothelial function in 7 patients with OS (Forced Expiratory Volume in 1 second/Forced Vital Capacity < 0.7) on continuous positive airway pressure therapy (n = 7) to assess the relationship between FMD and physical activity. We found a strong association between FMD and step counts (rho = 0.77, p = 0.04); and FMD and moderate physical activity (rho = 0.9, p = 0.005). Further, larger studies are needed to confirm that FMD may identify patients with OS at high risk of CVD who benefit from increased physical activity.

IntroductionThe prevalence of poor sleep quality and sleep apnea differs by race and ethnicity and may contribute to racial disparities in cognitive aging. We investigated whether sleep quality and sleep apnea risk were associated with cognitive function and decline and whether the associations differed by race/ethnicity.MethodsParticipants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE; N = 1690; mean age: 75.7 years) study, a cohort of Asian, Black, Latino, and White participants, completed a modified Pittsburgh Sleep Quality Index assessing subjective sleep quality, latency, duration, disturbances, sleep medication use, and daytime dysfunction. Sleep apnea risk was measured by questions about snoring, tiredness, and whether apnea was observed. Executive function and verbal episodic memory were assessed at three time points over an average of 2.7 years with the Spanish and English Neuropsychological Assessment Scale. We fit linear mixed-effect models and stratified analyses by race/ethnicity.ResultsHigher sleep apnea risk was associated with faster declines in verbal episodic memory (β^ sleep apnea = -0.02, 95% confidence interval [CI], -0.04, -0.001) but not in executive function. Poorer sleep quality was associated with lower levels of and faster decline in executive function but not in verbal episodic memory. Race/ethnicity modified these associations: compared to estimated effects among White participants, poorer global sleep quality (β^ sleep*time = -0.02, 95% CI, -0.02, -0.01) was associated with larger effects on decline in executive function among Black participants. Estimated effects of some individual sleep quality components were also modified by race/ethnicity; for example, sleep medication use was associated with faster declines in executive function (β^ sleep*time = -0.05, 95% CI, -0.07, -0.03) and verbal episodic memory β^ sleep*time = -0.04, 95% CI, -0.07, -0.02) among Black participants compared to White participants.DiscussionObservational evidence indicates sleep quality is a promising target for addressing racial/ethnic disparities in cognitive aging, especially among Black older adults.HighlightsSleep apnea risk was associated with faster declines in verbal episodic memory but not executive function among all participants.Global sleep quality was associated with lower levels of and faster decline in executive function but not verbal episodic memory among all participants.Black older adults were particularly susceptible to the estimated adverse cognitive impacts of global sleep quality, particularly the use of sleep medication.

Tonsillectomy is considered the standard of care in patients with obstructive sleep apnea (OSA) and large tonsils; however, there are selected cases where this procedure should not be considered. We present two patients with tonsil grade 4 and severe OSA where tonsillectomy was not the solution for their problem and could be a superfluous procedure. In our experience, a preoperatory drug-induced sleep endoscopy (DISE) and proper patient phenotyping will prevent this type of surgical failure. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. Methods: This is a cross‐sectional, case‐control, population‐based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD‐9‐CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. Results: Twenty‐three thousand seven hundred and sixty‐seven hospital admissions for HS were compared with 95,068 age‐ and sex‐matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170–1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419–1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157–2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182–1.374]; P < 0.001). Conclusion: HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients. [ABSTRACT FROM AUTHOR]

Objective: To study 24-hour urine metabolic abnormalities in patients with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography. The purpose was to identify whether OSAS is independently associated with a distinctive set of 24-hour urine studies in a cohort of stone formers. Patients and Methods: Using our institutional stone database (2013–2017), 1132 consecutive patients with 24-hour urine collections were identified. After applying our exclusion criteria, the final cohort consisted of 376 patients of which 45 patients had OSAS. Descriptive statistics were used to compare 24-hour urine parameters between patients with and without OSAS. Logistic regression models were used to assess the association between OSAS and 24-hour urine parameters. Results: On univariate analysis, patients with OSAS were older (57.7 versus 48.2, p < 0.001) with a higher body mass index (BMI) (35 versus 27.8, p < 0.001), and higher likelihood of diabetes mellitus (DM) (57.8 versus 10.6%, p < 0.001) and hypertension (HTN) (60% versus 23.9%, p < 0.001). Patients with OSAS had higher 24-hour total amount of urine volume (2018 versus 1818 ml, p = 0.03), calcium (279.7 versus 208 mg, p = 0.02), oxalate (41.6 versus 31.3 mg, p < 0.001), yet lower 24-hour urine pH (5.75 versus 6.03, p = 0.001). On multivariable linear regression analysis, OSAS did not affect any of the 24-hour urinary parameters. Conclusion: OSAS is a prevalent comorbidity among nephrolithiasis patients. We found no major differences in 24-hour urine parameters between nephrolithiasis patients with OSAS and those without OSAS. Further study is needed to determine whether the severity of OSAS and compliance with treatment play a role in the pathogenesis of stone formation. Level of evidence: 2b [ABSTRACT FROM AUTHOR]

