Search Results (598)

Background/Objectives: Obstructive sleep apnea (OSA) is a common and serious sleep-related disorder that causes repeated interruptions in breathing during sleep. Traditional diagnostic methods, such as polysomnography, are accurate but costly, time-consuming, and unsuitable for large-scale screening. This study proposes and evaluates a lightweight diagnostic framework based on an Extreme Learning Machine (ELM) optimized by a set of basic and advanced metaheuristic optimizers. The model aims to evaluate whether metaheuristic optimization can improve ELM-based classification performance using structured demographic, clinical, and sleep-related predictors. Methods: Two real datasets were employed to train and evaluate the proposed framework: (i) a clinical OSA dataset with 274 subjects and 31 demographic/anthropometric and sleep-related predictors, and (ii) a public strongly imbalanced Sleep-Disordered Breathing (SDB) dataset with 500 subjects and 10 structured predictors. Metaheuristic algorithms are used to optimize ELM weights and biases, addressing the instability of random initialization and improving model generalization. The optimized models are evaluated against eight baseline classifiers, including logistic regression (LR), k-nearest neighbors (KNN), decision tree (DT), random forest (RF), support vector machine (SVM), multilayer perceptron (MLP), XGBoost (XGB), and a standard ELM classifier. Results: Results show that metaheuristic optimization moderately improves ELM on the OSA dataset, increasing ROC-AUC from 0.6527 to about 0.73 and accuracy from 0.6573 to about 0.69–0.70, while on the highly imbalanced SDB dataset, it yields modest ROC-AUC gains (from 0.5132 to about 0.544–0.548) with small decreases in accuracy and F1-score. We additionally assess class-imbalance handling on the SDB dataset and analyze feature importance with permutation importance and SHAP, which shows the models rely heavily on diagnosis-derived predictors. Conclusions: The proposed framework provides a lightweight ELM-based decision-support approach with low inference cost after offline optimization. The results suggest potential value for screening-oriented OSA/SDB classification, but further validation with larger cohorts and a screening-only feature set is needed before clinical implementation. Full article

Objectives: To explore volumetric changes in the nasopharynx, oropharynx, hypopharynx, and total pharyngeal airway after Class II functional orthodontic treatment and to relate these anatomical changes to patient-reported breathing and sleep comfort. Methods: A retrospective observational study of 63 growing patients (11–14 years) with Class II mandibular retrusion was conducted. Pre- and post-treatment cone beam computed tomography (CBCT) scans (NewTom 5G) were exported as uncompressed digital imaging and communications in medicine (DICOM) files and analyzed with Dolphin Imaging v11.9. The pharyngeal airway was manually segmented into naso-, oro-, and hypopharyngeal regions; volumes were measured twice by a single examiner to assess reliability. Inter-examiner reliability was assessed in a 15-patient subgroup. Patients completed a 5-point Likert rating of perceived breathing and sleep changes. Statistical tests included Wilcoxon signed-rank, Friedman with Holm post hoc, Mann–Whitney U, and Spearman correlation; p < 0.05 was considered significant. Results: Intra-examiner reliability was excellent (ICC1 mean 0.988), and inter-examiner reliability was good to excellent (ICC2 0.87–0.95). Mean total pharyngeal airway volume during the treatment interval in growing Class II patients treated with functional appliances increased from 18,183.62 mm³ at T0 to 23,524.42 mm³ at T1—an average augmentation of approximately 5340.80 mm³ (~29.4%). Regional gains followed the following pattern: Oropharynx > Nasopharynx > Hypopharynx. Nasopharyngeal and total airway changes were found to be associated with improvements in reported breathing (ρ = 0.79 and 0.69) and sleep comfort (total airway ρ = 0.74). Conclusions: Functional mandibular advancement in growing Class II patients was associated with enlargement of the pharyngeal airway—most notably in the oropharynx—and these volumetric gains were followed by improved patient-reported breathing and sleep comfort within the limitations of retrospective study design. Full article

