Life | Special Issue : Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives

Research

14 pages, 1242 KiB

Open AccessArticle

A Dietary and Lifestyle Intervention Improves Treatment Adherence and Clinical Outcomes in Overweight and Obese Patients with Obstructive Sleep Apnea: A Randomized, Controlled Trial

by Izolde Bouloukaki, Eleni Daskalaki, Eleni Mavroudi, Violeta Moniaki, Sophia E. Schiza and Ioanna Tsiligianni

Life 2023, 13(8), 1755; https://doi.org/10.3390/life13081755 - 16 Aug 2023

Cited by 2 | Viewed by 1694

Abstract

The study’s objective was to assess the impact of Mediterranean diet/lifestyle interventions for weight loss on positive airway pressure (PAP) adherence, body mass index (ΒΜΙ), sleepiness, and blood pressure measurements (BP) in patients with obstructive sleep apnea (OSA). We designed a randomized, controlled [...] Read more.

The study’s objective was to assess the impact of Mediterranean diet/lifestyle interventions for weight loss on positive airway pressure (PAP) adherence, body mass index (ΒΜΙ), sleepiness, and blood pressure measurements (BP) in patients with obstructive sleep apnea (OSA). We designed a randomized, controlled trial, including overweight and obese patients with moderate to severe OSA, randomized to standard care (SCG, n = 37) or a Mediterranean diet group (MDG, n = 37). The SCG received healthy lifestyle advice, while the MDG underwent a 6-month behavioral intervention aiming to enhance weight loss and adherence to a Mediterranean diet. PAP adherence, BMI, Epworth Sleepiness Scale (ESS), and BP measurements were evaluated pre- and post-intervention. Post-intervention PAP use was higher in the MDG compared to the SCG (6.1 vs. 5.4, p = 0.02). Diet/lifestyle intervention was one of the most significant predictive factors for PAP adherence (OR = 5.458, 95% CI = 1.144–26.036, p = 0.03). The SCG demonstrated a rise in BMI, while the MDG displayed a decline (0.41 vs. −0.75, p = 0.02). The MDG also demonstrated a substantial reduction in adjusted SBP (−5.5 vs. 2.8, p = 0.014) and DBP (−4.0 vs. 2.5, p = 0.01). Ultimately, incorporating a dietary/lifestyle intervention with standard care yields superior PAP adherence, BMI, and BP measurements in contrast to standard care alone, emphasizing the advantages of dedicating more time and support within the MDG. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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8 pages, 581 KiB

Open AccessCommunication

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results

by Katarína Klobučníková, Branislav Kollár, Matúš Jurík, Katarína Valovičová, Miroslava Hardoňová, Michal Poddaný, Miroslav Tedla, Michal Riant, Pavel Klail, Peter Turčáni and Pavel Šiarnik

Life 2023, 13(2), 517; https://doi.org/10.3390/life13020517 - 13 Feb 2023

Viewed by 1551

Abstract

Background: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in [...] Read more.

Background: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. Material and Methods: The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. Results: We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). Conclusions: In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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11 pages, 1215 KiB

Open AccessCommunication

Lipoprotein Subfractions Associated with Endothelial Function in Previously Healthy Subjects with Newly Diagnosed Sleep Apnea—A Pilot Study

by Alzbeta Hluchanova, Branislav Kollar, Katarina Klobucnikova, Miroslava Hardonova, Michal Poddany, Ingrid Zitnanova, Monika Dvorakova, Katarina Konarikova, Miroslav Tedla, Milan Urik, Pavel Klail, Petr Skopek, Peter Turcani and Pavel Siarnik

Life 2023, 13(2), 441; https://doi.org/10.3390/life13020441 - 4 Feb 2023

Cited by 2 | Viewed by 1671

Abstract

Background: Obstructive sleep apnea (OSA) activates several pathophysiological mechanisms which can lead to the development of vascular diseases. Endothelial dysfunction (ED) is an initial step in the development of atherosclerosis. The association between ED and OSA has been described in several studies, even [...] Read more.

