Sleep medicine最新文献

{"title":"Association between left ventricular end-diastolic volume and cardiovascular disease in systemic hypertensive patients with obstructive sleep apnea","authors":"Sharezhati Yishajiang ,&nbsp;Qing Zhu ,&nbsp;Delian Zhang ,&nbsp;Shasha Liu ,&nbsp;Mengru Wang ,&nbsp;Ting Wu ,&nbsp;Jing Hong ,&nbsp;Nanfang Li","doi":"10.1016/j.sleep.2026.108832","DOIUrl":"10.1016/j.sleep.2026.108832","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Systemic hypertension and obstructive sleep apnea (OSA) are closely linked conditions that substantially increase the risk of cardiovascular disease (CVD). Left ventricular end-diastolic volume (LVEDV) is a crucial echocardiographic marker of cardiac remodeling; however, its prognostic value in patients with concomitant systemic hypertension and OSA remains poorly defined. This study aimed to examine the association between LVEDV and the incidence of CVD in this high-risk population.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with confirmed systemic hypertension and OSA, who were stratified into tertiles based on baseline LVEDV. Multivariable Cox proportional hazards models, adjusted for demographic factors, comorbid conditions, and OSA severity, were used to evaluate CVD risk. Sensitivity and stratified analyses were conducted to assess the robustness of the findings.</div></div><div><h3>Results</h3><div>A total of 1914 patients (mean age 48.7 ± 10.2 years) were followed for a median of 83 months, during which 186 incident CVD events were documented. The incidence of CVD increased progressively across LVEDV tertiles. In fully adjusted analyses, patients in the highest tertile (T3: &gt;81 mL) showed a significantly higher risk of CVD compared with those in the lowest tertile (T1: &lt;70 mL) (hazard ratio [HR] = 1.86; 95% confidence interval [CI]: 1.30–2.67; <em>P</em> = 0.001). Although a higher risk was observed for the intermediate tertile (T2: 70–81 mL), this association did not reach statistical significance (HR = 1.29; 95% CI: 0.88–1.88; <em>P</em> = 0.19). These associations remained stable across sensitivity and stratified analyses.</div></div><div><h3>Conclusion</h3><div>Elevated LVEDV is independently associated with an increased risk of CVD in patients with coexisting systemic hypertension and OSA. These findings support LVEDV as a novel and readily obtainable echocardiographic biomarker for cardiovascular risk stratification in this population. Routine assessment of LVEDV may enable earlier identification of individuals at heightened risk and inform timely preventive strategies in patients with OSA-related systemic hypertension.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108832"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-level surgery for obstructive sleep apnoea in syndromic and non-syndromic paediatric patients – A systematic review and meta-analysis","authors":"Ryan Seng Hong Wong ,&nbsp;Tanya Xin Yu Tan ,&nbsp;Omkar Mahadevan ,&nbsp;Brian Sheng Yep Yeo ,&nbsp;Celeste Ann Chua ,&nbsp;Lynn Huiting Koh ,&nbsp;Henry Kun Kiaang Tan ,&nbsp;Chu Qin Phua","doi":"10.1016/j.sleep.2026.108826","DOIUrl":"10.1016/j.sleep.2026.108826","url":null,"abstract":"<div><h3>Study objectives</h3><div>Multilevel surgery for obstructive sleep apnoea treatment is a well-accepted option for adult patients. However, in paediatric populations, it is less established. This study evaluates the efficacy of multi-level airway surgery in treating both non-syndromic and syndromic paediatric obstructive sleep apnoea.</div></div><div><h3>Methods</h3><div>PubMed, Embase and The Cochrane Library databases were searched from inception to November 30, 2025. Two independent authors performed screening and extraction of studies according to PRISMA guidelines. Observational and randomised studies pertaining to sleep outcomes of various multi-level sleep surgeries in syndromic and non-syndromic children were selected. Pooled analyses were performed for post-operative improvements in Apnoea-Hypopnea Index (AHI) and SpO₂ Sleep Nadir. Quality of evidence assessment was assessed with respective risk of bias appraisal tools.