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State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 21989

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Dr. Domenico Ciavarella

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Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, FG, Italy
Interests: obstructive sleep apnea; temporomandibular joint disease; orthodontics; craniofacial morphology
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Prof. Dr. Giuseppe Troiano

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Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia FG, Italy
Interests: systematic review; meta-analysis; oral medicine; oral pathology; dental implants; prosthodontics; periodontology; prediction models; bioinformatics

Prof. Dr. Michele Tepedino

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Guest Editor

Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, V. le S. Salvatore, Edificio Delta 6, 67100 L’Aquila, Italy
Interests: orthodontics; obstructive sleep apnea; impacted teeth; functional appliances
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I invite you to contribute to a Special Issue of the journal Applied Sciences entitled “State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders”, which aims to present the most up-to-date knowledge in the diagnosis and interdisciplinary management of sleep-related breathing disorders in both children and adults.

The term “sleep-related breathing disorders” (SRBDs) encompasses a range of pathologic conditions characterized by abnormal respiration during sleep that can affect both children and adults. The expanding knowledge on this topic has revealed that impaired sleeping and breathing have profound effects on many systemic functions; therefore, a modern approach requires the collaboration of different professionals, such as otorhinolaryngologists, pneumologists, neurologists, cardiologists, psychologists, dentists, and many others. The real prevalence of such conditions is unknown, especially in children, even though a growing awareness can be found among governments, researchers, and public opinion, especially with regard to the social implications that SRBDs can have. Moreover, recent studies have raised attention on comorbidities that can be associated with SRBDs, and these comorbidities can influence SRBDs and vice versa. Regarding the current international situation, it would be interesting to evaluate the progress of COVID-19 disease in SRBD patients.
Defining the state-of-the-art knowledge on all the conditions orbiting around SRBDs from all points of view (etiology, diagnosis, clinical management, interdisciplinarity, and public health management) would be of great interest and impact to improve future research and the quality of life of SRBD patients.
I therefore invite you to submit your research on these topics, in the form of original research papers, reviews, and perspective articles.

Prof. Domenico Ciavarella
Prof. Giuseppe Troiano
Prof. Michele Tepedino
Guest Editors

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Keywords

sleep-related breathing disorder
obstructive sleep apnea
central sleep apnea
sleep-related hypoventilation
sleep-related hypoxemia disorder
mandibular advancement devices
craniofacial morphology
airway
bruxism
temporomandibular joint
COVID-19
SARS-CoV-2
pulmonary disease
cardiovascular disease
neurological disease
growth and development
child
sleep endoscopy
polysomnography

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Published Papers (9 papers)

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Editorial

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4 pages, 195 KiB

Open AccessEditorial

State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders

by Domenico Ciavarella, Michele Tepedino and Giuseppe Troiano

Appl. Sci. 2021, 11(17), 8056; https://doi.org/10.3390/app11178056 - 31 Aug 2021

Cited by 1 | Viewed by 1514

Abstract

The term “sleep-related breathing disorders” (SRDB) comprehends a spectrum of pathologic conditions characterized by abnormal respiration during sleep, that can affect both adults and growing subjects. The expanding knowledge on this topic has revealed that impaired sleeping and breathing have profound effects on many systemic functions, therefore a modern approach requires the collaboration of different professionals like the otorhinolaryngologist, pneumologist, neurologist, cardiologist, psychologist, dentist, and many others. The real prevalence of such conditions is unknown, especially in children, even though a growing awareness can be found among Governments, researchers, and public opinion, especially for the social implications that SRDB can have. Moreover, recent studies have raised attention on comorbidities that can be associated with SRDB, influencing each other. Regarding the current international situation, it would be interesting to evaluate the progress of COVID-19 disease in SRDB patients. Defining the state-of-the-art knowledge on all the conditions orbiting around SRDB, from all points of view—aetiology, diagnosis, clinical management, interdisciplinarity, public health management—would be of great interest and impact to improve future research and the quality of life of SRDB patients. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

Research

Jump to: Editorial, Review

11 pages, 429 KiB

Open AccessArticle

Paediatric Sleep Questionnaire for Obstructive Sleep Apnoea Syndrome Screening: Is Sleep Quality Worthy of Note?

by Vera Panzarella, Giovanna Giuliana, Paola Spinuzza, Gaetano La Mantia, Laura Maniscalco, Giuseppe Pizzo and Domenica Matranga

