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Medicina
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Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management
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Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 13255

Special Issue Editors

Dr. Andrea de Vito

E-Mail Website
Guest Editor
Head & Neck Department, Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Romagna Health Company, 48121 Ravenna, Italy
Interests: obstructive sleep apneas syndrome; OSA pathophysiology; drug-induced sleep endoscopy
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio M. Esquinas

E-Mail Website
Guest Editor
Intensive Care Unit, Hospital Morales Meseguer, 30007 Murcia, Spain
Interests: sleep disordered breathing; noninvasive mechanical ventilation therapy; continuous positive airway pressure
Special Issues, Collections and Topics in MDPI journals
Dr. Nicola Vitulano

E-Mail Website
Guest Editor
Cardiology Unit – Ente Ecclesiastico Ospedale Generale Regionale “F.Miulli”, Bari, Italy
Interests: hypertension; mechanical ventilation; continuous positive airway pressure

Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is the most frequent but underdiagnosed sleep-disordered breathing (SDB), with a prevalence of 2–4% in men and 1–2% in women of average age. OSA represents a risk factor for cardiovascular cerebrovascular, and metabolic disorders.

This Special Issue is focused on up-to-date data about the epidemiology, pathophysiology, diagnostic and therapeutic management of OSA, which could be useful in daily practice. Specific issues have been related to open questions in the field of OSA diagnosis and treatment, analyzing the most important technological advancements.

Dr. Andrea de Vito
Prof. Dr. Antonio M. Esquinas
Dr. Nicola Vitulano
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. 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 2200 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

  • hypertension
  • obstructive sleep apnea
  • OSA pathophysiology
  • hypertension therapy
  • apnea–hypopnea index
  • sympathetic nervous system
  • baroreflex
  • chemoreflex

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Published Papers (5 papers)

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Editorial

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3 pages, 726 KiB  
Editorial
The Heart Beats as It Breathes, or Is It the Other Way Around?
by Nicola Vitulano
Medicina 2023, 59(8), 1431; https://doi.org/10.3390/medicina59081431 - 8 Aug 2023
Viewed by 979
Abstract
One third of human life is spent sleeping, thus the importance of sleep in the maintenance of correct homeostatic balance is well established [...] Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management)
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Research

