Obstructive Sleep Apnea: New Perspective

Comparative Efficacy of Continuous Positive Airway Pressure and Antihypertensive Medications in Obstructive Sleep Apnea-Related Hypertension: A Narrative Review

INTRODUCTION

Obstructive sleep apnea (OSA) presents a significant global health concern, affecting a substantial portion of the population, particularly among young and middle-aged adults.

AIM

This review aims to assess the efficacy of continuous positive airway pressure (CPAP) compared to antihypertensive medications in managing OSA-related hypertension.

METHODS

A comprehensive literature search was conducted across multiple databases, yielding studies published from 2000 to March 2024 that investigated CPAP, antihypertensives, or their combination therapy in OSA patients. Six definitive studies were analyzed, including two randomized controlled trials (RCTs), one randomized double-blind placebo-controlled crossover trial, one placebo-controlled trial, one open-label multicenter trial, and one longitudinal cohort study. These studies comprised 939 participants, with intervention durations ranging from four weeks to six months.

RESULTS

Analysis of CPAP monotherapy revealed variable efficacy, with some studies demonstrating significant reductions in 24-hour mean blood pressure and diastolic pressure, while others reported non-significant changes. CPAP therapy combined with antihypertensives showed additive effects, particularly in reducing office blood pressure measurements. Antihypertensive medications, such as valsartan, exhibited superior efficacy in reducing blood pressure compared to CPAP alone. Factors influencing therapy effectiveness included CPAP compliance, patient characteristics, and coexisting comorbidities. Patients with good CPAP adherence experienced greater reductions in blood pressure. The duration of exposure to OSA and the type of hypertension also impacted the therapy response.

CONCLUSION

While CPAP and antihypertensive medications offer significant benefits in managing hypertension among OSA patients, challenges such as CPAP intolerance and medication side effects exist. Personalized treatment considering individual patient factors is crucial for optimal management.

In silico and in vivo experiments of Huperzine A modulating the development of obstructive sleep apnea by transcriptionally regulating pyruvate carboxylase expression via retinoid X receptor alpha

IntroductionThis study investigated the molecular mechanism by which HuA influences the expression of pyruvate carboxylase via retinoid X receptor alpha (RXRA), thereby affecting the progression of obstructive sleep apnea (OSA).MethodsBioinformatics analysis including screening of differentially expressed genes (DEGs) and searching the downstream target genes of RXRA were conducted. Cognitive function, neuronal damage, oxidative stress, and inflammation were evaluated in chronic intermittent hypoxia (CIH) mouse models. The Morris water maze test was used to assess swimming path length, escape latency, and platform crossing times. H&E and Nissl staining was performed to evaluate pathological changes and neuronal counts in brain tissue. ELISA was utilized to measure the oxidative stress levels and inflammatory cytokines. RXRA enrichment in the pyruvate carboxylase promoter region in CIH was assessed using Chromatin Immunoprecipitation (ChIP), and the effect of RXRA on pyruvate carboxylase promoter activity was analyzed using dual-luciferase assay.ResultsRXRA was identified as a potential regulatory target gene of HuA. Pyruvate carboxylase was identified as a RXRA target gene and a significant DEG in OSA. CIH-induced cognitive impairment, neuronal damage, oxidative stress, and inflammation in mice, while such symptoms were alleviated by HuA treatment. In OSA, suppression of RXRA expression led to reduced pyruvate carboxylase expression. HuA treatment enhanced RXRA expression, thereby promoting pyruvate carboxylase expression. HuA alleviated CIH-induced cognitive impairment, neuronal damage, oxidative stress, and inflammation via the RXRA/pyruvate carboxylase axis.ConclusionIn summary, HuA alleviates CIH-induced cognitive impairment, neuronal damage, oxidative stress, and inflammation by promoting the RXRA/pyruvate carboxylase axis.

The use of preoperative continuous positive airway pressure in patients with obstructive sleep apnea following total knee arthroplasty: a propensity score matched analysis

INTRODUCTION

Patients with sleep apnea, affecting up to 1 in 4 older men in the United States, may be at increased risk of postoperative complications after total knee arthroplasty (TKA), including increased thromboembolic and cerebrovascular events, as well as respiratory, cardiac, and digestive complications. However, the extent to which the use of CPAP in patients with sleep apnea has been studied in TKA is limited.

METHODS

A national, all-payer database was queried to identify all patients who underwent a primary TKA between 2010 and 2021. Patients who had any history of sleep apnea were identified and then stratified based on the use of CPAP. A propensity score match analysis was conducted to limit the influence of confounders. Medical complications, such as cardiac arrest, stroke, pulmonary embolism, transfusion, venous thromboembolism, and wound complications, were collected at 90-days, 1-year, and 2-years.

RESULTS

The bivariate analysis showed inferior outcomes for sleep apnea with CPAP use compared to sleep apnea with no CPAP use, in terms of length of stay (5.9 vs. 5.2, p < 0.001), PJI (1.31% vs. 1.14%, p < 0.001), stroke (0.97% vs. 0.82%, p < 0.001), VTE (1.04% vs. 0.82, p < 0.001), and all other complications at 90-days (p < 0.001) except cardiac arrest (0.14% vs. 0.11%, p = 0.052), and aseptic revision (0.40% vs. 0.39%, p = 0.832), PJI (1.81% vs. 1.55%, p < 0.001) and aseptic revision (1.25% vs. 1.06%, p < 0.001) at 1-year, and PJI (2.07 vs. 1.77, p < 0.001) and aseptic revision (1.98 vs. 1.17, p < 0.001) at 2-years.

