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Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: 5 May 2025 | Viewed by 14262

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Dr. Jinkwan Kim

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Department of Biomedical Laboratory Science, Jungwon University 85, Munmu-ro, Goesan-eup, Goesan-gun 28204, Chungbuk, Republic of Korea
Interests: obstructive sleep apnoea; sleep fragmentation; inflammation; exosome and biomarkers; cardio-metabolic disease; epigenetics; mesenchymal stem cell
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Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a common disease that can lead to serious health problems, such as hypertension, diabetes mellitus, dyslipidemia, and neurocognitive dysfunction. OSA affects up to 1 billion people worldwide and is a complex and heterogeneous disorder. It is characterized by intermittent hypoxia and sleep fragmentation due to repetitive collapse of upper airway during sleep. These physiological properties lead to activation and propagation of oxidative stress, inflammation, and sympathetic hyperactivity. Due to the lack of experimental models that can mimic OSA, the underlying mechanisms linking OSA and comorbidities are not clearly elucidated. However, advances in molecular and biological technologies have made it possible to better understand the pathophysiological phenomena of OSA-related diseases. In this Special Issue, we will cover recent outstanding findings regarding treatment strategies, biomarkers, and pathophysiological mechanisms of various diseases associated with OSA, important clinical and epidemiological results, and big data analysis. This integrated approach is expected to provide readers with a better understanding of the pathophysiologic consequences of OSA and related disorders.

Dr. Jinkwan Kim
Guest Editor

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Keywords

obstructive sleep apnea
sleep fragmentation
cardiometabolic dysfunction
inflammation
co-morbidities

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Published Papers (9 papers)

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Research

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9 pages, 211 KiB

Open AccessArticle

The Role of Polysomnography for Children with Attention-Deficit/Hyperactivity Disorder

by Chien-Heng Lin, Po-Yen Wu, Syuan-Yu Hong, Yu-Tzu Chang, Sheng-Shing Lin and I-Ching Chou

Life 2025, 15(4), 678; https://doi.org/10.3390/life15040678 - 21 Apr 2025

Viewed by 192

Abstract

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children, characterized by inattention, hyperactivity, and impulsive behavior. In recent years, studies have shown that patients with ADHD often experience sleep problems, raising clinical interest in the potential role of polysomnography (PSG) in the diagnosis and management of ADHD. This study examines polysomnographic findings in children with ADHD who present with diverse sleep complaints. Methods: A cohort of children aged younger than 18 years, diagnosed with ADHD based on DSM-5 criteria, underwent overnight polysomnography. The study assessed various sleep parameters, including sleep latency, sleep efficiency, total sleep time, and the presence of sleep-disordered breathing. Results: A retrospective analysis was conducted on 36 children (29 boys and 7 girls) aged 6 to 14 years, diagnosed with ADHD, who underwent polysomnography between 2021 and 2024. Polysomnographic findings revealed that 77.78% of the children demonstrated significant snoring. Furthermore, 50.0% were diagnosed with obstructive sleep apnea syndrome (OSAS). In addition, eight children exhibited parasomnias. Among them, six had bruxism, three were diagnosed with periodic limb movement disorder (PLMD), and two experienced sleep talking. Other notable sleep-related conditions included two cases of narcolepsy, one case of prolonged sleep onset latency, and one case of central apnea syndrome. Total sleep time (TST) was significantly longer in females compared to males (400.71 ± 32.68 min vs. 361.24 ± 41.20 min, p = 0.0215), whereas rapid eye movement (REM) latency was longer in males compared to females (118.62 ± 55.60 min vs. 78.57 ± 27.82 min, p = 0.0194). These findings highlight the high prevalence of sleep-disordered breathing (SDB) in children with ADHD who present with sleep disturbances. Furthermore, sleep quality, as indicated by longer TST and shorter REM latency, appears to be better in females with ADHD. Conclusions: The findings of this study underscore the critical role of polysomnography (PSG) in the assessment of children with ADHD. PSG provides an objective evaluation of sleep abnormalities commonly associated with ADHD, which may influence symptom manifestation and treatment outcomes. Notably, the results suggest that females with ADHD exhibit better sleep quality, as indicated by longer total sleep time (TST) and shorter rapid eye movement (REM) latency compared to males. We recommend incorporating polysomnography (PSG) into the comprehensive assessment of children with ADHD who present with significant sleep disturbances. Further research is warranted to investigate the impact of targeted interventions for sleep abnormalities on ADHD symptoms, prognosis, and potential sex-specific differences. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

