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Medicina
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Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment
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Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 January 2020) | Viewed by 24152

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Andras Bikov

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Guest Editor
1. Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
2. North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
Interests: respiratory physiology; respiratory mechanics; asthma; lung; pulmonary medicine; airway obstruction; chronic obstructive pulmonary disease; OSA; pulmonary function test; pneumology; sputum; respiratory immunology; exhaled biomarkers
Special Issues, Collections and Topics in MDPI journals
Dr. Silvano Dragonieri

E-Mail Website
Guest Editor
Associate Professor, Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
Interests: obstructive lung diseases; airway obstruction; chronic obstructive pulmonary disease (COPD); obstructive sleep apnea; pulmonary medicine; respiration disorders; spirometry; allergic asthma; asthma; allergic diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population; however, the exact prevalence in different communities is unknown. OSA is associated with the development of cardiometabolic and mood disorders, and cognitive dysfunction. Hence, it leads to impaired quality of life and work performance, car accidents, and heightened morbidity and mortality. Interestingly, factors leading to the development of comorbidities, cognitive impairment and daytime sleepiness are not fully understood. Continuous positive airway pressure (CPAP) is the gold standard treatment and is highly effective in moderate to severe disease cases. The data on the effects of CPAP in mild disease cases, as well as the effects of second-line treatment (i.e., mandibular advancement device, surgical procedures, etc), however, provided much less evidence.

We invite you to contribute an original research or review article on OSA. We are particularly interested in epidemiological studies from countries that have not been represented in previous publications. We are also keen to receive articles dealing with the pathophysiological pathways connecting OSA to comorbidities. Articles on human studies and experimental animal and cell culture models are equally encouraged. Please, do not hesitate to submit the results of clinical trials as well.

Dr. Andras Bikov
Dr. Silvano Dragonieri
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. Medicina 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 1800 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

  • OSA
  • Comorbidities
  • Inflammation
  • OSA treatment

Published Papers (8 papers)

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Editorial

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3 pages, 226 KiB  
Editorial
Obstructive Sleep Apnea: A View from the Back Door
by Silvano Dragonieri and Andras Bikov
Medicina 2020, 56(5), 208; https://doi.org/10.3390/medicina56050208 - 25 Apr 2020
Cited by 4 | Viewed by 2175
Abstract
Obstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population and whose incidence continues to rise, as well as its health and socio-economic burden. OSA is a well-known risk factor for motor vehicles accidents and [...] Read more.
Obstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population and whose incidence continues to rise, as well as its health and socio-economic burden. OSA is a well-known risk factor for motor vehicles accidents and decline in work performance and it is frequently accompanied by cardiovascular diseases. The aim of this Special Issue is to focus on the characteristics of OSA in special populations which are less frequently investigated. In this regard, seven groups of experts in the field of sleep medicine gave their contribution in the realization of noteworthy manuscripts which will support all physicians in improving their understanding of OSA with the latest knowledge about its epidemiology, pathophysiology and comorbidities in special populations, which will serve as a basis for future research. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)

