Search Results (205)

Background: Obstructive sleep apnoea (OSA) is a highly prevalent yet underdiagnosed disorder in patients with cardiovascular disease. Growing evidence suggests a pathophysiological link between OSA and coronary artery disease (CAD); however, the relationship between OSA severity and anatomical complexity of coronary lesions remains incompletely understood. Aim: The aim of this study is to assess the prevalence of OSA in patients undergoing coronary angiography and to evaluate the association between sleep-disordered breathing parameters and the severity of CAD expressed by the SYNTAX score. Methods: This prospective study enrolled 103 consecutive patients referred for invasive coronary angiography. All participants underwent overnight type III cardiorespiratory polygraphy. OSA severity was classified according to the Apnea–Hypopnea Index (AHI). The anatomical complexity of CAD was assessed using the SYNTAX score. Linear regression analyses were performed to determine associations between polysomnographic parameters and SYNTAX score. Results: Significant CAD was diagnosed in 74.8% of patients. OSA was highly prevalent, with severe OSA observed in 36.4% of patients with significant CAD compared to 3.8% in those without significant stenoses (p = 0.003). Patients with significant CAD had higher AHI (18.8 vs. 13.5 events/h; p = 0.003), higher oxygen desaturation index (ODI) (19.3 vs. 12.9 events/h; p = 0.003), and greater mean oxygen desaturation (4.1% vs. 3.8%; p = 0.008). In multivariable regression analysis, AHI (B = 0.329; 95% CI [0.083, 0.576]; p = 0.009) and nicotinism (B = 8.693; 95% CI [2.573, 14.814]; p = 0.006) independently predicted higher SYNTAX scores. Interestingly, each 1% increase in snoring percentage was associated with a 0.203-point reduction in SYNTAX score (95% CI [−0.339, −0.068]; p = 0.004). Conclusions: OSA is highly prevalent in patients undergoing coronary angiography and is independently associated with greater anatomical complexity of CAD. Sleep-disordered breathing, particularly AHI and nocturnal hypoxemia, may represent important non-traditional risk markers of advanced coronary atherosclerosis. Systematic screening for OSA should be considered in patients with suspected or confirmed CAD. Full article

(1) Background: Early treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) after acute myocardial infarction (AMI) has been shown to improve myocardial salvage. This analysis evaluates nocturnal electrocardiogram (ECG) Holter data, derived from polygraphy in a randomised clinical trial (NCT02093377), to assess the occurrence of nocturnal cardiac arrhythmias in patients with SDB and to explore the effect of ASV therapy. (2) Methods: In the TEAM-ASV I trial, patients were stratified by the presence/absence of SDB, defined by an apnoea–hypopnoea index (AHI) ≥15 events/h assessed with polygraphy. Those with SDB were subsequently randomised to receive ASV in addition to standard AMI care. Guideline-conforming semi-automated ECG analysis of nocturnal cardiac arrhythmias was conducted via Holter–ECG software (custo diagnostic, version 5.4). (3) Results: Patients with SDB had an increased incidence of non-sustained ventricular tachycardia (NSVT) (SDB: n = 8 (16%) vs. no SDB: n = 1 (2%); p = 0.024) and premature atrial contractions (PAC) (SDB: 1.2/h [0.3, 3.4] vs. no SDB: 0.3/h [0.1, 1.2]; p = 0.017). In patients with SDB who were randomised to ASV treatment early after AMI, we found no reduction in cardiac arrhythmias when ASV was added to standard care. (4) Conclusions: After AMI, SDB was linked to increased NSVT and PAC. ASV treatment demonstrated neither a harmful nor a beneficial effect on the occurrence of nocturnal cardiac arrhythmias. Further trials are warranted to confirm these findings. Full article