13 pages, 2130 KiB

Open AccessArticle

Physiological Parameters of Sleep and the Risk of Obstructive Sleep Apnea in Competitive Athletes with Poor Sleep Quality

by Feng-Yin Chen, Yung-An Tsou, Nai-Jen Chang and Wen-Dien Chang

Life 2025, 15(4), 610; https://doi.org/10.3390/life15040610 - 6 Apr 2025

Viewed by 366

Abstract

This study aimed to explore the sleep conditions and obstructive sleep apnea (OSA) risk in athletes with poor sleep quality. Athletes with poor sleep quality before competition were recruited. Cardiopulmonary coupling analysis, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Insomnia Severity Index were used to assess and compare athletes at risk of OSA (apnea-hypopnea index (AHI) ≥ 5 events per hour) with those not at risk (AHI < 5 events per hour). Comparisons were made between the non-OSA group (n = 23) and the OSA risk group (n = 19, AHI = 10.79 ± 4.47 events per hour). The OSA risk group exhibited a significantly higher percentage of Stage 1 (S1) and Stage 2 (S2) sleep and greater heart rate variability (HRV) (p < 0.05). Positive correlations were found between AHI and the percentage of S1 and S2 sleep, low-frequency (LF), and the LF/HF ratio (p < 0.05). Conversely, significant negative correlations were observed between AHI and the percentage of Stage 3 (S3) and Stage 4 (S4) sleep, as well as HRV (p < 0.05). Athletes with poor sleep quality and high OSA risk demonstrated reduced parasympathetic activity, increased sympathetic activity, and affected sympathovagal balance during nocturnal HRV. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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12 pages, 1320 KiB

Open AccessArticle

Obstructive Sleep Apnea after COVID-19: An Observational Study

by George-Cosmin Popovici, Costinela-Valerica Georgescu, Mihaela-Camelia Vasile, Constantin-Marinel Vlase, Anca-Adriana Arbune and Manuela Arbune

Life 2024, 14(8), 1052; https://doi.org/10.3390/life14081052 - 22 Aug 2024

Cited by 1 | Viewed by 2122

Abstract

The risk factors of hospitalized COVID-19 and obstructive sleep apnea (OSA) overlap. The aim of this study is to evaluate the prevalence and associated factors of post-COVID-19 OSA in hospitalized adult patients from southeastern Romania. A follow-up study was conducted on patients hospitalized for COVID-19 at the Pneumology Hospital in Galati, Romania, between 2021 and 2022. OSA was evaluated using the Epworth and STOP-BANG questionnaires and nocturnal polygraphy monitoring. Out of 331 patients, 257 were evaluated for sleep apnea in the 12th week. The prevalence of severe OSA was 57.97%. Significant associations were found with male gender, an age over 60, obesity, and cardiovascular co-morbidities. Non-invasive ventilatory therapy (NIV) and a hygienic–dietary regimen were recommended based on severity following a control visit after a month. Developing strategies for diagnosing and monitoring sleep disorders, including home sleep apnea tests and patient education, are the next directions for post-COVID-19 management. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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14 pages, 419 KiB

Open AccessArticle

Impact of Intermittent Hypoxia Related to Obstructive Sleep Apnoea Syndrome on Low-Grade Inflammation in Hypertensive Patients: Potential Implications for Cardiovascular Risk

by Matthieu Hein, Benjamin Wacquier, Matteo Conenna, Jean-Pol Lanquart and Camille Point

Life 2024, 14(5), 592; https://doi.org/10.3390/life14050592 - 6 May 2024

Cited by 2 | Viewed by 1707

Abstract

There is evidence for a particular relationship between low-grade inflammation (LGI) and intermittent hypoxia (IH) related to obstructive sleep apnoea syndrome (OSAS). However, despite the potential deleterious cardiovascular consequences associated with this LGI in hypertensive patients, few studies have investigated the impact of IH related to OSAS on CRP levels in this subpopulation. In total, 1404 hypertensive patients were selected retrospectively from the Sleep Laboratory database. CRP levels ≥3 mg/L but <10 mg/L were used as cut-offs to identify hypertensive patients with LGI. Logistic regressions were conducted to examine the risk of LGI associated with IH related to OSAS in hypertensive patients. LGI was frequent (33.8%) in hypertensive patients. After adjustment for confounders, multivariate logistic regressions revealed that only moderate to severe OSAS (apnoea–hypopnoea index ≥ 15/h) with high IH (oxygen desaturation index ≥ 15/h) [OR 1.51 (95% CI 1.06–2.14)] was significantly associated with LGI in hypertensive patients (p-value = 0.045). Consistent with our hypothesis, our results demonstrated the existence of a particular subtype of hypertensive patients at high cardiovascular risk characterised by the presence of LGI induced by IH hypoxia related to moderate to severe OSAS, which justifies the establishment of adequate management of this pathology to allow better cardiovascular prevention in this subpopulation. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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15 pages, 1011 KiB