Appl. Sci. 2021, 11(4), 1440; https://doi.org/10.3390/app11041440 - 5 Feb 2021

Cited by 11 | Viewed by 2799

Abstract

Obstructive sleep apnoea syndrome (OSAS) is the most severe condition on the spectrum of sleep-related breathing disorders (SRBDs). The Paediatric Sleep Questionnaire (PSQ) is one of the most used and validated screening tools, but it lacks the comprehensive assessment of some determinants of OSAS, specifically anamnestic assessment and sleep quality. This study aims to assess the accuracy of some specific items added to the original PSQ, particularly related to the patient’s anamnestic history and to the quality of sleep, for the screening of OSAS in a paediatric population living in Sicily (Italy). Fifteen specific items, divided into “anamnestic” and “related to sleep quality” were added to the original PSQ. The whole questionnaire was administered via a digital form to the parents of children at 4 schools (age range: 3–13 years). For each item, sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The highest sensitivity (80.0, 95% CI: 28.4; 99.5), in combination with the highest specificity (61.1, 95% CI: 35.7; 82.7), was found for the Item 32 (“assumption of bizarre or abnormal positions during sleep”). This item was found statistically significant for predicting the occurrence of OSAS in children (p-value ≤0.003). The study demonstrates the accuracy of specific items related to sleep quality disturbance for the preliminary assessment of the disease. Although these results should be validated on a larger sample of subjects, they suggest that including the factors discriminating sleep quality could further increase the efficiency and accuracy of PSQ. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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6 pages, 226 KiB

Open AccessArticle

Frequency of Sleep Bruxism Behaviors in Healthy Young Adults over a Four-Night Recording Span in the Home Environment

by Anna Colonna, Marzia Segù, Luca Lombardo and Daniele Manfredini

Appl. Sci. 2021, 11(1), 195; https://doi.org/10.3390/app11010195 - 28 Dec 2020

Cited by 13 | Viewed by 2526

Abstract

Objectives: This study aimed to assess frequency and multiple-night variability of sleep bruxism (SB) as well as sleep-time masticatory muscle activities (sMMA) in the home environment in healthy young adults using a portable device that provides electrocardiographic (ECG) and surface electromyographic (EMG) recordings from the masticatory muscles. Methods: The study was performed on 27 subjects (11 males, 16 females; mean age 28.3 ± 1.7 years) selected from a sample of healthy young students. Evaluation was carried out for four nights to record data on masticatory muscle activities using a compact portable device that previously showed an excellent agreement with polysomnography (PSG) for the detection of SB events. The number of SB episodes per sleep hour (bruxism index), and the number of tonic, phasic and mixed sMMA events per hour were assessed. A descriptive evaluation of the frequency of each condition was performed on all individuals, and gender comparison was investigated. Results: Mean sleep duration over the four recording nights was 7 ± 1.3 h. The average SB index was 3.6 ± 1.2. Most of the sMMA were tonic (49.9%) and phasic (44.1%). An ANOVA test showed the absence of significant differences between the four nights. No significant gender differences were detected for the SB index, phasic or tonic contractions; conversely, gender differences were detected for mixed sMMA events (p < 0.05). Conclusion: This investigation supports the concept that sMMA events are quite frequent in healthy adults. Differences over the four-night recording span were not significant. These data could be compared to subjects with underlying conditions that may lead to an additive bruxism activity and possible clinical consequences. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

12 pages, 1887 KiB

Open AccessArticle

Association between Rapid Maxillary Expansion and Nocturnal Enuresis in Children: A Pilot Study for a Randomized Controlled Clinical Trial

by Xiaowen Niu, Marie A. Cornelis, Konstantinos Kamperis and Paolo M. Cattaneo

Appl. Sci. 2020, 10(24), 9025; https://doi.org/10.3390/app10249025 - 17 Dec 2020

Cited by 1 | Viewed by 2058

Abstract

Objectives: This pilot study was conducted to test the protocol of a randomized controlled trial evaluating whether rapid maxillary expansion (RME) can relieve nocturnal enuresis (NE) and improve breathing in children, after ruling out a placebo effect, and investigating whether the effects of RME and NE are related to the morphology of the upper airway. Methods: Seventy 6–15-year-old patients with NE were assessed for eligibility (e.g., constricted maxilla). Enrolled subjects were randomized to immediate treatment with RME (Group 1) or to have the same treatment (RME) delayed for at least six weeks (Group 2). Outcomes comprised the number of wet nights per week, the nocturnal urine production, and the scores of a pediatric sleep questionnaire at baseline, after active treatment (Group 1) or delayed treatment (Group 2), and after 3 months’ retention. Cone beam computed tomographies were taken at baseline and after retention. Results: Six patients were randomized: three in each group. In four of six patients, the number of wet nights per week decreased. Moreover, in responders, nocturnal urine production was reduced following RME. Conclusions: This pilot study suggested that RME might reduce the severity of NE and showed that the protocol of this randomized controlled clinical trial was appropriate. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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9 pages, 925 KiB