Background: Obstructive sleep apnea (OSA) activates several pathophysiological mechanisms which can lead to the development of vascular diseases. Endothelial dysfunction (ED) is an initial step in the development of atherosclerosis. The association between ED and OSA has been described in several studies, even in previously healthy subjects. High-density lipoproteins (HDL) were generally considered to be atheroprotective, and low-density lipoprotein (LDL) to be an atherogenic component of lipoproteins. However, recent findings suggest a pro-atherogenic role of small HDL subfractions (8–10) and LDL subfractions (3–7). This study aimed to evaluate the relationship between endothelial function and lipid subfractions in previously healthy OSA subjects. Material and Methods: We prospectively enrolled 205 subjects with sleep monitoring. Plasma levels of triacylglycerols, total cholesterol, LDL, HDL, and their subfractions were assessed. Endothelial function was determined using peripheral arterial tonometry, and reperfusion hyperemia index (RHI) was assessed. Results: Plasma levels of small and intermediate HDL subfractions have statistically significant pro-atherogenic correlations with endothelial function (p = 0.015 and p = 0.019). In other lipoprotein levels, no other significant correlation was found with RHI. In stepwise multiple linear regression analysis, small HDL (beta = −0.507, p = 0.032) was the only significant contributor in the model predicting RHI. Conclusions: In our studied sample, a pro-atherogenic role of small HDL subfractions in previously healthy subjects with moderate-to-severe OSA was proven. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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11 pages, 2024 KiB

Open AccessArticle

The Efficacy of the Partial Glossectomy for Prevention of Airway Volume Reduction in Orthognathic Surgery of Class III Patients

by Suyun Seon, Junho Jung, Baek-Soo Lee, Yong-Dae Kwon, Byung-Joon Choi and Joo-Young Ohe

Life 2023, 13(2), 280; https://doi.org/10.3390/life13020280 - 19 Jan 2023

Viewed by 1904

Abstract

The aim of this study was to evaluate the effects of a partial glossectomy on volumetric changes of pharyngeal airway space (PAS) in patients with mandibular setback surgery. Overall, 25 patients showing clinical features related to macroglossia treated with mandibular setback surgery were [...] Read more.

The aim of this study was to evaluate the effects of a partial glossectomy on volumetric changes of pharyngeal airway space (PAS) in patients with mandibular setback surgery. Overall, 25 patients showing clinical features related to macroglossia treated with mandibular setback surgery were included in this retrospective study. Subjects were divided into two groups: the control group (G1, n = 13, with BSSRO) and the study group (G2, n = 12, with both BSSRO and partial glossectomy). The PAS volume of both groups was measured by the OnDemand 3D program on CBCT taken shortly before operation (T0), 3 months post-operative (T1), and 6 months post-operative (T2). A paired t-test and repeated analysis of variance (ANOVA) were used for statistical correlation. Total PAS and hypopharyngeal airway space were increased after operation in Group 2 compared to Group 1 (p < 0.05), while oropharyngeal airway space showed no significant statistical difference with the tendency of increasing. The combination of partial glossectomy and BSSRO surgical techniques had a significant effect on increasing the hypopharyngeal and total airway space in class III malocclusion patients (p < 0.05). Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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10 pages, 1377 KiB

Open AccessArticle

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency—A Prospective Study

by Zdeněk Knížek, Miloš Kotulek, Pavlína Brothánková, Eva Pecháčková, Pavel Klail, Tomáš Kostlivý and Jan Vodička

Life 2023, 13(1), 219; https://doi.org/10.3390/life13010219 - 12 Jan 2023

Cited by 1 | Viewed by 1585

Abstract

The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose [...] Read more.