Open AccessArticle

Prevalence and Characteristics of Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: Overlap Syndrome

by Michail Fanaridis, Izolde Bouloukaki, Georgios Stathakis, Paschalis Steiropoulos, Nikos Tzanakis, Violeta Moniaki, Eleni Mavroudi, Ioanna Tsiligianni and Sophia Schiza

Life 2024, 14(5), 547; https://doi.org/10.3390/life14050547 - 25 Apr 2024

Cited by 4 | Viewed by 2692

Abstract

Overlap syndrome (OVS) is a distinct clinical entity that seems to result in potential cardiovascular consequences. We aimed to estimate the prevalence and risk factors for OVS in OSA patients and analyze clinical and PSG characteristics associated with OVS. In this cross-sectional study, 2616 patients evaluated for OSA underwent type-1 polysomnography (PSG). They were grouped as pure OSA (AHI > 15/h) and OVS patients. Demographics, PSG data, pulmonary function tests and arterial blood gases (ABGs) were compared between groups after adjustments for confounders. OSA was diagnosed in 2108 out of 2616 patients. Of those, 398 (19%) had OVS. Independent predictors of OVS were older age [OR: 5.386 (4.153–6.987)], current/former smoking [OR: 11.577 (7.232–18.532)], BMI [OR: 2.901 (2.082–4.044)] and ABG measurements [PaCO₂ ≥ 45 OR: 4.648 (3.078–7.019), PO₂ [OR: 0.934 (0.920–0.949)], HCO₃⁻ [OR: 1.196 (1.133–1.263), all p < 0.001]. OVS was also associated with prevalent hypertension [OR: 1.345 (1.030–1.758), p = 0.03] and cardiovascular disease [OR: 1.617 (1.229–2.126), p < 0.001], depressive symptoms [OR: 1.741 (1.230–2.465), p = 0.002] and nocturia [OR: 1.944 (1.378–2.742), p < 0.001], as well as with indices of OSA severity. Disturbances in sleep architecture were more prominent in OVS expressed by lower %N3 and REM% and higher arousal index. Our data suggest that OVS is prevalent among OSA patients, with distinct clinical and PSG characteristics. These characteristics could be utilized as predictive factors for early identification and further evaluation of these patients towards desirable patient-reported outcomes. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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Review

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18 pages, 1312 KiB

Open AccessReview

Exploring the Relationship Between Obstructive Sleep Apnea and Olfactory Function

by Antonino Maniaci, Mario Lentini, Maria Rita Bianco, Daniele Salvatore Paternò, Salvatore Lavalle, Annalisa Pace, Giannicola Iannella, Paolo Boscolo-Rizzo, Miguel Mayo-Yanez, Christian Calvo-Henriquez, Jerome R. Lechien and Luigi La Via

Life 2025, 15(4), 675; https://doi.org/10.3390/life15040675 - 21 Apr 2025

Viewed by 251

Abstract

Obstructive sleep apnea (OSA) is increasingly recognized as a chronic condition that is closely interrelated to olfactory disorders, with a significant contribution to quality of health and overall quality of life. This narrative review aims to provide a thorough overview of the emerging evidence that now integrates these two previously considered distinct physiologic systems. Studies published recently have reported a significantly higher frequency of olfactory dysfunction among OSA patients compared to the general population, which raises the possibility of a causal relationship. We explore the postulated mechanisms behind this association, namely, the chronic intermittent hypoxia, local inflammatory effect, and neuroanatomical changes attributed to OSA. The review further explores the clinical impacts of this relationship through proposing the potential for an olfactory assessment to be used as a diagnostic modality for OSA and the effects of OSA treatment on olfactory function. Thus, we explore the difficulties in treating patients who experience both and suggest future areas for research. This review attempts to bridge the gap between the existing literature and impending investigation necessary for a better management of the interaction of sleep apnea and the human sense of smell. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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23 pages, 1633 KiB

