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Obstructive Sleep Apnea (OSA): What Can We Do Now?

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (14 April 2024) | Viewed by 18746

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Dr. Pierluigi Carratù

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Institute of Internal Medicine “A. Murri”, Department of Precision and Regenerative Medicine and Ionian Area, Università Degli Studi di Bari Aldo Moro, Bari, Italy
Interests: obstructive sleep apnea (OSA); respiratory diseases; COPD; noninvasive ventilation; pulmonary fibrosis; lung function; smoking; pollution
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Dear Colleagues,

Obstructive sleep apnea (OSA) represents a public health problem by its strong incidence with the concomitantly increasing age of the world population and the obesity epidemic, of which we are all witnesses to. The cost-effectiveness of the diagnostic methods and the treatment modalities of this pathology should indisputably be reviewed. New and important information is expected to emerge on the factors of compliance with different treatments, but behavioral therapeutic methods will certainly play a role in the future.

Obesity is a major risk factor for the development and progression of obstructive sleep apnea (OSA). Obesity may worsen OSA with an increased fat deposition in the tissues of the upper airway, and in the thorax, reducing the cardiac performance, chest compliance, and functional capacity. The combination of these factors augment the cardiovascular risk in these subjects. It is a matter of debate whether the severity of OSA per se can be considered as an independent factor of increasing the cardiovascular risk in obese patients.

Changes in lifestyle habits to reduce a sedentary lifestyle, but also the early management in childhood of the developmental anomalies of the elements of the mandibular/masticatory system, must be included in the management of OSA. Finally, in adults at a high cardiovascular risk and the elderly, the clarification of the “good indications” of treatment (in particular for CPAP) should be proposed. Indeed, CPAP treatment has been demonstrated to reduce, in OSA patients, the atheromatous plaques both in the brachial artery as well as in the carotid artery, thus reducing the cardiovascular risk, which remains the major cause of mortality in the increasing population of these patients.

The purpose of this Special Issue will therefore be to present original research work centered around these new questions. First, we wish to establish the role of lifestyle in order to reduce the number of OSA patients. Second, to evaluate compliance with different treatments, including mandibular/masticatory system tools. Third, to evidence, as far as possible, new markers of disease. Finally, we aim to early on detect the severity of the cardiovascular risk in young patients, who could reduce it, by introducing an immediate therapy strategy.

Dr. Pierluigi Carratù
Guest Editor

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Keywords

OSA
obesity
treatment
CPAP
cardiovascular risk

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Published Papers (10 papers)

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Research

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11 pages, 1244 KiB

Open AccessArticle

Association of High-Risk Obstructive Sleep Apnea with Artificial Intelligence-Guided, CT-Based Severity Scores in Patients with COVID-19 Pneumonia

by Zeynep Atceken, Yeliz Celik, Cetin Atasoy and Yüksel Peker

J. Clin. Med. 2024, 13(21), 6415; https://doi.org/10.3390/jcm13216415 - 26 Oct 2024

Viewed by 611

Abstract

Background: We have previously demonstrated that high-risk obstructive sleep apnea (HR-OSA), based on a modified Berlin Questionnaire (mBQ), is linked to worse clinical outcomes. Chest computed tomography (CT) imaging with the implementation of an artificial intelligence (AI) analysis program has been a valuable tool for the speedy assessment of huge numbers of patients during the COVID-19 epidemic. In the current study, we addressed how the severity of AI-guided, CT-based total opacity ratio (TOR) scores are associated with high-risk OSA and short-term outcomes in the same cohort. Methods: The ratio of the volume of high opacity areas to that of the total lung volume constituted the TOR. We arbitrarily applied thresholds of <5 (no or mild TOR), ≥5 and <15 (moderate TOR), and ≥15 (severe TOR). Results: In total, 221 patients were included. HR-OSA was observed among 11.0% of the no or mild TOR group, 22.2% of the moderate TOR group, and 38.7% of the severe TOR group (p < 0.001). In a logistic regression analysis, HR-OSA was associated with a severe TOR with an adjusted odds ratio of 3.06 (95% confidence interval [CI] 1.27–7.44; p = 0.01). A moderate TOR predicted clinical worsening with an adjusted hazard ratio (HR) of 1.93 (95% CI 1.00–3.72; p = 0.05) and a severe TOR predicted worsening with an HR of 3.06 (95% CI 1.56–5.99; p = 0.001). Conclusions: Our results offer additional radiological proof of the relationship between HR-OSA and worse outcomes in patients with COVID-19 pneumonia. A TOR may also potentially indicate the individuals that are at higher risk of HR-OSA, enabling early intervention and management strategies. The clinical significance of TOR thresholds needs further evaluation in larger samples. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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10 pages, 440 KiB