The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose patency and CPAP adherence. Material and methods: A cohort of 450 consecutive patients suspected of having OSA were prospectively enrolled. For further analyses, 47 OSA patients undergoing CPAP treatment were selected (13 females and 34 males, average age, 65.3 years, BMI 34.1, apnea-hypopnea index. AHI 51.0). The patients were divided into two groups: patients with good CPAP adherence (n = 35) and patients who did not adhere to CPAP therapy (n = 12). The influence of nasal endoscopy and flow measurement on CPAP adherence was explored. Results: We found a statistical independence between adherence to CPAP and AHI (p = 0.124), T90 (p = 0.502), endoscopic findings (p = 0.588) and nasal patency measured by a flowmeter (p = 0.498). Conclusions: In our studied sample, endoscopic findings and nasal patency measured by a flowmeter were not predictors of CPAP non-adherence in the first year of the treatment. Our data show that while an endoscopic finding in the nasal cavity could indicate that a patient has a severe obstruction, compliance with CPAP therapy is not reduced in these patients and neither is it reduced with a decrease in nasal flow, according to our observation. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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10 pages, 1468 KiB

Open AccessArticle

Sleep Endoscopy with Positive Airway Pressure: A Method for Better Compliance and Individualized Treatment of Patients with Obstructive Sleep Apnea

by Michaela Masárová, Petr Matoušek, Ondřej Jor, Vilém Novák, Adéla Vrtková, Vojtěch Kubec, Karol Zeleník, Pavel Komínek and Martin Formánek

Life 2022, 12(12), 2108; https://doi.org/10.3390/life12122108 - 15 Dec 2022

Cited by 1 | Viewed by 2283

Abstract

In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases [...] Read more.

In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases in which PAP was ineffective. This prospective study was conducted from June 2018 to June 2022. PAP testing was performed during DISE in patients with moderate and severe OSA. The pressure was gradually increased over the range from 6.0 to 18.0 hPa. Our findings were evaluated using the VOTE classification. The examination was performed in 56 patients, with a median apnea–hypopnea index (AHI) of 26.4. Complete obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete oropharyngeal obstruction, and least effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients. DISE with PAP is a simple diagnostic method that can be helpful for identifying anatomic and dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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16 pages, 785 KiB

Open AccessArticle

The Predictive Role of the Upper-Airway Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea

by Viktória Molnár, Zoltán Lakner, András Molnár, Dávid László Tárnoki, Ádám Domonkos Tárnoki, László Kunos, Zsófia Jokkel and László Tamás

Life 2022, 12(10), 1543; https://doi.org/10.3390/life12101543 - 4 Oct 2022

Cited by 15 | Viewed by 2564

Abstract

This study aimed to analyse the thickness of the adipose tissue (AT) around the upper airways with anthropometric parameters in the prediction and pathogenesis of OSA and obstruction of the upper airways using artificial intelligence. One hundred patients were enrolled in this prospective [...] Read more.

This study aimed to analyse the thickness of the adipose tissue (AT) around the upper airways with anthropometric parameters in the prediction and pathogenesis of OSA and obstruction of the upper airways using artificial intelligence. One hundred patients were enrolled in this prospective investigation, who were divided into control (non-OSA) and mild, moderately severe, and severe OSA according to polysomnography. All participants underwent drug-induced sleep endoscopy, anthropometric measurements, and neck MRI. The statistical analyses were based on artificial intelligence. The midsagittal SAT, the parapharyngeal fat, and the midsagittal tongue fat were significantly correlated with BMI; however, no correlation with AHI was observed. Upper-airway obstruction was correctly categorised in 80% in the case of the soft palate, including parapharyngeal AT, sex, and neck circumference parameters. Oropharyngeal obstruction was correctly predicted in 77% using BMI, parapharyngeal AT, and abdominal circumferences, while tongue-based obstruction was correctly predicted in 79% using BMI. OSA could be predicted with 99% precision using anthropometric parameters and AT values from the MRI. Age, neck circumference, midsagittal and parapharyngeal tongue fat values, and BMI were the most vital parameters in the prediction. Basic anthropometric parameters and AT values based on MRI are helpful in predicting OSA and obstruction location using artificial intelligence. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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9 pages, 321 KiB

Open AccessArticle

A Comparison of the Reliability of Five Sleep Questionnaires for the Detection of Obstructive Sleep Apnea

by Šárka Solecka, Karel Matler, Tomáš Kostlivý, Vojtěch Kubec, Hana Tomášková and Jaroslav Betka

Life 2022, 12(9), 1416; https://doi.org/10.3390/life12091416 - 10 Sep 2022

Cited by 5 | Viewed by 2928

Abstract

The aim of this study was to compare the reliability of five sleep questionnaires in detecting the occurrence of obstructive sleep apnea (OSA). The study was conducted on a group of 201 patients. The patients completed five sleep questionnaires: the Epworth Sleepiness Scale [...] Read more.

