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Obstructive Sleep Apnea: Latest Advances and Prospects
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Obstructive Sleep Apnea: Latest Advances and Prospects

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

Deadline for manuscript submissions: 25 March 2026 | Viewed by 12192

Special Issue Editor

Dr. Carlos O’Connor Reina

E-Mail Website
Guest Editor
Department of Otolaryngology, Hospital Quiron Salud Marbella, 29603 Marbella, Spain
Interests: sleep apnea; sleep medicine; myofunctional therapy; sleep disordered breathing; sleep surgery; oropharyngeal exercise
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a major public health concern, with significant consequences for cardiovascular health, metabolic function, and overall quality of life. Despite important advances in recent years, many challenges remain in its diagnosis, treatment, and long-term management. This Special Issue, entitled “Obstructive Sleep Apnea: Latest Advances and Prospects”, aims to bring together the latest research and clinical perspectives to improve our understanding of and approach to this complex disorder.

We encourage the submission of original studies, reviews, and clinical research focusing on key aspects of OSA, including novel diagnostic tools, home sleep testing, personalized treatment strategies, myofunctional therapy, surgical interventions, and emerging therapies such as neurostimulation and pharmacological treatments. Additionally, we welcome contributions exploring patient adherence, quality-of-life outcomes, and the role of multidisciplinary management in optimizing care.

By gathering insights from experts in sleep medicine, otolaryngology, pulmonology, and other related fields, this Special Issue seeks to provide a comprehensive overview of current advancements and future directions in OSA research and treatment. We invite researchers and clinicians to share their findings and contribute to the ongoing progress in this evolving field.

Dr. Carlos O’Connor Reina
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • obstructive sleep apnea
  • sleep medicine
  • myofunctional therapy
  • sleep surgery
  • neurostimulation
  • personalized treatment
  • biomarkers
  • adherence
  • home sleep testing

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Published Papers (6 papers)