Open AccessArticle

Sleep Bruxism Episodes in Patients with Obstructive Sleep Apnea Syndrome Determined by In-Laboratory Polysomnography

by Dong Hyun Kim, Sang Hwa Lee and Sang Haak Lee

Appl. Sci. 2020, 10(23), 8587; https://doi.org/10.3390/app10238587 - 30 Nov 2020

Cited by 5 | Viewed by 2219

Abstract

Findings on sleep bruxism (SB) in patients with obstructive sleep apnea syndrome (OSAS) are controversial, and some of these findings have relied on in-laboratory polysomnography (PSG). We aimed to identify the factors associated with SB episodes in 100 patients with OSAS using in-laboratory PSG records. Subjects with OSAS were divided into those with and without SB episodes. We analyzed the differences in patient characteristics and PSG indices. Age, gender, height, weight, body mass index, neck, waist, and hip circumferences, and the rates of hypertension and diabetes mellitus were not significantly different between the two groups. A greater proportion of stage N2 sleep in the total sleep time, longer total sleep time, longer sleep time in a supine position, shorter sleep time in a nonsupine position, lower apnea–hypopnea index (AHI), lower AHI regardless of sleeping position, lower AHI during nonrapid eye movement sleep, and higher mean oxygen saturation level were associated with SB episodes in patients with OSAS. Among these factors, longer sleep time in a supine position remained a statistically significant factor in multivariate analysis. We conclude that longer sleep time in a supine position (especially >280 min) might be associated with SB episodes in patients with OSAS. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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7 pages, 424 KiB

Open AccessArticle

Respiratory and Cardiovascular Parameters Evaluation in OSA Patients Treated with Mandibular Advancement Device

by Ciavarella Domenico, Tepedino Michele, Burlon Giuseppe, Ferrara Donatella, Cazzolla Angela Pia, Laurenziello Michele, Illuzzi Gaetano, Suriano Carmela and Cassano Michele

Appl. Sci. 2020, 10(22), 8175; https://doi.org/10.3390/app10228175 - 18 Nov 2020

Cited by 5 | Viewed by 2291

Abstract

Obstructive sleep apnea (OSA) is associated with a number of cardiovascular comorbidities, including hypertension, heart rate (HR) alterations, cardiac arrhythmias, endothelial dysfunction and atherosclerosis. HR, in particular, is an important sign correlated with cardiac stress and survival. Previous investigations on the effects of mandibular advancement device (MAD) therapy on HR resulted in contradictory findings. The aim of the present retrospective cohort study was to evaluate the effects of MAD therapy with a fully customizable appliance on respiratory and cardiovascular parameters. Fifty adult consecutive cases with mild to severe OSA underwent split-night polysomnography (SN-PSG) at baseline (T0) and after three months of MAD treatment (T1), after appropriate titration. The apnea/hypopnea index (AHI), 4% oxygen desaturation index (ODI) and HR (average, minimum and maximum) values are recorded at T0 and at T1 and statistically compared. The AHI and ODI values improved after three months of MAD treatment. The minimum HR increased after treatment, while the maximum HR decreased after treatment. MAD treatment with a fully customizable appliance was effective in improving breathing and cardiovascular parameters in adult patients with mild to severe OSA. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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12 pages, 1311 KiB

Open AccessArticle

A Non-Framework Multilevel Surgery May Reduce Mean Heart Rate in Patients with Very Severe Obstructive Apnea Having Confined Retroglossal Space and Framework

by Ethan I. Huang, Shu-Yi Huang, Yu-Ching Lin, Chieh-Mo Lin, Chin-Kuo Lin, Ying-Chih Huang and Jian-An Su

Appl. Sci. 2020, 10(22), 8094; https://doi.org/10.3390/app10228094 - 15 Nov 2020

Cited by 3 | Viewed by 1889

Abstract

An elevated mean heart rate in untreated patients of obstructive sleep apnea (OSA) may lead to a higher risk of mortality and the development of various cardiovascular diseases. The elevation may positively relate to the severity of OSA and present in both wakefulness and sleep. A reduction in heart rate has been presented in reports of treating OSA patients with continuous positive airway pressure (CPAP). However, patients with very severe OSA may refuse use of CPAP devices and advocated surgeries, such as direct skeletal surgery or tracheostomy. It is unclear whether the non-framework multilevel surgery we reported previously can overcome the unfavorable anatomy and reduce mean heart rate, which serves as a risk factor of mortality. Here, we show that multilevel surgery reduced the mean heart rate from 68.6 to 62.7 with a mean reduction of 5.9 beats/min. The results suggest that the surgery may reduce the risk of consequences and mortality associated with an elevated mean heart rate, such as various cardiovascular diseases. We disclose these findings, along with the variations and possible risks to our future patients with very severe OSA who refuse or cannot use a CPAP device or reject direct skeletal surgery. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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11 pages, 1912 KiB

