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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.

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.)

Observational studies indicate that the risk of prostatitis in sleep apnea patients is higher than those without sleep apnea. However, the causal relationships remain to be determined. This study aims to investigate the causal relationships of sleep apnea on prostatitis using Mendelian randomization (MR). Summary-level data for sleep apnea (16,761 cases and 201,194 controls) and prostatitis (1859 cases and 72,799 controls) were available from the GWAS summary data. Two-sample MR analyses were performed to investigate the causal relationship between sleep apnea and prostatitis. The inverse variance weighted (IVW) analysis was employed as the primary statistical method. In 2-sample MR analyses, we found that IVW estimates revealed that sleep apnea inferred an effect on risk of prostatitis at statistical significance (odds ratio [OR] = 1.370, 95% confidence interval [CI] = 0.094-0.535, P = .005). This MR study strengthens the evidence of a causal relationship between sleep apnea and prostatitis in Europeans., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Although asthma is common in children with sleep-disordered breathing (SDB), it is unclear whether and to what extent asthma is associated with SDB-related outcomes. Our objectives are to describe risk factors for asthma among children with mild SDB (mSDB) and assess the association between asthma and the severity of sleep-related outcomes., Methods: Cross-sectional analyses were conducted for children aged 3-12.9 years with mSDB enrolled in Pediatric Adenotonsillectomy for Snoring Children Study. Sleep-related outcomes included SDB symptoms (Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder scale (PSQ-SRBD)), SDB-specific quality of life (OSA-18), sleepiness (modified Epworth Sleepiness Score) and polysomnographic and actigraphic measures. Asthma was defined by caregiver-reported diagnosis with current asthma symptoms and medication use, or a Composite Asthma Severity Index (CASI) score ≥ 4. Asthma was further categorized into mild (CASI < 4) and moderate-to-severe (CASI ≥ 4). Regression analyses were conducted to identify asthma risk factors and estimate the associations between mild and moderate-to-severe asthma with sleep-related outcomes., Results: The sample included 425 children (20.3%-Black, 17.4%-Hispanic; 51.7%-female). The prevalence of asthma was 19.1% (7.1% moderate-to-severe, 12.0% mild). Environmental tobacco smoke exposure and markers of atopy were associated with asthma in multivariable-adjusted analyses. Moderate-to-severe asthma was associated with increased OSA symptoms measured by PSQ-SRBD (adjusted effect estimate for moderate-to-severe vs. no asthma ( β ^ adj ; 95%CI): 0.08; 0.01, 0.15)) and decreased quality of life measured by OSA-18 ( β ^ adj ; 95%CI: 7.5; 1.20, 13.82)), and a small increase in the arousal index ( β ^ adj ; 95%CI: 0.80; 0.09, 1.51))., Conclusion: Moderate-to-severe asthma was associated with worse QoL and greater SDB symptoms among children with mSDB. The co-occurrence of common risk factors for mSDB and asthma and worse symptoms and quality of life in children with both conditions support coordinated strategies for prevention and co-management of both disorders., Clinical Trial: Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040, https://clinicaltrials.gov/study/NCT02562040., Competing Interests: Declarations. Human and animal rights and informed consent: All procedures performed in studies involving human participants were in accordance with the ethical standards of each site participating in PATS and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board at each site. Written informed consent was obtained from caregivers and assent from children older than 7 or 8 years (according to each site’s local requirements). Conflict of interest: Dr. Redline reports consulting fees from Apnimed Inc, Eli Lilly and Jazz Pharma, unrelated to this study., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: To investigate gray matter volume (GMV) changes in patients with comorbid insomnia and sleep apnea (COMISA) of differing severity and relationships between GMV alterations and clinical measures., Methods: Thirty-four COMISA patients and 24 healthy controls (HC) were recruited. All patients underwent structural MRI and completed measures related to respiration, sleep, mood, and cognition. COMISA patients were further divided into a mild and moderate COMISA (MC) and a severe COMISA (SC) group. Changes in GMV of COMISA patients were investigated via VBM. The voxel-wise differences in GMV were compared between HC group and COMISA group. Analysis of covariance (ANCOVA) was performed on individual GMV maps in MC, SC, and HC groups to further investigate effects of different stages of COMISA severity on GMV. Partial correlation analysis was then performed to analyze relationships between altered GMV and clinical measures., Results: GMV atrophy was mainly located in the temporal lobes and fusiform gyrus in COMISA group. The post-hoc analysis of the ANCOVA revealed temporal lobes and fusiform gyrus atrophy in MC and SC groups compared to HC and the temporal lobe atrophy was expanded in SC group based on cluster size. Moreover, the SC group showed GMV atrophy of the right amygdala compared to both MC and HC groups. Partial correlation analysis revealed positive relationships between the GMV and mood-and cognitive-related measures and negative correlation between GMV and respiration measure., Conclusions: Our findings showed GMV atrophy expansion from temporal lobe to limbic system (right amygdala) as severity stages increase in COMISA patients. These findings contribute to our understanding of neurobiological mechanisms underlying different stages of severity in COMISA patients., 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 © 2024 Elsevier B.V. All rights reserved.)

