The common link between sleep apnea syndrome and osteoarthritis: a literature review.

Patients with Osteoarthritis (OA) often also suffer from Sleep Apnea Syndrome (SAS), and many scholars have started to notice this link, although the relationship between the two is still unclear. In this review, we aim to summarize the current literature on these two diseases, integrate evidence of the OA and OSA connection, explore and discuss their potential common mechanisms, and thus identify effective treatment methods for patients with both OA and SAS. Some shared characteristics of the two conditions have been identified, notably aging and obesity as mutual risk factors. Both diseases are associated with various biological processes or molecular pathways, including mitochondrial dysfunction, reactive oxygen species production, the NF-kB pathway, HIF, IL-6, and IL-8. SAS serves as a risk factor for OA, and conversely, OA may influence the progression of SAS. The effects of OA on SAS are underreported in the literature and require more investigation. To effectively manage these patients, timely intervention for SAS is necessary while treating OA, with weight reduction being a primary requirement, alongside combined treatments such as Continuous positive airway pressure (CPAP) and medications. Additionally, numerous studies in drug development are now aimed at inhibiting or clearing certain molecular pathways, including ROS, NF-KB, IL-6, and IL-8. Improving mitochondrial function might represent a viable new strategy, with further research into mitochondrial updates or transplants being essential.

Impact of Nadi Shuddhi Pranayama on Apnea Hypopnea Index, Respiratory Distress Index, and Oxygen Desaturation Index Among Adolescents With Sleep Apnea Syndrome.

Background Sleep apnea syndrome has gained significant recognition over the last decade as a potential cause of substantial childhood morbidity. This study aimed to evaluate the impact of the Apnea Hypopnea Index (AHI), Respiratory Distress Index (RDI), and Oxygen Desaturation Index (ODI) among adolescents with sleep apnea syndrome. Objectives The objective of this study is to compare the impact of Nadi Shuddhi Pranayama with routine treatment modalities on the AHI, RDI, and ODI among adolescents with sleep apnea syndrome. Specifically, the study aims to evaluate the effectiveness of Nadi Shuddhi Pranayama in improving AHI, RDI, and ODI in this population. Methods This study was an interventional case-control study and enrolled 34 adolescents aged 10 to 18 years who were diagnosed with sleep apnea syndrome. The participants were divided into two groups: the Nadi Shuddhi Pranayama group (n=17) and the control group (n=17). Baseline assessments included the collection of demographic information, medical history, and polysomnography results to determine the AHI, RDI, and ODI. Follow-up assessments were conducted post-intervention to measure changes in the AHI, RDI, and ODI. Results There were no significant differences between groups in terms of age (p = 0.176) or gender distribution (p = 0.300). After the intervention period, participants in the Nadi Shuddhi Pranayama group showed significant improvements in the Apnea Hypopnea Index compared to the standard care group (p = 0.007). However, there were no significant differences in the Respiratory Distress Index (p = 0.547) or Oxygen Desaturation Index (p = 0.304) between the groups post-intervention. Subgroup analysis based on severity categories (Mild, Normal) for the Apnea Hypopnea Index showed a significant difference between the Nadi Shuddhi Pranayama and standard care groups (p = 0.037). However, there were no significant differences in the Respiratory Distress Index (p = 0.300) and Oxygen Desaturation Index (p = 0.169) between the groups in this subgroup. Conclusion These findings suggest that Nadi Shuddhi Pranayama may improve the Apnea Hypopnea Index in adolescents with sleep apnea, particularly in those with mild symptoms, but did not significantly affect the Respiratory Distress Index or Oxygen Desaturation Index.

Evaluation of Choroidal Thickness and Retinal Vessel Density with Serum HIF-1α and TNF-α Level in Patients with OSAS.