Jump to: Editorial

19 pages, 1493 KiB  
Article
Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients
by Dragana Milicic Ivanovski, Branka Milicic Stanic and Ivan Kopitovic
Medicina 2023, 59(5), 873; https://doi.org/10.3390/medicina59050873 - 1 May 2023
Cited by 4 | Viewed by 3223
Abstract
Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly [...] Read more.
Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four groups: 33 patients had mild OSA (5 ≤ AHI < 15), 33 patients had moderate OSA (15 ≤ AHI < 30), 31 patients had severe OSA (AHI ≥ 30), and 41 individuals had AHI < 5, which were a part of the control group. SCORE-2 increased in line with OSA severity and was higher in OSA groups compared to the control group (H = 29.913; DF = 3; p < 0.001). Charlson Index was significantly higher in OSA patients compared to controls (p = 0.001), with a higher prevalence of total comorbidities in the OSA group of patients. Furthermore, CCI 10-year survival score was significantly lower in the OSA group, suggesting a shorter survival of those patients with a more severe form of OSA. We also examined the prediction model for OSA severity. Conclusions: Determining the comorbidity profile and estimation of the 10-year risk score of OSA patients could be used to classify these patients into various mortality risk categories and, according to that, provide them with adequate treatment. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management)
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13 pages, 332 KiB  
Article
Effect of Short-Term Treatment with Continuous Positive Airway Pressure on Cardiopulmonary Exercise Tolerance, Pulmonary and Cardiac Function in Patients with Obstructive Sleep Apnea
by Laima Kondratavičienė, Lina Padervinskienė, Tomas Lapinskas, Eglė Ereminienė, Kęstutis Malakauskas, Marius Žemaitis and Skaidrius Miliauskas
Medicina 2023, 59(2), 326; https://doi.org/10.3390/medicina59020326 - 9 Feb 2023
Viewed by 2116
Abstract
Background: Obstructive sleep apnea (OSA) is a condition with a high prevalence, linked to an increased risk of cardiovascular disease as well as increased morbidity and death. CPAP is currently considered the “gold standard” treatment for OSA, but more thorough research and testing [...] Read more.
Background: Obstructive sleep apnea (OSA) is a condition with a high prevalence, linked to an increased risk of cardiovascular disease as well as increased morbidity and death. CPAP is currently considered the “gold standard” treatment for OSA, but more thorough research and testing are required to assess its efficacy on cardiopulmonary function. Objectives: To evaluate pulmonary function of OSA patients, cardiopulmonary exercise tolerance test (CPET) performance, cardiac magnetic resonance imaging (MRI) parameters, and polysomnographic changes before and after 3 months of CPAP therapy. Materials and methods: A total of 34 patients diagnosed with moderate or severe OSA, as well as 17 patients as a control group for the evaluation of the cardiac MRI, were included in this study. All the subjects were obese (body mass index (BMI) > 30 kg/m2). Lung function tests, CPETs, cardiac MRIs, and polysomnography were performed at the time of the study’s enrolment before the initiation of the CPAP therapy and after 3 months of the CPAP treatment. Results: The patients‘ VO2max during the CPAP treatment tended to increase, but no statistical significance was found (before treatment it was 17.52 ± 3.79 mL/kg/min and after 3 months of treatment, it was 18.6 ± 3,4 mL/kg/min; p = 0.255). The CPAP treatment had positive effects on pulmonary ventilation at the anaerobic threshold (VEAT): 44.51 L/min (43.21%) during the baseline visit and 38.60 L/min (37.86%) after the 3-month treatment period (p = 0.028). The ventilator equivalent for the carbon dioxide slope (VE/VCO2) at peak exercise decreased from 23.47 to 20.63 (p = 0.042). The patients’ pulmonary function tests were without abnormalities and did not change after treatment. When assessing cardiac the MRIs, the RV ejection fraction was lower in the OSA group compared to that of the control subjects (53.69 ± 8.91 and 61.35 ± 9.08, p = 0.016). Both LA and RA global longitudinal strains (GLS) improved after 3 months of treatment with CPAP (20.45 ± 7.25 and 26.05 ± 14.00, p = 0.043; 21.04 ± 7.14 and 26.18 ± 7.17, p = 0.049, respectively). Additionally, it was found that CPAP therapy led to statistical improvements in RV end-diastolic volume (164.82 ± 32.57 and 180.16 ± 39.09, p = 0.042). The AHI and oxygen desaturation index (ODI) significantly changed after 3 months of the initiation of the CPAP treatment (p = 0.049 and p = 0.001, respectively). The REM sleep duration decreased, while the duration of non-REM sleep increased after treatment initiation with CPAP (p = 0.016 and p = 0.017, respectively). Conclusions: Short-term CPAP treatment improves pulmonary ventilation, sleep efficiency, and sleep architecture. Significant alterations in both atrias’ GLS and RV end-diastolic volume were observed after 3 months of treatment. Longer-term follow-up and a larger patient sample are needed to confirm the reproducibility of our results. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management)