Study Objectives: The aim of the study was to examine the prevalence of sleep-disordered breathing (SDB) in children and adolescents with large overjet due to mandibular retrognathia compared to a control group., Methods: In this case-control study children with large overjet ≥ 6 mm due to mandibular retrognathia (study group) were compared to a group with neutral occlusion (controls). All participants underwent respiratory polygraphy (PG) and questionnaires regarding sleepiness and snoring. Differences across groups were tested by chi-square test; a general linear model adjusted for age, sex, and body mass index; and a Mann-Whitney U test. Differences in results of PG were also tested by a general linear model adjusted for age, sex, and body mass index according to severity of mandibular retrognathia., Results: Thirty-seven (19 male;18 female; median age 12.3 years) participants were included in the study group and 32 (16 male;16 female; median age 12.2 years) in the control group. No significant difference in SDB assessed by PG or questionnaires between the groups was found, even though the snore index was higher in the study group ( P = .051). The snore index was higher than the parent-reported snoring. Respiration rate was significantly reduced in the study group ( P = .043), and estimated sleep time efficiency was significantly reduced in males compared with females ( P < .001)., Conclusions: No significant differences in SDB were found between the groups even though the snore index was higher in the study group. The snore index of the PG was higher than the parent-reported snoring. Estimated sleep time efficiency was reduced in males. The study improves the understanding of risk of SDB in nonobese children with large overjet due to mandibular retrognathia and may contribute to an interdisciplinary approach to risk assessment of SDB in children with malocclusion., Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep, Upper Airway and Dental Occlusion in Children With Large Overjet; URL: https://clinicaltrials.gov/study/NCT04964830?term=NCT04964830&rank=1; Identifier: NCT04964830., Citation: Hansen C, Sonnesen L, Bakke M, Markström A. Prevalence of sleep-disordered breathing in children and adolescents with large horizontal maxillary overjet due to mandibular retrognathia: a case-control study. J Clin Sleep Med. 2024;20(12):1871-1878., (© 2024 American Academy of Sleep Medicine.)

Study Objectives: Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population., Methods: A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects., Results: The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent., Conclusions: There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required., Competing Interests: Declarations Ethical approval For this type of study formal consent is not required. Informed consent This article does not contain any studies with human participants performed by any of the authors. Conflict of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars., Methods: A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test., Results: There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants., Conclusion: Concerns of the impact of first premolar extractions on SDB were not supported with this study., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We aimed to evaluate the presence of sleep-disordered breathing (SDB) in generalized anxiety disorder (GAD) patients and its impacts after 12-week of escitalopram treatment. In this prospective observational study, GAD patients were followed up to determine whether comorbid SDB affects their treatment response. They underwent a home sleep apnea test (HSAT), and oxygen desaturation index ≥5 was considered indicative of SDB. All participants were treated with escitalopram 5 mg in the first 2 weeks and 10 mg in the remaining 10 weeks. They underwent assessments of heart rate variability and completed questionnaires for sleep, mood, attention, and daytime sleepiness on the day of enrollment, and 2 weeks, 4 weeks, and 12 weeks later. A total of 45 GAD participants (mean age, 56.2 years) were included in the study. Of these, 53.3% had comorbid SDB. Participants with GAD and SDB had higher baseline Beck Anxiety Inventory (BAI) and STOP-BANG scores. Both groups of participants with GAD showed overall improvement in anxiety, depression, and insomnia symptoms after 12 weeks of escitalopram treatment. Additionally, there were no statistically significant differences in the changes in BAI, Beck Depression Inventory, and Epworth Sleepiness Scale scores between the two groups at the Week 2, Week 4, and Week 12 assessments compared to baseline. However, the GAD group with comorbid SDB seemed to have a lower tendency for improvement in depressive symptoms than the group with non-comorbid SDB. Compared with the GAD group without comorbid SDB, the GAD group with comorbid SDB exhibited more severe anxiety symptoms at baseline and tended to show less improvement in depressive symptoms after 12 weeks of escitalopram treatment., Competing Interests: Declaration of competing interest The authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Sleep-related breathing disorders (SBD) are conditions of abnormal and difficult respiration during sleep, including chronic snoring, obstructive sleep apnea (OSA), central sleep apnea (CSA), sleep-related hypoventilation disorders and sleep-related hypoxemia. Some of them have a limited impact on health, but others (e.g., OSA) can have serious consequences, because of their dangerous effects on sleep and the hematic balance of oxygen and carbon dioxide. According to several population-based studies, prevalence of OSA is relatively high, approximately 3-7% for adult males and 2-5% for adult females in the general population. However, methodological differences and difficulties in characterizing this syndrome yielded to variability in estimates. Moreover, it is estimated that only about 40% of patients with OSA are diagnosed, which can lead to underestimation of disease prevalence. OSA is directly correlated with age and male sex and to risk factors such as obesity. Several studies found that OSA is associated with an increased risk of diabetes, some cancer types, cardiovascular and cerebrovascular diseases, such as hypertension, coronary artery disease and stroke. Pulmonary hypertension (PH), a noted cardiovascular disease, is significantly associated with sleep-related breathing disorders and lot of scientific studies published in the literature demonstrated a strong link between these conditions and the development of pulmonary hypertension PH. PH is relatively less common than sleep-related breathing disorders. The purpose of this systematic review is to analyze both the current knowledge around the consequences that SBD may have on pulmonary hemodynamics and the effects resulting from pharmacological and non-pharmacological treatments of SDB on PH.

