Background Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women. Objective We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry. Methods Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) >= 5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively. Results In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7 %), of whom 70.2 % were male and 29.8 % were female. In the OSA group, women were older (56.7 +/- 11.9 vs. 49.5 +/- 11.3 years; p < 0.001) and more obese (body mass index 34.3 +/- 7.2 vs. 31.4 +/- 5.6 kg/m(2); p < 0.001) and had lower AHI (29.8 +/- 24.1 vs. 36.8 +/- 26.2 events/h; p < 0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p < 0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p < 0.05 for each). Conclusions Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI.

The aim of this study was to evaluate the prevalence and predictors of poor sleep quality in patients undergoing stem cell mobilization and transplantation, and to investigate the relationship between sleep quality and post-transplant engraftment. This prospective, observational study comprised 107 patients with hematopoietic stem cell transplantation. Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale [HADS] and World Health Organization Quality of Life-Brief Version [WHOQOL] questionnaires were administered before and after transplantation. Mann–Whitney and Student's t-tests were used to compare means. Logistic regression was used to analyze predictors of poor sleep quality after transplantation. Of 107 patients [mean age 53.1 ± 13.6 years; 44.9

Obstructive Sleep Apnoea (OSA) is a heterogeneous disorder characterized by recurrent upper airway obstructions during sleep. Positional OSA (POSA) and non-positional OSA are major subgroups that differ in clinical, polysomnographic, and treatment aspects. Furthermore, POSA can be classified into supine-isolated POSA (siPOSA) and supine-predominant POSA (spPOSA), which exhibit distinct characteristics. This study compares POSA and non-POSA patients, as well as siPOSA and spPOSA subgroups, focusing on their clinical, demographic, and polysomnographic differences. This retrospective observational study included patients who underwent polysomnography (PSG) in a tertiary care hospital between 2007 and 2021 due to suspected sleep-breathing disorders. Patients were classified into POSA and non-POSA groups, with POSA further divided into siPOSA and spPOSA subgroups. POSA was defined as an AHI at least twice as high in the supine position compared to other positions. siPOSA included patients with a non-supine AHI < 5 events/h, whereas spPOSA included those with a non-supine AHI > 5 events/h. Demographic, anthropometric, and PSG parameters were compared. Among 2390 OSA patients, 884 were siPOSA, 519 spPOSA, and 987 non-POSA. POSA patients were younger (50.7 vs. 52.9 years, p < 0.001), had lower BMI (30.6 vs. 34.8 kg/m², p < 0.001), and milder OSA severity compared to non-POSA. spPOSA patients showed higher AHI and more severe OSA than siPOSA (p < 0.001). POSA represents a milder subgroup compared to non-POSA, and siPOSA is milder than spPOSA. Identifying these subgroups enables tailored, patient-specific treatment approaches, enhancing therapeutic outcomes. Obstructive sleep apnoea is a common and heterogeneous disorder, with positional sleep apnoea being a distinct subtype. Positional sleep apnoea and its subgroups differ in terms of severity, demographic characteristics, and clinical profiles, yet these differences are not always fully considered in treatment planning. Identifying and classifying these subgroups is crucial for tailoring personalized therapies. This study highlights that patients with positional sleep apnoea generally have milder disease compared to those with non-positional sleep apnoea. Among the subgroups, individuals with supine-isolated positional sleep apnoea show the mildest clinical and polysomnographic profiles, while those with supine-predominant positional sleep apnoea have more severe disease and require more intensive treatment strategies. Recognizing these distinct subgroups allows for the development of personalized, patient-specific treatment approaches, improving clinical outcomes and offering a more precise way to manage obstructive sleep apnoea.

PURPOSE:Evaluation of scleral thickness with anterior segment optical coherence tomography (AS-OCT) in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN:Cross-sectional study. METHODS:A total of 30 severe (Group 1), 30 moderate (Group 2) and 30 mild (Group 3) OSAS patients and 22 healthy volunteers (Group 4) were included in the study. Scleral thickness measurements were taken with AS-OCT, 6 mm, 4 mm and 2 mm posterior to the scleral spur, in four gaze positions. Data and findings were examined comparatively. RESULTS:At 6 mm posterior to the scleral spur, the mean thickness was found to be significantly higher in all quadrants in Group 1 (p<0.05 for all). Superior thickness was higher in Group 2 compared to Group 4 (p=0.034). At 4 mm posterior to the scleral spur; in Group 1, the mean thickness was found higher than Group 2 and 3 only in the inferior (p=0.01, p=0.021, respectively) and was found higher than Group 4 in the nasal and inferior (p<0.001, p=0.006, respectively). At 2 mm posterior to the scleral spur; significant difference was observed between Groups 1 and 2 only in the inferior (p=0.002), between Groups 1 and 3 in the nasal and inferior (p=0.029, p=0.002), and between Groups 1 and 4 the in nasal and inferior (p=0.002, p<0.001). CONCLUSION:The scleral thickness measured from 6 mm posterior to the scleral spur was higher in all quadrants in patients with severe OSAS. It is possible that the increase in scleral thickness, especially in severe OSAS, is due to extracellular matrix accumulation in the scleral tissue.

