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Obstructive Sleep Apnea (OSA): Pathogenesis, Symptoms and Treatments

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (25 June 2023) | Viewed by 8431

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Special Issue Editor

Dr. Huajun Xu

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Guest Editor

1. Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, China
2. Shanghai Key Laboratory of Sleep Disordered Breathing, 600 Yishan Road, Shanghai, China
3. Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, China
Interests: obstructive sleep apnea; intermittent hypoxia; sleep fragmentation; sleep-disordered breathing

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a common respiratory sleep disorder characterized by episodes of complete/partial upper airway collapse together with airflow reduction or cessation. OSA is associated with systemic organ damage, such as heart failure, diabetes mellitus and cognitive dysfunction. Thus, efforts aiming to define the symptoms and clarify the pathogenesis of OSA are essential for the exploration of new treatments.

This Special Issue of the Journal of Personalized Medicine aims to highlight some of the latest studies on the pathogenesis, symptoms and treatment of OSA and the application of precision medicine to patients with OSA.

Dr. Huajun Xu
Guest Editor

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Keywords

obstructive sleep apnea
sleep disorder
precision medicine

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Published Papers (4 papers)

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Research

13 pages, 1231 KiB

Open AccessFeature PaperArticle

Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence

by Jae-Seon Park, Bin Kwon, Hyun-Seok Kang, Seong-Jin Yun, Sung-Jun Han, Yeso Choi, Sung-Hun Kang, Mi-Yeon Lee, Kyung-Chul Lee and Seok-Jin Hong

J. Pers. Med. 2023, 13(8), 1196; https://doi.org/10.3390/jpm13081196 - 27 Jul 2023

Viewed by 1640

Abstract

Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid–posterior nasal spine (H-PNS), posterior nasal spine–mandibular plane (PNS-MP), and hyoid–mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3–12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea–hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25–6.86) and 4.00 (1.87–8.56). In the case of H-PNS, they were 2.58 (1.14–5.81) and 4.86 (2.24–10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): Pathogenesis, Symptoms and Treatments)

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10 pages, 411 KiB

Open AccessCommunication

Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample

by Rupak Desai, Sandeep Singh, Sai Priyanka Mellacheruvu, Adil Sarvar Mohammed, Roshni Soni, Ayodya Perera, Venkata Akhil Makarla, Sarayu Santhosh, Muneeb Ali Siddiqui, Bilal Khan Mohammed, Zaki Ur Rahman Mohammed, Zainab Gandhi, Ankit Vyas, Akhil Jain, Rajesh Sachdeva and Gautam Kumar

J. Pers. Med. 2023, 13(5), 782; https://doi.org/10.3390/jpm13050782 - 30 Apr 2023

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Abstract

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS− groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78–2.64]; 3.18 [95% CI 2.58–3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08–1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08–1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14–2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): Pathogenesis, Symptoms and Treatments)

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12 pages, 300 KiB

Open AccessArticle

The Usefulness of Questionnaires in Assessing the Risk of Obstructive Sleep Apnea in Patients in the Managed Care after Acute Myocardial Infarction Program—The Results of a Cross-Sectional Study

by Danuta Łoboda, Michalina Stepanik, Anna Szajerska-Kurasiewicz, Maciej Turski, Dagmara Urbanczyk-Świć, Jacek Durmała and Krzysztof S. Gołba

