Search

Since randomized clinical trials currently do not support continuous positive airway pressure treatment of asymptomatic obstructive sleep apnea (OSA) we proposed the Obesity, Symptoms, and CARdiovascular assessment (OSCAR) algorithm to aid clinicians in the management of asymptomatic low-risk moderate-severe OSA, focusing on weight loss, symptoms and cardiovascular disease (CVD) risk assessment. Exploiting the data of the Sleep Heart Health Study we selected subjects with a body mass index (BMI) < 30 Kg/m 2 , no history of CVD or sleepiness and compared 552 patients with moderate-severe OSA (OSCAR(-)) to 916 individuals without OSA (No-OSA). After adjusting for age, gender, and BMI, there was no significant difference in the risk of major adverse cardiovascular events (MACE) between OSCAR(-) and No-OSA (1.05; 95%CI 0.81-1.37). The study suggests that low-risk moderate-severe OSA patients may not have a greater risk of MACE compared to those without OSA and highlights the need for further research on this topic., (© 2024. The Author(s).)

Purpose of Review: Sleep is crucial for human health and life. There is still limited attention to the association between sleep disorders beyond sleep apnea and cardiovascular (CV) health. We investigated the current evidence between non-respiratory sleep disorders and CV health., Recent Findings: Current evidence suggests an important association between sleep duration, circadian rhythm, insomnia, disorders of hypersomnolence and CV health. Sleep-related movement disorders exhibit a moderate association with CV health. Further research is needed to explore the effects of each sleep disorder on CV health., Summary: Given the close association between non-respiratory sleep disorders and CV health, it is crucial to recognize and address sleep disorders in patients with a high CV risk., Competing Interests: Conflict of Interest: The authors report no conflicts of interest.

Background: Clinical practice guidelines recommend the Lateralization Index (LI) as the standard for determining surgical eligibility in primary aldosteronism (PA). Our goal was to identify the optimal LI cut-offs in adrenal venous sampling (AVS) for diagnosing PA that is amenable to surgical cure., Methods: We conducted a retrospective international cohort study across 16 institutions in 11 countries, including 1,550 patients with PA who underwent AVS, with and/or without ACTH stimulation. The establishment of optimal cut-offs was informed by a survey of 82 PA patients in Japan, aimed at determining the LI cut-off aligned with patient expectations for a surgical cure rate., Results: The survey revealed that a median cure rate expectation of 80% would motivate PA patients towards undergoing adrenalectomy. The optimal LI cut-offs achieving an adjusted positive predictive value (PPV) of 80% were identified as 3.8 for unstimulated AVS and 3.4 for ACTH-stimulated AVS. Furthermore, a contralateral ratio of less than 0.4 and the detection of an adrenal nodule on CT imaging were identified as independent predictors of surgically curable PA. Incorporating these factors with the optimal LI cut-offs, the adjusted PPV increased to 96.6% for unstimulated AVS and 89.6% for ACTH-stimulated AVS. No clear differences in predictive ability between unstimulated and ACTH-stimulated LI were found., Conclusions and Relevance: The present study clarified the optimal LI cut-offs for without and with ACTH stimulation. The presence of contralateral suppression and adrenal nodule on CT imaging seems to provide additional available information besides LI for surgical indication., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)