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Study Objectives: It is unknown whether loudness of snoring or hypoxic burden are related to higher hyperactivity scores in habitually snoring children and whether this effect is impacted by the severity of sleep-disordered breathing (SDB). This study investigates the prevalence of hyperactivity in children with habitual snoring and the independent effects of loudness of snoring, as reported by the parents, hypoxic burden and obstructive sleep apnea syndrome's severity (OSAS) on hyperactivity, as measured by the Conners' Parent Rating Scale-Hyperactivity Index (CPRS-HI)., Methods: Children with habitual snoring aged 3-18 years were recruited for an overnight polysomnography reporting apnea-hypopnea index (AHI) and hypoxic burden, acoustic rhinometry, clinical examination and parental questionnaires assessing snoring loudness and CPRS-HI., Results: The study analysis included 512 children (median (25th; 75th percentile) age, 10.6 (7.6; 13.4) years; 295 (58 %) males), of whom 358 (70 %) were overweight or obese and 179 (35 %) had an obstructive AHI >3/h. Findings revealed that 36 % [95 % CI: 32%-41 %] of children exhibited increased hyperactivity/impulsivity, and 25 % [21%-29 %] showed emotional lability. Snoring loudness was significantly correlated with higher hyperactivity scores, particularly for hyperactivity/impulsivity, while hypoxic burden showed no significant association (rho s  = -0.09; p = 0.082). Multivariate analysis showed that the presence of very loud as compared to mildly quiet snoring was an independent predictor of hyperactivity symptoms, while an obstructive AHI >3/h was associated with decreased hyperactivity scores., Conclusions: These results suggest that the loudness of snoring, independent of OSAS severity, contributes to hyperactivity in children., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate whether abnormal sleep is associated with adverse outcomes for children who survived acute provoked neonatal seizures, and their parents., Study Design: This 9-center study prospectively followed newborns with acute provoked seizures. When children reached age 5 years, parents completed the Children's Sleep Habits Questionnaire (CSHQ), the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorders (PSQ-SRBD) subscale, the Vineland Adaptive Behavior Scales-3, and the Hospital Anxiety Depression Scale. Children were also assessed with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Spearman correlations and multivariable analyses were used to evaluate risk factors for sleep problems., Results: The mean CSHQ score was 45 ± 7; 77 of 118 children (65%) had an abnormal score (above the healthy sleep threshold of 41). On the PSQ-SRBD, 32 of 119 children (27%) screened positive for sleep-disordered breathing (SDB). SDB symptoms were more common among children with cerebral palsy (42% with vs 22% without; P = .03) and epilepsy (54% with vs 24% without; P = .02). Children with lower scores on the Vineland-3 (rho = -0.25; P = .01) and WPPSI-IV (rho = -0.31; P = .004) at 5 years of age were more likely to have symptoms of SDB. Worse CSHQ and PSQ-SRBD scores were associated with higher parental anxiety (rho = 0.28 [P = .002] and rho = 0.34 [P = .0002], respectively) and depression scores on the Hospital Anxiety Depression Scale (rho = 0.16 [P = .08] and rho = 0.17 [P = .07], respectively)., Conclusions: Two-thirds of early school-aged survivors of acute provoked neonatal seizures had parent-reported sleep abnormalities and one-quarter screened positive for SDB. Early screening and effective treatment for sleep disorders could be an innovative, practice-changing approach to improve outcomes after neonatal seizures., Competing Interests: Declaration of Competing Interest Renée Shellhaas reports financial support for this study was provided by National Institute of Neurological Disorders and Stroke and the Patient-Centered Outcomes Research Institute. Renée Shellhaas reports a relationship with Pediatric Epilepsy Research Foundation that includes: board membership and employment. Renée Shellhaas reports a relationship with The Epilepsy Study Consortium that includes: consulting or advisory. Renée Shellhaas reports a relationship with UptoDate Inc that includes: royalties for authorship of topics related to neonatal seizures. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Data on sleep apnea is scarce in the elderly. We aimed to provide insight into the presentation of sleep apnea in people over 70 years of age including gender differences., Methods: We conducted a registry study in sleep apnea patients >18 years of age diagnosed at Turku University Hospital in 2012-2019. Patients whose sleep apnea was classified at least moderate according to apnea-hypopnea index were included (N = 5870; Men = 65.7%; Mean age 57.5 ± 13.5 years). Data on cardiorespiratory polygraphy (PG) variables, Body Mass Index (BMI), pre-existing depression diagnoses, number of comorbidities, the scores of Epworth Sleepiness Scale (ESS), depression scale (DEPS) and psychological distress (12-item General Health Questionnaire, GHQ-12), and capillary blood gas results were derived from electronic medical records. Patients were stratified into three groups according to age: <70 (young-middle aged), 70-80 (elderly) and >80 years of age (very elderly)., Results: The severity of sleep apnea did not differ between the age groups based on any of the PG variables studied. No significant differences were found in the level of subjective daytime sleepiness between age groups. Women had higher DEPS scores than men in all age groups. Very elderly men had higher DEPS scores compared to men in other age groups (6.3 ± 4.6 vs. 5.6 ± 5.9 vs. 5.1 ± 4.8, p < 0.05) while the differences in DEPS scores did not reach significance among women. Each unit increase in SpO2 was associated with a 22% decrease in the odds of having a DEPS score of ≥9., Conclusion: The severity of sleep apnea or subjective daytime sleepiness did not differ among age groups in moderate-severe sleep apnea patients. Occurrence of depressive symptoms was consistently more common in women than in men of comparable age. Mental wellbeing was the worst in the very elderly. Higher SpO2 was associated with less depressive symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Lyyra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Sleep-disordered breathing (SDB) and the related clinical syndrome, sleep apnoea syndrome (SAS), are highly prevalent in patients with ischaemic heart disease and often remain undiagnosed. The AMI-Sleep study will describe its prevalence in patients with acute myocardial infarction (AMI) and assess the independent contribution of the type and severity of SDB/SAS to subsequent incident cardiovascular events and mortality., Methods and Analysis: This prospective study will include patients hospitalised for AMI enrolled in the multicentre nationwide prospective French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry. A nightly simplified polygraphy is performed before discharge from the index AMI admission, and participants complete two self-administered sleep questionnaires. Baseline data are obtained from the FRENCHIE registry. Each participant will be subsequently followed based on data from the National Health Data System (SNDS). Over a period of 4 years, the AMI-Sleep study is expected to recruit approximately 2000 participants. Assuming at least a 10% rate of incident cardiovascular events over 1 year, there would be an estimated 200 events during the first year of follow-up that would be sufficient in multivariable analysis. The primary objective is to describe the prevalence and severity of SDB in AMI and to analyse the association between the type and severity of SDB (based on the apnoea-hypopnoea index) and the occurrence of cardiovascular events (incident acute coronary syndrome, transient ischaemic attack, stroke) or all-cause death after AMI. Secondary objectives include determining the association between the presence of SAS and coronary artery disease severity, in-hospital mortality, morbidity events, healthcare consumption and related costs., Ethics and Dissemination: Eligible individuals are provided with information about the AMI-Sleep study and provided written informed consent. The protocol was approved by the regional Ethics Committee (CPP Ouest II - Angers, RCB N°2018-A00719-46) on 17 February 2019, is registered on ClinicalTrials.gov (NCT04064593) and started in January 2019 with the expected publication of primary outcome results in 2025., Trial Registration Number: ClinicalTrials.gov, NCT04064593., Competing