BACKGROUND: There is a strong association between obstructive sleep apnea and hypertension, but the effects of obstructive sleep apnea symptoms on the risk of incident hypertension are not well documented. The aim of this prospective study was to examine whether snoring and sleepiness are associated with incident hypertension. METHODS: Data from the French population-based CONSTANCES cohort were analyzed. Normotensive participants, aged 18 to 69 years, were included between 2012 and 2016 and screened for snoring, morning fatigue, and daytime sleepiness in 2017 using items of the Berlin Questionnaire. We used Cox models, adjusted for multiple potential confounders, including body mass index, baseline blood pressure, sleep duration, and depressive symptoms, to compute hazards ratios of incidentally treated hypertension. RESULTS: Among 34 727 subjects, the prevalence of self-reported habitual snoring, morning fatigue, and excessive daytime sleepiness (≥3× a week for each) was 23.6%, 16.6%, and 19.1%, respectively. During a median follow-up of 3.1 years (interquartile range, 3.0–3.5), the incidence of treated hypertension was 3.8%. The risk of de novo treated hypertension was higher in participants who reported habitual snoring (adjusted hazard ratio, 1.17 [95% CI, 1.03–1.32]) and excessive daytime sleepiness (adjusted hazard ratio, 1.42 [95% CI, 1.24–1.62]), and increased with the weekly frequency of symptoms, with a dose-dependent relationship (Ptrend≤0.02 for all symptoms). CONCLUSIONS: Self-reported snoring and excessive daytime sleepiness are associated with an increased risk of developing hypertension. Identification of snoring and daytime sleepiness may be a useful public health screening tool in primary care for hypertension prevention. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the adverse events associated with hypoglossal nerve stimulator (HNS) implantation for treating obstructive sleep apnea (OSA), drawing data from the Manufacturer and User Facility Device Experience (MAUDE) database. We aim to provide a comprehensive and updated account of these adverse events. Study Design: Retrospective analysis. Setting: MAUDE Database review. Methods: A retrospective analysis was performed on the MAUDE database to collect all HNS‐related reports from May 2014 to December 2023. Variables collected included date of event, event description, nature of event, iatrogenic injuries, required interventions, and, if available, root causes. Each event description was analyzed to classify the adverse event, the postevent intervention, and device model number. Results: Out of 1178 reports fulfilling the inclusion criteria, 1312 adverse events were identified. Common adverse events included infection (24.0%), pain (19.7%), and hematoma/seroma (10.2%). Approximately 83.1% of these adverse events necessitated medical and/or surgical intervention. The most frequent procedures included explantation (29.4%) and device repositioning (15.8%). Pneumothorax was reported in 50 cases, with 41 (82.0%) requiring a chest tube to be inserted. Three adverse events described overstimulation in the setting of magnetic resonance imaging (MRI) despite the implantation of MRI‐compatible second‐generation internal pulse generators. Conclusion: While HNS implantation has been established as a reliable intervention for OSA in cases of continuous positive airway pressure failure or intolerance, this study highlights several perioperative and postoperative difficulties and complications. Understanding these challenges is essential for refining surgical practices and enhancing patient consent processes, ultimately aiming to improve therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Fat mass and obesity‐associated protein (FTO) is the first identified N6‐methyladenosine (m6A) demethylase widely distributed in various tissues in adults and children. It plays an essential role in diverse mRNA‐associated processes including transcriptional stability, selective splicing, mRNA translocation, and also protein translation. Recently, emerging studies have shown that FTO is involved in the genesis and development of oral diseases. However, the correlation between FTO and oral diseases and its specific regulatory mechanism still needs further study. In this review, we will summarize the discovery, distribution, gene expression, protein structure, biological functions, inhibitors, and quantifying methods of FTO, as well as its regulatory role and mechanism in oral diseases. Notably, FTO genetic variants are strongly associated with periodontal diseases (PDs), temporomandibular joint osteoarthritis (TMJOA), and obstructive sleep apnea (OSA). Besides, the latest studies that describe the relationship between FTO and PDs, head and neck squamous cell carcinoma (HNSCCs), TMJOA, and OSA will be discussed. We elaborate on the regulatory roles of FTO in PDs, HNSCCs, and TMJOA, which are modulated through cell proliferation, cell migration, apoptosis, bone metabolism, and immune response. The review will enrich our understanding of RNA epigenetic modifications in oral diseases and present a solid theoretical foundation for FTO to serve as a novel diagnosis and prognostic biomarker for oral diseases. [ABSTRACT FROM AUTHOR]

Summary C‐reactive protein (CRP) appears to improve the ability to detect cardiometabolic risk in young and middle‐aged adults with mild‐to‐moderate obstructive sleep apnea (mmOSA). The aim of this study is to assess utility of CRP in identifying the risk of hypertension and insulin resistance across a wide age range including older patients with mmOSA. Adults (n = 216) of a wide age range (28–90 years old, mean age 52.64 ± 12.74) with mmOSA (5 ≤ AHI < 30) completed in‐lab polysomnography or home sleep apnea testing, physical examination including blood pressure (BP) measures, structured medical history questionnaire, and blood draw for CRP and fasting glucose and insulin levels. In adults < 60 years, lnCRP but not the apnea–hypopnea index (AHI) was associated with greater odds for hypertension (odds ratio [OR] = 2.40, 95% CI = 1.20–4.84, p = 0.01; OR = 1.00, 95% CI = 0.92–1.08, p = 0.92, respectively) and with higher average systolic and diastolic BP. Also, in adults < 60 years lnCRP but not AHI, was associated with higher lnHOMA values. In contrast, in adults > 60 years neither lnCRP nor AHI were associated with greater odds for hypertension, average systolic and diastolic BP, and lnHOMA. Receiver‐operating characteristics curves revealed that adding CRP to standard clinical factors (age, sex, and BMI) yielded moderately good risk models for hypertension in patients < 60 years (AUC = 0.721). In conclusion, CRP improves the ability to detect cardiometabolic risk in young and middle‐aged, but not older adults with mmOSA, suggesting that inflammation may be a primary pathogenetic mechanism in younger patients with OSA. [ABSTRACT FROM AUTHOR]