PURPOSE: To reveal changes in choroidal thickness, retinal vessel density, and serum HIF-1α and TNF-α levels in obstructive sleep apnea syndrome (OSAS) and their correlation. METHODS: This prospective case-control study included 118 patients divided into mild-to-moderate OSAS (n = 40), severe OSAS (n = 39), and a control group (n = 39). Choroidal thickness was evaluated with OCT, vessel density with OCTA, AHI index with polysomnography, and serum HIF-1α and TNF-α levels were analyzed using the enzyme-linked immunosorbent assay. RESULTS: The serum HIF-1α values of the participants in the mild-moderate OSAS and severe OSAS groups were [893.25(406.7-2068) and 1027(453-2527), respectively], and were both significantly higher than the control group [(521.5(231.6-2741))] (p < 0.001). Serum TNF-α levels did not differ significantly between the groups (p = 0.051).). Subfoveal choroidal thickness (SFCT) values of the severe OSAS groups were significantly lower than the control group (p < 0.05). The superficial and deep capillary plexus vascular density (SVD and DVD) values of the severe OSAS group were lower than the control group (p < 0.05). Serum HIF-1α and TNF-α levels of all participants were negatively correlated with both their SVD values (p < 0.05, r: -0.220 and p < 0.05, r: -0.252, respectively) and their DVD values (p < 0.001, r: -0.324 and p = 0.001, r: -0.299, respectively). CONCLUSIONS: Increased serum levels of inflammatory mediators (HIF-1α ve TNF-α) in OSAS cause a decrease in SFCT, SVD, and DVD, which is an indication of systemic vascular damage. Further research on developing treatment strategies to modulate TNF-α ve HIF-1α may help recede vascular morbidity in OSAS patients.

Multimodal Data Integration Enhance Longitudinal Prediction of New-Onset Systemic Arterial Hypertension Patients with Suspected Obstructive Sleep Apnea.

Background: It is crucial to accurately predict the disease progression of systemic arterial hypertension in order to determine the most effective therapeutic strategy. To achieve this, we have employed a multimodal data-integration approach to predict the longitudinal progression of new-onset systemic arterial hypertension patients with suspected obstructive sleep apnea (OSA) at the individual level. Methods: We developed and validated a predictive nomogram model that utilizes multimodal data, consisting of clinical features, laboratory tests, and sleep monitoring data. We assessed the probabilities of major adverse cardiac and cerebrovascular events (MACCEs) as scores for participants in longitudinal cohorts who have systemic arterial hypertension and suspected OSA. In this cohort study, MACCEs were considered as a composite of cardiac mortality, acute coronary syndrome and nonfatal stroke. The least absolute shrinkage and selection operator (LASSO) regression and multiple Cox regression analyses were performed to identify independent risk factors for MACCEs among these patients. Results: 448 patients were randomly assigned to the training cohort while 189 were assigned to the verification cohort. Four clinical variables were enrolled in the constructed nomogram: age, diabetes mellitus, triglyceride, and apnea-hypopnea index (AHI). This model accurately predicted 2-year and 3-year MACCEs, achieving an impressive area under the receiver operating characteristic (ROC) curve of 0.885 and 0.784 in the training cohort, respectively. In the verification cohort, the performance of the nomogram model had good discriminatory power, with an area under the ROC curve of 0.847 and 0.729 for 2-year and 3-year MACCEs, respectively. The correlation between predicted and actual observed MACCEs was high, provided by a calibration plot, for training and verification cohorts. Conclusions: Our study yielded risk stratification for systemic arterial hypertension patients with suspected OSA, which can be quantified through the integration of multimodal data, thus highlighting OSA as a spectrum of disease. This prediction nomogram could be instrumental in defining the disease state and long-term clinical outcomes.

Exploring the bidirectional causal association between Sleep Apnea Syndrome and Depression: A Mendelian randomization study involving gut microbiota, serum metabolites, and inflammatory factors.