Background and Objectives: Variations in serum 25-hydroxyvitamin D [25(OH)D] concentrations have been described among individuals working in different settings. Moreover, published evidence suggests an association between Obstructive Sleep Apnea Syndrome (OSAS) and 25(OH)D insufficiency. The aim of this study was to assess the association between certain exposures in the occupational environment and 25(OH)D levels, in relation to OSAS severity. Materials and Methods: For a period of 12 months, 25(OH)D serum levels were assessed in subjects consecutively investigated for OSAS. These were divided into group A (control subjects working indoors), group B (control subjects working outdoors), group C (OSAS patients working indoors) and group D (OSAS patients working outdoors). Results: A total of 189 subjects were included (155 males and 34 females), comprising 129 OSAS patients and 60 non-apnoeic controls. Serum 25(OH)D levels were significantly higher in group B compared to the other groups (32 ± 13 vs. 23 ± 7 ng/mL for group A, p = 0.001; vs. 15 ± 8 ng/mL for group C, p < 0.001; and vs. 23 ± 9 ng/mL for group D, p < 0.001). Additionally, serum 25(OH)D levels were higher in group A compared with group C (23 ± 7 vs. 15 ± 8 ng/mL, p = 0.001), while no significant difference was observed between groups A and D (p > 0.05). Regression analysis revealed that the apnoea–hypopnoea index (β = 0.02, OR = 1.02, 95% CI: 1.00–1.04, p = 0.02) and indoor occupation (β = 1.03, OR = 2.80, 95% CI: 1.17–6.70, p = 0.02) were independently associated with vitamin D insufficiency. Conclusions: Serum 25(OH)D levels are decreased in OSAS patients working indoors. Thus, the working environment should also be considered in the overall assessment of 25(OH)D status in OSAS patients. Full article

Transoral robotic surgery (TORS) offers a targeted surgical option for addressing base of tongue (BOT) and epiglottic obstruction in selected obstructive sleep apnoea (OSA) cases; however, most published evidence evaluates TORS within multilevel approaches, limiting understanding of single-level outcomes. A PRISMA-guided systematic review of PubMed, Embase, and Central Cochrane was conducted from inception to March 2025, aiming to evaluate objective sleep outcomes and patient-reported measures following single-level TORS BOT surgery. Inclusion criteria were adult patients with moderate-to-severe OSA and CPAP failure/intolerance, with evidence of BOT hypertrophy. Of 219 screened records, five studies met the inclusion criteria with 105 patients. Eighty-six (81.9%) were male with a combined mean age of 45.2 years and BMI of 28.2 kg/m². Combined mean AHI improved from 34.2 preoperatively to 14.7 events/hour postoperatively. Reported surgical success ranged from 54.2% to 100%. Where reported, ESS improved postoperatively with a combined mean reduction from 13 to 4.5. Most commonly reported complications were dysgeusia (n = 16, 15.2%), dysphagia/odynophagia (n = 14, 13.3%), and postoperative bleeding (n = 10, 9.5%). Single-level TORS BOT appears to improve objective and subjective outcomes in carefully selected patients, although heterogeneity and inconsistency of reported outcomes limit definitive conclusions and highlight the need for standardised outcome reporting and follow-up. Full article

Background: Obstructive sleep apnea (OSA) affects quality of life and increases cardiovascular risk. Nocturnal oxygen therapy (NOT) offers a potential alternative for patients intolerant to CPAP. The objective of this study was to compare NOT and continuous positive airway pressure (CPAP) by evaluating five-year survival in patients with obstructive sleep apnea. Methods: A retrospective cohort study was conducted using propensity score matching (PSM) methodology. A PSM analysis was conducted to reduce selection bias due to differences in baseline characteristics between patients using CPAP and those receiving oxygen therapy. Balance between treated and untreated groups was assessed using standardized mean differences. A PSM was estimated using a logistic regression model, matching patients adherent to CPAP therapy to those treated with NOT. Results: A total of 497 patients with a confirmed diagnosis of OSA were included in the analysis. The mean age was 62.1 years (SD13.6), and 54.3% (270/497) were male. Overall, 42.1% (209/497) of the patients were over 65 years old. Of the total, 303 patients received CPAP therapy and 194 received NOT. After PSM, a matched cohort of 370 patients (185 per group) was obtained. The CPAP-treated group showed a significantly lower residual Apnea–Hypopnea Index compared to the oxygen therapy group (3.9, IQR: 1.8–6.5 vs. 15, IQR:7.5–29.1; p < 0.001), indicating better physiological control of respiratory events. Treatment with CPAP was associated with a significantly lower risk of mortality compared with NOT across analytical approaches, including weighted logistic regression (OR = 0.11; 95% CI 0.02–0.48; p = 0.004) and PSM with bootstrap estimation (ATT = −0.12; 95% CI −0.22 to −0.01; p = 0.030). Conclusions: In this cohort, higher five-year survival was observed among patients with OSA treated with CPAP compared with those receiving supplemental oxygen. These findings indicate a favorable association between CPAP use and long-term outcomes, supporting its role as the preferred first-line therapy in patients with OSA. Full article

