Search Results (365)

Obstructive sleep apnea (OSA) in children is a common disorder with significant effects on behavior, cognition, and quality of life. Its diagnosis is primarily based on clinical history and examination, supported by standardized questionnaires such as the Sleep-Related Breathing Disorder subscale of the Pediatric Sleep Questionnaire (SRDB-PSQ), which provides high diagnostic accuracy. Although polysomnography remains the gold standard, its use should be limited to high-risk patients or unclear cases due to availability and cost constraints. Adenotonsillar hypertrophy represents the main cause of pediatric OSA and is often self-limiting. For children with mild symptoms, a watchful waiting approach may be appropriate. Randomized controlled trials (e.g., CHAT, POSTA) demonstrate that spontaneous improvement in polysomnographic parameters occurs in some children, though clinical symptoms often persist. Patients with low apnea-hypopnea-index (AHI), mild obesity, and mild symptoms appear suitable for observation but require a close follow-up. Adenotonsillectomy remains the most effective treatment for clinically significant OSA, leading to marked improvements in sleep quality, daytime symptoms, and quality of life, largely independent of polysomnographic findings. Partial tonsillectomy offers similar efficacy with reduced postoperative morbidity. Management should be individualized and focus on clinical presentation more than on sleep recordings. Future research should focus on identifying which children benefit most from conservative or surgical strategies. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by repeated episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep architecture. Orofacial myofunctional therapy (OMT) has emerged as a promising non-invasive approach to improving airway patency in individuals with mild-to-moderate OSA. However, the role of sleep ergonomics—including sleep posture and pillow support—in enhancing OMT outcomes remains underexplored. This study aimed to evaluate whether ergonomic interventions could augment the therapeutic effects of OMT in adult patients with mild-to-moderate OSA. Methods: A 12-week prospective cohort study was conducted involving 60 adult participants diagnosed with mild-to-moderate OSA. All participants underwent a structured orofacial myofunctional therapy (OMT) program comprising exercises for tongue elevation, lip seal enhancement, and soft palate strengthening. In addition, ergonomic instructions were provided regarding optimal sleeping posture and pillow adjustment. Compliance with ergonomic practices was monitored weekly using infrared night-vision cameras and reviewed by a blinded sleep technician. Pre- and post-intervention assessments included apnea–hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), and Ep-worth Sleepiness Scale (ESS). Results: Statistically significant improvements were observed in all measured parameters following the intervention. AHI scores reduced from 18.2 ± 4.5 to 10.6 ± 3.9 events/hour (p < 0.001), PSQI scores improved from 11.3 ± 2.1 to 6.5 ± 1.8 (p < 0.001), and ESS scores declined from 13.7 ± 2.6 to 7.4 ± 2.0 (p < 0.001). Participants with high adherence to ergonomic recommendations demonstrated significantly greater clinical improvements compared to less adherent individuals. Conclusions: The combination of ergonomic sleep posture interventions with OMT was associated with positive improvements in sleep-related outcomes, comparable to or in some cases better than those reported in previous studies evaluating these interventions independently. As an observational cohort without a control arm, this study cannot establish causality but provides preliminary evidence to guide the design of future randomized clinical trials. Full article