</div></div><div><h3>Results</h3><div>From 2925 initial non-duplicate studies, 17 studies were included for analysis, comprising 338 children (228 non-syndromic children, 80 children with Down Syndrome and 30 children with other syndromes). In non-syndromic children, AHI improved by −10.13 (95%CI -13.30 to −6.97; I² = 71.7%) and SpO₂ sleep nadir by 4.39 (95%CI 1.68–7.11; I² = 79.5%), with AHI normalisation rate at 66.4%. In children with Down syndrome, AHI improved by −14.58 (95%CI [-16.23, −12.93], I² = 0%) and SpO₂ nadir by +3.75 (95%CI [1.72, 5.78], I² = 0%).</div></div><div><h3>Conclusion</h3><div>Multi-level airway surgery presents a valuable adjunct to adenotonsillectomy in addressing paediatric OSA, particularly for selected syndromic and refractory cases. Future research should identify specific syndromic subgroups that would benefit most from multi-level surgery, to better inform individualised treatment strategies.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108826"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Association between high loop gain sleep apnea detected by respiratory self-similarity and left ventricular remodeling” [Sleep Med 140 (2026) 108796]","authors":"Wentao Wu ,&nbsp;Shanlin Zhong ,&nbsp;Eline Oppersma ,&nbsp;Wolfgang Ganglberger ,&nbsp;Fengming Luo ,&nbsp;Yuenan Ni ,&nbsp;Robert Joseph Thomas","doi":"10.1016/j.sleep.2026.108821","DOIUrl":"10.1016/j.sleep.2026.108821","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108821"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circadian rhythms in ischemic stroke: From pathogenesis to chronotherapy","authors":"Hongli Fan ,&nbsp;Zhuorao Wu ,&nbsp;Jianqiao Zhao ,&nbsp;Jingjing Kou ,&nbsp;Qiang Xu","doi":"10.1016/j.sleep.2026.108825","DOIUrl":"10.1016/j.sleep.2026.108825","url":null,"abstract":"<div><div>Circadian rhythms significantly influence the onset, development, and outcome of ischemic stroke, with the biological clock likely playing a key role in its pathophysiology. In this review, we provide a systematic summary of the influence of circadian rhythms on stroke risk factors, including blood pressure, glucose metabolism, lipid homeostasis, and atrial fibrillation, and further explore their impact across different stages of recovery post-stroke. These encompass metabolic alterations in the ischemic penumbra during the hyperacute phase, excitotoxicity, oxidative stress, and neuroinflammation in the acute phase, as well as glial scar formation and neural remodeling during the subacute and chronic recovery phases. Building on this mechanistic foundation, we assess the role of chronobiology in stroke interventions, including thrombolysis, thrombectomy, neuroprotective strategies, and rehabilitation training. We also discuss key challenges in the field, such as barriers to translating preclinical findings to clinical applications, limitations in circadian rhythm assessment, and practical challenges in implementing circadian-based interventions. Ultimately, this review aims to evaluate the potential of chronotherapy in ischemic stroke and to advance the development of personalized, precision medicine approaches.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108825"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in quality of life in patients with atrial fibrillation and central sleep apnea treated with transvenous phrenic nerve stimulation","authors":"Shahrokh Javaheri ,&nbsp;Scott W. McKane ,&nbsp;Robin E. Germany","doi":"10.1016/j.sleep.2026.108824","DOIUrl":"10.1016/j.sleep.2026.108824","url":null,"abstract":"<div><h3>Background</h3><div>It is well-known patients with atrial fibrillation (AF) have significant fatigue and impaired quality of life (QoL). Because central sleep apnea (CSA) could be associated with AF, CSA could be a contributory but treatable comorbidity.</div></div><div><h3>Objectives</h3><div>Retrospective assessment of the impact of CSA treatment with transvenous phrenic nerve stimulation (TPNS) on sleep and QoL in a subgroup of patients with CSA and AF from the <strong>rem</strong>edē® System pivotal trial.</div></div><div><h3>Methods</h3><div>Patients were implanted with a TPNS device and randomized to treatment or control. Therapy was activated in the treatment arm and remained off in control for 6 months, when TPNS was also activated. Patients were followed through 12 months.