Continuous respiratory rate (RR) monitoring can improve the detection of clinical events, such as pulmonary infections, cardiac arrests, and sleep apnoea. Wi-Fi-based systems offer a low-cost, contactless alternative to radar and video. However, existing studies are limited to narrow respiratory ranges and small-scale validation. We present VitalCSI, a vital sign monitoring system using off-the-shelf, low-power Wi-Fi hardware. We recorded 15 healthy university athlete volunteers and developed RR estimation algorithms benchmarked against nasal airflow sensors. VitalCSI uses a consumer Wi-Fi access point and a Raspberry Pi computer to capture channel state information (CSI). We estimated the RR from CSI via principal component analysis (PCA), spectral peak detection, and breath (counting in 30 s windows), which were then fused by a multidimensional Kalman filter. VitalCSI showed strong agreement with airflow references ($r^2=0.93$, MAE = 1.20 brpm), tracking RR across 6–33 brpm and outperforming prior Wi-Fi studies. VitalCSI demonstrates the feasibility of RR monitoring with a single-antenna, single-board microcomputer as the Wi-Fi transmitter. It is the first validated system for continuous, contactless RR monitoring using consumer-grade Wi-Fi over an extended respiratory range, paving the way for use in both home and sports monitoring contexts. Full article

Background and Objectives: Obesity is a major public health concern associated with reduced quality of life (QoL) and multiple comorbidities. Bariatric surgery is an effective treatment for severe obesity; however, postoperative QoL outcomes in Latvia remain insufficiently studied. This prospective study evaluated short-term changes in QoL, weight loss, and selected health parameters six months after bariatric surgery. Materials and Methods: Data were collected from 17 adults who underwent bariatric surgery at a single centre in Riga, Latvia. QoL was assessed preoperatively and six months postoperatively using the validated Bariatric Quality of Life (BQL) questionnaire. Anthropometric measurements, self-reported comorbidities, and medication use were obtained at both time points. Statistical analysis was performed using non-parametric methods (p < 0.05). Results: Participants had a median age of 54 years, and 76% were female. Six months after surgery, significant reductions were observed in BMI (39.7 to 31.6 kg/m²; p < 0.0001), total weight (−23.3%), and excess weight (−60.7%). The total BQL score increased from 44.5 to 52.0 points (p = 0.004), indicating improved QoL. Self-reported hypertension and sleep apnoea decreased, and all individuals with preoperative reflux symptoms reported resolution. Waist circumference declined but often remained above metabolic risk thresholds. Hair loss was the most frequently reported postoperative adverse effect. Conclusions: Bariatric surgery was associated with short-term improvements in QoL, weight loss, and several obesity-related symptoms. Hair loss was common but expected. Given the small sample size and single-centre design, findings should be interpreted as exploratory. Larger studies with longer follow-up are needed to better characterize long-term outcomes and support the development of bariatric care in Latvia. Full article

Pancreatic β-cells are metabolically active endocrine cells with a high oxygen demand to sustain glucose-stimulated insulin secretion (GSIS). Hypoxia, arising from vascular disruption, islet isolation, or pathological states such as type 2 diabetes (T2D) and obstructive sleep apnoea (OSA), is a potent metabolic stressor that impairs β-cell function, survival, and differentiation. At the molecular level, hypoxia-inducible factors (HIF-1α and HIF-2α) orchestrate transcriptional programs that shift β-cell metabolism from oxidative phosphorylation to glycolysis, modulate mitochondrial function, and regulate survival pathways such as autophagy and mitophagy. Crosstalk with nutrient-sensing mechanisms, redox regulation, growth factor signaling, and protein synthesis control further shapes adaptive or maladaptive outcomes. Hypoxia alters glucose, lipid, and amino acid metabolism, while mitochondrial dysfunction, oxidative stress, and inflammatory signaling contribute to progressive β-cell failure. Therapeutic strategies including incretin hormones, GABAergic signaling, erythropoietin, ChREBP inhibition, and activation of calcineurin–NFAT or oxygen-binding globins—offer potential to preserve β-cell viability under hypoxia. In islet transplantation, oxygen delivery technologies, ischemic preconditioning, mesenchymal stem cell–derived exosomes, and encapsulation systems show promise in mitigating hypoxic injury and improving graft survival. This review synthesizes current knowledge on β-cell responses to hypoxic stress, with emphasis on metabolic reprogramming, molecular signaling, and translational interventions, underscoring that targeted modulation of β-cell metabolism and oxygen handling can enhance resilience to hypoxia and improve outcomes in diabetes therapy and islet transplantation. Full article

