Search Results (1,821)

Objective: The objective of this study is to investigate the clinical value of the triglyceride-glucose (TyG) index combined with alanine aminotransferase (ALT) in identifying prevalent metabolic-associated fatty liver disease (MAFLD) in patients with obstructive sleep apnea (OSA), and to construct and validate a diagnostic risk-stratification model. Methods: Clinical data of OSA patients were retrospectively collected from two centers: the Department of Geriatrics, Peking University People’s Hospital (August 2021 to December 2025) and the Department of Geriatrics, Shijiazhuang People’s Hospital (June 2023 to December 2025). MAFLD was diagnosed by abdominal ultrasonography performed by experienced radiologists blinded to laboratory results. Candidate predictors were selected using univariate logistic regression, LASSO regression, and bootstrap stability testing. Model performance was assessed by discrimination (area under the receiver operating characteristic curve, AUC), calibration (Hosmer–Lemeshow test, calibration curves), and clinical utility (decision curve analysis). Internal validation was performed using 10-fold cross-validation and bootstrap resampling with optimism correction. External validation was conducted in an independent cohort. Sensitivity analyses included subgroup analyses stratified by sex, age, BMI, and OSA severity. Results: A total of 962 patients were included in the development set and 116 in the external validation set. Multivariate analysis identified TyG index (OR = 1.95, 95% CI: 1.51–2.53), LDL-C (OR = 1.24, 95% CI: 1.02–1.49), BMI (OR = 1.21, 95% CI: 1.16–1.26), and ALT (OR = 1.04, 95% CI: 1.02–1.05) as variables independently associated with prevalent MAFLD, while platelet-to-lymphocyte ratio (PLR) was protective (OR = 0.996, 95% CI: 0.993–0.999). The simplified TyG-ALT model achieved an AUC of 0.714 (95% CI: 0.685–0.744) in the development set, with an optimism-corrected AUC of 0.712, and an AUC of 0.783 (95% CI: 0.701–0.866) in external validation. The model demonstrated good calibration and favorable clinical net benefit within the threshold range of 0.30–0.70. The optimal cutoff was 0.564, with sensitivity of 68.7% and specificity of 79.6%. Conclusions: The TyG-ALT model demonstrates good discriminative ability, calibration, and clinical utility for case-finding and risk stratification of prevalent MAFLD in OSA patients, particularly for identifying high-risk individuals requiring confirmatory imaging. Full article

Objective: The association of smoking with sleep apnea is often based on subjective data. This study quantified the effects of smoking on sleep architecture using exhaled carbon monoxide (eCO) and polysomnography (PSG). Methods: A total of 183 patients with suspected obstructive sleep apnea (OSA) were included in this prospective study. Following full-night PSG, eCO was measured within 10 min. Data were analyzed using the Generalized Linear Model (GLM). Results: Although initial unadjusted analyses showed an inverse correlation between eCO levels and central apnea count, GLM revealed that male gender was the only independent predictor for central apnea, negating the effect of eCO. GLM analyses, adjusted for age, gender, BMI, and alcohol and drug use, revealed that cumulative smoking load (pack-years) was independently associated after multivariable adjustment with reduced REM sleep duration (B = −0.345, 95% CI [−0.571; −0.119], p = 0.003) and REM sleep percentage (B = −0.099, 95% CI [−0.158; −0.040], p = 0.001). Similarly, smoking duration (years) significantly predicted decreased REM sleep duration (B = −0.426, 95% CI [−0.724; −0.128], p = 0.005) and REM percentage (B = −0.119, 95% CI [−0.197; −0.041], p = 0.003). Formal interaction analyses did not detect a statistically significant interaction with body mass index (BMI) (p > 0.05 for all interaction terms). Conclusions: In OSA, smoking is independently associated with alterations in REM sleep architecture rather than respiratory events. Cumulative smoking load and smoking duration are independently associated with alterations in REM sleep after adjusting for any other major clinical comorbidities. Full article