Cheese consumption may play a role in mitigating sleep apnea risk, according to our Mendelian randomization (MR) study. Sleep apnea, a prevalent disorder associated with various health complications, affects millions worldwide, generating interest in dietary interventions. This study analyzed data from the UK Biobank and the FinnGen Biobank, focusing on cheese intake and its potential impact on sleep apnea through various biomarkers. Results revealed a significant inverse association between cheese consumption and sleep apnea risk (OR=0.724, p=0.00478), indicating that higher cheese intake is linked to a reduced likelihood of developing the disorder. Additionally, the analysis identified six biomarkers, including aspartate aminotransferase (1.33 %), urea (3.85 %), cystatin C (2.98 %), sex hormone-binding globulin (1.78 %), testosterone (1.94 %), and diastolic blood pressure (5.46 %), as mediators of this relationship. Notably, cheese consumption influenced levels of 23 biomarkers. These findings underscore the potential of dietary interventions in public health strategies aimed at decreasing sleep apnea prevalence and associated health risks. Overall, this study highlights the complex connections between diet, biomarkers, and sleep apnea, emphasizing the necessity for further research across diverse populations to enhance the generalizability of these results., Competing Interests: Declaration of competing interest All authors declare that there are no conflicts of interest to disclose in this research., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Dizziness is a debilitating multifactorial disorder commonly affecting the elderly. Daytime somnolence and sleep apnea have been linked to dizziness, but previous studies were limited by small sample sizes. The purpose of this study was to examine the relationship between dizziness and daytime somnolence and sleep-disordered breathing, in a nationally representative sample of elderly adults, while adjusting for possible confounders and mediators., Study Design: Data from the National Health and Nutrition Examination Study (NHANES; 2017-2020 prepandemic data) were analyzed in a cross-sectional manner using survey methods., Setting: Community-based setting in the United States., Participants: A total of 1,490 nationally representative participants aged ≥70 years., Main Outcomes: Multivariable logistic regression was used to examine the relationship between dizziness and daytime somnolence, snoring, and apnea, while adjusting for covariates (gender, age, body mass index, and various medical conditions that may confound this relationship)., Results: Frequent daytime somnolence five or more times monthly (odds ratio, 2.13; 95% confidence interval, 1.49-3.06) and presence of apnea (odds ratio, 1.65; 95% confidence interval, 1.20-2.27) were found to be associated with greater odds of dizziness when adjusting for medical comorbidities. A significant association was not found between snoring and dizziness., Conclusions and Relevance: In the elderly, daytime somnolence and apnea were independently associated with increased odds of dizziness, even after adjusting for medical comorbidities. Daytime somnolence and sleep apnea should be added to the differential diagnosis in this patient population. Optimizing sleep may help reduce symptoms of dizziness in this population, but prospective studies would be required to confirm these findings.Level of evidence: 4., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Purpose: To clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them., Methods: An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years' precipitation and temperature in each subjects' home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea., Results: There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough [adjusted OR 1.80 (1.30-2.51) per 100 mm, p < 0.001, and 1.57 (1.19-2.07) per 100 mm, p = 0.001, respectively]. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices., Conclusion: Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there., Competing Interests: Declarations. Conflict of Interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests. Ethical Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kuopio University Hospital (289/2015). Consent to Participate: The decision to respond to the questionnaire was considered as an informed consent. Consent to Publish: Not applicable., (© 2024. The Author(s).)

Obstructive sleep apnea (OSA) is a frequent pathology with clinical implications. Its comorbidity with the complaint of insomnia is common, and has been increasingly studied in recent years, due to the multiple negative synergies highlighted by these two conditions, notably on all-cause excess mortality, cardiovascular risk, quality of life and sleep, as well as mental health. This comorbidity between insomnia and sleep apnea has recently been referred to as COMISA («co-morbid insomnia and sleep apnea»). In this article, we explore the relationship between OSA and insomnia, as well as its consequences and currently available treatments, through an analysis of the existing literature., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease., Methods: This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls., Results: Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001)., Conclusion: HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients., (© 2024 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Purpose of Review: There is increasing evidence for relevant sex differences in pathophysiology, symptom presentation and outcomes in obstructive sleep apnoea (OSA). However, research on sex differences and sex-specific phenotypes in sleep-disordered breathing (SDB) is still in its infancy and data on sex differences in other SDB is still very scarce., Recent Findings: While OSA is more common in men than in premenopausal women, the prevalence of OSA doubles postmenopausally and becomes comparable to that of men. Women have a lower collapsibility of the upper airway and a lower arousal threshold. In addition, the rapid eye movement (REM)-apnoea-hypopnoea index (AHI) is typically higher in women than in men, but the non-REM-AHI and thus the total AHI is often lower. Women are often symptomatic at lower AHI and present more frequently with symptoms of sleep fragmentation and poor sleep quality. Both certain forms of OSA (e.g. REM-OSA) and certain phenotypes (e.g. COMISA) are more common in women. Men have a higher risk of high loop gain central sleep apnoea., Summary: For a better understanding of sex-typical phenotypes with the aim of a more targeted treatment approach of SDB, adequately powered studies on sex differences in SDB should be conducted., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Postpartum depression (PPD) is widely recognized as the most prevalent mental health crisis following childbirth and has been linked to sleep disturbances. However, the potential causal relationships between various sleep traits and PPD remain unclear. This study employs a bidirectional two-sample Mendelian randomization (MR) approach to investigate these associations., Methods: The inverse-variance-weighted method was used to evaluate the causally linked sleep traits on postpartum depression. The weighted median, weighted mode, and MR-Egger were used to estimate the robustness of the inverse-variance-weighted method. The leave-one-out method estimated the sensitivity of the result. Cochran's Q method was used for the heterogeneous test. The MR-Egger intercept and MR-PRESSO methods detected the horizontal pleiotropy., Results: We examined the genetic causal relationships between nine sleep traits and postpartum depression. Sleep apnea syndrome (OR: 1.122; 95%CI: 1.063-1.185; p = 0.000), sleeplessness/insomnia (OR: 1.465; 95%CI: 1.104-1.943; p = 0.008), and frequency of tiredness/lethargy in last 2 weeks (OR: 1.725; 95%CI: 1.345-2.213; p = 0.000) genetically predicted the increased risk of postpartum depression. The reverse Mendelian randomization analysis showed PPD caused sleeplessness/insomnia (β: 0.006; 95%CI: 0.001-0.010; p = 0.016) and frequency of tiredness/lethargy in last 2 weeks (β: 0.007; 95%CI: 0.002-0.011; p = 0.004). The remaining six sleep traits showed no significant association with PPD. There was no heterogeneity or horizontal pleiotropy., Conclusions: Genetic evidence reveals causal relationships between specific sleep traits and PPD, including sleep apnea syndrome, sleeplessness/insomnia, and tiredness. Whether certain sleep health indicators suggest a risk of postpartum depression or sleep issues that are caused by PPD, both may offer insights into the prevention and treatment of PPD., (© 2024. The Author(s).)

