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PURPOSE: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the Definition of Surgical Success/Failure after OSA Surgery. Regarding the Predictive Factors of Surgical Failure in OSA Surgery, consensus was reached on 10 out of 13 statements. In the context of the Diagnostic Workup in OSA Surgery, consensus was achieved on 9 out of 13 statements. Lastly, in Treatment in Surgical Failure Cases, consensus was reached on 12 out of 24 statements. CONCLUSION: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition associated with a major healthcare burden. Current diagnostic tools, such as full-night polysomnography (PSG), pose a limited accessibility to diagnosis due to their elevated costs. Recent advances in Artificial Intelligence (AI), including Machine Learning (ML) and deep learning (DL) algorithms, offer novel potential tools for an accurate OSA screening and diagnosis. This systematic review evaluates articles employing AI-powered models for OSA screening and diagnosis in the last decade. Methods: A comprehensive electronic search was performed on PubMed/MEDLINE, Google Scholar, and SCOPUS databases. The included studies were original articles written in English, reporting the use of ML algorithms to diagnose and predict OSA in suspected patients. The last search was performed in June 2024. This systematic review is registered in PROSPERO (Registration ID: CRD42024563059). Results: Sixty-five articles, involving data from 109,046 patients, met the inclusion criteria. Due to the heterogeneity of the algorithms, outcomes were analyzed into six sections (anthropometric indexes, imaging, electrocardiographic signals, respiratory signals, and oximetry and miscellaneous signals). AI algorithms demonstrated significant improvements in OSA detection, with accuracy, sensitivity, and specificity often exceeding traditional tools. In particular, anthropometric indexes were most widely used, especially in logistic regression-powered algorithms. Conclusions: The application of AI algorithms to OSA diagnosis and screening has great potential to improve patient outcomes, increase early detection, and lessen the load on healthcare systems. However, rigorous validation and standardization efforts must be made to standardize datasets. [ABSTRACT FROM AUTHOR]

Purpose: Obstructive Sleep Apnea is a widespread disease but is very underdiagnosed and undertreated. The aim of this study is to assess the effectiveness and patient satisfaction of using the WatchPAT® ONE, a disposable home sleep apnea test device, within a telemedicine-based management pathway. Methods: All patients who used the telemedicine services for OSA diagnosis using the WatchPAT® ONE were prospectively enrolled in the study. Patients receive the device at home and download its associated application to learn how to perform the test autonomously at night. Clinicians then review automated results transmitted by the cloud and conduct the follow-up visit via telemedicine, providing diagnostic and therapeutic guidance. Results: The study included 167 patients (78% male; mean age 55 ± 14 years; BMI: 27.5 ± 4.5 kg/cm²), with a mean distance of 147.29 ± 172.35 km from our hospital. The median time from test request to result delivery was 5 working days. The study cohort showed a median pAHI of 16.7 events/h, a median pODI was 7.9 events/h, and an pRDI of 20.7 events/h. 99% of respondents were satisfied with the remote management. Half of the subjects found both the application installation and the device operation extremely easy, and 60% of them were willing to recommend the use of WatchPAT® ONE. Conclusion: The telemedicine pathway represents an efficient and patient-friendly method for diagnosing OSA. This approach improves diagnostic ease and accessibility while reducing time to diagnosis and societal and healthcare costs. Further large-scale studies are necessary to confirm these results. [ABSTRACT FROM AUTHOR]

Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers and their bed partners. Effective snoring treatment, which aims to reduce or eliminate the sound, is challenging and depends on factors like age, comorbidities, disease severity, and anatomical features. This review aims to provide a systematic overview of the current literature on the effects of positional therapy (PT) on snoring. Various devices facilitate PT, including anti-snoring pillows and vibration alarms. PT devices maintain head and neck alignment to keep airways open, while head of bed elevation (HOBE) solutions reduce upper airway collapses by elevating the head and trunk. Studies show that PT and HOBE reduce snoring by increasing airway cross-sectional area and decreasing closing pressure. Despite their benefits, these non-surgical treatments have limitations, such as discomfort in certain sleeping positions and intolerance to prolonged head elevation. While reducing snoring intensity is critical for health reasons, further comparative studies between the different devices are needed to enhance snoring management. [ABSTRACT FROM AUTHOR]