Atrial fibrillation (AF) and diabetes mellitus frequently coexist and together define a high-risk cardiometabolic phenotype. Diabetes is associated with an increased incidence of AF, although this relationship is strongly influenced by obesity, hypertension, chronic kidney disease (CKD), heart failure (HF), sleep-disordered breathing, and broader metabolic risk clustering. Once AF develops, diabetes is associated with greater thromboembolic and HF risk, impaired quality of life, cognitive vulnerability, and excess mortality. These adverse outcomes may be partly explained by a multidimensional atrial substrate, described here within the conceptual framework of diabetic atrial cardiomyopathy, in which hyperglycaemia, insulin resistance, glycaemic variability, oxidative stress, inflammation, autonomic dysfunction, microvascular disease, lipotoxicity, and epicardial adipose tissue dysfunction may contribute to atrial fibrosis, electrical heterogeneity, impaired calcium handling, mitochondrial injury, and mechanical dysfunction. Collectively, these abnormalities may facilitate AF initiation, persistence, progression, and recurrence after rhythm-control interventions. Management should therefore extend beyond rhythm control and anticoagulation alone. In individuals at increased risk of AF, priorities include cardiometabolic optimization, treatment of obesity, hypertension, CKD, HF, and sleep apnoea, lifestyle intervention, and selective rhythm surveillance. In subclinical AF, decisions regarding anticoagulation should account for AF burden, thromboembolic and bleeding risk, renal function, frailty, and patient preference. In established AF, stroke prevention, symptom-directed rate or rhythm control, cardiometabolic therapy, and longitudinal reassessment remain central. This narrative review integrates the epidemiology, mechanisms, and management of AF in diabetes across the continuum from AF risk to subclinical and clinical disease. Full article

Background/Objectives: Upper airway constriction and craniofacial structural variation are recognised risk factors for paediatric sleep-disordered breathing (SDB). Population-specific normative cephalometric reference data are lacking, and are needed to characterise these features in paediatric orthodontic patients, especially in Asian populations. This study examined upper airway structure and lymphoid tissue hypertrophy in a large paediatric orthodontic population. The aims of the study were to investigate upper airway differences across skeletal patterns, age, gender, and ancestry groups, establish pharyngeal airway, skeletal, dental, and soft tissue cephalometric dimensions, and determine adenotonsillar hypertrophy prevalence in a large paediatric orthodontic population in Singapore. Methods: Lateral cephalograms of children aged 7–11 years were obtained from a national dental centre, and a retrospective analysis was performed. Standardised cephalometric measurements were used to assess airway, skeletal, dental, and soft tissue parameters, with comparisons across demographic and skeletal groups. Results: A total of 404 children (203 boys, 201 girls; aged 7.04–10.99 years) were included in the final analysis. Thirteen airway variables differed significantly by gender and age, six by antero-posterior, and four by vertical skeletal pattern. One variable (AH-CV) differed between Chinese and non-Chinese children. A form of lymphoid tissue hypertrophy (Ad/Np ≥ 0.5 and/or Tn/Op ≥ 0.5) was present in 92.3% of subjects, comprising combined adenotonsillar hypertrophy (49.5%), isolated tonsillar hypertrophy (36.6%), and isolated adenoid hypertrophy (6.2%). Conclusions: Cephalometric norms for upper airway, skeletal, dental, and soft tissue structures in a 7–11-year-old orthodontic population in Singapore were reported. Adenotonsillar hypertrophy was present in nearly half of the subjects, while isolated tonsillar hypertrophy affected about one-third. Patients who were younger, male, Chinese, Class I, Class II, and had increased mandibular plane angles displayed cephalometric features associated with anatomical risk indicators for SDB. These population-specific cephalometric reference data provide a benchmark for contextualising upper airway and craniofacial measurements in paediatric orthodontic patients, supporting the potential utility of cephalometric assessment to identify children who may benefit from referral for comprehensive SDB evaluation. Full article

Background: Gorlin–Goltz syndrome is a rare autosomal dominant condition with characteristic craniofacial and odontogenic anomalies. Orofacial alterations in childhood may precede dermatological findings, highlighting the relevance of early orthodontic and functional evaluation. Objective: This case describes a multidisciplinary orthodontic and Home Sleep Apnea Testing (HSAT)-based approach for the assessment of craniofacial morphology and sleep-disordered breathing (SDB) risk in a pediatric patient with Gorlin–Goltz syndrome. Methods: A 12-year-old male with a genetically confirmed PTCH1 mutation underwent digital intraoral scanning, orthodontic evaluation, and SDB screening using the Pediatric Sleep Questionnaire (PSQ). Following a positive screening score, HSAT with the Philips Alice NightOne^® system was performed under specialist supervision. Results: The patient showed recurrent odontogenic cysts, a lateral open bite, and unilateral Class II canine relationship. The PSQ score was 0.579, exceeding the validated cut-off of 0.33 and indicating an elevated SDB risk. HSAT findings were suggestive of mild obstructive sleep apnea based on Respiratory Event Index (REI) values (REI 4.7/h), with an isolated SpO₂ nadir of 77% and a maximum recorded apnea duration of 425 s, warranting cautious specialist interpretation and follow-up assessment. Conclusions: Integrating orthodontic assessment, digital documentation, validated screening tools, and objective HSAT-based evaluation may support the early recognition of functional compromise in syndromic pediatric patients. Positive screening results should prompt specialist referral and objective sleep assessment, while attended polysomnography remains indicated when comprehensive sleep architecture evaluation or definitive characterization is required. 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

Obstructive sleep apnea (OSA) constitutes a chronic disorder characterized by recurrent upper airway collapse during sleep. This condition is prevalent among patients with cardiac rhythm disturbances and represents a potent independent risk factor for arrhythmia. Although most studies have concentrated on the association between OSA and atrial fibrillation (AF), numerous investigations have established connections with ventricular and supraventricular arrhythmias. Arrhythmogenesis in OSA represents a complex multifactorial phenomenon. Acute mechanisms involve induction of negative intrathoracic pressure during the effort to breathe, which triggers recurrent episodes of hypoxia, hypercapnia, alterations in carbon dioxide and acid–base equilibrium, as well as surges in sympathetic nervous system activity. Chronic intermittent hypoxia (CIH) and negative thoracic pressure (NTP) induce atrial stretch, chronic structural remodeling, and elevated vagal tone, thereby heightening susceptibility to bradycardic and conduction arrhythmias. Intermediate pathways through which OSA may precipitate arrhythmia encompass heightened systemic inflammation, oxidative stress, a prothrombotic state, and vascular dysfunction. Long-term OSA is linked with atrial enlargement and fibrosis, ventricular hypertrophy, hypertension, and coronary artery disease. These factors predispose to cardiac arrhythmias through the following mechanisms: shortening of the atrial effective refractory period, abnormal automaticity, promotion of slowed and heterogeneous conduction, enhancement of reentrant arrhythmia persistence, and prolongation of the QT interval. In this paper, we aim to present the pathophysiological mechanisms underpinning the association between obstructive sleep apnea and cardiac arrhythmias. Understanding the precise pathophysiological pathways by which obstructive sleep apnea contributes to arrhythmogenesis will enable targeted preventive stratification of patients at risk for cardiovascular events and promote the development of innovative therapies to attenuate OSA-induced arrhythmogenicity. Full article

Temporomandibular disorder (TMD) and bruxism affect a significant portion of the adult population, yet why patients with comparable occlusal findings respond so differently to identical interventions remains unexplained by both structural and biopsychosocial frameworks. Traditional occlusal paradigms identified the importance of structural relationships but could not account for clinical variability. Biopsychosocial models advanced understanding of central regulation but lack the physiological specificity needed to connect regulatory state to functional jaw behavior. This paper proposes the Functional Occlusion Regulated Model (FORM), a hierarchical framework integrating central regulatory state, masticatory performance, and structure into a coherent model of jaw function, and identifies its clinical and research implications. Narrative synthesis of the peer-reviewed literature across masticatory physiology, autonomic neuroscience, pain neuroscience, and clinical dentistry was conducted; seventy-two references are cited. Converging evidence supports a three-tier hierarchy in which autonomic and neuromuscular regulatory state is proposed to shape masticatory performance, which influences how structural occlusal conditions are expressed and clinically experienced. FORM generates four testable predictions distinguishing it from existing models, and a preliminary clinical observation documents symptom resolution through regulatory intervention alone without occlusal modification, representing an early published dental observation of this connection. FORM provides a physiologically grounded framework for understanding treatment response variability and proposes central regulatory state as a potentially important upstream influence on functional jaw outcomes. Full article

Background/Objectives: Obstructive sleep apnea (OSA) and related sleep disorders affect a substantial proportion of hospitalized patients, with an estimated 48% pooled prevalence of undiagnosed OSA in cardiac inpatients and up to 80% of moderate-to-severe community OSA cases carrying no formal diagnosis at the time of hospital admission. In parallel, frailty—a state of heightened physiological vulnerability arising from cumulative multi-system biological decline—is present in 40–80% of inpatients and shares deep, bidirectional neurobiological pathways with sleep-disordered breathing through circadian dysregulation, intermittent hypoxia, hypothalamic–pituitary–adrenal axis activation, and chronic low-grade inflammation. Despite this convergence, no prior study has integrated validated, administratively computable frailty phenotyping with a machine learning framework specifically designed to predict inpatient sleep disorder diagnosis—and OSA in particular—at the point of hospital admission. The present study addresses this gap by developing an admission-time, explainable machine learning framework for the prediction of inpatient sleep disorder diagnoses (ICD-10 G47.x, encompassing OSA G47.3, insomnia G47.0, hypersomnia, and circadian rhythm disorders) and of insomnia specifically (ICD-10 G47.00). Methods: We developed and evaluated a suite of five binary classification models—XGBoost, Random Forest, LightGBM, CatBoost, and Decision Tree—using 9682 balanced hospitalization episodes from the MIMIC-IV (version 2.2) database. The predictor set comprised 23 admission-time structured features across three domains: (i) frailty and comorbidity burden, including the Hospital Frailty Risk Score (HFRS) derived from ICD-10 codes, the Elixhauser comorbidity index, prior admission history, and six binary disease flags (obesity, hypertension, type 2 diabetes, heart failure, COPD, and depression/anxiety); (ii) physiological and laboratory biomarkers from the first 24 h of care, including minimum SpO₂, heart rate variability, hemoglobin, creatinine, albumin, and arterial blood gas parameters; and (iii) sociodemographic and administrative variables encompassing age, sex, ethnicity, insurance type, and admission acuity. Model performance was assessed through five-fold stratified cross-validation and bootstrap confidence intervals (n = 1000 iterations), with predictor importance quantified using SHapley Additive exPlanations (SHAP). Results: XGBoost achieved the strongest aggregate performance across all evaluation metrics, attaining an area under the receiver operating characteristic curve (AUC) of 0.871 (95% CI: 0.856–0.887), accuracy of 79.6%, F1-score of 0.820, and sensitivity of 94.9%, correctly identifying 903 of 952 true positive cases in the held-out test set; all gradient boosting frameworks substantially outperformed the Decision Tree baseline (AUC 0.836). SHAP analysis identified the HFRS and Elixhauser index as the two dominant predictors, followed by depression/anxiety, obesity, hypertension, and minimum SpO₂—a hierarchy that recapitulates the canonical clinical phenotype of obstructive sleep apnea in frail inpatients rather than that of primary insomnia, indicating that the model is preferentially capturing the OSA–frailty axis within the broader G47.x outcome. The predicted probability outputs were well-calibrated across all risk deciles. Conclusions: Frailty-derived features, in combination with admission-time clinical and physiological data, can predict inpatient sleep disorder diagnoses—predominantly OSA—with high sensitivity and well-calibrated risk estimates. The deployable, interpretable nature of the XGBoost model makes it directly suitable for integration into clinical decision support systems, offering a screening tool that requires no dedicated instrumentation beyond routine admission data. By flagging high-risk patients at the moment of admission, the framework provides a concrete mechanism for accelerating referral for definitive diagnostic confirmation (overnight oximetry, polysomnography) and earlier initiation of CPAP and related therapies, with direct implications for reducing the persistent diagnostic gap, perioperative risk, and preventable adverse outcomes in frail hospitalized populations. Full article

