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Life
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Obstructive Sleep Apnea: Current Knowledge and Future Perspectives
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Obstructive Sleep Apnea: Current Knowledge and Future Perspectives

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: 21 November 2024 | Viewed by 13111

Special Issue Editors

Prof. Dr. Doina Todea

E-Mail Website
Guest Editor
Department of Pulmonology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
Interests: obstructive sleep apnea; biomarkers; polysomnography; respiratory diseases; smoking cessation; lifestyle medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Larry D. Sanford

E-Mail Website
Guest Editor
Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA 23507, USA
Interests: learning and memory; neurocircuits; neuroimmunology; sleep; spaceflight stress
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems since the obesity pandemic is continually increasing. OSA is a common disease, being a result of repeated upper airway collapse during sleep, with disturbances of central regulation and arousal threshold with intermittent hypoxia. Those with OSA reported snoring, witnessed apnoeas, and excessive sleepiness during the day negatively affecting daily functioning, cognition, mood, and other aspects of well-being. These patients have associated comorbidities such as cardiovascular diseases (systemic hypertension, coronary artery disease, arrhythmias and stroke), cerebrovascular disease, respiratory diseases (COPD, asthma) and metabolic disorders (diabetes mellitus, dyslipidaemias, gout) which increase the risk of worse prognosis. Interestingly, OSA probably has the highest risk among diseases to be associated with motor vehicle accidents, with a great impact on hospital admission and with high costs. Based on symptoms and comorbidities, but also on the anatomy and pathophysiology of OSA, the clinical and pathophysiological phenotypes of OSA which are involved in personalized treatment can be differentiated.

Diagnosis of this disease represents a challenge since it requires an overnight monitoring of sleep disordered breathing through polysomnography (PSG), but this record alone cannot demonstrate the individual susceptibility for systemic effects of OSA. The association with biomarkers and vascular parameters may better predict the prognosis and response to treatment. Serum and salivary biomarkers might be useful in the life-long monitoring of the severity of the disease.

Continuous positive airway pressure (CPAP) therapy is the treatment for most patients, especially those with moderate-to-severe obstructive sleep apnoea, but not all patients tolerate and remain adherent to the therapy. Therefore, the management of OSA also includes another options, such as mandibular advancement devices, surgery, hypoglossal nerve stimulation, and of course lifestyle modification by promoting weight loss and moderate exercise is required. The aim of this Special Issue is to point out advances and new perspectives for the diagnosis, personalized treatment, and follow-up for patients with OSA, among other relevant topics.

Prof. Dr. Doina Todea
Dr. Larry D. Sanford
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sleep apnoea syndrome—clinical and pathophysiological phenotypes
  • diagnosis and comorbidities
  • biomarkers
  • personalized treatment
  • predictors of outcomes
  • prognosis and mortality

Published Papers (7 papers)

