Search Results (151)

Background: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for the treatment of snoring and obstructive sleep apnea. In a retrospective clinical trial, we compared the two surgical techniques regarding objective sleep parameters and patients’ reported outcomes. Materials and Methods: Patients treated with UPPP or ESP between January 2016 and February 2020 were included in this retrospective clinical trial. Pre- and postoperative AHI, BMI, and smoking habits were recorded. Subjective improvement was assessed by the ESS score and symptom relief reported by patients and their bed partners. Results: Between 2016 and 2020, 114 patients were included in the study, 74 patients suffered from OSA, and 30 patients had non-apnoeic snoring (AHI < 5/h). No preoperative sleeping studies were available in 10 patients (10/114; 9%). Based on the findings during drug-induced sedation endoscopy, most patients received an ESP (71/114, 62%), and 43 patients received a UPPP (43/114, 38%). Additionally, in 52/114 (46%), radio frequency ablation of the tongue base was performed if DISE revealed retrolingual collapse. ESP reduced AHI from 21.1 ± 10.8/h to 13.3 ± 12.1/h (p = 0.04), whereas UPPP caused a non-significant decrease in the AHI from 25.0 ± 13.8/h to 18.2 ± 14.6/h (p = 0.6). A minor secondary bleeding was observed in 32 patients, which was effectively treated with electrocautery or conservative therapy (32/114). This was more common in the ESP group (22/71; 31%) than in the UPPP group (10/43; 23%). Postoperative need for analgesics was higher in the ESP group than in the UPPP group. The ESS score showed no significant improvement after UPPP or ESP (p = 0.3), but subjective improvement in snoring was reported by 87/114 (76%) patients. Conclusion: AHI reduction was significantly higher in the ESP patient group than in the UPPP group. ESP patients had a slightly higher rate of minor secondary bleeding and postoperative need for analgesics than UPPP patients. Full article

Obstructive sleep apnoea (OSA) is a prevalent condition characterised by intermittent upper airway obstruction during sleep, resulting in recurrent hypoxia and sleep fragmentation. Emerging evidence highlights the significant impact of OSA on neuro-ophthalmological health, linking it to conditions such as glaucoma, optic neuropathy, papilledema, and visual field defects. These associations emphasise the importance of understanding the mechanisms connecting OSA to neuro-ophthalmological disorders to enhance early diagnosis and management. This review explores the pathophysiological pathways, including hypoxia-induced vascular dysregulation, oxidative stress, inflammation, and intracranial pressure fluctuations, that contribute to ocular and neurological impairments in OSA patients. Advanced diagnostic tools, such as optical coherence tomography and polysomnography, offer promising avenues for detecting subclinical neuro-ophthalmological changes, enabling timely intervention. Management strategies, primarily centred on continuous positive airway pressure therapy, have shown efficacy in mitigating OSA-related neuro-ophthalmological complications. However, surgical and pharmacological interventions and lifestyle modifications remain vital components of a multidisciplinary approach to care. Despite advancements, significant research gaps persist, particularly in understanding the long-term impact of OSA treatment on neuro-ophthalmological outcomes and identifying specific biomarkers for early detection. Future research should prioritise longitudinal studies, interdisciplinary collaborations, and personalised medicine approaches to address these challenges. Recognising and treating neuro-ophthalmological disorders in OSA patients is imperative for improving quality of life and preventing irreversible visual and neurological damage. Full article

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

Background: Treacher Collins Syndrome (TCS) is a rare, congenital craniofacial syndrome. Its most characteristic feature is mandibular and midface hypoplasia. Due to malformations of the facial skeleton, airway abnormalities can also be observed, predisposing individuals to obstructive sleep apnoea (OSA). OSA in TCS may contribute to significant morbidity, including developmental delays, cardiovascular disorders and reduced quality of life. Objectives: This narrative review aims to present the true prevalence of OSA and the treatment options for TCS patients. Additionally, the pathophysiology and diagnostic tools for this condition were briefly outlined. Methods: The literature search included publications from PubMed, Scopus, Web of Science and Cochrane Library. The chosen period of time for these publications was 2000–2024. Results: The results showed that OSA is a serious problem among TCS patients. Although there is no standardised treatment protocol, the primary methods often include mandibular distraction osteogenesis (MDO) and continuous positive airway pressure (CPAP). Approaches such as hypoglossal nerve stimulation (HNS) need further investigation, especially with longitudinal observations. Conclusions: The development of treatment options seems to be promising, suggesting a favourable outlook for standardising the treatment protocols. Full article