Objective: Approximately 30% of adults globally suffer from sleep disorders. However, there are few longitudinal studies on the association between dietary vitamin C and sleep disorders. This study aimed to investigate the association between dietary vitamin C intake and various types of sleep disorders, including sleep apnea and insomnia. Methods: We enrolled 68,221 participants from the UK Biobank. Dietary vitamin C intake was assessed using a 24 h dietary recall questionnaire. We employed a Cox regression model to assess the association between dietary vitamin C and sleep disorders and used restricted cubic spline models to investigate potential nonlinear relationships. Stratified and sensitivity analyses were also conducted to validate the findings. Results: The results indicated that vitamin C intake at the Q4 level (132.88-191.51 mg/d) was significantly associated with a reduced risk of sleep disorders, with an HR (95% CI) of 0.78 (0.65-0.94), and against sleep apnea, with an HR (95% CI) of 0.75 (0.62-0.92). The protective effect persisted significant in stratified analyses of men and those aged ≤ 60 years; the results were consistent in the sensitivity analyses. Conclusions: Our findings suggest that sufficient dietary vitamin C intake may help to prevent sleep disorders.

To investigate the use of lipid-lowering drugs and abnormal serum lipid levels in patients at risk of sleep apnea syndrome. Three types of Mendelian randomization (MR) analyses were used. First, a 2-sample Mendelian randomization (TSMR) analysis was used to investigate the association between sleep apnea syndrome risk and serum lipid levels. Multivariate Mendelian randomization (MVMR) analysis was subsequently used to investigate the effects of confounding variables on SAS incidence of sleep apnea syndrome. Finally, drug-target Mendelian randomization (DMR) analysis was used to analyze the association between lipid-lowering drug use and sleep apnea syndrome risk. According to the TSMR analysis, the serum HDL-C concentration was negatively correlated with sleep apnea syndrome (OR = 0.904; 95% CI = 0.845-0.967; P = .003). Serum TG levels were positively correlated with sleep apnea syndrome (OR = 1.081; 95% CI = 1.003-1.163; P = .039). The association between serum HDL-C levels and sleep apnea syndrome in patients with MVMR was consistent with the results in patients with TSMR (OR = 0.731; 95% CI = 0.500-1.071; P = 3.94E-05). According to our DMR analysis, HMGCR and PCSK9, which act by lowering serum LDL-C levels, were inversely associated with the risk of sleep apnea syndrome (OR = 0.627; 95% CI = 0.511-0.767; P = 6.30E-06) (OR = 0.775; 95% CI = 0.677-0.888; P = .0002). LPL, that lowered serum TG levels, was positively associated with the risk of sleep apnea syndrome (OR = 1.193; 95% CI = 1.101-1.294; P = 1.77E-05). Our analysis suggested that high serum HDL-C levels may reduce the risk of sleep apnea syndrome. Low serum TG levels have a protective effect against sleep apnea syndrome. The DMR results suggested that the use of HMGCR lipid-lowering drugs (such as statins) and PCSK9 inhibitors has a protective effect against sleep apnea syndrome. However, LPL-based lipid-lowering drugs may increase the risk of sleep apnea syndrome., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Endothelial dysfunction is an integral pathophysiologic mechanism in sickle cell disease (SCD), and can lead to many complications. Sleep-disordered breathing (SDB) is a SCD complication with diverse incidence and pathophysiology. This study aimed to determine the prevalence of SDB in children with SCD and to assess its relation to endothelial dysfunction., Methods: Sixty children with SCD and 60 healthy controls were enrolled. The levels of TNF-α, IL-6, and IL-17A were evaluated in the entire cohort using enzyme-linked immunosorbent assay (ELISA) kits. Polysomnography (PSG) was performed for all SCD patients after completion of the Pediatric Sleep Questionnaire (PSQ)., Results: TNF-α, IL-6, and IL-17A levels were significantly greater in children with SCD than in controls (p-values < 0.001, < 0.001, and 0.006, respectively). The PSQ revealed symptoms suggestive of SDB in 50 children with SCD (83.3%), and PSG revealed obstructive sleep apnea (OSA) in 44 children with SCD (73.3%); 22 patients had mild OSA, and 22 had moderate-to-severe OSA according to the apnea-hypopnea index (AHI). TNF-α was significantly greater in SCD children who reported heavy or loud breathing, trouble breathing or struggle to breathe, and difficulty waking up in the morning (p-values = 0.002, 0.002, and 0.031, respectively). The IL-6 levels were significantly greater in SCD children who stopped growing normally (p-value = 0.002). The levels of IL-6 and IL-17A were significantly greater in SCD children with morning headaches (p-values = 0.007 and 0.004, respectively)., Conclusion: Children with SCD showed a high prevalence of SDB with significantly elevated levels of markers of endothelial function, highlighting the interplay of SDB and endothelial dysfunction in SCD., (© 2024. The Author(s).)