Interests: Competing interests: PGS has received grants from Amarin, AstraZeneca, Bayer, Sanofi and Servier, consulting fees from Amgen, AstraZeneca, BMS/Myokarddia, Merck, Novo-Nordisk and Regeneron, Steering Comitee or Critical Event Committee from Amarin, AstraZeneca, Bayer, Boerhriger Ingelheim, BristolMyers Squibb, Idorsia, Novartis, PhaseBio, Pfizer, Sanofi and Servier, payments for lectures from AstraZeneca, Novartis and Novo-Nordisk, support for attending meetings from AstraZeneca and participation on a Data Safety Monitoring Board or Advisory Board from Servier, Sanofi, PHRI and Monash University and no other relationships or activities that could appear to have influenced the submitted work. All other authors have no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

The prevalence of both obstructive sleep apnea (OSA) and albuminuria increase with advanced age. The data on the association between OSA and albuminuria in subjects with advanced age were limited. Hence, the present study aimed to assess the association between sleep apnea (SA) and albuminuria in middle age and elderly population. Data on participants with age ≥ 40 years during 2005 to 2008 and 2015 to 2020 National Health and Nutrition Examination Survey were analyzed. SA was evaluated based on the sleep questionnaire and albuminuria was assessed by albumin-to-creatinine ratio. The independent relationship between SA and albuminuria was explored by using multivariate logistic regression. A total of 13,902 subjects with 11,788 cases of normoalbuminuria and 2114 cases of albuminuria were included for data analysis. The proportion of albuminuria increased as SA severity aggravation. Univariate logistic analysis showed that frequently SA was positively associated with albuminuria (OR = 1.301, 95% CI = 1.089-1.547, P = .003). In multivariate logistic analysis, frequently SA was independently associated with increased risk of albuminuria after adjusting for confounding factors (OR = 1.309, 95% CI = 1.010-1.683, P = .039). The present study suggested that self-reported frequently SA was independently associated with increased risk of albuminuria in middle age and elderly population., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Sleep disordered breathing (SDB) is a common comorbidity in patients with atrial fibrillation (AF). Patients undergoing pulmonary vein isolation (PVI) for AF have a high prevalence of SDB. In previous studies, some patients with AF had Cheyne-Stokes respiration (CSR). The aim of the present study was to assess the prevalence of SDB and the correlates of SDB severity and CSR in AF patients who have undergone PVI. The study was conducted using a single-center observational design. All participants underwent a home sleep apnea test (ApneaLink Air, ResMed, Australia), which could determine the severity of SDB as assessed by the apnea-hypopnea index (AHI) and the percentage of CSR (%CSR) pattern. 139 AF patients who underwent PVI were included in the study. Overall, 38 (27.3%) patients had no SDB (AHI < 5), 53 (38.1%) had mild SDB (5 ≤ AHI < 15), 33 (23.7%) had moderate SDB (15 ≤ AHI < 30), and 15 (10.8%) had severe SDB (AHI ≥ 30). Correlates of the increased AHI included male sex (β = 0.23, p = 0.004), age (β = 0.19, p = 0.020), high body mass index (β = 0.31, p < 0.001), and β blockers usage (β = 0.18, p = 0.024). Conversely, correlates with the %CSR rate included male sex (β = 0.18, p = 0.020), age (β = 0.19, p = 0.015), non-paroxysmal AF (β = 0.22, p = 0.008), and high glycohemoglobin A1c (β = 0.36, p < 0.001) and N-terminal pro-brain natriuretic peptide (β = 0.24, p = 0.005) levels. SDB is prevalent in patients with AF who have undergone PVI; predisposing factors for SDB include male sex, older age, and obesity. CSR occurs in patients with AF who have undergone PVI; predisposing factors for CSR include male sex, older age, high left ventricular filling pressure, and abnormal blood glucose level., Competing Interests: Declarations. Conflict of interest: Drs. Sato, Naito, and Kasai are affiliated with a department endowed by Philips, ResMed, and Fukuda Denshi. Dr. Kasai and Mrs. Shiroshita are affiliated with a department endowed by Paramount Bed. Ethical statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised on 2013). The research protocol was approved by the