Research

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13 pages, 2900 KiB  
Article
CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities
by Ioana Mădălina Zota, Cristian Stătescu, Radu Andy Sascău, Mihai Roca, Radu Sebastian Gavril, Teodor Flaviu Vasilcu, Daniela Boișteanu, Alexandra Maștaleru, Alexandra Jitaru, Maria Magdalena Leon Constantin and Florin Mitu
Medicina 2020, 56(2), 80; https://doi.org/10.3390/medicina56020080 - 15 Feb 2020
Cited by 7 | Viewed by 3385
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing [...] Read more.
Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual’s aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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10 pages, 1429 KiB  
Article
Circulating Soluble Urokinase-Type Plasminogen Activator Receptor in Obstructive Sleep Apnoea
by Renata Marietta Bocskei, Martina Meszaros, Adam Domonkos Tarnoki, David Laszlo Tarnoki, Laszlo Kunos, Zsofia Lazar and Andras Bikov
Medicina 2020, 56(2), 77; https://doi.org/10.3390/medicina56020077 - 14 Feb 2020
Cited by 4 | Viewed by 2916
Abstract
Background and Objectives: Obstructive sleep apnoea (OSA) is associated with heightened systemic inflammation and a hypercoagulation state. Soluble urokinase-type plasminogen activator receptor (suPAR) plays a role in fibrinolysis and systemic inflammation. However, suPAR has not been investigated in OSA. Materials and Methods [...] Read more.
Background and Objectives: Obstructive sleep apnoea (OSA) is associated with heightened systemic inflammation and a hypercoagulation state. Soluble urokinase-type plasminogen activator receptor (suPAR) plays a role in fibrinolysis and systemic inflammation. However, suPAR has not been investigated in OSA. Materials and Methods: A total of 53 patients with OSA and 15 control volunteers participated in the study. Medical history was taken and in-hospital sleep studies were performed. Plasma suPAR levels were determined by ELISA. Results: There was no difference in plasma suPAR values between patients with OSA (2.198 ± 0.675 ng/mL) and control subjects (2.088 ± 0.976 ng/mL, p = 0.62). Neither was there any difference when patients with OSA were divided into mild (2.134 ± 0.799 ng/mL), moderate (2.274 ± 0.597 ng/mL) and severe groups (2.128 ± 0.744 ng/mL, p = 0.84). There was no significant correlation between plasma suPAR and indices of OSA severity, blood results or comorbidities, such as hypertension, diabetes, dyslipidaemia or cardiovascular disease. Plasma suPAR levels were higher in women when all subjects were analysed together (2.487 ± 0.683 vs. 1.895 ± 0.692 ng/mL, p < 0.01), and also separately in controls (2.539 ± 0.956 vs. 1.411 ± 0.534 ng/mL, p = 0.02) and patients (2.467 ± 0.568 vs. 1.991 ± 0.686 ng/mL, p < 0.01). Conclusions: Our results suggest that suPAR does not play a significant role in the pathophysiology of OSA. The significant gender difference needs to be considered when conducting studies on circulating suPAR. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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8 pages, 286 KiB  
Article
The Association of Obstructive Sleep Apnea Syndrome and Accident Risk in Heavy Equipment Operators
by Hakan Celikhisar and Gulay Dasdemir Ilkhan
Medicina 2019, 55(9), 599; https://doi.org/10.3390/medicina55090599 - 17 Sep 2019
Cited by 8 | Viewed by 2511
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) is the most frequent sleep disorder, characterized by the repeated collapse of the upper respiratory tract during sleep. In this study, we aimed to determine the prevalence of OSAS in heavy equipment operators and [...] Read more.
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) is the most frequent sleep disorder, characterized by the repeated collapse of the upper respiratory tract during sleep. In this study, we aimed to determine the prevalence of OSAS in heavy equipment operators and to determine the relationship between the work accidents that these operators were involved in and the OSAS symptoms and severity. In doing this, we aimed to emphasize the association of OSAS, which is a treatable disease, and these accidents, which cause loss of manpower, financial hampering, and even death. Materials and Methods: STOP BANG questionnaire was provided to 965 heavy equipment operators and polysomnography (PSG) was performed, in Izmir Esrefpasa Municipality Hospital, to the operators at high risk for OSAS. Demographic data, health status, and accidents of these operators were recorded. Results: All operators who participated in the study were male. The ages of the cases ranged from 35 to 58 and the mean age was 45.07 ± 5.54 years. The mean STOP BANG questionnaire results were 4.36 ± 3.82. In total, 142 operators were identified with high risk for OSAS and PSG could be performed on 110 of these 142 operators. According to the PSG results of the operators, 41 (37.3%) patients had normal findings, while 35 (31.8%) had mild, 20 (18.2%) had moderate, and 14 (12.7%) had severe OSAS. Among those 110 patients, 71 (64.5%) of the cases had no history of any accidents, 25 (22.8%) were almost involved in an accident due to sleepiness, and 14 (12.7%) were actually involved in an accident. There was a statistically significant relationship between the accident rate and OSAS severity (p: 0.009). Conclusion: Based on the data acquired in the present study, a positive correlation was determined between the accident statuses of drivers with OSAS severity. We want to attract attention to the necessity of evaluating the OSAS symptoms in professional heavy equipment operators during the certification period and at various intervals afterwards, and to carry out OSAS evaluations by PSG for those having a certain risk. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
11 pages, 325 KiB  
Article
Particularities of Older Patients with Obstructive Sleep Apnea and Heart Failure with Mid-Range Ejection Fraction
by Carmen Loredana Ardelean, Sorin Pescariu, Daniel Florin Lighezan, Roxana Pleava, Sorin Ursoniu, Valentin Nadasan and Stefan Mihaicuta
Medicina 2019, 55(8), 449; https://doi.org/10.3390/medicina55080449 - 7 Aug 2019
Cited by 8 | Viewed by 2789
Abstract
Background and objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) are increasing in prevalence with a greater impact on the health system. The aim of this study was to assess the particularities of patients with OSAS and HF, focusing on [...] Read more.
Background and objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) are increasing in prevalence with a greater impact on the health system. The aim of this study was to assess the particularities of patients with OSAS and HF, focusing on the new class of HF with mid-range ejection fraction (HFmrEF, EF = 40%–49%), and comparing it with reduced EF (HFrEF, EF < 40%) and preserved EF (HFpEF, EF ≥ 50%). Materials and Methods: A total of 143 patients with OSAS and HF were evaluated in three sleep labs of “Victor Babes” Hospital and Cardiovascular Institute, Timisoara, Western Romania. We collected socio-demographic data, anthropometric sleep-related measurements, symptoms through sleep questionnaires and comorbidity-related data. We performed blood tests, cardio-respiratory polygraphy and echocardiographic measurements. Patients were divided into three groups depending on ejection fraction. Results: Patients with HFmrEF were older (p = 0.0358), with higher values of the highest systolic blood pressure (mmHg) (p = 0.0016), higher serum creatinine (p = 0.0013), a lower glomerular filtration rate (p = 0.0003), higher glycemic levels (p = 0.008) and a larger left atrial diameter (p = 0.0002). Regarding comorbidities, data were presented as percentage, HFrEF vs. HFmrEF vs. HFpEF. Higher prevalence of diabetes mellitus (52.9 vs. 72.7 vs. 40.2, p = 0.006), chronic kidney disease (17.6 vs. 57.6 vs. 21.5, p < 0.001), tricuspid insufficiency (76.5 vs. 84.8 vs.59.1, p = 0.018) and aortic insufficiency (35.3 vs.42.4 vs. 20.4, p = 0.038) were observed in patients with HFmrEF, whereas chronic obstructive pulmonary disease(COPD) (52.9 vs. 24.2 vs.18.3, p = 0.009), coronary artery disease(CAD) (82.4 vs. 6.7 vs. 49.5, p = 0.026), myocardial infarction (35.3 vs. 24.2 vs. 5.4, p < 0.001) and impaired parietal heart kinetics (70.6 vs. 68.8 vs. 15.2, p < 0.001) were more prevalent in patients with HFrEF. Conclusions: Patients with OSAS and HF with mid-range EF may represent a new group with increased risk of developing life-long chronic kidney disease, diabetes mellitus, tricuspid and aortic insufficiency. COPD, myocardial infarction, impaired parietal kinetics and CAD are most prevalent comorbidities in HFrEF patients but they are closer in prevalence to HFmrEF than HFpEF. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
10 pages, 828 KiB  
Article
Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic
by Prakash Mathiyalagen, Venkatesh Govindasamy, Anandaraj Rajagopal, Kavita Vasudevan, Kalaipriya Gunasekaran and Dhananjay Yadav
Medicina 2019, 55(7), 391; https://doi.org/10.3390/medicina55070391 - 20 Jul 2019
Cited by 4 | Viewed by 3087
Abstract
Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed—or rather not diagnosed—in primary care settings due to the costly diagnostic techniques involved. This [...] Read more.
Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed—or rather not diagnosed—in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents’ socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist–hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22–4.48), body mass index (aOR, 95% CI = 1.15, 1.06–1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07–1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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Review

