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12 pages, 2409 KiB  
Review
Tumors of the Parapharyngeal Space Presenting with Obstructive Sleep Apnea: A Case Report and Literature Review
by Luca Cerri, Francesco Giombi, Michele Cerasuolo, Gian Marco Pace, Anna Losurdo, Giuseppe Lunardi, Francesco Grecchi, Elena Volpini and Luca Malvezzi
J. Pers. Med. 2025, 15(8), 331; https://doi.org/10.3390/jpm15080331 - 28 Jul 2025
Viewed by 261
Abstract
Introduction: Obstructive sleep apnea syndrome (OSAS) is caused by anatomical and non-anatomical factors which lead to upper airway (UA) obstruction during sleep. Intrinsic UA collapse is the most frequent determinant of OSA. In the era of personalized medicine, adopting a tailored diagnostic [...] Read more.
Introduction: Obstructive sleep apnea syndrome (OSAS) is caused by anatomical and non-anatomical factors which lead to upper airway (UA) obstruction during sleep. Intrinsic UA collapse is the most frequent determinant of OSA. In the era of personalized medicine, adopting a tailored diagnostic approach is essential to rule out secondary causes of UA collapse, particularly those stemming from extrinsic anatomical factors. Although being rarely considered in the differential diagnosis, space-occupying lesions of deep cervical spaces such as the parapharyngeal space (PPS) may be responsible for airway obstruction and lead to OSAS. Objective: This study aimed to present an atypical case of OSAS caused by extrinsic PPS compression, outlining the relevance of modern personalized medicine in the diagnostic and therapeutic protocols, and to enhance understanding through a comprehensive literature review. Methods: A 60-year-old female presented with sleep-disordered complaints and was diagnosed with severe OSAS after polysomnography. At physical examination, a swelling of the right posterior oropharyngeal mucosa was noticed. Imaging confirmed the suspicion of a PPS tumor, and transcervical resection was planned. Case presentation was adherent to the CARE checklist. A comprehensive literature review was conducted using the most reliable scientific databases. Results: Surgery was uneventful, and the patient made a full recovery. The histopathology report was consistent with the diagnosis of pleomorphic adenoma. Postoperative outcomes showed marked improvement in polysomnographic parameters and symptom burden. Conclusions: Parapharyngeal space tumors are a rare, often overlooked cause of OSA. This case highlights the role of a personalized head and neck assessment in OSA patients, particularly in identifying structural causes and offering definitive surgical management when indicated. Full article
(This article belongs to the Section Personalized Therapy and Drug Delivery)
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25 pages, 2026 KiB  
Review
Mapping the Fat: How Childhood Obesity and Body Composition Shape Obstructive Sleep Apnoea
by Marco Zaffanello, Angelo Pietrobelli, Giorgio Piacentini, Thomas Zoller, Luana Nosetti, Alessandra Guzzo and Franco Antoniazzi
Children 2025, 12(7), 912; https://doi.org/10.3390/children12070912 - 10 Jul 2025
Viewed by 433
Abstract
Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and [...] Read more.
Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article
(This article belongs to the Section Translational Pediatrics)
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23 pages, 5089 KiB  
Review
Optimizing Airway Function Through Craniofacial and Cervical Manipulations and Emergency-Anesthesia Maneuvers: Applications in Airway Function Enhancement, Pneumonia, and Asthma—Narrative Review
by Jason Park, Luz Benitez, Amethyst Hamanaka, Ghulam Husain Abbas, Emmanuel Faluade, Sjaak Pouwels and Jamie Eller
J. Clin. Med. 2025, 14(13), 4494; https://doi.org/10.3390/jcm14134494 - 25 Jun 2025
Viewed by 668
Abstract
Background: Even with advanced management involving pharmacologic and ventilatory strategies, respiratory dysfunction increases morbidity and reduces the quality of life. This narrative review examines how craniofacial and cervical manipulative interventions—including nasomaxillary skeletal expansion, breathing re-education, and structural techniques—may holistically optimize airway function by [...] Read more.
