European Respiratory Society statement on advanced telemedicine for obstructive sleep apnoea (e-Sleep).

Telemedicine (TM) as a means of remote patient-physician interaction is gaining popularity in nearly every field, and (respiratory) sleep medicine is no exception. Because obstructive sleep apnoea (OSA) is a chronic condition, and requires a continuous treatment and monitoring of therapy success, telematic communications could be useful to establish diagnostic and therapeutic strategies. This Statement summarises the evidence and efficacy of TM options in OSA.

Implementation of European national driving regulations for obstructive sleep apnoea: challenges and recommendations.

Background: Obstructive sleep apnoea (OSA) carries an increased risk of motor vehicle accidents, which resulted in the European Commission introducing a legal directive (2014/85/EU) restricting driving in patients with moderate/severe OSA and sleepiness, unless effectively treated. We assessed the implementation of the directive in European Union (EU) member and non-member states.

Methods: National sleep societies and/or selected other sleep specialists in EU member states and selected other European countries completed a questionnaire on the local introduction of the EU Directive, or similar, the OSA severity to restrict driving, criteria to resume driving, and the validity period for different driving licences.

Occupational and Driving Challenges Within Sleep Medicine.

Shift work is a necessity for a society that requires 24/7 services. However, working around the clock can cause a misalignment with our sleep-wake cycle, resulting in sleepiness, impaired cognition and poor health. Due to the prevalence of shift work within safety-critical contexts, there is a need to further understand the causes and consequences of non-typical work on sleep, wellbeing, health and safety, as well as ways to effectively reduce this risk.

Management of Adult Obstructive Sleep Apnoea: Many Questions, Not Enough Answers!

Obstructive sleep apnoea (OSA) conveys a substantial global public burden due to its high prevalence and causative relationship with cardiometabolic diseases. The current diagnostic reliance on the apnoea/hypopnoea index (AHI) is insufficient to address the complex, multifaceted condition, and a revision of the standard criteria is urgently needed. Together with a better understanding of the clinical, pathophysiological, and sleep diagnostic phenotypic characteristics, this will pave the way to personalised, holistic treatment approaches.

Search filters for systematic reviews and meta-analyses in sleep medicine.

Systematic reviews and meta-analyses are increasingly common in sleep research, although the methodological quality level has been a matter of concern. Efforts towards methodological standardization are needed to ensure the reliability of sleep-related systematic reviews. The development of search strategies is a critical step in a systematic review, which often lead to methodological biases.

Driving restrictions in patients with obstructive sleep apnoea: who, how and are they effective?

https://bit.ly/3zzQUEN.

Treatment of OSA and its Impact on Cardiovascular Disease, Part 2: JACC State-of-the-Art Review.

Many studies have shown an association of obstructive sleep apnea (OSA) with incident cardiovascular diseases, particularly when comorbid with insomnia, excessive sleepiness, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease. Randomized controlled trials (RCTs) have demonstrated that treatment of OSA with positive airway pressure devices (CPAP) improves systemic hypertension, particularly in those with resistant hypertension who are adherent to CPAP. However, large RCTs have not shown long-term benefits of CPAP on hard cardiovascular outcomes, but post hoc analyses of these RCTs have demonstrated improved hard outcomes in those who use CPAP adequately.

Interactions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1: JACC State-of-the-Art Review.

The American Heart Association considers sleep health an essential component of cardiovascular health, and sleep is generally a time of cardiovascular quiescence, such that any deviation from normal sleep may be associated with adverse cardiovascular consequences. Many studies have shown that both impaired quantity and quality of sleep, particularly with obstructive sleep apnea (OSA) and comorbid sleep disorders, are associated with incident cardiometabolic consequences. OSA is associated with repetitive episodes of altered blood gases, arousals, large negative swings in intrathoracic pressures, and increased sympathetic activity.

Sleep disordered breathing: OSA-COPD overlap.

Introduction: Sleep has important effects on breathing and gas exchange that may have negative consequences in patients with chronic obstructive pulmonary disease (COPD). COPD and obstructive sleep apnea (OSA) are highly prevalent and may coexist, which is referred to as the overlap syndrome.

Areas Covered: The probability of OSA-COPD overlap represents the balance of protective and promoting factors such as hyperinflation and fluid retention; thus, different clinical COPD phenotypes influence the likelihood of comorbid OSA.

Does Obstructive Sleep Apnea Lead to Progression of Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have important bidirectional relationships that influence the pathophysiology of each disorder. The slim hyperinflated "pink puffer" phenotype of COPD protects against OSA, whereas the heavier "blue bloater" phenotype predisposes to OSA by fluid retention. OSA may aggravate COPD by promoting airway inflammation.

Guidelines for the development, performance evaluation and validation of new sleep technologies (DEVSleepTech guidelines) - a protocol for a Delphi consensus study.

New sleep technologies are being developed, refined and delivered at a fast pace. However, there are serious concerns about the validation and accuracy of new sleep-related technologies being made available, as many of them, especially consumer-sleep technologies, have not been tested in comparison with gold-standard methods or have been approved by health regulatory agencies. The importance of proper validation and performance evaluation of new sleep technologies has already been discussed in previous studies and some recommendations have already been published, but most of them do not employ standardized methodology and are not able to cover all aspects of new sleep technologies.

Co-existence of OSA and respiratory diseases and the influence of gender.

Introduction: Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease.

Areas Covered: This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations.

Expert Opinion: Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone.

Review and perspective on sleep-disordered breathing research and translation to clinics.

Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed.

Ambulatory diagnosis of sleep-disordered breathing: Pushing out the boundaries.

Advances in signal technology facilitate the ambulatory diagnosis of obstructive sleep apnea and represent an important development in the management of this highly prevalent disorder. The recent report of Traverso and co-authors describes a novel diagnostic approach by an ingestible vital-monitoring pill that is capable of detecting sleep apnea.

The economic cost of obstructive sleep apnea: A systematic review.

Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA.

Translation of obstructive sleep apnea pathophysiology and phenotypes to personalized treatment: a narrative review.

Obstructive Sleep Apnea (OSA) arises due to periodic blockage of the upper airway (UA) during sleep, as negative pressure generated during inspiration overcomes the force exerted by the UA dilator muscles to maintain patency. This imbalance is primarily seen in individuals with a narrowed UA, attributable to factors such as inherent craniofacial anatomy, neck fat accumulation, and rostral fluid shifts in the supine posture. Sleep-induced attenuation of UA dilating muscle responsiveness, respiratory instability, and high loop gain further exacerbate UA obstruction.

Consumer sleep technology for the screening of obstructive sleep apnea and snoring: current status and a protocol for a systematic review and meta-analysis of diagnostic test accuracy.

There are concerns about the validation and accuracy of currently available consumer sleep technology for sleep-disordered breathing. The present report provides a background review of existing consumer sleep technologies and discloses the methods and procedures for a systematic review and meta-analysis of diagnostic test accuracy of these devices and apps for the detection of obstructive sleep apnea and snoring in comparison with polysomnography. The search will be performed in four databases (PubMed, Scopus, Web of Science, and the Cochrane Library).

Arterial bicarbonate is associated with hypoxic burden and uncontrolled hypertension in obstructive sleep apnea - The ESADA cohort.

Objective: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3]) and nocturnal hypoxia as well as comorbid hypertension in OSA.

Methods: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed.

Sleep medicine in Europe: 50 years of evolution.

https://bit.ly/3AVexV8.

Obstructive Sleep Apnoea: Focus on Pathophysiology.

Obstructive sleep apnoea (OSA) is characterized by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain.