Obstructive Sleep Apnea (OSA)

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 21387

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Guest Editor
Ear, Nose, and Throat Department, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
Interests: obstructive sleep apnoea; snoring; robotic surgery; thyroid surgery; parathyroid surgery; head and neck; paediatric otorhinolaryngology; rhinology
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Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and is characterised by recurrent episodes of complete or partial upper airway obstruction during sleep, resulting in oxygen desaturation, autonomic dysfunction and sleep fragmentation. It can affect both children and adults, and the main clinical symptoms include loud snoring, witnessed apneas and breathing difficulties during sleep. Overnight polysomnography is the gold-standard method for diagnosing OSA. Although OSA is common, it is a frequently unrecognised cause of serious disability with serious health and social consequences. If untreated, OSA may cause impaired cognitive ability, road traffic accidents, cardiovascular morbidity and all-cause mortality. 

Various therapeutic options for OSA exist. CPAP is the standard treatment for adult OSA, although its clinical application can be compromised by intolerance and poor compliance, while adenotonsillectomy is the primary treatment option for children with OSA and adenotonsillar hypertrophy.

We encourage authors to submit original or review articles on related topics in the field of sleep apnea.

Dr. Konstantinos Chaidas
Guest Editor

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Keywords

  • obstructive sleep apnea
  • snoring
  • sleep-disordered breathing
  • adult sleep apnea
  • paediatric sleep apnea

Published Papers (11 papers)

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Editorial

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3 pages, 156 KiB  
Editorial
Editorial on the Special Issue “Obstructive Sleep Apnea (OSA)”
by Konstantinos Chaidas
Life 2024, 14(6), 669; https://doi.org/10.3390/life14060669 - 23 May 2024
Viewed by 167
Abstract
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and is characterized by recurrent episodes of complete or partial upper airway obstruction during sleep, resulting in oxygen desaturation, autonomic dysfunction and sleep fragmentation [...] Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))