Background: Even with advanced management involving pharmacologic and ventilatory strategies, respiratory dysfunction increases morbidity and reduces the quality of life. This narrative review examines how craniofacial and cervical manipulative interventions—including nasomaxillary skeletal expansion, breathing re-education, and structural techniques—may holistically optimize airway function by enhancing neurological and lymphatic dynamics, modulating vagal tone, reducing pharyngeal collapsibility, and supporting immune regulation across diverse clinical settings. Objectives: To explore manual techniques that influence respiratory and autonomic function and to evaluate their reported clinical efficacy and supporting evidence, particularly in the context of airway disorders such as asthma and pneumonia. Methods: A narrative review of the literature from PubMed and Google Scholar was conducted using search terms related to airway function and osteopathic manipulative techniques (OMTs). The inclusion criteria spanned 2010–2025 English-language peer-reviewed full-text articles on airway function, OMT, and emergency airway maneuvers. Clinical trials, observational studies, and reviews were included; non-peer-reviewed content and animal studies (unless mechanistically relevant) were excluded. Chapman’s reflexes related to respiratory function were incorporated to highlight somatic–visceral correlations. Key Findings: The techniques reviewed included frontal lift, vomer manipulation, maxillary and zygomatic balancing, and cervical adjustments. Thoracic OMT methods, such as diaphragm doming and lymphatic pump techniques, were also addressed. Emergency techniques, such as the BURP and Larson maneuvers, prone positioning, and high-frequency chest wall oscillation, were presented as comparative strategies to OMTs for acute airway management. Conclusions: Craniofacial and cervical manipulations can be a promising adjunct for enhancing airway function. However, the current literature displays heterogeneity and lack of large-scale randomized trials, which emphasize the necessity for standardized research and the establishment of clinical guidelines with the collected evidence. Full article
(This article belongs to the Section Respiratory Medicine)
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18 pages, 690 KiB  
Review
The Lung Microbiome and Its Impact on Obstructive Sleep Apnea: A Diagnostic Frontier
by Aliki Karkala, Serafeim-Chrysovalantis Kotoulas, Asterios Tzinas, Eleni Massa, Eleni Mouloudi, Foteini Gkakou and Athanasia Pataka
Diagnostics 2025, 15(11), 1431; https://doi.org/10.3390/diagnostics15111431 - 4 Jun 2025
Viewed by 733
Abstract
Obstructive sleep apnea (OSA), a prevalent disorder characterized by recurrent upper airway collapse, is increasingly recognized as a systemic inflammatory condition influenced by microbial dysregulation. Emerging evidence underscores the lung microbiome as a mediator in OSA pathophysiology, where dysbiotic shifts driven by intermittent [...] Read more.
Obstructive sleep apnea (OSA), a prevalent disorder characterized by recurrent upper airway collapse, is increasingly recognized as a systemic inflammatory condition influenced by microbial dysregulation. Emerging evidence underscores the lung microbiome as a mediator in OSA pathophysiology, where dysbiotic shifts driven by intermittent hypoxia, oxidative stress and mechanical airway trauma amplify inflammatory cascades and perpetuate respiratory instability. This review synthesizes current knowledge on the bidirectional interplay between OSA and lung microbial communities. It aims to highlight how hypoxia-induced alterations in microbial ecology disrupt immune homeostasis, while inflammation-driven mucosal injury fosters pathogenic colonization. Clinical correlations between specific taxa like Streptococcus and Prevotella, and disease severity, suggest microbial signatures as novel biomarkers for OSA progression and treatment response. Furthermore, oxidative stress markers and pro-inflammatory cytokines emerge as potential diagnostic tools that bridge microbial dysbiosis with sleep-related outcomes. However, challenges persist in sampling standardization of the low-biomass lower airways, as well as in causative mechanisms linking microbial dysbiosis to OSA pathophysiology. By integrating microbial ecology with precision sleep medicine, this paradigm shift promises to transform OSA management from mechanical stabilization to holistic ecosystem restoration. Full article
(This article belongs to the Section Diagnostic Microbiology and Infectious Disease)
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12 pages, 11070 KiB  
Article
Bilateral Stylopharyngeus Transection Alters Respiratory Airflow in Conscious Rats
by Eriko Hamada, Thomaz Fleury Curado, Kingman Strohl and Yee-Hsee Hsieh
Surg. Tech. Dev. 2025, 14(2), 15; https://doi.org/10.3390/std14020015 - 7 May 2025
Viewed by 338
Abstract
Background/Objectives: Upper airway patency is a key pathophysiological factor in obstructive sleep apnea (OSA). Research has primarily focused on the role of the genioglossus muscle in maintaining airway patency in OSA. However, hypoglossal nerve stimulation (HNS) therapy, which activates the genioglossus muscle, has [...] Read more.
Background/Objectives: Upper airway patency is a key pathophysiological factor in obstructive sleep apnea (OSA). Research has primarily focused on the role of the genioglossus muscle in maintaining airway patency in OSA. However, hypoglossal nerve stimulation (HNS) therapy, which activates the genioglossus muscle, has been associated with poor outcomes in patients with lateral oropharyngeal collapse. The stylopharyngeus muscle is an upper airway dilator muscle that supports the lateral pharyngeal wall. Its role in maintaining upper airway patency and its effect on normal respiratory airflow is unclear. We hypothesize that bilateral transection of the stylopharyngeus muscles disrupts normal breathing. Currently, no animal model depicting lateral pharyngeal collapse has been reported. This study aims to introduce a novel rodent model with bilateral transection of the stylopharyngeus muscles to examine its effect on respiratory airflow and tracing. Methods: Adult male Sprague Dawley rats were divided into two groups: (1) bilateral stylopharyngeus muscle transection (n = 4) and (2) sham surgery (n = 2). Under anesthesia, the stylopharyngeus muscle was transected bilaterally in the transection group, while only exposure of the muscle was performed in the sham group. Respiratory airflow was measured using whole-body plethysmography before and after surgery, and airflow tracings were analyzed. Results: Significant alterations in respiratory airflow and tracings, particularly a flattening in inspiratory flow and sharp expiratory peaks, were observed on the first post-operative day in the transection group. The flattening of the inspiratory flow persisted over 3 days. No significant changes were noted in the sham group. Conclusions: Bilateral stylopharyngeus muscle transection alters normal airflow in a conscious rodent model, supporting the hypothesis that stylopharyngeus muscle plays a vital role in shaping respiratory airflow. The flattening of the inspiratory airflow is an indication of flow limitations through the upper airway patency due to the loss of stylopharyngeus function. Full article
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22 pages, 273 KiB  
Article
Retrospective Study of Chronic Coughing in Dogs in a Referral Centre in the UK: 329 Cases (2012–2021)
by Carla Asorey Blazquez, Ico Jolly Frahija, Arran Smith, Rachel Miller, Mayank Seth, Edgar Garcia Manzanilla and Ferran Valls Sanchez
Animals 2025, 15(2), 254; https://doi.org/10.3390/ani15020254 - 17 Jan 2025
Viewed by 1500
Abstract
Chronic coughing is a common complaint in small animal medicine and it has an extensive differential diagnosis with very different treatment and prognosis. Coughing is considered chronic when it lasts at least 8 weeks. This retrospective study aimed to describe the most common [...] Read more.