OBJECTIVE: This study aimed to investigate the potential causal association between Sleep Apnea Syndrome (SAS) and Depression, focusing on the roles of gut microbiota, serum metabolites, and inflammatory factors in these conditions. METHODS: Mendelian Randomization (MR) analysis was performed using data from genome-wide association studies to assess 211 types of gut microbiota, 1400 serum metabolites, and 91 inflammatory factors as potential contributing factors. Causal inference was conducted using the Inverse Variance Weighted (IVW) method, with additional robustness checks through Cochran's Q test, MR-Egger regression intercept test, MR-PRESSO global test, and leave-one-out analysis. RESULTS: The MR analysis indicated a positive correlation between the risk of SAS and Depression (OR = 1.12, 95 % CI: 1.05-1.19, P < 0.001), with a reciprocal analysis showing a similar positive correlation between Depression and the risk of SAS (OR = 1.19, 95 % CI: 1.07-1.31, P = 0.001). Additionally, causal associations were identified between 15 types of gut microbiota, 36 serum metabolites, and 2 inflammatory factors with SAS, and between 11 types of gut microbiota, 23 serum metabolites, and 3 inflammatory factors with Depression (IVW, all P < 0.05). The robustness of these findings was confirmed through the MR-Egger regression intercept test and MR-PRESSO global test. CONCLUSION: This study provides epidemiological evidence of a bidirectional causal association between SAS and Depression, emphasizing the potential roles of gut microbiota, serum metabolites, and inflammatory factors in the pathogenesis of these disorders. These findings may inform the development of new therapeutic strategies.

Comparison of physical activity and quality of life between obese individuals with obstructive sleep apnea syndrome and individuals with obesity hypoventilation syndrome.

PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) and Obesity Hypoventilation Syndrome (OHS) share common causal factors and comorbidities but may have a variable effect on physical activity and associated quality of life, due to differences in pathophysiology. The aim of this study was to compare the levels of physical activity, mental health and quality of life between matched obese patients with either OSAS or OHS, aiming to identify which of the two syndromes may impose the most severe impact on these variables, for the first time in literature. METHODS: A total of 76 obese patients (OSAS: Ν1 = 48, OHS: N2 = 26) of similar age (58.2 ± 12.2 vs. 63.6 ± 9.8; p > 0.05), BMI (37.2 ± 6.2 vs. 40.3 ± 7.3; p > 0.05), and Apnea-Hypopnea Index (AHI) under non-invasive ventilation, completed International Physical Activity Questionnaire (IPAQ), Short-Form Health Questionnaire (SF-36), Personal Well-Being (PWB) Scale and Hospital Anxiety and Depression Scale (HADS-A and HADS-D), in this cross-sectional study. RESULTS: Both groups had similar scores in SF-36, HADS-A and HADS-D, while prevalence of clinical cases of anxiety (HADS-A > 8) and depression (HADS-D > 8) were also similar. OSAS patients scored significantly higher in physical activity [absolute IPAQ values 1100.75(7753.5) for OSAS vs. 518(3806) for OHS; p = 0.029]. Group comparisons yielded significant differences in physical functioning (p < 0.05) and general health perceptions (p < 0.05), in favor of the OSAS group. CONCLUSION: Both syndromes significantly affect patients' quality of life and physical activity, with the burden being heavier for OHS patients. Daily physical activity seems to be more impaired among obese OHS patients perhaps due to daytime hypercapnia.

ELK4 ameliorates cognitive impairment and neuroinflammation induced by obstructive sleep apnea.

