Elvia Battaglia

This study aimed to explore the lived experiences of patients with Obstructive Sleep Apnea (OSA) and their bed partners as they adapted to Continuous Positive Airway Pressure (CPAP), focusing on the psychological, relational, and experiential processes influencing adherence over time. Semi-structured interviews were conducted with 12 OSA patients and their bed partners, purposefully sampled across three adaptation phases: before starting CPAP, within the first year of use, and after more than one year. Patients also completed the Epworth Sleepiness Scale(ESS) to provide a standardized measure of daytime sleepiness, complementing the qualitative findings. Semi-structured interviews were analyzed according to a Multi-Perspective Interpretative Phenomenological Analysis (MP-IPA) approach, which allowed for the identification of both individual and dyadic meaning-making processes. Three superordinate themes emerged: Making Sense of the Illness, Living the Illness Together, and From CPAP Resistance to Acceptance. Findings illustrate the evolving nature of illness representations, the central but ambivalent role of the partner in facilitating care, and the relational dynamics shaping CPAP engagement. While patients gradually integrated CPAP into their self-management, partners transitioned from active promoters to quieter sources of emotional and practical support. Dyadic tensions, divergent illness perceptions, and shifting motivations influenced the trajectory of adaptation. Results from the ESS indicated that patients with long-term CPAP use reported normalized sleepiness, whereas those in earlier stages experienced clinically significant daytime drowsiness. CPAP adaptation is thus a dynamic, relational process influenced by how both patients and partners conceptualize the illness and navigate the challenges of therapy. Partner involvement plays a key role but must balance support with respect for patient autonomy. Interventions aimed at enhancing adherence should consider the couple as a unit, integrating psychoeducational and relational components. Future research should expand on these findings using larger, more diverse samples and evaluate the impact of tailored interventions and telemedicine in long-term CPAP management.

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder in middle-aged and elderly populations, marked by breathing interruptions during sleep. Diagnosis faces challenges due to the absence of specific biomarkers and increasing screening demands. This study aims to identify salivary biomarkers for the diagnosis and monitoring of OSAS using a simplified, rapid, and non-invasive method. Saliva from 51 OSAS patients and 34 healthy controls (CTR) was analyzed using Raman spectroscopy, which identified disease-specific biochemical fingerprints. Raman analysis revealed differences between the OSAS and CTR groups. The area under the curve of the lactic acid peak (920 cm⁻¹) appeared higher in the OSAS group compared to the CTR group, suggesting potential diagnostic relevance. Significant correlations were found between biomolecular and clinical data, and a final linear model indicated that the lactate concentration significantly influenced the canonical variable. The Raman-based approach and the lactic acid peak represent a promising tool for OSAS diagnosis, monitoring, and supporting decisions in pulmonary rehabilitation. However, further investigation with a larger cohort is needed to clarify the observed discrepancies.

Obstructive sleep apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with significant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alternative therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review synthesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods such as the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it performs favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies.

Obstructive Sleep Apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with sig-nificant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alterna-tive therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review syn-thesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods like the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it per-forms favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies.

Obesity hypoventilation syndrome (OHS) is a multifaceted condition characterized by significant respiratory, cardiovascular, and psychological consequences. Positive airway pressure (PAP) therapy remains the cornerstone treatment, improving respiratory function, neurocognition, and mental health disorders such as depression and anxiety. However, its long-term impact on quality of life, physical activity, and broader health outcomes is not fully understood. Challenges such as residual apnoea/hypopnea index, reduced physical activity, and impaired quality of life persist despite high adherence rates. Factors like hypercapnia and daytime respiratory symptoms play a pivotal role in patient outcomes, underscoring the need for strategies beyond adherence alone. This review explores the interplay between OHS, heart failure, and sleep dysfunction, advocating for personalized PAP settings, targeted management of residual respiratory events, and enhanced patient education. Digital health technologies, including remote monitoring and feedback systems, present promising tools to optimize care delivery and foster holistic management. By integrating physiological, psychological, and digital health perspectives, this narrative review aims to advance understanding and improve outcomes for patients with OHS and other complex sleep-disordered breathing conditions.

Article: Pulmonary hypertension in patients affected by sleep-related breathing disorders: up to date from the literature - Minerva Medica 2024 Jul 17 - Minerva Medica - Journals

Aim of our study is to validate a new biophotonic-based method to identify biomolecular markers present within saliva, that can be a decision support tool to clinically phenotypize patients. The study takes avantage of Raman spectroscopy (RS), a vibrational spectroscopy technique that provides a spectrum, which represents a biochemical fingerprint of the sample and can be used to discriminate OSA from control subjects (CTR). OSA patients (n=63) and heallthy NOT-OSA subjects (CTR, n=50) were recruited. Saliva was collected through a swab-Salivette® (SARSTEDT) and then it was centrifuged. The biofluid was analyzed with a Raman microspectroscope. Colorimetric and immunobased assays were also performed to quantify some of the molecules supposed to influence salivary signature after Raman data interpretation. The average Raman fingerprint obtained for the two groups, showed different peaks, that highlight significant differences in the molecular composition of saliva in OSA, compared to CTR. The interpretation of the spectrum and its comparison with reported databases, suggest that lactic acid can play a central role in the discrimination between OSA and CTR saliva, being prevalent in the spectrum of OSA patients. This observation was confirmed by the calculation of the spectral Area Under the Curve (AUC) and by colorimetric Lactate Assay. Our data demonstrate that saliva is an informative and easily access biofluid for OSA patients monitoring. Besides, the Raman Spectroscopy approach allowed us to make a step forward in the identification of a potential biomaker (the Raman spectrum), that could be used to monitor OSA patients and test therapy efficacy.