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns across provider types remain unclear. This study assessed whether board-certified sleep medicine provider (BCSMP) status is associated with differences in provider-billed HST charges and evaluated how organizational and payment contexts influence these charges. Methods: A retrospective cross-sectional analysis was conducted using 2019 data from Optum’s de-identified Clinformatics^® Data Mart Database (N = 61,531 adult HST claims). The main exposure was provider status (BCSMP vs. non-BCSMP). The outcome was total provider-requested charge per HST procedure. Generalized Linear Models with a gamma distribution estimated adjusted charge differences, controlling for organizational context, place of service, and payer type. Results: BCSMP encounters had significantly lower adjusted mean HST charges than non-BCSMPs (mean difference: −$78.04; 95% CI: −$89.06 to −$67.02; p < 0.001). Individual practitioners charged $168.48 less than hospital-affiliated providers, while group practices and other facilities charged more (all p < 0.001). Fee-for-service arrangements were associated with lower charges than commercial and Medicare Advantage plans (p < 0.001). Conclusions: Board-certified sleep medicine providers and individual practice settings were associated with lower billed charges for home sleep testing; however, these findings do not necessarily reflect actual cost reduction. To translate these baseline charge differences into equitable clinical protocols and healthcare policies, future research must analyze negotiated reimbursement rates, billing structures, and practice environments to determine how these cost parameters impact the overall cost of an OSA diagnosis. Full article

Considering the high user engagement and collaborative content creation in the digital cultural industry, we explore how digital platform capabilities (DPCs) enable value co-creation in corporate innovation ecosystems (VCC-CIE). Drawing on dynamic capability theory and survey data from 504 employees of Chinese digital cultural enterprises, we analyze the impact of DPCs on VCC-CIE. DPCs were found to positively affect VCC-CIE, with organizational structural agility (OSA) and business model innovation (BMI) serving as mediators. Furthermore, digital business intensity (DBI) not only positively moderates the direct relationship between DPCs and VCC-CIE but also significantly moderates the mediating role of OSA, creating a moderated mediation model. This research advances our understanding of value co-creation in the digital age. Practically, it reveals that digital cultural enterprises can boost VCC-CIE by enhancing their DPCs, improving OSA, and adopting BMI. Full article

Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3–12 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 ± 5.5 to 36.2 ± 6.7 dB; p < 0.001), as did OSA-18 scores (44.9 ± 7.9 to 80.4 ± 10.3; p < 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37–6.77; p < 0.001), a 14.89-point OSA-18 increase (95% CI 12.87–16.92; p < 0.001), and 5.12-fold higher odds of PTA > 30 dB (95% CI 2.84–9.24; p < 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification. Full article

Glaucoma is a chronic, progressive optic neuropathy and the second leading cause of irreversible blindness worldwide. Although elevated intraocular pressure (IOP) remains the principal modifiable risk factor, it is neither necessary nor sufficient for disease development. The literature indicates that systemic conditions such as obstructive sleep apnea (OSA) may contribute to its pathogenesis. The pathophysiology of glaucoma is supported by several theories, primarily the mechanical and vascular theories. This review describes the pathophysiological links between OSA and glaucoma considering current theories. The principal connecting mechanism appears to be chronic intermittent hypoxia and reduced ocular perfusion pressure, which trigger optic nerve head hypoxia, oxidative stress, and biomechanical remodeling of the lamina cribrosa. These processes interact within a vicious cycle that progressively compromises the metabolic support of optic nerve axons. The mechanisms described are particularly relevant to normal-tension glaucoma, which may be associated with OSA. Retinal nerve fiber layer thinning appears among the earliest markers of optic nerve vulnerability, whereas IOP and visual field changes are more variable. These observations underscore the clinical relevance of the OSA–glaucoma relationship and support a multidisciplinary approach incorporating routine ophthalmic screening for subclinical optic nerve damage. Full article

Obstructive sleep apnea (OSA) is a common condition defined by recurrent upper airway collapse, intermittent hypoxia, and sleep fragmentation that leads to sympathetic activation and adverse cardiometabolic effects. OSA and type 2 diabetes mellitus (T2DM) share a complex, bidirectional relationship driven in part by obesity, but also by overlapping pathophysiologic mechanisms. Diabetes may worsen upper airway collapsibility, while untreated OSA may exacerbate hyperglycemia, contributing to a self-perpetuating cycle of metabolic abnormalities. Continuous positive airway pressure (CPAP) remains the first-line therapy for OSA, and improves symptoms and some cardiometabolic parameters, although effects on glycemic control have been mixed and may depend on patient factors. Alternative therapies play important roles in some patients. Incretin-based therapies, particularly tirzepatide, have emerged as promising treatments for obesity-related OSA following the SURMOUNT-OSA trial, demonstrating significant reductions in apnea–hypopnea index and cardiometabolic risk factors, though their effect in patients with T2DM remains unclear. Considerations such as sarcopenia with weight loss and evolving pharmacologic and procedural strategies further shape management decisions. This review synthesizes current evidence on the pathophysiologic overlap, therapeutic approaches, and future directions in optimizing care for patients with coexisting OSA and diabetes. Full article