Hospital Ethics Committee Juntendo University Hospital. (UMIN000029327). Informed consent for publication was not obtained in each subject due to the observational analysis of hospitalized patients., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium-glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: The primary objective was to determine any difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus those undergoing total tonsillectomy for sleep-disordered breathing or obstructive sleep apnea., Methods: All children undergoing total tonsillectomy from November 2015 to December 2017 and intracapsular tonsillectomy from May 2016 to July 2020 for sleep-disordered breathing or obstructive sleep apnea were included in the study., Results: 2408 patients underwent total tonsillectomy whereas 410 patients underwent intracapsular tonsillectomy. The incidence of major respiratory complications was 13.9 % for intracapsular tonsillectomy and 8.9 % for total tonsillectomy in an unmatched cohort and 13.8 % for intracapsular tonsillectomy and 10.5 % for total tonsillectomy in a matched cohort. Surgical technique was not significant for both major (OR:0.969, 95 % CI:0.596-1.573, p = 0.8979) and minor (OR 0.9, 95 % CI:0.431-1.878, p = 0.7785) respiratory complications in the unmatched cohort and also not significant for major (OR:0.996, 95 % CI:0.353 2.809, p = 0.9944) and minor (OR:1.5, 95 % CI:0.66-3.612, p = 0.31) respiratory complications in the matched cohort. Factors associated with an increased incidence of major perioperative respiratory complications in the unmatched cohort included race (Black or African American) (OR:1.768, 95 % CI:1.298-2.409, p = 0.0038), reactive airway disease (OR:1.814, 95 % CI:1.39-2.367, p=<0.0001), and an upper respiratory infection (OR:1.631, 95 % CI:1.095-2.431, p = 0.0161) whereas reactive airway disease (OR:3.596,95 % CI:1.217-10.621, p=<0.0206), an upper respiratory infection (OR:5.779, 95 % CI:1.392-23.99, p = 0.0157), and the presence of obstructive sleep apnea (OR:4.174, 95 % CI:1.242-14.025, p = 0.0208) were significant in the matched cohort., Conclusion: There was no difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus total tonsillectomy., Competing Interests: Declaration of competing interest The authors declare there are no conflicts of interest., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Objectives: This retrospective cohort study examined clinically diagnosed insomnia and sleep apnea and analyzed associations with deployment and combat exposure in active-duty soldiers (n=1,228,346) from 2010 to 2019., Methods: Retrospective data were obtained from the Soldier Performance, Health, and Readiness database., Results: Overseas soldier deployments peaked in 2010, decreasing thereafter as soldiers were withdrawn from Iraq and Afghanistan. From 2010 to 2012 insomnia incidence increased at a rate of 6.7 cases/1000 soldier-years, then decreased after 2012 at 5.3 cases/1000 soldier-years. Sleep apnea increased 2010-2016 at 1.9 cases/1000 soldier-years and generally declined thereafter. Risk of insomnia increased with deployment (hazard ratio=1.51; 95% confidence interval=1.49-1.52) and combat exposure (hazard ratio=1.15; 95% confidence interval=1.13-1.17). Risk of sleep apnea was increased by deployment (hazard ratio=1.89; 95% confidence interval, 1.86-1.92) and combat exposure (hazard ratio=1.09; 95% confidence interval, 1.07-1.11). Most relationships remained after accounting for other factors in multivariable analyses, except that the association between sleep apnea and combat exposure was reduced (hazard ratio=0.94; 95% confidence interval=0.92-0.97)., Conclusions: Insomnia risk decreased in the period nearly in parallel with a reduction in the number of deployments; nonetheless deployment and combat exposure increased insomnia risk in the period examined. Risk of sleep apnea increased in the period and was related to deployment but not combat exposure after accounting for demographics and comorbid conditions. Despite reductions in insomnia incidence and a slowing in sleep apnea incidence, sleep disorders remain highly prevalent, warranting continued emphasis on sleep-disorder screening and improving the soldier sleep habits., Competing Interests: Declaration of conflicts of interest None., (Published by Elsevier Inc.)

