Sleep-Disordered Breathing: Key Pathophysiological Mechanisms and Their Clinical Implications

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

Deadline for manuscript submissions: 30 June 2026 | Viewed by 857

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Guest Editor
Department of Biomedical Laboratory Science, Jungwon University 85, Munmu-ro, Goesan-eup, Goesan-gun, Cheongju 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,

Sleep-disordered breathing (SDB) is a condition characterized by abnormal respiratory events during sleep. The underlying pathophysiology of this condition involves recurrent upper airway collapse, resulting from obesity, anatomical predisposition, neuromuscular dysfunction, and compromised pharyngeal dilator muscle activity during sleep. The cyclical pattern of airway obstruction, hypoxemia, and arousal triggers a cascade of pathological mechanisms that extend far beyond respiratory dysfunction. Intermittent hypoxia activates the sympathetic nervous system, leading to increased risk of hypertension and cardiovascular disease. Oxidative stress and systemic inflammation have been demonstrated to contribute to endothelial dysfunction and accelerated atherosclerosis. Moreover, the impact of SDB on metabolic homeostasis is significant, manifesting in the disruption of glucose metabolism, the development of insulin resistance, and the alteration of adipokine regulation. Recently, neuroinflammation and compromised glymphatic clearance during fragmented sleep have been demonstrated to contribute to cognitive impairment and neurodegenerative processes. In this Special Issue, we will cover recent outstanding findings regarding treatment strategies, biomarkers, and the pathophysiological mechanisms of diseases associated with SDB. This integrated approach is expected to provide readers with a better understanding of the pathophysiological consequences of SDB, from basic research to clinical practice.

Dr. Jinkwan Kim
Guest Editor

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Keywords

  • sleep-disordered breathing
  • sleep fragmentation
  • inflammation
  • cardiovascular disease
  • insulin resistance

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Published Papers (1 paper)

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Research

12 pages, 233 KB  
Article
Analysis of Interrater Reliability and Interpretive Discrepancies in Polysomnography Scoring Across Clinical Subgroups
by Ji Ho Choi, Tae Kyoung Ha, Ji Eun Moon and Seockhoon Chung
Life 2026, 16(4), 669; https://doi.org/10.3390/life16040669 - 14 Apr 2026
Viewed by 493
Abstract
Background: Polysomnography (PSG) is the gold standard for diagnosing sleep disorders. However, the subjectivity of manual scoring can lead to inter-scorer variability, undermining diagnostic accuracy and subsequent clinical decisions. This study aims to quantitatively assess scoring concordance among multiple scorers across various clinical [...] Read more.
Background: Polysomnography (PSG) is the gold standard for diagnosing sleep disorders. However, the subjectivity of manual scoring can lead to inter-scorer variability, undermining diagnostic accuracy and subsequent clinical decisions. This study aims to quantitatively assess scoring concordance among multiple scorers across various clinical subgroups to identify the factors that contribute to interpretive discrepancies. Methods: We conducted a retrospective analysis of overnight diagnostic PSG data from adult patients at a tertiary university hospital sleep center. Interrater reliability was evaluated by three independent expert scorers for 30 subjects selected through stratified random sampling. The polysomnographic data were independently and blindly scored according to the American Academy of Sleep Medicine criteria, focusing on sleep stages, arousals, respiratory events, and leg movements, all scored in 30 s epochs. Interrater agreement was measured using Fleiss’ κ, along with 95% confidence intervals, and included subgroup analyses by diagnostic category. Results: The analysis included a total of 28,291 epochs from 30 adults across normal, insomnia, obstructive sleep apnea (OSA) [mild–severe], and periodic limb movement (PLM) disorder subgroups. The overall interrater agreement for sleep staging among the three scorers was nearly perfect (Fleiss’ κ = 0.932), with the highest concordance observed in stages W, N2, and R, and excellent agreement in stages N1 and N3. Respiratory events showed particularly high reliability, with near-perfect agreement for apnea (κ = 0.955) and substantial agreement for hypopnea, arousals, and PLMs. Pairwise analyses indicated the highest concordance between scorer 1 and scorer 3, while the agreement between scorer 1 and scorer 2 was lower, particularly for detecting arousals and limb movements. Subgroup analyses showed the highest and most stable agreement in moderate OSA, whereas severe OSA exhibited reduced reliability for sleep staging and arousal scoring, indicating increased scoring complexity with greater sleep fragmentation. Conclusions: Although expert PSG scoring demonstrates high overall reliability, significant variability persists in complex cases like severe OSA. These findings underscore the necessity for structured quality assurance and automated tools to improve diagnostic consistency in clinical practice. Full article
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