Background: Sleep-disordered breathing (SDB) is frequently accompanied by autonomic nervous system (ANS) dysfunction, which is closely associated with an increased incidence of cardiovascular diseases and elevated mortality risk. Heart rate variability (HRV) serves as a classic metric for evaluating sympathovagal balance; however, the specific impacts of four distinct types of respiratory events—obstructive apnea (OA), central apnea (CA), mixed apnea (MA), and hypopnea (HYP)—on HRV remain underinvestigated. Utilizing ultra-short-term HRV analysis, this study aimed to evaluate the immediate effects of different respiratory events on ANS function, while further exploring the modulatory roles of arousal, Apnea–Hypopnea Index (AHI) severity and sleep stages (non-rapid eye movement [NREM] vs. rapid eye movement [REM]). Methods: A total of 108 patients with SDB undergoing overnight polysomnography (PSG) were included. A total of 19,862 respiratory events, including obstructive apnea (OA), central apnea (CA), mixed apnea (MA), and hypopnea (HYP), were analyzed using 15 s ECG segments. Linear mixed-effects models (LMMs) and estimated marginal means (EMMs) with Sidak-adjusted pairwise comparisons were constructed to evaluate differences in ECG-derived features and to analyze differences between event types. Results: Central apnea (CA) was associated with significantly reduced HRV and heart rate indices, including Standard Deviation of Successive Differences (SDSD), Root Mean Square of the Successive (RMSSD), Standard Deviation 1 (SD1), and heart rate (HR), compared with other respiratory event types (all p < 0.05). Across all event types, HRV metrics exhibited consistent dynamic changes before, during, and after respiratory events (all p < 0.001), characterized by a decrease during the event followed by post-event recovery. In the interaction effect of sleep stage, SDSD was significantly lower in CA compared with both OA (estimate = −11.67, 95% CI −18.78 to −4.59, p < 0.001) and HYP (estimate = −11.38, 95% CI −18.55 to −4.20, p < 0.001) during NREM sleep. No significant differences in HRV parameters, heart rate, or QRS duration were observed between OA and HYP (all p > 0.05). Conclusions: This study is the first to elucidate the differential impacts of four distinct types of sleep respiratory events on ultra-short-term HRV, confirming that CA events exert the most profound effects on autonomic function. These findings suggest that the proportion of CA occurrences could serve as a more precise biomarker for identifying individuals at high risk for cardiovascular diseases within the SDB population. Full article

Sleep disturbances represent one of the most frequent and clinically significant comorbidities in children with autism spectrum disorder (ASD), affecting approximately 50–80% of individuals. Clinically, these disturbances encompass a broad spectrum of disorders, including insomnia, parasomnias, sleep-related movement disorders, and sleep-related breathing disorders, commonly presenting with prolonged sleep latency, frequent nocturnal awakenings, reduced total sleep time, and alterations in sleep architecture. Circadian rhythm dysregulation, abnormalities in neurotransmitter systems such as GABA and serotonin, and altered melatonin signaling have been consistently implicated. These processes may reflect underlying genetic and metabolic influences affecting circadian clock regulation and synaptic function. The management of sleep disturbances in ASD requires a comprehensive approach combining behavioral strategies, caregiver education, and sleep hygiene interventions, while pharmacological options, particularly melatonin, may be considered when non-pharmacological measures are insufficient. Understanding the multifactorial mechanisms underlying sleep disturbances in ASD is essential for improving early recognition and developing individualized therapeutic strategies. This review synthesizes current evidence on the prevalence, biological mechanisms, clinical manifestations, and management of sleep disturbances in ASD, providing an integrated perspective for both clinicians and researchers. Full article