Intermittent hypoxia (IH) in patients with obstructive sleep apnea (OSA) syndrome elicited neuron injury (especially in the hippocampus and cortex), contributing to cognitive dysfunction. This study investigated the effects and clarified the mechanisms of ETS domain-containing protein Elk-4 (ELK4) on the cognitive function and neuroinflammation of mice with IH. Mouse microglia BV2 cells were induced with IH by exposure to fluctuating O2 concentrations (alternating from 5 % to 21 % every 30 min), and mice with OSA were developed and subjected to lentivirus-mediated gene intervention. ELK4 expression was significantly reduced in IH-induced microglia and brain tissues of mice with OSA. Overexpression of ELK4 attenuated oxidative stress, decreased the pro-inflammatory factors IL-1ß, IL-6, and TNF-α, and increased the level of the anti-inflammatory factors IL-10 and TGF-ß1, as well as the neuroprotective factor BDNF. ELK4 promoted the transcription of fibronectin type III domain-containing protein 5 (FNDC5) by binding to the promoter of FNDC5. Knockdown of FNDC5 in IH-induced microglia and animals reversed the protective effects of ELK4 on OSA-associated neuroinflammation and cognitive dysfunction. Overall, the results demonstrated that ELK4 overexpression repressed microglial activation by inducing the transcription of FNDC5, thus attenuating neuroinflammation and cognitive dysfunction induced by OSA.

Risk of Comorbid Insomnia Disorder Associated with Major Depression in Apneic Patients: A Cross-Sectional Study.

Given the limitations of available studies, the objective of this study was to explore the role played by current and remitted major depression in the occurrence of comorbid insomnia disorder for apneic patients. Data from 1488 apneic patients were extracted from the medical reports of polysomnographic recordings available in the database of the Sleep Laboratory. The presence of comorbid insomnia disorder in these apneic patients was defined based on the diagnostic criteria of the American Academy of Sleep Medicine Work Group. The risk of comorbid insomnia disorder associated with current or remitted major depression in apneic patients was investigated using multivariate logistic regression models. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that remitted and current major depression were significantly associated with the occurrence of comorbid insomnia disorder in apneic patients. The findings of this study seem to indicate that comorbid insomnia disorder could be a residual symptom and a marker of major depression in apneic patients, which justifies the establishment of an adequate treatment for major depressive episodes and their potential residual symptoms to allow the better management of comorbid insomnia disorder and the better prevention of its potential negative consequences in this particular subpopulation.

Artificial Intelligence-Based Diagnosis of Obstructive Sleep Apnea Syndrome: A Scoping Review

SUMMARY: To diagnose obstructive sleep apnea syndrome (OSAS), polysomnography is used, an expensive and extensive study requiring the patient to sleep in a laboratory. OSAS has been associated with features of facial morphology, and a preliminary diagnosis could be made using an artificial intelligence (AI) predictive model. This study aimed to analyze, using a scoping review, the AI-based technological options applied to diagnosing OSAS and the parameters evaluated in such analyses on craniofacial structures. A systematic search of the literature was carried out up to February 2024, and, using inclusion and exclusion criteria, the studies to be analyzed were determined. Titles and abstracts were independently selected by two researchers. Fourteen studies were selected, including a total of 13,293 subjects analyzed. The age of the sample ranged from 18 to 90 years. 9,912 (74.56 %) subjects were male, and 3,381 (25.43 %) were female. The included studies presented a diagnosis of OSAS by polysomnography; seven presented a control group of subjects without OSAS and another group with OSAS. The remaining studies presented OSAS groups in relation to their severity. All studies had a mean accuracy of 80 % in predicting OSAS using variables such as age, gender, measurements, and/or imaging measurements. There are no tests before diagnosis by polysomnography to guide the user in the likely presence of OSAS. In this sense, there are risk factors for developing OSA linked to facial shape, obesity, age, and other conditions, which, together with the advances in AI for diagnosis and guidance in OSAS, could be used for early detection.

