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Caranti, Alberto; Campisi, Ruggero; Facchini, Fabio; Moretti, Francesco; Cerritelli, Luca; Pang, Kenny; Maniaci, Antonino; Iannella, Giannicola; Vicini, Claudio
doi: 10.1007/s11325-026-03719-7pmid: 42189386
IntroductionObstructive Sleep Apnea (OSA) is a prevalent disorder managed with CPAP, though adherence is often poor. Alternatives include MAD, positional therapy, and surgery. Drug-Induced Sleep Endoscopy (DISE) allows dynamic airway assessment. This study compares NOHL classification in awake versus sedated states to evaluate differences in collapse patterns and severity.Material and methodThis study enrolled adult OSA patients (confirmed by polysomnography) undergoing DISE between October 2023 and December 2024. Excluding comorbidities or incomplete data, patients were assessed using the NOHL classification during both awake and sedated states. Collapse degree and pattern at oropharyngeal and hypopharyngeal levels were compared to evaluate concordance.ResultWe enrolled 96 OSA patients (93.8% male; mean age: 52 years). A comparison between evaluations performed during wakefulness using the Müller maneuver and those performed with DISE revealed significant discrepancies in the grades and patterns of oropharyngeal and hypopharyngeal collapse. DISE identified more severe collapses (> 2) and frequent changes in collapse patterns, particularly in latero-lateral collapses. Correlation between awake and sedated findings was low, but improved when categorizing collapse as above or below 50%. Circular patterns were notably unstable across both levels.ConclusionOur study confirms significant differences in collapse degree and pattern between awake and sedated assessments using the NOHL classification. These discrepancies influence surgical decision-making in OSA patients. Further research is needed to improve patient phenotyping and guide more accurate, personalized treatment strategies for optimal surgical outcomes.
Zhang, Xuexue; Wang, Xujie; Qu, Hua; Zhang, Wantong; Weng, Weiliang; Li, Qiuyan
doi: 10.1007/s11325-026-03713-zpmid: 42154404
BackgroundSleep disorders present a substantial challenge to public health. This study aims to analyze patterns in self-reported trouble sleeping, duration of sleep, and the utilization of prescription medications commonly used for insomnia (MCUFI) among the adult in the US.MethodsData from five cycles of cross-sectional studies were gathered via the National Health and Nutrition Examination Survey (NHANES) spanning the years 2009 to 2010 through 2017 to 2018. Participants were asked to self-report on their trouble sleeping and sleep duration.ResultsThe prevalence of self-reported trouble sleeping rose noticeably from 24.93% (95% confidence interval [CI],22.73%-27.28%) in 2009–2010 to 30.03% (95%CI, 27.22%-33.00%) in 2017–2018 (P for trend = 0.001). In 2017–2018, 24.25% (95%CI, 22.04%-26.60%) reported < 7 h of sleep, which is a decreased of 11.94% since 2009–2010, while those reported ≥ 9 h increased from 7.14% (95%CI, 6.21%-8.20%) to 20.89% (95%CI, 19.90%-21.92%). However, those who slept for 7–9 h did not experience a significant change. Moreover, a U-shaped relationship was observed between sleep duration and trouble sleeping, indicating that the optimal amount of sleep for adults is 7.5 h. Furthermore, 3.72% (95%CI, 3.39%-4.09%) of adults used a MCUFI, with the most commonly used medications being zolpidem and trazodone. The overall MCUFI use did not change from 2009 to 2018 (P for trend = 0.9923).ConclusionIn conclusion, the prevalence of self-reported trouble sleeping has risen in the US during the past decade, whereas the utilization of MCUFI has remained steady. Evidence from this study has shown that a sleep duration of 7.5 h is the optimal time for sleep with the lowest risk of encountering trouble sleeping.
Kerget, Buğra; Çınar, İsmail; Çelik, Kadir; Özkan, Hatice Beyza; Aksakal, Alperen; Uçar, Elif Yılmazel
doi: 10.1007/s11325-026-03708-wpmid: 42174307
ObjectiveObstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxemia and increased respiratory effort. This study investigated whether evening-to-morning changes in respiratory muscle strength reflect short-term physiological responses to overnight apnea–hypopnea-related loading.MethodsEighty patients undergoing overnight polysomnography for suspected OSA between February and June 2025 were prospectively evaluated. Maximal inspiratory (MIP) and expiratory (MEP) pressures were measured in the evening before and in the morning after PSG, and changes were calculated as morning minus evening values (ΔMIP and ΔMEP).ResultsPositive ΔMIP and ΔMEP values were significantly higher in patients with OSA compared to the control group (p < 0.001 for both). During sleep, both minimum and maximum oxygen saturation values were significantly lower in the OSA group than in controls (p < 0.001, 0.009). In multivariate regression analysis, ΔMIP was positively associated with BMI (β = 0.609, p < 0.001), REM-AHI (β = 0.693, p < 0.001), and supine AHI (β = 1.597, p < 0.001), and negatively associated with ODI (β = −1.000, p < 0.001). Similarly, ΔMEP was positively associated with BMI (β = 0.370, p = 0.001), REM-AHI (β = 0.506, p = 0.002), and supine AHI (β = 1.706, p < 0.001), while negatively associated with ODI (β = −1.128, p < 0.001).ConclusionEvening-to-morning changes in respiratory muscle strength reflect acute overnight respiratory muscle loading in patients with OSA and provide physiological insight into short-term neuromuscular adaptations associated with recurrent apnea–hypopnea events.