</div></div><div><h3>Results</h3><div>Sixty-four of 151 implanted participants had AF, including 32 per arm. The apnea hypopnea index and central apnea index decreased significantly from medians of 49 and 20 events/hour of sleep at baseline to 21 and 1/hour after 6 months of TPNS therapy (p &lt; 0.001 for each), respectively. In parallel, changes in arousal index (48 at baseline vs. 25/hour of sleep at 6 months, p &lt; 0.001) and percent of sleep time with oxygen saturation less than 90% (8% vs. 4%, p = 0.071) improved. Compared to the control group, Patient Global Assessment and Epworth Sleepiness Scale improved significantly with treatment. Improvements were sustained for 12 months and results were similar in the control group after therapy activation.</div></div><div><h3>Conclusions</h3><div>AF was highly prevalent in patients with CSA. TPNS therapy may significantly improve sleep metrics, QoL, and daytime sleepiness in patients with CSA and AF.</div></div><div><h3>Registration</h3><div>ClinicalTrials.gov identifier NCT01816776.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108824"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swipe for sleep - a standardized evaluation of mobile health apps for insomnia in children and adolescents","authors":"Laura Simon ,&nbsp;Lena Sophia Steubl ,&nbsp;Merritt Gossmann ,&nbsp;Michael Stach ,&nbsp;Yannik Terhorst ,&nbsp;Julia Witte ,&nbsp;Olaf Reis ,&nbsp;Michael Kölch ,&nbsp;Christoph Berger ,&nbsp;Rüdiger Pryss ,&nbsp;Harald Baumeister ,&nbsp;Alexander Dück","doi":"10.1016/j.sleep.2026.108814","DOIUrl":"10.1016/j.sleep.2026.108814","url":null,"abstract":"<div><h3>Introduction</h3><div>Access to cognitive behavioral therapy for insomnia (CBT-I) in children and adolescents is limited. Mobile health applications (MHAs) available in app stores may provide an accessible and scalable option for delivering CBT-I. This study systematically evaluated the quality of MHAs targeting insomnia in children and adolescents and examined their evidence base and treatment components.</div></div><div><h3>Methods</h3><div>In November 2024, a systematic search of the Google Play and Apple App Stores was conducted to identify MHAs targeting insomnia in children and adolescents. MHAs were screened for eligibility in a two-level process: first based on app store descriptions, then after downloading the MHA. Eligible MHAs were independently evaluated using the German Mobile Application Rating Scale (MARS-G), which rates MHAs from 1 (inadequate) to 5 (excellent) across the subscales engagement, functionality, aesthetics, and information. Additionally, the featured treatment components and supporting scientific evidence were assessed.</div></div><div><h3>Results</h3><div>Of 2341 MHAs initially identified, eight MHA products met the inclusion criteria. The overall quality was moderate (mean = 3.5, SD = 0.4). Among the subscales, functionality was rated highest (mean = 3.8, SD = 0.6), followed by aesthetics (mean = 3.6, SD = 0.6), engagement (mean = 3.3, SD = 0.4), and information (mean = 3.1, SD = 0.8). Sleep hygiene was the most commonly featured treatment component (seven MHA products). While scientific evidence was identified for five MHA products, none specifically evaluated insomnia in the target population.</div></div><div><h3>Conclusion</h3><div>Although many MHAs claim to target sleep in children and adolescents, few incorporate CBT-I components beyond sleep hygiene. The moderate quality and limited evidence base underscore the need for theory-driven, rigorously evaluated MHAs tailored to this age group.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108814"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOMAS – an open-source software for the analysis of muscle activity during sleep","authors":"Matteo Cesari ,&nbsp;Raffaele Ferri ,&nbsp;Birgit Högl ,&nbsp;Ambra Stefani ,&nbsp;Alessandro Silvani","doi":"10.1016/j.sleep.2026.108791","DOIUrl":"10.1016/j.sleep.2026.108791","url":null,"abstract":"<div><h3>Study objectives</h3><div>While several algorithms exist for analyzing muscle activity during sleep, none provides information on both muscle tone and movements as open-source software. We aimed to overcome this limitation by developing SOMAS (Sleep Open-source Muscle activity Analysis System).