Emerging Trends in Obstructive Sleep Apnea

A special issue of Clocks & Sleep (ISSN 2624-5175). This special issue belongs to the section "Disorders".

Deadline for manuscript submissions: 30 November 2026 | Viewed by 4549

Special Issue Editor


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Guest Editor
Sleep Disorders Research Center, Western New York Healthcare System, Buffalo, NY 10030, USA
Interests: pulmonary & critical care medicine; sleep medicine

Special Issue Information

Dear Colleagues,

This Special Issue, entitled “Emerging Trends in Obstructive Sleep Apnea”, highlights advances in disease characterization, novel therapies, and precision medicine approaches, which seek to inform future research directions and improve clinical outcomes for individuals affected by OSA.

Obstructive sleep apnea (OSA) is a heterogeneous disorder with distinct pathophysiological endotypes influencing treatment response. In this Special Issue, we explore the evolving understanding of these endotypes and their implications for personalized therapy. We review the predictive value of EEG-derived biomarkers on the incidence of cardiovascular disease. Notwithstanding the recognition of diverse contributors to OSA pathogenesis, the introduction of incretin agonists has emerged as a promising avenue, potentially modifying both weight-related and neuromuscular contributors to airway collapse.

Beyond airway obstruction, OSA frequently coexists with insomnia, complicating clinical management and exacerbating daytime impairment. Addressing this dual presentation requires tailored interventions that balance cognitive behavioral strategies with pharmacologic approaches. Moreover, cardiovascular complications remain a major concern, with emerging biomarkers offering novel insights into risk stratification and mechanistic pathways linking OSA to adverse outcomes.

Given the limitations of continuous positive airway pressure (CPAP) adherence, pharmacotherapy is gaining attention as a potential adjunct or alternative treatment. We investigate the latest pharmacologic developments, including agents targeting ventilatory control instability, upper airway collapsibility, and neurochemical modulation.

I would like to thank the authors who contributed to this Special Issue for their in-depth analysis and valuable insights that enhance our understanding of obstructive sleep apnea and its evolving management strategies.

Prof. Dr. Ali Albert el-Solh
Guest Editor

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Keywords

  • sleep apnea
  • pharmacotherapy
  • GLP-1
  • COMISA
  • biomarkers

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Published Papers (3 papers)

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Research

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12 pages, 602 KB  
Article
Uvulopalatopharyngoplasty Versus Expansion Sphincter Pharyngoplasty: A Single Centre Experience
by Teresa Bernadette Steinbichler, Birte Bender, Roland Hartl, Verena Strasser, Daniel Sontheimer, Sladjana Buricic, Barbara Kofler, Birgit Högl, Herbert Riechelmann and Benedikt Hofauer
Clocks & Sleep 2025, 7(3), 38; https://doi.org/10.3390/clockssleep7030038 - 29 Jul 2025
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Abstract
Background: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for the treatment of snoring and obstructive sleep apnea. In a retrospective clinical trial, we compared the two surgical techniques regarding objective sleep parameters and patients’ reported outcomes. Materials and [...] Read more.
Background: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for the treatment of snoring and obstructive sleep apnea. In a retrospective clinical trial, we compared the two surgical techniques regarding objective sleep parameters and patients’ reported outcomes. Materials and Methods: Patients treated with UPPP or ESP between January 2016 and February 2020 were included in this retrospective clinical trial. Pre- and postoperative AHI, BMI, and smoking habits were recorded. Subjective improvement was assessed by the ESS score and symptom relief reported by patients and their bed partners. Results: Between 2016 and 2020, 114 patients were included in the study, 74 patients suffered from OSA, and 30 patients had non-apnoeic snoring (AHI < 5/h). No preoperative sleeping studies were available in 10 patients (10/114; 9%). Based on the findings during drug-induced sedation endoscopy, most patients received an ESP (71/114, 62%), and 43 patients received a UPPP (43/114, 38%). Additionally, in 52/114 (46%), radio frequency ablation of the tongue base was performed if DISE revealed retrolingual collapse. ESP reduced AHI from 21.1 ± 10.8/h to 13.3 ± 12.1/h (p = 0.04), whereas UPPP caused a non-significant decrease in the AHI from 25.0 ± 13.8/h to 18.2 ± 14.6/h (p = 0.6). A minor secondary bleeding was observed in 32 patients, which was effectively treated with electrocautery or conservative therapy (32/114). This was more common in the ESP group (22/71; 31%) than in the UPPP group (10/43; 23%). Postoperative need for analgesics was higher in the ESP group than in the UPPP group. The ESS score showed no significant improvement after UPPP or ESP (p = 0.3), but subjective improvement in snoring was reported by 87/114 (76%) patients. Conclusion: AHI reduction was significantly higher in the ESP patient group than in the UPPP group. ESP patients had a slightly higher rate of minor secondary bleeding and postoperative need for analgesics than UPPP patients. Full article
(This article belongs to the Special Issue Emerging Trends in Obstructive Sleep Apnea)
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Review