Aims: Sleep disordered breathing (SDB), lower urinary tract dysfunction (LUTD), and enuresis (NE) are common in children and adolescents and have serious consequences, especially on social and emotional development. Even though much is known about the association between SDB and NE among adults, the number of articles in children and adolescents is limited. Therefore, the aim of the present scoping review was to map out the current knowledge about SDB and LUTD in children and adolescents., Methods: Four electronic databases (i.e., Embase, PsychInfo, Pubmed, Web of Science) were searched in accordance with the Johanna Briggs Institute (JBI) manual for Evidence Synthesis 1 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). 2 The Quality Assessment Tool for Quantitative Studies (QATQS) was used to evaluate the methodological quality of the included studies. 63,64 All articles in this scoping review met the following inclusion criteria: (a) the sample included children/adolescents between the ages of 5 and 18; (b) there was a presence of both LUTD and (a clinical manifestation of) SDB, (c) the article was published in English and/or Dutch; (d) the article was available in full text. The following exclusion criteria were used: (a) studies with solely one of the two main concepts (e.g., LUTD or SRBD); (b) studies with a third variable, other than treatment-oriented variables; (c) articles published in a language other than English or Dutch; (d) meta-analyses and reviews., Results: The search resulted in the inclusion of 17 articles related to SDB and LUTD in children and adolescents. Even though all included articles found a clear association between SDB and NE in children, very limited information was found on SDB and other LUTS and/or how the association impacts children and adolescents with developmental delays (DD's). In addition, limited and/or conflicting results were found related to SDB, NE and other variables (e.g., family history of NE, obstructive sleep apnea (OSA) severity, gender, preoperative ADH/BNP levels, obesity and ADHD). An adenotonsillectomy (T&A) had a significant beneficial therapeutic effect on NE in children and adolescents with SDB., Conclusions: This scoping review found a clear association between SDB/OSA and NE, as the arousability and urine production at night are impacted. T&A could be considered as a treatment option for children and adolescents who do not respond to standard NE treatment. However, more research is needed to determine mechanisms involved in responders and non-responders and to examine the possible association between SDB in children and adolescents with other LUTS and/or developmental delays. The need for a multidisciplinary approach and future research is highlighted to provide children and adolescents with comorbid disorders adequate care based on the understanding of underlying conditions and mechanisms involved., (© 2025 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Introduction: This review explores the interplay between comorbid insomnia and sleep apnea (COMISA) and erectile dysfunction (ED), 2 conditions that significantly impact men's health. COMISA, a recently recognized condition characterized by the coexistence of insomnia and obstructive sleep apnea, has been shown to disrupt sleep architecture and cause intermittent hypoxia. These disturbances are increasingly linked to the exacerbation of ED, a prevalent issue among men. Understanding the connection between COMISA and ED is crucial for developing integrated treatment approaches that address both sleep and sexual health., Objectives: We aim to explore the epidemiological, physiological, and potential therapeutic intersections of COMISA and ED. This review sets out to develop a better understanding of the relationship between these conditions and to emphasize the need for an integrated diagnostic and therapeutic approach that addresses both sleep and sexual health., Methods: Through a comprehensive analysis, including a detailed examination of extant studies, we address the hormonal imbalances and alterations in neural pathways that collectively contribute to the complex pathophysiology of ED and how these are particularly susceptible to the concurrent presence of COMISA., Results: Our analysis indicates that disruptions in sleep architecture and intermittent hypoxia associated with COMISA can exacerbate ED. Hormonal imbalances, endothelial dysfunction, autonomic imbalance, and increased inflammation and oxidative stress are key mechanisms through which COMISA influences ED. These factors collectively impair vascular health, reduce testosterone levels, disrupt neural control of erections, and contribute to the severity of ED., Conclusions: This review underscores the necessity for an integrated approach to diagnosis and therapy that considers both sleep and sexual health to improve overall outcomes. These insights should foster a deeper understanding of the relationship between COMISA and ED, encourage further research in this area, and potentially lead to the development of innovative treatment strategies to manage these closely intertwined health concerns., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The existence of intersected pathways between the mechanisms of insomnia, sleep-disordered breathing and persistent/chronic pain has been documented. Such concurrence will eventually contribute to a higher burden of cardiometabolic diseases, a main cause of death worldwide. The aim of this study was to evaluate the interactions between insomnia, sleep-disordered breathing, cardiometabolic risk, and psychosocial stress in patients seeking care at an orofacial pain clinic. Anonymized data of 1236 patients seeking care at the orofacial pain unit of the University of Zurich were analysed. Prevalence data was estimated for insomnia, sleep disordered breathing/sleep apnea and increased risk of a combination of insomnia and sleep disordered breathing/sleep apnea, both regarding demographics and cardiometabolic risk factors. Psychosocial stress factors acting as additional cardiometabolic risk factors were assessed. Among patients with persistent orofacial pain, increased risk of combination of insomnia and sleep disordered breathing/ sleep apnea was present in 11.5% of cases, and it was likely to increase psychosocial stress as an aditional independent risk factor for cardiometabolic disorder.