Aims: Sleep-disordered breathing (SDB) is closely related to cardiovascular diseases. The higher the apnoea-hypopnoea index (AHI), the higher the prevalence of cardiovascular diseases. Despite these findings suggesting a close link between SDB and heart failure, the relationship between the severity of SDB and the onset of heart failure symptoms in individuals without apparent heart failure symptoms (Heart Failure Stage A + B) remains poorly understood., Methods and Results: Between December 2010 and June 2017, we conducted full-night polysomnography (PSG) at the Nippon Medical School Chiba Hokusoh Hospital, extracting patients who were at risk of heart failure (Stage A or B in the Heart Failure Guidelines). Using a median cut-off of AHI ≥ 41.6 events/hour, we divided the patients into two groups and examined the composite endpoint of all-cause mortality plus hospitalization due to heart failure as the primary endpoint. We included 230 patients (mean age 63.0 ± 12.5 years, 78.3% males) meeting the selection criteria. When comparing the two groups, those with AHI < 41.6 events/hour (L group, n = 115) and those with AHI ≥ 41.6 events/hour (H group, n = 115), the H group had higher body mass index and higher serum triglyceride, and lower the frequency of acute coronary syndrome and lower estimated glomerular filtration rate than did the L group, but no other patient characteristics differed significantly. The H group had a significantly higher incidence of the composite endpoint than did the L group (10.6% vs. 2.6%, P = 0.027). Factors associated with the composite endpoint were identified through multivariate analyses, with AHI, haemoglobin, and left atrial dimension emerging as significant factors (hazard ratio [HR] = 1.02, 95% confidence interval [CI] = 1.00-1.04, P = 0.024; HR = 0.71, 95% CI = 0.54-0.94, P = 0.017; and HR = 1.10, 95% CI = 1.03-1.18, P = 0.006, respectively). Conversely, the minimum SpO 2 during PSG (<80%) was not associated with the composite endpoint., Conclusions: In patients with SDB who are at risk of heart failure, severe SDB is associated with a high risk of all-cause mortality and the development of heart failure. Additionally, combining cardiac echocardiography and PSG data may improve risk stratification, offering potential assistance for early intervention. Further examination with a validation cohort is necessary., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Study Objectives: We investigated the association between maternal early pregnancy body mass index (BMI) and offspring sleep apnea diagnosis., Methods: We conducted a nationwide cohort study among 3,281,803 singleton live births in Sweden born 1983-2015. Using national registers with prospectively recorded information, we followed participants for a sleep apnea diagnosis from 2 to up to 35 years of age. We compared sleep apnea risks by early pregnancy BMI categories using hazard ratios with 95% confidence intervals from adjusted Cox models. To address confounding by factors shared within families, we conducted sibling-controlled analyses and studied the relation of siblings' maternal BMI with index offspring's sleep apnea risk., Results: There were 17,830 sleep apnea diagnoses. Maternal early pregnancy BMI was positively associated with offspring sleep apnea risk; compared with women with normal BMI (18.5-24.9), adjusted hazard ratios (95% confidence intervals) of offspring sleep apnea for maternal BMI categories 25.0-29.9 (overweight), 30.0-34.9 (obesity class I), and ≥35.0 (obesity class II or III) were, respectively, 1.14 (1.09, 1.19), 1.28 (1.20, 1.36), and 1.40 (1.27, 1.54). Corresponding hazard ratios from sibling-controlled analyses representing risk change for maternal BMI differences between pregnancies were, respectively, 1.13 (1.01, 1.26), 1.17 (0.97, 1.42), and 1.32 (0.97, 1.80). Hazard ratios by siblings' maternal BMI were attenuated, suggesting a weak role for shared familial factors. Other pregnancy, birth, and neonatal complications were associated with offspring sleep apnea risk but did not substantially mediate the association with maternal obesity., Conclusions: Maternal overweight and obesity are associated with offspring sleep apnea risk in a dose-response manner., Citation: Zhu MQ, Cnattingius S, O'Brien LM, Villamor E. Maternal early pregnancy body mass index and risk of sleep apnea in the offspring. J Clin Sleep Med. 2024;20(10):1675-1684., (© 2024 American Academy of Sleep Medicine.)

Objective: Despite recognition that people with HIV (PWH) are more vulnerable to sleep issues, there is limited understanding of clinically recognized sleep disorders in this population. Our objective was to evaluate the full spectrum of sleep disorder types diagnosed among PWH in care., Methods: We conducted a retrospective cohort study of PWH, and a comparator group of people without HIV (PWoH), in a large healthcare system. The incidence of clinically diagnosed sleep disorders was calculated using Poisson regression for three outcomes: any type of sleep disorder, insomnia, and sleep apnea. Incidence was compared between PWH and PWoH by computing the adjusted incidence rate ratio (aIRR), accounting for sleep disorder risk factors. Comparisons to PWoH were made for all PWH combined, then with PWH stratified by HIV management status (well-managed HIV defined as being on antiretroviral therapy, HIV RNA <200 copies/mL, and CD4 count ≥500 cells/μL)., Results: The study included 9076 PWH and 205 178 PWoH (mean age 46 years, 90% men). Compared with PWoH, sleep disorder incidence was greater among PWH overall [aIRR = 1.19, 95% confidence interval (CI): 1.12-1.26], particularly for insomnia (aIRR = 1.56, 95% CI: 1.45-1.67). Sleep apnea incidence was lower among PWH (aIRR = 0.90, 95% CI: 0.84-0.97). In HIV management subgroups, PWH without well-managed HIV had lower sleep apnea incidence (vs. PWoH: aIRR = 0.79, 95% CI: 0.70-0.89) but PWH with well-managed HIV did not (vs. PWoH: aIRR = 0.97, 95% CI: 0.89-1.06)., Conclusions: PWH have high sleep disorder incidence, and insomnia is the most common clinical diagnosis. Lower sleep apnea incidence among PWH may reflect underdiagnosis in those with sub-optimally treated HIV and will be important to investigate further., (© 2024 British HIV Association.)