Open AccessArticle

Long-Term Adherence to Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnoea Set Up in a Complete Remote Pathway: A Single-Centre Service Evaluation Project

by Andras Bikov, Andrew Bentley, Balazs Csoma, Nicola Smith, Bryn Morris and Saba Bokhari

J. Clin. Med. 2024, 13(10), 2891; https://doi.org/10.3390/jcm13102891 - 14 May 2024

Cited by 2 | Viewed by 1703

Abstract

Background: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA). Maintaining adherence to CPAP in the long term is a clinical problem, and numerous factors have been identified that impact adherence. Although fully remote diagnostic and CPAP services were frequently utilised during the COVID-19 pandemic for patients with OSA, long-term adherence data have not been published. The aim of this service evaluation project was to describe the long-term adherence to CPAP. We also analysed factors that are associated with it. Methods: two-hundred and eighty patients diagnosed with OSA and set up on CPAP remotely during the first wave of the COVID-19 pandemic as part of routine clinical practice were analysed. Results: One-hundred and seven patients (38%) were fully adherent to CPAP at 24 months, determined by at least 4 h of usage on at least 70% of the days. Of the factors analysed, body mass index, disease severity, driving status and the presence of depression were related to long-term adherence (all p < 0.05). Conclusions: with the likelihood of future pandemics similar to COVID-19, our data provide evidence that fully remote pathways for management of patients with OSA can be designed and be sustainable with good long-term adherence. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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12 pages, 591 KiB

Open AccessArticle

A New Screening Tool (BAMSA) for Sleep Apnea in Male Professional Truck Drivers

by Riikka Huhta, Mariusz Sieminski, Kari Hirvonen, Eemil Partinen and Markku Partinen

J. Clin. Med. 2024, 13(2), 522; https://doi.org/10.3390/jcm13020522 - 17 Jan 2024

Cited by 1 | Viewed by 1361

Abstract

Obstructive sleep apnea (OSA) is common in professional truck drivers. It is important that OSA is recognized since undiagnosed and/or untreated sleep apnea is a risk factor for sleepiness-related traffic accidents. In this study, we developed a new simple tool to screen for obstructive sleep apnea (OSA) in this population. Altogether, 2066 professional truck drivers received a structured questionnaire. A total of 175 drivers had a clinical examination and were invited to participate in sleep laboratory studies, including cardiorespiratory polygraphy. We studied associations of different risk factors with the presence of sleep apnea. We established a new simple screening tool for obstructive sleep apnea (OSA) that was compared to other existing screening tools. A total of 1095 drivers completed the questionnaire. Successful cardiorespiratory polygraphy was obtained for 172 drivers. Full data were available for 160 male drivers included in the analyses. The following five risk factors for sleep apnea formed the BAMSA score (0 to 5): BMI > 30 kgm⁻², age > 50 years, male gender, snoring at least one night per week, and the presence of apnea at least sometimes. BAMSA showed a sensitivity of 85.7% and a specificity of 78.8% in detecting AHI ≥ 15 when using a cut-off point of 4, and the ROC area was 0.823. BAMSA is a sensitive and easy-to-use tool in predicting obstructive sleep apnea in male professional drivers. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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6 pages, 4187 KiB

