Search Results (2,021)

Background: Obstructive sleep apnea (OSA) is common in patients with chronic respiratory disease, but whether its risk differs between emphysema and bronchiectasis remains unclear. We compared the subsequent risk of OSA between these two structural lung diseases using a large real-world database. Methods: This retrospective cohort study used data from the TriNetX research network. Adults with emphysema or bronchiectasis were identified and followed for incident OSA. Baseline demographic characteristics, comorbidities, and medication use were balanced using 1:1 propensity score matching. OSA risk was evaluated at 1-, 2-, 3-, 4-, and 5-year intervals and cumulatively through 29 July 2026, using risk ratios, odds ratios, and hazard ratios (HRs). Results: Before matching, 526,877 patients with emphysema and 147,700 with bronchiectasis were included. After propensity score matching, 129,761 patients remained in each cohort, with all standardized differences below 0.10. In the matched analysis, OSA risk was modestly lower in the emphysema group at 1 year (HR = 0.829, 95% CI = 0.778–0.883), 2 years (0.885, 0.843–0.931), 3 years (0.923, 0.884–0.964), 4 years (0.946, 0.910–0.984), and 5 years (0.960, 0.925–0.995). However, the cumulative hazard did not differ significantly between groups (HR = 1.006, 95% CI = 0.976–1.038). Conclusion: After propensity score matching, bronchiectasis was associated with a modestly higher early risk of OSA, but this difference diminished over time and was absent over long-term follow-up. These findings should be considered hypothesis-generating and warrant prospective confirmation. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder caused by recurrent upper-airway collapse during sleep, leading to intermittent hypoxia, sleep fragmentation, and excessive daytime sleepiness. Although continuous positive airway pressure (CPAP) remains the first-line therapy, long-term adherence is often suboptimal, underscoring the need for more tolerable and flexible treatment options. This review aims to summarize the pathophysiological rationale for pharmacotherapy in OSA and to discuss recent developments in drug-based interventions. Methods: We conducted a narrative review of the literature on pharmacological interventions for OSA, with a systematic search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov up to 4 August 2026. We included randomised controlled trials, observational studies, meta-analyses, and mechanistic human or animal studies that reported relevant sleep and respiratory outcomes, and graded evidence according to the principles of GRADE framework. Results: Several drug classes have shown promise: agents that increase upper-airway dilator muscle activity, respiratory stabilizers that reduce loop gain, medications that raise the arousal threshold, topical anti-inflammatory drugs for mucosal edema, and systemic metabolic modulators such as glucagon-like peptide-1 receptor agonists and dual incretin receptor agonists. Emerging strategies, including gene therapy directed at the hypoglossal motor system, are also under investigation at the preclinical stage. Moreover, combining pharmacotherapy with CPAP or other devices can produce synergistic benefits, enabling lower device pressures and enhanced patient comfort. Conclusions: Pharmacotherapy for OSA is progressively moving from exploratory research towards targeted, phenotype-driven personalized treatment. Future studies should focus on robust patient phenotyping, multi-mechanistic combination regimens, and long-term clinical outcome evaluations to facilitate the integration of drug-based therapies into routine OSA management, particularly in specific subgroups such as those with COMISA. Full article