Background/Objectives: Obesity is a significant risk factor for obstructive sleep apnea (OSA); however, conventional anthropometric measures, such as body mass index (BMI), may not fully reflect the physiological burden associated with adiposity. The triponderal mass index (TMI) has been proposed as an alternative anthropometric indicator, while inflammation-related biomarkers have emerged as potential complementary tools for characterizing OSA severity. This study aimed to evaluate the relationships between BMI, TMI, hypoxemia, and systemic inflammation, and to assess whether combining anthropometric indices with inflammatory biomarkers improves the identification of severe OSA. Methods: In this retrospective cross-sectional study, 238 adults undergoing full-night polysomnography were classified into four groups: non-OSA, mild OSA, moderate OSA, and severe OSA, based on the apnea–hypopnea index (AHI). Anthropometric indices, polysomnographic parameters, and a comprehensive panel of laboratory biomarkers—including C-reactive protein (CRP), neutrophil- and platelet-derived inflammatory indices, prognostic nutritional index (PNI), CRP-to-albumin ratio (CAR), and CRP-to-lymphocyte ratio (CLR)—were analyzed. Associations were evaluated using Spearman correlation analyses, and diagnostic performance for severe OSA (AHI ≥ 30 events/h) was assessed using receiver operating characteristic (ROC) analyses, DeLong tests, and multivariable models. Results: Both BMI and TMI increased progressively with OSA severity (both p < 0.001) and showed comparable correlations with AHI and nocturnal oxygenation parameters. ROC analyses demonstrated similar discriminative performance for severe OSA (BMI AUC = 0.834; TMI AUC = 0.823; p = 0.229). Among inflammatory biomarkers, CRP, multi-inflammatory index (MII), CAR, and CLR showed moderate diagnostic accuracy. Among the evaluated markers, serum albumin (AUC = 0.836) and PNI demonstrated the highest diagnostic accuracy (AUC = 0.994). A combined model integrating BMI or TMI with PNI achieved near-perfect discrimination for severe OSA (BMI-based AUC = 0.9956; TMI-based AUC = 0.9969), while the addition of CRP-based inflammatory markers did not yield meaningful incremental benefit. Conclusions: BMI and TMI exhibit comparable performance in relation to OSA severity, hypoxemia, and systemic inflammation, with no clear superiority of TMI over BMI in adult patients. Inflammation-related biomarkers—particularly PNI—provide additional discriminatory value beyond anthropometric measures alone. Integrating simple biochemical markers with anthropometric and polysomnographic parameters may enhance risk stratification and identification of severe OSA phenotypes. Full article

Background: Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but its effects on upper airway structural support, particularly the hyoid complex, are not well defined. This study assessed the short-term effects of OMT on hyoid bone position and sleep-related indices in adults with mild to moderate OSA. Methods: In this assessor-blinded randomized controlled trial (ClinicalTrials.gov Identifier: NCT06079073), 13 adults with mild to moderate OSA were randomized to a 12-week web-based OMT program (n = 9) or a waitlist control group (n = 4). Cone-beam computed tomography (CBCT) and three-night home sleep testing were performed at baseline and follow-up. The primary outcome was change in axis-based cephalometric hyoid position measures; secondary outcomes included sleep parameters such as the apnea–hypopnea index (AHI). Results: No significant within- or between-group differences were observed in AHI, oxygen desaturation index, or mean nocturnal SpO₂ after 12 weeks (all p > 0.05). However, several cephalometric variables showed significant between-group differences. The waitlist group exhibited greater posterior–inferior hyoid displacement than the OMT group, with large effect sizes across multiple vector measures (all p ≤ 0.045; r = 0.56–0.66). Posterior and inferior hyoid displacement was associated with higher AHI and lower SpO₂, whereas increased lower pharyngeal airway width was associated with lower AHI. Conclusions: Short-term OMT did not improve sleep-disordered breathing indices but was associated with stabilization of hyoid bone position. These findings suggest that structural stabilization may precede functional improvement and highlight the clinical relevance of vector-based hyoid analysis. Full article

