Sleep and Breathing

Filchenko, Irina; Brill, Anne-Kathrin; Dekkers, Martijn P. J.; Baillieul, Sébastien; Seiler, Andrea; Manconi, Mauro; Wiest, Roland; Bernasconi, Corrado; Schmidt, Markus H.; Bassetti, Claudio L. A.

doi: 10.1007/s11325-025-03540-8pmid: 41348375

PurposeSleep-disordered breathing (SDB) is a risk factor of ischemic stroke but can also appear “de novo” after the acute brain damage. The link between SDB and stroke topography, which remains controversial, was assessed in this study.MethodsThis is a post-hoc analysis of the multicenter prospective SAS-CARE-1 study, which included 259 patients with acute stroke or transient ischemic attack. Assessments comprised demographics, medical history, and brain magnetic resonance imaging (MRI) at admission. In 101 patients with acute stroke, MRI-based stroke topography was binary coded for the involvement as supra- (cortical and/or subcortical) and/or infratentorial (brainstem and/or cerebellar) locations. Polysomnography was performed at admission (n = 101) and at 3 months post-stroke (n = 72).ResultsA linear regression with adjustments for age and sex identified an association of brainstem stroke with a higher obstructive apnea index (OAI; 9.91 events/h for brainstem stroke versus no brainstem involvement, p = 0.003) at acute stroke, but not at 3 months post-stroke. Correspondingly, the decrease of OAI from acute to 3 months post-stroke was associated with brainstem (-10.72 events/h, p = 0.011) stroke with adjustment for age and sex. However, this association was not significant with an additional adjustment for baseline OAI. There were no other significant associations.ConclusionThis study confirms the previously reported association between brainstem stroke and obstructive apneas. Further research is needed to elucidate the link between focal brain damage and respiratory control during sleep.Graphical abstract[graphic not available: see fulltext]

Casale, Manuele; Moffa, Antonio; Baptista, Peter; Iafrati, Francesco; Alfifi, Iman Al; Iannella, Giannicola; Lugo, Rodolfo; Pang, Kenny P.; Vicini, Claudio

doi: 10.1007/s11325-025-03526-6pmid: 41396445

IntroductionBarbed Pharyngoplasty (BP), a minimally invasive, muscle-preserving surgical technique utilizing Barbed Sutures (BS) for palatal suspension and remodelling, has shown efficacy in younger cohorts but remains underexplored in older adults. The aim of this study was to show the effectiveness and safety of the BP technique as a standalone surgical treatment in selected elderly patients with moderate-severe OSA and concentric pharyngeal collapse non-compliant, intolerant, or refractory to CPAP.MethodsA retrospective study was conducted on 17 patients aged ≥ 65 years (older group) and 23 patients aged < 65 years (younger group) who underwent BP. Pre- and postoperative assessments included Apnea–Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Epworth Sleepiness Scale (ESS), and snoring severity via bed partner Visual Analog Scale (VAS).ResultsIn the older group, the mean AHI significantly decreased from 39.9 ± 20.1 to 21.1 ± 14.4 events/hour (p = 0.0002), and ODI from 32.6 ± 21.8 to 17.8 ± 12.5 events/hour (p = 0.002). Postoperative ESS and VAS scores also demonstrated significant improvement (14 ± 6.4 to 6.0 ± 3.2, and 7.9 ± 2.9 to 3.4 ± 1.5, respectively; p < 0.05). Surgical success was achieved in 42% of older group compared to 78% in the younger group. No major complications were observed.ConclusionBP is a viable, safe, and effective surgical option for selected elderly patients with moderate-to-severe OSA who are non-adherent to CPAP therapy are. Although its success rate is lower than in younger populations, likely due to age-related anatomical changes, BP provides clinically significant improvements in respiratory function and symptoms.