Beeldens, Jente; Makhout, Sanae; Van Hoorenbeeck, Kim; Verhulst, Stijn; Van Eyck, Annelies
doi: 10.1007/s11325-026-03714-ypmid: 42159625
PurposeThe aim of this scoping review is to provide a comprehensive overview of existing research exploring the potentially triadic relation between obesity, OSA, and MASLD in children.MethodsA systematic literature search of PubMed and Web of Science was conducted in accordance with the PRISMA Extension for Scoping Review (PRISMA-ScR) guidelines. Following title and abstract screening, eligible studies were subjected to full-text assessment, resulting in the inclusion of 15 studies in the final review.ResultsThe initial search identified 263 studies, of which 15 met the inclusion criteria following title and abstract screening and full-text review. Data extraction enabled a comprehensive synthesis of current evidence on the pairwise associations and the potential triadic relationship between obesity, OSA, and MASLD in children. The findings suggest that oxidative stress and inflammation are key underlying mechanisms contributing to this triadic interplay.ConclusionKey causative factors identified for the triad between pediatric obesity, OSA, and MASLD encompass adipocyte dysfunction, hypoxia-induced IR, and inflammation. However, certain ambiguities remain. Future research should clarify the underlying mechanisms, including fat distribution and the gut-liver axis, and investigate the impact of intermittent hypoxia on adipose tissue to inform treatment strategies targeting all components of the triad.
Thomas, Elezabeth Donna; Venkatnarayan, Kavitha; Veluthat, Chitra; Selvam, Sumithra; Ramachandran, Priya; Devaraj, Uma; Krishnaswamy, Uma Maheswari
doi: 10.1007/s11325-026-03712-0pmid: 42141168
PurposeInterstitial lung diseases are frequently associated with sleep disturbances that adversely affect health-related quality of life (HRQoL), yet these remain under-recognized. This study aimed to assess sleep quality and sleep disordered breathing in patients with ILD and evaluate their association with HRQoL.MethodsIn this cross-sectional study, conducted at a tertiary care centre in India, adults with a confirmed diagnosis of ILD were enrolled. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) and HRQoL using King’s Brief ILD and EQ-5D-5 L questionnaires respectively. Consenting participants underwent level I polysomnography. Linear regression was used to identify risk factors independently associated with HRQoL measures.ResultsOf the 100 participants included, 69 underwent polysomnography. Poor sleep quality (PSQI > 5) was observed in 75% and OSA was diagnosed in 71% respectively. Poor sleep quality was associated with higher neck circumference, higher ESS score and significantly poorer generic and disease-specific HRQoL. OSA was associated with older age, higher BMI, and greater neck circumference but showed no association with HRQoL measures. Regression analysis identified that poor sleep quality was independently associated with excessive daytime sleepiness and poorer HRQoL.ConclusionPoor sleep quality and obstructive sleep apnea were frequent in our study population. Poor sleep quality (PSQI) was independently associated with worse HRQoL, highlighting the importance of evaluating sleep in patients with ILD.
Kempen, Trees; Boon, Mieke; Dereymaeker, Anneleen; Rochtus, Anne; Proost, Renee; Lemmens, Katrien; Jansen, Katrien
doi: 10.1007/s11325-026-03709-9pmid: 42154139
PurposePrader-Willi syndrome (PWS) is a rare genetic disorder characterized by hypothalamic dysfunction and brainstem immaturity, contributing to central sleep apnea (CSA), hypoventilation and hypersomnolence. Obstructive sleep apnea (OSA) is more common in older children with PWS due to adenotonsillar hypertrophy and obesity. Data on polysomnographic findings in infants remain scarce. This study aimed to assess sleep-disordered breathing and its possible association with brain maturation, based on electroencephalography (EEG) findings, in infants (< 12 months) with PWS.MethodsWe conducted a retrospective analysis of polysomnography (PSG) and EEG data, from seven growth hormone-naive infants with PWS. Statistical comparisons were made between neonatal and older infants, and between those with age-appropriate versus dysmature EEGs.ResultsOne infant died suddenly and unexpectedly before PSG could be completed. The median central apnea index was 1.42/h; none of the infants met criteria for CSA. OSA was present in 66.6% of PSGs, with a median obstructive apnea–hypopnea index of 3.94/h. All infants had low arousal indices. Delayed brain maturation was observed in three infants on EEG, with no correlation found between EEG maturity and apnea indices.ConclusionOSA also presents in infants with PWS and is mainly caused by hypotonia and a narrow oropharynx. No correlation was found between EEG-based brain immaturity and central apnea severity. Given the respiratory vulnerability of these infants, a baseline PSG is strongly recommended. Larger studies are needed to confirm these findings and to clarify their clinical implications, including the potential role of EEG in early risk stratification.