Research

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11 pages, 1922 KiB  
Article
Palatopharyngeal Arch Staging System (PASS): Consensus about Oropharyngeal Evaluation
by Marta Morato, Maribel P. Cardona-Sosa, Gabriela Bosco, Nuria Pérez-Martín, Mayerin M. Marte-Bonilla, Alfonso Marco, Carlos O’Connor-Reina, Rodolfo Lugo and Guillermo Plaza
Life 2023, 13(3), 709; https://doi.org/10.3390/life13030709 - 6 Mar 2023
Cited by 1 | Viewed by 4381
Abstract
Intraoral examinations are essential in the evaluation of the upper airway in patients with obstructive sleep apnea (OSA). The morphology of the anatomic structures of the soft palate, the tonsillar fossae, and the palatoglossus and palatopharyngeal muscles is an important determinant of the [...] Read more.
Intraoral examinations are essential in the evaluation of the upper airway in patients with obstructive sleep apnea (OSA). The morphology of the anatomic structures of the soft palate, the tonsillar fossae, and the palatoglossus and palatopharyngeal muscles is an important determinant of the size and collapsibility of the velum and oropharynx. The Palatopharyngeal Arch Staging System (PASS) is a systematic way to explore the oropharynx and report anatomic variations in the visible part of the palatopharyngeal muscle. In this prospective study, 30 sleep surgeons evaluated the reliability of the PASS using a selection of 23 videos of oropharyngeal examinations of healthy patients. The corresponding score on the PASS scale was graded for each examination. For internal structure and internal agreement, the Cronbach and Krippendorff alpha values were 0.96 and 0.46, which corresponded to a nearly perfect interrelationship and a moderate agreement, respectively. These findings suggest that the PASS is a valuable tool for evaluating the position of the palatopharyngeus muscle during oropharyngeal examinations and may be useful for creating a common language for sleep surgeons when evaluating the palatopharyngeal muscle. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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10 pages, 656 KiB  
Article
Effects of Rapid Maxillary Expander and Delaire Mask Treatment on Airway Sagittal Dimensions in Pediatric Patients Affected by Class III Malocclusion and Obstructive Sleep Apnea Syndrome
by Sara Caruso, Emanuela Lisciotto, Silvia Caruso, Alessandra Marino, Fabiana Fiasca, Marco Buttarazzi, David Sarzi Amadè, Melania Evangelisti, Antonella Mattei and Roberto Gatto
Life 2023, 13(3), 673; https://doi.org/10.3390/life13030673 - 1 Mar 2023
Cited by 3 | Viewed by 1776
Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander [...] Read more.
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander (RME) in association with the Delaire mask is a common treatment protocol for class III malocclusion. The aim of this work was to evaluate the cephalometric variations of upper airway dimensions and OSA-related clinical conditions after orthodontic treatment with an RME and the Delaire mask, as recorded in pediatric patients with a class III malocclusion who were affected by OSAS. In this preliminary study, 14 pediatric patients with mixed dentition, aged between 6 and 10 years, were selected. All patients were treated with an RME and the Delaire mask. Pre- and post-treatment cephalometric radiographs were traced, analyzed, and compared. The results demonstrated a significant increase in the upper airway linear measurements and the nasopharyngeal and oropharyngeal dimensions (p ≤ 0.05). This increase creates an improvement in airway patency and in OSAS-related clinical conditions. The use of the RME in association with the Delaire mask can be effective in the treatment of pediatric patients with a class III malocclusion who are affected by OSAS. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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9 pages, 736 KiB  
Article
Association between Patient- and Partner-Reported Sleepiness Using the Epworth Sleepiness Scale in Patients with Obstructive Sleep Apnoea
by Konstantinos Chaidas, Kallirroi Lamprou, John R. Stradling and Annabel H. Nickol
Life 2022, 12(10), 1523; https://doi.org/10.3390/life12101523 - 29 Sep 2022
Viewed by 1222
Abstract
Excessive daytime sleepiness in obstructive sleep apnoea (OSA) is often measured differently by patients and their partners. This study investigated the association between patient- and partner-completed Epworth Sleepiness Scale (ESS) scores and a potential correlation with OSA severity. One hundred two participants, 51 [...] Read more.
Excessive daytime sleepiness in obstructive sleep apnoea (OSA) is often measured differently by patients and their partners. This study investigated the association between patient- and partner-completed Epworth Sleepiness Scale (ESS) scores and a potential correlation with OSA severity. One hundred two participants, 51 patients and 51 partners, completed the ESS before and three months after initiating CPAP treatment. There was no significant difference when comparing patients’ and partners’ ESS scores at baseline (10.75 ± 5.29 vs. 11.47 ± 4.96, respectively) and at follow-up (6.04 ± 4.49 vs. 6.41 ± 4.60, respectively). There was a strong correlation between patients’ and partners’ ESS scores on both (baseline and follow-up) assessments (p < 0.001). There was significant improvement in patients’ and partners’ ESS scores after CPAP therapy (p < 0.001). There was no significant difference in patients’ or partners’ ESS scores between patients with mild, moderate or severe OSA. There was no significant correlation between oxygen desaturation index (ODI) and ESS score reported either by patient or by partner. In conclusion, our study revealed a strong correlation between patient- and partner-reported ESS scores. However, neither patient- nor partner-completed ESS scores were associated with OSA severity. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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10 pages, 1017 KiB  