Background: Diet and sleep are both established risk factors for cardiometabolic diseases. Prior evidence suggests a potential link between these behaviors, though longitudinal evidence for how diet associates with sleep is scarce. This study aimed to determine the prospective association between diet quality in young adulthood and multiple sleep outcomes at midlife in the Bogalusa Heart Study (BHS). Methods: This prospective study included 593 BHS subjects with dietary assessment at the 2001–2002 visit and sleep questionnaire responses from the 2013–2016 visit, after an average of 12.7 years (baseline mean age: 36 years, 36% male, 70%/30% White and Black persons). A culturally tailored, validated food frequency questionnaire assessed usual diet. Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015, and the alternate Mediterranean (aMed) dietary score. Robust Poisson regression with log-link function estimated risk ratios (RR) for insomnia symptoms, high sleep apnea score, and having a healthy sleep pattern by quintile and per standard deviation (SD) increase in dietary patterns. Models adjusted for potential confounders including multi-level socioeconomic factors, depression, and body mass index. Trends across quintiles and effect modification by sex, race, and education were tested. Results: Higher diet quality in young adulthood, measured by both AHEI and HEI, was associated with lower probability of having insomnia symptoms at midlife. In the adjusted model, each SD-increase in AHEI (7.8 points; 7% of score range) conferred 15% lower probability of insomnia symptoms at follow-up (RR [95% confidence interval CI]: 0.85 [0.77, 0.93]), those in Q5 of AHEI had 0.54 times the probability as those in Q1 (95% CI: 0.39, 0.75), and there was a significant trend across quintiles (trend p = 0.001). There were no significant associations between young adult diet quality and having a high sleep apnea risk or a healthy sleep pattern at follow-up. Conclusions: A healthy diet was associated with a lower probability of future insomnia symptoms. If replicated, these findings could have implications for chronic disease prevention strategies incorporating the lifestyle behaviors of sleep and diet. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is associated with a number of adverse health effects, particularly on brain health. Chronic sleep disruption caused by OSA can adversely affect cognitive health. Exercise is recommended as a nonpharmacological intervention for patients who are intolerant to continuous positive airway pressure (CPAP) and has been shown to have beneficial effects on brain health and cognitive function. This protocol aims to investigate the effects of a 12-week tele-exercise program on cognitive function and specific parameters of brain activity, including brain metabolism and oxygenation, in patients with OSA. The project aims to demonstrate the multidimensional relationship between exercise, cognition, and brain oxygenation/metabolism. Our local ethics committee has approved the study. Our population sample (Group A, OSA with cognitive impairment (CI) and tele-exercise; Group B, OSA with CI and no tele-exercise; Group C, OSA without CI and no tele-exercise) will undergo assessment both before and after a 12-week tele-exercise intervention program. This assessment will include a comprehensive battery of subjective and objective assessment tests. Data will be analyzed according to group stratification. We hypothesize a beneficial effect of tele-exercise on sleep and cognitive parameters, and we are confident that this study will raise awareness among healthcare professionals of the brain health benefits of exercise in patients with low compliance to CPAP treatment. The protocol of our manuscript entitled "The impact of a 12-week tele-exercise program on cognitive function and cerebral oxygenation in patients with OSA: Randomized Controlled Trial -Protocol Study" has been registered on ClinicalTrials.gov with ID NCT06467682. [ABSTRACT FROM AUTHOR]

Background: Over the past decades, it has become increasingly evident that sleep disturbance contributes to inflammation‐mediated disease, including depression, mainly through activation of the innate immune system and to an increased risk of infections. Methods: A comprehensive literature search was performed in PubMed to identify relevant research findings in the field of immunity, inflammation and infections, with a focus on translational research findings from the past 5 years. Results: Physiological sleep is characterized by a dynamic interplay between the immune system and sleep architecture, marked by increased innate immunity and T helper 1 (Th1) ‐mediated inflammation in the early phase, transitioning to a T helper 2 (Th2) response dominating in late sleep. Chronic sleep disturbances are associated with enhanced inflammation and an elevated risk of infections, while other inflammatory diseases may also be affected. Conversely, inflammation in response to infection can also disrupt sleep patterns and architecture. This narrative review summarizes current data on the complex relationships between sleep, immunity, inflammation and infections, while highlighting translational aspects. The bidirectional nature of these interactions are addressed within specific conditions such as sleep apnea, HIV, and other infections. Furthermore, technical developments with the potential to accelerate our understanding of these interactions are identified, including advances in wearable devices, artificial intelligence, and omics technology. By integrating these tools, novel biomarkers and therapeutic targets for sleep‐related immune dysregulation may be identified. Conclusion: The review underscores the importance of understanding and addressing immune imbalance related to sleep disturbances to improve disease outcomes. [ABSTRACT FROM AUTHOR]

Background: Sleep apnea and nocturnal bruxism belong to sleep disorders that can affect the quality of life. The aim of this study was to investigate the effects on patients with moderate sleep apnea and nocturnal bruxism of Botox injection as monotherapy or associated with wearing thermoformed occlusal splints and to determine the patients' satisfaction degree after the applied treatments. Methods: The selected patients for study were divided into two groups: in the first group, the patients (n = 18) treatment consisted of injecting Botox (Allergan) into the masseter muscle as monotherapy; in the second group, the patients (n = 18) benefited from associated therapy, Botox injections in masseter muscle, and the wear of thermoformed occlusal splints. At baseline, at three weeks, at three months, and six months after the effectuation of therapies, the monitoring sessions were realized. Results: The associated therapy presented better results in decreasing the studied symptoms than the monotherapy. Both therapies improved patient satisfaction. Conclusions: The applied therapies for treating the specific symptomatology in moderate sleep apnea and sleep bruxism were efficacious. Patient satisfaction was very good in both groups after the applied treatments, but the associated therapy presented better results than monotherapy. [ABSTRACT FROM AUTHOR]

Introduction In children, obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is caused by adenotonsillar hypertrophy and is characterized by upper airway obstruction disturbing sleep. Objective We conducted this study to evaluate health-related quality of life (QoL) in children with OSA before and after adenotonsillectomy. Methods A descriptive, observational study was conducted among 43 children in the 4-to-12 years old age group who had symptoms of OSA due to adenotonsillar hypertrophy and who underwent adenotonsillectomy at a tertiary care center during the period from February 2020 to February 2021. The QoL was assessed using the OSA-18 questionnaire preoperatively and at 2 and 6 months postoperatively. Results Among the study population, males (72)%) were more affected with OSA, with a male-to-female ratio of 2.6:1. Based on the OSA-18 questionnaire assessment, the most severe and frequently observed symptoms were in the domains of sleep disturbance and physical symptoms, in which the mean score was 77 preoperatively. After adenotonsillectomy, the mean OSA-18 score decreased to 28.605 and 22.465 at 2 and 6 months, respectively. At 2 months postsurgery, more significant improvement was noticed in sleep disturbances, physical symptoms, and parent's concern while at 6 months postsurgery, all domains showed equal improvement. Therefore, following adenotonsillectomy, the QoL improved significantly. Conclusion Obstructive sleep apnea can adversely affect sleep quality as well as neurocognitive and cardiovascular functions. Adenotonsillectomy resulted in significant improvement in the QoL. [ABSTRACT FROM AUTHOR]