Background: Obstructive sleep apnea (OSA) is a heterogeneous disorder associated with substantial cardiometabolic and neurocognitive morbidity. Although the apnea–hypopnea index (AHI) remains the conventional measure of OSA severity, it only partially reflects the underlying pathophysiological complexity. Growing evidence indicates that nocturnal hypoxemia may be a more powerful marker of adverse outcomes than event frequency alone. Therefore, this study aimed to identify distinct OSA phenotypes based on oximetry-derived features and to assess whether these profiles offer additional clinical insight beyond traditional AHI-based classification. Methods: This multicenter retrospective study, part of the Living with OSA and CPAP: The Apulia Region Experience project, included 1386 adults diagnosed with OSA across 15 sleep centers in Southern Italy. Standardized clinical, anthropometric, and polysomnographic (PSG) data were collected. Hierarchical clustering analysis was performed based on PSG oximetry-derived variables. Resulting clusters were compared across demographic, clinical, hypoxemic, and therapeutic features. Results: Three reproducible clusters emerged. Cluster 1 (mild–non-obese) included younger, leaner patients with lower AHI (22.9 ± 10.5 events·h⁻¹), minimal desaturation (T90 5.6 ± 7.6%), and limited comorbidities. Cluster 2 (severe–obese–hypoxemic) represented the most critical phenotype, characterized by marked obesity (BMI 39.2 ± 8.2 kg·m⁻²), severe OSA (AHI 74.9 ± 17.9 events·h⁻¹), profound nocturnal hypoxemia (T90 51.5 ± 28.2%), and a high prevalence of metabolic disorders (76%), requiring higher CPAP pressures and frequent oxygen supplementation. Cluster 3 (older–comorbid) comprised older males (63.7 ± 11.8 years) with moderate-to-severe OSA (AHI 44.8 ± 15.2 events·h⁻¹) and multiple cardiometabolic comorbidities. Conclusions: Oximetry-derived variables identify distinct and clinically meaningful OSA phenotypes that extend beyond traditional AHI-based classification. Recognizing hypoxemia-driven subtypes could improve risk stratification and enable more personalized management strategies in clinical practice. Full article

Background/Objectives: This study aimed to quantitatively and noninvasively evaluate the changes in the Genioglossus (GG) and Geniohyoid (GH) muscles in patients with Obstructive Sleep Apnea (OSA) using ultrasonography (US) and shear wave elastography (SWE). Methods: This prospective study included 94 adults (18–73 years) who underwent polysomnography (27 normal; 67 OSA). GG and GH muscle thickness was measured with US, and stiffness with SWE. Participants were grouped as non-OSA (Group 0) and OSA (Group 1). OSA patients were further divided by apnea–hypopnea index (AHI) into mild, moderate, and severe (Groups 1–3), forming four groups including controls. Results: No significant differences were observed in genioglossus or geniohyoid muscle thickness between groups. Shear wave elastography revealed significantly higher stiffness values for both the genioglossus and geniohyoid muscles bilaterally in OSA patients compared with non-OSA individuals (approximately 2.7 m/s vs. 2.4–2.5 m/s, p < 0.01). Geniohyoid muscle stiffness on both sides increased progressively with OSA severity, with significantly higher values in severe compared with mild OSA (p < 0.05). In contrast, genioglossus stiffness did not differ significantly across OSA severity subgroups. Conclusions: In patients with OSA, GH and GG muscle thickness remains unchanged, but their stiffness measured by SWE increases. GH stiffness also rises with increasing disease severity. These results indicate that GG and GH muscle stiffness may serve as useful noninvasive markers for OSA. Full article