Article
The Automatic Algorithm of the Auto-CPAP Device as a Tool for the Assessment of the Treatment Efficacy of CPAP in Patients with Moderate and Severe Obstructive Sleep Apnea Syndrome
by Beata Brajer-Luftmann, Tomasz Trafas, Marcin Mardas, Marta Stelmach-Mardas, Halina Batura-Gabryel and Tomasz Piorunek
Life 2022, 12(9), 1357; https://doi.org/10.3390/life12091357 - 31 Aug 2022
Viewed by 2105
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder where precise treatment assessment is of high importance. We aimed to validate an automatic algorithm of the auto-CPAP device and reveal polygraph usefulness in the OSAS diagnosis and treatment of outpatients. One [...] Read more.
Obstructive sleep apnea syndrome (OSAS) is a common sleep-related breathing disorder where precise treatment assessment is of high importance. We aimed to validate an automatic algorithm of the auto-CPAP device and reveal polygraph usefulness in the OSAS diagnosis and treatment of outpatients. One hundred patients with moderate OSAS, severe OSAS, and excessive daytime sleepiness qualified for CPAP treatment were included. The study was conducted in three stages. The first stage included a minimum 6-hour polysomnographic examination to select moderate and severe OSAS. The second stage involved an auto-CPAP treatment lasting at least 4 h with simultaneous polygraph recording. The third stage was a titration of at least 4 h with auto-CPAP. The Apnea–Hypopnea Index (AHI) and oxygen desaturation index (ODI) were calculated under auto-CPAP treatment, simultaneously using polygraph (stage two), and as a result of treatment with auto-CPAP (stage three). The mean AHI was 40.0 ± 20.9 for OSAS. Auto-CPAP treatment was effective in 97.5%. The mean residual AHI was 8.6 ± 4.8; there was no significant difference between the AHI CPAP, and the AHI polygraph values were assessed with an accuracy of 3.94/h. The sensitivity and specificity of calculated cut point 8.2 event/hour were: 55% and 82%, respectively. The calculated AUC for the AHI CPAP parameter was 0.633. Presented data confirmed that the automatic algorithm of auto-CPAP is a good tool for the assessment of the treatment efficacy of CPAP in patients, i.e., home setting, with a moderate or severe stage OSAS-presented high sleepiness. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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8 pages, 233 KiB  
Communication
Improvements in Plasma Tumor Necrosis Factor-Alpha Levels after a Weight-Loss Lifestyle Intervention in Patients with Obstructive Sleep Apnea
by Michael Georgoulis, Nikos Yiannakouris, Roxane Tenta, Ioanna Kechribari, Kallirroi Lamprou, Emmanouil Vagiakis and Meropi D. Kontogianni
Life 2022, 12(8), 1252; https://doi.org/10.3390/life12081252 - 17 Aug 2022
Cited by 2 | Viewed by 1295
Abstract
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight [...] Read more.
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight patients with a diagnosis of moderate-to-severe OSA were randomized to a standard care (SCG, n = 42) or a Mediterranean lifestyle group (MLG, n = 42). Both groups were prescribed continuous positive airway pressure (CPAP), while the MLG additionally participated in a 6-month behavioral intervention aiming at healthier weight and lifestyle habits according to the Mediterranean pattern. Plasma TNF-a was measured by an immunoenzymatic method both pre- and post-intervention. Drop-out rates were 33% (n = 14) for the SCG and 24% (n = 10) for the MLG. Intention-to-treat analysis (n = 84) revealed a significant decrease in median TNF-a only in the MLG (from 2.92 to 2.00 pg/mL, p = 0.001). Compared to the SCG, the MLG exhibited lower follow-up TNF-a levels (mean difference adjusted for age, sex, baseline TNF-a and CPAP use: −0.97 pg/mL, p = 0.014), and further controlling for weight loss did not attenuate this difference (p = 0.020). Per protocol analyses (n = 60) revealed similar results. In conclusion, a healthy lifestyle intervention can lower plasma TNF-a levels in patients with OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
11 pages, 498 KiB  
Article
The Changes in the Severity of Deep Neck Infection Post-UPPP and Tonsillectomy in Patients with OSAS
by Pin-Ching Hu, Liang-Chun Shih, Wen-Dien Chang, Jung-Nien Lai, Pei-Shao Liao, Chih-Jaan Tai, Chia-Der Lin, Hei-Tung Yip, Te-Chun Shen and Yung-An Tsou
Life 2022, 12(8), 1196; https://doi.org/10.3390/life12081196 - 5 Aug 2022
Viewed by 1473
Abstract
The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of [...] Read more.
The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD) in Taiwan from 1 January 2000 to 31 December 2012. Patients who had undergone combined UPPP and tonsillectomy were selected using National Health Insurance (NHI) surgical order. Patients with DNI were selected using International Classification of Diseases (ICD-9-CM) code. A logistic regression model was applied for risk analysis. There were 1574 patients in the UPPP+ T cohort, and 6,296 patients who did not undergo combined UPPP and tonsillectomy for the control group. Our analysis showed that patients with an obstructive sleep apnea syndrome (OSAS) history constitute 76.1% (n = 1198) of the UPPP+ T cohort. Compared to the control group, there was no significantly increased incidence rate of DNI after UPPP+ T within 1–60 months. Patients undergoing combined UPPP and tonsillectomy had a lower intubation rate for DNI, with an adjusted odds ratio of 0.47 (95% CI = 0.32–0.69). The combined UPPP and tonsillectomy does not increase the risk of DNI within 1–60 months. Furthermore, combined UPPP and tonsillectomy can reduce the severity for DNI by decreasing the intubation rate and length of hospitalization. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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Review