In mice, intermittent hypoxia is associated with an increase in microvessels in the hippocampus, whereas in humans with obstructive sleep apnoea (OSA), microvessels are lost from the heart and retina. The present study investigated microvascular changes in the hippocampus of patients with OSA, and whether patient age or use of continuous positive airway pressure (CPAP) influence microvascularisation. Using autopsy samples from 31 people with confirmed OSA, microvessels were immunolabelled and quantitatively analysed. Compared to the Low OSA group, the High OSA group had larger mean microvessel diameters in the fimbria and CA4, and greater mean microvessel length in the fimbria, which are indicative of microvascular remodelling. An absence of angiogenesis was indicated by similar mean vessel counts in both OSA severity groups. Increased age was associated with microvascular remodelling in the fimbria only. Treatment with CPAP was not associated with changed patterns of microvascularisation. We conclude that: (i) no evidence was found for angiogenesis in the human hippocampus in OSA or ageing; (ii) increased OSA severity is associated with microvascular remodelling in the fimbria and CA4; (iii) microvascular remodelling does not appear to be influenced by CPAP use; (iv) limited adaptability of the microvasculature may underpin the vulnerability of the hippocampus to hypoxic injury, particularly in severe OSA. Full article

Obstructive sleep apnoea (OSA) is a complex health condition associated with significant health risks and diminished quality of life. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for years, its poor adherence is well documented. With the emergence of drug-induced sleep endoscopy (DISE) and phenotypic approach to OSA, traditional surgical and non-surgical treatment pathways have been improved to allow personalised treatment and minimising suboptimal treatment to patients demonstrating various upper airway obstruction of OSA endotypes. Sedation protocol propofol, midazolam and dexmedetomidine have been suggested. The VOTE classification for documenting DISE findings have been proposed to unify results across studies. DISE plays an invaluable role in offering insights on treatment successes for positive airway pressure (PAP) therapy, mandibular advancement device (MAD) therapy, positional therapy, and surgical interventions including palatal surgeries, tongue base surgeries, upper airway stimulation (UAS) surgery and maxillomandibular advancement (MMA). This review aims at consolidating current evidence on DISE protocols, indications, and treatment implications to improve therapeutic success in OSA management. Full article

Background and Objectives: This study aimed to investigate the influence of continuous positive airway pressure in patients with obstructive sleep apnoea on hearing and the possibility of recovering cochlear receptor cells. Materials and Methods: Forty-two patients with obstructive sleep apnoea (OSA) were assigned to the study group. Patients underwent pure-tone audiometry and transient-evoked (TEOAE) and distortion-product (DPOAE) otoacoustic emissions before starting continuous positive airway pressure (CPAP) therapy and six months after CPAP therapy. Subjects were further divided into the following two groups: those who adequately used the therapy and those who did not adhere to treatment recommendations. Results: There is no significant difference in hearing thresholds for specific frequencies after six months of CPAP therapy. There is no significant difference in TEOAE and DPOAE SNR values at any frequency after 6 months of CPAP therapy. There is no significant difference in hearing threshold results for specific frequencies as a function of subject co-operation with treatment. After therapy, there is a significant difference in the SNR values in TEOAEs at 2 kHz and 4 kHz in subjects of the OSA target group, depending on co-operation, being higher in co-operative subjects, while there are no significant differences at other frequencies. There is a significant difference in the SNR results in DPOAEs, where they are higher in co-operative subjects at 1000, 6000, 7000 and 8000 Hz. Conclusions: The use of continuous positive airway pressure as a therapy for OSA has no effect on hearing and cochlear receptor cell recovery. Co-operation with CPAP treatment does not affect hearing threshold, but does affect cochlear receptor cell function, which is better at mid and higher frequencies in those who co-operate. These findings underscore the clinical significance of treatment adherence. Consistent adherence is associated with measurable improvements in hearing, particularly at higher frequencies, which cannot typically be evaluated in routine clinical practice using standard pure-tone audiometry. Our results emphasise the importance of promoting compliance with CPAP therapy not only for cardiovascular and neurological protection, but also for maintaining hearing health. Full article

