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Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 July 2026 | Viewed by 2154

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Special Issue Editor

Dr. Gonzalo Labarca

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1. Division of Respiratory, Allergy and Sleep Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
2. Department of Respiratory Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile
Interests: obstructive sleep apnea; sleep disorder breathing; central apnea; precision medicine
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Dear Colleagues,

Obstructive sleep apnea (OSA) is a heterogeneous condition with multiple clinical presentations. Current diagnostic metrics for OSA rely predominantly on frequency-based indices, particularly the apnea–hypopnea index (AHI). In recent years, various endotypes (underlying pathophysiological mechanisms) and phenotypes (observable clinical presentations) have been described, revealing different patterns of disease severity that extend beyond the AHI alone.

Recent advances in signal processing of data from sleep studies, combined with a better understanding of the clinical presentation of OSA across the lifespan, provide valuable information for determining which patients are most likely to benefit from continuous positive airway pressure (CPAP) therapy, mandibular advancement devices, pharmacological treatments, surgery, or combination therapies beyond CPAP alone.

This topic/collection aims to review recent updates in the clinical diagnosis and management of OSA, with special interest in novel approaches to identifying and characterizing OSA patients beyond the AHI. We welcome submissions of original research articles and reviews on this topic.

Dr. Gonzalo Labarca
Guest Editor

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Keywords

obstructive sleep apnea
sleep disorder breathing
central apnea
apnea–hypopnea index
precision medicine

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Published Papers (4 papers)

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Research

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12 pages, 573 KB

Open AccessArticle

Association of High-Risk Obstructive Sleep Apnea with Microvascular Complications in Adults with Type 1 Diabetes Mellitus: A Case–Control Study

by Selin Cakmak Demir, Adnan Batman, Dilek Yazici, Oguzhan Deyneli and Yüksel Peker

J. Clin. Med. 2026, 15(8), 2901; https://doi.org/10.3390/jcm15082901 - 10 Apr 2026

Viewed by 503

Abstract

Background: Obstructive sleep apnea (OSA) is a common but underrecognized sleep-related breathing disorder characterized by intermittent hypoxemia and autonomic dysfunction. OSA prevalence and clinical relevance in Type 1 Diabetes Mellitus (T1DM), particularly in relation to diabetes-related vascular complications, remain insufficiently explored. Objective: The aim of this study was to evaluate the prevalence of high-risk OSA in adults with T1DM and controls, and to investigate the association between high-risk OSA and microvascular complications among individuals with T1DM. Methods: In this cross-sectional case–control study, 102 adults with T1DM and 126 controls were included. OSA risk was assessed using the modified Berlin Questionnaire (mBQ). Analyses of vascular complications were restricted to participants with T1DM. Multivariable logistic regression models adjusted for age and sex were used to assess associations, with additional adjustments for body mass index, hypertension, current smoking, alcohol use and glycated hemoglobin A1c. Results: High-risk OSA was identified in 18.6% of individuals with T1DM and 11.9% of controls, with no significant difference between groups. Among participants with T1DM, the prevalence of microvascular complications (retinopathy and/or neuropathy) was substantially higher in those with high-risk OSA compared with those at low risk (68.4% vs. 18.07%, p <0.001). In univariate logistic regression analysis, high-risk OSA was significantly associated with microvascular complications (odds ratio [OR] 4.85; 95% confidence interval [CI] 1.65–14.24; p = 0.004). This association remained significant in the fully adjusted model (OR 5.55; 95% CI 1.36–22.65; p = 0.017). Conclusions: High-risk OSA is not more prevalent in adults with T1DM compared with controls; however, among individuals with T1DM, high-risk OSA is strongly and independently associated with microvascular complications. Given the potential contribution of diabetic microvascular and autonomic neuropathy to upper airway dysfunction, the relationship between OSA and vascular complications in T1DM may be bidirectional, warranting further longitudinal investigation. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management)

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15 pages, 1647 KB

Open AccessArticle

Obstructive Sleep Apnea Risk and Incidental Coronary Artery Calcification on Routine Chest Computed Tomography

by Zeynep Atceken, Sezer Kula, Irem Sena Konakci, Cetin Atasoy, Aylin Pihtili and Yüksel Peker