Access to in-laboratory polysomnography (PSG) is restricted by prolonged waiting lists, and first-night effects can distort typical sleep architecture. This study evaluates the PneumoWave biosensor as a scalable, unobtrusive alternative for longitudinal single-channel home sleep apnea monitoring. Over three nights in an uncontrolled home environment, the biosensor’s respiratory rate agreement was evaluated against smartwatch-derived respiratory rate estimates, whilst apnea/hypopnea detection was compared with concurrent pulse oximetry. PneumoWave and smartwatch devices demonstrated good correlation (r = 0.870; p < 0.001). The PneumoWave device showed strong measurement agreement and provided a highly predictive screening pathway for patients with intermediate-to-high obstructive sleep apnea (OSA) risk. Longitudinal analysis confirmed consistent multi-night performance without first-night effect biases (ICC = 0.956, p < 0.001). Furthermore, its intuitive design yielded zero patient-induced setup errors, highlighting its operational robustness for self-administered use. Combining this continuous chest wall monitor with the STOP-Bang clinical questionnaire has the potential to provide an effective predictive screening pathway, improving community OSA screening and assisting clinical triage. Further validation against full polysomnography is warranted before clinical adoption. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is traditionally classified according to the apnea–hypopnea index (AHI), although AHI alone does not fully capture the heterogeneity of disease severity. This study introduces a novel polysomnography-derived biomarker, the Sleep Disturbance Ratio (SDR), and evaluates its contribution to OSA severity classification using explainable machine learning approaches. Methods: A retrospective study was conducted using polysomnographic data from 767 adults who underwent overnight sleep studies. SDR was calculated as the logarithmic ratio between light sleep (N1 + N2) and restorative sleep (N3 + REM). Predictive models were trained and evaluated using four established machine learning algorithms: Decision Tree, Random Forest, Extreme Gradient Boosting (XGBoost), and Artificial Neural Network (ANN). Model performance was assessed using accuracy, Cohen’s kappa, F1-score, multiclass AUC, ROC analysis, feature importance ranking, partial dependence plots, and clinical risk mapping. Results: Although SDR did not differ significantly across conventional OSA severity groups in univariate analysis (p = 0.77), explainable machine learning analyses consistently demonstrated that increasing SDR was associated with a higher probability of severe OSA, particularly in combination with lower mean oxygen saturation. SDR also showed strong physiological relevance by correlating positively with N2 sleep (r = 0.85) and negatively with N3 sleep (r = −0.83), supporting its role as a biomarker of sleep fragmentation. Among the predictive models, Random Forest achieved the highest classification accuracy (75.0%), whereas XGBoost demonstrated the best multiclass discrimination (AUC = 0.895) and the highest ROC performance for severe OSA (AUC = 0.962). ESS remained the most influential predictor across all models. Conclusions: This study introduces SDR as a novel polysomnography-derived biomarker that captures sleep architecture disruption beyond conventional AHI-based assessment. Although SDR is not an independent diagnostic marker, explainable machine learning analyses demonstrated that it provides complementary physiological information for OSA severity classification, particularly when integrated with oxygenation parameters. Full article

Obstructive sleep apnea (OSA) is associated with renin–angiotensin–aldosterone system (RAAS) dysregulation. This study examined the relationship between salivary aldosterone and OSA severity, identified predictors of salivary aldosterone, evaluated the moderating role of mean arterial pressure (MAP), and compared the diagnostic performance of salivary aldosterone with the STOP-BANG questionnaire. This cross-sectional study included 67 adults grouped as healthy or mild OSA (apnea–hypopnea index [AHI] < 15; n = 34) versus moderate-to-severe OSA (AHI ≥ 15; n = 33). Morning salivary aldosterone was measured using enzyme-linked immunosorbent assay. Generalized linear models assessed independent predictors, MAP moderation was tested using PROCESS Model 1, and diagnostic performance was evaluated using receiver operating characteristic analysis. Salivary aldosterone did not differ between OSA severity groups and showed poor diagnostic performance. Age was negatively associated with aldosterone levels, while MAP moderated the relationship between AHI and salivary aldosterone. In contrast, the STOP-BANG questionnaire demonstrated acceptable discriminative ability and significantly higher specificity. Salivary aldosterone is not a reliable standalone OSA screening biomarker. However, MAP moderated the OSA–aldosterone relationship, suggesting potential utility in OSA patients with elevated MAP. Age independently predicted lower aldosterone, likely reflecting age-related RAAS decline. These findings support selective utility of salivary aldosterone in OSA patients with elevated blood pressure. Full article

