Orthognathic surgery in skeletal Class III patients may alter upper airway morphology, particularly when posterior airway space is limited. This study evaluated changes in pharyngeal airway volume and sleep-related parameters after bimaxillary surgery and assessed postoperative hyoid bone displacement in patients with high-risk airways (posterior airway space ≤ 11 mm). A prospective single-arm, pre–post interventional study was conducted between 2022 and 2024 at a university hospital. Fourteen adults (9 women, 5 men; mean age 25.36 ± 4.73 years) without prior obstructive sleep apnea (OSA) underwent Le Fort I advancement and bilateral sagittal split ramus osteotomy. Cone-beam computed tomography was performed preoperatively (T0), immediately postoperatively (T1), and at 6 months (T2). Pharyngeal airway volume and hyoid position were measured. Sleep parameters included apnea-hypopnea index (AHI), STOP-BANG, and Epworth Sleepiness Scale (ESS). Repeated-measures ANOVA with Bonferroni correction was applied (P < 0.05). Mean maxillary advancement was 2 mm and mandibular setback 7.13 mm. Hypopharyngeal volume decreased significantly from T0 to T1 and T2 (P = 0.046), while nasopharyngeal and oropharyngeal volumes showed no significant change. Hyoid position shifted posteriorly and inferiorly (P < 0.05). Sleep parameters remained within normal ranges with no new OSA cases. In this cohort, bimaxillary surgery with moderate mandibular setback was not associated with the development of OSA in Class III patients with anatomically high-risk airways. Hypopharyngeal volume remained significantly reduced at 6 months, and the hyoid remained posteriorly displaced, without corresponding changes in sleep parameters.
Despite representing a highly prevalent comorbidity, standard screening tools for obstructive sleep apnea (OSA) lack validation in the hypertrophic cardiomyopathy (HCM) population. We sought to prospectively evaluate the diagnostic accuracy of three widely used screening tools against gold-standard polysomnography in an HCM cohort and to explore the potential for a tailored predictive model. In this prospective cohort study, patients with HCM completed the Epworth Sleepiness Scale (ESS), Berlin (BQ) and STOP-Bang questionnaires before undergoing inpatient overnight polysomnography. Of 159 participants (median age 60; 64
Obstructive sleep apnea (OSA) is a common condition, and positive airway pressure (PAP) is the standard therapy; however, its effectiveness depends on adherence. Remote patient monitoring (RPM) may improve PAP adherence, but evidence remains limited. We conducted a prospective, open-label, active-comparator, randomized trial comparing an RPM program with standard of care (SOC) in PAP-naive adults (≥ 18 years) with OSA who owned a smartphone. Participants were randomized 1:1 to SOC (PAP therapy with a standard coaching program) or RPM (PAP therapy monitored through a web-based application with coaching). The primary endpoint was Medicare-defined PAP adherence (> 4 h of use on > 70
Obstructive sleep apnea (OSA) is highly prevalent among geriatric patients and is associated with increased mortality, reduced quality of life, depression, and cognitive decline. Early identification and treatment are particularly important in older psychiatric patients, in whom typical OSA symptoms overlap with psychiatric and aging-related symptoms. Screening questionnaires are used to identify patients at risk for OSA, but their performance in older psychiatric populations is largely unknown. This study compared the diagnostic accuracy of screening questionnaires between younger and older psychiatric inpatients at risk for OSA and assessed the discriminative value of chronological age alone. Observational study of consecutive admissions to a psychiatric ward at University Hospital Erlangen (June 2016–December 2022). 128 screened patients at risk for OSA with valid overnight polygraphy and questionnaire data were analyzed (72 aged 18–64 years; 56 aged ≥ 65 years). Risk scores were calculated for STOP-Bang, STOP-B28, BOAH, GOAL, NoSAS and No-Apnea questionnaires. The reference standard was apnea-hypopnea-index (AHI) measured by polygraphy. Primary outcome measures were the area under the receiver operating characteristic curve (AUC), sensitivity and specificity for any OSA (AHI ≥ 5 events/h). The discriminative value of age and individual questionnaire components was evaluated in the entire cohort. In the screened cohort of psychiatric inpatients, older patients had higher median AHI (7.7 vs. 1.8 events/h; p = 0.007), greater prevalence of any OSA (AHI ≥ 5: 73.2
This narrative review examines whether volume status may act as an underrecognized, state-dependent modifier of obstructive sleep apnea (OSA) severity in chronic kidney disease (CKD) and dialysis-dependent kidney failure. The main question was which links between extracellular volume, rostral fluid shift, and OSA are supported by empirical studies, and which implications for assessment and treatment remain hypothesis-generating. Evidence was synthesized from thematic searches of PubMed/MEDLINE, Embase, Scopus, and Web of Science from inception to May 1, 2026, supplemented by reference-list review. An integrative narrative approach used purposive study selection and qualitative interpretation rather than systematic screening, pooled analysis, or formal risk-of-bias assessment. Sleep apnea is common in CKD and end-stage kidney disease, particularly when objective testing is used. Small physiological and imaging studies, mainly in hemodialysis patients, associate fluid overload and regional fluid measures with sleep apnea severity. Responses to fluid removal are heterogeneous, and some intervention studies include both obstructive and central events. These findings do not establish a reproducible volume-sensitive OSA phenotype. Effects on sleep-study timing, positive airway pressure (PAP) requirements, residual events, drug-induced sleep endoscopy, and upper-airway intervention outcomes remain unestablished. Volume status is a plausible state-dependent modifier of OSA severity in selected patients, supported predominantly by small dialysis studies. Distinguishing systemic from regional fluid and transient measurement states from reproducible patient characteristics provides a framework for testable hypotheses. Current evidence does not justify changes to sleep-study scheduling, PAP management, or upper-airway treatment selection.