The aim of this study was to compare the reliability of five sleep questionnaires in detecting the occurrence of obstructive sleep apnea (OSA). The study was conducted on a group of 201 patients. The patients completed five sleep questionnaires: the Epworth Sleepiness Scale (ESS), the STOP-Bang questionnaire, the STOP questionnaire, the Berlin questionnaire (BQ) and the Pittsburgh Sleep Quality Index (PSQI). Subsequently, the patients were examined using limited polygraphy, and the sensitivity and specificity of the questionnaires were evaluated. The STOP-Bang, Berlin and STOP questionnaires had the highest sensitivity for OSA detection (81.6%, 78.7%, and 74.2%, respectively), while the sensitivities of PSQI and ESS were low (50.8% and 34.5%). The ESS, STOP-Bang, STOP and Berlin questionnaires had the highest specificity (82.6%, 75%, 61.9%, and 61.9%). In our sample, we found the STOP-Bang and Berlin questionnaires to be the most suitable for OSA screening with the highest sensitivities (81.6%, 78.7%) and satisfactory specificities (75%, 61.9%). The STOP questionnaire was also relatively reliable, especially given its time-saving nature; though short, it preserved satisfactory sensitivity (74.2%) and specificity (61.9%). The ESS and PSQI were unsuitable for OSA screening. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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10 pages, 1458 KiB

Open AccessArticle

Epiglottopexy Is a Treatment of Choice for Obstructive Sleep Apnea Caused by a Collapsing Epiglottis

by Michaela Masárová, Martin Formánek, Ondřej Jor, Vilém Novák, Adéla Vrtková, Petr Matoušek, Pavel Komínek and Karol Zeleník

Life 2022, 12(9), 1378; https://doi.org/10.3390/life12091378 - 5 Sep 2022

Cited by 3 | Viewed by 8025

Abstract

Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA [...] Read more.

Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA caused by epiglottic collapse with the patients’ previous PAP outcomes. Fifteen consecutive adult patients with OSA and epiglottic collapse during DISE were included; ten were analyzed. Before inclusion, PAP was indicated and ineffective in six patients, one of whom underwent unsuccessful uvulopalatopharyngoplasty. PAP was performed during DISE in all patients before epiglottopexy and was uniformly ineffective. ENT control was performed at 1 week and 1 month, and control limited polygraphy to 6 months after surgery. The apnea–hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) were significantly improved (p < 0.001 and p = 0.003, respectively) in all patients after epiglottopexy. Surgery was successful in 9/10 patients; the remaining patient had a significantly decreased AHI and could finally tolerate PAP. Transoral laser epiglottopexy is used to treat OSA in patients with epiglottic collapse. Unlike other methods, it significantly reduces both AHI and ESS and should be considered for these patients. An active search for OSA patients with epiglottic collapse is recommended to prevent treatment failure. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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7 pages, 262 KiB

Open AccessCommunication

Cognition in Patients with Sleep-Disordered Breathing: Can Obstructive and Central Apneic Pauses Play a Different Role in Cognitive Impairment?

by Patrik Karapin, Pavel Šiarnik, Bianka Suchá, Matúš Jurík, Miroslav Tedla, Michal Poddaný, Katarína Klobučníková, Stanislav Šutovský, Peter Turčáni and Branislav Kollár

Life 2022, 12(8), 1180; https://doi.org/10.3390/life12081180 - 2 Aug 2022

Cited by 1 | Viewed by 1620

Abstract

Background: There are increasing data linking sleep apnea with cognitive impairment. We aimed to clarify the relationship between sleep-disordered breathing (SDB) and cognition. Detailed attention was assigned to the potential role of central versus obstructive apneic pauses in cognitive impairment. Methods: Patients with [...] Read more.

