UNASSIGNED: Obstructive sleep apnea (OSA) is a common breathing disorder during sleep that is associated with symptoms such as snoring, excessive daytime sleepiness, and breathing interruptions. Polysomnography (PSG) is the most reliable diagnostic test for OSA; however, its high cost and lengthy testing duration make it difficult to access for many patients. With the availability of free snore applications for home-monitoring, this study aimed to validate the top three ranked snore applications, namely SnoreLab (SL), Anti Snore Solution (ASS), and Sleep Cycle Alarm (SCA), using PSG.
UNASSIGNED: Sixty participants underwent an overnight PSG while simultaneously using three identical smartphones with the tested apps to gather sleep and snoring data.
UNASSIGNED: The study discovered that all three applications were significantly correlated with the total recording time and snore counts of PSG, with ASS showing good agreement with snore counts. Furthermore, the Snore Score, Time Snoring of SL, and Sleep Quality of SCA had a significant correlation with the natural logarithm of apnea hypopnea index (lnAHI) of PSG. The Snore Score of SL and the Sleep Quality of SCA were shown to be useful for evaluating snore severity and for pre-diagnosing or predicting OSA above moderate levels.
UNASSIGNED: These findings suggest that some parameters of free snore applications can be employed to monitor OSA progress, and future research could involve adjusted algorithms and larger-scale studies to further authenticate these downloadable snore and sleep applications.

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The aim of this study was to analyze drug-induced sleep endoscopy (DISE) findings performed in 64 patients and to evaluate the association of DISE findings with PSG parameters. This retrospective, single center, observational study included patients with obstructive sleep apnoea (OSA) who have undergone DISE as part of surgical planning. DISE was performed using dexmedetomidine infusion. The data were documented as per VOTE (velum, oropharynx, tongue base and epiglottis) classification. The patient characteristics and level 2 Polysomnography (PSG) findings were analyzed with DISE findings. Among 62 patients, mean AHI and lowest oxygen saturation levels were 39.68 ± 27.59 and 78.36 ± 9.38, respectively. Mean ESS, SSS and PSQI levels were 10.74 ±  - 4.96, 7.73 ±  - 1.52, and 8.92 +/- 4.99, respectively. A Single level of obstruction was observed in 4.8% patients, followed by 40.3%, 43.5%, and 11.3% were found to have 2, 3, and 4 levels of obstruction, respectively. All patients had palatal involvement, followed by the oropharyngeal (88.7%), the tongue base (59.7%), and the epiglottis (12.9%) obstruction. There was no significant correlation between partial collapse at velopharynx with AHI. However, complete collapse at the level of the oropharynx (p < 0.05) and the tongue base (p < 0.001) showed a statistically significant association with AHI. Also, a significant correlation was observed between the number of sites and AHI Grade (p < 0.0001). The study helps to understand the association of different patterns and degrees of anatomical obstruction in OSA with different PSG parameters. PSG and DISE findings are complimentary to each other in treatment planning and selection of surgical procedures.

Sleep-disordered breathing affects children\'s growth and development, mental health, and learning ability. Postoperative scarring causes anteroposterior and vertical developmental disorders of the maxilla. Obstructive apnea is likely to occur due to the influence on the maxillofacial and airway morphology. In this study, we investigated the sleep-respiratory dynamics of school-aged children with unilateral cleft lip and palate by performing a simple overnight sleep study, maxillofacial morphology, airway analysis using lateral cranial radiographs, and model analysis. Children with unilateral cleft lip and palate showed a significantly higher respiratory event index (REI) than normal children; the maxilla was located in the posterior position in terms of maxillofacial morphology and airway morphology showed narrow values for all distance measurement items. Moreover, the width and length of the dental arch and the width of the alveolar base arch were significantly smaller. Furthermore, REI and SNA, ANB, and REI were negatively correlated with alveolar base arch width. Children with unilateral cleft lip and palate are more likely than normal children to develop sleep-disordered breathing due to increased airway resistance caused by undergrowth of the maxilla and narrowing of the upper airway and oral volume.