Evaluation of the retinal vascular structure with optic coherence tomography angiography (OCT-A) in patients with obstructive sleep apnea (OSA). A total of 47 severe (Group 1), 30 moderate (Group 2), and 25 mild (Group 3) OSA patients and 51 healthy volunteers (Group 4) were included. Total, parafoveal, perifoveal superficial (SCP), and deep capillary plexus (DCP) vascular densities, foveal avascular zone (FAZ) and blood flow of choriocapillaris and outer retina were evaluated. Results were examined comparatively, and their correlation with hypoxia parameters (minSpO2, meanSpO2, T90

Objective: The aim of this study was to evaluate sleep quality in nurses and to investigate the relationship between poor sleep quality and occupational accidents. Materials and Methods: This cross-sectional study was conducted with nurses (n=164) who had been working in different clinics of a university hospital for at least one year and who had not previously been diagnosed with sleep disorders and who agreed to participate in the research. In the data collection form, sociodemographic characteristics, medical history, information about sleep and working conditions, and hospital employee health and safety unit records were questioned. Pittsburgh Sleep Quality Index was used to evaluate sleep quality. Results: It was found that 77.4% of nurses had poor sleep quality. It was determined that 66.9% of nurses with poor sleep quality and 45.9% of nurses with good sleep quality worked day and night in shifts. It was observed that 38% of the nurses who participated in the study had an occupational accident in the last year, and it was found that all occupational accidents occurred in the group with impaired sleep quality and a significant difference was found between the two groups in terms of the frequency of occupational accidents. Conclusion: It was found that nurses had poor sleep quality. Individuals with impaired sleep quality have a high frequency of working alternating day and night shifts and continuous night shifts.

Introduction:In mild to moderate obstructive sleep apnoea (OSA), positive airway pressure (PAP) and mandibular advancement devices (MADs) are recommended treatments according to guidelines. This cross-sectional study aimed to determine the clinical and organisational predictors for treatment recommendations in mild to moderate OSA. Methods:In the European Sleep Apnea Database, factors predicting the choice of MAD or PAP treatment were determined in patients with newly diagnosed mild to moderate OSA. Accessibility and reimbursement of MADs study sites was obtained via questionnaire. The regression model included anthropometrics, Epworth Sleepiness Scale score, OSA severity, MAD accessibility and reimbursement, and a comorbidity index variable. Results:6618 (65.5%) patients received PAP and 3491 (34.5%) were recommended MADs. MAD recommendations varied between centres (0% to 76%). Significant factors favouring MADs include mild versus moderate OSA (odds ratio 6.0, 95% CI 5.3-6.8), negligible versus moderate intermittent hypoxia (OR 2.0, 95% CI 1.7-2.4), no versus excess daytime sleepiness (OR 2.6, 95% CI 2.1-3.1), a comorbidity index score of 0 compared to 3 or more (OR 3.8, 95% CI 3.1-4.6) and no insomnia diagnosis versus diagnosed insomnia (OR 2.0, 95% CI 1.7-2.4). MAD accessibility and reimbursement predicted MAD treatment recommendations (OR 2.3, 95% CI 1.8-2.9 and OR 1.5, 95% CI 1.4-1.7, respectively). Conclusion:In mild to moderate OSA, MADs are less frequently recommended than PAP, particularly amongst patients with a higher disease burden. MADs were more frequently used when they were more accessible and reimbursed. Thus, MADs are likely an underused treatment in mild to moderate OSA.

