Search Results (131)

Background: Obesity hypoventilation syndrome (OHS) is a life-threatening condition often underdiagnosed in patients with obstructive sleep apnea (OSA). While bariatric surgery induces weight loss, it does not immediately resolve upper airway obstruction. We investigated the feasibility and clinical predictors of a novel transdisciplinary approach—Combined Airway and Bariatric Surgery (CABS)—in treating OHS. Methods: This prospective observational cohort study (December 2022–November 2024) recruited 36 adults with obesity (body mass index [BMI] ≥ 30 kg/m²) and OSA (apnea–hypopnea index [AHI] ≥ 5 events/h). OHS was diagnosed by daytime hypercapnia (PaCO₂ ≥ 45 mmHg) after excluding other causes of hypoventilation. Participants received CABS or positive airway pressure therapy via shared decision-making. Primary outcomes included changes in AHI, BMI, PaCO₂, and Epworth Sleepiness Scale (ESS). Results: Nine of 36 individuals (25%) had OHS. Multivariate logistic regression identified BMI and ESS as significant predictors. Receiver operating characteristic curve analysis showed high OHS prediction with BMI ≥ 35.5 kg/m² (area under the curve [AUC] = 0.85), ESS ≥ 12 (AUC = 0.72), and a novel OHS prediction score > 20 (AUC = 0.94). Among 6 OHS patients who underwent CABS, one-year follow-up showed significant improvements: AHI decreased from 98.1 to 26.8 events/h, BMI from 40.1 to 29.1 kg/m², and PaCO₂ from 50.2 to 37.9 mmHg (all p < 0.05). Conclusions: OHS was present in one-quarter of individuals with obesity and OSA in this cohort. CABS was feasible and associated with encouraging improvements in sleep-disordered breathing, ventilatory status, and weight among selected patients. These preliminary findings support further evaluation of this transdisciplinary strategy in larger, comparative studies. Full article

Goldenhar syndrome is a developmental defect of the 1st and 2nd brachial arches. Facial asymmetry and ear–eye abnormalities are observed. Frequent presence of concomitant issues, including severe OSA (obstructive sleep apnea) and sialorrhea, have also been recorded. The presentation of Goldenhar syndrome is highly variable, and treatment procedures also differ, with surgical treatment often being mandatory. Common symptoms of OSA include loud snoring, gasping, and morning headaches. If untreated, it may lead to high blood pressure, hyperinsulinemia, heart problems, stroke, and daytime sleepiness. Its etiology in Goldenhar syndrome is primarily anatomical and multifactorial. The most common treatment options are based on surgical procedures. Continuous positive airway pressure (CPAP) could be considered for use in individuals with Goldenhar syndrome. Mandibular advancement is a standard procedure for relieving the symptoms of OSA. In general, mandibular advancement would reduce apnea and hypopnea. Another method of managing OSA is hypoglossal nerve stimulation (HNS). Adenotonsillectomy is often the first-line surgical treatment for OSA but it is rarely curative in Goldenhar patients due to underlying skeletal issues. In contrast to American Academy of Sleep Science recommendations of managing OSA, in patients with congenital syndromes, surgical intervention seems to be the most optimal method of treatment. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is highly prevalent in children with unilateral cleft lip and palate (UCLP) due to maxillary retrusion and upper airway compromise. While palatal morphology may influence pediatric OSA, three-dimensional (3D) evaluations in this population remain limited. This study evaluated palatal dimensions and maxillary widths in UCLP children with and without OSA using cone-beam computed tomography (CBCT) and examined their associations with OSA severity (apnea–hypopnea index, AHI). Methods: Forty CBCT scans of Thai children with non-syndromic UCLP (mean age 8.98 ± 1.99 years) were analyzed. Participants were categorized into OSA (n = 20; AHI ≥ 1) and non-OSA (n = 20; AHI < 1) groups. Reconstructed palatal structures were measured for surface area, volume, height, and transverse maxillary widths. Group differences were assessed using independent t-tests, and associations with AHI were examined via Pearson’s correlation and linear regression (p < 0.05). Results: Children with OSA exhibited significantly reduced palatal surface area, volume, height, and buccal alveolar crest width compared with those without OSA (p < 0.05). Other transverse widths showed no significant intergroup differences. Linear regression identified palatal volume as the only variable independently associated with AHI (β = −0.631, p < 0.001). Conclusions: Children with UCLP and OSA exhibit significantly constricted palatal morphology. Among the measured parameters, reduced three-dimensional palatal volume was the only variable independently associated with increased OSA severity in this sample. Thus, CBCT-based palatal volume assessment may serve as a preliminary screening parameter to help identify OSA risk within multidisciplinary cleft care, though further validation is needed. Full article