Background: Snoring and mild to moderate obstructive sleep apnoea (OSA) are common sleep-related breathing disorders with increasing demand for minimally invasive treatment options. This study aimed to systematically evaluate the efficacy and safety of erbium:yttrium–aluminium–garnet (Er:YAG) laser therapy for these conditions. Methods: A systematic review and meta-analysis were conducted in line with PRISMA guidelines. Studies published between 2015 and 2025 were retrieved from major biomedical databases based on predefined inclusion criteria. Data were extracted on treatment outcomes, laser parameters, patient characteristics, and adverse effects. Results: Fifty-six studies were included. Er:YAG laser treatment, particularly in non-ablative SMOOTH and long-pulse modes, significantly reduced snoring intensity and improved subjective sleep quality. High patient satisfaction (65–85%) and a favourable safety profile were observed, with adverse effects generally mild and transient. Therapeutic effects typically lasted 12–24 months, though 25–40% of patients required maintenance sessions. Treatment success was associated with BMI, oropharyngeal anatomy, smoking status, and baseline apnoea-hypopnoea index scores (AHI 5–30 events/hour). Conclusions: Er:YAG laser therapy appears to be a safe and effective short- to medium-term treatment for selected patients with snoring or mild to moderate OSA. Optimising patient selection and treatment protocols may enhance long-term outcomes. Based on moderate-quality evidence for the immediate effects and safety profile, but low to very low quality evidence for long-term outcomes, erbium:yttrium–aluminium–garnet laser treatment appears to be a potentially effective and well-tolerated option for achieving short- to medium-term improvement in carefully selected patients with primary snoring or mild to moderate obstructive sleep apnoea. The practical significance of these findings lies in the refinement of candidate selection criteria, laser parameter settings, and the development of optimal protocols for long-term snoring control. Full article

Background and Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is a burdensome symptom associated with impaired patient-reported outcomes. There is a paucity of research in this area with unclear aetiology, under-reporting of this symptom, and limited treatment options and management strategies in clinical settings. The objective of this study was to investigate the prevalence of CKD-aP, patient and dialysis-related factors associated with the occurrence of CKD-aP, and the correlation between CKD-aP severity and quality of life, sleep, anxiety, and depression. Materials and Methods: This cross-sectional study was conducted in 88 adult (≥18 years) patients undergoing haemodialysis at the outpatient dialysis centre at a major Australian tertiary care university teaching hospital. Demographic- and dialysis-related factors were obtained from electronic medical records and/or patients, while patient outcomes were determined from the self-reported questionnaires; 5-D itch scale, EQ-5D-5L, Patient Health Questionnaire-9, and Beck Anxiety Inventory. We compared demographic, patient-, and dialysis-related factors associated with CKD-aP. Results: Out of 88 patients, 67 (76%) agreed to participate in the study. In total, 27 patients (40%) reported having CKD-aP. Most participants experienced moderate CKD-aP severity (n = 12), followed by severe or very severe (n = 9) and mild (n = 6) symptoms. Whilst there was no significant difference in the demographic characteristics, number of medications, dialysis vintage, and Kt/V, a higher number of pruritic participants experienced obstructive sleep apnoea. There was a statistically significant correlation between CKD-aP severity and depression scores (p = 0.009). However, there were no significant correlation between CKD-aP and HRQOL (p = 0.506). The correlations between CKD-aP severity and outcomes such as sleep and anxiety were also not statistically significant, although they were marginally close (p = 0.069 and p = 0.095, respectively). Conclusions: This study reports a substantial prevalence of CKD-aP reported among patients undergoing HD and the association of severe CKD-aP with depression. Despite the limitation of a small sample size from a single dialysis centre, our findings suggest that the severity of CKD-aP may have implications for patient-reported outcomes. This warrants further investigation in larger-scale studies to better understand the association and optimise outcomes. Full article

Introduction: Older people with sleep disturbances also have other chronic pathologies that may interfere with these disturbances. One of the comorbidities that is frequently present is type 2 diabetes. Objective: This research aims to find out whether type 2 diabetes mellitus present in elderly people affects the level of severity of obstructive sleep apnoea syndrome (OSAS). Methodology: A cross-sectional descriptive study was carried out on a sample of 134 elderly people who attended the Sleep Unit of Andalusia’s Door Hospital in Jaen, who were diagnosed with OSAS and classified according to severity. A total of 34 participants had a diagnosis of diabetes mellitus at the time of the study. Results: There were significant differences in the severity of obstructive sleep apnoea syndrome between participants with and without type 2 diabetes mellitus, with the former having higher scores (p < 0.01). Participants with a BMI that classified them as obese had more severe apnoea than those with a normal weight at the time of the study (p = 0.043). Discussion: This study, focused exclusively on older adults, demonstrates an association between type 2 diabetes mellitus and a greater severity of OSAS. Using polysomnography (PSG) as the gold standard, we identified a significant relationship between obesity and severe OSAS. Furthermore, the connection between OSAS, type 2 diabetes mellitus, and CPAP use highlights the importance of a comprehensive approach in this population. Full article