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20 pages, 549 KiB  
Review
Unraveling the Complexities of Oxidative Stress and Inflammation Biomarkers in Obstructive Sleep Apnea Syndrome: A Comprehensive Review
by Salvatore Lavalle, Edoardo Masiello, Giannicola Iannella, Giuseppe Magliulo, Annalisa Pace, Jerome Rene Lechien, Christian Calvo-Henriquez, Salvatore Cocuzza, Federica Maria Parisi, Valentin Favier, Ahmed Yassin Bahgat, Giovanni Cammaroto, Luigi La Via, Caterina Gagliano, Alberto Caranti, Claudio Vicini and Antonino Maniaci
Life 2024, 14(4), 425; https://doi.org/10.3390/life14040425 - 22 Mar 2024
Cited by 1 | Viewed by 1198
Abstract
Background: Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased [...] Read more.
Background: Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased morbidity and mortality, particularly in the cardiovascular and cognitive domains. The cyclic pattern of intermittent hypoxia in OSAS triggers oxidative stress, contributing to cellular damage. This review explores the intricate relationship between OSAS and oxidative stress, shedding light on molecular mechanisms and potential therapeutic interventions. Methods: A comprehensive review spanning from 2000 to 2023 was conducted using the PubMed, Cochrane, and EMBASE databases. Inclusion criteria encompassed English articles focusing on adults or animals and reporting values for oxidative stress and inflammation biomarkers. Results: The review delineates the imbalance between pro-inflammatory and anti-inflammatory factors in OSAS, leading to heightened oxidative stress. Reactive oxygen species biomarkers, nitric oxide, inflammatory cytokines, endothelial dysfunction, and antioxidant defense mechanisms are explored in the context of OSAS. OSAS-related complications include cardiovascular disorders, neurological impairments, metabolic dysfunction, and a potential link to cancer. This review emphasizes the potential of antioxidant therapy as a complementary treatment strategy. Conclusions: Understanding the molecular intricacies of oxidative stress in OSAS is crucial for developing targeted therapeutic interventions. The comprehensive analysis of biomarkers provides insights into the complex interplay between OSAS and systemic complications, offering avenues for future research and therapeutic advancements in this multifaceted sleep disorder. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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Other

