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Medicina
Special Issues
Pathogenesis and Treatment of Obstructive Sleep Apnoea
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Pathogenesis and Treatment of Obstructive Sleep Apnoea

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonary".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 9725

Special Issue Editors

Dr. Esther I. Schwarz

E-Mail Website
Guest Editor
Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
Interests: obstructive sleep apnoea; pathophysiology; CPAP; alternative OSA treatment modalities; cardiovascular consequences of OSA; respiratory failure; sleep-disordered breathing; non-invasive ventilation
Dr. Martino F Pengo

E-Mail Website
Guest Editor
Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
Interests: systemic hypertension; secondary hypertension; sleep apnoea; blood pressure variability; CPAP; alternative OSA treatment modalities; cardiovascular consequences of OSA

Special Issue Information

I would like to invite you to contribute to a Special Issue on the pathogenesis and treatment of obstructive sleep apnoea (OSA) to provide a summary on the current knowledge on pathophysiology, OSA phenotypes, treatment effects, and different treatment modalities.

From in vitro and rodent models to epidemiological studies and randomised controlled interventional trials, we have learned about the effects of intermittent hypoxia and the cardiovascular consequences of OSA, and have generated hypotheses on treatment effects that have not been confirmed in all OSA patients, particularly not in randomised controlled trials. Recent research has focused on different phenotypes of OSA associated with different symptom burden and prognostic impact, and on novel treatment modalities that should allow a phenotype-oriented and individually tailored treatment approach to this prevalent sleep-related breathing disorder. These aspects should be outlined and discussed in this Special Issue on the pathogenesis and treatment of OSA. Narrative reviews, meta-analyses, and original research articles are welcome.

 Thank you for your interest and your contribution in advance.

Dr. Esther I. Schwarz
Dr. Martino F Pengo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Pathophysiology of obstructive sleep apnoea: upper airway anatomy, upper airway collapsibility, arousal threshold, loop gain
  • Acute consequences of OSA: intermittent hypoxia, intrathoracic pressure swings, sleep fragmentation, sympathetic overdrive
  • OSA phenotypes
  • Diagnosis of OSA: sleep studies and comprehensive sleep assessment
  • Symptoms of OSA and their assessment
  • Cardiovascular and systemic consequences of OSA
  • Continuous positive airway pressure
  • Other treatment modalities for OSA: MAD, hypoglossal nerve stimulation, bariatric surgery, upper airway surgery, lifestyle modification, drugs
  • Individually tailored treatment

Published Papers (4 papers)

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Research

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12 pages, 2258 KiB  
Article
Subclinical Changes in Cardiac Functional Parameters as Determined by Cardiovascular Magnetic Resonance (CMR) Imaging in Sleep Apnea and Snoring: Findings from UK Biobank
by Adrian Curta, Holger Hetterich, Regina Schinner, Aaron M. Lee, Wieland Sommer, Nay Aung, Mihir M. Sanghvi, Kenneth Fung, Elena Lukaschuk, Jackie A. Cooper, José Miguel Paiva, Valentina Carapella, Stefan Neubauer, Stefan K. Piechnik and Steffen E. Petersen
Medicina 2021, 57(6), 555; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57060555 - 31 May 2021
Cited by 2 | Viewed by 2673
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a common disorder with an increased risk for left ventricular and right ventricular dysfunction. Most studies to date have examined populations with manifest cardiovascular disease using echocardiography to analyze ventricular dysfunction with little or no [...] Read more.
Background and Objectives: Obstructive sleep apnea (OSA) is a common disorder with an increased risk for left ventricular and right ventricular dysfunction. Most studies to date have examined populations with manifest cardiovascular disease using echocardiography to analyze ventricular dysfunction with little or no reference to ventricular volumes or myocardial mass. Our aim was to explore these parameters with cardiac MRI. We hypothesized that there would be stepwise increase in left ventricular mass and right ventricular volumes from the unaffected, to the snoring and the OSA group. Materials and Methods: We analyzed cardiac MRI data from 4978 UK Biobank participants free from cardiovascular disease. Participants were allocated into three cohorts: with OSA, with self-reported snoring and without OSA or snoring (n = 118, 1886 and 2477). We analyzed cardiac parameters from balanced cine-SSFP sequences and indexed them to body surface area. Results: Patients with OSA were mostly males (47.3% vs. 79.7%; p < 0.001) with higher body mass index (25.7 ± 4.0 vs. 31.3 ± 5.3 kg/m²; p < 0.001) and higher blood pressure (135 ± 18 vs. 140 ± 17 mmHg; p = 0.012) compared to individuals without OSA or snoring. Regression analysis showed a significant effect for OSA in left ventricular end-diastolic index (LVEDVI) (β = −4.9 ± 2.4 mL/m²; p = 0.040) and right ventricular end-diastolic index (RVEDVI) (β = −6.2 ± 2.6 mL/m²; p = 0.016) in females and for right ventricular ejection fraction (RVEF) (β = 1.7 ± 0.8%; p = 0.031) in males. A significant effect was discovered in snoring females for left ventricular mass index (LVMI) (β = 3.5 ± 0.9 g/m²; p < 0.001) and in males for left ventricular ejection fraction (LVEF) (β = 1.0 ± 0.3%; p = 0.001) and RVEF (β = 1.2 ± 0.3%; p < 0.001). Conclusion: Our study suggests that OSA is highly underdiagnosed and that it is an evolving process with gender specific progression. Females with OSA show significantly lower ventricular volumes while males with snoring show increased ejection fractions which may be an early sign of hypertrophy. Separate prospective studies are needed to further explore the direction of causality. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Obstructive Sleep Apnoea)
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11 pages, 883 KiB  
Article
Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness
by Karolina Charčiūnaitė, Rasa Gauronskaitė, Goda Šlekytė, Edvardas Danila and Rolandas Zablockis
Medicina 2021, 57(4), 335; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040335 - 01 Apr 2021
Cited by 2 | Viewed by 2048
Abstract
Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease [...] Read more.
Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Obstructive Sleep Apnoea)
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10 pages, 1738 KiB  
Article
Does the Severity of Obstructive Sleep Apnea Have an Independent Impact on Systemic Inflammation?
by Romana Suša, Vojislav Ćupurdija, Ljiljana Novković, Miloš Ratinac, Slobodan Janković, Danijela Đoković, Jovan Jovanović, Katarina Pantić, Stefan Simović, Danijela Bazić-Sretenović and Ivan Čekerevac
Medicina 2021, 57(3), 292; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030292 - 22 Mar 2021
Cited by 1 | Viewed by 1886
Abstract
Background and Objectives: This paper aims to show whether obstructive sleep apnea (OSA) severity increases the level of systemic inflammation markers regardless of body mass index (BMI) and body composition. Materials and Methods: In total, 128 patients with OSA were included [...] Read more.
Background and Objectives: This paper aims to show whether obstructive sleep apnea (OSA) severity increases the level of systemic inflammation markers regardless of body mass index (BMI) and body composition. Materials and Methods: In total, 128 patients with OSA were included in the study. Examinees were divided into two groups: one with mild OSA (apnea–hypopnea index (AHI) < 15) and one with moderate and severe OSA (AHI ≥ 15). Nutritional status was assessed using body mass index, body composition by dual X-ray absorptiometry. Systemic inflammation was assessed on the basis of plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and serum level of C-reactive protein (CRP). Results: We found elevated mean values of the evaluated systemic inflammation markers (CRP, TNF-α, IL-6) in a group with AHI ≥ 15, although there was no statistical significance. Our research found a significant positive correlation with BMI (r = 0.633, p < 0.001), as well as with body fat percentage (r = 0.450, p = 0.024) and serum CRP values. Significant correlation was found between the plasma IL-6 concentration and body fat percentage (FM%) (r = 0.579, p = 0.003) and lean body mass (r = −0.501, p = 0.013). Multivariate regression analysis did not show any independent predictor (parameters of OSA, nutritional status, body composition) of the systemic inflammation markers. Conclusions: Neither one tested parameter (nutritional status and body composition) of the severity of OSA was identified as an independent prognostic factor for the severity of systemic inflammation in patients with OSA. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Obstructive Sleep Apnoea)
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Review