Introduction Expansion sphincter pharyngoplasty has been shown to be a good alternative to continuous pressure devices in patients with moderate to severe obstructive sleep apnea. On the other hand, drug-induced sleep endoscopy provides information on the pattern of collapse in obstructive sleep apnea, although it is unclear whether this information improves the surgical outcomes. Objective To evaluate the success rate obtained when performing expansion sphincter pharyngoplasty on a group of patients diagnosed with moderate to severe obstructive sleep apnea who were not previously selected by drug-induced sleep endoscopy. Methods We present a series of patients with moderate to severe obstructive sleep apnea who underwent surgery. Pre- and postoperative home sleep apnea tests were performed. The success rate was calculated, and we assessed whether there were statistically significant pre- and postoperative differences in the apnea-hypopnea index and oximetry values. Results In total, 20 patients were included, and the surgical success rate was of 80%. Statistically significant improvements were demonstrated in the mean apnea-hypopnea index (from 40.25 ± 15.18 events/hour to 13.14 ± 13.82 events/hour; p < 0. 0001), the mean oximetric data (from 26.3 ± 12.97 desaturations/hour to 13.57 ± 15.02 desaturations/hour; p = 0.034), and in the mean percentage of total sleep time in which the patient had less than 90% of saturation (from 8.64 ± 9.25% to 4.4 ± 7.76%; p = 0.028). Conclusion The results showed significant improvements in the apnea-hypopnea index and in the oximetric data, with a surgical success rate of 80%, despite the lack of prior drug-induced sleep endoscopy screening. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter. [ABSTRACT FROM AUTHOR]

Summary: Sleep‐disordered breathing is common in patients with coronary artery disease undergoing coronary artery bypass grafting. Sleep‐disordered breathing is associated with increased perioperative morbidity, arrhythmias (e.g. atrial fibrillation) and mortality. This study investigated the impact of sleep‐disordered breathing on the postoperative course after coronary artery bypass grafting, including development of atrial fibrillation. This prospective single‐centre cohort study included adults undergoing coronary artery bypass grafting. All were screened for sleep‐disordered breathing (polygraphy) and atrial fibrillation (electrocardiogram) preoperatively; those with known sleep‐disordered breathing or atrial fibrillation were excluded. Endpoints included new‐onset atrial fibrillation, duration of mechanical ventilation, time in the intensive care unit, and postoperative infection. Regression analysis was performed to identify associations between sleep‐disordered breathing and these outcomes. A total of 508 participants were included (80% male, median age 68 years). The prevalence of any (apnea–hypopnea index ≥ 5 per hr), moderate (apnea–hypopnea index = 15–30 per hr) and severe (apnea–hypopnea index > 30 per hr) sleep‐disordered breathing was 52.9%, 9.3% and 10.2%, respectively. All‐cause 30‐day mortality was 0.98%. After adjustment for age and sex, severe sleep‐disordered breathing was associated with longer respiratory ventilation support (crude odds ratio [95% confidence interval] 5.28 [2.18–12.77]; p < 0.001) and higher postoperative infection rates (crude odds ratio 3.32 [1.45–7.58]; p < 0.005), but not new‐onset atrial fibrillation or mortality. New‐onset atrial fibrillation was significantly associated with postoperative infection and prolonged hospital stay. The significant associations between sleep‐disordered breathing and several adverse outcomes after coronary artery bypass grafting support the need for preoperative sleep‐disordered breathing screening in individuals undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Summary: Sleep‐disordered breathing is highly prevalent in individuals with high‐level spinal cord injury. In addition, chest mechanics are known to be altered, leading to paradoxical breathing. Here we investigated the interaction between paradoxical breathing and sleep quality in these patients, and its association with measurements of respiratory function, hypercapnic ventilatory response and peak exercise ventilation. Home‐based polysomnography was performed in 13 patients with spinal cord injury (C4 to T4) untreated for sleep‐disordered breathing. We defined paradoxical breathing as counterphase between thoracic and abdominal movements during slow‐wave and rapid eye movement sleep. Sleep quality, pulmonary function, hypercapnic ventilatory responses and peak exercise ventilation were compared between those with and without paradoxical breathing. Half of individuals presented with nocturnal paradoxical breathing. Despite similar age, body mass index, injury level, time since injury, and respiratory function, those with paradoxical breathing had higher apnea–hypopnea index (13 ± 8 versus 5 ± 3 events per hr) and average sleep heart rate (67 ± 12 versus 54 ± 4 bpm; p < 0.05). Moreover, paradoxical breathing was associated with lower hypercapnic ventilatory response (slope: 0.35 ± 0.17 versus 0.96 ± 0.38) and lower peak exercise ventilation (33 ± 4 versus 48 ± 12 L min−1; p < 0.05). Nocturnal respiratory muscle desynchronization could play a role in the pathophysiology of sleep apnea, and could relate to low ventilatory responses to both hypercapnia and exercise in high‐level spinal cord injury. Polysomnography may be an important diagnostic tool for these patients for whom therapeutic approaches should be considered to treat this abnormality. [ABSTRACT FROM AUTHOR]