Background/Objectives: Enhanced Recovery After Surgery (ERAS) protocols improved outcomes in colorectal surgery, but global implementation remains heterogeneous. In centers without structured ERAS programs, the lack of standardized discharge criteria could lead to conservative decisions and prolonged hospital stays. This study aimed to evaluate the feasibility and safety of early discharge (ED) on postoperative day (POD) 3 using the five Tavernier’s criteria in a real-world setting without formal ERAS pathways. Methods: This retrospective analysis of a prospectively maintained database included all consecutive adult patients undergoing elective laparoscopic colorectal resection between February 2025 and February 2026 at a high-volume tertiary center. Patients were stratified into the EARLY group (discharged on POD 3 upon fulfilling all five Tavernier criteria: C-reactive protein < 150 mg/L, temperature < 38 °C, passage of flatus, Visual Analogue Scale score < 5, and oral diet tolerance) and the STANDARD group (discharged after POD 3). The primary endpoint was the safety and negative predictive value (NPV) of the five-criteria bundle regarding 30-day complications. Results: Seventy-seven patients were included (EARLY: n = 44; STANDARD: n = 33). In the STANDARD group, the primary barriers to discharge were prolonged intravenous analgesic requirements (81.8%) and delayed bowel function (36.4%). The five-criteria bundle demonstrated an NPV of 84.1%, a sensitivity of 68.2%, and a specificity of 67.3% for identifying patients at low risk of complications. The overall 30-day complication rate was significantly lower in the EARLY group compared to the STANDARD group (15.9% vs. 45.5%; p = 0.010). No major complications (Clavien–Dindo ≥ III) occurred in the EARLY group compared to 6.1% in the STANDARD group. Conclusions: This exploratory feasibility analysis suggests that early discharge on POD 3 guided by the five Tavernier criteria is potentially safe and feasible in a real-world clinical setting without formal ERAS pathways. However, given the small sample size and inherent methodological biases, these findings remain preliminary, and larger prospective multi-center trials are strictly required to validate the safety and formal impact of this strategy. Full article

Background/Objectives: Irreversible electroporation (IRE) is a non-thermal tissue ablation technology, offering potential advantages such as reductions in pain, bleeding, and procedural time. With this study, we aimed to evaluate the safety and efficacy of IRE for the treatment of adenotonsillar hypertrophy in pediatric patients. Methods: In this prospective, two-center, interventional case series, we enrolled 31 children aged 3–13 years with adenotonsillar hypertrophy and upper airway obstruction. All procedures were performed under general anesthesia. IRE was applied to the tonsils and adenoids using the ENTire™ system. Postoperative pain was recorded daily for seven days using the Parent’s Postoperative Pain Measure. Disease-specific quality of life was assessed at baseline and three months post-procedure using the Obstructive Sleep Apnea questionnaire (OSA-18). Tonsillar size was graded according to the Brodsky Scale. Results: The mean procedure time was 10:40 ± 03:40, and there was no intraoperative or postoperative bleeding. Patients were discharged on the day of the procedure. The postoperative pain on day 1 was ranked as 3.5 ± 1.5 and resolved completely in all patients by day 7. From baseline to 3 months, the mean OSA-18 decreased from 66.4 ± 14.9 to 24.6 ± 9.9 (Wilcoxon signed-rank test p-value of <0.0001), and the Brodsky grade decreased from 3.26 ± 0.63 to 0.92 ± 0.61 (p < 0.001). Conclusions: In this preliminary cohort, non-thermal adenotonsillar ablation using irreversible electroporation was safe, well tolerated, and demonstrated short-term improvements in parent-reported symptoms and oropharyngeal tonsillar size in children. These findings support further investigation in larger, multicenter trials with extended follow-ups. Full article