BACKGROUND: There are limited data reporting diagnostic practices, compared to clinical guidelines, for patients with chronic respiratory failure requiring home mechanical ventilation (HMV). There are no data detailing the current use of downloaded physiological monitoring data in day-to-day clinical practice during initiation and follow up of patients on HMV. This survey reports clinicians\' practices, with a specific focus on the clinical approaches employed to assess, monitor and manage HMV patients.
METHODS: A web-based international survey was open between 1 January and 31 March 2023.
RESULTS: In total, 114 clinicians responded; 84% of the clinicians downloaded the internal physiological ventilator data when initiating and maintaining HMV patients, and 99% of the clinicians followed up with patients within 3 months. Adherence, leak and the apnea-hypopnea index were the three highest rated items. Oxygen saturation was used to support a diagnosis of nocturnal hypoventilation and was preferred over measurements of carbon dioxide. Furthermore, 78% of the clinicians reviewed data for the assessment of patient ventilator asynchrony (PVA), although the confidence reported in identifying certain PVAs was reported as unconfident or extremely unconfident.
CONCLUSIONS: This survey confirmed that clinical practice varies and often does not follow the current guidelines. Despite PVA being of clinical interest, its clinical relevance was not clear, and further research, education and training are required to improve clinical confidence.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder that is caused by the reduction or cessation of airflow in the upper airway. Irisin, retinol-binding protein-4 (RBP-4), and adiponectin are the three significant factors in the metabolic process of the human body. The objective of this study was to investigate whether plasma irisin, RBP-4, and adiponectin levels are associated with the severity of OSAS.
According to inclusion and exclusion criteria, 125 patients with OSAS and 46 healthy, gender-matched controls were included in this study. The patients were classified according to the apnea hypopnea index (AHI) as 14 mild cases (5 < AHI < 15), 23 moderate OSAS cases (15 < AHI < 30), and 88 severe OSAS cases (AHI > 30). The plasma irisin, RBP-4, and adiponectin levels were measured and compared between groups.
RBP-4 levels were higher in severe OSAS compared to other groups, and irisin levels were significantly lower in severe OSAS compared to other groups. There was a negative correlation between irisin and RBP-4 (r = -0.421; p < 0.001), and irisin and AHI (r = -0.834; p < 0.001), and a positive correlation between irisin and adiponectin (r = 0.240; p = 0.002). There was a negative correlation between RBP-4 and adiponectin (r = -0.507; p < 0.001) and a positive correlation between RBP-4 and AHI (r = 0.473; p < 0.001). As a predictor of OSAS, adiponectin showed the highest specificity (84.8%) and RBP-4 the highest sensitivity (92.0%).
Circulating adiponectin, irisin, and RBP-4 may be new biomarkers in OSAS patients in addition to risk factors such as diabetes, obesity, and hypertension. When polysomnography is not available, these parameters and clinical data can be used to diagnose the disease. As a result, patients with an AHI score greater than thirty should be closely monitored for metabolic abnormalities.

Background: Obstructive sleep apnea (OSA) is characterized by recurring episodes of pharyngeal collapse, which can partially or completely block airflow during sleep and cause cardiorespiratory and neurological imbalances. Therefore, the purpose of this study was to assess OSA and the relationship between AHI and polysomnographic characteristics in OSA patients. Methodology: A prospective study was conducted at the Department of Pulmonology and Sleep Medicine for two years. All 216 participants underwent polysomnography, and 175 of them were reported to have OSA (AHI ≥ 5), while 41 of them did not (AHI < 5). ANOVA and Pearson\'s correlation coefficient test were performed. Results: In terms of the study population\'s average AHI, Group 1 had 1.69 ± 1.34, mild OSA had 11.79 ± 3.55, moderate OSA had 22.12 ± 4.34, and severe OSA was found to have 59.16 ± 22.15 events/hour. The study group\'s average age was 53.77 ± 7.19 out of 175 OSA patients. According to AHI, the BMI for mild OSA was 31.66 ± 8.32 kg/m2, for moderate OSA, it was 30.52 ± 3.99 kg/m2, and for severe OSA, it was 34.35 ± 8.22 kg/m2. The average number of oxygen desaturation events and snoring duration were 25.20 ± 18.63 and 24.61 ± 28.53 min, respectively. BMI (r = 0.249, p < 0.001), average oxygen saturation (r = -0.387, p < 0.000), oxygen desaturation (r = 0.661, p < 0.000), snoring time (r = 0.231, p < 0.002), and the number of snores (r = 0.383, p < 0.001) were the polysomnographic variables that showed significant correlations with AHI in the study group. Conclusions: In this study, a substantial prevalence of obesity and a high OSA frequency were found in men. Our research showed that individuals with obstructive sleep apnea experience nocturnal desaturations. Polysomnography is the primary test for early detection of this treatable condition.