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Research

Jump to: Review

20 pages, 435 KB  
Article
Consensus Statements Among European Sleep Surgery Experts on Tongue, Hypopharynx, and Supraglottis Associated with Snoring and Obstructive Sleep Apnea: Part 1: Evaluation and Decision Making
by Ewa Olszewska, Andrea De Vito, Peter Baptista, Matej Delakorda, Clemens Heiser, Ryan C. T. Cheong, Guillermo Plaza, Olivier Vanderveken, Nuria Pérez-Martin, Bhik Kotecha, Joachim T. Maurer and Claudio Vicini
J. Clin. Med. 2026, 15(1), 80; https://doi.org/10.3390/jcm15010080 - 22 Dec 2025
Viewed by 428
Abstract
Introduction: The tongue base, hypopharynx, and supraglottis (TngHpxSgl) play distinct roles in snoring and obstructive sleep apnea (OSA). Aim of the Study: To assess the level of consensus on the assessment and decision-making for the management of snoring and OSA associated with TngHpxSgl. [...] Read more.
Introduction: The tongue base, hypopharynx, and supraglottis (TngHpxSgl) play distinct roles in snoring and obstructive sleep apnea (OSA). Aim of the Study: To assess the level of consensus on the assessment and decision-making for the management of snoring and OSA associated with TngHpxSgl. Methods: A set of statements on the assessment and decision-making for the management of snoring and OSA associated with TngHpxSgl was developed based on the literature and circulated among 12-panel members of European experts on sleep surgery, using the modified Delphi method, seeking at least 80% consensus. Responses were categorized as agree or disagree for each statement, and the comments from the panelists were used to assess the level of consensus. Statements containing aggregated anonymized responses and comments were sent to each panel member in the second and final rounds of the survey. Results: The final set included 147 statements. Of these, 52.6%, 14.7%, and 5.8% achieved consensus among all 12, 11, and 10 panelists, respectively. Conclusions: There was a high level of consensus (73.2%) among European sleep surgery experts on the statements. This consensus will help establish standards and guide further research on snoring and OSA related to TngHpxSgl. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
13 pages, 810 KB  
Article
Association Between Depressive Symptoms and Altered Heart Rate Variability in Obstructive Sleep Apnea
by Ji Hye Shin, Min Ji Song and Ji Hyun Kim
J. Clin. Med. 2025, 14(19), 6978; https://doi.org/10.3390/jcm14196978 - 2 Oct 2025
Viewed by 1504
Abstract
Background/Objectives: Obstructive sleep apnea (OSA) is strongly associated with cardiovascular morbidity, and depressive symptoms are common in affected individuals. Both OSA and depression have been linked to autonomic dysfunction, but the independent contribution of depressive symptoms to autonomic dysfunction in OSA remains unclear. [...] Read more.
Background/Objectives: Obstructive sleep apnea (OSA) is strongly associated with cardiovascular morbidity, and depressive symptoms are common in affected individuals. Both OSA and depression have been linked to autonomic dysfunction, but the independent contribution of depressive symptoms to autonomic dysfunction in OSA remains unclear. We investigated whether depressive symptom severity is associated with autonomic function, indexed by heart-rate variability (HRV), in patients with OSA. Methods: We retrospectively analyzed 1713 adults with OSA at a university-affiliated sleep center from 2011 to 2024. HRV was derived from electrocardiography during polysomnography, and frequency-domain indices (natural log-transformed LF, HF, VLF, TP, and LF/HF) were computed. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II). Associations between BDI-II and HRV indices were evaluated using univariable and multivariable linear regressions. Results: In univariable regression analyses, higher BDI-II scores were significantly associated with lower HRV indices (ln LF, ln HF, ln VLF, ln TP; all p < 0.01). In multivariable analyses, higher BDI-II scores were independently associated with lower ln LF, ln HF, and ln TP (all p < 0.05), adjusting for age, sex, body mass index, hypertension, diabetes, apnea–hypopnea index, arousal index, and sleep quality. Conclusions: Greater depressive symptom burden is independently associated with reductions in multiple HRV indices, suggesting attenuated parasympathetic activity and autonomic dysregulation in patients with OSA. These findings support integrated management strategies that address both physiological and psychological domains in OSA and motivate longitudinal studies to test whether effective depression treatment improves HRV and mitigates long-term cardiovascular risk. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
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20 pages, 275 KB  
Article
Role of Questionnaires in the Assessment of Severity and the Outcomes of Minimally Invasive Surgery for Snoring and Obstructive Sleep Apnea
by Natalia Olszewska, Ewa Olszewska and Cuneyt M. Alper
J. Clin. Med. 2025, 14(15), 5268; https://doi.org/10.3390/jcm14155268 - 25 Jul 2025
Cited by 1 | Viewed by 916
Abstract
Background/Objectives: Sleep questionnaires are used as screening tools to estimate the presence and severity of snoring and obstructive sleep apnea (OSA). The aim was to prospectively assess the diagnostic and prognostic accuracy of sleep questionnaires (Epworth Sleepiness Scale (ESS), Visual Analog Scale [...] Read more.
Background/Objectives: Sleep questionnaires are used as screening tools to estimate the presence and severity of snoring and obstructive sleep apnea (OSA). The aim was to prospectively assess the diagnostic and prognostic accuracy of sleep questionnaires (Epworth Sleepiness Scale (ESS), Visual Analog Scale for snoring loudness (VAS), Short Form Health Survey 36 (SF-36), STOP-Bang, and Pittsburgh Quality of Sleep (PSQI)) in subjects who underwent minimally invasive surgery for snoring and OSA. Methods: A total of 49 participants with primary snoring and/or OSA underwent minimally invasive surgery. Pre- and post-operative sleep study parameters and sleep questionnaire results were analyzed to assess the correlation between the subjective and objective parameters before and after surgery and changes with the surgery. Results: Pre-operative sleep study parameters demonstrated: an apnea–hypopnea index (AHI) of 16.71 ± 9.31, oxygen desaturation index (ODI) of 14.43 ± 9.31, and mean percentage of snoring time (ST) of 17.26 ± 14.5%, ESS of 9.04 ± 5.76, VAS of 8.18 ± 1.93, SF-36 of 42.12 ± 22.86, STOP-Bang of 3.65 ± 1.13, and PSQI of 6.61 ± 3.23. Post-operative sleep study parameters demonstrated an AHI of 10.39 ± 7.86, ODI of 10.17 ± 7.78, and ST of 12.55 ± 13.36%, ESS of 6.61 ± 4.55, VAS of 4.13 ± 2.87, SF-36 of 42.45 ± 24.70, STOP-Bang of 2.49 ± 1.42, and PSQI of 4.98 ± 2.13. Changes with surgery for sleep parameters demonstrated a decrease in AHI: 37.83%, ODI: 29.52%, ST: 27.3%, ESS: 26.86%, VAS: 49.50%, PSQI: 24.69%, and STOP-Bang: 31.84%. The score of SF-36 was not significant. Conclusions: Sleep questionnaires are an essential component of the workup for patients with snoring and OSA. There are differences in their ability to identify the presence and quantify the severity of snoring and OSA when compared to objective sleep parameters. Their sensitivity in assessing changes with treatment also varies. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
13 pages, 1153 KB  
Article
A Novel Approach to the Study of Pathophysiology in Patients with Obstructive Sleep Apnea Using the Iowa Oral Performance Instrument (IOPI)
by Andrés Navarro, Gabriela Bosco, Bárbara Serrano, Peter Baptista, Carlos O’Connor-Reina and Guillermo Plaza
J. Clin. Med. 2025, 14(13), 4781; https://doi.org/10.3390/jcm14134781 - 7 Jul 2025
Cited by 2 | Viewed by 2092
Abstract
Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with [...] Read more.
Background: Myofunctional therapy has emerged as a treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) enables objective measurement of lingual and orofacial muscle strength, although it was originally designed for evaluating dysphagia. OSA is frequently associated with a hypotonic phenotype characterized by reduced strength in upper airway muscles, but its identification remains unclear. Objective: We evaluated the usefulness of IOPI measurements in identifying hypotonic phenotypes among patients with obstructive sleep apnea (OSA). Methods: We carried out a cross-sectional study analyzing the relationship between IOPI scores, sleep polygraphy metrics—such as the apnea–hypopnea index (AHI)—and findings from physical examination. In addition to the standard IOPI protocol, we introduced novel maneuvers aimed at providing a more comprehensive assessment of oropharyngeal muscle function. Results: Although IOPI conventional maneuvers showed no clear association with AHI or ODI, the inferior tongue maneuver showed higher awake tongue strength, with a statistically significant correlation to both AHI (r = 0.2873; p = 0.008) and ODI (r = 0.2495; p = 0.032). Performing each exercise three times yielded highly consistent results across trials (r > 0.94), but did not significantly alter the overall outcome. Interestingly, lower tongue strength values were observed in patients with a high-arched palate (p < 0.05), whereas no relevant associations were found with the presence of a restricted lingual frenulum or CPAP use. Conclusions: Incorporating specific IOPI maneuvers, especially the inferior tongue exercise, may provide additional insight into muscle function in OSA. Selective repetition is advisable for borderline values. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
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Review