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19 pages, 3190 KiB  
Review
Exhaled Breath Analysis in Obstructive Sleep Apnea Syndrome: A Review of the Literature
by Panaiotis Finamore, Simone Scarlata, Vittorio Cardaci and Raffaele Antonelli Incalzi
Medicina 2019, 55(9), 538; https://doi.org/10.3390/medicina55090538 - 27 Aug 2019
Cited by 18 | Viewed by 3840
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) represents an independent risk factor for cardiovascular, metabolic and neurological events. Polysomnography is the gold-standard for the diagnosis, however is expensive and time-consuming and not suitable for widespread use. Breath analysis is an innovative, non-invasive [...] Read more.
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) represents an independent risk factor for cardiovascular, metabolic and neurological events. Polysomnography is the gold-standard for the diagnosis, however is expensive and time-consuming and not suitable for widespread use. Breath analysis is an innovative, non-invasive technique, able to provide clinically relevant information about OSAS. This systematic review was aimed to outline available evidence on the role of exhaled breath analysis in OSAS, taking into account the techniques’ level of adherence to the recently proposed technical standards. Materials and Methods: Articles reporting original data on exhaled breath analysis in OSAS were identified through a computerized and manual literature search and screened. Duplicate publications, case reports, case series, conference papers, expert opinions, comments, reviews and meta-analysis were excluded. Results: Fractional exhaled Nitric Oxide (FeNO) is higher in OSAS patients than controls, however its absolute value is within reported normal ranges. FeNO association with AHI is controversial, as well as its change after continuous positive airway pressure (C-PAP) therapy. Exhaled breath condensate (EBC) is acid in OSAS, cytokines and oxidative stress markers are elevated, they positively correlate with AHI and normalize after treatment. The analysis of volatile organic compounds (VOCs) by spectrometry or electronic nose is able to discriminate OSAS from healthy controls. The main technical issues regards the dilution of EBC and the lack of external validation in VOCs studies. Conclusions: Exhaled breath analysis has a promising role in the understanding of mechanisms underpinning OSAS and has demonstrated a clinical relevance in identifying individuals affected by the disease, in assessing the response to treatment and, potentially, to monitor patient’s adherence to mechanical ventilation. Albeit the majority of the technical standards proposed by the ERS committee have been followed by existing papers, further work is needed to uniform the methodology. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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Other