Sambou, Muhammed Lamin; Wang, Yifan; Xu, Feifei; Yakubu, Salimata; Liang, Shuang; Dai, Juncheng

doi: 10.1007/s11325-025-03488-9pmid: 41335219

BackgroundThe determinants of chronic diseases are complex, and we demonstrated how lifestyle-related factors interact with physiological factors to influence the risk of healthspan termination (HST).MethodsThis prospective cohort study include 217,412 UK Biobank participants aged 37 to 73. Multivariate-adjusted Cox regression models assessed individual associations between physiological and lifestyle-related factors with HST. Weighted Quantile Sum (WQS) regression models examined the relative importance of each risk factor and their cumulative effects on HST. Structural Equation Modeling (SEM) was conducted to clarify pathways linking lifestyle, physiological factors, and HST.ResultsWe observed statistically significant associations between lifestyle-related and physiological factors with HST. WQS models also indicates that unhealthy lifestyle (OR = 2.77; 95% CI: 2.65–2.89; P < 0.01) and physiological factors (OR = 3.27; 95% CI: 3.06–3.50; P < 0.01) substantially increased risk of HST. Path analysis revealed that healthspan was positively correlated with biomarker (r = 0.03; P < 0.01), sleep behavior (r = 0.14; P < 0.01), and lifestyle (r = 0.16; P < 0.01), but negatively correlated with mental health (r = -0.13; P < 0.01).ConclusionLifestyle-related factors interact with physiological factors through multiple pathways, influencing the risk of a shortened healthspan.

Dereli, Seçkin; Şeker, Onur Osman

doi: 10.1007/s11325-025-03553-3pmid: 41370000

IntroductionCongestive heart failure (CHF) affects 65 million people worldwide, with significant prevalence among the elderly. Despite therapeutic advancements, CHF often coexists sleep disorder, impacting morbidity and mortality. Optimizing heart failure management is crucial, especially in light of recent debates on respiratory therapies for heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan (SV) has shown promise in reducing cardiovascular mortality and hospital readmissions, though its impact on sleep is less explored.MethodsThis prospective, cohort, open-label study evaluated HFrEF patients with LVEF < 40%, NYHA class II-IV, and optimized medical management. Exclusions included sleep apnea, primary insomnia, or psychiatric conditions. Patients transitioned from ACE inhibitors or ARBs to SV, with dose adjustments and biweekly clinical assessments. Sleep quality and daytime alertness were measured using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) at baseline and after reaching the target dosage of SV. Functional capacity was assessed via the six-minute walk test (6-MWT).ResultsOver a mean follow-up of 132 ± 31 days, adjusted analyses showed improvement in PSQI (β − 2.60, 95% CI − 3.20 to − 2.00; p < 0.001) and ESS (β − 3.10, − 3.80 to − 2.40; p < 0.001), with increases in LVEF (+ 6.8 pp, + 5.2 to + 8.3; p < 0.001) and 6-MWT (+ 96 m, + 35 to + 157; p = 0.002); odds of PSQI > 5 and ESS ≥ 11 at follow-up were lower (OR 0.30, 0.18–0.48; p < 0.001 and OR 0.25, 0.11–0.52; p = 0.001; Table 3, and 4).ConclusionSV improves sleep quality, reduces daytime dysfunction, and enhances exercise capacity in HFrEF patients, indicating potential dual therapeutic benefits. Further studies are needed to explore SV’s full impact on sleep parameters and quality of life in this high-risk group.

Dosso, Marine; Griffon, Lucie; Vedrenne-Cloquet, Meryl; Poirault, Clément; Fauroux, Brigitte; Khirani, Sonia