Background: Obstructive sleep apnea (OSA) is a heterogeneous disorder traditionally classified and stratified by the apnea–hypopnea index (AHI), which fails to capture variability in symptom burden, comorbid associations, and treatment responses. Clinical phenotyping has emerged as a promising strategy to improve disease characterization and management over the last decade. Methods: We conducted a narrative literature review of studies published between January 2014 and December 2022 that used cluster analysis to define OSA phenotypes in adults with moderate-to-severe disease (AHI ≥ 15 events/h). Eligible studies employed validated questionnaires, symptom reporting, and comorbidity profiling to identify subgroups. Findings were summarized across diverse populations, with emphasis on phenotype reproducibility, comorbidity associations, and treatment implications. Results: Across international cohorts, three reproducible symptom-based phenotypes were consistently identified: excessively sleepy (ES), disturbed sleep (DS), and minimally symptomatic (MS). Additional subtypes, such as upper airway dominant (UA) and moderately sleepy (MoS), were described in larger cohorts. Phenotypes differed in demographic profiles, comorbidity burden, and treatment adherence. ES patients exhibited the greatest symptom burden, higher cardiovascular risk, and better adherence to positive airway pressure (PAP) therapy, with significant symptomatic improvement. DS patients frequently reported insomnia symptoms, showed modest PAP-related gains, and may benefit from adjunctive insomnia-targeted interventions. MS patients, despite low symptom burden, often carried substantial comorbidity risk, specifically buildup of OSA-related cardiovascular risk. Conclusions: Symptom-based OSA phenotypes are reproducible across diverse populations and provide clinically meaningful insights beyond AHI. They allow for improved risk stratification, highlight gaps in detection of minimally symptomatic patients, and inform personalized treatment strategies. Integrating phenotyping into clinical practice has the potential to enhance diagnostic accuracy, optimize therapeutic outcomes, and refine cardiovascular risk prediction in OSA. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is diagnosed using pulse oximetry, which is less accurate in patients with darker skin. Two hypopnea definitions are in use: the American Academy of Sleep Medicine allows either (A) a 30% airflow decrease with a 3% oxygen desaturation or EEG arousal (“3% Rule”) or (B) a 30% airflow decrease with a 4% oxygen desaturation (“4% Rule”). The Centers for Medicare and Medicaid Services and many payers use only the 4% Rule. We hypothesized that patients from racial minority groups with darker skin tones would be less likely to qualify for OSA treatment using the 4% Rule compared to the 3% Rule. A secondary aim was to examine sex disparities. Methods: We reviewed records of adults undergoing overnight sleep studies at an urban academic hospital. Demographics, medical history, and comorbidities were collected. Analyses controlled for age, sex, BMI, anxiety, depression, hypertension, COPD, and smoking. Results: A total of 1354 records were analyzed. We found no racial or sex disparities in the proportion of participants who met the 3% but not the 4% Rule. After controlling for covariates, no racial group differed from White participants in meeting only the 3% Rule. However, female participants were significantly less likely than males to meet the 4% Rule. Conclusions: Despite known limitations of pulse oximetry associated with skin tone, no racial differences in the diagnosis of OSA were seen in this cohort. However, female patients had lower odds of meeting the 4% Rule, suggesting a potential barrier to treatment. Full article

Purpose: This study investigates the association between obstructive sleep apnea (OSA), dry eye disease (DED), and glaucoma, focusing on the impact of positive airway pressure (PAP) usage and air leakage. Methods: This retrospective cross-sectional study included 57 adults with polysomnography-confirmed OSA between 2010 and 2023. Participants were grouped into PAP users (PAP+, n = 40) and non-users (PAP−, n = 17). Ocular assessments included tear film break-up time, Schirmer’s test, Oxford staining, meibomian gland evaluation, intraocular pressure, cup-to-disc (C/D) ratio, and retinal nerve fiber layer thickness. PAP device data (usage duration and air leak rate) and OSA severity metrics were recorded. Group comparisons used chi-square and Student’s t-test, and regression analyses identified associations between PAP leakage and ocular parameters. Results: Among the 57 OSA patients, PAP users showed a trend toward a higher risk of glaucoma (OR = 0.83) and DED (OR = 0.69) compared to non-users, but neither trend was statistically significant. PAP users had significantly more severe OSA, including longer N1 sleep stage (p = 0.0005), higher apnea-hypopnea index (AHI, p = 0.0001), and poorer oxygenation. PAP leakage: 95% (mean = 25.84 L/min) exceeded the 24 L/min threshold specified in ResMed’s clinical guidelines, suggesting suboptimal therapy. Higher PAP leak was significantly associated with a lower Schirmer’s test value (p = 0.031) and a higher C/D ratio (p = 0.040) on regression analysis. However, no significant differences were found in ophthalmic parameters between PAP+ and PAP− groups. Conclusions: Suboptimal PAP therapy as mask leakage or nocturnal hemodynamic changes may worsen evaporative dry eye and affect intraocular pressure. Our findings highlight the association between PAP mask leakage and reduced tear production, and suggest that OSA-related optic nerve stress may persist unless both hypoxia and nocturnal IOP fluctuations are properly managed. However, due to the relatively small sample size and retrospective cross-sectional design, future prospective studies with larger cohorts are needed to confirm these associations. Full article