Atrial cardiomyopathy (ACM) is defined as any complex of structural, architectural, functional, electrophysiological, and molecular changes affecting the atria that may result in clinically significant health consequences. ACM can be caused by a variety of factors, including age-related changes, valvular or vascular disease, genetic diseases, congestive heart failure, metabolic diseases, cardiovascular disease (CVD) risk factors such as arterial hypertension (AH) or obesity, obstructive sleep apnea, and other infectious or noninfectious diseases predisposing to chronic inflammation. The diagnosis of ACM relies on several modalities, including electrocardiography, echocardiography, cardiac magnetic resonance imaging (MRI), computed tomography (CT), electroanatomical mapping (EAM), genetic studies, and biomarkers, which can detect and characterize structural, mechanical, and electrical atrial dysfunction. These changes often include structural atrial remodeling (fibrosis), abnormal structure of the atrial wall and its components, and contractile and electrical dysfunctions. When assessing aspects of ACM, structural changes in the atria such as left atrium (LA) size and fibrosis; LA architectural changes such as the expression of remodeling; changes in LA mechanics such as echocardiographic stress indices; changes in reservoir function and changes in contraction; biological factors determining changes in biomarkers; possible genetic predispositions and higher expression of certain genes encoding certain proteins; and arrhythmogenic factors associated with a higher risk of atrial fibrillation (AF) and stroke and a worse short- and long-term prognosis are very important. When considering the challenges of diagnosing ACM, it should be noted that without standardized diagnostics, most ACM diagnostic situations remain primarily research tools rather than practical clinical diagnostic methods. This review critically evaluates the evidence and translational gaps in the diagnosis of ACM, synthesizing the emerging role of advanced diagnostics and their clinical and prognostic implications as a key future tool for individual risk stratification. Full article

Background: Obstructive sleep apnea (OSA) and primary aldosteronism (PA) are linked by bidirectional mechanisms. Although guidelines recommend PA screening in hypertensive patients with OSA, simple tools for clinical prioritization remain limited. We aimed to characterize clinical, polysomnographic, and biochemical features associated with coexisting PA in patients with OSA. Methods: We conducted a cross-sectional study in 107 adults with OSA and definitive PA classification, including 30 patients in the OSA+PA group and 77 in the OSA-only group. Clinical, polysomnographic, and fasting biochemical variables were collected using standardized procedures. Multivariable logistic regression was used to examine factors associated with coexisting PA. Results: Compared with the OSA-only group, the OSA+PA group had a larger neck circumference (42.0 ± 4.6 vs. 39.8 ± 3.7 cm, p = 0.010), a higher snoring index (369.9 ± 320.3 vs. 252.0 ± 264.9, p = 0.040), and higher aldosterone levels (25.8 ± 18.8 vs. 10.7 ± 7.3 ng/dL, p = 0.001), while glycated hemoglobin was lower (6.4 ± 1.6 vs. 7.5 ± 2.1, p = 0.005) and serum potassium was significantly reduced (3.5 ± 0.4 vs. 4.0 ± 0.4 mmol/L, p = 0.001). In multivariable analysis, aldosterone (OR = 1.138, p = 0.001) and serum potassium (OR = 0.017, p = 0.001) were associated with coexisting PA. Conclusions: Higher aldosterone and lower serum potassium were readily available biochemical features associated with coexisting PA among clinically selected patients with OSA. Full article

Obstructive sleep apnea (OSA) is characterized by chronic intermittent hypoxia (CIH), which contributes to systemic metabolic disorders. However, the mechanisms underlying CIH-induced intestinal dysfunction remain unclear. In this study, we investigated the effects of CIH on intestinal barrier integrity, gut microbiota, and host metabolism using a multi-omics approach. Male C57BL/6J mice were exposed to six weeks of CIH or normoxia. Colonic barrier integrity was assessed by histological and molecular analyses. Gut microbiota was profiled by full-length 16S rRNA gene sequencing. Untargeted metabolomics was performed on fecal and serum samples, followed by integrated microbiome–metabolome analysis. CIH markedly impaired colonic barrier integrity, as evidenced by disrupted crypt architecture, reduced goblet cell abundance, and decreased expression of ZO-1, Occludin, and Claudin-5. CIH also induced gut microbial dysbiosis, characterized by depletion of the beneficial mucin-associated bacterium Akkermansia muciniphila and enrichment of several anaerobic taxa. Metabolomic analysis revealed opposite alterations of PC (20:2/0:0) and LysoPE (20:5/0:0) between feces and serum, whereas melatonin was consistently decreased in both compartments. Integrated multi-omics analysis further revealed close associations between microbial dysbiosis and metabolic remodeling. Collectively, these findings demonstrate that CIH disrupts intestinal homeostasis through coordinated alterations in barrier integrity, gut microbiota composition, and host metabolism, providing new insights into the intestinal mechanisms underlying OSA-associated systemic dysfunction. Full article