Background: Sleep‐related bruxism (SB) is the habit of grinding or clenching the teeth during sleep, mediated by the non‐peripheral central nervous system. Purpose: The objectives of this cross‐sectional study were to evaluate associations between SB, microarousals and oxyhaemoglobin desaturations and to compare the frequency of SB and microarousals in sleep stages, in an apnoeic population. Methods: Two hundred and forty individuals composed the sample, who underwent a single full‐night polysomnography. Self‐reports and clinical inspections were not considered for assessing SB. The polysomnographic assessment of SB was performed using electrodes placed on masseter muscles and chin. SB was defined as more than two events of rhythmic masticatory muscle activity per hour of sleep. Microarousals were considered when there were abrupt changes in electroencephalogram frequencies, without complete awakening, lasting from 3 to 15 s. Oxyhaemoglobin desaturations were defined as significant drops (≥3%) in basal oxygen saturations. With these data, SB, microarousals and oxyhaemoglobin desaturations were evaluated and submitted to statistical analysis. Results: Statistically significant differences were observed between bruxers and non‐bruxers when comparing the rates of microarousals (p <.001) and oxyhaemoglobin desaturations (p =.038). There was a higher number of SB and microarousals in NREM (non‐rapid eye movement) two sleep stage (p < 0.001). Bruxers had a greater risk of higher numbers of microarousals (OR = 1.023; p =.003), which did not occur for oxyhaemoglobin desaturations (OR = 0.998; p =.741). Conclusions: A higher number of microarousals presents relationship with SB; associations between SB and oxyhaemoglobin desaturations remained inconclusive; higher frequency of SB and microarousals was observed in NREM 2 sleep stage. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea. Polysomnography (PSG) represents the gold standard for SA diagnosis. This laboratory-based procedure is complex and costly, and less cumbersome wearable devices have been proposed for SA detection and monitoring. A novel textile multi-sensor monitoring belt recording electrocardiogram (ECG) and breathing frequency (BF) measured by thorax excursion was developed and tested in a sleep laboratory for validation purposes. The aim of the current study was to evaluate the diagnostic performance of ECG-derived heart rate variability and BF-derived breathing rate variability and their combination for the detection of sleep apnea in a population of patients with a suspicion of SA. Fifty-one patients with a suspicion of SA were recruited in the sleep laboratory of the Cantonal Hospital St. Gallen. Patients were equipped with the monitoring belt and underwent a single overnight laboratory-based PSG. In addition, some patients further tested the monitoring belt at home. The ECG and BF signals from the belt were compared to PSG signals using the Bland-Altman methodology. Heart rate and breathing rate variability analyses were performed. Features derived from these analyses were used to build a support vector machine (SVM) classifier for the prediction of SA severity. Model performance was assessed using receiver operating characteristics (ROC) curves. Patients included 35 males and 16 females with a median age of 49 years (range: 21 to 65) and a median apnea-hypopnea index (AHI) of 33 (IQR: 16 to 58). Belt-derived data provided ECG and BF signals with a low bias and in good agreement with PSG-derived signals. The combined ECG and BF signals improved the classification accuracy for SA (area under the ROC curve: 0.98; sensitivity and specificity greater than 90%) compared to single parameter classification based on either ECG or BF alone. This novel wearable device combining ECG and BF provided accurate signals in good agreement with the gold standard PSG. Due to its unobtrusive nature, it is potentially interesting for multi-night assessments and home-based patient follow-up. [ABSTRACT FROM AUTHOR]

Objective: Despite recognition that people with HIV (PWH) are more vulnerable to sleep issues, there is limited understanding of clinically recognized sleep disorders in this population. Our objective was to evaluate the full spectrum of sleep disorder types diagnosed among PWH in care. Methods: We conducted a retrospective cohort study of PWH, and a comparator group of people without HIV (PWoH), in a large healthcare system. The incidence of clinically diagnosed sleep disorders was calculated using Poisson regression for three outcomes: any type of sleep disorder, insomnia, and sleep apnea. Incidence was compared between PWH and PWoH by computing the adjusted incidence rate ratio (aIRR), accounting for sleep disorder risk factors. Comparisons to PWoH were made for all PWH combined, then with PWH stratified by HIV management status (well‐managed HIV defined as being on antiretroviral therapy, HIV RNA <200 copies/mL, and CD4 count ≥500 cells/μL). Results: The study included 9076 PWH and 205 178 PWoH (mean age 46 years, 90% men). Compared with PWoH, sleep disorder incidence was greater among PWH overall [aIRR = 1.19, 95% confidence interval (CI): 1.12–1.26], particularly for insomnia (aIRR = 1.56, 95% CI: 1.45–1.67). Sleep apnea incidence was lower among PWH (aIRR = 0.90, 95% CI: 0.84–0.97). In HIV management subgroups, PWH without well‐managed HIV had lower sleep apnea incidence (vs. PWoH: aIRR = 0.79, 95% CI: 0.70–0.89) but PWH with well‐managed HIV did not (vs. PWoH: aIRR = 0.97, 95% CI: 0.89–1.06). Conclusions: PWH have high sleep disorder incidence, and insomnia is the most common clinical diagnosis. Lower sleep apnea incidence among PWH may reflect underdiagnosis in those with sub‐optimally treated HIV and will be important to investigate further. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality is often reported by individuals with asthma, particularly by those who have poor asthma control overall. However, there is little understanding of how underlying sleep disorders such as insomnia may impact asthma control. Furthermore, given the frequent overlap of depression and insomnia, the incremental impact of mood disorders and insomnia on asthma control remains unclear. Methods: We conducted a retrospective analysis of patients at a large asthma center to further elucidate connections between these disease processes. Asthma patients with and without a diagnosis of insomnia were matched by age, sex, Charlson comorbidity index, and biologic therapy. We evaluated the presence of concurrent obstructive sleep disorder, mood disorders, exacerbation frequency, and asthma control test (ACT) scores. Results: From a cohort of 659 patients with an asthma diagnosis, 89 subjects with insomnia (13.5%) were matched 1:1 to patients without insomnia. Compared to those without insomnia, patients with insomnia were more likely to have a concurrent diagnosis of obstructive sleep apnea (57.3% vs. 18%, p < 0.001) and to have a diagnosis of depression or anxiety (68.5% vs. 11.4%, p < 0.001). Among insomnia patients, there was an average of 0.93 asthma exacerbations per year, compared to 0.59 exacerbations per year for those without insomnia (p = 0.039). Conclusion: Our data reveal a considerable interaction between insomnia, depression, and obstructive sleep apnea in individuals with asthma. The increased exacerbation rate suggests that underlying sleep and mood disorders negatively affect asthma control. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) is a sleep-related breathing disorder characterized by breathing pauses during sleep. A person's sleep schedule is significantly influenced by that person's hectic lifestyle, which may include unhealthy eating habits and their line of work. Polysomnographic (PSG) sleep studies examine sleep-related disorders by recording various biosignals from the human body. However, SA classification methods could be more robust in terms of performance because they rely on feature-engineering strategies or employ a particular signal from PSG recording for diagnosis. This study aims to classify the severity of SA according to the apnea–hypopnea index (AHI) into normal, mild, and moderate-to-severe groups using oxygen saturation (SpO2), electroencephalogram (EEG), and electrocardiogram (ECG) signals. The proposed deep neural network (DNN)-bidirectional long short-term memory (DNN-BiLSTM) framework addresses the issue of low detection accuracy in analysis. The DNN-BiLSTM approach employs features extracted from a multiscale dilation attention 1D convolutional neural network (MSDA-1DCNN) as input for detection and classification purposes. The MSDA-1DCNN network extracts deep features from processed SpO2, EEG, and ECG signals. The developed firefly combined electric fish optimization (FCEFO) algorithm improves performance by optimizing the hidden neuron count of the DNN and the learning rate of the BiLSTM framework. The performance measures proved the effectiveness of the model over conventional machine and deep learning approaches. With the integration of deep features, the proposed DNN-BiLSTM model provides enhanced performance in terms of accuracy and precision. Thus, the proposed approach is progressive and can be used for medical diagnosis. [ABSTRACT FROM AUTHOR]