Background: Hypoglossal nerve stimulation (HNS) is an established surgical therapy for adults with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Although aggregate response rates of ~70–80% have been reported, substantial variability across clinical settings remains poorly understood. Prior meta-analyses have largely emphasized pooled continuous outcomes, limiting interpretation of responder-based endpoints and drivers of between-study heterogeneity. Methods: A PRISMA-compliant systematic review and meta-analysis was performed. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through 31 December 2025. Eligible studies enrolled adults with OSA treated with implantable HNS, reported Sher-defined response (≥50% AHI reduction and residual AHI < 20 events/hour), and/or continuous outcomes, and included ≥20 patients. Random-effects models (REML) were applied. Heterogeneity was quantified using I² and τ², with prediction intervals. Meta-regression assessed baseline AHI, BMI, and follow-up duration. Subgroup analyses examined device laterality, stimulation modality, sleep assessment method, and follow-up. Results: Thirty-eight studies (39 cohorts; n = 3220) were included. The pooled Sher response rate was 74.0% (95% CI 67.6–79.5%). Heterogeneity was substantial. HNS significantly improved all continuous outcomes (AHI −23.3 events/hour; ESS −4.5 points; ODI −14.5 events/hour). Comparative analyses favored HNS over surgical comparators, inactive stimulation, and delayed treatment. Revision and explantation rates were 5% and 4%, respectively. Meta-regression showed no significant effects of baseline AHI, BMI, or follow-up, explaining negligible variance. Subgroups suggested numerically higher response with breathing-synchronized stimulation, but heterogeneity remained high. Conclusions: HNS achieves Sher response in approximately three-quarters of appropriately selected CPAP-intolerant OSA patients, with durable clinical benefits and a favorable safety profile. Persistent unexplained heterogeneity highlights limitations of conventional predictors and underscores the need for more granular response determinants. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle accidents, traditionally attributed to excessive daytime sleepiness (EDS). However, subjective sleepiness may be underreported and does not consistently reflect functional impairment. We aimed to examine the association between objectively measured drowsiness during simulated driving and traffic accidents in OSA, and to compare the predictive roles of objective drowsiness, subjective sleepiness, and OSA severity. Methods: Fifty-one male drivers underwent overnight polysomnography followed by a 50-min driving simulation. OSA severity was categorized as moderate-to-severe (AHI ≥ 15 events/h) or no/mild (AHI < 15 events/h). A frontal camera captured facial expressions. Drowsiness was quantified using eye-closure-based metrics: PERCLOS, the ratio of frames with closed eyes to total observable frames, and CLOSDUR, representing eye-closure duration. Drowsiness was defined as PERCLOS ≥ 0.3 or CLOSDUR ≥ 2 s. Drowsiness-related traffic accidents were recorded. Multivariable logistic regression models were adjusted for age, body mass index, Epworth Sleepiness Scale (ESS), and total sleep time. Results: Drowsiness-related traffic accidents occurred more frequently in participants with moderate-to-severe OSA than in those with no or mild OSA (72.2% vs. 40.0%, p = 0.030). Drowsiness duration, but not ESS, was positively associated with the number of traffic accidents (r = 0.46, p = 0.001). While continuous AHI was not associated with accidents, moderate-to-severe OSA was independently associated with higher accident risk (adjusted OR 6.45, 95% CI 1.43–29.13; p = 0.015). Conclusions: Driving-related accident risk in OSA was associated with objectively measured drowsiness and moderate-to-severe disease, whereas subjective sleepiness assessed by the ESS showed no significant association. These findings suggest that functional impairment, rather than self-reported symptoms, may be more relevant for identifying high-risk drivers. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a common and serious sleep-related disorder that causes repeated interruptions in breathing during sleep. Traditional diagnostic methods, such as polysomnography, are accurate but costly, time-consuming, and unsuitable for large-scale screening. This study proposes and evaluates a lightweight diagnostic framework based on an Extreme Learning Machine (ELM) optimized by a set of basic and advanced metaheuristic optimizers. The model aims to evaluate whether metaheuristic optimization can improve ELM-based classification performance using structured demographic, clinical, and sleep-related predictors. Methods: Two real datasets were employed to train and evaluate the proposed framework: (i) a clinical OSA dataset with 274 subjects and 31 demographic/anthropometric and sleep-related predictors, and (ii) a public strongly imbalanced Sleep-Disordered Breathing (SDB) dataset with 500 subjects and 10 structured predictors. Metaheuristic algorithms are used to optimize ELM weights and biases, addressing the instability of random initialization and improving model generalization. The optimized models are evaluated against eight baseline classifiers, including logistic regression (LR), k-nearest neighbors (KNN), decision tree (DT), random forest (RF), support vector machine (SVM), multilayer perceptron (MLP), XGBoost (XGB), and a standard ELM classifier. Results: Results show that metaheuristic optimization moderately improves ELM on the OSA dataset, increasing ROC-AUC from 0.6527 to about 0.73 and accuracy from 0.6573 to about 0.69–0.70, while on the highly imbalanced SDB dataset, it yields modest ROC-AUC gains (from 0.5132 to about 0.544–0.548) with small decreases in accuracy and F1-score. We additionally assess class-imbalance handling on the SDB dataset and analyze feature importance with permutation importance and SHAP, which shows the models rely heavily on diagnosis-derived predictors. Conclusions: The proposed framework provides a lightweight ELM-based decision-support approach with low inference cost after offline optimization. The results suggest potential value for screening-oriented OSA/SDB classification, but further validation with larger cohorts and a screening-only feature set is needed before clinical implementation. Full article