doi: 10.1007/s11325-025-03561-3pmid: 41396563

PurposeAn appropriate interface is essential for the success of home mechanical ventilation (HMV). The objective of the study was to describe the interfaces used in a large cohort of children.MethodsThe underlying disorder, model of interface, age, weight, and head circumference (for children < 3 years old) at HMV initiation, were gathered. The patients were divided by categories of age and disorder (children < 3 years old).ResultsThe data were available for 476 interfaces from 380 patients. Mean age was 6.4 ± 5.9 (range 0.02–23.1) years old. The most common interface was the pediatric Soft baby XS nasal interface (Air Liquide; n = 100). The second most used interface was the adult Wisp nasal interface (Philips Respironics, n = 69). The interface used at the youngest age was the Soft baby XXS nasal interface (mean age 0.2 ± 0.2 years old). For children < 1 year old, 2 different interfaces were used with different sizes of headgear and/or cushion. From 3 years old, a larger range of interfaces was used, and from 12 years old, only 3/108 (3%) patients used a pediatric interface. The patient with the minimal head circumference had Robin sequence, and the one with the maximal head circumference had a faciostenosis.ConclusionAs expected, the most used interface was a pediatric nasal mask, but interestingly an adult nasal mask was the second most used interface. The choice is still limited in young children. A larger range of interfaces, especially for young children, and custom-made interfaces for selected patients, may facilitate the implementation of HMV worldwide.

Zhang, Yingkun; Wang, Jinxian; Han, Tong; Wu, Huipan

doi: 10.1007/s11325-025-03542-6pmid: 41361098

BackgroundSleep disturbances represent a prevalent health concern among the elderly population, exhibiting significant correlations with chronic diseases and substantially diminishing quality of life. Chronic conditions may indirectly impact sleep quality through somatic pain and depressive symptoms; however, this chain mediation mechanism remains inadequately supported by empirical research. This study aims to investigate the relationship between chronic diseases and sleep disturbances in the elderly population, while examining the chain mediation effects of somatic pain and depressive symptoms between these variables.DesignThis study was a cross-sectional study that used a structural equation model to test the chain mediating effect.MethodsData from 7,631 elderly people aged 60 and above in the 2018 China Health and Retirement Longitudinal Study (CHARLS) were utilized. Statistical analysis was conducted using SPSS 26.0 and the PROCESS macro program. The number of chronic diseases was the independent variable, sleep duration was the dependent variable, and somatic pain and depressive symptoms were the mediating variables for the chain mediating effect test.ResultsThe number of chronic diseases in the elderly was negatively correlated with sleep duration (β = -0.36, P < 0.001). Somatic pain and depressive symptoms played a significant chain mediating role between chronic diseases and sleep, accounting for 25.53% of the total effect.ConclusionsThe more chronic diseases the elderly have, the shorter their sleep duration at night. Somatic pain and depressive symptoms play a chain mediating role in the process by which chronic diseases affect sleep, suggesting that medical staff should pay attention to pain management and mental health intervention for elderly patients with chronic diseases to improve their sleep quality.

Wu, Shi-Cheng; Yang, Chu-Dan; Lin, Xue-Jun; Chen, Shu-Ting; Cai, Jia-Ying; Lin, Li; Lian, Ning-Fang; Cai, Zhi-Ming; Chen, Li-Da

doi: 10.1007/s11325-025-03532-8pmid: 41331387

ObjectiveThis longitudinal study evaluated the predictive value of ten anthropometric indices including Waist Circumference (WC), Hip Circumference (HC), Neck Circumference (NC), Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), Waist-to-Hip Ratio (WHR), A Body Shape Index (ABSI), Body Roundness Index (BRI), Weight-adjusted Waist Index (WWI), and Neck-to-Height Ratio (NHR) for incident obstructive sleep apnea (OSA), aiming to identify optimal clinical predictors.MethodsData were obtained from the Sleep Heart Health Study at baseline and at an average follow-up of approximately 5 years. Multivariable logistic regression (adjusted for demographics and comorbidities), restricted cubic splines, subgroup analyses, and ROC curves were used to assess associations, nonlinearity, interactions, and predictive performance, respectively.ResultsAmong 1,306 participants (876 non-OSA, 430 OSA), all indices except ABSI were significantly associated with OSA risk after adjustment, with the strongest associations observed in the highest quartiles: NC (OR = 3.11, 95% CI: 1.94–5.00, p < 0.001), followed by WHtR (OR = 2.92, 95% CI: 2.03–4.21, p < 0.001), BRI (OR = 2.92, 95% CI: 2.03–4.21, p < 0.001), WC (OR = 2.68, 95% CI: 1.84–3.83, p < 0.001), and NHR (OR = 2.67, 95% CI: 1.83–3.91, p < 0.001). BRI demonstrated a nonlinear dose-response relationship with a threshold at BRI = 5.43: below this value, OSA risk increased significantly (OR = 1.48 per unit); above it, no further risk increase was observed. WHtR showed a linear association with OSA. In ROC analysis, both WHtR and BRI had the highest discriminative ability (AUC = 0.624), while NHR also showed comparable predictive performance (AUC = 0.620).ConclusionsWHtR and BRI are key anthropometric predictors for OSA, with BRI displaying a threshold effect. NHR also shows potential as a supplementary screening marker.