Para diagnosticar el Síndrome Apnea Obstructiva del Sueño (SAOS) se utiliza la polisomnografía, el cual es un costoso y extenso estudio que exige que el paciente duerma en un laboratorio. El SAOS ha sido asociado con características de la morfología facial y mediante un modelo predictivo de la Inteligencia Artificial (IA), se podría realizar un diagnóstico preliminar. El objetivo de este estudio fue analizar por medio de una revisión de alcance, las opciones tecnológicas basadas en IA aplicadas al diagnóstico del SAOS, y los parámetros evaluados en dichos análisis en las estructuras craneofaciales. Se realizó una búsqueda sistemática de la literatura hasta febrero del 2024 y mediante criterios de inclusión y exclusión se determino los estudios a analizar. Los títulos y resúmenes fueron seleccionados de forma independiente por dos investigadores. Se seleccionaron 14 estudios, incluyeron un total de 13.293 sujetos analizados. El rango edad de la muestra oscilo entre 18 y 90 años. 9.912 (74.56 %) sujetos eran de sexo masculino y 3.381 (25,43 %) eran de sexo femenino. Los estudios incluidos presentaron diagnóstico de SAOS mediante polisomnografía, siete estudios presentaron un grupo control de sujetos con ausencia de SAOS y otro grupo con presencia de SAOS. Mientras que los demás estudios, presentaron grupos de SAOS en relación con su severidad. Todos los estudios tuvieron una precisión media del 80 % en la predicción de SAOS utilizando variables como la edad, el género, mediciones y/o mediciones imagenológicas. no existen exámenes previos al diagnóstico por polisomnografía que permitan orientar al usuario en la probable presencia de SAOS. En este sentido, existen factores de riesgo para desarrollar SAOS vinculados a la forma facial, la obesidad, la edad y otras condiciones, que sumados a los avances con IA para diagnóstico y orientación en SAOS podrían ser utilizados para la detección precoz del mismo.

Risk Factors of Obstructive Sleep Apnea (OSA) in Pediatric Patients: A Systematic Review and Meta-analysis.

INTRODUCTION: This review aimed to assess the risk factors of Obstructive Sleep Apnea (OSA) in pediatric children, a common condition with serious long-term sequela. METHODS: PubMed, CENTRAL, Scopus, and Google Scholar were searched using the keywords "Apnea", "Obstructive Sleep" OR "Obstructive Sleep Apnea Syndrome" AND "Child" OR "Children" OR "Pediatrics". Data from 35 studies involving 497,688 pediatric patients diagnosed with OSA using polysomnography were reviewed. Risk factors examined included sex, obesity, neck circumference, tonsillar/adenoid hypertrophy, respiratory infections, nasal stenosis, parental OSA/smoking, ethnicity, preterm birth, and breastfeeding history. Relative Risk (RR) with 95% Confidence Intervals (95% CI) were calculated, using Cochrane Q and I² statistics to estimate heterogeneity. RESULTS: Tonsillar hypertrophy (RR = 3.55), adenoid hypertrophy (RR = 1.63), respiratory tract infection (RR = 2.59), obesity (RR = 1.74), and family history of OSA (RR = 3.03) were significantly associated with pediatric OSA. White ethnicity was protective (RR = 0.77). DISCUSSION: Recognizing these risk factors aids in early diagnosis and treatment of pediatric OSA.

Formulas to predict continuous positive airway pressure level using a home auto-adjusting device for obstructive sleep apnea treatment.

PURPOSE: To develop equations to predict therapeutic continuous positive airway pressure (CPAPT) based on home-based CPAP titration, including the type of interface used. METHOD: Retrospective study conducted in adult patients with obstructive sleep apnea (OSA) who used home-based autoCPAP titration (AutoSet S10, ResMed®). CPAPT was obtained manually through a visual analysis of autoCPAP data (CPAPV) and automatically using the 95th percentile pressure (CPAPP95). Multiple linear regression and K-fold cross-validation were applied. Independent variables were AHI, neck circumference (NC), BMI, and mask. Two formulas were generated based on mask and the Miljeteig and Hoffstein formula. RESULTS: We included 702 patients (174 women), median age, BMI and AHI of 58 years, 32 kg/m2 and 32 ev/h, respectively. Predictors for CPAPv (M1) were BMI, NC, AHI and type of interface (R2: 0.19); and for CPAPP95 (M2), BMI, AHI and mask (R2: 0.09). Error and precision between the formulas and CPAPT were: 0 (CPAPV/CPAPP95), and - 3.2 to 3.2 (CPAPV) and - 4 to 4 cm H2O (CPAPP95). CPAPV was higher with oronasal mask (10 vs. 9 cm H2O, p < 0.01). Accuracy defined as; a difference ± 2 cm H2O between estimated CPAP and CPAPT was greater in M1 than in M2 (79% vs. 64%, p < 0.01). CONCLUSION: In both models, calculated error was close to zero. CPAPV (± 3.2 cm H2O) showed more precision than CPAPP95 (± 4 cm H2O). With M1 (CPAPV), 79% of patients could start CPAP with reasonable accuracy (error of ± 2 cm H2O).