Background: There are increasing data linking sleep apnea with cognitive impairment. We aimed to clarify the relationship between sleep-disordered breathing (SDB) and cognition. Detailed attention was assigned to the potential role of central versus obstructive apneic pauses in cognitive impairment. Methods: Patients with suspected SDB were prospectively enrolled, and a complex sleep study was performed that included overnight polysomnography. A revised version of Addenbrooke‘s Cognitive Examination (ACE-R) was used to assess cognition, evaluating overall cognition and individual subdomains. Results: A total number of 101 participants were included in the study. In multivariate binary logistic regression analysis, obstructive apnea index ([OAI], 95% CI: 1.009–1.057, p = 0.008) was the only significant contributor to the model predicting attention deficit. The proportion of N1 stage of NREM sleep was the only significant contributor to the model predicting impaired verbal fluency (95% CI: 1.004–1.081, p = 0.029). No significant differences in sleep-related indices were observed in the remaining ACE-R subdomains. Conclusion: Except for verbal fluency and attention, we failed to find any significant association of sleep-related indices with the impairment in different cognitive subdomains. Our data suggest that impairment observed in verbal fluency is associated with a higher proportion of shallow NREM sleep, and attention deficit is associated with higher OAI. Obstructive respiratory episodes seem to play a more important role in cognitive impairment when compared to central ones. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

15 pages, 304 KiB

Open AccessArticle

Risk of Cardiovascular Disease in Apnoeic Individuals: Role of Comorbid Insomnia Disorder

by Matthieu Hein, Benjamin Wacquier, Jean-Pol Lanquart and Gwenolé Loas

Life 2022, 12(7), 944; https://doi.org/10.3390/life12070944 - 23 Jun 2022

Cited by 8 | Viewed by 1614

Abstract

Given the limited data available, the aim of this study was to examine the 10-year cardiovascular disease (CVD) risk associated with comorbid insomnia disorder and its specific subtypes in apnoeic individuals. Data from 1104 apnoeic individuals recruited from the database of the Erasme [...] Read more.

Given the limited data available, the aim of this study was to examine the 10-year cardiovascular disease (CVD) risk associated with comorbid insomnia disorder and its specific subtypes in apnoeic individuals. Data from 1104 apnoeic individuals recruited from the database of the Erasme Hospital Sleep Laboratory were analysed. Only apnoeic individuals with a Framingham Risk Score ≥10% were included in the group at moderate-to-high 10-year CVD risk. Logistic regression analyses were conducted to examine the risk of 10-year CVD risk associated with comorbid insomnia disorder and its specific subtypes in apnoeic individuals. Moderate-to-high 10-year CVD risk was present in 59.6% of the apnoeic individuals in our sample. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that comorbid insomnia disorder and, more particularly, its subtype with short sleep duration were significantly associated with moderate-to-high 10-year CVD risk in apnoeic individuals. In this study, we demonstrate that comorbid insomnia disorder and, more specifically, its subtype with short sleep duration appear to have a negative cumulative effect on 10-year CVD risk in apnoeic individuals, which justifies more systematic research and adequate therapeutic management of this disorder to allow for better cardiovascular disease prevention in this particular subpopulation. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

11 pages, 2688 KiB

Open AccessArticle

Pharyngeal Airspace Alterations after Using the Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea Syndrome

by Pedro Dias Ferraz, Inês Francisco, Maria Inês Borges, Adriana Guimarães, Fátima Carvalho, Francisco Caramelo, José Pedro Figueiredo and Francisco Vale

Life 2022, 12(6), 835; https://doi.org/10.3390/life12060835 - 2 Jun 2022

Cited by 1 | Viewed by 2331

Abstract

Background: Mandibular Advancement Devices (MADs), inserted in non-surgical treatments for obstructive sleep apnea and hypopnea syndrome (OSAHS), are used intra-orally during the sleep period, with the aim of promoting mandibular protrusion. The aim of the study is to analyze the changes in the [...] Read more.