Chronic coughing is a common complaint in small animal medicine and it has an extensive differential diagnosis with very different treatment and prognosis. Coughing is considered chronic when it lasts at least 8 weeks. This retrospective study aimed to describe the most common causes of chronic coughing in a population of dogs that presented to a referral hospital in England between January 2012 and December 2021. In addition, we aimed to evaluate if an association with signalment, weight, coughing characteristics, and/or concomitant clinical signs could be identified. A total of 329 dogs met the inclusion criteria. The most frequent diagnoses were airway collapse (102/329, 30.7%), chronic bronchitis (80/329, 24.3%), neoplasia (62/329, 18.8%), and infectious bronchopneumonia (54/329, 16.4%). Other diagnoses were also identified in a lower number of cases. Pomeranian, Chihuahua, and Yorkshire Terrier were over-represented breeds for airway collapse. No predictive factors were identified for chronic bronchitis. Lower body weight (odds ratio [OR] 0.92, 95% confidence interval [CI]: 0.90–0.95), non-productive (OR 14.3 CI 3.44–50) paroxysmal coughing (OR 4.9, 95%, CI: 2.2–11.0), and exercise intolerance (OR 3.3, 95%, CI: 1.7–6.3) increased the odds of airway collapse. Older dogs (OR 1.025, 95%, CI: 1.014–1.036), higher body weight (OR 1.048, 95%, CI: 1.018–1.080), lethargy (OR 5.1, 95%, CI: 1.5–17.7), haemoptysis (OR 8.6, 95%, CI: 1.9–38.4), weight loss (OR 4.0, 95%, CI: 1.1–15.3), and inappetence (OR 6.5, 95%, CI: 1.9–22.1) increased the odds of neoplasia. Productive coughing (OR 3.0, 95%, CI: 1.5–6) and nasal discharge (OR 4.1, 95%, CI: 1.4–11.9) were predictive factors of infectious bronchopneumonia. Younger age (OR 0.96, 95%, CI: 1.061–1.150), higher body weight (OR 1.097, 95%, CI: 1.037–1.161), and haemoptysis (OR 11.8, 95%, CI: 1.8–78.5), increased the odds of airway foreign body. Higher body weight (OR 1.105, 95%, CI: 1.061–1.150), older age (OR 1.041, 95%, CI: 1.022–1.061), and regurgitation were predictive factors of laryngeal paralysis. Epiglottic retroversion was associated with younger age (OR 0.969, 95%, CI: 0.943–0.994), dysphagia (OR 42.5, 95%, CI: 4.7–382.7), and regurgitation (OR 11.6, 95%, CI: 1.2–113.1). All the aforementioned findings are valuable for prioritising differential diagnoses and consequently increasing the efficacy of the diagnostic plan and prioritising tests, which becomes even more important in cases where financial constraints are present. Finally, an appropriate selection of diagnostics tools helps optimise veterinary resources. Full article
(This article belongs to the Section Veterinary Clinical Studies)
9 pages, 2111 KiB  
Case Report
Remifentanil-Propofol-Ketamine- Based Total Intravenous Anesthesia with Spontaneous Breathing for Adult Rigid Bronchoscopy
by Luca Frasca, Antonio Sarubbi, Filippo Longo, Fabio Costa, Domenico Sarubbi, Alessandro Strumia, Valentina Marziali and Pierfilippo Crucitti
J. Clin. Med. 2025, 14(2), 377; https://doi.org/10.3390/jcm14020377 - 9 Jan 2025
Cited by 2 | Viewed by 1622
Abstract
Background: Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There [...] Read more.
Background: Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There is no consensus on the optimal anesthetic approach, with options including general anesthesia with neuromuscular blockers or spontaneous assisted ventilation (SAV). Methods: This case series presents our anesthetic protocol using remifentanil–propofol–ketamine total intravenous anesthesia (TIVA) with SAV in four patients with airway obstructions. Muscle relaxants were avoided in all cases. Results: Ketamine’s ability to preserve respiratory drive and airway reflexes, along with its bronchodilating properties, made it ideal for managing CAO. All procedures successfully restored airway patency without complications or drug-related side effects. Conclusions: Our findings suggest that remifentanil–propofol–ketamine TIVA combined with SAV is a viable anesthetic approach for therapeutic RB, offering effective sedation, maintaining airway patency, and minimizing perioperative complications. Full article
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15 pages, 5311 KiB  
Review
Local Anesthetic Infiltration, Awake Veno-Venous Extracorporeal Membrane Oxygenation, and Airway Management for Resection of a Giant Mediastinal Cyst: A Narrative Review and Case Report
by Felix Berger, Lennart Peters, Sebastian Reindl, Felix Girrbach, Philipp Simon and Christian Dumps
J. Clin. Med. 2025, 14(1), 165; https://doi.org/10.3390/jcm14010165 - 30 Dec 2024
Viewed by 1429
Abstract
Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This [...] Read more.