10 pages, 1923 KiB  
Brief Report
Sleep Architecture and Daytime Sleepiness in Patients with Erectile Dysfunction
by Helena Martynowicz, Rafal Poreba, Tomasz Wieczorek, Zygmunt Domagala, Robert Skomro, Anna Wojakowska, Sylwia Winiewska, Piotr Macek, Grzegorz Mazur and Paweł Gac
Life 2023, 13(7), 1541; https://doi.org/10.3390/life13071541 - 11 Jul 2023
Cited by 1 | Viewed by 1795
Abstract
Obstructive sleep apnea is considered a risk factor for erectile dysfunction. The aim of this study was to determine sleep architecture and assess daytime sleepiness in patients with erectile dysfunction. The study group included 280 patients. The 107 enrolled patients had reported erectile [...] Read more.
Obstructive sleep apnea is considered a risk factor for erectile dysfunction. The aim of this study was to determine sleep architecture and assess daytime sleepiness in patients with erectile dysfunction. The study group included 280 patients. The 107 enrolled patients had reported erectile dysfunction. The control group consisted of 173 patients who had no history of erectile dysfunction. The Epworth sleepiness scale (ESS) was used to measure the subjects’ level of daytime sleepiness. All patients underwent a standardized overnight, single-night polysomnography in sleep laboratory. In the erectile dysfunction group, we observed increased ESS total score and N1 sleep phase duration. Mean and minimal oxygen saturation and mean oxygen desaturation were decreased in comparison to the control group. In summary, subjects with erectile dysfunction have altered sleep architecture, oxygen saturation parameters and increased daytime sleepiness. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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11 pages, 611 KiB  
Systematic Review
Artificial Intelligence as an Aid in CBCT Airway Analysis: A Systematic Review
by Ioannis A. Tsolakis, Olga-Elpis Kolokitha, Erofili Papadopoulou, Apostolos I. Tsolakis, Evangelos G. Kilipiris and J. Martin Palomo
Life 2022, 12(11), 1894; https://doi.org/10.3390/life12111894 - 15 Nov 2022
Cited by 11 | Viewed by 1888
Abstract
Background: The use of artificial intelligence (AI) in health sciences is becoming increasingly popular among doctors nowadays. This study evaluated the literature regarding the use of AI for CBCT airway analysis. To our knowledge, this is the first systematic review that examines the [...] Read more.
Background: The use of artificial intelligence (AI) in health sciences is becoming increasingly popular among doctors nowadays. This study evaluated the literature regarding the use of AI for CBCT airway analysis. To our knowledge, this is the first systematic review that examines the performance of artificial intelligence in CBCT airway analysis. Methods: Electronic databases and the reference lists of the relevant research papers were searched for published and unpublished literature. Study selection, data extraction, and risk of bias evaluation were all carried out independently and twice. Finally, five articles were chosen. Results: The results suggested a high correlation between the automatic and manual airway measurements indicating that the airway measurements may be automatically and accurately calculated from CBCT images. Conclusions: According to the present literature, automatic airway segmentation can be used for clinical purposes. The main key findings of this systematic review are that the automatic airway segmentation is accurate in the measurement of the airway and, at the same time, appears to be fast and easy to use. However, the present literature is really limited, and more studies in the future providing high-quality evidence are needed. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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12 pages, 367 KiB  
Systematic Review
Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review
by Kyriaki Vallianou and Konstantinos Chaidas
Life 2022, 12(11), 1845; https://doi.org/10.3390/life12111845 - 11 Nov 2022
Cited by 6 | Viewed by 2099
Abstract
The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with [...] Read more.
The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with OSA. The Pubmed and Scopus databases were searched for relevant articles up to and including March 2022 and sixteen studies were selected. Overall, six different surgical techniques were described, including partial epiglottectomy, epiglottis stiffening operation, glossoepiglottopexy, supraglottoplasty, transoral robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. All surgical methods were reported to be safe and effective in managing selected OSA patients with airway narrowing at the level of epiglottis. The surgical management of epiglottic collapse can improve OSA severity or even cure OSA, but can also improve CPAP compliance. The selection of the appropriate surgical technique should be part of an individualised, patient-specific therapeutic approach. However, there are not enough data to make definitive conclusions and additional high-quality studies are required. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA))
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