Background: Mandibular Advancement Devices (MADs), inserted in non-surgical treatments for obstructive sleep apnea and hypopnea syndrome (OSAHS), are used intra-orally during the sleep period, with the aim of promoting mandibular protrusion. The aim of the study is to analyze the changes in the upper airway after the use of an MAD in the treatment of OSAHS. Methods: 60 patients diagnosed with OSAHS, as established by the Sleep Medicine Service, underwent treatment with the Silensor SL device at the Stomatology Service of the University Hospital Center of Coimbra, from January 2018 to January 2019. All patients completed two polysomnographies and two lateral teleradiographies: one before starting treatment (T0) and one after 1 year of treatment (T1). In the lateral teleradiography performed after one year of treatment, the patient had the MAD placed intra-orally. The linear measurements of the airspace proposed by the Arnett/Gunson FAB Surgery cephalometric analysis were measured at four craniometric points: A, MCI, B, Pog. Results: The results demonstrate an anteroposterior airway enlargement in two of the four points studied with the MAD placed intra-orally (B and Pog point). The greatest average increase is observed at point Pog (3 mm), followed by B (1 mm), and finally, point A (0.6 mm). Conclusions: This study proved that there is an improvement in anteroposterior measurements at various points in the upper airways after treatment with MAD. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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10 pages, 233 KiB

Open AccessArticle

Nasal Symptoms in Patients with Obstructive Sleep Apnoea and Their Association with Continuous Positive Airway Pressure Usage

by Konstantinos Chaidas, Kallirroi Lamprou, Amberley Munnings, John R. Stradling and Annabel H. Nickol

Life 2022, 12(2), 305; https://doi.org/10.3390/life12020305 - 17 Feb 2022

Cited by 1 | Viewed by 1861

Abstract

The role of nasal symptoms in continuous positive airway pressure (CPAP) tolerance is not completely clear. This study aimed to investigate the association between CPAP usage and nasal symptoms, either prior to, or developing during, CPAP use in patients with obstructive sleep apnoea [...] Read more.

The role of nasal symptoms in continuous positive airway pressure (CPAP) tolerance is not completely clear. This study aimed to investigate the association between CPAP usage and nasal symptoms, either prior to, or developing during, CPAP use in patients with obstructive sleep apnoea (OSA). Two hundred thirty patients were studied and divided into high-, low-, and non-CPAP users. Nasal symptoms and related quality of life parameters were evaluated prior to CPAP initiation and after three months. We also investigated predictive factors for CPAP usage. Non-CPAP users had significantly worse baseline scores for runny nose compared with high and low users (1.34 vs. 0.68 and 0.75, respectively, p = 0.006). There were no other significant differences between the groups. Runny nose was an independent predictive factor for lower CPAP usage (p = 0.036). An evaluation after three months showed worsening in runny nose score in high-CPAP users (p = 0.025) but not in low- and non-users. There were no significant changes in other nasal symptoms. Our study demonstrates that nasal symptoms were very common in this population but rhinorrhoea was the only symptom associated with poorer CPAP adherence. Moreover, rhinorrhoea worsened after a three-month trial of high-CPAP usage. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

Review

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16 pages, 899 KiB

Open AccessReview

A Scoping Review of Sleep Apnea: Where Do We Stand?

by Rahim Hirani and Abbas Smiley

Life 2023, 13(2), 387; https://doi.org/10.3390/life13020387 - 31 Jan 2023

Cited by 5 | Viewed by 4832

Abstract

Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a [...] Read more.