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Research

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12 pages, 305 KiB  
Article
10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects
by Laura Draelants, Camille Point, Benjamin Wacquier, Jean-Pol Lanquart, Gwenolé Loas and Matthieu Hein
Life 2023, 13(6), 1379; https://doi.org/10.3390/life13061379 - 13 Jun 2023
Cited by 1 | Viewed by 1299
Abstract
Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. [...] Read more.
Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. Framingham Risk Score ≥ 10% was used as a cut-off to identify hypertensive subjects with high 10-year risk for CVD. The association between 10-year risk for CVD and COMISA was investigated using logistic regression analyses. 65.3% of hypertensive subjects from our sample presented a high 10-year risk for CVD. After controlling for major confounding factors, multivariate logistic regression analyses demonstrated that unlike its components present separately, COMISA was significantly associated with high 10-year risk for CVD in hypertensive subjects (OR 1.88, 95% CI 1.01–3.51). In this study, we have demonstrated that the negative synergy between obstructive sleep apnea syndrome and insomnia disorder seems to play a central role in the 10-year risk for CVD in hypertensive subjects, which seems to indicate that the establishment of a systematic research and an adapted treatment of COMISA could open new perspectives to promote a better cardiovascular outcome in this specific subgroup of patients. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
14 pages, 301 KiB  
Article
Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution
by Wen-Hua Hsu, Cheng-Chang Yang, Cheng-Yu Tsai, Arnab Majumdar, Kang-Yun Lee, Po-Hao Feng, Chien-Hua Tseng, Kuan-Yuan Chen, Jiunn-Horng Kang, Hsin-Chien Lee, Cheng-Jung Wu, Yi-Chun Kuan and Wen-Te Liu
Life 2023, 13(5), 1218; https://doi.org/10.3390/life13051218 - 19 May 2023
Cited by 1 | Viewed by 1651
Abstract
Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships [...] Read more.
Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E–I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E–I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
9 pages, 550 KiB  
Article
Influence of Lingual Tonsillar Volume in Patients with Obstructive Sleep Apnea
by Yung Jee Kang, Byung Kil Kim, Sang Duk Hong, Yong Gi Jung, Gwanghui Ryu and Hyo Yeol Kim
Life 2022, 12(11), 1920; https://doi.org/10.3390/life12111920 - 18 Nov 2022
Cited by 1 | Viewed by 1419
Abstract
This study aimed to evaluate the influence of lingual tonsil (LT) volume measured using a three-dimensional (3D) reconstruction volume rendering program on clinical parameters and polysomnography (PSG) results. A total of 100 patients who underwent PSG, computed tomography (CT), and allergy test from [...] Read more.
This study aimed to evaluate the influence of lingual tonsil (LT) volume measured using a three-dimensional (3D) reconstruction volume rendering program on clinical parameters and polysomnography (PSG) results. A total of 100 patients who underwent PSG, computed tomography (CT), and allergy test from April 2016 to April 2020 were randomly selected. LT volume was measured using an imaging software program that enables 3D reconstruction of CT images. PSG parameters were analyzed by dividing the subjects into two groups according to LT volume (each 50 people). Based on the medial volume of 0.863 cm3, the upper half LT volume group and the lower half LT volume group were analyzed. Clinical factors such as body weight, neck circumference, body mass index (BMI), and age showed no difference between the two groups. Among PSG parameters, supine arousal index and non-rapid eye movement (NREM) arousal index were significantly higher in the upper half LT volume group (p = 0.012, 0.037). However, there was no significant difference in apnea-hypopnea index (AHI) between the upper and lower half LT volume groups (p = 0.749). Arousal snoring index and REM arousal index also showed no difference between the two groups. The prevalence of allergic rhinitis was not different in the two groups. High LT volume is associated with NREM arousal and arousal in the supine position, but it is not related to AHI. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
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8 pages, 1191 KiB  
Article
Evaluation of the Muscle Strength of the Tongue with the Tongue Digital Spoon (TDS) in Patients with Obstructive Sleep Apnea
by Laura Rodríguez-Alcalá, Felipe Benjumea, Juan Carlos Casado-Morente, Peter M. Baptista, Carlos O’Connor-Reina and Guillermo Plaza
Life 2022, 12(11), 1841; https://doi.org/10.3390/life12111841 - 10 Nov 2022
Cited by 5 | Viewed by 1836
Abstract
Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue [...] Read more.
Myofunctional therapy (MT) is a recent treatment option for obstructive sleep apnea (OSA). The Iowa Oral Performance Instrument (IOPI) is a useful but expensive tool for measuring tongue strength in patients with OSA. We validated the Tongue Digital Spoon (TDS) to monitor tongue hypotonia in patients with OSA. Measurements with the IOPI and TDS were compared in patients with OSA before and after MT for tongue hypotonia. Baseline mean tongue strength measured with the IOPI in patients with moderate and severe OSA were 35.36 ± 9.05 and 33.83 ± 12.05, respectively, and that with the TDS were 168.55 ± 42.8 and 129.61 ± 53.7, respectively. After MT, mean tongue strength significantly improved: measured with the IOPI in patients with moderate and severe OSA were 53.85 ± 10.09 and 55.50 ± 9.64 (p = 0.8), and that with the TDS were 402.36 ± 52.92 and 380.28 ± 100.75 (p = 0.01), respectively. The correlation between the IOPI and TDS was high (r = 0.74; p = 0.01 pre-treatment, and r = 0.25; p = 0.05 post-treatment). The TDS is a useful tool for monitoring the efficacy of MT in patients with short-term OSA. Future randomized studies will determine the effectiveness of MT for the treatment of OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