Background and Objectives: It is well established that obstructive sleep apnea syndrome (OSAS) is associated with functional lung volumes. The aim of this study was to investigate the relationship between morphological lung volume and the severity of OSAS. Materials and Methods: Adult patients evaluated for sleep disorders between January 2020 and January 2024 were retrospectively reviewed. Patients with an AHI greater than 5, who underwent both spirometry and thoracic CT within a three-month interval, were included. Spirometric functional volume and morphological CT lung volume were assessed. Associations between OSAS severity and both functional and morphological lung volumes were analyzed. Results: A total of 195 patients were enrolled, of whom 166 had CT scans suitable for lung volume assessment. Among all patients, 20 (10.3%) were in the mild, 39 (20.0%) in the moderate, and 136 (69.7%) in the severe OSAS group. Ordinal regression analysis was performed to evaluate the factors influencing these categories. Age (p < 0.001) and BMI (p < 0.001) were positively correlated with disease severity, whereas female sex was associated with a lower risk of severe disease (p = 0.003). Conclusions: Functional and morphological lung volumes did not affect OSAS severity. Functional and morphological lung volumes were positively correlated with each other. Both morphological and functional lung volumes showed negative correlations with BMI. Full article

Background: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep-related breathing disorder associated with significant systemic complications and reduced quality of life. Mandibular advancement devices (MADs) represent an established alternative therapy for patients who cannot tolerate continuous positive airway pressure (CPAP). However, concerns remain regarding their potential effects on temporomandibular disorders (TMD). Materials and Methods: This retrospective exploratory study analyzed clinical records of 26 patients (mean age 55.4 ± 5.8 years) with polysomnography-confirmed OSAS and baseline TMD-related symptoms treated with a custom-made monobloc MAD. Clinical parameters were evaluated at baseline (T0) and after approximately 6 months of therapy (T1). Outcomes included apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Fonseca Anamnestic Index, and health-related quality of life assessed using the SF-36 questionnaire. Repeated measures ANOVA and linear regression analyses were performed. Results: After six months of MAD therapy, a significant reduction in AHI was observed (30 ± 13.76 vs. 10.87 ± 3.9; p < 0.00001). Daytime sleepiness significantly decreased (ESS: 9.31 ± 3.53 vs. 3.38 ± 1.77; p < 0.00001). TMD symptom severity also decreased significantly according to the Fonseca Index (33.85 ± 17.74 vs. 10.00 ± 8.94; p < 0.00001). Quality of life scores improved significantly (SF-36: 41.15 ± 9.52 vs. 65.38 ± 5.82; p < 0.00001). Linear regression analysis showed no significant association between changes in AHI and changes in TMD symptoms, ESS scores, or quality of life. Conclusions: Within the limitations of this retrospective study, MAD therapy was not associated with symptom aggravation of temporomandibular disorders in patients with pre-existing TMD symptoms. Significant improvements in respiratory parameters, daytime sleepiness, and quality of life were observed after six months of therapy. Full article

Background: Continuous Positive Airway Pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea–hypopnea syndrome (OSAHS), and photoplethysmography (PPG) sensors are commonly used in wearable devices for home sleep apnea testing. The recorded airflow and PPG signals from both sensors capture rich physiological patterns. We hypothesize that by combining information from these signals, we can efficiently estimate sleep dynamics of patients receiving CPAP treatment. Methods: The airflow signals were obtained from CPAP titration devices, denoted as CPAP-airflow, while the PPG signals were collected using the PranaQ TipTraQ (TTQ001), a fingertip-worn wearable device. We separately trained one-dimensional convolutional neural networks for CPAP-airflow and PPG signals and fused their outputs through probabilistic ensembling to predict sleep stages. The ensemble method is a late-fusion soft-voting scheme that computes a linearly weighted combination of synchronized softmax probability vectors from the modality-specific models. Results: For three-stage classification (Wake, REM, NREM), the PPG-based and CPAP-airflow-based models achieved overall Cohen’s kappa scores of 0.511 and 0.452, respectively, while the ensembled model improved the overall kappa to 0.587. The F1-score for the REM stage improved to 0.706 using the ensemble method, compared to 0.685 and 0.532 achieved by the individual models, respectively. In the four-stage classification (Wake, REM, Light, Deep) task, a deep sleep sensitivity of 0.596 was attained through the application of probabilistic ensembling. Conclusions: A fusion scheme of complementary information from the CPAP and PPG enhances the accuracy of sleep stage detection and hence enables more precise sleep monitoring, especially with an improved REM identification. Clinical implications include applying the proposed algorithm to improve in-home auto-CPAP titration by capturing REM-related respiratory instability and avoiding under-titration in REM-dominant OSAHS, better reflecting the patient’s true nocturnal respiratory needs. Full article

