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Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea-hypopnea index, correlates poorly with related comorbidities and symptoms. Obstructive sleep apnea severity is measured by counting respiratory events, while other physiologically relevant consequences are ignored. Furthermore, as the clinical methods for analysing polysomnographic signals are outdated, laborious, and expensive, most patients with obstructive sleep apnea remain undiagnosed. Therefore, more personalised diagnostic approaches are urgently needed. The Sleep Revolution, funded by the European Union's Horizon 2020 Research and Innovation Programme, aims to tackle these shortcomings by developing machine learning tools to better estimate obstructive sleep apnea severity and phenotypes. This allows for improved personalised treatment options, including increased patient participation. Also, implementing these tools will alleviate the costs and increase the availability of sleep studies by decreasing manual scoring labour. Finally, the project aims to design a digital platform that functions as a bridge between researchers, patients, and clinicians, with an electronic sleep diary, objective cognitive tests, and questionnaires in a mobile application. These ambitious goals will be achieved through extensive collaboration between 39 centres, including expertise from sleep medicine, computer science, and industry and by utilising tens of thousands of retrospectively and prospectively collected sleep recordings. With the commitment of the European Sleep Research Society and Assembly of National Sleep Societies, the Sleep Revolution has the unique possibility to create new standardised guidelines for sleep medicine.

Background and objective: Obstructive sleep apnoea (OSA) and dyslipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and plasma lipid concentrations in patients enrolled in the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 8592 patients without physician-diagnosed hyperlipidaemia or reported intake of a lipid-lowering drug (age 50.1 ± 12.7 years, 69.1% male, BMI: 30.8 ± 6.6 kg/m2, mean apnoea–hypopnoea index (AHI): 25.7 ± 25.9 events/h). The independent relationship between measures of OSA (AHI, oxygen desaturation index (ODI), mean and lowest oxygen saturation) and lipid profile (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and fasting triglycerides (TG)) was determined by means of general linear model analysis. Results: There was a dose response relationship between TC and ODI (mean ± SE (mg/dL): 180.33 ± 2.46, 184.59 ± 2.42, 185.44 ± 2.42 and 185.73 ± 2.44; P < 0.001 across ODI quartiles I–IV). TG and LDL concentrations were better predicted by AHI than by ODI. HDL-C was significantly reduced in the highest AHI quartile (mean ± SE (mg/dL): 48.8 ± 1.49 vs 46.50 ± 1.48; P = 0.002, AHI quartile I vs IV). Morbid obesity was associated with lower TC and higher HDL-C values. Lipid status was influenced by geographical location with the highest TC concentration recorded in Northern Europe. Conclusion: OSA severity was independently associated with cholesterol and TG concentrations.

Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p&nbsp

[No abstract available], ResMed Foundation; Philips; European Respiratory Society, ERS; Fondation Air Liquide, Conflict of interest: A. Pataka has nothing to disclose. M.R. Bonsignore has nothing to disclose. S. Ryan has nothing to disclose. R.L. Riha has nothing to disclose. J-L. Pepin reports grants and research funds from Air Liquide Foundation, Agiradom, AstraZeneca, Fisher and Paykel, Mutualia, Philips, Resmed and Vitalaire, personal fees from Agiradom, AstraZeneca, Boehringer Ingelheim, Jazz Pharmaceutical, Night Balance, Philips, Resmed and Sefam. S. Schiza has nothing to disclose. O.K. Basoglu has nothing to disclose. P. Sliwinski has nothing to disclose. O. Ludka has nothing to disclose. P. Steiropoulos has nothing to disclose. U. Anttalainen has nothing to disclose. W.T. McNicholas has nothing to disclose. J. Hedner reports grants from ResMed Foundation, Philips Respironics and the European Respiratory Society, for start-up and conduct of the study. L. Grote reports grants from Resmed Foundation and Respironics Foundation, during the conduct of the study; personal fees for lecturing from Resmed, Philips and Itamar, grants from Resmed, other (equipment) from Itamar, outside the submitted work; in addition, L. Grote has a patent for sleep apnoea treatment pending., Support statement: The ESADA network has received support from the European Union COST action B26 and is currently a Clinical Research Collaboration funded by the European Respiratory Society. Additionally, the ESADA study group has received unrestricted seeding grants from the ResMed and the Philips Respironics Foundation for the establishment of the database in 2007 and 2011. The ESADA has an ongoing collaboration with Bayer AG. Non-financial support was provided by the European Sleep Research Society and the European Respiratory Society for communication, meetings and data presentations for the ESADA collaborators.

Normotensive patient characteristics across StHCO3- quartiles (n = 388). Table S2. Association between LogStHCO3 - and systolic blood pressure in a generalized linear model. Table S3. Association between LogStHCO3 - and diastolic blood pressure in a generalized linear model. Figure S1. Relationship between pCO2 and stHCO3 - (Spearman correlation). Figure S2. Relationship between apnea hypopnea index and stHCO3 - (Spearman correlation). (DOCX 107 kb)

Normotensive patient characteristics across StHCO3- quartiles (n = 388). Table S2. Association between LogStHCO3 - and systolic blood pressure in a generalized linear model. Table S3. Association between LogStHCO3 - and diastolic blood pressure in a generalized linear model. Figure S1. Relationship between pCO2 and stHCO3 - (Spearman correlation). Figure S2. Relationship between apnea hypopnea index and stHCO3 - (Spearman correlation). (DOCX 107 kb)

There are some critical issues that determine the sustainability of the ESADA project in the long term. We need to develop strategies to maintain high data quality and enable new research activities related to the database. Funding may be provided by public and academic institutions or by collaborations with industry. We plan to submit EU research or public health projects, and cooperation with other cohorts will help to reach the critical mass necessary to cover the entire European area. Again, the CRC is a very good opportunity to pursue this goal, not only for the visibility provided by the endorsement of a leading society like the ERS, but also for the practical support in submission of big projects. With these prospects, we anticipate a bright future for the highly successful collaborative ESADA project.

Sleep disordered breathing has increasingly been recognised as a frequent cause of ill-health in the community. Moderate or severe forms of the most common condition, obstructive sleep apnea (OSA), occur in up to 12% of the adult male population. A substantial body of literature has been published on the potential relationship between OSA and cardiovascular disease. In particular, OSA has been associated with cardiac failure, stroke, myocardial infarction and hypertension. Part of this association may be explained by other confounders, mainly obesity, which is common in OSA patients. The present review was prepared following a workshop aimed to critically review available scientific evidence suggesting that hypertension is a direct consequence of OSA. In addition, pathophysiologic mechanisms that may be involved in the relationship between OSA and cardiovascular disease, particularly brief intermittent elevation of blood pressure and sustained systemic hypertension, are discussed.