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9 pages, 293 KiB  
Article
Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy
by Peter Baptista, I. Madeleine Di Frisco, Elena Urrestarazu, Juan Alcalde, Manuel Alegre, Isabel Sanchez, Carlos O’Connor-Reina and Guillermo Plaza
Life 2022, 12(11), 1737; https://doi.org/10.3390/life12111737 - 28 Oct 2022
Cited by 3 | Viewed by 2279
Abstract
Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire® device constitutes a minimally invasive operative option. The main objective of this [...] Read more.
Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire® device constitutes a minimally invasive operative option. The main objective of this study is to estimate, under real-world clinical practice conditions, the 3-month impact on the quality of life (IQoL) of the HNS in patients with moderate/severe OSA who do not tolerate or accept CPAP, compared to patients who did not receive HNS. As a baseline, the unadjusted EuroQol utility index was 0.764 (SD:0.190) in the intervention group (IGr) and 0.733 (SD:0.205) in the control group (CGr); three months later, the indexes were 0.935 (SD: 0.101) and 0.727 (SD:0.200), respectively. The positive impact on quality of life was estimated to be +0.177 (95% CI: 0.044–0.310; p = 0.010). All dimensions in the IGr improved compared to CGr, especially for usual activities (p < 0.001) and anxiety/depression (p > 0.001). At the end of the follow-up, there was no significant difference in the quality of life between the general Spanish population and the IGr (difference: 0.012; CI95%: −0.03 to −0.057; p = 0.0578) for the same age range; however, there was a difference concerning the CGr (difference: −0.196; CI95%: −0.257 to −0.135; p < 0.001). In conclusion, patients with moderate/severe OSA implanted with the Inspire® device showed a positive IQoL. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
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17 pages, 1331 KiB  
Article
The Predictive Role of Subcutaneous Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea
by Viktória Molnár, Zoltán Lakner, András Molnár, Dávid László Tárnoki, Ádám Domonkos Tárnoki, László Kunos and László Tamás
Life 2022, 12(10), 1504; https://doi.org/10.3390/life12101504 - 27 Sep 2022
Cited by 4 | Viewed by 1564
Abstract
Introduction: Our aim was to investigate the applicability of artificial intelligence in predicting obstructive sleep apnoea (OSA) and upper airway obstruction using ultrasound (US) measurements of subcutaneous adipose tissues (SAT) in the regions of the neck, chest and abdomen. Methods: One hundred patients [...] Read more.
Introduction: Our aim was to investigate the applicability of artificial intelligence in predicting obstructive sleep apnoea (OSA) and upper airway obstruction using ultrasound (US) measurements of subcutaneous adipose tissues (SAT) in the regions of the neck, chest and abdomen. Methods: One hundred patients were divided into mild (32), moderately severe-severe (32) OSA and non-OSA (36), according to the results of the polysomnography. These patients were examined using anthropometric measurements and US of SAT and drug-induced sleep endoscopy. Results: Using SAT US and anthropometric parameters, oropharyngeal obstruction could be predicted in 64% and tongue-based obstruction in 72%. In predicting oropharyngeal obstruction, BMI, abdominal and hip circumferences, submental SAT and SAT above the second intercostal space on the left were identified as essential parameters. Furthermore, tongue-based obstruction was predicted mainly by height, SAT measured 2 cm above the umbilicus and submental SAT. The OSA prediction was successful in 97% using the parameters mentioned above. Moreover, other parameters, such as US-based SAT, with SAT measured 2 cm above the umbilicus and both-sided SAT above the second intercostal spaces as the most important ones. Discussion: Based on our results, several categories of OSA can be predicted using artificial intelligence with high precision by using SAT and anthropometric parameters. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
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Review

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10 pages, 1309 KiB  
Review
A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities
by Margaret Bublitz, Nour Adra, Leen Hijazi, Fidaa Shaib, Hrayr Attarian and Ghada Bourjeily
Life 2022, 12(12), 2003; https://doi.org/10.3390/life12122003 - 01 Dec 2022
Cited by 7 | Viewed by 2227
Abstract
Introduction: Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature’s focus away from the latter population. As such, [...] Read more.
Introduction: Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature’s focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. Methods: To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. Results: Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more “atypical” symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. Discussion: More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Current Knowledge and Future Perspectives)
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