Background: This study aimed to evaluate the effects of obstructive sleep apnea syndrome (OSAS) surgery on oxidative stress, antioxidant capacity, and oxidative protein modifications. Changes in Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Advanced Oxidation Protein Products (AOPP), Ischemia-Modified Albumin (IMA), and Total Thiol (TT) levels were analyzed in the preoperative and postoperative periods. Methods: Sixty-seven patients aged 18–65 years with an Apnea–Hypopnea Index (AHI) > 5 who underwent OSAS surgery were included. Demographic characteristics were recorded. Venous blood samples were collected at four time points: before anesthesia induction (T1), at the end of surgery (T2), on postoperative day 3 (T3), and at postoperative month 3 (T4). TOS, TAS, AOPP, IMA, and TT levels were measured and statistically evaluated. Results: Of the patients, 13.4% (n = 9) were female and 86.6% (n = 58) were male. No significant changes were observed in TOS, TAS, AOPP, or IMA levels between time points. However, TT levels at postoperative month 3 were significantly higher than those at earlier measurements (p < 0.05). Positive correlations were found between AHI and TOS, AOPP, and IMA levels, while TAS and TT showed no significant correlation with AHI. Conclusions: Surgery for OSAS did not produce significant postoperative improvements in oxidative stress parameters except for TT elevation. These results indicate that surgical intervention alone may be insufficient for biochemical recovery in OSAS and should be complemented by lifestyle and supportive therapies. Full article

Background: The alternative Overlap Syndrome (aOVS), the coexistence of bronchial asthma and Obstructive Sleep Apnea (OSA), represents a distinct clinical phenotype associated with worse clinical outcomes, but little is yet known about its characteristics. We aimed to investigate differences in sleep stability and clinical burden between OSA and aOVS patients matched for age, gender, BMI and Apnea-Hypopnea Index (AHI). Methods: 45 aOVS and 45 OSA patients were compared using demographic, clinical and polysomnographic data. Results: Patients with aOVS exhibited significantly higher odds ratio product (ORP) values for total sleep time (ORPmed: 0.8 ± 0.2 vs. 0.5 ± 0.1, p < 0.001) and Non-Rapid Eye Movement (ORPnr: 0.7 ± 0.3 vs. 0.4 ± 0.1, p < 0.001) sleep compared with OSA patients. Furthermore, patients with aOVS showed a significantly higher risk of developing clinically significant anxiety and fatigue, showing a significantly higher General Anxiety Disorder-7 (GAD-7: 8.7 ± 5.6 vs. 5.7 ± 4.7, p = 0.02) and significantly higher prevalence of fatigue (71% vs. 41%, p = 0.01). These associations remained significant after multivariable adjustment and were independent of OSA severity (AHI). Conclusions: Our findings support the concept that aOVS is characterised by significantly more unstable sleep and a greater psychological burden, even after matching with OSA patients for age, gender, BMI and AHI. Our study also highlights the need to integrate traditional sleep measures with more recent ones, such as ORP, in order to better capture the multidimensional burden of aOVS. Full article

Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre–post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49–0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I² = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies. Full article

Background/Objectives: Obstructive sleep apnea (OSA) syndrome is characterized by recurrent upper airway obstruction during sleep and is closely associated with systemic inflammation and cardiometabolic risk. α-Klotho and fibroblast growth factor-23 (FGF-23) are emerging biomarkers with potential roles in vascular homeostasis, inflammation, and metabolic regulation. However, their relevance in OSA remains insufficiently elucidated. The aim of this study was to evaluate serum α-Klotho and FGF-23 levels in patients with OSA and to investigate their associations with disease severity. This represents a novel approach that may provide new insights into the pathophysiological mechanisms linking OSA with cardiometabolic risk. Methods: A total of 133 participants were included in this study and categorized into three groups according to apnea–hypopnea index: 1—simple snoring (n = 44); 2—non-severe OSA (n = 44); and 3—severe OSA (n = 45). Comparisons between two groups were performed using Student’s t-test for normally distributed variables. Comparisons among three or more groups were conducted using one-way ANOVA and the Kruskal–Wallis test. ANCOVA was applied to compare α-Klotho and FGF-23 levels between groups after adjustment for age, BMI, diabetes, hypertension, asthma, COPD, and thyroid disease. The predictive performance of α-Klotho and FGF-23 for severe obstructive sleep apnea was evaluated using ROC curve analysis. Results: Serum α-Klotho levels decreased significantly with increasing OSA severity (p = 0.001). Serum FGF-23 levels increased significantly across AHI groups (p = 0.001). After adjustment for age, BMI, diabetes, hypertension, asthma, thyroid disease, COPD and vitamin D levels, α-Klotho levels were lower in the severe and non-severe OSA group (p = 0.001, both) compared to the simple snoring group, whereas FGF-23 levels were higher in the severe and non-severe OSA group (p = 0.001; both) compared to the simple snoring group. In predicting the risk of severe OSA compared with non-severe OSA, an α-Klotho cut-off value of 280.3 yielded a sensitivity of 84.44% and specificity of 75%, whereas an FGF-23 cut-off value of 75.5 yielded a sensitivity of 62.2% and specificity of 72.7%. Conclusions: Serum α-Klotho levels significantly decrease while FGF-23 levels increase in correlation with OSA severity. α-Klotho exhibited superior predictive performance over FGF-23 in identifying severe OSA, suggesting its potential as a more sensitive biomarker for systemic involvement. These results indicate that the α-Klotho/FGF-23 axis is independently associated with OSA and may play a pivotal role in the pathophysiological mechanisms linking intermittent hypoxia to increased cardiometabolic risk. Full article