Intermittent hypoxia in sleep apnea syndrome (SAS) patients increases the oxidative stress and can cause serious cardiovascular diseases such as hypertension or atherosclerotic diseases through endothelial dysfunction. The evaluation of risk caused by oxidative stress, however, is not easy in a clinical setting. Thus, we intended to evaluate the changes in oxidative stress by SAS treatment using a simple method that can be easily used in the clinical testing. We enrolled 42 consecutive newly diagnosed severe SAS patients (30 men). Reactive oxygen species metabolites (d-ROMs) for oxidative stress and biological antioxidant (BAP) in blood samples were estimated using FREE Carrio Duo® before and 3 months after continuous positive airway pressure (CPAP) treatment. SAS parameters were obtained by polysomnography before CPAP and endothelial function was measured twice as well. The body mass index and apnea hypopnea index (AHI) were 29.1 ± 5.3 and 57.9 ± 19.7/h. The d-ROMs and BAP were 317.4 ± 71.8 CARR U and 2121.2 ± 299.6 μmol/L. Although no significant correlation was found between hypoxia parameters and d-ROMs or BAP before CPAP treatment, we found a significant negative correlation between basal AHI or basal oxygen desaturation index representing intermittent hypoxia and the change in d-ROMs (r = − 0.31, p = 0.046/r = − 0.33, p = 0.03) and between the change in SpO2 < 90% duration (min) representing continuous hypoxia and the change in BAP (r = − 0.35, p = 0.03) after CPAP treatment. The changes in d-ROM and BAP might reflect the different kind of reduction of oxidative stress by CPAP treatment and, thus, can be used as handy indicators of the treatment effect. [ABSTRACT FROM AUTHOR]

Advanced signal processing of photoplethysmographic data enables novel analyses which may improve the understanding of the pathogenesis of dysglycemia associated with sleep disorders. We aimed to identify sleep-related pulse wave characteristics in diabetic patients compared to normoglycemic individuals, independent of cardiovascular-related comorbidities. This cross-sectional evaluation of the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) included overnight oximetry-derived pulse wave data from 3997 subjects (45 % males, age 50–64 years). Metabolic status was classified as normoglycemic (n = 3220), pre-diabetic (n = 544), or diabetic (n = 233). Nine validated pulse wave features proposed to influence cardiovascular risk were derived and compared between metabolic status groups. Logistic prediction models and genetic matching were applied to capture diabetes-related pulse wave characteristics during sleep. The model was controlled for anthropometrics, lifestyle, sleep apnea, and in the final adjustment even for cardiometabolic factors like dyslipidaemia, hypertension, and coronary artery calcification. Pulse wave-derived parameters differed between normoglycemic and diabetic individuals in eight dimensions in unadjusted as well as in the partially adjusted model (anthropometric factors and sleep apnea, p ≤ 0.001). All covariates confirmed significant differences between normoglycemic and diabetic subjects (all p ≤ 0.001). Reduced cardio-respiratory coupling (respiratory-related pulse oscillations) (β = −0.010, p = 0.012), as well as increased vascular stiffness (shortened pulse propagation time (β = −0.015, p = 0.001), were independently associated with diabetes even when controlled for cardiometabolic factors. These results were confirmed through a matched cohort comparative analysis. Photoplethysmographic pulse wave analysis during sleep can be utilized to capture multiple features of modified autonomic regulation and cardiovascular consequences in diabetic subjects. Dampened heart rate variability and increased vascular stiffness during sleep showed the strongest associations with diabetes. • Several characteristics of the nocturnal pulse wave signal (PPG) are associated with diabetes. • Elevated vascular stiffness and reduced heart rate modulation identified in diabetic subjects. • Overnight PPG may detect diabetes-related consequences of metabolic dysfunction during sleep. [ABSTRACT FROM AUTHOR]

Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. Despite this, physiological alterations during the sleep onset are not well-understood. In particular, insomnia and obstructive sleep apnea (OSA) are highly prevalent co-morbid conditions, where autonomic regulation may be altered. We aimed to characterize heart rate variability (HRV) during sleep onset as a potential measure of pre-sleep hyperarousal. We described the profile of pre-sleep HRV measures and explore autonomic differences in participants with self-reported insomnia disorder (with no OSA, n = 69; with mild OSA, n = 70; with moderate or severe OSA, n = 66), compared to normal sleep controls (n = 123). Heart rate data during the sleep onset process were extracted for HRV analyses. During the sleep onset process, compared to normal sleep controls, participants with insomnia had altered HRV, indicated by higher heart rate (p = 0.004), lower SDNN (p = 0.003), reduced pNN20 (p < 0.001) and pNN50 (p = 0.010) and lower powers (p < 0.001). Participants with insomnia and moderate/severe OSA may have further deteriorated HRV outcomes compared to no/mild OSA patients with insomnia but differences were not significant. Insomnia itself was associated with significantly higher heart rate, lower pNN20, and lower high frequency power even after adjustment for age, gender, BMI and OSA severity. Participants with insomnia had lower vagal activity during the sleep onset period, which may be compounded by OSA, reflected in higher heart rates and lower HRV. These altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress. • Altered heart rate dynamics may present in subjects with insomnia even before sleep. • HRV may be a biomarker of hyper-arousal during wakefulness before sleep onset. • Tracking HRV during sleep onset may have value in evaluation/treatments for insomnia. • Bedtime HRV is a target marker for sleep onset difficulty due to hyperarousal/stress. [ABSTRACT FROM AUTHOR]