Background: Mediastinal mass syndrome represents a major threat to respiratory and cardiovascular integrity, with difficult evidence-based risk stratification for interdisciplinary management. Methods: We conducted a narrative review concerning risk stratification and difficult airway management of patients presenting with a large mediastinal mass. This is supplemented by a case report illustrating our individual approach for a patient presenting with a subtotal tracheal stenosis due to a large cyst of the thyroid gland. Results: We identified numerous risk stratification grading systems and only a few case reports of regional anesthesia techniques for extracorporeal membrane oxygenation patients. Clinical Case: After consultation with his general physician because of exertional dyspnea and stridor, a 78-year-old patient with no history of heart failure was advised to present to a cardiology department under the suspicion of decompensated heart failure. Computed tomography imaging showed a large mediastinal mass that most likely originated from the left thyroid lobe, with subtotal obstruction of the trachea. Prior medical history included the implantation of a dual-chamber pacemaker because of a complete heart block in 2022, non-insulin-dependent diabetes mellitus type II, preterminal chronic renal failure with normal diuresis, arterial hypertension, and low-grade aortic insufficiency. After referral to our hospital, an interdisciplinary consultation including experienced cardiac anesthesiologists, thoracic surgeons, general surgeons, and cardiac surgeons decided on completing the resection via median sternotomy after awake cannulation for veno-venous extracorporeal membrane oxygenation via the right internal jugular and the femoral vein under regional anesthesia. An intermediate cervical plexus block and a suprainguinal fascia iliaca compartment block were performed, followed by anesthesia induction with bronchoscopy-guided placement of the endotracheal tube over the stenosed part of the trachea. The resection was performed with minimal blood loss. After the resection, an exit blockade of the dual chamber pacemaker prompted emergency surgical revision. The veno-venous extracorporeal membrane oxygenation was explanted after the operation in the operating room. The postoperative course was uneventful, and the patient was released home in stable condition. Conclusions: Awake veno-venous extracorporeal membrane oxygenation placed under local anesthetic infiltration with regional anesthesia techniques is a feasible individualized approach for patients with high risk of airway collapse, especially if the mediastinal mass critically alters tracheal anatomy. Compressible cysts may represent a subgroup with easy passage of an endotracheal tube. Interdisciplinary collaboration during the planning stage is essential for maximum patient safety. Prospective data regarding risk stratification for veno-venous extracorporeal membrane oxygenation cannulation and effectiveness of regional anesthesia is needed. Full article
(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesia)
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12 pages, 3183 KiB  
Article
Tongue Ultrasonography in the Screening of Severe Obstructive Sleep Apnea Syndrome—Promising Potential for Overloaded Sleep Centers
by Milan Smiesko, Ester Jenigarova, Peter Stanko, Zsolt Kasa, Ivan Cavarga and Stefan Lassan
Diseases 2024, 12(12), 330; https://doi.org/10.3390/diseases12120330 - 14 Dec 2024
Viewed by 1146
Abstract
Obstructive sleep apnea syndrome (OSAS) is a frequently underdiagnosed sleep disorder marked by recurrent episodes of apnea and/or hypopnea during sleep, primarily resulting from the partial or complete collapse of the upper airway. OSAS significantly affects patients’ health and quality of life. Additionally, [...] Read more.