A meta-analysis of the correlation between obstructive sleep apnea syndrome and renal injury.

OBJECTIVE: To conduct a meta-analysis on the correlation between obstructive sleep apnea syndrome (OSAS) and renal injury. METHODS: Literature search was carried out in PubMed, Embase and Ovid-Medline databases between the date of database establishment and June 30th 2024. The keywords included obstructive sleep apnea hypopnea syndrome, sleep apnea hypopnea syndrome, renal injury, and correlation. Two researchers 1st independently screened the titles and abstracts based on the eligibility criteria, then extracted the data and evaluated the quality, and used Review Manager 5.3 for data processing. All analysis methods were based on PRISMA. RESULTS: Finally, 8 studies that matched the inclusion criteria were included, and the relationship between obstructive sleep apnea syndrome and serum cystatin C was analyzed. The homogeneity test showed (P < 0.01, I2 = 98%), and from the meta-analysis results, it could be known that the level of serum cystatin C in sufferers with OSAS was obviously greater than the control one (OR = 1.12, 95% CI 0.96-1.28, P < 0.01). The relationship between OSAS and serum creatinine was analyzed, and homogeneity test showed (P < 0.01, I2 = 96%). From the meta analysis result, it could be known that the serum creatinine level of obstructive sleep apnea syndrome was obviously greater than the control one (OR = 1.01, 95% CI 0.85 ~ 1.17, P < 0.01). The relationship between obstructive sleep apnea syndrome with serum urea nitrogen was analyzed, and homogeneity test showed (P < 0.01, I2 = 91%). From the meta-analysis results, it could be known that serum urea nitrogen of OSAS was obviously greater than the control one (OR = 1.38, 95% CI 01.17 ~ 1.59, P < 0.01). CONCLUSIONS: Eight articles have been included to determine the correlation between obstructive sleep apnea syndrome and renal injury, and it has been found that obstructive sleep apnea syndrome is closely related to renal injury, and the two may be risk factors for each other.

Small airway resistance in obese and nonobese patients with obstructive sleep apnea syndrome using impulse oscillometry.

Background/aim: There is limited information on the pathologic changes in the small airways among obese and nonobese patients with obstructive sleep apnea syndrome (OSAS). Impulse oscillometry (IOS) measures airway resistance and reactance independently of patient effort. This study aimed to compare airway resistance in small airways using IOS between obese and nonobese patients with OSAS. Materials and methods: In this real-life cross-sectional study, demographic information was collected from obese and nonobese subjects diagnosed with moderate and severe OSAS without any other underlying diseases. Spirometry and IOS measurements were conducted, and the values of both groups were statistically analyzed. Results: The nonobese group had a mean age of 45.6 ± 11.7 years (median 45), while the obese group had a mean age of 48.4 ± 9.5 years (median 47.5). The mean body mass index (BMI) for the nonobese group was 26.2 ± 2.1 kg/m2 (median 27 kg/m2), and for the obese group, it was 35.6 ± 6.4 kg/m2 (median 33 kg/m2). Statistically significant differences were observed between the two groups in R5 - R20 percentage, reactance area (AX), and resonant frequency (Fres) values (p < 0.05). Conclusion: Among obese OSAS patients, there is an increase in resistance in small airways as indicated by IOS values. IOS shows promise as a potential screening tool for diagnosing OSAS.

Update on the clinical applications of SGLTis: Insight to benefits beyond hypoglycemic and cardiorenal protection.