Background: Sleep apnea (SA) has been linked to an increased risk of dementia in numerous observational studies; whether this is driven by neurodegenerative, vascular, or other mechanisms is not clear. We sought to examine the bidirectional causal relationships between SA, Alzheimer disease (AD), coronary artery disease (CAD), and ischemic stroke using Mendelian randomization., Methods and Results: Using summary statistics from 4 recent, large genome-wide association studies of SA (n=523 366), AD (n=94 437), CAD (n=1 165 690), and stroke (n=1 308 460), we conducted bidirectional 2-sample Mendelian randomization analyses. Our primary analytic method was fixed-effects inverse variance-weighted (IVW) Mendelian randomization; diagnostics tests and sensitivity analyses were conducted to verify the robustness of the results. We identified a significant causal effect of SA on the risk of CAD (odds ratio [OR IVW ]=1.35 per log-odds increase in SA liability [95% CI=1.25-1.47]) and stroke (OR IVW =1.13 [95% CI=1.01-1.25]). These associations were somewhat attenuated after excluding single-nucleotide polymorphisms associated with body mass index (OR IVW =1.26 [95% CI=1.15-1.39] for CAD risk; OR IVW =1.08 [95% CI=0.96-1.22] for stroke risk). SA was not causally associated with a higher risk of AD (OR IVW =1.14 [95% CI=0.91-1.43]). We did not find causal effects of AD, CAD, or stroke on risk of SA., Conclusions: These results suggest that SA increased the risk of CAD, and the identified causal association with stroke risk may be confounded by body mass index. Moreover, no causal effect of SA on AD risk was found. Future studies are warranted to investigate cardiovascular pathways between sleep disorders, including SA, and dementia.

Background: Sleep-disordered breathing (SDB) and allergic rhinitis (AR) are common problems that can lead to worsening quality of life (QOL) in children with these conditions. There is scarce evidence on the QOL of children with SDB outside of the hospital setting with inconsistent evidence on the association of AR and QOL concerning the SDB in children. Thus, the primary objective of this study is to determine the QOL concerning the SDB of elementary school students by using OSA-18. We also aim to provide the relationship of allergic rhinitis to the QOL., Methods: A cross-sectional study was conducted on all elementary school students, aged 6-12 years, from 10 elementary schools. The QOL of all participants was evaluated by the Thai version of the caregiver-administered OSA-18 questionnaire. The simple and multiple linear regression models were used to determine the effect of allergic rhinitis on the OSA-18 total scores., Results: A total of 3,053 children were included in the final analysis, 50.1% male. At least a moderate impact on QOL from SDB was observed in 9.4% of the population. Children with AR had significantly higher mean total OSA- 18 scores than the children without AR (47.5 ± 15.0 VS 38.5 ± 13.1, p < 0.001). After the adjustment for age, gender, body mass index, household income, and history of asthma, the point estimate of the adjusted beta regression coefficient on the OSA-18 total score in children with AR was 7.82 (95% CI: 6.00-9.65, p < 0.001). Significant associations were observed between AR and all domains except for emotional distress., Conclusions: A substantial number of elementary school children had at least a moderate impact on the QOL from SDB, especially those with AR. Thus, effective screening of SDB in children with AR should be done to improve the QOL of these children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sritipsukho 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.)

The community population based studies on the relationship between obstructive sleep apnea and liver injury are limited. The study aimed to clarify the association between sleep apnea (SA) and liver injury by using the data in The National Health and Nutrition Examination Survey. SA was assessed by the sleep questionnaire and liver injury was evaluated by liver function test, hepatic steatosis index, and fibrosis-4. Weighted multivariable linear regression was performed to examine the association between SA and liver injury. Subgroup analyses and sensitivity analysis were also conducted. A total of 19,362 eligible participants were included in the study. After adjusting for confounders, the presence of SA was significantly associated with increased levels of lnALT, lnAST/alanine aminotransferase, lnGGT, and lnHSI (all P values < .05), but not with lnFIB-4 (P > .05). There is a dose-response relationship between the severity of SA and increased levels of lnALT, lnGGT, and decreased levels of lnAST/alanine aminotransferase (test for trend, all P values < .05). Subgroup analyses revealed that the positive association between SA and liver function, liver steatosis showed a tendency to exist in nonobese, younger, non-Hispanic Black, and male populations. Sensitive analysis showed the relationship between SA and liver injury was stable. Self-reported SA was independently associated with elevated liver enzymes and liver steatosis among US population. The association was more pronounced among nonobese, younger, non-Hispanic Black, and male populations., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: In children, asthma and sleep-disordered breathing (SDB) may affect quality of life (QoL), and SDB may complicate asthma management., Objective: To evaluate the prevalence of SDB, its association with asthma control, and risk factors associated with SDB in a cohort of asthmatic children. The effects of asthma control and SDB on QoL were also investigated., Methods: We consecutively recruited asthmatic children referred to our Pulmonology Service from December 1, 2022 to May 31, 2023. Data on anthropometrics, respiratory function, and allergies were collected. The prevalence of SDB was assessed by the Pediatric Sleep Questionnaire (PSQ). Asthma control status was assessed by the Childhood Asthma Control Test (C-ACT), while QoL was evaluated by the Pediatric Quality of Life Inventory (PedsQL) questionnaire. Factors associated with SDB were analyzed., Results: A total of 78 asthmatic children aged 5-12 years were included. SDB was found in 37.2% of them, with a higher prevalence in children with uncontrolled versus well-controlled asthma (60.1% vs. 27.3%; p-value = 0.005). The C-ACT score was significantly lower in SDB-positive versus SDB-negative group, and uncontrolled asthma (C-ACT ≤19) was associated with a 4.15-fold increased risk of SDB. The PedsQL score was significantly lower in asthmatic children with than without SDB and was associated with lower SDB risk. SDB increased the risk of uncontrolled asthma in children, and asthmatic children with SDB had lower QoL., Conclusion: In asthmatic children, SDB affects both asthma control and QoL. Children with uncontrolled asthma should be referred for polysomnography to identify a possible underlying SDB., 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To study whether poor sleep and comorbidities are associated with high symptom levels of patient-reported outcomes (PROs) pain, patient global assessment and fatigue in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), in a nation-wide cross-sectional setting., Methods: Clinical data were extracted from The Finnish Rheumatology Quality Register between 1.2021 and 9.2022. Self-reported sleep was categorized as "good" (little/no difficulties) or "poor" (great difficulties/can't) sleep. Data concerning comorbidities were collected from national registers. Descriptive statistics were used. Regression analyses were applied to analyze independent associations of sleep status, comorbidities and disease activity with pain in RA and PsA, adjusting for age and sex., Results: Among 13,512 patients with RA, 6052 [mean (SD) age 62 (13), 71% female] had sleep status reported; in PsA 1861/3636 [age 55 (13), 48% female]. In RA, 5072 (84%) reported good and 980 (16%) poor sleep; the corresponding numbers in PsA were 1460 (78%) and 401 (22%). Median values for objective disease activity were low and similar in patients with poor sleep and good sleep in both diseases. Among patients with no swollen joints, the median values for PROs were approximately three times higher for patients with poor sleep vs. good sleep in both diagnoses (P<0.001). In regression analyses, "poor" sleep was independently associated with higher symptoms in pain [B (95%CI) 20 (18,22) in RA and 23 (19, 26) in PsA], followed by comorbid fibromyalgia, as well as depression in RA and sleep apnea in PsA., Conclusion: "Poor" sleep quality and comorbidities are independently associated with pain. Patient's sleep status is important to know especially in patients with severe symptoms without objective disease activity., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Aim: Prospective studies suggest that sleep-disordered breathing enhances the risk of diabetes. However, it remains unclear whether diabetes could worsen sleep-disordered breathing., Methods: The participants from Sleep Heart Health Study underwent two polysomnograms at a 5-year interval. The relationship of baseline diabetes to change in the apnoea-hypopnoea index (AHI) was examined based on general linear models, adjusting for demographics, lifestyles, history of hypertension, pulmonary function, length of follow-up and baseline AHI., Results: In total, 161 of the 2603 participants were diagnosed with diabetes at the first polysomnograms. Compared with participants without diabetes, those with diabetes had a higher baseline and larger increases in follow-up AHI and obstructive apnoea index (oAI). Diabetes increased 2.52 events per hour (95% confidence interval 0.45-4.59; p = .017) for AHI change and 1.13 events per hour (95% confidence interval 0.04-2.23; p = .042) for oAI change, respectively. In addition, subgroup analysis suggested that the association was consistent across baseline obstructive sleep apnoea severity and body mass index groups., Conclusions: Baseline diabetes was associated with worsening sleep-disordered breathing over 5 years, which mainly increased the change in AHI and oAI., (© 2024 John Wiley & Sons Ltd.)