Background/Objectives: Paediatric Obstructive Sleep Apnoea (OSA) is characterised by recurrent episodes of upper airway obstruction during sleep, manifesting as snoring, intermittent oxygen desaturation, and frequent nocturnal awakenings. Standard treatments include surgical interventions, pharmacological therapies, intranasal corticosteroids, and oral montelukast. However, significant variability exists across studies regarding dosage and outcome assessment. This literature review systematically evaluated clinical evidence regarding the efficacy and safety of intranasal corticosteroids and oral montelukast for treating sleep-disordered breathing and its primary underlying condition, adenoid hypertrophy, in otherwise healthy children. Methods: The MEDLINE (PubMed), Scopus, and Web of Science databases were systematically searched up to 13 February 2025, using tailored search terms combining keywords and synonyms related to paediatric OSA, adenoidal hypertrophy, corticosteroids, montelukast, and randomised controlled trials. Owing to variability in outcome measures, Fisher’s method for p-value combination was employed to enable a comprehensive comparison of drug effects. Results: Available evidence shows that intranasal corticosteroids (mometasone, beclometasone, budesonide, fluticasone, and flunisolide), either as monotherapy or in combination with other agents, consistently lead to clinical and instrumental improvements in adenoid hypertrophy and related respiratory symptoms, with a generally favourable safety profile. Combining montelukast with intranasal corticosteroids appears to offer superior benefits compared with monotherapy. Nevertheless, the reviewed studies varied widely in dosage, treatment duration, design, and sample size. The reported side effects are mostly mild; however, long-term studies are lacking to establish the complete safety of these treatments in children. Conclusions: Intranasal corticosteroids and oral montelukast effectively and safely manage adenoid hypertrophy and mild-to-moderate OSA symptoms in children. Nonetheless, the heterogeneity of study designs necessitates larger prospective trials with standardised protocols and more extended follow-up periods to draw more robust conclusions. Future studies should aim to stratify treatment outcomes based on OSA severity and duration to tailor therapeutic approaches better. Full article

Background and Objectives: Sleep disorders are highly prevalent in society and require focused attention within healthcare systems. While patient history, reported complaints, and subjective sleep questionnaires can provide initial insights into potential sleep issues, polysomnography (PSG) remains the gold standard for diagnosing various sleep disorders. However, long waiting times for PSG appointments in many healthcare facilities pose challenges for timely diagnosis and treatment. This study aimed to evaluate the diagnostic value of subjective measures, including patient-reported parameters, in comparison to the objective findings of PSG. Materials and Methods: In this study, we retrospectively analysed the data from 562 patients who underwent clinical evaluation and PSG testing at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2018 and 2024. We report the diagnostic accuracy of different sleep questionnaires to detect various sleep disorders in our population. Results: We report the corresponding sensitivity and specificity values: the Epworth Sleepiness Scale (ESS)—73.2% and 44.1% for detecting severe obstructive sleep apnoea and 87.1% and 76.8% for detecting hypersomnia; the Insomnia Severity Index (ISI)—77.2% and 63.3% for detecting insomnia; the Berlin Questionnaire (BQ)—67.8% and 68.8% for detecting obstructive sleep apnoea; the Ullanlina Narcolepsy Scale (UNS)—84.4% and 58.9% for detecting hypersomnia; the Innsbruck REM Sleep Behaviour Disorder Inventory (RBD-I)—93.3% and 52.5% for detecting RBD; the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q)—73.3% and 81.0% for detecting RBD; and the Paris Arousal Disorder Severity Scale (PADSS)—57.5% and 90.5% for detecting parasomnia. Conclusions: When comparing our findings with the previous literature, we found that the screening tools generally demonstrated a slightly poorer performance in our population. However, our results suggest that certain individual questions from the comprehensive questionnaires may provide comparable diagnostic values, while reducing the patient burden. We propose a targeted screening approach that integrates fundamental clinical parameters, key screening questions, and selected validated questionnaires, enabling primary care and outpatient clinicians to more efficiently identify patients who may require referral for specialised sleep evaluation and treatment. Full article