Introduction: Insomnia and sleep apnea (SA) can have adverse effects on operating aircraft. This study examined trends in insomnia and SA incidence rates in U.S. military aviators from 2006-2022 and examined associated demographic and operational factors., Methods: Data on incidence cases of outpatient insomnia and SA, aviator demographics, and operational factors were obtained from the Defense Medical Epidemiological Database, a comprehensive online archive of military medical data. Insomnia and SA cases were identified using specific International Classification of Diseases codes., Results: For the entire military aviator population (N = 331,992 ± 1649, mean ± SD) overall rates of insomnia and SA were 10.2 and 24.9 cases/1000 person-years, respectively. Compared to the entire U.S. military nonaviator population, aviators had lower incidence of insomnia, but higher incidence of SA. Insomnia rates among aviators increased up to 2015 and declined afterwards, while SA rate generally rose over the period. Insomnia and SA rates among aviators increased with age, were higher among those of black and other nonwhite races, were highest among Army personnel (compared to other services) and were highest among helicopter pilots (compared to fixed-wing aircraft pilots). Insomnia rates were similar among male and female aviators, but SA rates were higher among men., Discussion: These data indicate that insomnia and SA are prevalent within the military aviation population; however, the incidence of insomnia appears to have fallen as the tempo of military operations has decreased while the incidence of SA continues on an upward trajectory, possibly associated with the growing problem of obesity. Caldwell JA, Knapik JJ. Trends and factors associated with insomnia and sleep apnea in U.S. military aviators, 2006-2022. Aerosp Med Hum Perform. 2025; 96(1):23-30.

Background: Obstructive sleep apnea is associated with increased dementia risk, yet its role in postoperative neurocognitive disorders is unclear. Here, we studied whether the severity of untreated obstructive sleep apnea is associated with the severity of postoperative neurocognitive disorder., Methods: In this single-center prospective cohort study, older noncardiac surgery patients aged 60 years and above underwent preoperative home sleep apnea testing, and pre- and postoperative delirium assessments and cognitive testing. Sleep apnea severity was determined using the measured respiratory event index (REI). Global cognitive change from before to 6 weeks (and 1 year) after surgery was used to measure postoperative neurocognitive disorder severity. Postoperative changes in individual cognitive domain performance along with subjective cognitive complaints and/or deficits in instrumental activities of daily living were used to measure postoperative neurocognitive disorder incidence., Results: Of 96 subjects who completed home sleep apnea testing, 58 tested positive for sleep apnea. In univariable analyses, sleep apnea severity was not associated with increased postoperative neurocognitive disorder severity at 6 weeks (global cognitive change ; [95% confidence interval [CI], -0.02 to 0.03]; P = .79) or 1-year after surgery (; [95% CI, -0.02 to 0.03]; P = .70). Adjusting for age, sex, baseline cognition, and surgery duration, sleep apnea severity remained not associated with increased postoperative neurocognitive disorder severity at 6 weeks (; [95% CI, -0.02 to 0.04]; P = .40) or 1-year after surgery (; [95% CI, -0.02 to 0.04]; P = .55). In a multivariable analysis, sleep apnea severity was not associated with postoperative neurocognitive disorder (either mild or major) incidence at 6 weeks (odds ratio [OR] = 0.89, [95% CI, 0.59-1.14]; P = .45) or 1-year postoperatively (OR = 1.01, [95% CI, 0.81-1.24]; P = .90). Sleep apnea severity was also not associated with postoperative delirium in univariable analyses (delirium incidence OR = 0.88, [95% CI, 0.59-1.10]; P = .37; delirium severity ; [95% CI, -0.02 to 0.03]; P = .79) or in multivariable analyses (delirium incidence OR = 1.07, [95% CI, 0.81-1.38]; P = .74; delirium severity OR = 0.95, [95% CI, 0.81-1.10]; P = .48)., Conclusions: In this older noncardiac surgery cohort, untreated sleep apnea was not associated with increased incidence or severity of postoperative neurocognitive disorder or delirium., Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Background: Although sex differences in the prevalence of sleep disordered breathing (SDB) is recognized, whether a sex difference exists among obese individuals with SDB with or without comorbidities has not been well investigated. This study aimed to explore the relationships of sex differences among SDB, obesity, and metabolic comorbidities., Methods: This study evaluated 7713 