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17 pages, 1021 KB  
Review
Recent Advancements in the Clinical Pathway of Respiration-Synchronized Hypoglossal Nerve Stimulation Therapy for Obstructive Sleep Apnea
by Dorine Van Loo, Eldar Tukanov, Marijke Dieltjens, Sara Op de Beeck, Eli Van de Perck, Johan Verbraecken and Olivier M. Vanderveken
J. Clin. Med. 2025, 14(22), 8241; https://doi.org/10.3390/jcm14228241 - 20 Nov 2025
Viewed by 1769
Abstract
Background: Respiration-synchronized hypoglossal nerve stimulation (HGNS) is an effective treatment option for selected patients with obstructive sleep apnea (OSA). While literature on the standardization of the post-implant care pathway for patients treated with HGNS therapy remains limited, the growing global use of [...] Read more.
Background: Respiration-synchronized hypoglossal nerve stimulation (HGNS) is an effective treatment option for selected patients with obstructive sleep apnea (OSA). While literature on the standardization of the post-implant care pathway for patients treated with HGNS therapy remains limited, the growing global use of HGNS has made structured post-implant care management increasingly important. Methods: This narrative review summarizes the advancements related to the clinical pathway for respiration-synchronized HGNS therapy over the past 5 years, with a special focus on post-implant care management. Results: Selection criteria for respiration-synchronized HGNS are changing as new clinical findings emerge, including both anatomical and non-anatomical markers. Evidence suggests that adopting single-amplitude, full-night sleep testing may provide a more reliable assessment of HGNS treatment efficacy. Several studies have described optimization strategies for patients with suboptimal HGNS therapy response or therapy-related discomfort, including the use of awake endoscopy and drug-induced sleep endoscopy for advanced HGNS programming and the use of combination therapy, although data remains limited. Conclusions: The clinical care pathway for respiration-synchronized HGNS continues to evolve, including patient selection, evaluation of treatment success, and strategies for managing incomplete responders or patients with therapy-related discomfort. Nonetheless, addressing insufficient treatment responses remains a significant challenge and a key area for future research and clinical optimization. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
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21 pages, 364 KB  
Review
Advancing Obstructive Sleep Apnea Management: Recent Trends from Conventional to Innovative Therapies
by Soo Kyoung Park and Ji Ho Choi
J. Clin. Med. 2025, 14(21), 7586; https://doi.org/10.3390/jcm14217586 - 26 Oct 2025
Viewed by 4657
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep, leading to intermittent hypoxemia and sleep fragmentation. Untreated OSA is associated with increased risks of cardiovascular, metabolic, and neurocognitive comorbidities, as well as considerable socioeconomic burden. Positive [...] Read more.
Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse during sleep, leading to intermittent hypoxemia and sleep fragmentation. Untreated OSA is associated with increased risks of cardiovascular, metabolic, and neurocognitive comorbidities, as well as considerable socioeconomic burden. Positive airway pressure (PAP) remains the gold standard therapy; however, limited long-term adherence underscores the need for alternative, patient-centered approaches. Conventional modalities such as oral appliances, surgery, weight reduction, and positional therapy provide clinical benefits but have variable efficacy and tolerability. Recent advances highlight innovative strategies, including hypoglossal nerve stimulation (HGNS), anti-obesity pharmacotherapy with glucagon-like peptide-1 receptor agonists, and upper airway muscle–targeted agents, which exemplify precision medicine approaches tailored to individual OSA phenotypes. This review synthesizes current evidence on both conventional and emerging therapies, emphasizing the transition from a “one-size-fits-all” model toward integrated, phenotype-driven management aimed at improving outcomes and quality of life for patients with OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Latest Advances and Prospects)
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