Life | Special Issue : Obstructive Sleep Apnea: Current Knowledge and Future Perspectives

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10 pages, 2527 KiB

Open AccessArticle

A Novel Design of an Oral Appliance for Monitoring Electromyograms of the Genioglossus Muscle in Obstructive Sleep Apnea Syndrome

by Thamer Y. Marghalani, Ruwaa M. Salamah and Haitham M. Alangari

Life 2024, 14(8), 952; https://doi.org/10.3390/life14080952 - 29 Jul 2024

Viewed by 1098

Abstract

Obstructive sleep apnea (OSA) is a prevalent source of sleep-disordered breathing. OSA is most commonly associated with dysfunctions in the genioglossus (GG) muscle. In this study, we present the first version of a medical device that produces an electromyogram (EMG) of the GG. [...] Read more.

Obstructive sleep apnea (OSA) is a prevalent source of sleep-disordered breathing. OSA is most commonly associated with dysfunctions in the genioglossus (GG) muscle. In this study, we present the first version of a medical device that produces an electromyogram (EMG) of the GG. The prototype is composed of a (custom-made) 3D-printed mouthpiece. Impressions were taken for the lower arch and scanned with a lab scanner to be converted into digital impressions. ExoCad software was used to design the appliance. Fusion 360 software was then used to modify the design and create tubes to house the electrodes in a bilateral configuration to secure excellent and continuous contact with the GG muscle. Silver–silver chloride electrodes were incorporated within the appliance through the created tubes to produce a muscle EMG. In this preliminary prototype, an EMG amplifier was placed outside the mouth, and isolated electric wires were connected to the amplifier input. To test the design, we ran experiments to acquire EMG signals from a group of OSA patients and a control group in wakefulness. The GG EMGs were acquired from the participants for 60 s in a resting state whereby they rested their tongues without performing any movement. Then, the subjects pushed their tongues against the fontal teeth with steady force while keeping the mouth closed (active state). Several features were extracted from the acquired EMGs, and statistical tests were applied to evaluate the significant differences in these features between the two groups. The results showed that the mean power and standard deviation were higher in the control group than in the OSA group (p < 0.01). Regarding the wavelength during the active state, the control group had a significantly longer wavelength than the OSA group (p < 0.01). Meanwhile, the mean frequency was higher in the OSA group (p < 0.01) at rest. These findings support research that showed that impairment in GG activity continues in the daytime and does not only occur during sleep. Future research should focus on developing the device to be more user-friendly and easily used at home during wakefulness and sleep. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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12 pages, 305 KiB

Open AccessArticle

10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects

by Laura Draelants, Camille Point, Benjamin Wacquier, Jean-Pol Lanquart, Gwenolé Loas and Matthieu Hein

Life 2023, 13(6), 1379; https://doi.org/10.3390/life13061379 - 13 Jun 2023

Cited by 7 | Viewed by 1706

Abstract

Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. [...] Read more.

Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. Framingham Risk Score ≥ 10% was used as a cut-off to identify hypertensive subjects with high 10-year risk for CVD. The association between 10-year risk for CVD and COMISA was investigated using logistic regression analyses. 65.3% of hypertensive subjects from our sample presented a high 10-year risk for CVD. After controlling for major confounding factors, multivariate logistic regression analyses demonstrated that unlike its components present separately, COMISA was significantly associated with high 10-year risk for CVD in hypertensive subjects (OR 1.88, 95% CI 1.01–3.51). In this study, we have demonstrated that the negative synergy between obstructive sleep apnea syndrome and insomnia disorder seems to play a central role in the 10-year risk for CVD in hypertensive subjects, which seems to indicate that the establishment of a systematic research and an adapted treatment of COMISA could open new perspectives to promote a better cardiovascular outcome in this specific subgroup of patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

14 pages, 301 KiB

Open AccessArticle

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution

by Wen-Hua Hsu, Cheng-Chang Yang, Cheng-Yu Tsai, Arnab Majumdar, Kang-Yun Lee, Po-Hao Feng, Chien-Hua Tseng, Kuan-Yuan Chen, Jiunn-Horng Kang, Hsin-Chien Lee, Cheng-Jung Wu, Yi-Chun Kuan and Wen-Te Liu

Life 2023, 13(5), 1218; https://doi.org/10.3390/life13051218 - 19 May 2023

Cited by 2 | Viewed by 2242

Abstract

Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships [...] Read more.

Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E–I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E–I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

9 pages, 550 KiB

Open AccessArticle

Influence of Lingual Tonsillar Volume in Patients with Obstructive Sleep Apnea

by Yung Jee Kang, Byung Kil Kim, Sang Duk Hong, Yong Gi Jung, Gwanghui Ryu and Hyo Yeol Kim

Life 2022, 12(11), 1920; https://doi.org/10.3390/life12111920 - 18 Nov 2022

Cited by 1 | Viewed by 1808

Abstract

This study aimed to evaluate the influence of lingual tonsil (LT) volume measured using a three-dimensional (3D) reconstruction volume rendering program on clinical parameters and polysomnography (PSG) results. A total of 100 patients who underwent PSG, computed tomography (CT), and allergy test from [...] Read more.