Purpose: While sleep apnea (SA) gets more prevalent with advancing age, the impact of age on the association between SA and health outcomes is not well known. We assessed the association between the severity of SA and all-cause mortality in different age groups using large longitudinal data., Method: We applied a Natural Language Processing pipeline to extract the apnea-hypopnea index (AHI) from the physicians' interpretation of sleep studies performed at the Veteran Health Administration (FY 1999-2022). We categorized the participants as no SA (n-SA, AHI< 5) and severe SA (s-SA, AHI≥30). We grouped the cohort based on age: Young≤40; Middle-aged:40-65; and Older adults≥65; and calculated the odds ratio (aOR) of mortality adjusted for age, sex, race, ethnicity, BMI, and Charlson-Comorbidity Index (CCI) using n-SA as the reference., Results: We identified 146,148 participants (age 52.23 ± 15.02; BMI 32.11 ± 6.05; male 86.7 %; White 66 %). Prevalence of s-SA increased with age. All-cause mortality was lower in s-SA compared to n-SA in the entire cohort (aOR,0.56; 95%CI: 0.54,0.58). Comparing s-SA to n-SA, the all-cause mortality rates (Young 1.86 % vs 1.49 %; Middle-aged 12.07 % vs 13.34 %; and Older adults 26.35 % vs 40.18 %) and the aOR diminished as the age increased (Young: 1.11, 95%CI: 0.93-1.32; Middle-aged: 0.64, 95%CI: 0.61-0.67; and Older adults: 0.44, 95%CI: 0.41-0.46)., Conclusion: The prevalence of severe SA increased while the odds of all-cause mortality compared to n-SA diminished with age. SA may exert less harmful effects on the aged population. A causality analysis is warranted to assess the relationship between SA, aging, and all-cause mortality., 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., (Published by Elsevier B.V.)