Obstructive sleep apnea (OSA), a condition in which there is a recurrent collapse of the upper airway while sleeping, is a widespread disease affecting 5% to 10% people worldwide. Despite several advances in the treatment modalities for OSA, morbidity and mortality remain a concern. Common symptoms include loud snoring, gasping for air during sleep, morning headache, insomnia, hypersomnia, attention deficits, and irritability. Obese individuals, male gender, older age (65+), family history, smoking, and alcohol consumption are well recognized risk factors of OSA. This condition holds the ability to increase inflammatory cytokines, cause metabolic dysfunction, and increase the sympathetic output, all of which exacerbate OSA due to their effect on the cardiovascular system. In this review, we discuss its brief history, risk factors, complications, treatment modalities, and the role of clinicians in curbing its risk. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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12 pages, 572 KiB

Open AccessReview

Adherence to CPAP Treatment: Can Mindfulness Play a Role?

by Athanasia Pataka, Seraphim Chrysovalantis Kotoulas, Panagiotis Raphael Gavrilis, Alice Karkala, Asterios Tzinas and Aimiliza Stefanidou

Life 2023, 13(2), 296; https://doi.org/10.3390/life13020296 - 20 Jan 2023

Cited by 7 | Viewed by 4605

Abstract

Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients’ adherence, as almost 50% [...] Read more.

Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients’ adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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19 pages, 2454 KiB

Open AccessReview

Effect of Continuous Positive Airway Pressure on Changes of Plasma/Serum Ghrelin and Evaluation of These Changes between Adults with Obstructive Sleep Apnea and Controls: A Meta-Analysis

by Amin Golshah, Mohammad Moslem Imani, Masoud Sadeghi, Mozhgan Karami Chalkhooshg, Annette Beatrix Brühl, Laleh Sadeghi Bahmani and Serge Brand

Life 2023, 13(1), 149; https://doi.org/10.3390/life13010149 - 4 Jan 2023

Cited by 1 | Viewed by 1613

Abstract

Background and objective: Obstructive sleep apnea (OSA) can be related to high ghrelin hormone levels that may encourage additional energy intake. Herein, a new systematic review and meta-analysis were performed to check the changes in serum/plasma levels of ghrelin in adults with OSA [...] Read more.

Background and objective: Obstructive sleep apnea (OSA) can be related to high ghrelin hormone levels that may encourage additional energy intake. Herein, a new systematic review and meta-analysis were performed to check the changes in serum/plasma levels of ghrelin in adults with OSA compared to controls, as well as before compared after continuous positive airway pressure (CPAP) therapy in adults with OSA. Materials and methods: Four main databases were systematically and comprehensively searched until 17 October 2022, without any restrictions. For assessing the quality, we used the Joanna Briggs Institute (JBI) critical appraisal checklist adapted for case–control studies and the National Institutes of Health (NIH) quality assessment tool for before–after studies. The effect sizes were extracted by the Review Manager 5.3 software for the blood of ghrelin in adults with OSA compared with controls, as well as before and after CPAP therapy. Results: Fifteen articles involving thirteen studies for case–control studies and nine articles for before–after studies were included. The pooled standardized mean differences were 0.30 (95% confidence interval (CI): −0.02, 0.61; p = 0.07; I² = 80%) and 0.10 (95% CI: −0.08, 0.27; p = 0.27; I² = 42%) for case–control and before–after studies, respectively. For thirteen case–control studies, nine had moderate and four high qualities, whereas for nine before–after studies, five had good and four fair qualities. Based on the trial sequential analysis, more studies are needed to confirm the pooled results of the analyses of blood ghrelin levels in case–control and before–after studies. In addition, the radial plot showed outliers for the analysis of case–control studies that they were significant factors for high heterogeneity. Conclusions: The findings of the present meta-analysis recommended that the blood levels of ghrelin had no significant difference in the adults with OSA compared with the controls, nor did they have significant difference in adults with OSA before compared with after CPAP therapy. The present findings need to be confirmed in additional studies with more cases and higher qualities. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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17 pages, 1016 KiB

Open AccessReview

Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea—A Narrative Review

by Dinko Martinovic, Daria Tokic, Ema Puizina-Mladinic, Sanja Kadic, Antonella Lesin, Slaven Lupi-Ferandin, Marko Kumric and Josko Bozic

Life 2023, 13(1), 142; https://doi.org/10.3390/life13010142 - 4 Jan 2023

Cited by 3 | Viewed by 4197

Abstract

Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially [...] Read more.

Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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12 pages, 267 KiB

Open AccessReview

Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy

by Susanna Esposito, Giampiero Ricci, Riccardo Gobbi, Claudio Vicini, Fabio Caramelli, Silvia Pizzi, Agatina Fadda, Salvatore Ferro and Giuseppe Plazzi

Life 2022, 12(5), 739; https://doi.org/10.3390/life12050739 - 16 May 2022

Cited by 6 | Viewed by 2657

Abstract

Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time [...] Read more.

Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time symptoms. Unfortunately, there are few data on shared diagnostic-therapeutic pathways that address OSA with a multidisciplinary approach in paediatric age. This document summarizes recommendations from the Emilia-Romagna Region, Italy, developed in order to provide the most appropriate tools for a multidisciplinary approach in the diagnosis, treatment and care of paediatric patients with OSA. The multidisciplinary group of experts distinguished two different ‘step’ pathways, depending on the age group considered (i.e., under or over two years). In most cases, these pathways can be carried out by the primary care paediatrician, who represents the first filter for approaching the problem. For this reason, it is essential that the primary care paediatrician receives adequate training on how to formulate the diagnostic suspicion of OSA and on what criteria to use to select patients to be sent to the hospital centre. The relationship between the paediatrician of the patient and her/his parents must see a synergy of behaviour between the various players in order to avoid uncertainty about the diagnostic and therapeutic decisions as well as the follow-up phase. The definition and evaluation of the organizational process and outcome indicators of the developed flow-chart, and the impact of its implementation will remain fundamental. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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10 pages, 414 KiB

Open AccessBrief Report

Serum Cytokines as Biomarkers in Heart Failure with Preserved Ejection Fraction and Sleep Apnea: A Prospective Cohort Study

by Alexey Yakovlev, Alexander Teplyakov, Elena Grakova, Sergey Shilov, Natalia Yakovleva, Kristina Kopeva, Valery Shirinsky and Ivan Shirinsky

Life 2023, 13(3), 628; https://doi.org/10.3390/life13030628 - 23 Feb 2023

Cited by 1 | Viewed by 1772

Abstract

Heart failure with preserved ejection fraction (HFpEF) and obstructive sleep apnea (OSA) frequently co-occur and this comorbidity represents a separate phenotype of HFpEF. While many research attempts are focused on biomarkers of HFpEF, currently, there is a lack of validated biomarkers of HFpEF [...] Read more.

Heart failure with preserved ejection fraction (HFpEF) and obstructive sleep apnea (OSA) frequently co-occur and this comorbidity represents a separate phenotype of HFpEF. While many research attempts are focused on biomarkers of HFpEF, currently, there is a lack of validated biomarkers of HFpEF and OSA. In this study, we aimed to evaluate prognostic significance of several serum cytokines in patients with HFpEF and OSA. The patients with HFpEF and OSA were recruited from the Sleep Apnea Center of Novosibirsk, Russian Federation and followed up for 12 months. The main analyzed outcomes were five-point major adverse cardiovascular events (MACE) and the 6-min walk test (6MWT). The analyzed cytokines were circulating IL-6, IL-10, and VEGF measured at baseline. We recruited 77 male patients with HFpEF and OSA, the data of 71 patients were available for analyses. Patients who developed MACE had four-fold elevated concentrations of serum IL-10. There was no association between baseline cytokine levels and longitudinal changes in 6MWT. Circulating IL-10 levels are positively associated with MACE in men with HFpEF and OSA and thus may be a potential prognostic biomarker in this subgroup of patients. These results should be confirmed in larger studies encompassing both males and females. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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9 pages, 266 KiB

Open AccessCommentary

The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome

by Rizwana Sultana, Fatoumatta Sissoho, Vinod P. Kaushik and Mukaila A. Raji

Life 2022, 12(8), 1222; https://doi.org/10.3390/life12081222 - 12 Aug 2022

Cited by 10 | Viewed by 3626

Abstract

Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug–drug and drug–disease interactions, decreased quality [...] Read more.

Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug–drug and drug–disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a “one-stop shop” for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: History, Current Status, Perspectives)

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