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32 pages, 4795 KB  
Review
Obstructive Sleep Apneas and Cardiovascular Diseases
by Vincenzo Castiglione, Paolo Morfino, Iacopo Fabiani, Francesco Gentile, Edoardo Airò, Benedetta Volpi, Daniela Cardinale, Claudio Passino, Alberto Giannoni and Michele Emdin
Clocks & Sleep 2026, 8(2), 28; https://doi.org/10.3390/clockssleep8020028 - 21 May 2026
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Abstract
Obstructive sleep apnea (OSA) is a sleep-disordered breathing condition characterized by recurrent upper-airway obstruction, leading to intermittent hypoxemia, sleep fragmentation, and sympathetic activation. OSA is highly prevalent in patients with cardiovascular diseases and is strongly associated with hypertension, atrial fibrillation, coronary artery disease, [...] Read more.
Obstructive sleep apnea (OSA) is a sleep-disordered breathing condition characterized by recurrent upper-airway obstruction, leading to intermittent hypoxemia, sleep fragmentation, and sympathetic activation. OSA is highly prevalent in patients with cardiovascular diseases and is strongly associated with hypertension, atrial fibrillation, coronary artery disease, heart failure, and adverse prognosis. This review summarizes current evidence on the pathophysiology of OSA, its cardiovascular consequences, and available diagnostic and therapeutic strategies, with particular attention to clinical implications in cardiology practice. We discuss established treatments such as lifestyle interventions, continuous positive airway pressure, mandibular advancement devices, and selected surgical options, as well as emerging therapies, including pharmacological approaches targeting weight loss and ventilatory control. While OSA treatment improves symptoms and quality of life, evidence for cardiovascular event reduction remains heterogeneous and appears strongly influenced by patient selection and treatment adherence. Identifying patients most likely to benefit from targeted OSA management remains a key challenge. Full article
(This article belongs to the Special Issue Emerging Trends in Obstructive Sleep Apnea)
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20 pages, 1194 KB  
Review
Obstructive Sleep Apnea in Critically Ill Patients: A Structured Narrative Review of Prevalence, Diagnostic Barriers, and Clinical Implications in the ICU
by Christine Gharib, Catherine Kim, Jun Ling and Madhu Varma
Clocks & Sleep 2026, 8(2), 27; https://doi.org/10.3390/clockssleep8020027 - 20 May 2026
Viewed by 355
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent yet frequently underdiagnosed condition that is associated with significant cardiopulmonary, metabolic, and neurocognitive outcomes. Risk factors for OSA overlap with illnesses commonly observed in intensive care unit (ICU) patients, resulting in a disproportionately elevated burden [...] Read more.
Obstructive sleep apnea (OSA) is a highly prevalent yet frequently underdiagnosed condition that is associated with significant cardiopulmonary, metabolic, and neurocognitive outcomes. Risk factors for OSA overlap with illnesses commonly observed in intensive care unit (ICU) patients, resulting in a disproportionately elevated burden on healthcare. This structured narrative review synthesizes current evidence regarding the prevalence, diagnostic challenges, and clinical implications of obstructive sleep apnea (OSA) in critically ill adults admitted to intensive care units (ICUs) using PubMed, EMBASE, and Scopus. Key search terms included “obstructive sleep apnea,” “ICU,” and “critical illness.” Results showed that OSA is present in up to 60–70% of ICU patients, yet only ~5% are formally diagnosed during hospitalization. Underdiagnosis is linked to prolonged mechanical ventilation, extubation failure rates as high as 30%, 2-fold higher perioperative complication rates, cardiovascular instability, 1.8-fold greater 30-day ICU readmission rates, and 2.2-fold mortality. Standard screening tools have limited applicability in ICU patients. Emerging alternatives, such as overnight oximetry, polygraphy, and machine learning models lack validation. Our analyses reveal that current diagnostic and treatment strategies are poorly adapted to critically ill patients. Integration of OSA as a part of ICU management, diagnosis, and intervention may reduce readmissions and mortality. Full article
(This article belongs to the Special Issue Emerging Trends in Obstructive Sleep Apnea)
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