Open AccessReview

The Effect of Sleep Disruption on Cardiometabolic Health

by SeokHyun Hong, Da-Been Lee, Dae-Wui Yoon, Seung-Lim Yoo and Jinkwan Kim

Life 2025, 15(1), 60; https://doi.org/10.3390/life15010060 - 7 Jan 2025

Viewed by 1923

Abstract

Sleep disruption has emerged as a significant public health concern with profound implications for metabolic health. This review synthesizes current evidence demonstrating the intricate relationships between sleep disturbances and cardiometabolic dysfunction. Epidemiological studies have consistently demonstrated that insufficient sleep duration (<7 h) and poor sleep quality are associated with increased risks of obesity, type 2 diabetes, and cardiovascular disease. The underlying mechanisms are multifaceted, involving the disruption of circadian clock genes, alterations in glucose and lipid metabolism, the activation of inflammatory pathways, and the modulation of the gut microbiome. Sleep loss affects key metabolic regulators, including AMPK signaling and disrupts the secretion of metabolic hormones such as leptin and ghrelin. The latest evidence points to the role of sleep-induced changes in the composition and function of gut microbiota, which may contribute to metabolic dysfunction through modifications in the intestinal barrier and inflammatory responses. The NLRP3 inflammasome and NF-κB signaling pathways have been identified as crucial mediators linking sleep disruption to metabolic inflammation. An understanding of these mechanisms has significant implications for public health and clinical practice, suggesting that improving sleep quality could be an effective strategy for preventing and treating cardiometabolic disorders in modern society. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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17 pages, 3069 KiB

Open AccessReview

Possible Molecular Mechanisms of Hypertension Induced by Sleep Apnea Syndrome/Intermittent Hypoxia

by Yoshinori Takeda, Fuminori Kimura and Shin Takasawa

Life 2024, 14(1), 157; https://doi.org/10.3390/life14010157 - 22 Jan 2024

Cited by 2 | Viewed by 2438

Abstract

Intermittent hypoxia (IH) is a central characteristic of sleep apnea syndrome (SAS), and it subjects cells in the body to repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Since SAS is linked to various serious cardiovascular complications, especially hypertension, many studies have been conducted to elucidate the mechanism of hypertension induced by SAS/IH. Hypertension in SAS is associated with numerous cardiovascular disorders. As hypertension is the most common complication of SAS, cell and animal models to study SAS/IH have developed and provided lots of hints for elucidating the molecular mechanisms of hypertension induced by IH. However, the detailed mechanisms are obscure and under investigation. This review outlines the molecular mechanisms of hypertension in IH, which include the regulation systems of reactive oxygen species (ROS) that activate the renin–angiotensin system (RAS) and catecholamine biosynthesis in the sympathetic nervous system, resulting in hypertension. And hypoxia-inducible factors (HIFs), Endotheline 1 (ET-1), and inflammatory factors are also mentioned. In addition, we will discuss the influences of SAS/IH in cardiovascular dysfunction and the relationship of microRNA (miRNA)s to regulate the key molecules in each mechanism, which has become more apparent in recent years. These findings provide insight into the pathogenesis of SAS and help in the development of future treatments. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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Other

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9 pages, 227 KiB

Open AccessOpinion

Non-Invasive Positive Pressure Ventilation Use—Practice Recommendations of the Slovak Society of Pulmonology and Phthisiology

by Pavol Pobeha, Imrich Mucska, Robert Vysehradsky, Marta Hajkova, Ivana Paranicova and Pavol Joppa

Life 2024, 14(3), 376; https://doi.org/10.3390/life14030376 - 13 Mar 2024

Viewed by 1413

Abstract

Non-invasive positive pressure ventilation (NIPPV) is increasingly used as a treatment method for patients with respiratory failure. The first recommendations for the use of NIPPV in Slovakia were developed by the Slovak Society of Pulmonology and Phthisiology in 2007 and were partially revised in 2015. New scientific evidence prompted the present update, which is based on widely accepted international guidelines and was adapted to address local needs. Important features of the present update include a classification of acute indications for NIPPV into three categories based on the level of supporting evidence, namely 1. definite indications for in-hospital use of NIPPV; 2. possible indications for in-hospital use of NIPPV; and 3. disorders and states in which in-hospital use of NIPPV is not recommended. The current update also reflects the importance of comorbid sleep-related breathing disorders and other chronic respiratory conditions, as well as the use and limitations of continuous positive airway pressure therapy. Since oxygen therapy is often administered along with NIPPV, guidance on the safe use of oxygen in NIPPV-treated patients has also been included. Also, the present update extends the range of its users, addressing the needs of specialists in pediatric respiratory medicine as a novelty. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea and Related Disorders: Pathophysiological Traits and Strategies for Treatment)

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