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Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy
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Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy

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

Deadline for manuscript submissions: closed (15 August 2022) | Viewed by 15153

Special Issue Editor

Dr. Athanasia Pataka

E-Mail Website
Guest Editor
Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: pulmonary medicine; sleep disorders; respiratory diseases; interstitial lung disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea syndrome (OSAS) is a chronic and prevalent disorder characterized by repetitive episodes of apneas and hypopneas during sleep. OSAS has been associated with inceased morbidity and mortality and has emerged as an important potential etiologic factor of several cardiometabolic diseases, including hypertension, atrial fibrillation, stroke, insulin resistance (IR), and diabetes mellitus.

The primary cause of OSAS is considered to be a narrow or collapsible upper airway (UA). However, in some patients, the impairment of the UA may be modest  and other factors such as a low respiratory arousal threshold, respiratory control instability (high loop gain), and differences in pharyngeal dilator muscle control during sleep may play a crucial role, constituting potential therapeutic targets of OSAS.

Most of the treatment options for OSAS, including continuous positive airway pressure (CPAP), mandibular advancement devices, UA surgery, and hypoglossal nerve stimulation, are focused on improving the impaired UA anatomy. The ‘gold standard‘ of OSAS treatment remains CPAP; however, it has a rather low compliance rate. There also remain gaps in our scientific and clinical knowledge of different pathways for targeted therapy for OSAS. There is a need to identify key clinical phenotypes of OSAS in order to employ a more targeted treatment approach and also to identify predictive factors in order to facilitate personalized treatment of this disease.

Dr. Athanasia Pataka
Guest Editor

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Keywords

  • Obstructive sleep apnea syndrome
  • Phenotypes
  • Targeted treatment
  • CPAP
  • Mandibular advancement devices
  • UA surgery
  • Hypoglossal nerve stimulation
  • Medications

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Published Papers (5 papers)

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Editorial

Jump to: Research, Review

3 pages, 198 KiB  
Editorial
‘One Size Doesn’t Fit for All’: There Is a Need for Targeted Personalized Therapy in Obstructive Sleep Apnea Syndrome
by Athanasia Pataka
J. Clin. Med. 2022, 11(13), 3595; https://doi.org/10.3390/jcm11133595 - 22 Jun 2022
Viewed by 1673
Abstract
The estimated prevalence of moderate to severe obstructive sleep apnea syndrome (OSA) has increased by 14–55% over the last few decades [...] Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy)

Research

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10 pages, 3316 KiB  
Article
Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea
by Adriana Neagos, Mihai Dumitru, Cristian Mircea Neagos, Mihaela Mitroi and Daniela Vrinceanu
J. Clin. Med. 2022, 11(18), 5347; https://doi.org/10.3390/jcm11185347 - 12 Sep 2022
Cited by 9 | Viewed by 2012
Abstract
Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of [...] Read more.
Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy)
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12 pages, 1276 KiB  
Article
Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial
by Valérie Attali, Olivier Jacq, Karine Martin, Isabelle Arnulf and Thomas Similowski
J. Clin. Med. 2022, 11(1), 99; https://doi.org/10.3390/jcm11010099 - 24 Dec 2021
Cited by 2 | Viewed by 3704
Abstract
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); [...] Read more.
(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy)
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17 pages, 6300 KiB  
Article
Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices
by Sara Camañes-Gonzalvo, Rocío Marco-Pitarch, Andrés Plaza-Espín, Javier Puertas-Cuesta, Rubén Agustín-Panadero, Antonio Fons-Font, Carla Fons-Badal and Marina García-Selva
J. Clin. Med. 2021, 10(22), 5255; https://doi.org/10.3390/jcm10225255 - 11 Nov 2021
Cited by 11 | Viewed by 2239
Abstract
Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the [...] Read more.
Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033). Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy)
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Review

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16 pages, 608 KiB  
Review
Does Smoking Affect OSA? What about Smoking Cessation?
by Athanasia Pataka, Seraphim Kotoulas, George Kalamaras, Asterios Tzinas, Ioanna Grigoriou, Nectaria Kasnaki and Paraskevi Argyropoulou
J. Clin. Med. 2022, 11(17), 5164; https://doi.org/10.3390/jcm11175164 - 31 Aug 2022
Cited by 19 | Viewed by 4502
Abstract
The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, [...] Read more.
The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, reduced sleep efficiency, total sleep time, and slow wave sleep. Smoking cessation has been related with impaired sleep. The health consequences of cigarette smoking are well documented, but the effect of smoking cessation on OSA has not been extensively studied. Smoking cessation should improve OSA as upper airway oedema may reduce, but there is limited data to support this hypothesis. The impact of smoking cessation pharmacotherapy on OSA has been studied, especially for nicotine replacement therapy (NRT). However, there are limited data on other smoking cessation medications as bupropion, varenicline, nortriptyline, clonidine, and cytisine. The aim of this review was to explore the current evidence on the association between smoking and OSA, to evaluate if smoking cessation affects OSA, and to investigate the possible effects of different pharmacologic strategies offered for smoking cessation on OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—New Pathways for Targeted Therapy)
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