Background: Obesity is a key factor in obstructive sleep apnea (OSA), though Body Mass Index (BMI) may not fully capture this risk as it ignores visceral fat distribution. The Body Roundness Index (BRI), which uses waist circumference and height to better reflect visceral adiposity, has not been widely validated for OSA screening. This study assesses a BRI-based model for predicting severe OSA. Methods: Patients undergoing polysomnography (PSG) were retrospectively enrolled from January 2022 to March 2025 and prospectively enrolled from March 2025 to June 2025. Least absolute shrinkage and selection operator (LASSO) regression was used to identify optimal predictors of severe OSA. A predictive model for severe OSA (Apnea–Hypopnea Index [AHI] ≥ 30 events/h) was developed using BRI and other relevant factors. Subgroup analyses were performed by sex and age. Results: A total of 7579 patients were included in the final analysis, of whom 3864 (51%) were diagnosed with severe OSA. Univariable logistic regression revealed that each unit increase in BRI was associated with a significantly elevated risk of severe OSA (OR 2.01, 95% CI 1.93–2.10; p < 0.001). The predictive severe OSA model incorporating BRI yielded higher area under the receiver operating characteristic curve (AUC) values (Training: 0.762 vs. 0.747; Test: 0.820 vs. 0.803; DeLong test p < 0.05). Subgroup analyses by sex and age revealed higher AUCs across all groups, with the most pronounced improvements in sensitivity observed in women (84.3% vs. 73.0%) and individuals aged ≤ 50 years (75.6% vs. 60.2%). Conclusions: BRI is more strongly correlated with severe OSA than BMI and may enhance screening efficacy in Chinese adults. Full article

Sleep is increasingly acknowledged as a cornerstone of public health, with chronic sleep loss implicated in preventable injury and deaths. Obstructive sleep apnea (OSA) affects over one billion people worldwide but remains widely under-diagnosed due to dependence on polysomnography (PSG), an overnight, hospital-based intrusive procedure. As an adjunct to the clinical diagnosis of OSA, this paper presents a low-cost, smartphone-based Generative AI agent framework for sleep apnea detection and sleep coaching at the bedside. Powered by an on=device Generative AI model, the four agents of this framework include a classifier, an analyser, a visualiser, and a sleep coach. The key agent activities performed are sleep apnea detection, sleep data management, data analysis, and natural language sleep coaching. The framework was empirically evaluated on a subject-independent hold-out set drawn from a dataset of 500 clinician annotated clips collected from 10 clinically diagnosed OSA patients. Sleep apnea detection achieved an accuracy of 0.89, precision of 0.91, and recall of 0.88, with nightly Apnea–Hypopnea Index (AHI) estimates strongly correlated with PSG-based clinical scores. The framework was further assessed on the performance metrics of computation, latency, memory, and energy usage. The results of these experiments confirm the feasibility of the proposed framework for large-scale, low-cost OSA screening, with pathways for future work in federated learning, noise robustness, and broad clinical validation. Full article

Background/Objectives: Obstructive sleep apnea (OSA) during pregnancy may reduce maternal oxygenation, cause sleep fragmentation, and influence offspring development. This pilot study explored potential associations between OSA during pregnancy and child outcomes at age 3. Methods: Pregnant women aged 23–48 years who underwent home sleep apnea testing (HSAT) at 28–32 weeks of gestation between June 2021 and July 2025 were enrolled. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5. Mothers and children were prospectively followed until the child reached 3 years of age. Children’s developmental levels (motor, cognitive/adaptive, language/social, and total) were evaluated using the New K-Type Developmental Test. Anthropometric measures (height, weight, and head circumference) and dental occlusion were also assessed. Correlations between the maternal AHI and developmental indices were examined. Results: Thirty-four women, including six with OSA, completed the follow-up assessment. No significant differences were observed in children’s physical growth or occlusion between the OSA and non-OSA groups. The maternal AHI showed a negative tendency with the total developmental index and the cognitive/adaptive and language/social domains. One participant with severe OSA (AHI = 69.3) showed markedly lower developmental scores, suggesting a possible dose-dependent trend rather than a definitive threshold. Given the small number of OSA cases and the influence of a single severe case, these findings should be interpreted cautiously as preliminary and descriptive. Conclusions: OSA during pregnancy may be associated with differences in early childhood development. The findings highlight the importance of maternal sleep health awareness and feasible screening approaches, such as HSAT, during pregnancy. Full article