Objective: Obstructive sleep apnea (OSA) during pregnancy is associated with adverse maternal and fetal outcomes, yet commonly used screening questionnaires may perform differently because of pregnancy-specific physiological changes. This study compared questionnaire-based OSA risk classifications obtained using the Berlin Questionnaire and STOP-BANG and examined their associations with metabolic parameters and diabetes-related history. Methods: This cross-sectional study included 210 pregnant women attending a tertiary obstetrics clinic. Berlin Questionnaire high risk was defined as positivity in at least two categories. STOP-BANG scores of 0–2, 3–4, and 5–8 indicated low, moderate, and high risk, respectively. Sociodemographic, obstetric, anthropometric, and biochemical variables were analyzed using multivariable logistic regression. Results: The Berlin Questionnaire classified 34 participants (16.2%) as high risk. STOP-BANG classified 183 (87.1%) as low risk, 5 (2.4%) as moderate risk, and 22 (10.5%) as high risk. Higher current weight was associated with increased questionnaire-based OSA risk according to both tools. In the Berlin model, HbA1c, BMI, and family history of diabetes were independently associated with high questionnaire-based OSA risk. No independent associations were identified in the STOP-BANG model. Although the Berlin model had 83.3% overall accuracy, it correctly classified only 2.9% of high-risk participants. Conclusions: The questionnaires identified different patterns of OSA risk. Findings were instrument-specific and do not indicate confirmed OSA. Given the absence of polysomnography, modest model performance, and limited high-risk classification, the results should be interpreted cautiously. Full article

Wearable sleep monitoring systems provide a scalable and low-burden alternative to laboratory-based polysomnography, but overnight physiological recordings collected from wearable sensors are frequently corrupted by poor skin contact, sensor displacement, flatline behavior, saturation, abrupt autoscaling, outliers, and non-physiological noise. These low-quality segments can prevent reliable extraction of clinically relevant biomarkers, including heart rate, heart rate variability, pulse rate, oxygen saturation, and electrodermal activity, thereby limiting the robustness of downstream sleep stage classification and sleep apnea prediction. In this work, we present a multistage hybrid anomaly detection framework for signal quality assessment in a custom-designed multimodal wearable sleep monitoring platform. The proposed framework is shared across modalities: each sensor stream is segmented into windows, screened using signal processing algorithms for obvious sensor failures, and then analyzed using an autoencoder trained on normal windows to detect subtler morphology-level deviations from normal physiological patterns. On chest ECG recordings collected over 10 overnight sessions, the hybrid fusion detector achieves an accuracy of 0.9067, AUROC of 0.9068, F1 score of 0.8739, precision of 0.9470, and recall of 0.8202, outperforming rule-based detection and autoencoder-based detection alone. Additional experiments on PPG, EDA and ExG recordings show consistently high F1 scores of 0.9431, 0.9567 and 0.8728, respectively. These results demonstrate that hybrid anomaly detection can serve as an effective quality-control layer for multimodal wearable sleep monitoring and provide a foundation for future work on robust sleep stage and apnea prediction under real-world sensing conditions. Full article

Background: Obstructive sleep apnea (OSA) has been implicated in declarative memory impairment. Here, we evaluated immediate recall and overnight declarative memory in patients with suspected OSA before and after standard clinical management in a longitudinal cohort of 265 patients. Methods: A nocturnal polysomnographic study (PSG) was performed at baseline and repeated six months later. The Pictorial-Based Declarative Memory Questionnaire (PDMQ) was administered and consisted of four learning trials followed by free-recall 10 min before PSG and the following morning upon awakening. The primary cognitive endpoint was the change in pictorial declarative memory performance from baseline to 6-month follow-up, expressed as the number of correctly recalled items on the PDMQ. Results: Both immediate and delayed recall performances significantly improved in the no OSA/mild OSA and severe OSA groups, whereas only immediate recall improved in the moderate OSA group. In the severe group, comparisons between patients whose apnea–hypopnea index decreased to <30 events/hour and those whose AHI remained >30 revealed significant cognitive improvements in both subgroups, particularly in initial and late trials (Trials 1, 2, 5, 6). In multivariable models, baseline PDMQ performance and indices of SpO₂ desaturation and sleep fragmentation emerged as independent predictors of change in declarative memory. Conclusions: These findings suggest that routine clinical management of patients with OSA was accompanied by modest, albeit statistically significant improvements in declarative memory, and that both intermittent hypoxia and sleep fragmentation play important roles in memory change. Full article