Background/Objectives: Obstructive sleep apnea (OSA) causes recurrent apneas/hypopneas and intermittent oxygen desaturation during sleep. Chronic intermittent hypoxia (CIH) may be linked to metabolic dysfunction-associated steatotic liver disease (MASLD) and fibrosis through metabolic dysfunction. This study evaluated the relationship between OSA severity/hypoxemia indices and MASLD and fibrosis assessed by transient elastography. Methods: We prospectively enrolled 400 adults evaluated for suspected OSA at a respiratory disease outpatient clinic in Rize, Türkiye. All patients underwent overnight polysomnography. The apnea–hypopnea index (AHI), oxygen desaturation index (ODI), mean SpO₂, and mean of each participant’s minimum SpO₂ values were recorded. MASLD and fibrosis were assessed in the same individuals using FibroScan, with CAP (controlled attenuation parameter) and LSM (liver stiffness measurement) values recorded. OSA severity was categorized by AHI, and multivariable logistic regression was used to identify independent associations. Results: MASLD was present in 76% and fibrosis in 34.5% of patients. Patients with fibrosis had higher AHI (13.8 [8.2–35.2]) and ODI (11.5 [4.5–33.2]) and lower minimum SpO₂ (p < 0.001). In multivariable models, BMI (OR 1.09; p < 0.001) and metabolic syndrome (OR 3.34; p < 0.001) were independently associated with MASLD, while BMI (OR 1.02; p < 0.001), metabolic syndrome (OR 2.03; p = 0.015), and ALT (OR 1.02; p = 0.032) were independently associated with fibrosis. Conclusions: MASLD and fibrosis were associated with OSA severity and hypoxemia before multivariable adjustment. However, after adjustment for obesity-related factors, liver outcomes were primarily explained by BMI and metabolic syndrome. Liver assessment should be considered in patients with OSA, particularly in those with high BMI and metabolic syndrome. Full article

Background: Obstructive sleep apnea (OSA) syndrome is a common sleep-related breathing disorder characterized by recurrent upper airway collapse during sleep and is closely associated with metabolic dysregulation, including insulin resistance, adipose tissue dysfunction, and impaired lipid metabolism. Perilipin-2 (PLIN-2), a lipid droplet-associated protein involved in triglyceride storage and regulation of lipolysis, may reflect alterations in lipid homeostasis associated with OSA. Objective: This study aimed to evaluate the association between serum PLIN-2 levels and OSA and to assess the relationship between PLIN-2 concentrations and disease severity. Methods: A total of 231 participants were included in this study, comprising 70 healthy controls and 161 patients with OSA. Patients were classified according to apnea–hypopnea index (AHI) as having mild (n = 60), moderate (n = 52), or severe OSA (n = 49). All participants underwent overnight polysomnography (PSG). Results: Serum PLIN-2 levels were significantly higher in patients with OSA and increased progressively with disease severity. PLIN-2 levels were positively correlated with polysomnographic indices of OSA severity, including AHI and oxygen desaturation index. ROC analysis demonstrated good discriminative performance of PLIN-2 for OSA presence and for distinguishing mild from severe OSA. Conclusions: This study is the first to demonstrate an association between serum PLIN-2 levels and OSA. Our findings suggest that PLIN-2 may serve as a novel biomarker reflecting metabolic and lipid-related disturbances in OSA and may provide new insights into the pathophysiological link between intermittent hypoxia and altered lipid metabolism. Full article