Background: Obstructive sleep apnea (OSA) is frequent but underrecognized after stroke, worsening prognosis, recurrence, and mortality. Polysomnography is rarely feasible in acute care, and existing screening tools have limited accuracy. We aimed to identify simple OSA clinical predictors to improve risk stratification in stroke patients. Methods: In this prospective study, 116 consecutive acute stroke patients (mean age 73 years, 57% male) underwent standardized clinical evaluation, Berlin Questionnaire, Epworth Sleepiness Scale (ESS), and home sleep apnea test during hospitalization. OSA was defined as apnea–hypopnea index (AHI) ≥ 15. Logistic regression identified independent predictors; the model’s performance was assessed by accuracy, sensitivity, specificity, and ROC curves. Results: OSA was diagnosed in 42 patients (36%). OSA patients showed higher NIHSS at admission (p = 0.048) and higher ESS scores (p = 0.047), but similar vascular risk factors and stroke subtypes compared to non-OSA patients. In a multivariate analysis, age (OR 1.05; 95% CI 1.00–1.10; p = 0.036) and witnessed apneas (OR 6.20; 95% CI 1.31–29.22; p = 0.021) were OSA independent predictors. The two-variable models achieved 72.9% accuracy, 90.3% specificity, 41.2% sensitivity, Nagelkerke R² = 0.223, and AUC = 0.739 (p < 0.001), outperforming both the Berlin Questionnaire (AUC 0.596) and ESS (AUC 0.616). Conclusions: A simple model based on age and witnessed apneas reliably identified stroke patients at high risk for OSA, with good discriminative performance and higher accuracy than standard questionnaires. Its high specificity supports targeted allocation of sleep studies in resource-limited acute settings, potentially improving early detection, secondary prevention, and care pathways after stroke. Full article

Objective: This observational study aimed to evaluate occlusal changes in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device after two years of therapy. Methods: Sixty adult patients with mild to moderate OSA (apnea–hypopnea index 15–30 events/h) were treated with the IMYS MAD for 24 months. Digital dental impressions were analyzed using Autodesk Meshmixer and Fusion 360 to measure sagittal, frontal, and occlusal angles, as well as upper incisor inclination at baseline (T0) and after treatment (T1). In addition, changes in the polysomnographic indices AHI and ODI were evaluated. Statistical analyses were performed using paired t-tests or Wilcoxon signed-rank tests depending on data normality (p < 0.05). Results: No significant differences were found between T0 and T1 in sagittal (IC 95% −2.053,1.433), occlusal (IC 95%, −1.202, 0.722) or frontal angles (IC 95% −1.487, 0.447), or in upper incisor inclination (IC 95%, 0.06,3.04). Polysomnographic parameters improved significantly, with mean AHI decreasing from 27.7 ± 12.3 (IC 95% 24.53–30.87) to 6.2 ± 4.0 events/h (IC 95% 5.17–7.27) and ODI from 19.7 ± 9.4 (IC 95% 17.27–22.13) to 4.7 ± 3.2 (IC 95% 3.82–5.48, p < 0.001). Conclusions: This study found that the IMYS MAD did not induce significant variations in occlusal plane orientation or upper incisors inclination after two years of treatment. These null findings suggest that the IMYS device may provide effective OSA management while minimizing the risk of occlusal or dental side effects. However, the retrospective design and the 24-month follow-up duration should be taken into consideration. Full article

Obstructive sleep apnea (OSA) is associated with increased risks of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare respiratory predictors of all-cause mortality over 5, 10, and 15 years. A single-center study was conducted at a Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA who underwent polysomnography were admitted, 853 died during the study. We performed Cox regression analyses with dynamic hazard ratios to evaluated predictors of mortality. Prevalence of OSA was high—75.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). AHI_REM was associated with higher mortality risk in 0–5, 0–10, 0–15 years of observation in contrast to AHIN_REM and AHI_TST. The hazard ratio analysis showed that mortality risk changed over time depending on sleep stage and event type: risk increased for AHI_REM and AHI_TST, while it stayed the same or decreased for AHI_NREM and most central apneas. Full article