J. Clin. Med. 2026, 15(6), 2230; https://doi.org/10.3390/jcm15062230 - 15 Mar 2026

Cited by 1 | Viewed by 485

Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity; however, its relationship with subclinical coronary atherosclerosis detected incidentally on routine chest computed tomography (CT) remains incompletely defined. We aimed to evaluate the association between questionnaire-based OSA risk and moderate-to-severe coronary artery calcification (CAC) in patients without known cardiac disease undergoing non-contrast chest CT for non-cardiac indications. Methods: In this prospective cross-sectional study, 268 consecutive adults undergoing routine non-contrast chest CT were included. OSA risk was assessed using the Berlin Questionnaire (BQ) and a modified BQ (mBQ), excluding hypertension and obesity components. CAC was quantified using the Agatston method on non-gated CT images, and moderate-to-severe CAC was defined as a score > 100. Multivariable logistic regression models were adjusted for age, sex, smoking status, alcohol use, obesity, lung disease, diabetes mellitus and hypertension. Results: Moderate-to-severe CAC was substantially more prevalent among patients at high risk for OSA than among those at low risk (43.1% vs. 12.0%, p < 0.001). In unadjusted analyses, high-risk OSA was strongly associated with CAC > 100. After multivariable adjustment, BQ-defined high-risk OSA remained independently associated with moderate-to-severe CAC (adjusted odds ratio [OR] 2.74, 95% confidence interval [CI] 1.29–5.78, p = 0.008). Similar results were observed with the mBQ (adjusted OR 2.62, 95% CI 1.27–5.41, p = 0.009). Increased snoring intensity was also independently associated with CAC > 100 (adjusted OR 2.25, 95% CI 1.07–4.72, p = 0.032). Conclusions: Questionnaire-defined high-risk OSA is independently associated with moderate-to-severe incidental CAC detected on routine chest CT. These findings support the integration of sleep-related risk assessment into opportunistic cardiovascular imaging frameworks and highlight the potential role of thoracic CT in multidimensional cardiovascular risk stratification. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management)

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11 pages, 463 KB

Open AccessArticle

The Relationship Between Chronic Intermittent Hypoxia and MASLD and Fibrosis in Obstructive Sleep Apnea Patients

by Sidem Gul, Songul Ozyurt, Caglayan Keklikkiran and Aziz Gumus

J. Clin. Med. 2026, 15(5), 1911; https://doi.org/10.3390/jcm15051911 - 3 Mar 2026

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Abstract

Background/Objectives: Obstructive sleep apnea (OSA) causes recurrent apneas/hypopneas and intermittent oxygen desaturation during sleep. Chronic intermittent hypoxia (CIH) may be linked to metabolic dysfunction-associated steatotic liver disease (MASLD) and fibrosis through metabolic dysfunction. This study evaluated the relationship between OSA severity/hypoxemia indices and MASLD and fibrosis assessed by transient elastography. Methods: We prospectively enrolled 400 adults evaluated for suspected OSA at a respiratory disease outpatient clinic in Rize, Türkiye. All patients underwent overnight polysomnography. The apnea–hypopnea index (AHI), oxygen desaturation index (ODI), mean SpO₂, and mean of each participant’s minimum SpO₂ values were recorded. MASLD and fibrosis were assessed in the same individuals using FibroScan, with CAP (controlled attenuation parameter) and LSM (liver stiffness measurement) values recorded. OSA severity was categorized by AHI, and multivariable logistic regression was used to identify independent associations. Results: MASLD was present in 76% and fibrosis in 34.5% of patients. Patients with fibrosis had higher AHI (13.8 [8.2–35.2]) and ODI (11.5 [4.5–33.2]) and lower minimum SpO₂ (p < 0.001). In multivariable models, BMI (OR 1.09; p < 0.001) and metabolic syndrome (OR 3.34; p < 0.001) were independently associated with MASLD, while BMI (OR 1.02; p < 0.001), metabolic syndrome (OR 2.03; p = 0.015), and ALT (OR 1.02; p = 0.032) were independently associated with fibrosis. Conclusions: MASLD and fibrosis were associated with OSA severity and hypoxemia before multivariable adjustment. However, after adjustment for obesity-related factors, liver outcomes were primarily explained by BMI and metabolic syndrome. Liver assessment should be considered in patients with OSA, particularly in those with high BMI and metabolic syndrome. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management)

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Review

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22 pages, 1254 KB

Open AccessReview

Beyond the Apnea–Hypopnea Index: Circulating Biomarkers and Device-Based Metrics for Cardiometabolic Risk Stratification in Obstructive Sleep Apnea

by Dumitru Cătălin Sârbu, Mara Andreea Vultur, Maria Beatrice Ianoși, Hédi-Katalin Sárközi, Dragoș Huțanu and Edith Simona Ianoși

J. Clin. Med. 2026, 15(10), 3668; https://doi.org/10.3390/jcm15103668 - 10 May 2026

Viewed by 244

Abstract

Obstructive sleep apnea (OSA) is increasingly recognized not merely as a localized anatomical airway disorder, but as a complex systemic condition. While the apnea–hypopnea index (AHI) remains the traditional standard for diagnosis, it possesses inherent limitations in adequately predicting downstream adverse outcomes, necessitating the adoption of novel, comprehensive markers for refined risk stratification. This narrative review summarizes recent evidence on circulating biomarkers and device-based metrics that may complement the AHI for risk stratification in OSA. Beyond traditional metrics, emerging biomarkers in obstructive sleep apnea offer a multifaceted view of the disease, utilizing inflammatory, vascular, metabolic and novel molecular indicators to enhance clinical characterization. These biomarkers reflect key pathophysiological mechanisms, including systemic inflammation, endothelial dysfunction, metabolic imbalance and altered gut microbiota. Commonly studied markers show associations with disease severity and adverse health outcomes. In addition, novel molecular markers, such as microRNAs and advances in sleep study metrics, provide further insight into disease burden, prognosis and cardiovascular comorbidities. A multidimensional framework integrating accessible laboratory markers with device-based metrics may improve identification of patients with OSA who are at highest risk for cardiovascular and metabolic complications. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management)

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