Background and objective: Obstructive sleep apnea (OSA) is a common pediatric sleep disorder, most often caused by adenotonsillar hypertrophy. Although adenotonsillectomy (AT) is the standard first–line treatment, a substantial proportion of children experience residual OSA (rOSA). This systematic review aimed to synthesize current evidence on risk factors associated with rOSA in children following AT. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed and the Cochrane Library were searched without date restrictions using English–language terms related to rOSA, children, and adenotonsillectomy. Studies assessing postoperative persistence of OSA and associated risk factors were included. Results: Thirteen studies published between 2010 and 2024 met the inclusion criteria. The reported prevalence of rOSA varied widely (18.6–85.0%), reflecting heterogeneity in study design, patient populations, baseline disease severity, and follow–up methods. Obesity emerged as the most consistently identified risk factor, with significantly higher rOSA rates reported among children with elevated body mass index. Age also influenced outcomes, with both very young (<3 years) and older (>7 years) children demonstrating an increased likelihood of persistent disease. Comorbid conditions, particularly asthma and Down syndrome, were associated with poorer postoperative improvement. Additional contributors included craniofacial or developmental abnormalities and higher preoperative apnea–hypopnea index. Limited evidence also suggested that socioeconomic and environmental factors may affect postoperative outcomes. Conclusions: Residual OSA is common following adenotonsillectomy in children. Obesity, age, and comorbidities are key predictors, underscoring the need for comprehensive preoperative risk stratification and structured postoperative follow–up. Full article

Background: The mechanisms underlying cognitive impairment in obstructive sleep apnea syndrome (OSAS) remain incompletely understood. In particular, the relative contribution of daytime sleepiness versus the direct effects of hypoxia on the brain requires clarification. Objectives: This study aims to explore the association between verbal memory and problem-solving abilities, OSAS severity, self-reported daytime sleepiness, and neurofilament light chain (NfL) serum concentration, as marker of neuroaxonal injury possibly related to chronic hypoxia. Methods: In this cross-sectional study, cognitive performance was assessed in 72 patients with mild to severe OSAS using the Selective Reminding Test (SRT) and the Tower of London (ToL). The apnea–hypopnea index (AHI), the Epworth Sleepiness Scale (ESS) and serum NfL concentrations were collected. Hierarchical multiple linear regression analyses adjusting for age, years of education, body mass index, and duration of continuous positive airway pressure (CPAP) treatment, were conducted for each cognitive outcome. Results. Neither AHI, ESS scores nor serum NfL concentrations were significantly associated with verbal memory or problem-solving performance. Higher age and lower education were significant predictors of lower verbal memory indices, whereas longer CPAP treatment duration was positively correlated with verbal memory performance and problem-solving speed. Conclusions: In this sample, cognitive performance was more strongly related to demographic factors and CPAP exposure compared to disease severity, subjective sleepiness, or peripheral markers of neuroaxonal injury. These findings suggest that AHI, subjective measures of sleepiness and NfL may inadequately capture neurocognitive vulnerability in OSAS. Moreover, they underscore the imperative for longitudinal and larger studies to clarify mechanisms linking OSAS and cognitive impairments. Full article

We report a thirty-six-year-old woman with intellectual disability who was referred for evaluation of suspected obstructive sleep apnea. The initial clinical impression suggested a syndromic case, so comprehensive genetic testing was undertaken. Overnight polysomnography revealed a severe rapid eye movement–predominant obstructive sleep apnea syndrome with an apnea–hypopnea index of 31.9 events per hour, rapid eye movement apnea–hypopnea index of 113.8 events per hour, and lowest oxygen saturation of 66%. Treatment with continuous positive airway pressure improved respiratory and sleep quality indices and was well tolerated. Whole-exome sequencing identified a de novo splice site variant in the pleckstrin homology domain interacting protein gene (c.41-1G > A), confirming a molecular diagnosis of Chung–Jansen Syndrome. Chung–Jansen syndrome is a rare neurodevelopmental disorder caused by heterozygous pathogenic variants in the pleckstrin homology domain interacting protein gene, marked by developmental delay, intellectual disability, behavioral abnormalities, dysmorphism, and progressive obesity. PHIP influences central and peripheral pathways controlling satiety, pancreatic function, and body weight. Despite frequent reports of sleep problems, systematic evaluation of sleep-disordered breathing has been limited. This adult case provides the first polysomnographic confirmation in the syndrome, supporting proactive screening for obstructive sleep apnea—especially in those with obesity. Integrating genetic assessment into sleep care can reduce diagnostic delays and better guide therapy and prognosis. Full article