Open AccessCommunication

Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population

by Paul Stark and Eric Y. Chang

J. Clin. Med. 2023, 12(14), 4634; https://doi.org/10.3390/jcm12144634 - 12 Jul 2023

Cited by 1 | Viewed by 1127

Abstract

We have investigated the concurrence of sleep apnea and pulmonary hypertension in a Veteran population. We retrospectively reviewed 142 patients who underwent chest CT scans and had a dilated main pulmonary artery, defined as a width exceeding 29 mm on axial images. Approximately 40% of patients with pulmonary hypertension had associated sleep apnea. No significant difference in pulmonary artery diameters could be found between the group without sleep apnea and the group with sleep apnea (34.5 ± 4.2 mm vs. 34.7 ± 4.4 mm, p = 0.373). Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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12 pages, 996 KiB

Open AccessArticle

Time Spent with Saturation below 80% versus 90% in Patients with Obstructive Sleep Apnoea

by András Bikov, Stefan Frent, Oana Deleanu, Martina Meszaros, Mariela Romina Birza, Alina Mirela Popa, Andrei Raul Manzur, Loredana Gligor and Stefan Mihaicuta

J. Clin. Med. 2023, 12(13), 4205; https://doi.org/10.3390/jcm12134205 - 22 Jun 2023

Cited by 4 | Viewed by 2594

Abstract

Background: Nocturnal hypoxaemia measured as the percentage of total sleep time spent with saturation below 90% (TST90%) may better predict cardiovascular consequences of obstructive sleep apnoea (OSA) than the number of obstructive respiratory events measured with the apnoea–hypopnea index (AHI). Deeper hypoxaemia may potentially induce more severe pathophysiological consequences. However, the additional value of the percentage of total sleep time spent with saturation below 80% (TST80%) to TST90% is not fully explored. Methods: Comprehensive medical history was taken and fasting lipid and C-reactive protein levels were measured in 797 volunteers participating in two cohort studies in Hungary and Romania. Sleep parameters, including AHI, TST90% and TST80%, were recorded following a polysomnography (PSG, n = 598) or an inpatient cardiorespiratory polygraphy (n = 199). The performance of TST80% to predict cardiovascular risk was compared with TST90% using linear and logistic regression analyses as well receiver operating characteristics curves. Sensitivity analyses were performed in patients who had PSG, separately. Results: Both parameters are significantly related to cardiovascular risk factors; however, TST80% did not show better predictive value for cardiovascular risk than TST90%. On the other hand, patients with more severe hypoxaemia reported more excessive daytime sleepiness. Conclusions: TST80% has limited additional clinical value compared to TST90% when evaluating cardiovascular risk in patients with OSA. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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13 pages, 1383 KiB

Open AccessArticle

Current Smoking Determines the Levels of Circulating MPO and MMP-9 in Adults with Coronary Artery Disease and Obstructive Sleep Apnea