BACKGROUND: Obstructive sleep apnea (OSA) syndrome is associated with a high mortality, and blood oxygen indexes play an important role in evaluating this disease. The objective of this study was to explore the value of blood oxygen indexes, including minimum oxygen saturation (LSpO2), oxygen reduction index (ODI) and time spent with oxygen saturation below 90% (TS 90%), as diagnostic markers for OSA syndrome.
METHODS: In this retrospective study, 320 patients with OSA treated in Ningbo First Hospital from June 2018 to June 2021 were included and divided into mild, moderate, and severe groups according to the severity of the condition (n = 104, 92, and 124, respectively). The blood oxygen indexes as well as the apnea-hypopnea index (AHI) were compared. The Spearman correlation analysis was performed to explore the relationship between the parameters. Receiver operating characteristic curves were generated to evaluate the diagnostic value of the blood oxygen indexes for OSA syndrome.
RESULTS: There were significant differences in body weight, body mass index, and blood pressure before and after sleep among the groups (P < 0.05). LSpO2 levels followed a pattern with the severe group showing the lowest values, followed by the moderate group, and then the mild group, whereas ODI and TS 90% levels showed the opposite (P < 0.05). Spearman correlation analysis showed that AHI, ODI, TS 90% were positively correlated with severity of OSA, whereas LSpO2 was negatively correlated with severity of OSA. ODI showed a high diagnostic value for OSA (area under curve (AUC) = 0.823, 95% CI: 0.730-0.917). TS 90% showed a high diagnostic value for OSA (AUC = 0.872, 95% CI: 0.794-0.950). LSpO2 showed high accuracy in diagnostic value for OSA (AUC = 0.716, 95% CI: 0.596-0.835). The combination of the 3 indexes demonstrated a high diagnostic value for OSA (AUC = 0.939, 95% CI: 0.890-0.989). The diagnostic value of the combined signature was found to be significantly higher compared to the value of individual indexes (P < 0.05).
CONCLUSIONS: The evaluation of the severity of OSA should not rely solely on a single observation index, but rather on a combination of ODI, LSpO2 and TS 90%. This combined diagnostic signature can provide a more comprehensive assessment of the patient\'s condition and serve as an alternative diagnostic basis to ensure timely diagnosis and appropriate clinical treatment for OSA.

Obstructive sleep apnea (OSA) is frequently reported among patients with chronic kidney disease resulting in considerable morbidity and mortality. OSA may cause repetitive stimulation of the sympathetic nervous system and elevations in pulmonary artery pressure leading to an elevated risk of cardiac and vascular complications in patients with chronic kidney disease. Furthermore, OSA is associated with progressive worsening of kidney injury and loss of renal function.
In this systematic review and meta-analysis, we evaluated the effect of renal transplantation on the progression of OSA in patients with end-stage kidney disease.
The meta-analysis included eight studies with a total of 401 patients. Findings showed that kidney transplantation does not lead to a statistically significant effect on the apnea-hypopnea index (MD 2.6 events/hr, 95% CI -3.2 to 8.3, p = 0.21), total sleep time (MD 14.7 min/night, 95% CI -8.4 to 37.8, p = 0.76), sleep efficiency (MD 2.5%, 95% CI -1.4 to 6.3, p = 0.57), slow wave sleep (MD 0.4% of total sleep time, 95% CI -7.5 to 8.4, p = 0.05), and rapid eye movement sleep (MD 0.6% of total sleep time, 95% CI -2.2 to 3.3, p = 0.98). There was no statistically significant effect of kidney transplantation on OSA in patients with chronic renal disease.