Background: While sleep disorders are implicated in atrial fibrillation (AF), the interplay of physiologic alterations and symptoms remains unclear. Sleep-based phenotypes can account for this complexity and translate to actionable approaches to identify at-risk patients and therapeutic interventions., Objectives: This study hypothesized discrete phenotypes of symptoms and polysomnography (PSG)-based data differ in relation to incident AF., Methods: Data from the STARLIT (sleep Signals, Testing, And Reports LInked to patient Traits) registry on Cleveland Clinic patients (≥18 years of age) who underwent PSG from November 27, 2004, to December 30,2015, were retrospectively examined. Phenotypes were identified using latent class analysis of symptoms and PSG-based measures of sleep-disordered breathing and sleep architecture. Phenotypes were included as the primary predictor in a multivariable-adjusted Cox proportional hazard models for incident AF., Results: In our cohort (N = 43,433, age 51.8 ± 14.5 years, 51.9% male, 74.9% White), 7.3% (n = 3,166) had baseline AF. Over a 7.6- ± 3.4-year follow-up period, 8.9% (n = 3,595) developed incident AF. Five phenotypes were identified. The hypoxia subtype (n = 3,245) had 48% increased incident AF (HR: 1.48; 95% CI: 1.34-1.64), the apneas + arousals subtype (n = 4,592) had 22% increased incident AF (HR: 1.22; 95% CI: 1.10-1.35), and the short sleep + nonrapid eye movement subtype (n = 6,126) had 11% increased incident AF (HR: 1.11; 95% CI: 1.01-1.22) compared with long sleep + rapid eye movement (n = 26,809), the reference group. The hypopneas subtype (n = 2,661) did not differ from reference (HR: 0.89; 95% CI: 0.77-1.03)., Conclusions: Consistent with prior evidence supporting hypoxia as an AF driver and cardiac risk of the sleepy phenotype, this constellation of symptoms and physiologic alterations illustrates vulnerability for AF development, providing potential value in enhancing our understanding of integrated sleep-specific symptoms and physiologic risk of atrial arrhythmogenesis., Competing Interests: Funding Support and Author Disclosures This work was supported by a Transformative Neuroscience Research Resource Development Award funded by the Cleveland Clinic Foundation; a Neurological Institute Center for Outcomes Research and Evaluation Pilot Grant funded by the Cleveland Clinic Foundation; SMARRT (Supporting Multidisciplinary Achievement in Respiratory Research Training) grant T32HL155005 funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; and Physician Scientist Training Grant 302-PA-23 funded by the American Academy of Sleep Medicine Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Sleep Disorder Breathing (SDB) in pregnant patients ranges from 3 to 27% and varies depending on gestational age and method used to diagnose. SDB increases the risk of advanced pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension, and preeclampsia. Screening and diagnosis of SDB during pregnancy remains a challenge, with existing screening tools underperforming during pregnancy. This study aimed to validate a previously developed model for predicting SDB during late pregnancy and compare the predictive value of bedpartner responses., Methods: Ninety-six women in the third trimester of pregnancy underwent polysomnography and completed the Berlin Questionnaire (BQ), with 81 bedpartners completing the BQ about their pregnant partner. A subset of BQ items (snoring volume and tiredness upon awakening) along with BMI > 32 kg/m 2 was utilised to calculate the Wilson Optimized Model (WOM), which demonstrated strong predictive properties in development., Results: SDB (RDI/hr ≥ 5) was detected in 43.8% of women. BQ identified 72% of pregnant mothers as high risk for SDB (Sensitivity = 83%, Specificity = 37%), compared to 29% of mothers identified by the WOM (Sensitivity = 45%, Specificity = 83%). At RDI of ≥ 15, the WOM correctly classified more women according to SDB risk than the BQ (76.0% vs. 41.7% cases correct, X 2 (1) = 23.42, p < .001), with no difference at RDI ≥ 5. Bedpartners were more likely to report high risk for SDB on the WOM than pregnant women themselves (38.3% vs. 28.4%), however predictive ability was not improved by bedpartner input (RDI ≥ 5 bedpartner AUC = 0.69 v mother AUC = 0.73)., Conclusion: BQ largely overestimates the prevalence of SDB in pregnancy compared to the WOM which underestimates. Utilising bedpartner responses didn't improve screening for SDB in late pregnancy. More work is needed to develop a pregnancy-specific tool for quick and accurate screening for SDB., (© 2024. The Author(s).)

(1) Background: Sleep-disordered breathing and asthma are often interrelated. Children and adults with asthma are more susceptible to sleep apnea. Inhaled corticosteroids effectively reduce inflammation and prevent structural changes in the airways. Objective: to explore the existing literature to determine whether inhaled corticosteroids play a role in sleep-disordered breathing in patients with asthma. (2) Methods: We conducted a thorough search of the PubMed, Scopus, and Web of Science databases for English-language articles published up to 12 May 2024. We utilized the ROBINS-E tool to assess the risk of bias. (4) Conclusions: 136 articles were discerned upon conducting the literature search. A total of 13 articles underwent exhaustive full-text scrutiny, resulting in 6 being considered non-relevant. The remaining seven articles, assessed for eligibility, were incorporated into the final analysis. Five studies were identified in adults and two in children. In adult patients, inhaled corticosteroids, especially at high doses, appear to increase the risk of sleep apnea in a dose-dependent manner. Moreover, the properties of inhaled corticosteroids, such as particle size, may impact the risk of developing sleep apnea. In children, the severity of asthma is a key factor affecting the prevalence of sleep apnea, whereas inhaled corticosteroids appear to be a less significant risk factor compared to adults. All of the studies reviewed were classified as having a high risk of bias or some concerns regarding bias. Each study revealed at least one type of bias that raised notable concerns. This research highlights a complex interaction between the use of inhaled corticosteroids, the severity of asthma, and the onset of sleep apnea. Additional research is necessary to investigate these relationships further.

Background: The association between magnesium status and sleep quality is unclear. The aim of this study was to determine the relationship between renal reabsorption-related magnesium depletion score (MDS) and sleep quality., Methods: This study was conducted through a cross-sectional survey of adults aged ≥20 years who participated in NHANES 2005-2014. We used weighted logistic regression to examine the association between MDS and sleep quality and performed trend tests to analyze for the presence of a dose-response relationship. Subgroup analyses were performed based on various sleep outcomes and covariates., Results: A total of 20,585 participants were included in the study, with a mean age of 48.8 years and 50.7 % female. After adjusting for all covariates, we found a graded dose-response relationship between MDS and sleep trouble as well as sleep disorder. Further analyses revealed a significant positive association between MDS and sleep apnea (OR = 3.01; 95 % CI 1.37-6.62), but no association with restless legs, insomnia or insufficient sleep. In addition, subgroup analyses revealed that middle-aged, male, obese, low magnesium intake, and depressed patients were more prone to sleep trouble and sleep disorder; interestingly, MDS was positively associated with excessive sleep in subjects ≥60 years and without depression., Conclusions: Our study found a significant association between MDS and sleep quality, particularly sleep apnea, but adequate magnesium intake may be beneficial in mitigating this association. MDS may be associated with excessive sleep in older adults, but not with insufficient sleep or insomnia., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)