by Esra Özkan, Yeliz Celik, Tülay Yucel-Lindberg and Yüksel Peker

J. Clin. Med. 2023, 12(12), 4053; https://doi.org/10.3390/jcm12124053 - 14 Jun 2023

Cited by 3 | Viewed by 1399

Abstract

(1) Background: Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which a rupture of atherosclerotic plaques and oxidative stress play a role in the initiation and progression of the disorder. Circulating levels of myeloperoxidase (MPO), as an oxidative stress marker, as well as matrix metalloproteinase-9 (MMP-9), as a destabilizer of plaques, are known to be elevated in patients with CAD and are associated with worse prognosis. Some studies have suggested that OSA is associated with MPO and MMP-9, but the effect of OSA on these biomarkers in cardiac cohorts is unknown. (2) Aims: We addressed the determinants of high MPO and MMP-9 in a CAD cohort with concomitant OSA. (3) Materials and Methods: The current study was a secondary analysis of the RICCADSA trial that was conducted in Sweden between 2005 and 2013. A total of 502 revascularized CAD patients with OSA (apnea–hypopnea index [AHI] ≥ 15 events/h; n = 391) or no-OSA (AHI < 5 events/h; n = 101), based on a home sleep apnea test, and who had blood samples at baseline were included in the analysis. The patients were dichotomized into a high or low MPO and MMP-9 groups, based on the median cut-off values. (4) Results: The mean age of the participants was 63.9 (±8.6), and 84% of the study cohort were men. Median values of MPO and MMP-9 levels were 116 ng/mL and 269 ng/mL, respectively. In different multivariate linear and logistic regression models, neither OSA nor OSA severity in terms of AHI and oxygenation indices were associated with the high MPO and MMP-9 levels. Current smoking was significantly associated with both high MPO (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.06–2.84; p = 0.030) and high MMP-9 levels (OR 2.41, 95% CI 1.44–4.03; p < 0.001), respectively. Other significant determinants were revealed as beta blocker use (OR 1.81, 95% CI 1.04–3.16; p = 0.036) for high MPO as well as male sex (OR 2.07, 95% CI 1.23–3.50; p = 0.006) and calcium antagonist use (OR 1.91, 95% CI 1.18–3.09; p = 0.008) for high MMP-9 levels. (5) Conclusions: Current smoking, but not OSA, was significantly associated with high MPO and MMP-9 levels in this revascularized CAD cohort. Smoking status should be seriously taken into consideration while evaluating the effects of OSA and its treatment on long-term adverse cardiovascular outcomes in adults with CAD. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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17 pages, 2427 KiB

Open AccessArticle

Validation of the Modified Berlin Questionnaire for the Diagnosis of Obstructive Sleep Apnea in Patients with a History of COVID-19 Infection

by Yeliz Celik, Arzu Baygül and Yüksel Peker

J. Clin. Med. 2023, 12(9), 3047; https://doi.org/10.3390/jcm12093047 - 22 Apr 2023

Cited by 2 | Viewed by 2617

Abstract

(1) Background: The Berlin questionnaire (BQ) is a widely used survey to predict obstructive sleep apnea (OSA). Considering the confounding effect of obesity and hypertension on the clinical course of COVID-19, we have recently developed a modified BQ (mBQ) based on the subscales snoring intensity/frequency, witnessed apneas and morning/daytime tiredness, and demonstrated that patients with high-risk OSA had worse outcomes during the COVID-19 pandemic. In the current study, we aimed to validate the mBQ in adults with a history of COVID-19 infection. (2) Method: All cases who suffered from COVID-19 infection between 10 March and 22 June 2020, and who completed the mBQ in our first study, were invited to participate. Participants refilled the questionnaires, and an attended polysomnography (PSG) was conducted. An apnea−hypopnea index (AHI) of 15 events/h or more was considered as OSA. (3) Results: Out of the 70 participants, 27 (39%) were categorized as having a high risk of OSA based on the mBQ. According to the PSG results, 24 patients with high-risk OSA (89%) and 3 patients with low-risk OSA on the mBQ (7%) had AHI ≥ 15 events/h. The mBQ had a sensitivity of 89%, a specificity of 93%, a positive predictive value of 89%, a negative predictive value of 93%, and an accuracy of 91%. The area under the curve was 0.91 confirming a very good performance of the mBQ in screening for OSA. (4) Conclusions: The mBQ has a good level of diagnostic sensitivity, specificity, and accuracy among adults with a history of COVID-19 infection. Since the confounding effects of obesity and hypertension are eliminated, the mBQ may be used not only as a screening tool for high-risk OSA but also as a prognostic survey in clinical cohorts. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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10 pages, 853 KiB

Open AccessArticle

Subjective HRQoL in Patients with Sleep Apnea Syndrome Who Underwent PAP Therapy in a Rehabilitation Setting: A Longitudinal Study

by Antonia Pierobon, Martina Vigorè, Eugenia Taurino, Gemma Grassi, Valeria Torlaschi, Marina Maffoni, Rita Maestroni, Roberto Maestri and Francesco Fanfulla