This study aimed to evaluate the influence of lingual tonsil (LT) volume measured using a three-dimensional (3D) reconstruction volume rendering program on clinical parameters and polysomnography (PSG) results. A total of 100 patients who underwent PSG, computed tomography (CT), and allergy test from April 2016 to April 2020 were randomly selected. LT volume was measured using an imaging software program that enables 3D reconstruction of CT images. PSG parameters were analyzed by dividing the subjects into two groups according to LT volume (each 50 people). Based on the medial volume of 0.863 cm³, the upper half LT volume group and the lower half LT volume group were analyzed. Clinical factors such as body weight, neck circumference, body mass index (BMI), and age showed no difference between the two groups. Among PSG parameters, supine arousal index and non-rapid eye movement (NREM) arousal index were significantly higher in the upper half LT volume group (p = 0.012, 0.037). However, there was no significant difference in apnea-hypopnea index (AHI) between the upper and lower half LT volume groups (p = 0.749). Arousal snoring index and REM arousal index also showed no difference between the two groups. The prevalence of allergic rhinitis was not different in the two groups. High LT volume is associated with NREM arousal and arousal in the supine position, but it is not related to AHI. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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8 pages, 1191 KiB

Open AccessArticle

Evaluation of the Muscle Strength of the Tongue with the Tongue Digital Spoon (TDS) in Patients with Obstructive Sleep Apnea

by Laura Rodríguez-Alcalá, Felipe Benjumea, Juan Carlos Casado-Morente, Peter M. Baptista, Carlos O’Connor-Reina and Guillermo Plaza

Life 2022, 12(11), 1841; https://doi.org/10.3390/life12111841 - 10 Nov 2022

Cited by 5 | Viewed by 2275

Abstract

Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue [...] Read more.

Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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9 pages, 293 KiB

Open AccessArticle

Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire^® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy

by Peter Baptista, I. Madeleine Di Frisco, Elena Urrestarazu, Juan Alcalde, Manuel Alegre, Isabel Sanchez, Carlos O’Connor-Reina and Guillermo Plaza

Life 2022, 12(11), 1737; https://doi.org/10.3390/life12111737 - 28 Oct 2022

Cited by 3 | Viewed by 2812

Abstract

Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire^® device constitutes a minimally invasive operative option. The main objective of this [...] Read more.

Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire^® device constitutes a minimally invasive operative option. The main objective of this study is to estimate, under real-world clinical practice conditions, the 3-month impact on the quality of life (IQoL) of the HNS in patients with moderate/severe OSA who do not tolerate or accept CPAP, compared to patients who did not receive HNS. As a baseline, the unadjusted EuroQol utility index was 0.764 (SD:0.190) in the intervention group (IGr) and 0.733 (SD:0.205) in the control group (CGr); three months later, the indexes were 0.935 (SD: 0.101) and 0.727 (SD:0.200), respectively. The positive impact on quality of life was estimated to be +0.177 (95% CI: 0.044–0.310; p = 0.010). All dimensions in the IGr improved compared to CGr, especially for usual activities (p < 0.001) and anxiety/depression (p > 0.001). At the end of the follow-up, there was no significant difference in the quality of life between the general Spanish population and the IGr (difference: 0.012; CI95%: −0.03 to −0.057; p = 0.0578) for the same age range; however, there was a difference concerning the CGr (difference: −0.196; CI95%: −0.257 to −0.135; p < 0.001). In conclusion, patients with moderate/severe OSA implanted with the Inspire^® device showed a positive IQoL. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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17 pages, 1331 KiB

Open AccessArticle

The Predictive Role of Subcutaneous Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea

by Viktória Molnár, Zoltán Lakner, András Molnár, Dávid László Tárnoki, Ádám Domonkos Tárnoki, László Kunos and László Tamás

Life 2022, 12(10), 1504; https://doi.org/10.3390/life12101504 - 27 Sep 2022

Cited by 8 | Viewed by 1954

Abstract

Introduction: Our aim was to investigate the applicability of artificial intelligence in predicting obstructive sleep apnoea (OSA) and upper airway obstruction using ultrasound (US) measurements of subcutaneous adipose tissues (SAT) in the regions of the neck, chest and abdomen. Methods: One hundred patients [...] Read more.

Introduction: Our aim was to investigate the applicability of artificial intelligence in predicting obstructive sleep apnoea (OSA) and upper airway obstruction using ultrasound (US) measurements of subcutaneous adipose tissues (SAT) in the regions of the neck, chest and abdomen. Methods: One hundred patients were divided into mild (32), moderately severe-severe (32) OSA and non-OSA (36), according to the results of the polysomnography. These patients were examined using anthropometric measurements and US of SAT and drug-induced sleep endoscopy. Results: Using SAT US and anthropometric parameters, oropharyngeal obstruction could be predicted in 64% and tongue-based obstruction in 72%. In predicting oropharyngeal obstruction, BMI, abdominal and hip circumferences, submental SAT and SAT above the second intercostal space on the left were identified as essential parameters. Furthermore, tongue-based obstruction was predicted mainly by height, SAT measured 2 cm above the umbilicus and submental SAT. The OSA prediction was successful in 97% using the parameters mentioned above. Moreover, other parameters, such as US-based SAT, with SAT measured 2 cm above the umbilicus and both-sided SAT above the second intercostal spaces as the most important ones. Discussion: Based on our results, several categories of OSA can be predicted using artificial intelligence with high precision by using SAT and anthropometric parameters. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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Review

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10 pages, 1309 KiB

Open AccessReview

A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities

by Margaret Bublitz, Nour Adra, Leen Hijazi, Fidaa Shaib, Hrayr Attarian and Ghada Bourjeily

Life 2022, 12(12), 2003; https://doi.org/10.3390/life12122003 - 1 Dec 2022

Cited by 12 | Viewed by 2658

Abstract

Introduction: Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature’s focus away from the latter population. As such, [...] Read more.

Introduction: Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature’s focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. Methods: To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. Results: Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more “atypical” symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. Discussion: More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)

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