Background: There are limited data on the association between B12 levels, objective sleep quality, and cardiovascular disease in patients with obstructive sleep apnoea (OSA). Therefore, the aim of our study was to assess vitamin B12 levels in a sleep clinic population in Crete, Greece, and investigate possible correlations with polysomnographic parameters and prevalent cardiovascular disease (CVD). Methods: In this cross-sectional study, data from 1468 recruited patients with OSA from the clinical database of the Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, were analyzed. OSA was defined as an apnoea–hypopnoea index ≥ 5 events per hour of sleep after type-1 Polysomnography (PSG). Data regarding anthropometrics, socio-demographics, and medical history was obtained. Logistic regression analysis was applied to examine the effect of vitamin B12 levels on PSG parameters and prevalent CVD after controlling for potential explanatory variables, including age, gender, obesity, smoking status, and co-morbidities. Results: The median vitamin B12 was 380.5 (301, 490) pg/mL. After adjustments, Vitamin B12 levels < 380.5 were associated with 24% higher odds of prolonged sleep latency (≥40 min) prevalence (OR = 1.240, 95% CI = 1.005–1.531, p = 0.045) and alterations in the proportion of NREM and REM sleep stages with 2.3 times higher likelihood of elevated NREM sleep > 80% of total sleep time (OR = 2.312, 95% CI = 1.049–5.096, p = 0.038) and 2.9 times higher likelihood of low REM sleep < 20% of total sleep time (OR = 2.858, 95% CI = 1.197–6.827, p = 0.018). Moreover, Vitamin levels < 380.5 were significantly associated with a 59.9% increase in the odds of prevalent CVD (OR = 1.599, 95% CI = 1.035–2.471, p = 0.034). Conclusions: In conclusion, our results suggest that vitamin B12 status may be associated with impaired objective sleep quality in OSA patients, potentially influencing prevalent CVD. However, further prospective research is needed to establish causality and elucidate the potential underlying mechanisms that could link vitamin B12 levels to various sleep parameters and cardiovascular disease in patients with OSA. Full article

Background: Flexible bronchoscopy (FB) is a widely used diagnostic and therapeutic procedure in patients with pulmonary disease, many of whom are at risk of gas exchange impairment. FB may exacerbate hypoxaemia due to increased airway resistance, alveolar derecruitment, and haemodynamic fluctuations. Objectives: To assess the effectiveness of non-invasive respiratory support strategies in preventing oxygen desaturation and respiratory complications during FB. Methods: A systematic review and meta-analysis were conducted using PubMed and Cochrane databases, covering studies from 2000 to 2024. Inclusion criteria focused on adult patients undergoing FB with any form of non-invasive oxygen support. Twelve high-quality studies were selected, including randomised trials and prospective cohorts. Results: High-flow therapy (HFT) was more effective than conventional oxygen therapy (COT) in maintaining oxygenation and reducing procedure interruptions, especially in patients with moderate hypoxaemia or risk factors such as obesity and obstructive sleep apnoea. Continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) offered superior oxygenation and ventilatory support in patients with more severe respiratory or cardiac compromise. Conclusions: Non-invasive respiratory support should be individualised based on patient risk and procedural complexity. HFT benefits mild-to-moderate cases, while CPAP or NIV is preferable in more severe conditions. Further multicentre randomised trials are needed to establish formal guidelines. Full article

Background: Obstructive sleep apnoea (OSA) affects 1–4% of children and may cause significant health issues if left untreated. While adenotonsillectomy is the primary intervention, up to 33% of children experience residual OSA. Drug-induced sleep endoscopy (DISE) enables identification of the site of anatomical obstruction, thus facilitating targeted surgical interventions. The approach of the institution at which this research was conducted is to only perform DISE in selected patients including those who fail adenotonsillectomy or when adenotonsillectomy is not expected to be successful. Methods: This retrospective case series reviewed 19 children who underwent DISE and DISE-directed surgeries for OSA at Perth Children’s Hospital between 2018 and 2021. Polysomnography (PSG) parameters pre- and post-surgery were compared. Results: Overall, there were no significant improvements in PSG parameters in the group post-surgery. However, improvements were found with sub-group analyses in younger children, those with severe pre-operative OSA and non-obese children. No significant improvement was observed in children with Trisomy 21. Revision adenoidectomy was the most frequently performed surgery and tongue-base reduction achieved the highest rate of improvement (80%) based on PSG parameters. Conclusions: DISE-directed surgery offers a promising approach for managing residual paediatric OSA. Outcomes may be favourable in younger patients, those with severe OSA, and non-obese patients. Further research with larger cohorts is warranted to refine surgical strategies. Full article

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