Obstructive sleep apnea syndrome (OSAS) is a frequently underdiagnosed sleep disorder marked by recurrent episodes of apnea and/or hypopnea during sleep, primarily resulting from the partial or complete collapse of the upper airway. OSAS significantly affects patients’ health and quality of life. Additionally, it is a recognized risk factor for inducing microsleep episodes during daily activities, particularly in occupations such as professional driving, where sustained attention is critical. The aim of our study was to identify an effective screening test for use in outpatient settings, capable of distinguishing patients with a severe form of OSAS. Patients who test positive with this screening tool would subsequently be prioritized for polysomnographic evaluation in a sleep laboratory. A total of 64 patients who underwent polysomnography (PSG) or polygraphy (PG) examination at our clinic were subsequently examined by USG of the tongue with measurements of tongue base thickness (TBT) and the distance between lingual arteries (DLA) during wakefulness and in a relaxed tongue position. The measurements of TBT and DLA were subsequently correlated with the apnea–hypopnea index (AHI) obtained from PSG or PG. In our cohort of patients diagnosed with severe OSAS, a TBT threshold of ≥65 mm served as an effective cutoff value. A TBT value of ≥65 mm reached an AUC value of 78.1%, sensitivity of 74.4%, specificity of 61.9%, positive predictive value of 80%, negative predictive value of 54.2% and overall accuracy of 70.3%. A DLA value of ≥30 mm in our sample of patients with severe OSAS showed an AUC of 76.5%, sensitivity of 69.8%, specificity of 71.1%, positive predictive value of 83.3%, negative predictive value of 53.6%, and overall accuracy of 70.3%. Tongue USG markers, particularly TBT and DLA measurements during wakefulness and in a relaxed tongue position, show potential as effective screening tools for identifying severe OSAS in European populations. These markers demonstrate improved accuracy over traditional screening questionnaires by reducing the likelihood of false-negative results. Patients with a positive screening should preferably be referred for polysomnography. In this way, patients with a serious illness could receive adequate therapy sooner. Full article
(This article belongs to the Section Respiratory Diseases)
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9 pages, 252 KiB  
Review
The Emerging Role of Pharmacotherapy in Obstructive Sleep Apnea
by Nikhil Jaganathan, Younghoon Kwon, William J. Healy and Varsha Taskar
J. Otorhinolaryngol. Hear. Balance Med. 2024, 5(2), 12; https://doi.org/10.3390/ohbm5020012 - 7 Sep 2024
Cited by 1 | Viewed by 3168
Abstract
Obstructive sleep apnea (OSA) is a prevalent pathology with current modalities of treatment including continuous positive airway pressure (CPAP), surgery, weight loss, hypoglossal nerve stimulation, and pharmacotherapy. While CPAP is the current standard treatment for OSA, lack of tolerance and side effects necessitate [...] Read more.
Obstructive sleep apnea (OSA) is a prevalent pathology with current modalities of treatment including continuous positive airway pressure (CPAP), surgery, weight loss, hypoglossal nerve stimulation, and pharmacotherapy. While CPAP is the current standard treatment for OSA, lack of tolerance and side effects necessitate alternative modalities of treatment. Various pharmacologic agents exist with mechanisms that may target OSA. Early trials have demonstrated efficacy of noradrenergic-antimuscarinic combinations to stimulate the airway, promote pharyngeal muscle tone, and prevent airway collapse. These agents, which we discuss in detail, have demonstrated significant reductions in apnea-hypopnea index (AHI) and lowest oxygen saturations based on preliminary studies. Glucagon-like peptide 1 receptor agonists (GLP-1RA), which stimulate endogenous insulin, reducing glucagon release, and decreasing gastric emptying, have shown positive results for OSA patients through weight loss with reductions in AHI. In this narrative review article, we highlight the mechanisms, current data, and future potential for multiple drug classes, including respiratory stimulants and GLP-1RAs. Full article
18 pages, 1173 KiB  
Review
Obstructive Sleep Apnea and Serotoninergic Signalling Pathway: Pathomechanism and Therapeutic Potential
by Alicja Witkowska, Julia Jaromirska, Agata Gabryelska and Marcin Sochal
Int. J. Mol. Sci. 2024, 25(17), 9427; https://doi.org/10.3390/ijms25179427 - 30 Aug 2024
Cited by 5 | Viewed by 3468
Abstract
Obstructive Sleep Apnea (OSA) is a disorder characterized by repeated upper airway collapse during sleep, leading to apneas and/or hypopneas, with associated symptoms like intermittent hypoxia and sleep fragmentation. One of the agents contributing to OSA occurrence and development seems to be serotonin [...] Read more.