Sodium glucose cotransporter inhibitor (SGLTi) drugs have been widely used in clinical practice. In addition to their benefits in hyperglycemia, heart failure (HF), and kidney disease, their effects on obesity, metabolic dysfunction-associated steatotic liver disease (MASLD, formerly named nonalcoholic fatty liver disease [NAFLD]), polycystic ovarian syndrome (PCOS), abnormal lipid metabolism, hyperuricemia, obstructive sleep apnea syndrome (OSAS), anemia, and syndrome of inappropriate antidiuresis (SIAD, formerly named syndrome of inappropriate antidiuretic hormone [SIADH]) have been explored. In this review, we searched the data of clinical randomized controlled trials (RCTs) and meta-analyses of SGLTis in patients with diabetes from the PubMed library between January 1, 2020, and February 1, 2024. According to our review, certain SGLTis exhibit relatively superior clinical safety and effectiveness for treating the abovementioned diseases. Proper utilization of SGLTis in these patients can provide additional medication options for patients with different disease scenarios. However, studies of SGLTis in these diseases are relatively rare, with shortcomings such as small sample sizes and short intervention periods. Therefore, further large-scale, long-term, well-designed studies are needed to clarify the findings.

Application of bidirectional telemedicine in home CPAP for children with obstructive sleep apnea syndrome.

BACKGROUND: Traditional telemedicine follow-up proves unsuitable for home continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea syndrome (OSAS). Accompanying advancements in mobile internet, this study explores the feasibility and effectiveness of a mobile communication and remote monitoring system as a novel bidirectional telemedicine approach to enhance adherence to home CPAP in children with OSAS. METHODS: A prospective cohort utilizing bidirectional telemedicine follow-up from January to December 2022 (TM) was compared with a retrospective cohort receiving conventional phone follow-up from August 2018 to December 2021 (CP). Participants in TM group were subdivided into two groups based on the number of inquiries in the first week: a high-question group and a low-question group. The main endpoints included successful CPAP adaption and adherence at 2 months of follow-up. RESULTS: The TM group exhibited a significantly lower termination rate within 2 months compared to the CP group (1/24 vs. 6/22, p = 0.037). In the first week of home CPAP, the high-question group reported shorter average nightly usage and fewer days with usage of ≥4 h compared to the low-question group (5 h per night vs. 8.5 h per night, 4.5 days vs. 7 days, both p < 0.001). However, the high-question group showed significant improvement in adherence from the second week onward for the remainder of the study period. CONCLUSIONS: Bidirectional telemedicine represents an effective and feasible method to improve adherence to home CPAP therapy in children with OSAS. Considering the costs, researchers recommend applying bidirectional telemedicine for at least 1 week to better enhance long-term adherence.

Outcomes of endovascular therapy for Stanford type B aortic dissection in patients with sleep apnea syndrome.