12 pages, 1539 KiB  
Article
Alterations in Inflammatory Markers and Cognitive Ability after Treatment of Pediatric Obstructive Sleep Apnea
by Mohamed Shams Eldin, Mohamed Alahmer, Ebrahim Alkashlan, Mahmoud Zahran, Mohamed Eltonsy, Amr Zewail, Abdelfattah Kasem, Khaled Abdelaal, Mahrous Seddeek and Zakaria Ahmed
Medicina 2023, 59(2), 204; https://doi.org/10.3390/medicina59020204 - 19 Jan 2023
Cited by 4 | Viewed by 2430
Abstract
Background and Objectives: Determination of the impact of obstructive sleep apnea (OSA) on the cognitive function (CF), and serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and 1β levels and the effect of OSA management on these variables in children. Materials and Methods [...] Read more.
Background and Objectives: Determination of the impact of obstructive sleep apnea (OSA) on the cognitive function (CF), and serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and 1β levels and the effect of OSA management on these variables in children. Materials and Methods: A total of 224 patients were evaluated using the Pediatric Sleep Questionnaire, the NEPSY score for CF, and polysomnography (PSG) to grade OSA severity according to the apnea/hypopnea index (AHI). Adentonsillectomy (AT) was performed for patients with adenotonsillar hypertrophy grade > 2. Patients with overweight or obesity with mild or moderate OSAS underwent a 6-month protocol of lifestyle intervention (LSI). Blood samples were obtained for an enzyme-linked immunosorbent assay (ELISA) estimation of cytokine levels. All variables were re-evaluated at the end of the 6-month follow-up period. Results: A total of 181 patients had surgical interference and 43 patients underwent a LSI trial; 15 patients failed to respond and underwent surgery. At the end of the follow-up, 33 patients had residual OSAS with a significantly higher incidence among patients with severe OSAS, the mean score of the pediatric sleep questionnaire was significantly decreased in all patients, 181 patients showed an improved NESPY score, and cytokine levels were decreased. The baseline NESPY score, AHI index and sleep questionnaire score were negatively correlated. The percentage of change in the NESPY score and serum cytokine levels showed a positive correlation. Conclusions: OSAS is associated with cognitive dysfunction that significantly improves after adenotonsillectomy. LSI as a therapeutic line is satisfactory for children with mild OSAS and minimal cognitive dysfunction and is of value preoperatively to improve the surgical outcomes of AT. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management)
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9 pages, 956 KiB  
Article
CPAP Therapy on Depressive and Anxiety Symptoms in Patients with Moderate to Severe Obstructive Sleep Apnea Syndrome
by Diana Raluca Velescu, Monica Marc, Diana Manolescu, Daniel Trăilă and Cristian Oancea
Medicina 2022, 58(10), 1402; https://doi.org/10.3390/medicina58101402 - 6 Oct 2022
Cited by 6 | Viewed by 3577
Abstract
Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the [...] Read more.
Backgrounds and Objectives: There is a link between sleep apnea syndrome (OSA) and depressive and anxiety symptoms, but the underlying mechanisms are not fully understood. The study aimed to determine the prevalence of these symptoms in patients with OSA and to evaluate the impact of continuous positive airway pressure (CPAP) on depression and anxiety scores. Materials and Methods: Ninety-nine consecutive new patients diagnosed with moderate or severe (apnea-hypopnea index AHI ≥ 15 events/h) OSA were accepted for the CPAP therapy. Patients completed a patient health questionnaire (PHQ-9) for depressive symptoms and a generalized anxiety questionnaire (GAD-7) for anxiety symptoms before the CPAP treatment, after 6 months, and after 1 year of CPAP therapy with compliance. For both scores (PHQ-9 and GAD-7), a cut point ≥10 was used to indicate the presence of clinically depressive and anxiety symptoms. Results: Forty-eight individuals (48.48%) had PHQ-9 scores above the cut-off point ≥ 10, and twenty-seven participants (27.27%) had GAD-7 scores above the cut-off point ≥10. A significant correlation has been shown between PHQ-9 score and BMI (p < 0.0001), AHI (p < 0.0001), ODI (p < 0.001), ESS (p < 0.001), GAD-7 score (p < 0.0001), and [t90] (p < 0.0001), while GAD-7 was correlated with AHI (p < 0.030), ODI (p < 0.006), and [t90] (p < 0.001). The PHQ-9 and GAD-7 scores decreased significantly after 6 months of CPAP therapy in all groups and after 1 year of CPAP use. Conclusions: OSA patients should be screened for depression and anxiety. Furthermore, CPAP should be the first choice of treatment before starting other treatments for depression and anxiety symptoms. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea: Epidemiology, Pathophysiology, and Management)
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