Open AccessArticle

Increasing Hypopnea in Sleep Breathing Disturbance Improves Postoperative Oxygen Saturation in Patients with Very Severe Obstructive Sleep Apnea

by Ethan I. Huang, Shu-Yi Huang, Yu-Ching Lin, Chieh-Mo Lin, Chin-Kuo Lin, Ying-Chih Huang and Jian-An Su

Appl. Sci. 2020, 10(18), 6539; https://doi.org/10.3390/app10186539 - 18 Sep 2020

Cited by 6 | Viewed by 2365

Abstract

In patients of very severe obstructive sleep apnea (OSA) with confined framework, reducing volume is difficult to achieve a postoperative apnea-hypopnea index (AHI) qualifying the classical surgical success. However, a higher AHI with a larger part of hypopneas may have similar or even less severity of oxygen (O₂) desaturation, compared to a lower index mostly made of apneas. Here, in 27 consecutive enrolled patients, we show that besides the improvement of mean AHI, the multilevel surgery increased hypopnea in AHI from 29.1% to 77.3%, and improves postoperative O₂ saturation by reducing desaturation frequency (mean desaturation index decreased from 62.5 to 24.4 events/h) and level (mean oxyhemoglobin saturation of pulse oximetry (SpO₂) desaturation cut down from 10.0 to 5.8%). The mean SpO₂ improved from 92.3% to 94.7%, and the improvement was positively related to the proportion increase of hypopnea/AHI. The results suggest that the non-framework surgery could help patients with very severe OSA whose AHIs are ≥60 events/h in terms of improving postoperative O₂ saturation. Due to the improvement also presented in those not qualified as classical surgical success, further studies are needed to clarify the connection between O₂ desaturation and various consequences to reconsider defining a surgical success. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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Review

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20 pages, 1358 KiB

Open AccessFeature PaperReview

How to Obtain an Orthodontic Virtual Patient through Superimposition of Three-Dimensional Data: A Systematic Review

by Francesca Marradi, Edoardo Staderini, Maria Antonietta Zimbalatti, Andrea Rossi, Cristina Grippaudo and Patrizia Gallenzi

Appl. Sci. 2020, 10(15), 5354; https://doi.org/10.3390/app10155354 - 3 Aug 2020

Cited by 7 | Viewed by 3469

Abstract

Background: This systematic review summarizes the current knowledge on the superimposition of three-dimensional (3D) diagnostic records to realize an orthodontic virtual patient. The aim of this study is to analyze the accuracy of the state-of-the-art digital workflow. Methods: The research was carried out by an electronic and manual query effectuated from ISS (Istituto Superiore di Sanità in Rome) on three different databases (MEDLINE, Cochrane Library and ISI WEB OF SCIENCE) up to 31st January 2020. The search focused on studies that superimposed at least two different 3D records to build up a 3D virtual patient—information about the devices used to acquire 3D data, the software used to match data and the superimposition method applied have been summarized. Results: 1374 titles were retrieved from the electronic search. After title-abstract screening, 65 studies were selected. After full-text analysis, 21 studies were included in the review. Different 3D datasets were used: facial skeleton (FS), extraoral soft tissues (ST) and dentition (DENT). The information provided by the 3D data was superimposed in four different combinations: FS + DENT (13 papers), FS + ST (5 papers), ST + DENT (2 papers) and all the types (FS + ST + DENT) (1 paper). Conclusions: The surface-based method was most frequently used for 3D objects superimposition (11 papers), followed by the point-based method (6 papers), with or without fiducial markers, and the voxel-based method (1 paper). Most of the papers analyzed the accuracy of the superimposition procedure (15 papers), while the remaining were proof-of-principles (10 papers) or compared different methods (3 papers). Further studies should focus on the definition of a gold standard. The patient is going to have a huge advantage from complete digital planning when more information about the spatial relationship of anatomical structures are needed: ectopic, impacted and supernumerary teeth, root resorption and angulations, cleft lip and palate (CL/P), alveolar boundary conditions, periodontally compromised patients, temporary anchorage devices (TADs), maxillary transverse deficiency, airway analyses, obstructive sleep apnea (OSAS), TMJ disorders and orthognathic and cranio-facial surgery. Full article

(This article belongs to the Special Issue State of the Art in Comorbidities and Complications Associated with Sleep-Related Breathing Disorders)

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