Obstructive Sleep Apnea (OSA) is a disorder characterized by repeated upper airway collapse during sleep, leading to apneas and/or hypopneas, with associated symptoms like intermittent hypoxia and sleep fragmentation. One of the agents contributing to OSA occurrence and development seems to be serotonin (5-HT). Currently, the research focuses on establishing and interlinking OSA pathogenesis and the severity of the disease on the molecular neurotransmitter omnipresent in the human body—serotonin, its pathway, products, receptors, drugs affecting the levels of serotonin, or genetic predisposition. The 5-HT system is associated with numerous physiological processes such as digestion, circulation, sleep, respiration, and muscle tone—all of which are considered factors promoting and influencing the course of OSA because of correlations with comorbid conditions. Comorbidities include obesity, physiological and behavioral disorders as well as cardiovascular diseases. Additionally, both serotonin imbalance and OSA are connected with psychiatric comorbidities, such as depression, anxiety, or cognitive dysfunction. Pharmacological agents that target 5-HT receptors have shown varying degrees of efficacy in reducing the Apnea-Hypopnea Index and improving OSA symptoms. The potential role of the 5-HT signaling pathway in modulating OSA provides a promising avenue for new therapeutic interventions that could accompany the primary treatment of OSA—continuous positive airway pressure. Thus, this review aims to elucidate the complex role of 5-HT and its regulatory mechanisms in OSA pathophysiology, evaluating its potential as a therapeutic target. We also summarize the relationship between 5-HT signaling and various physiological functions, as well as its correlations with comorbid conditions. Full article
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
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12 pages, 431 KiB  
Article
The Association of Depression with Obstructive Sleep Apnea in Patients with Cystic and Non-Cystic Fibrosis Bronchiectasis
by Baran Balcan, Duygu Vezir, Sehnaz Olgun Yildizeli, Derya Kocakaya and Berrin Ceyhan
Life 2024, 14(8), 1026; https://doi.org/10.3390/life14081026 - 19 Aug 2024
Viewed by 1423
Abstract
Obstructive sleep apnea (OSA) and cystic fibrosis (CF) are chronic conditions that profoundly impact quality of life. OSA, characterized by repeated episodes of upper airway collapse, can exacerbate CF symptoms due to nocturnal airway obstruction. Recent studies highlight the prevalence of OSA in [...] Read more.
Obstructive sleep apnea (OSA) and cystic fibrosis (CF) are chronic conditions that profoundly impact quality of life. OSA, characterized by repeated episodes of upper airway collapse, can exacerbate CF symptoms due to nocturnal airway obstruction. Recent studies highlight the prevalence of OSA in CF patients, especially in adults, and its detrimental effects on health and quality of life. From April 2019 to December 2021, we conducted a study with 104 bronchiectasis patients at Marmara University Pendik Training and Research Hospital. After exclusions, 70 participants (35 CF and 35 non-CF) were included. Sleep parameters were assessed with polysomnography, and depressive mood was evaluated using the Zung Self-Rating Depression Scale (SDS). Daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS). The statistical analyses included t-tests, chi-square tests, and logistic regression. Among the CF patients, depressive mood was significantly associated with female sex (OR: 4.28, 95% CI: 1.27–12.04) and anemia (OR: 7.87, 95% CI: 1.50–41.27). Higher ESS scores indicated greater daytime sleepiness in the depressive groups (p = 0.051). Depressive CF patients also had a significantly longer disease duration and more frequent annual exacerbations. No significant differences were found in total sleep time, sleep efficiency, or sleep stages between the depressive and non-depressive groups. A lower forced vital capacity (FVC) was observed in the depressive CF patients, although not significantly. Depression is prevalent among adult CF patients with OSA, with significant associations with female sex and anemia. These findings underscore the need for integrated care addressing both physical and mental health aspects, including interventions for respiratory symptoms, anemia management, and sleep quality enhancement to improve overall quality of life. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA)—2nd Edition)
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11 pages, 483 KiB  
Protocol
Personalized Treatment for Obstructive Sleep Apnea: Beyond CPAP
by Margot Van Daele, Yannick Smolders, Dorine Van Loo, Charlotte Bultynck, Johan Verbraecken, Anneclaire Vroegop, Thérèse Lapperre, Sara Op de Beeck, Marijke Dieltjens and Olivier M. Vanderveken
Life 2024, 14(8), 1007; https://doi.org/10.3390/life14081007 - 13 Aug 2024
Cited by 4 | Viewed by 2277
Abstract
Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance [...] Read more.
Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients. Full article
(This article belongs to the Section Medical Research)
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15 pages, 2535 KiB  
Article
Awake 160-Slice Computed Tomography for Upper Airway Evaluation in 17 Dogs
by Marius B. Stordalen, Sharyn Bray, Felicity Stringer, Callum Stonebrook, Sergio Guilherme and Jonathan P. Bray
Vet. Sci. 2024, 11(8), 342; https://doi.org/10.3390/vetsci11080342 - 29 Jul 2024
Cited by 1 | Viewed by 2023
Abstract
This study investigated using a 160-slice multidetector computed tomography (CT) scanner for conscious image acquisition in dogs with upper airway disease, and describes findings in dogs that had previously undergone soft palate surgery. Seventeen client-owned dogs with upper airway disease were retrospectively reviewed, [...] Read more.
This study investigated using a 160-slice multidetector computed tomography (CT) scanner for conscious image acquisition in dogs with upper airway disease, and describes findings in dogs that had previously undergone soft palate surgery. Seventeen client-owned dogs with upper airway disease were retrospectively reviewed, and classified into three groups: group I, “untreated brachycephalic obstructive airway syndrome (BOAS) patients”; group II, “previously treated BOAS patients”; and group III, “patients with respiratory disease other than BOAS”. Data included signalment, clinical history, direct laryngoscopy and endoscopy findings, previous surgeries and CT findings. CT scans in group I revealed overlong and thickened soft palates in all dogs, and signs of laryngeal collapse in four dogs. Patients in group II exhibited normal soft palate lengths, while patients in group III displayed various findings such as nasopharyngeal narrowing and tracheal collapse. Upper airway examinations under general anaesthesia confirmed most CT findings. This study demonstrates the feasibility and value of conscious CT scanning for assessing upper airway diseases in dogs, providing valuable diagnostic information while eliminating the need for chemical immobilisation, thus reducing patient stress and cost. These findings offer new insight into upper airway anatomy in awake patients, especially in brachycephalic breeds, and lay a foundation for future research. Full article
(This article belongs to the Section Veterinary Surgery)
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14 pages, 541 KiB  
Systematic Review
The Potential Effect of Changing Patient Position on Snoring: A Systematic Review
by Antonio Moffa, Lucrezia Giorgi, Domiziana Nardelli, Francesco Iafrati, Giannicola Iannella, Giuseppe Magliulo, Peter Baptista, Claudio Vicini and Manuele Casale
J. Pers. Med. 2024, 14(7), 715; https://doi.org/10.3390/jpm14070715 - 2 Jul 2024
Cited by 1 | Viewed by 3839
Abstract
Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers [...] Read more.
Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers and their bed partners. Effective snoring treatment, which aims to reduce or eliminate the sound, is challenging and depends on factors like age, comorbidities, disease severity, and anatomical features. This review aims to provide a systematic overview of the current literature on the effects of positional therapy (PT) on snoring. Various devices facilitate PT, including anti-snoring pillows and vibration alarms. PT devices maintain head and neck alignment to keep airways open, while head of bed elevation (HOBE) solutions reduce upper airway collapses by elevating the head and trunk. Studies show that PT and HOBE reduce snoring by increasing airway cross-sectional area and decreasing closing pressure. Despite their benefits, these non-surgical treatments have limitations, such as discomfort in certain sleeping positions and intolerance to prolonged head elevation. While reducing snoring intensity is critical for health reasons, further comparative studies between the different devices are needed to enhance snoring management. Full article
(This article belongs to the Special Issue United Airway Disease: Current Perspectives)
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