8 pages, 1788 KiB  
Brief Report
Risk Assessment for Self Reported Obstructive Sleep Apnea and Excessive Daytime Sleepiness in a Greek Nursing Staff Population
by Alexia Alexandropoulou, Georgios D. Vavougios, Chrissi Hatzoglou, Konstantinos I. Gourgoulianis and Sotirios G. Zarogiannis
Medicina 2019, 55(8), 468; https://doi.org/10.3390/medicina55080468 - 12 Aug 2019
Cited by 7 | Viewed by 2495
Abstract
Background and objectives: The risk assessment of Obstructive Sleep Apnea (OSA) and Excessive Daytime Sleepiness (EDS) in specific occupational populations is important due to its association with morbidity. The aim of the present study was to identify the risk of OSA development [...] Read more.
Background and objectives: The risk assessment of Obstructive Sleep Apnea (OSA) and Excessive Daytime Sleepiness (EDS) in specific occupational populations is important due to its association with morbidity. The aim of the present study was to identify the risk of OSA development and EDS in a Greek nursing staff population. Materials and Methods: In this cross-sectional study a total of 444 nurses, 56 males (age = 42.91 ± 5.76 years/BMI = 27.17 ± 4.32) and 388 females (age = 41.41 ± 5.92 years/BMI = 25.08 ± 4.43) working in a Greek secondary and tertiary hospital participated during the period from 18 January 2015 to 10 February 2015. The participants completed the Berlin Questionnaire (BQ), concerning the risk for OSA and the Epworth Sleepiness Scale (ESS), concerning the EDS. The work and lifestyle habits of the participants were correlated with the results of the questionnaires. Results: According to the BQ results 20.5% (n = 91) of the nursing staff was at high risk for OSA. Increased daytime sleepiness affected 27.7% (n = 123) of the nurses according to ESS results. Nurses at risk for Obstructive Sleep Apnea Syndrome (OSAS), positive for both BQ and ESS, were 7.66% (n = 34). Out of the nurses that participated 77% (n = 342) were working in shifts status and had significant meal instability (breakfast p < 0.0001, lunch p < 0.0001, dinner p = 0.0008). Conclusions: The population at high risk for OSA and EDS in the nursing staff was found to be 20% and 28% respectively. High risk for OSAS was detected in 7.66% of the participants. The high risk for OSA and EDS was the same irrespective of working in shift status. In specific, nursing population age was an independent predictor for high risk for OSA and skipping lunch an independent predictor of daytime sleepiness. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathomechanism and Treatment)
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