Background: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of intermittent hypoxia and systemic inflammation. Pannexin-1 (Panx1) is a transmembrane channel involved in ATP release and purinergic signaling and has been implicated in hypoxia-related inflammatory responses. However, the clinical relevance of circulating Panx1 levels in patients with OSA remains poorly understood. This study aimed to evaluate serum Panx1 concentrations in patients with OSA and to investigate their association with nocturnal hypoxemic burden. Methods: In this cross-sectional study, 40 patients with obstructive sleep apnea (OSA) and 40 control subjects underwent overnight polysomnography for diagnostic evaluation. Serum Panx1 concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Logistic regression models were constructed to evaluate the association between Panx1 and OSA status while adjusting for clinical covariates. In addition, a propensity score–matched sensitivity analysis based on age, sex, and body mass index was performed to further assess potential confounding. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of Panx1 alone and in combination with clinical variables. Results: Serum Panx1 levels were significantly lower in patients with OSA than in controls (4.27 ± 2.66 vs. 6.24 ± 4.75 ng/mL, p = 0.013). Although Panx1 was not an independent predictor of OSA after adjustment for age, sex, and body mass index, its integration with clinical variables significantly improved diagnostic discrimination. The area under the receiver operating characteristic curve increased from 0.662 for Panx1 alone to 0.858 in the fully adjusted model. Sensitivity analyses attenuated the observed association after matching for major baseline characteristics, suggesting a potential contribution of demographic and anthropometric factors. In addition, Panx1 concentrations were inversely correlated with markers of nocturnal hypoxemic burden, particularly the cumulative time spent with oxygen saturation below 90% (T90). Conclusions: Lower serum Panx1 concentrations were associated with OSA status and nocturnal hypoxemic burden. While Panx1 alone demonstrated modest discriminatory ability, its integration with established clinical factors improved diagnostic performance. These findings suggest that Panx1 may represent a biologically plausible adjunct biomarker reflecting hypoxic burden and may contribute to multi-parameter approaches for OSA risk assessment; however, further validation in larger matched cohorts is warranted. Full article

Prefabricated myofunctional appliances (PMAs) are designed to improve airway function by advancing the mandible, enhancing tongue posture, and reducing airway resistance, thereby facilitating nasal breathing in children with sleep-disordered breathing (SDB). This retrospective study evaluated the effects of PMAs on airway dimensions in children with skeletal Class II division 1 malocclusion. Patients were selected from a departmental database (2017–2019). The treatment group included children with Class II division 1 malocclusion, an incisor overjet of ≥6 mm, cervical vertebral maturation (CVM) stage III or earlier, and documented myofunctional dysfunction (e.g., adenoid hypertrophy, allergic rhinitis, or mouth breathing), with complete pretreatment and one-year follow-up lateral cephalometric radiographs. Patients with prior orthodontic intervention or poor compliance were excluded. A matched observation group consisted of untreated patients undergoing growth monitoring. Airway dimensions of the nasopharynx, oropharynx, and hypopharynx were measured using cephalometric radiographs, along with McNamara Airway Analysis. The total nasal symptom score (TNSS) was used as a self-report measure. A total of 34 patients (mean age 9.4 years) were included in the PMA group and 29 patients (mean age 9.6 years) in the observation group. Compared with controls, the PMA group demonstrated significant increases in nasopharyngeal (p = 0.044) and oropharyngeal (p = 0.039) airway areas, while changes in the hypopharyngeal area were not significant (p = 0.121). McNamara Airway Analysis also showed a significant improvement in upper pharyngeal airway dimensions (p = 0.018). TNSS revealed significant changes following PMA therapy (p < 0.001). These findings indicate that PMA therapy is associated with enlargement of the nasopharyngeal and oropharyngeal airway in children with skeletal Class II division 1 malocclusion, suggesting functional airway adaptation beyond simple mandibular advancement. Full article

Background/Objectives: Sleep breathing disorders (SBDs) comprise a range of conditions characterized by abnormal respiratory patterns during sleep, with obstructive sleep apnea (OSA) being the most common. During pregnancy, SBDs are of clinical relevance, as they are associated with increased maternal and neonatal morbidity. Methods: A structured literature search was conducted to identify relevant studies addressing sleep breathing disordered in pregnancy, including longitudinal, observational, case-control, and cross-sectional studies, as well as other reviews and meta-analyses. Results: Adequate sleep during pregnancy is essential for maternal health and fetal development. OSA in pregnant women is strongly associated with hypertensive disorders of pregnancy (HDPs), potentially contributing to increased long-term cardiovascular risk. In addition to hypertensive complications, OSA has been linked to gestational diabetes and postpartum depression. Untreated SBDs may also have consequences beyond pregnancy, adversely affecting fetal and neonatal outcomes. Pathophysiological mechanisms related to maternal SBDs can result in fetal growth restriction, impaired neurocognitive development, and an increased risk of preterm birth. Conclusions: Current evidence indicates that OSA during pregnancy is associated with elevated short- and long-term risks for both mothers and offspring. Future research should prioritize large prospective studies with standardized diagnostic criteria and outcomes, as well as pragmatic trials to assess the implementation of SBD screening in prenatal care, particularly among high-risk populations such as obese women. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article