J. Pers. Med. 2023, 13(4), 642; https://doi.org/10.3390/jpm13040642 - 7 Apr 2023

Cited by 1 | Viewed by 1808

Abstract

Obstructive sleep apnea (OSA) worsens prognosis after myocardial infarction (MI) but often remains undiagnosed. The study aimed to evaluate the usefulness of questionnaires in assessing the risk of OSA in patients participating in managed care after an acute myocardial infarction program. Study group: 438 patients (349 (79.7%) men) aged 59.92 ± 10.92, hospitalized in the day treatment cardiac rehabilitation department 7–28 days after MI. OSA risk assessment: A 4-variable screening tool (4-V), STOP-BANG questionnaire, Epworth sleepiness scale (ESS), and adjusted neck circumference (ANC). The home sleep apnea testing (HSAT) was performed on 275 participants. Based on four scales, a high risk of OSA was found in 283 (64.6%) responders, including 248 (56.6%) based on STOP-BANG, 163 (37.5%) based on ANC, 115 (26.3%) based on 4-V, and 45 (10.3%) based on ESS. OSA was confirmed in 186 (68.0%) participants: mild in 85 (30.9%), moderate in 53 (19.3%), and severe in 48 (17.5%). The questionnaires’ sensitivity and specificity in predicting moderate-to-severe OSA were: for STOP-BANG—79.21% (95% confidence interval; CI 70.0–86.6) and 35.67% (95% CI 28.2–43.7); ANC—61.39% (95% CI 51.2–70.9) and 61.15% (95% CI 53.1–68.8); 4-V—45.54% (95% CI 35.6–55.8) and 68.79% (95% CI 60.9–75.9); ESS—16.83% (95% CI 10.1–25.6) and 87.90% (95% CI 81.7–92.6). OSA is common in post-MI patients. The ANC most accurately estimates the risk of OSA eligible for positive airway pressure therapy. The sensitivity of the ESS in the post-MI population is insufficient and limits this scale’s usefulness in risk assessment and qualification for treatment. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): Pathogenesis, Symptoms and Treatments)

9 pages, 259 KiB

Open AccessArticle

Drug-Induced Sleep Endoscopy Findings and Hypoglossal Nerve Stimulation Therapy Outcomes

by Johannes Pordzik, Christopher Seifen, Katharina Ludwig, Berit Hackenberg, Tilman Huppertz, Katharina Bahr-Hamm, Christoph Matthias and Haralampos Gouveris

J. Pers. Med. 2023, 13(3), 532; https://doi.org/10.3390/jpm13030532 - 16 Mar 2023

Viewed by 1696

Abstract

Hypoglossal-nerve stimulation (HGNS) is an established second-line therapy for patients with obstructive sleep apnea (OSA). Existing studies investigating the effect of preoperative drug-induced sleep endoscopic (DISE) findings on HGNS outcomes have mainly focused on the apnea/hypopnea index (AHI) among polysomnography (PSG) parameters, and have less frequently tested other PSG parameters such as the apnea index (AI), hypopnea index (HI), oxygen desaturation index (ODI), snoring index, and arousal index, or patient-reported excessive daytime sleepiness. The aim of this study was to investigate the correlation between DISE findings and the above-mentioned metrics after HGNS therapy. We only included patients with DISE findings providing detailed information about the degree of the anteroposterior velar (APV), oropharyngeal lateral wall (OPLW), or tongue-base (BT) obstruction based on the velum, oropharynx, base of tongue, and epiglottis (VOTE) classification. The data of 25 patients (9 female (36%)) were retrospectively evaluated. The mean age at the date of implantation was 54.52 ± 9.61 years, and the mean BMI was 29.99 ± 3.97 kg/m². Spearman’s rho correlation coefficients were calculated. Significant correlations were found between the degree of APV obstruction and postoperative HI (r = −0.5, p < 0.05), and between the degree of OPLW obstruction and postoperative snoring index (r = 0.42, p < 0.05). BT obstruction was strongly correlated with postoperative metrics such as AHI (r = −0.57, p < 0.01), AI (r = −0.5, p < 0.05), ODI (r = −0.57, p < 0.01), ∆ AHI (r = 0.58, p < 0.01), ∆ AI (r = 0.54, p < 0.01) and ∆ ODI (r = 0.54, p < 0.01). No significant correlation was found between DISE findings and postoperative Epworth Sleepiness Scale values. These findings suggest that preoperative DISE findings, especially the degree of BT obstruction, are important for predicting an HGNS therapy outcome. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): Pathogenesis, Symptoms and Treatments)

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