Background/Objectives: Pediatric obstructive sleep apnea (OSA), particularly when accompanied by mandibular retrognathia, presents as a complex, multifactorial condition. Dentofacial orthopedic treatment (DOT) has gained increasing clinical attention; however, high-level evidence specifically demonstrating its efficacy in pediatric OSA remains scarce. This study aimed to evaluate the efficacy of DOT and AT in managing mild to moderate OSA in children with mandibular retrognathia. Methods: This open-label, randomized controlled clinical trial recruited 93 children aged 7–10 years with mild to moderate OSA (an AHI of 1–10 events per hour) and mandibular retrognathia (ANB angle ≥ 4.5°). Participants were randomly allocated to four groups: pharmacotherapy, DOT (combined maxillary expansion and mandibular advancement appliance), AT (adenotonsillectomy under general anesthesia), and AT & DOT groups. The primary outcome was the change in apnea–hypopnea index (AHI) from baseline to 7 months post-treatment. Secondary outcomes included assessments of dentofacial development and volumetric changes in the upper airway. Results: Because of the high dropout/loss-to-follow-up rates in the pharmacotherapy and AT plus DOT groups, the final analysis was restricted to the DOT and AT groups, in which the overall dropout/loss-to-follow-up rate was 19.6%. Among the 43 participants allocated to the DOT (8 girls and 15 boys) and AT groups (8 girls and 12 boys), 36 completed the follow-up, the median baseline AHI was 3.7 events/h [IQR, 1.9–4.4]. Per protocol analysis revealed a mean reduction in AHI of 1.6 events/h in the DOT group and 1.3 events/h in the AT group, with no significant difference between the groups (−0.43 [95% CI, −1.48 to 0.61], p = 0.40). DOT significantly promoted sagittal mandibular growth without inducing a vertical clockwise rotation tendency, whereas AT had no significant effect on dentofacial development. Total upper airway volume increased significantly in both groups, with the increase concentrated in different regions of the upper airway depending on the group. Conclusions: In children with mild to moderate OSA and mandibular retrognathia, DOT demonstrated comparable efficacy to AT, which may be attributable to favorable anatomical remodeling of the upper airway. Full article