community participants with nocturnal oximetry ≥2 nights. SDB was assessed by the 3% oxygen desaturation index corrected for sleep duration obtained by wrist actigraphy (Acti-ODI3%), and moderate-to-severe SDB was defined as Acti-ODI3% levels ≥15/h. Obesity was defined as body mass index ≥25 kg/m 2 ., Results: The prevalence of moderate-to-severe SDB was 21.6%/0% among those with obesity/without obesity in women under 40 years old. The adjusted odds ratios for moderate-to-severe SDB in those with both diabetes/metabolic syndrome and obesity compared to others were 86.4 (95%CI 24.2-308.8)/40.4 (95%CI 15.0-108.8) in pre-menopausal women. The association among SDB, obesity, and metabolic comorbidities showed significant interactions between pre-menopausal women and men or post-menopausal women., Conclusions: Sex differences exist among the prevalence of SDB and the relationships among SDB, obesity, and metabolic comorbidities. Especially, pre-menopausal women are more vulnerable to the consequences of obesity. SDB prevalence may be impacted by the coexistence of obesity and diabetes or metabolic syndrome in pre-menopausal women., Competing Interests: Conflicts of interest Takeshi Matsumoto, Takuma Minami, Osamu Kanai, Kiminobu Tanizawa, Tomoko Wakamura, Naoko Komenami, Kazuya Setoh, Takahisa Kawaguchi, Satoshi Morita, Yoshimitsu Takahashi, and Toyohiro Hirai have nothing to disclosure. Hironobu Sunadome and Naomi Takahashi reports grants from Philips Japan, grants from ResMed, grants from Fukuda Denshi, grants from Fukuda Lifetec Keiji, outside the submitted work. Kimihiko Murase reports grants from Philips Japan, grants from Teijin Pharma, grants from Fukuda Denshi, grants from Fukuda Lifetec Keiji, outside the submitted work. Yasuharu Tabara reports grants from the Ministry of Education, Culture, Sports, Science & Technology in Japan, grants from Japan Science and Technology Agency, grants from Mitsubishi Foundation, grants from Daiwa Securities Health Foundation, and grants from Sumitomo Foundation, outside the submitted work. Satoshi Hamada reports grants from Teijin Pharma, outside the submitted work. Takeo Nakayama reports grants from Special Health Check-up Research Group from the Ministry of Health, Labor and Welfare of Japan, personal fees from Pfizer Japan Inc., personal fees from MSD K.K., personal fees from Ohtsuka Pharmaceutical co., personal fees from Dainippon Sumitomo Pharmaceutical co., personal fees from Ono Pharmaceutical co., personal fees from Chugai Pharmaceutical co., personal fees from Dentsu co., personal fees from Takeda Pharmaceutical co., personal fees from Novo Nordisk Pharma. co., personal fees from Janssen Pharmaceutical K.K., personal fees from Boehringer Ingelheim International GmbH, personal fees from Nikkei Business Publications, Inc., personal fees from Eli Lilly Japan K.K., personal fees from Novartis Pharma K.K., personal fees from Baxter, personal fees from Alexion Pharma, personal fees from Mitsubishi Tanabe Pharma Corporation, grants for the collaborative study from HANSHIN Dispensing Holding Co. Ltd., grants from Nakagawa Pharmacy Co., Ltd., grants from Konica Minolta, Inc., donations for the department from Nakamura hospital, donations from Japan Medical Data Center Toyota, donations from Tsusho All Life Co., outside the submitted work. Susumu Sato reports grants from Philips Japan, ResMed, Fukuda Denshi, Fukuda Lifetec Keiji, Fuji Film corporation and Nippon Boehringer Ingelheim, outside the submitted work. Fumihiko Matsuda reports grants from Kyoto University, grants from the Ministry of Education, Culture, Sports, Science and Technology in Japan, grants from the Center of Innovation Program, grants from Japan Science and Technology Agency, from the Practical Research Project for Rare/Intractable Diseases, during the conduct of the study. Kazuo Chin reports grants from the Japanese Ministry of Education, Culture, Sports, Science and Technology, grants from the Intractable Respiratory Diseases and Pulmonary Hypertension Research Group, the Ministry of Health, Labor and Welfare, Japan, grants from the Japan Vascular Disease Research Foundation, grants from Health, Labour and Welfare Sciences Research Grants, Research on Region Medical, during the conduct of the study; grants and personal fees from Philips Japan, grants and personal fees from Teijin Pharma, grants and personal fees from Fukuda Denshi, grants and personal fees from Fukuda Lifetec Keiji, grants from KYORIN Pharmaceutical Co., Ltd, grants from Nippon Boehringer Ingelheim Co., Ltd, grants and personal fees from GlaxoSmithKline, personal fees from MSD, personal fees from Resmed, personal fees from Astellas Pharma, personal fees from Eisai Co., Ltd., outside the submitted work., (Copyright © 2024. Published by Elsevier B.V.)