Objective: Immunocompromised hosts (ICH) are at a higher risk of severe infections and mortality. This study aimed to examine the clinical manifestations and outcomes of ICH who were admitted to the hospital for COVID-19. Method: A total of 384 patients (mean age 61.515.9 y, 168 female) who were hospitalized between March 2020 and December 2020 were included in the study. These patients were examined in three groups: the ICH (n=40), comorbid patients (n=101), and the control group comprising immunocompetent patients without any comorbidities (n=243). All clinical and laboratory data were retrieved from the electronic hospital records and compared between the three groups retrospectively. Results: The mean age was 61.215.0 for ICH, 66.112.3 for comorbid, and 59.617.0 for control groups (p=0.003). We found that the mean leukocyte and neutrophil counts, C-reactive protein (CRP), ferritin, and D-Dimer levels were significantly higher and the albumin level was lower in ICH compared to the other two groups (p

Background: Determining the self-efficacy perceptions of obstructive sleep apnea (OSA) patients has a key role in health care practices. With further evaluation, the Self-Efficacy Measure for Sleep Apnea (SEMSA) could serve as a useful scale to develop specific interventions to increase self-efficacy in patients with OSA during the acceptance and maintenance of continuous positive airway pressure (CPAP) therapy. Objective: The aim of this study is to translate the SEMSA into Turkish and to evaluate the psychometric properties of the translation. Methods: This cross-sectional study was carried out with a sample of patients recently diagnosed with CPAP-na & iuml;ve OSA. Linguistic and content validity of the scale were evaluated, while exploratory factor analysis and 2-level confirmatory factor analysis were used for validity. Internal consistency and test-retest methods were used in reliability analyses. Results: The mean (SD) age of the patients with OSA was 51.36 (11.29), and 68% were male. The item factor loads obtained as a result of the confirmatory factor analysis ranged from 0.44 to 0.94, confirming the three-factor structure of the instrument. The Cronbach's alpha coefficient of the scale was found to be 0.90. Measurements made within the scope of test-retest analysis were found to be related and consistent results were obtained in the intervening time (P < .01). Conclusions: In this study, the Turkish version of SEMSA was found to be a valid and reliable tool and it could be used to evaluate the adherence-related cognition in Turkish patients with OSA on CPAP therapy.

Background: The prognostic nutritional index (PNI) and the systemic immune inflammation index (SII) have been used as simple risk-stratification predictors for COVID-19 severity and mortality in the general population. However, the associations between these indices and mortality might differ due to age-related changes such as inflammaging and several comorbid conditions in older patients. Therefore, we aimed to compare the predictivity of the PNI and SII for mortality among hospitalized older patients and patients under 65 years old. Methods: Patients hospitalized with COVID-19 from March 2020 to December 2020 were retrospectively included. The PNI and SII were calculated from hospital records within the first 48 h after admission. Data were evaluated in the whole group and according to age groups (≥65 < years). Receiver operating characteristic curves were drawn to evaluate the predictivity of the PNI and SII. Results: Out of 407 patients included in this study, 48.4% (n = 197) were older patients, and 51.6% (n = 210) were under 65 years old. For mortality, the area under the curve (AUC) of the PNI and SII in the adult group (<65 years) was 0.706 (95% CI 0.583–0.828) (p = 0.003) and 0.697 (95% CI 0.567–0.827) (p < 0.005), respectively. The AUC of the PNI and SII in the older group was 0.515 (95% CI 0.427–0.604) (p = 0.739) and 0.500 (95% CI 0.411–0.590) (p = 0.993). Conclusions: The accuracy of the PNI and SII in predicting mortality in adult COVID-19 patients seemed to be fair, but no association was found in geriatric patients in this study. The predictivity of the PNI and SII for mortality varies according to age groups.

Introduction: and Objectives: The clinical presentation of Obstructive Sleep Apnoea (OSA) differs between genders. This study aimed to identify the specific OSA phenotypes of women in the European Sleep Apnoea Database (ESADA) cohort. Materials and methods: Latent class cluster analysis was applied to data from 9710 female OSA patients. Variables used included age, Body Mass Index (BMI), Epworth Sleepiness Scale (ESS), comorbidities (cardiovascular, pulmonary, psychiatric, metabolic, other) and the Apnoea Hypopnea Index (AHI). Results: Four different clusters were found: Cluster 1"Women with ischemic heart disease" (38.3 %):middle aged (59 years [53-65]),overweight to obese (BMI 30.1 kg/m2 [26.9-33.5]), AHI 22.9 events/h[17.4-30], ESS 9 [5,12] with the highest prevalence of ischemic heart disease (56 %). Cluster 2"Elderly women with comorbidities" (23 %): oldest (66 years[60-71]), obese (BMI 36 kg/m2 [31.6-40.4]),AHI 46 events/h [30-60.1]),ESS 9 [613] with the highest prevalence of comorbidities. Cluster 3"Sleepy obese women" (16.2 %): the youngest (49 years [42-55]), sleepiest (ESS 12 [8-16]), most obese(BMI 43 kg/m2[37.6-48.9]) females with severe OSA (AHI 53.3 events/h [32-80.5]). Cluster 4 "Women with mild OSA and low comorbidities" (22.5 %): middle aged (53.5 years [46-60]) with BMI 29 kg/m2[25-34.1],ESS9 [5,13]),AHI 8.6events/h[6.9-10.4])and low prevalence of comorbidities. The distribution of the clusters differed across Europe. PAP administration was higher in Clusters 2 and 3 but low in Cluster 4. Conclusion: Four distinct female phenotypes were identified with different clinical presentation and comorbidities. Sex-based phenotyping may provide improved risk stratification and personalized treatment.

Hintergrund Der Apnoe-Hypopnoe-Index (AHI) allein ist für die Festlegung der Behandlungsindikation bei obstruktiver Schlafapnoe (OSA) nicht ausreichend. Die OSA-Klassifikation von Baveno (2021) basiert stattdessen auf schlafbezogenen Symptomen und Endorganschäden. Die hier betrachtete Neudefinition dieser Klassifikation berücksichtigt zusätzlich den AHI und bewertet das Risiko kardiovaskulärer Erkrankungen (CVD) in Anlehnung an etablierte Leitlinien.

BACKGROUND:The "Baveno classification" replaced the apnoea-hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances. METHOD:OSA patients from the European Sleep Apnoea Database (ESADA) were retrospectively allocated into CVD risk groups 1-3 based on the SCORE2 risk prediction model and European Society of Cardiology guidelines. AHI ≥30 events·h-1 conferred strong treatment indication. When AHI was <30 events·h-1, symptoms and CVD risk dictated allocation to the weak, intermediate or strong treatment indication group. Changes in Epworth Sleepiness Scale (ESS) score and office systolic blood pressure (SBP) at follow-up (12-24 months) under positive airway pressure (PAP) were assessed. RESULTS:8625 patients were analysed (29% female; median (interquartile range) age 56 (49-64) years and body mass index 31.9 (28.4-36.3) kg·m-2). Treatment indication was weak in 501 (6%), intermediate in 2085 (24%) and strong in 6039 (70%). There was a continuous increase in age, SBP, C-reactive protein and glycosylated haemoglobin from weak to strong (p<0.001). PAP prescription increased from 52% to 64% to 93% (weak to strong; p<0.001). The change in ESS score was -2, -4 and -5, respectively (p<0.001). Reductions of ≥3 mmHg median SBP occurred when AHI was ≥30 events·h-1 and in symptomatic patients with CVD risk levels >1 when AHI was <30 events·h-1. CONCLUSION:This analysis provides supporting evidence for the key role of CVD risk assessment and severe breathing disturbances in the identification of OSA patients most likely to benefit from treatment.

OBJECTIVE: The optimal anticoagulant treatment regimen in hospitalized coronavirus disease 2019 (COVID-19) patients is uncertain. This study aimed to compare the rates of disease progression and mortality in patients treated with low-molecular-weight heparin (LMWH) according to baseline d-dimer levels and in those who received a fixed-dose regimen irrespective of the d-dimer level. MATERIAL AND METHODS: This was a retrospective analysis of all patients admitted to a university hospital for COVID-19 pneumonia during a 1-year period. The protocol for d-dimer-driven therapy (on-protocol) was as follows: prophylactic dose when the baseline level is <1000 ng/mL, intermediate dose when the level is between 1000 and 3000 ng/mL, and therapeutic dose when the level is >3000 ng/mL. We compared the progression and mortality rates between the on-protocol and off-protocol treatment groups. The offprotocol group consisted of patients that received a fixed-dose LMWH regimen, which was not in accordance with the defined protocol. RESULTS: Of 384 patients (mean age 61.5 ± 15.9 years, 216 male), 294 patients with complete data composed the study group, and 174 patients were treated on-protocol and 120 patients were treated off-protocol. The on-protocol group had lower C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and d-dimer levels and higher SpO2/FiO2 levels at admission. Disease progression developed in 45/174 on-protocol patients (25.9%) vs. 53/120 off-protocol patients (44.2%) during the follow-up (P = .001), and mortality was 29 (16.7%) vs. 32 (26.7%), respectively (P = .041). Logistic regression analysis was performed and included age, presence of comorbidities, LMWH regimen, baseline SpO2/FiO2, CRP, and LDH levels as independent variables. The presence of cardiac comorbidity, age, CRP, and LDH levels, but not the LMWH treatment regimen, were associated with both disease progression and mortality. CONCLUSION: A d-dimer-driven LMWH treatment protocol is not associated with better clinical outcomes in hospitalized COVID-19 patients.

Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.