Tschopp, Samuel; Reist, Arina; Borner, Urs; Caversaccio, Marco; Latzin, Philipp; Korten, Insa
doi: 10.1007/s11325-026-03677-0pmid: 42142179
PurposePediatric obstructive sleep-disordered breathing (SDB) is frequently diagnosed using single-night home sleep apnea testing (HSAT). However, concerns persist regarding diagnostic accuracy due to night-to-night variability and the first-night effect, defined as systematic differences between the first and subsequent nights. Previous research on pediatric polysomnography has yielded conflicting findings regarding these phenomena. This study assesses the presence of a first-night effect and quantifies night-to-night variability in respiratory parameters among children undergoing HSAT.MethodsThis retrospective study analyzed respiratory polygraphy data collected over two consecutive nights from a real-world, unselected population of children with suspected SDB. The primary outcome was the difference in apnea-hypopnea index (AHI) between the first and second nights, commonly referred to as the first-night effect. Secondary outcomes included differences in other respiratory parameters and between-night accuracy in diagnosing obstructive sleep apnea (OSA).ResultsForty-eight children (median age: 6.7 years, 75% male) were included in the analysis. No systematic differences were detected between the first and second nights in AHI or other respiratory parameters, suggesting an absence of the first-night effect. Nevertheless, for some participants, measurements varied widely between nights. This resulted in 29% of children changing the diagnostic category of OSA between nights.ConclusionPediatric HSAT in this real-world population with mostly mild SDB symptoms demonstrates no significant first-night effect; however, moderate night-to-night variability exists in some children. Clinicians must consider this variability when interpreting HSAT results in cases where clinical presentation and single-night HSAT outcomes conflict; a multi-night assessment may be warranted to improve diagnostic accuracy.
doi: 10.1007/s11325-026-03720-0pmid: 42228198
BackgroundObesity is strongly associated with left ventricular diastolic dysfunction (LVDD), an early phenotype along the heart failure with preserved ejection fraction spectrum. Obstructive sleep apnea (OSA) is common in obesity and may coexist with epicardial adiposity, systemic inflammation, and autonomic imbalance; however, whether screening-defined high OSA risk is associated with LVDD in obese adults remains uncertain.ObjectiveTo evaluate associations of OSA risk, epicardial adipose tissue (EAT) thickness, systemic inflammatory indices, and heart rate variability (HRV) with LVDD in obese adults and to explore their screening-oriented discriminative performance.MethodsIn this single-center, cross-sectional study, consecutive adult patients presenting to the cardiology outpatient clinic between January and December 2025 were screened. Eligible participants were adults in sinus rhythm with adequate echocardiographic image quality. The final cohort included 279 participants: 113 obese adults (body mass index [BMI] ≥ 30 kg/m2) and 166 non-obese controls (BMI < 25 kg/m2). LVDD was assessed by transthoracic echocardiography according to the 2016 ASE/EACVI recommendations. OSA risk was evaluated using the STOP-BANG questionnaire, with high risk prespecified as a score ≥ 3. Epicardial adipose tissue (EAT) thickness and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), were measured. LVDD prevalence comparisons were performed in the full cohort, whereas multivariable and discriminative analyses were prespecified and restricted to obese participants with definitive diastolic classification. Heart rate variability (HRV) parameters were analyzed as supportive mechanistic markers only.ResultsLVDD was more frequent in obese participants than in non-obese controls (43% vs 7%, p < 0.001). Within the obese subgroup, high STOP-BANG risk (≥ 3) was associated with greater EAT thickness, higher inflammatory burden, and lower HRV indices. In multivariable analyses restricted to obese participants, high STOP-BANG risk remained associated with LVDD in both the full model (OR 2.67, 95% CI 1.25–5.71; p = 0.011) and the reduced model (OR 2.55, 95% CI 1.31–5.55; p = 0.011). A reduced screening-oriented model incorporating STOP-BANG category, EAT thickness, and inflammatory indices showed acceptable discrimination for LVDD in obese adults.ConclusionsIn obese adults, STOP-BANG–defined high OSA risk is associated with a phenotype characterized by greater epicardial adiposity, higher inflammatory burden, autonomic impairment, and a higher prevalence of LVDD. A parsimonious model integrating STOP-BANG, EAT thickness, and inflammatory indices may support screening-oriented phenotypic characterization of obese adults with a higher likelihood of LVDD; however, these findings should not be interpreted as establishing causal inference or diagnostic confirmation of OSA.Graphical AbstractObesity is accompanied by greater epicardial adipose tissue thickness, low-grade systemic inflammation, and higher STOP-BANG–defined OSA risk. In this cross-sectional cohort, these interrelated features were associated with a less favorable diastolic phenotype and a higher prevalence of LVDD. A parsimonious model combining EAT thickness, inflammatory indices, and STOP-BANG category may support exploratory screening-oriented phenotypic characterization of obese adults with a higher likelihood of LVDD.[graphic not available: see fulltext]
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