J. Clin. Med. 2023, 12(5), 1907; https://doi.org/10.3390/jcm12051907 - 28 Feb 2023

Cited by 1 | Viewed by 1639

Abstract

Background: Obstructive sleep apnea (OSA) is often associated with decreased health-related quality of life (HRQoL). The aims of this study were to evaluate HRQoL, the clinical and psychological profile of suspected or verified OSA patients, and the impact of PAP therapy at 1-year follow-up. Methods: At T0, OSA-suspected subjects underwent clinical, HRQoL, and psychological assessment. At T1, OSA patients underwent PAP therapy in a multidisciplinary rehabilitation setting. At 1 year follow-up, OSA patients were evaluated for the second time. Results: At T0, OSA patients (n = 283) and suspected OSA subjects (n = 187) differed for AHI, BMI, and ESS. At T0, the PAP-treatment group (n = 101) showed moderate–severe anxious (18.7%) and depressive (11.9%) symptoms. At 1 year follow-up (n = 59), the sleep breathing pattern had normalized and there was a reduction of ESS scores and anxious symptoms. There was also an improvement in HRQoL (0.6 ± 0.4 vs. 0.7 ± 0.5, p = 0.032; 70.4 ± 19.0 vs. 79.2 ± 20.3, p = 0.001) and in satisfaction with sleep quantity (52.3 ± 31.7 vs. 71.4 ± 26.2, p = 0.001), sleep quality (48.1 ± 29.7 vs. 70.9 ± 27.1, p = 0.001), mood (58.5 ± 24.9 vs. 71.0 ± 25.6, p = 0.001), and physical resistance (61.6 ± 28.4 vs. 67.8 ± 27.4, p = 0.039). Conclusion: Considering the impact of PAP treatment on patients’ psychological and HRQoL evaluations that we observed, our data are valuable for unveiling different profiles characterizing this clinical population. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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Review

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14 pages, 641 KiB

Open AccessReview

The Role of Telemedicine in Children with Obstructive Sleep Apnea Syndrome (OSAS): A Review of the Literature

by Luisa Rizzo, Elena Barbetta, Flaminia Ruberti, Matilde Petz, Marco Tornesello, Michela Deolmi, Valentina Fainardi and Susanna Esposito

J. Clin. Med. 2024, 13(7), 2108; https://doi.org/10.3390/jcm13072108 - 4 Apr 2024

Cited by 2 | Viewed by 1675

Abstract

The advent of telemedicine marked a significant turning point in the healthcare landscape, introducing a revolutionary approach to the delivery of medical care. Digital technologies easily connect health professionals and patients, overcoming geographical and temporal barriers. Telemedicine has been used for sleep disorders including obstructive sleep apnea syndrome (OSAS) since the mid-1990s. In adult patients with OSAS, telemedicine is helpful both for consultation and diagnosis, the latter obtained through remote recordings of oxygen saturation and further parameters registered with telemonitored respiratory polygraphy or polysomnography. Remote monitoring can be used to follow up the patient and verify adherence to daily treatments including continuous positive airway pressure (CPAP). In children, studies on the role of telemedicine in OSAS are scarce. This narrative review aims to describe the application of telemedicine in children with obstructive sleep apnea syndrome (OSAS), assessing its advantages and disadvantages. In patients with OSA, telemedicine is applicable at every stage of patient management, from diagnosis to treatment monitoring also in pediatric and adolescent ages. While telemedicine offers convenience and accessibility in healthcare delivery, its application in managing OSAS could be associated with some disadvantages, including limitations in physical examination, access to diagnostic tools, and education and counseling; technology barriers; and privacy concerns. The adoption of a hybrid approach, integrating both in-office and virtual appointments, could effectively meet the needs of children with OSAS. However, more studies are needed to fully assess the effectiveness and safety of telemedicine in the pediatric population. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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13 pages, 601 KiB

Open AccessReview

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

by Nicole Mussi, Roberta Forestiero, Giulia Zambelli, Letizia Rossi, Maria Rosaria Caramia, Valentina Fainardi and Susanna Esposito

J. Clin. Med. 2023, 12(22), 7092; https://doi.org/10.3390/jcm12227092 - 14 Nov 2023

Cited by 8 | Viewed by 3115

Abstract

Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/− montelukast, and to compare the impact of standardized approaches for weight loss. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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