Bayle, J-Y.; Onen, F.; Onen, S-H.

doi: 10.1007/s11325-025-03558-ypmid: 41420132

PurposeThe impact of remote monitoring (RM) on the likelihood of continuing CPAP therapy in apneic patients remains unknown in the long term and was addressed by a comparative cohort analysis.MethodsThe probability of continuing CPAP (pC-CPAP) was compared by log-rank test between two groups of adult patients with obstructive sleep apnea syndrome: Group A = CPAP initiated without RM between 2015 and 2016 (n = 1806); Group B = CPAP initiated with RM between 2018 and 2019 (n = 3195). CPAP discontinuations were either legitimate (LD) or forced (FD). The impact of gender and age was assessed from the hazard ratio of FDs (Cox model) and propensity coefficient matching.ResultspC-CPAP at 3 years was higher if CPAP began with RM (72.3% with 95% CI = [70.8, 73.9] for group B versus 67.4% with 95% CI = [65.2, 69.6] for group A (log rank = 10,595 ; p = 0.001)). If the LD rate did not change, the risk of FD in group B decreased by 15.3% (p = 0.001), remained lower in men (p = 0.013), decreased in the age groups [31; 40] (p < 0.0001) and [41; 50] (p = 0.001). The class of age with the highest propensity to maintain CPAP was rejuvenated by a decade.ConclusionThese results are consistent with a benefit of RM from CPAP initiation for improving the chances of continuing CPAP in the long term with a generation-dependent gain.

Noah, William H.

doi: 10.1007/s11325-025-03562-2pmid: 41455035

Najafi, Arezu; Erfanian, Reza; Haghighi, Khosro Sadeghniiat; Yaghoobi Asl, Omid; Heidari, Reyhane

doi: 10.1007/s11325-025-03535-5pmid: 41452408

BackgroundA split-night sleep study is a specialized diagnostic tool that combines the evaluation and treatment of sleep apnea into a single night. The initial phase involves monitoring physiological parameters to assess the severity of sleep apnea, measured by the Apnea-Hypopnea Index (AHI). Subsequently, Positive Airway Pressure (PAP) therapy is initiated. This study aims to predict full-night AHI and severe obstructive sleep apnea (OSA) based on early-night data.MethodsConsecutive patients referred for full-night polysomnography (PSG) were included. Clinical data (gender, age, blood pressure, Body Mass Index (BMI), snoring, apnea, neck circumference, ESS) and first 2-hour physiological parameters (sleep amounts, efficiency, respiratory event indices, oxygen saturation) were collected. Multivariate regression analyses were used to predict severe OSA (AHI > 30 events/hr). For external validation, 40 cases suspected of OSA were selected from another sleep center.ResultsIn a study of 348 patients, 41% were found to have severe OSA. BMI was the most accurate clinical predictor, with an accuracy of 0.69. The initial 2-hour AHI proved to be the best physiological predictor, achieving an accuracy of 0.79. A multivariate model that combined AHI, mean oxygen saturation, and the hypopnea index showed an accuracy of 0.82 for both internal and external samples.ConclusionsA combined model using various PSG features can accurately identify patients who need split-night PSG. This method could enhance efficiency and lower costs in settings with limited resources.