Obstructive sleep apnea (OSA) affects nearly one billion adults worldwide and involves mechanical upper-airway obstruction alongside metabolic dysfunction, systemic inflammation, and gut–brain axis disruption. Despite the efficacy of continuous positive airway pressure (CPAP), suboptimal long-term adherence highlights the need for complementary pharmacological strategies. This narrative review synthesizes preclinical and clinical evidence on GLP-1-based therapies, encompassing selective GLP-1 receptor agonists and tirzepatide, a dual GIP/GLP-1 receptor agonist, in obesity-associated OSA. Preclinical studies show that GLP-1 receptor activation can reduce visceral adiposity, attenuate pro-inflammatory signaling, improve glucose and lipid metabolism, and modulate hypothalamic appetite circuits. However, the only identified murine study evaluating liraglutide during intermittent hypoxia—an experimental model of one component of OSA rather than the complete disorder—did not reverse hypoxia-induced insulin resistance, indicating that persistent intermittent hypoxia may limit metabolic improvement in that model. Clinically, liraglutide and tirzepatide have reduced the apnea–hypopnea index (AHI) and improved several cardiometabolic outcomes. Numerically larger AHI reductions were reported in the tirzepatide trials, although no head-to-head comparison with selective GLP-1 receptor agonists is available. Tirzepatide is approved by the U.S. Food and Drug Administration for moderate-to-severe OSA in adults with obesity, together with a reduced-calorie diet and increased physical activity, and may be used without concomitant positive airway pressure in eligible patients or as an adjunct to ongoing therapy. The observed respiratory benefits appear to be mediated predominantly by weight loss and related reductions in mechanical and metabolic burden. Evidence supporting additional weight-independent mechanisms remains insufficient, and longer-term mechanistic studies in broader populations are required. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a sleep condition characterized by intermittent hypoxia, systemic inflammation, and metabolic dysfunction. Contemporary diagnosis criteria depend on polysomnography (PSG), a procedure that is limited by cost and accessibility. Identifying reliable circulating biomarkers may facilitate disease diagnosis and treatment monitoring. Methods: Insulin-like growth factor binding protein-7 (IGFBP-7) has been implicated in pathways relevant to OSA, although its precise role remains elusive. While we previously identified IGFBP-7 as a candidate of interest, in this report, we assessed circulating IGFBP-7 levels in a single-cohort study of 164 participants (124 with OSA, 40 controls) at the Dasman Diabetes Institute. A Type I PSG test was performed in a level 1 sleep laboratory to diagnose sleep apnea. Among the 124 patients with OSA who underwent multilevel sleep surgery (MLS), 67 completed the 3-month postoperative follow-up and were included in the longitudinal analyses. In these participants, we evaluated the apnea–hypopnea index (AHI) at baseline and 3 months after surgery and examined the associations between circulating IGFBP-7 levels, OSA severity indices, and metabolic parameters. Results: Our data revealed a significant increase in IGFBP-7 levels in people with OSA compared to controls (p < 0.001). Importantly, the increase in IGFBP-7 was positively correlated with AHI (r = 0.272, p < 0.001), indicating a potential link with this condition. IGFBP-7 levels declined significantly following MLS (p < 0.001), paralleling improvements in AHI and suggesting responsiveness to therapeutic intervention and a reduced hypoxic burden. IGFBP-4 levels increased significantly in patients with OSA (p = 0.006) but were not correlated with IGFBP-7. The receiver operating characteristic (ROC) analysis identified IGFBP-7 with a cut-off value of 14,003.21 pg/mL as a potential biomarker for OSA, with moderate performance (AUC = 0.722, 95% CI: 0.636–0.808; sensitivity 73%, specificity 84%). Notably, combining IGFBP-7 with IGFBP-4 resulted in a modest improvement (AUC = 0.755). Conclusions: Our data suggest that IGFBP-7 shows a modest association with OSA severity and may have exploratory value as part of a multi-marker or risk-stratification approach. Further large-scale and longitudinal studies are warranted to extensively explore the potential utility of IGFBP-7 within multi-marker approaches. Full article

Obstructive sleep apnea syndrome (OSAS) is heavily implicated in subclinical cardiovascular disease; however, traditional polysomnographic metrics fail to capture the localized mechanical trauma exerted on the carotid artery. To address this methodological gap, this study evaluated exploratory associations between frequency-domain snoring characteristics and right carotid artery alterations in 50 patients with OSAS. Snoring was quantified using a dual-modality bioelectronic approach: an ambient microphone captured airborne snoring sound energy (SSE), while a portable neck-surface piezoelectric sensor recorded tissue-conducted snoring vibratory energy (SVE). Subclinical vascular changes, including carotid intima-media thickness (CIMT) and atherosclerosis, were assessed via ultrasonography. Hierarchical multivariable regression demonstrated that acoustic SSE%-404–500 Hz and mechanical SVE%-112–144 Hz independently correlated with preliminary CIMT increases (adjusted β = 0.033 and 0.021, respectively; both p < 0.05), alongside neck circumference. Conversely, SSE%-404–500 Hz emerged as an exploratory marker for focal carotid atherosclerosis (adjusted odds ratio = 1.828; p = 0.009). Integrating this metric with baseline parameters yielded exploratory diagnostic capacity (area under the curve = 0.833; p < 0.001), achieving 89% sensitivity and 69% specificity. These findings suggest that dual-modality spectral analysis provides a non-invasive exploratory framework for cardiovascular risk stratification, isolating localized mechanotransduction phenotypes independently of systemic hypoxia. Full article