OBJECTIVE: This study aimed to determine the influences of varying severity of sleep apnea syndrome (SAS) on the outcomes after thoracic endovascular aorta repair (TEVAR) in patients with Stanford type B aortic dissection (TBAD). METHODS: This observational study focused on individuals with TBAD plus SAS who received TEVAR between January 2018 and December 2022. Patients were divided into groups according to the results of the portable sleep-breathing monitoring systems: mild SAS (MSAS) and moderate-to-severe SAS (MSSAS). Clinical profiles were collected and analyzed. RESULTS: A total of 121 cases with TBAD plus SAS who underwent TEVAR were enrolled in this study. Two groups were formed by stratifying these cases: MSAS (74 cases) and MSSAS (47 cases). The MSSAS cases were found to be older relative to MSAS cases (51.7 ± 8.3 years vs 57.1 ± 12.8 years; P = .012) and had a higher body mass index (BMI; 25.7 ± 2.3 kg/m2vs 27.0 ± 2.3 kg/m2; P = .038). The investigation did not find any appreciable differences between the MSAS and MSSAS groups in terms of complications (endoleak, P = .403; stent-induced new entry, P >.999; and stent displacement: P >.999). However, the MSSAS group exhibited a significantly higher overall mortality rate compared with the MSAS group (log-rank P = .027). The tendency continued when examining cases with Marfan syndrome combined with MSSAS, where the overall mortality rate was significantly greater compared with Marfan syndrome cases with MSAS (log-rank P = .037). The absence of a significant difference was noteworthy in the freedom from reintervention between the MSAS and MSSAS groups (log-rank P = .278). The overall mortality rate was significantly higher in MSSAS group even after adjusting for varying potential confounders in the multivariate cox regression analysis (hazard ratio [HR], 1.875; 95% confidence interval [CI], 1.238-2.586; P = .012). A markedly higher rate of distal stent dilation in the MSSAS group was also observed compared with the MSAS group (HR, 2.5 mm/year [95% CI, 2-3 mm/year] vs HR, 4 mm/year [95% CI, 2.0-5.5 mm/year]; P = .029). CONCLUSIONS: MSSAS is associated with a significantly higher risk of overall mortality and dilation rate of the distal stent after TEVAR for TBAD patients. Hence, aggressive efforts to reverse the severity of SAS in time in these individuals seem to be necessary.

The relationship between haemoglobin concentrations and obstructive sleep apnea syndrome: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis investigates the relationship between haemoglobin (Hb) concentrations and obstructive sleep apnea syndrome (OSAS). METHODS: Following PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane Library from inception to March 8, 2024. Eligible studies included cross-sectional, cohort, and case-control designs comparing Hb concentrations in OSAS patients and healthy controls. Two reviewers independently screened records and extracted data. The risk of bias was assessed using the Joanna Briggs Institute checklist. RESULTS: A total of 27 studies involving 6499 OSAS subjects and 5199 controls were included. Hb concentrations were significantly higher in OSAS patients compared to controls (SMD: 0.28; 95 % CI: 0.18 to 0.39; I2 = 84.4 %). Subgroup analysis by OSAS severity showed that severe OSAS patients had higher Hb concentrations than those with mild/moderate OSAS. Sensitivity analyses confirmed the robustness of the findings. However, 7 studies reported opposite results, indicating possible regional or methodological differences. CONCLUSION: Hb concentrations are elevated in OSAS patients, with higher levels observed in severe cases. The significant heterogeneity and the predominance of studies from Turkey highlight the need for further research in diverse populations. Limitations include potential publication bias and variability in study designs.

[Modern view on the effectiveness of surgical methods for treating obstructive sleep apnea syndrome]. / Sovremennyi vzglyad na effektivnost' khirurgicheskikh metodov lecheniya sindroma obstruktivnogo apnoe sna.

Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.

Analysis of Macular Vascularization Using Optical Coherence Tomography Angiography in Patients with Obstructive Sleep Apnea Syndrome: A Prospective Clinical Study.

Background and Objectives: Given the conflicting data available in the literature, this study aimed to investigate the impact of obstructive sleep apnea syndrome (OSAS) on the macular vascular density (VD) and perfusion density (PD). Materials and Methods: Based on the obstructive apnea-hypopnea index (OAHI), 61 prospectively recruited patients were assigned to either a control group (n = 12; OAHI < 5/h) or an OSAS group (n = 49; OAHI ≥ 5/h). The macular VD and PD of the superficial and deep capillary plexuses (SCP and DCP, respectively) were measured in the parafoveolar and perifoveolar areas using Zeiss PLEX Elite 9000 (6 × 6 mm). The values were compared between the control and OSAS groups. Results: Compared with the control group, the OSAS group demonstrated an increased VD of the DCP in the parafoveolar and perifoveolar areas and PD of the DCP in the perifoveolar area. No significant differences in either the macular VD or PD of the SCP were observed. There was no correlation between the OAHI and macular VD or PD. Conclusions: This study indicates that collateral vessel formation and possible retinal vasodilation occur in the DCP of patients with OSAS.