The sympathetic division of the autonomic nervous system plays a crucial role in maintaining homeostasis, but its overactivity is implicated in various pathological conditions, including hypertension, hyperglycaemia, heart failure, and rheumatoid arthritis. Traditional pharmacotherapies often face limitations such as side effects and poor patient adherence, thus prompting the exploration of device-based multi-organ denervation as a therapeutic strategy. Crucially, this procedure can potentially offer therapeutic benefits throughout the 24 h circadian cycle, described as an “always-on” effect independent of medication compliance and pharmacokinetics. In this comprehensive review, we evaluate the evidence behind targeted multi-organ sympathetic denervation by considering the anatomy and function of the autonomic nervous system, examining the evidence linking sympathetic nervous system overactivity to various cardiometabolic and inflammatory conditions and exploring denervation studies within the literature. So far, renal denervation, developed in 2010, has shown promise in reducing blood pressure and may have broader applications for conditions including arrhythmias, glucose metabolism disorders, heart failure, chronic kidney disease and obstructive sleep apnoea. We review the existing literature surrounding the denervation of other organ systems including the hepatic and splenic arteries, as well as the pulmonary artery and carotid body, which may provide additional physiological benefits and enhance therapeutic effects if carried out simultaneously. Furthermore, we highlight the challenges and future directions for implementing multi-organ sympathetic ablation, emphasising the need for further clinical trials to establish optimal procedural technique, efficacy and safety. Full article

Background/Objectives: This study investigates differences in craniofacial morphology including skull thickness, sella turcica morphology, nasal bone length, and posterior cranial fossa dimensions, as well as differences in head posture and deviations in upper spine morphology, in adult OSA patients compared to healthy controls with neutral occlusion. Methods: 51 OSA patients (34 men, 17 women, mean age 51.9 ± 11.3 years) and 74 healthy controls (19 men, 55 women, mean age 38.7 years ± 14.0 years) with neutral occlusion were included. Craniofacial morphology and head posture were investigated using cephalometric measurements on lateral cephalograms and morphological deviations in sella turcica and upper spine were assessed through visual description of lateral cephalograms. Results: OSA patients had significantly more retrognathic maxilla (p = 0.02) and mandible (p = 0.032 and p = 0.009), significantly larger beta-angle (p = 0.006), and significantly smaller jaw angle (p = 0.045) compared to controls. OSA patients had significantly larger length (p = 0.003, p = 0.001, p = 0.044) and depth of the posterior cranial fossa (p < 0.001) compared to controls. OSA patients had a significantly more extended (p < 0.001) and forward-inclined head posture (p < 0.001) and morphological deviations in the upper spine occurred significantly more often in OSA patients compared to controls (p = 0.05). No significant differences in skull thickness, nasal bone length, and morphological deviations in the sella turcica (p = 0.235) were found between the groups. Conclusions: Significant deviations were found in craniofacial morphology, head posture, and morphological deviations in the upper spine. The results may prove valuable in the diagnostics of OSA patients and in considerations regarding etiology and the phenotypic differentiation of OSA patients. Full article

Background/Objectives: Sleep-disordered breathing (SDB) is a primary concern in children’s health. Research suggests that repeated oxygen drops during sleep—common in SDB—may harm the brainstem’s breathing control centres. This damage likely occurs through oxidative stress, inflammation, and cell death, which weaken the brain’s ability to regulate breathing. Over time, these effects could lead to functional changes (e.g., disrupted chemical signalling) and physical damage in critical brain regions, creating a cycle of unstable breathing. However, much of this evidence comes from animal or lab studies, leaving gaps in our understanding of how these mechanisms work in humans. This review synthesises existing research on how breathing disruptions during sleep—particularly episodes of intermittent hypoxia—affect the brain’s ability to control respiration in children and adolescents. Methods: We analysed studies from medical databases PubMed, Scopus, and Web of Science, focusing on how SDB (obstructive or central sleep apnoea) impacts the brain’s respiratory centres in young populations. Animal studies and research involving children on mechanical ventilation were excluded to focus on natural sleep patterns. Results: After removing duplicates, 54 studies remained. Additionally, 43 record were excluded for various reasons. Ultimately, 11 articles were selected for the final analysis, including three that focused on genetic conditions, such as Down syndrome, Prader–Willi syndrome, and Pierre Robin sequence. The findings suggest that repeated oxygen dips during sleep may harm the brainstem’s respiratory control areas, especially during critical developmental stages. This damage could lead to long-term issues, such as unstable breathing, cardiovascular strain, or neurological problems. However, most studies only captured the immediate effects of low oxygen, leaving uncertainty about permanent harm due to a lack of long-term follow-up. Conclusions: Repeated oxygen deprivation during sleep appears to damage the brainstem and disrupt breathing regulation. However, small study sizes and short observation periods limit the strength of these conclusions. Future research should use advanced imaging tools to clarify long-term risks, develop effective treatments, and track children over extended periods. More significantly, longer-term studies are urgently needed to guide clinical care for vulnerable populations. Full article