CONCLUSION

Patients with sleep apnea have increased postoperative complications after undergoing TKA in comparison to patients without sleep apnea. More severe sleep apnea, represented by CPAP usage in this study led to worse postoperative outcomes but further analysis is required signify the role of CPAP in this patient population. Patients with sleep apnea should be treated as a high-risk group.

Evaluation of daytime sleepiness and insomnia symptoms in OSA patients with a characterization of symptom-defined phenotypes and their involvement in depression comorbidity-a cross-sectional clinical study

Introduction

Recent research highlights the significance of insomnia and sleepiness, shifting from obstructive sleep apnea (OSA) severity and sleep structure, in defining OSA phenotypes.

Objectives

This study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA.

Materials and methods

This cross-sectional, clinical study included 181 participants who underwent polysomnography (PSG) and filled out questionnaires, including the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Index (BDI). They were categorized into phenotypes: insomnia-sleepiness (I + S; ESS ≥ 11; ISI ≥ 15; n = 20), sleepiness (S; ESS ≥ 11; ISI < 15; n = 22), insomnia (I; ESS < 11; ISI ≥ 15), and asymptomatic (A; ESS < 11; ISI<15; n=55).

Results

A linear regression model for the BDI score (R2 = 0.357, p < 0.001) included ISI score and subjective-to-objective sleep latency ratio. The ISI score was a predictive factor for mild and moderate DS [OR = 1.23 (95% CI: 1.09-1.38), p < 0.001 and OR = 1.39 (95% CI: 1.13-1.72), p = 0.002]. The I and I + S phenotypes are characterized by higher BDI scores (p < 0.001 and p = 0.02), longer subjective sleep latency (p = 0.008 and p = 0.04), and shorter subjective total sleep time (TST; p = 0.049 and p = 0.006) compared to A. Furthermore, the I and I + S groups had shorter subjective TST than S (p = 0.03 and p = 0.047). The I and I + S had higher BDI scores than A (p < 0.001 and p = 0.02, respectively) and S (p < 0.001 and p = 0.02, respectively). The I phenotype was associated with the risk of mild and moderate DS (OR = 5.61 (95% CI: 1.91-16.53), p < 0.001 and OR = 9.55 (95% CI: 1.81-50.48), p = 0.008 respectively). Moreover, the I + S phenotype presented an even greater risk for mild DS (OR = 10.29 (95% CI: 2.95-35.85), p < 0.001).

Conclusion

Using clinical features for OSA phenotyping holds promise for finding OSA individuals with increased risk for DS occurrence.

Identification of OSAHS patients based on ReliefF-mRMR feature selection

Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is a serious chronic sleep disorder. Snoring is a common and easily observable symptom of OSAHS patients. The purpose of this work is to identify OSAHS patients by analyzing the acoustic characteristics of snoring sounds throughout the entire night. Ten types of acoustic features, such as Mel-frequency cepstral coefficients (MFCC), linear prediction coefficients (LPC) and spectral entropy among others, were extracted from the snoring sounds. A fused feature selection algorithm based on ReliefF and Max-Relevance and Min-Redundancy (mRMR) was proposed for optimal feature set selection. Four types of machine learning models were then applied to validate the effectiveness of OSAHS patient identification. The results show that the proposed feature selection algorithm can effectively select features with high contribution, including MFCC and LPC. Based on the selected top-20 features and using a support vector machine model, the accuracies in identifying OSAHS patients under the thresholds of AHI = 5,15, and 30, were 100%, 100%, and 98.94%, respectively. This indicates that the proposed model can effectively identify OSAHS patients.

The association between sedentary behavior and obstructive sleep apnea: a cross-sectional study from the NHANES (2007-2008 to 2015-2020)

BACKGROUND

Sedentary behavior (SB) may contribute to obesity and lower extremity fluid retention, which may favor the development of obstructive sleep apnea (OSA). However, linking sedentary behavior to OSA is unclear. The purpose of this study was to determine if there is an association between SB and OSA.

METHODS

Three typical questions in the NHANES questionnaire(①The frequency of feeling excessively sleepy per month. ②The frequency of gasping, snorting or stopping breathing per week. ③The frequency of snoring per week.) have been used for the assessment of OSA. A physical activity questionnaire(On a typical day, the amount of time you spend sitting or reclining.) was used to assess SB. This secondary analysis included National Health and Nutrition Examination Survey (NHANES) participants (unweighted = 20,115). Weighted sample and multiple logistic regression complex sample analysis techniques were used in this study.

RESULTS

After adjustment for confounders, participants with SB(> 8 h/d) had a higher risk of OSA compared to SB(< 4 h/d). Stratified analysis by gender showed that there was no significant association of SB and OSA in men. However, in women, with SB(< 4 h/d) as the reference, participants with(≥ 4 h/d) had an increased risk of OSA. By age-stratified analysis, the association of SB with OSA was stronger among older participants.

CONCLUSION

Analysis in this study showed a positive association between SB and OSA, more pronounced in women and participants older than 60 years old.