Positional obstructive sleep apnea (POSA) is a subtype of obstructive sleep apnea in which the apnea–hypopnea index (AHI) is significantly greater in the supine position than in non-supine positions. However, POSA remains underrecognized and lacks a universally accepted clinical definition. POSA’s prevalence can exceed 50% of OSA patients and occurs most frequently in patients with mild/moderate disease. In the supine position, gravity-dependent posterior displacement of the tongue and soft palate can increase upper airway collapsibility and drive the pathophysiology of POSA. These disturbances can carry meaningful cardiovascular consequences, including acute blood pressure surges that correlate with oxygen desaturation severity. As OSA is increasingly understood as a heterogeneous disorder shaped by variable anatomical and physiological traits, POSA offers a clinically actionable framework for precision sleep medicine. Current therapeutic strategies demonstrate that targeting the specific mechanisms of POSA can improve outcomes beyond what standardized CPAP treatment achieves alone. Racial and ethnic disparities in both POSA prevalence and treatment adherence further highlight the importance of individualized, culturally informed care. This review synthesizes the current understanding of the mechanisms, epidemiology, and therapeutic implications of POSA and evaluates its role as a model for individualized therapy in obstructive sleep apnea treatment. Full article

Glucagon-like peptide-1 (GLP-1) is an incretin hormone secreted in response to food intake that acts biologically by binding to GLP-1 receptors. The primary function of GLP-1 is to stimulate insulin secretion and inhibit glucagon secretion, which helps limit after-meal spikes in blood glucose. GLP-1 reduces intestinal contractility, slows down gastrointestinal motility and emptying, and also acts directly on the hypothalamus, thereby regulating appetite and food intake. Due to its metabolic effects, GLP-1 forms the basis of medications currently used to treat type 2 diabetes (T2DM) and obesity. However, it has also been observed that the use of GLP-1 agonists in the treatment of obesity or diabetes has a beneficial effect on comorbid respiratory conditions. This narrative review analyzes the scientific literature and describes the most recent information on the impact of GLP-1 receptor agonist (GLP-1 RA) therapies on the most common respiratory disorders—both the beneficial and undesirable effects. We discuss evidence that acute lung injury, COVID-19, pulmonary fibrosis, asthma, chronic obstructive pulmonary disease (COPD), and obstructive sleep apnea can benefit from therapies with various GLP-1 RAs. They can complement existing lung-targeted treatments, but as research progresses, they are likely to play an ever more important role in the treatment of respiratory diseases. Full article

Aim: The aim of this observational cross-sectional study was to evaluate whether blood renalase concentration, total antioxidant status (TAS), main cardiovascular risk factors, and obstructive sleep apnea severity are associated with the anatomical severity of coronary artery disease assessed by CCTA in patients with suspected OSA. Materials and methods: The study included 93 patients with suspected OSA. All patients were assessed for main risk factors for cardiovascular disease. Polysomnography was performed to verify the suspicion of OSA, as well as coronary computed tomography angiography (CCTA) with a systematic assessment of the severity of coronary artery disease using the CAD-RADS classification. Blood renalase concentration and total antioxidant status (TAS) were determined. Results: The apnea–hypopnea index (AHI) in the study group was 16.57 ± 17.17 /h. OSA was diagnosed in 73.1% of the study group. In CCTA examinations, significant coronary artery disease (CAD-RADS ≥ 3) was suspected in 22.6% of the subjects, including 16.1% classified as CAD-RADS 3, 4.3% as CAD-RADS 4, and 2.1% as CAD-RADS 5. Patients with AHI ≥ median were significantly more often classified as CAD-RADS ≥ 3 than patients with AHI < median. Patients with blood renalase concentration ≥ median were significantly less often classified as CAD-RADS ≥ 3 than patients with blood renalase concentration < median. Similarly, patients with TAS ≥ median were significantly less often classified as CAD-RADS ≥ 3 than those with TAS < median. Older age, higher systolic blood pressure, higher blood cholesterol levels, and lower TAS were independently associated with CAD-RADS ≥ 3 in logistic regression analysis. In multivariable regression analysis, higher pack-years of smoking, higher AHI, and lower blood renalase concentration were independently associated with lower TAS. Conclusions: Higher pack-years of smoking, higher AHI values, and lower blood renalase concentration were associated with lower total antioxidant status, which, along with older age, higher systolic blood pressure, and higher total cholesterol concentration, was independently associated with suspected anatomically significant coronary artery disease on CCTA. Full article