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11 pages, 299 KiB  
Review
The Assessment of Endothelial Dysfunction among OSA Patients after CPAP Treatment
by Klaudia Brożyna-Tkaczyk, Wojciech Myśliński and Jerzy Mosiewicz
Medicina 2021, 57(4), 310; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040310 - 25 Mar 2021
Cited by 12 | Viewed by 2479
Abstract
Background and Objectives: Microcirculation dysfunction is present in patients with obstructive sleep apnea (OSA). Intermittent hypoxia generates “oxidative stress”, which contributes to chronic inflammation. The secretion of nitric oxide (NO), which is responsible for adequate regulation of the endothelium, is impaired due [...] Read more.
Background and Objectives: Microcirculation dysfunction is present in patients with obstructive sleep apnea (OSA). Intermittent hypoxia generates “oxidative stress”, which contributes to chronic inflammation. The secretion of nitric oxide (NO), which is responsible for adequate regulation of the endothelium, is impaired due to a decrease in endothelial nitric oxide synthetase (eNOS) expression and an increase in endogenous eNOS inhibitors. Furthermore, nocturnal awakenings lead to the dysregulation of cortisol release and increased stimulation of the sympathetic nervous system. The non-invasive method of choice in OSA treatment is continuous positive airway pressure (CPAP). Materials and Methods: PubMed, Scopus, and Google Scholar databases were searched, and only papers published in the last 15 years were subsequently analyzed. For this purpose, we searched for keywords in article titles or contents such as “obstructive sleep apnea”, “microcirculation”, and “CPAP”. In our review, we only studied English articles that reported systemic reviews and meta-analyses, clinical studies, and case reports. Results: Endothelial dysfunction can be assessed by methods based on reactive hyperemia, such as flow-mediated dilation (FMD) measured by ultrasonography, laser-Doppler flowmetry (LDF), or capillaroscopy. In invasive techniques, intravenous administration of vasodilator substances takes place. Some surveys detected impaired microcirculation in OSA patients compared with healthy individuals. The level of dysfunction depended on the severity of OSA. CPAP treatment significantly improved endothelial function and microvascular blood flow and lowered the inflammatory mediator level. Conclusions: The first-choice treatment—CPAP—reduces the number of apneas and hypopneas during the night, induces the reversal of hypopnea and the chronic inflammatory state, and enhances activation of the sympathetic nervous system. Changes are visible as improved blood flow in both macro- and microcirculation, increased arterial elasticity, and decreased stiffness. Thus, early implementation of adequate treatment could be essential to reduce high cardiovascular risk in patients with OSA. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Obstructive Sleep Apnoea)
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