Aldosterone, the primary adrenal mineralocorticoid hormone, as an integral part of the renin–angiotensin–aldosterone system (RAAS), is crucial in blood pressure regulation and maintaining sodium and potassium levels. It interacts with the mineralocorticoid receptor (MR) expressed in the kidney and promotes sodium and water reabsorption, thereby increasing blood pressure. However, MRs are additionally expressed in other cells, such as cardiomyocytes, the endothelium, neurons, or brown adipose tissue cells. Therefore, aldosterone (especially aldosterone excess) may have other major impacts besides simply regulating blood pressure and circulating ion balance. Recent studies have reported a non-hypertensive impact on the cardiovascular, immune, and metabolic systems, a pro-oxidant effect, and a pro-fibrotic effect. In this review, we emphasise the non-hypertension-related effects of aldosterone, including advances in our understanding of the cellular mechanisms by which aldosterone mediates its cellular effects. We also summarise potential clinical complications related to both the hypertensive and non-hypertensive effects of aldosterone. Full article

Background/Objectives: Obstructive sleep apnoea (OSA) is a sleep-related breathing condition that involves the presence of episodic disruptions to the sleeping pattern due to partial or complete airway obstruction. There are a range of treatment options that exist to alleviate the symptoms of this condition including CPAP, mandibular advancement, and maxillary expansion techniques. This systematic review and meta-analysis of published articles aims to determine if rapid maxillary expansion (“RME”) is an effective treatment option in the management of OSA, using quantitative parameters of AHI and SpO₂. Methods: An exhaustive review of the literature was conducted on EBSCO, PubMed, and Scopus databases. The PICO question for the systematic review was “Can rapid maxillary expansion be used as a viable treatment option using comparative AHI and SpO₂ parameters in the management of obstructive sleep apnoea?” A meta-analysis was also performed and the software used to carry out the meta-analysis was R 4.3.2 (R Core Team (2013)). Results: From the initial search, 62 articles were found and a further 4 articles were obtained from manual findings. Nine articles were included in the final systematic review and meta-analysis. Eight of the studies concluded that RME was successful to varying degrees in the management of OSA across both outcome variables assessed. The meta-analysis indicated that RME is an effective treatment option in the management of adult and paediatric OSA with the improvement of both parameters. The paediatric OSA sample with specific pre-treatment anatomical presentation (clear maxillary deficiency, narrow hard palate with crossbite) showed a noted resolution of OSA following RME at a pre-pubertal age, indicating that RME can be employed as a genuine treatment option for paediatric OSA as suggested by theory. Conclusions: The systematic review and meta-analysis provided sufficient significant data in favour of the alternative hypothesis to indicate that RME is an effective treatment option in the management of obstructive sleep apnoea, in terms of the AHI reduction and SpO₂ increase. Full article

Transoral robotic surgery (TORS) for tongue base reduction (TBR) and/or epiglottic surgery is an effective treatment option for selected patients with moderate to severe obstructive sleep apnoea (OSA). This systematic review aims to provide an up-to-date overview of current practices and challenges associated with TORS for OSA. PubMed and Embase databases were searched up to December 2022 following PRISMA guidelines. Primary outcome measures were surgical technique, intraoperative measures, postoperative management and complications. A total of 32 articles, including 2546 patients, met the inclusion criteria. TORS was most commonly performed as part of a multilevel surgical approach. Nasotracheal intubation was the preferred method for general anaesthesia. The surgical technique for TORS tongue base and epiglottis did not differ significantly among institutions, although some variations exist. Postoperative management varied, with most authors aiming for immediate postoperative extubation, routine postoperative ward admission and early oral intake initiation. Common postoperative complications were dysphagia and bleeding, with no reported mortality. TORS is established as a safe and feasible surgical option for selected OSA patients, addressing tongue base and/or epiglottic obstruction. However, further studies are required to determine patients’ selection criteria, preferred volume of excised tongue tissue and to assess the necessity for postoperative intensive care unit monitoring. Full article