Sleep apnea involves almost one billion individuals throughout the world, including 40 million Americans. Of major medical concern is the fact that the prevalence of sleep apnea is significantly increasing due to the epidemic of obesity, physical inactivity, and diabetes mellitus which are important risk factors for the development and persistence of sleep apnea in individuals. Sleep apnea is characterized by multiple episodes of apnea or hypopnea during sleep, which cause nocturnal arousals, gasping for breath during the night, daytime sleepiness, irritability, forgetfulness, fatigue and recurrent headaches. Obstructive sleep apnea occurs when upper airway obstruction occurs in an individual during sleep with absent or markedly reduced airflow in the presence of continued activity of inspiratory thoracic and diaphragmatic muscles. Central sleep apnea is defined as the absence or the significant reduction of naso-oral airflow due to the withdrawal during sleep of ponto-medullary respiratory center stimulation of the nerves of the inspiratory thoracic and diaphragmatic muscles and absence of contraction of these muscles during apnea. Complex sleep apnea occurs when an individual exhibits characteristics of both obstructive and central sleep apnea. The severity of sleep apnea is measured by polysomnography and the apnea hypopnea index (AHI), which is the average number of apneas and hypopneas per hour of sleep measured by polysomnography. Sleep apnea is mild if the AHI is 5-14/h with no or mild symptoms, moderate if the AHI is 15 to 30/h with occasional daytime sleepiness, and severe if the AHI is >30/h with frequent daytime sleepiness that interferes with the normal activities of daily life. Chronic sleep apneas and hypopneas followed by compensatory hyperpneas are associated with significant adverse cardiovascular consequences including: 1) recurrent hypoxemia and hypercarbia; 2) Increased sympathetic nerve activity and decreased parasympathetic nerve activity; 3) oxidative stress and vascular endothelial dysfunction; and 4) cardiac remodeling and cardiovascular disease. Moderate or severe sleep apnea significantly increases the risk of coronary artery disease, congestive heart failure, cerebral vascular events (strokes), and cardiac dysrhythmias, and also increase the morbidity and mortality of these diseases. Nevertheless, sleep apnea is currently underdiagnosed and untreated in many individuals due to the challenges in the prediction and detection of sleep apnea and a lack of well-defined optimal treatment guidelines. Chronic continuous positive airway pressure for ≥4 h/night for >70% of nights is beneficial in the treatment of patients with sleep apnea. CPAP Improves sleep quality, reduces the AHI, augments cardiac output and increases oxygen delivery to brain and heart, reduces resistant hypertension, decreases cardiac dysrhythmias, and reduces daytime sleepiness. The present article discusses the diagnosis of obstructive sleep apnea, central sleep apnea, and complex apnea. Thereafter the important pathophysiologic mechanisms in sleep apnea and the relationship of these pathophysiologic mechanics to atherosclerotic vascular disease are reviewed. Guidelines are then provided for the treatment of mild, moderate and severe sleep apnea. In order to reduce the cardiovascular morbidity and mortality caused by sleep apnea and facilitate the diagnosis and the long-term, effective treatment of sleep apnea in patients, the close cooperation is necessary of cardiovascular specialists, pulmonary specialists, and respiratory therapy/rehabilitation specialists., Competing Interests: Declaration of competing interest The author declare that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)