Introduction: Sleep Disordered Breathing (SDB) has been shown to increase the risk of stroke and despite recommendations, routine evaluation for SDB in acute stroke is not consistent across institutions. The necessary logistics and expertise required to conduct sleep studies in hospitalized patients remain a significant barrier. This study aims to evaluate the feasibility of high-resolution pulse-oximetry (HRPO) for the screening of SDB in acute stroke. Secondarily, considering impact of SDB on acute stroke, we investigated whether SDB at acute stroke predicts functional outcome at discharge and at 3 months post-stroke. Methods: Patients with acute mild to moderate ischemic stroke underwent an overnight HRPO within 48 h of admission. Patients were divided into SDB and no-SDB groups based on oxygen desaturations index(ODI > 10/h). Stepwise multivariate logistic regression analysis was applied to identify the relevant predictors of functional outcome (favorable [mRS 1–2 points] versus unfavorable [mrS > = 3 points]). Results: Of the 142 consecutively screened patients, 96 were included in the analysis. Of these, 33/96 (34%) were identified as having SDB and were more likely to have unfavorable mRS scores as compared to those without SDB (odds ratio = 2.70, p-value = 0.032). Conclusion: HRPO may be a low-cost and easily administered screening method to detect SDB among patients hospitalized for acute ischemic stroke. Patients with SDB (as defined by ODI) have a higher burden of neurological deficits as compared to those without SDB during hospitalization. [ABSTRACT FROM AUTHOR]

Purpose: Although the validity of the Epworth Sleepiness Scale (ESS) as an effectiveness measure for sleep apnea treatments such as continuous positive airway pressure (CPAP) has been supported by multiple studies, some researchers continue to challenge it. They suggest that in addition to its impact on relieving patients' daytime sleepiness, CPAP also alters the internal standards patients use to evaluate their sleepiness (i.e., response shift; RS), confounding the meaning of the difference in the ESS scores. We believe an issue yet to be addressed in this debate is that all existing evidence of RS has been obtained through the then-test approach, a retrospective method sensitive to various cognitive mechanisms. Thus, in the current study, we re-examined this issue using the structural equation modeling (SEM) approach, a method that can be directly applied to randomized clinical trial (RCT) data without retrospective measures. Methods: With the ESS data from two independent RCTs, we conducted cross-sectional and longitudinal measure invariance tests in SEM to examine whether CPAP would lead to RS. Results: The ESS demonstrated cross-sectional and longitudinal scalar invariance against CPAP treatments. Its factorial pattern, loadings, and thresholds were invariant between the treatment and control groups and pre- and post-treatment, supporting the comparability of the observed mean ESS scores across time and groups. Conclusion: Our results support the validity of the average difference scores of the ESS for quantifying the effectiveness of CPAP on group-level daytime sleepiness in RCTs with relatively large sample sizes. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric sleep apnea begins in toddlerhood when sleep is vital for neurocognitive development and rapid somatic growth. As polysomnography (PSG) can be challenging in this age group, this study described the first PSG for children aged 2 to 6 years old in regards to completion and risk-factors for intolerance. Methods: Single center chart review in a pediatric-only hospital-based sleep center. Results: Of the 342 children age 2 to 6 years old, 99.5% completed the study and 56% cooperated with the full hook-up; the nasal monitors were the least tolerated. Children who did not achieve a full hook-up slept 0.7 h fewer (p = 0.04), woke up more often (p = 0.015), and took 15 min longer to fall asleep (p = 0.012). Younger age and having autism were independent risk factors for poor tolerance. Conclusion: The majority of pre-schoolers tolerated their first PSG. Interventional trials to increase PSG success in this population should prepare those under 3-years-old and with sensory processing issues to cooperate with nasal monitors. [ABSTRACT FROM AUTHOR]

In the general population, Bronchial Asthma (BA) and Obstructive Sleep Apnea (OSA) are among the most prevalent chronic respiratory disorders. Significant epidemiologic connections and complex pathogenetic pathways link these disorders via complex interactions at genetic, epigenetic, and environmental levels. The coexistence of BA and OSA in an individual likely represents a distinct syndrome, that is, a collection of clinical manifestations attributable to several mechanisms and pathobiological signatures. To avoid terminological confusion, this association has been named alternative overlap syndrome (vs overlap syndrome represented by the chronic obstructive pulmonary disease--OSA association). This comprehensive review summarizes the complex, often bidirectional links between the constituents of the alternative overlap syndrome. Cross-sectional, population, or clinic-based studies are unlikely to elucidate causality or directionality in these relationships. Even longitudinal epidemiological evaluations in BA cohorts developing over time OSA, or OSA cohorts developing BA during follow-up cannot exclude time factors or causal influence of other known or unknown mediators. As such, a lot of pathophysiological interactions described here have suggestive evidence, biological plausibility, potential or actual directionality. By showcasing existing evidence and current knowledge gaps, the hope is that deliberate, focused, and collaborative efforts in the near-future will be geared toward opportunities to shine light on the unknowns and accelerate discovery in this field of health, clinical care, education, research, and scholarly endeavors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Exploring and establishing a consensus on palatal surgery, the outcomes and follow-up after the palatal surgery, the complications of palatal surgery, and the post-operative management after palatal surgery for snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the surgical management of patients with such conditions. Methods: Using the Delphi method, a set of statements was developed based on the literature and circulated among a panel of eight European experts. Responses included agreeing and disagreeing with each statement, and the comments were used to assess the level of consensus and to 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 over a total of five rounds. Results: The final set included a total of 111 statements, 27 of which were stand-alone questions and 21 of which contained 84 sub-statements. Of the 34 statements regarding palatal surgery, consensus was achieved among all eight, seven, and six panelists for 50%, 35.3%, and 5.9% of the questions, respectively. Of the 43 statements regarding the outcomes and follow-up after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 53.5%, 23.3%, and 4.7% of the questions, respectively. Of the 24 statements regarding complications after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 91.7%, 0%, and 4.2% of the questions, respectively. Of the 10 statements regarding post-operative management after palatal surgery, consensus was achieved among all eight, seven, and six panelists for 10%, 30%, and 30% of the papers, respectively. Conclusions: This consensus provides an overview of the work of European sleep surgeons to develop a set of statements on palatal surgery for the treatment of snoring and OSA, the outcomes and follow-up, the complications, and the post-operative management of palatal surgery. We believe that this will be helpful in everyday practice. It also indicates key areas for further studies in sleep surgery. [ABSTRACT FROM AUTHOR]

No therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA). The authors sought to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity. Adult patients with a body mass index 35 to 70 kg/m2 and moderate-to-severe OSA at a U.S. health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap-weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022. A total of 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m2 [Q1-Q3: 37.6-46.2 kg/m2]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (Q1-Q3: 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6-27.6 kg) or 19.3% (95% CI: 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI: 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI: 33.8%-37.4%) in the nonsurgical group (adjusted HR: 0.58 [95% CI: 0.48-0.71]; P < 0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%-12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%-13.8%) in the nonsurgical group (adjusted HR: 0.63 [95% CI: 0.45-0.89]; P = 0.009). Among patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death. [ABSTRACT FROM AUTHOR]

Introduction and purpose Sleep apnea is a disturbance of sleep that affects about 10% of adult population and is not easily detected due to unspecific symptoms. The aim of this literature review is to present, respectively, obstructive sleep apnea and central sleep apnea symptoms and integrate the available data in the literature regarding the pathogenesis and treatment methods. Materials and methods A review of literature was performed using PubMed and Google Scholar database. The search criteria included keywords such as sleep apnea, obstructive sleep apnea treatment, central sleep apnea treatment. State of knowledge Sleep disturbances that involve breathing can be categorized as obstructive sleep apnea (OSA) and central sleep apnea. First one is associated with the obstruction of the upper airways and the second one -- with malfunctioning breathing generator in the pontomedullary breathing pacemaker. Symptoms are unspecific which makes diagnostic process difficult. However, the right diagnosis and treatment may prevent patients from developing many cardiovascular diseases. Treatment options for OSA include: CPAP, reducing body weight, changing sleep position, braces and surgeries; for CSA: CPAP and acetazolamide. Conclusions OSA and CSA need to be further investigated in order to find more precise ways of diagnosis and treatment, as these diseases remain underreported. It is worth noting, that these conditions predispose to serious diseases, e.g. stroke. Therefore, developing new treatment techniques would beneficial for the health of population. [ABSTRACT FROM AUTHOR]

Background: Over the past three decades, our understanding of sleep apnea in women has advanced, revealing disparities in pathophysiology, diagnosis, and treatment compared to men. However, no real-life study to date has explored the relationship between mask-related side effects (MRSEs) and gender in the context of long-term CPAP. Methods: The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks, no gender specific mask series). MRSE were assessed by the patient using visual analog scales (VAS). CPAP-non-adherence was defined as a mean CPAP-usage of less than 4 h per day. The primary objective of this ancillary study was to investigate the impact of gender on the prevalence of MRSEs reported by the patient. Secondary analyses assessed the impact of MRSEs on CPAP-usage and CPAP-non-adherence depending on the gender. Results: A total of 1484 patients treated for a median duration of 4.4 years (IQ25–75: 2.0–9.7) were included in the cohort, with women accounting for 27.8%. The prevalence of patient-reported mask injury, defined as a VAS score ≥ 5 (p = 0.021), was higher in women than in men (9.6% versus 5.3%). For nasal pillow masks, the median MRSE VAS score for dry mouth was higher in women (p = 0.039). For oronasal masks, the median MRSE VAS score for runny nose was higher in men (p = 0.039). Multivariable regression analyses revealed that, for both women and men, dry mouth was independently and negatively associated with CPAP-usage, and positively associated with CPAP-non-adherence. Conclusion: In real-life patients treated with long-term CPAP, there are gender differences in patient reported MRSEs. In the context of personalized medicine, these results suggest that the design of future masks should consider these gender differences if masks specifically for women are developed. However, only dry mouth, a side effect not related to mask design, impacts CPAP-usage and non-adherence. Trial Registration: InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).First registration date is 2016–12-23. [ABSTRACT FROM AUTHOR]

Introduction: Hypertrophy of adenoids is a common condition in childhood, resulting in obstructive symptoms such as sleep apnea, snoring, and rhinosinusitis. Adenotonsillectomy is recommended to improve prognosis and quality of life. This case-control study compared facial angles and lip position related to dentofacial and mouth growth in symptomatic children with adenoid hypertrophy and asymptomatic control groups. Materials and Methods: The study included children aged 5 to 7 who presented with obstructive symptoms and confirmed severe adenoid hypertrophy in lateral neck radiography. Standard lateral photography was taken. The Nasofacial and Nasomental angles, and upper and lower lip positions and their distance behind the Ricketts line, were measured and compared with the normal control group. Results: This study included 54 children with severe adenoid hypertrophy and 66 normal children. Facial angles were not significantly different between the two groups, but the mean horizontal position of the upper and lower lip in children with adenoid hypertrophy was significantly lower than in the control group (P value = 0.05). The lips were too close to the Ricketts line compared with the control group. Conclusions: This research demonstrates that children with severe adenoid hypertrophy have more dentofacial disorders than others. Adenotonsillectomy surgery is necessary for children with obstructive symptoms caused by tonsil enlargement, and if symptoms like snoring persist post-surgery, complementary orthodontic treatments should be considered. [ABSTRACT FROM AUTHOR]