</div></div><div><h3>Methods</h3><div>SOMAS processes European Data Format+ (EDF+) files with wake-sleep state and candidate leg movement annotations without online data sharing, quantifies muscle tone using the atonia index and the distribution of normalized electromyography values (DNE), and calculates leg movement indices based on the 2016 World Association of Sleep Medicine criteria. To demonstrate that SOMAS achieves its intended purpose, we analyzed recordings from eight patients with isolated REM sleep behavior disorder (iRBD), five with restless legs syndrome (RLS), seven with sleep breathing disorders, and five controls. SOMAS-derived atonia index and leg movement indices were compared with those from Hypnolab, a non-open access software. Additionally, SOMAS-derived indices were used to differentiate patients with iRBD or with RLS from other patients and/or controls.</div></div><div><h3>Results</h3><div>SOMAS-derived atonia index and leg movement indices strongly correlated with Hypnolab results (Spearman coefficients &gt;0.97) with minimal bias. The DNE and atonia index in REM sleep effectively differentiated patients with iRBD from other patients and controls (AUC 0.89–1.00). The periodic leg movement and periodicity indices differentiated patients with RLS from controls (AUC 0.71–0.75).</div></div><div><h3>Conclusions</h3><div>SOMAS reliably quantifies muscle tone and movements during sleep from EDF+ files using open-source algorithms, with the potential of enhancing reproducibility and collaboration in research on sleep-related movement disorders.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108791"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insomnia-LCA classifier: an open web application for insomnia subtype classification using latent class analysis","authors":"Matteo Carpi ,&nbsp;Daniel Ruivo Marques","doi":"10.1016/j.sleep.2026.108813","DOIUrl":"10.1016/j.sleep.2026.108813","url":null,"abstract":"<div><div>The heterogeneity of insomnia presentations has long challenged research and clinical practice, motivating efforts to identify reliable disorder phenotypes. Person-centered, data-driven approaches such as latent class analysis (LCA) have provided new insights, suggesting that insomnia subtypes may differ not only in nocturnal symptoms but also in perceived impact and daytime distress. Despite this progress, LCA solutions often remain confined to the original datasets, limiting replication and applied use.</div><div>To address this gap, we developed the <em>insomnia-LCA classifier</em>, an open-source web application that assigns new Insomnia Severity Index (ISI) response profiles to one of four subtypes identified in a previously published LCA of Italian university students: no insomnia (NI), subthreshold insomnia (SI), high insomnia risk (HI), and predominant daytime symptoms (DS). Using the original model's class priors and item-level conditional response probabilities, the app computes posterior class probabilities from user-entered ISI responses, individually or in batch mode. Outputs include class probabilities and modal assignment, ISI total and subscale scores, and a visual comparison between the individual profile and subtype mean patterns.</div><div>Reclassification of the original dataset showed near-perfect agreement with the latent class model (accuracy = 0.999; Cohen's kappa = 0.999), and synthetic profiles behaved as expected. The <em>insomnia-LCA classifier</em> provides a practical, reproducible tool for deploying and testing LCA-derived phenotypes in clinical research.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108813"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive sleep apnea as a potential mechanistic link between second-generation antipsychotics and metabolic syndrome: a narrative review","authors":"Folkert H. van Bruggen ,&nbsp;Roger S. McIntyre","doi":"10.1016/j.sleep.2026.108831","DOIUrl":"10.1016/j.sleep.2026.108831","url":null,"abstract":"<div><div>This narrative review examines why metabolic syndrome is highly prevalent among individuals treated with second-generation antipsychotics (SGAs), yet weight gain alone does not fully explain this elevated risk. Metabolic disturbances frequently emerge soon after antipsychotic initiation, even without clinically significant changes in body mass, suggesting weight-independent mechanisms. Emerging evidence indicates that SGAs may influence respiratory regulation and increase vulnerability to obstructive sleep apnea (OSA), a common but underrecognized comorbidity in psychiatric populations. OSA contributes to metabolic dysfunction through recurrent nocturnal hypoxia, inflammation, sympathetic activation, and impaired glucose regulation, raising the possibility that SGA-related alterations in breathing could precipitate or exacerbate OSA thereby accelerating metabolic deterioration. Observational studies report higher OSA prevalence among individuals with psychiatric disorders and suggest that SGA use may increase OSA risk independently of adiposity. Proposed mechanisms include SGA-induced reductions in upper-airway muscle tone, alterations in ventilatory control, and metabolic disturbances such as insulin resistance, each of which may heighten airway collapsibility or breathing instability. Collectively, these findings support the hypothesis that OSA may represent a mechanistic link between SGA exposure and metabolic syndrome. Clarifying this relationship could identify a modifiable pathway and inform screening and treatment strategies aimed at reducing cardiometabolic and psychiatric burden in SGA-treated populations.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108831"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of CPAP and isolated or combined non-invasive therapies for obstructive sleep apnea: A network meta-analysis","authors":"Merly Fernanda Illera Castellanos ,&nbsp;Janina Lied da Costa ,&nbsp;Leandro Machado Oliveira ,&nbsp;Jênifer de Oliveira ,&nbsp;Fabricio Batistin Zanatta ,&nbsp;Carine Cristina Callegaro","doi":"10.1016/j.sleep.2026.108795","DOIUrl":"10.1016/j.sleep.2026.108795","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstructive sleep apnea (OSA) is a prevalent condition associated with an increased risk of multiple adverse health outcomes. CPAP is the standard treatment. However, poor adherence has increased interest in alternative and combined non-invasive therapies.</div></div><div><h3>Objective</h3><div>This network meta-analysis compares the effectiveness of CPAP alone, isolated non-invasive therapies, and their combinations in key clinical outcomes for OSA.</div></div><div><h3>Methods</h3><div>Fifty-five randomized controlled trials were analyzed, comparing interventions such as CPAP, mandibular advancement devices (MAD), oropharyngeal myofunctional therapy (OMT), inspiratory muscle training (IMT), and combined approaches. Outcomes assessed included apnea-hypopnea index (AHI), minimum oxygen saturation (SpO₂), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and oxygen desaturation index (ODI). The certainty of evidence was evaluated using the GRADE framework.</div></div><div><h3>Results</h3><div>CPAP was the most effective for reducing AHI and improving minimum SpO₂. OMT outperformed CPAP in reducing daytime sleepiness, while the combination of CPAP and IMT was more effective than CPAP alone in improving sleep quality. CPAP showed no significant differences compared to other interventions regarding mean SpO₂, time spent with SpO₂ &lt; 90%, and ODI. Compared to the control group, MADs and OMT reduced AHI, while IMT and OMT decreased daytime sleepiness and improved sleep quality.</div></div><div><h3>Conclusion</h3><div>Although CPAP remains the gold standard for treating OSA, combining CPAP with IMT and using OMT alone provide additional benefits for sleep quality and daytime sleepiness, respectively. MADs and OMT are viable alternatives for patients who are intolerant to CPAP. However, the effectiveness of combination therapies requires further high-quality evidence.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"141 ","pages":"Article 108795"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}