The bidirectional relationship between obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) represents a critical intersection in metabolic medicine. Therefore, the present review examines the most recent data regarding molecular mechanisms linking OSA and T2DM, analyzing key biomarkers including hypoxia-inducible factors (HIF 1α), inflammatory mediators, adipokines, microRNAs, hormones, and neuropeptides that serve as both diagnostic indicators and potential therapeutic targets. Key molecular findings from the scientific literature report elevated HIF-1α promoting insulin resistance, decreased SIRT1 levels, dysregulated microRNA-181a and microRNA-199a, increased inflammatory cytokines (TNF-α, IL-6, CRP), and altered adipokine profiles with reduced adiponectin and elevated leptin and resistin. Current clinical evidence reveals significant therapeutic potential for modern antidiabetic medications in the management of OSA. GLP-1 receptor agonists, particularly tirzepatide, received FDA approval as the first medication for moderate-to-severe OSA in obese adults, showing a 55–63% AHI reduction. SGLT2 inhibitors also demonstrate promising results through weight loss and cardiovascular protection mechanisms. This integrated approach represents the evolution toward comprehensive OSA management beyond traditional mechanical ventilation strategies. Future research should focus on developing personalized treatment algorithms based on individual molecular biomarker profiles, investigating combination therapies, and exploring novel targets, including chronotherapy agents.

Esophageal pressure (Pes) measurements could optimise ventilator parameters in acute respiratory failure (ARF) patients requiring noninvasive ventilation (NIV). Consequently, the objectives of our study were to evaluate the safety and accuracy of applying a Pes measuring protocol in ARF patients with AECOPD under NIV in our respiratory intermediate care unit (RICU). An observational cohort study was undertaken. The negative inspiratory swing of Pes (ΔPes) was measured: in an upright/supine position in the presence/absence of NIV at D1 (day of admission), D3 (3rd day of NIV), and DoD (day of discharge). A digital filter for artefact removal was developed. We included 15 patients. The maximum values for ∆Pes were recorded at admission (mean ∆Pes 23.2 cm H₂O) in the supine position. ∆Pes decreased from D1 to D3 (p < 0.05), the change being BMI-dependent (p < 0.01). The addition of NIV decreased ∆Pes at D1 and D3 (p < 0.01). The reduction of ∆Pes was more significant in the supine position at D1 (8.8 cm H₂O, p < 0.01). Under NIV, ∆Pes values remained higher in the supine versus upright position. Therefore, the measurement of Pes in AECOPD patients requiring NIV can be safely done in an RICU. Under NIV, ∆Pes reduction is most significant within the first 24 h of admission.

The present review examines the most recent data regarding molecular mechanisms linking OSA and T2DM, analyzing key biomarkers including hypoxia-inducible factors (HIF 1α), inflammatory mediators, adipokines, microRNAs, hormones, and neuropeptides that serve as both diagnostic indicators and potential therapeutic targets. Key molecular findings from the scientific literature report elevated HIF-1α promoting insulin resistance, decreased SIRT1 levels, dysregulated microRNA-181a and microRNA-199a, increased inflammatory cytokines (TNF-α, IL-6, CRP), and altered adipokine profiles with reduced adiponectin and elevated leptin and resistin. Current clinical evidence reveals significant therapeutic potential for modern anti-diabetic medications in the management of OSA. GLP-1 receptor agonists, particularly tirzepatide, that received FDA approval as the first medication for moderate-to-severe OSA in obese adults, showing 55-63% AHI reduction. SGLT2 inhibitors also demonstrate promising results through weight loss and cardiovascular protection mechanisms. This integrated approach represents the evolution toward comprehensive OSA management beyond traditional mechanical ventilation strategies. Future research should focus on developing personalized treatment algorithms based on individual molecular biomarker profiles, investigating combination therapies, and exploring novel targets, including chronotherapy agents.

Background and Objectives: Acute exacerbation of COPD (AECOPD) poses a major burden on healthcare systems, with critically ill AECOPD patients having increased morbidity and mortality. Since adverse outcomes are due both to respiratory failure and the systemic inflammatory response, prognostic markers accounting for these patterns are needed. Our aim was to investigate the predictive power of derived hematological indices for intensive care unit (ICU) mortality in patients with non-infectious versus infectious AECOPD. Materials and Methods: This is a retrospective, observational, monocentric cohort study on 88 AECOPD patients admitted to the ICU between 2018 and 2023. Descriptive statistics were performed for the entire cohort, and for predefined subgroups (non-infectious, infectious and bacterial AECOPD). Receiver Operating Characteristics (ROC) analysis was performed to test the predictive power of the studied indices. Cut-off values were identified using the Youden index. Kaplan–Meier analysis was conducted to test the association with ICU mortality. Results: Overall ICU mortality was 44%. For the whole cohort, neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelets ratio (NPR) and systemic inflammation response index (SIRI) showed moderate predictive power for ICU mortality (areas under the curve (AUCs) of 0.71–0.73). Non-infectious and infectious subgroups were comparable in terms of size, demographics, comorbidities and baseline COPD characteristics (p > 0.05). Mortality was significantly higher in infectious AECOPD (64.6% versus 20%, p < 0.001). For non-infectious AECOPD, monocyte-to-lymphocyte ratio (MLR) and SIRI had very good predictive power (AUCs between 0.82 and 0.855), while NPR and systemic inflammation index (SII) showed moderate AUC values (between 0.7 and 0.79). In infectious AECOPD, only NPR retained fair predictive power (AUC 0.691), which improved in bacterial AECOPD (AUC 0.781). Conclusions: Derived hematological indices have different predictive values for ICU mortality. MLR and SIRI exhibited very good predictive power in non-infectious AECOPD, while NPR was the best discriminator in bacterial AECOPD. These stress the importance of individualized prognostication in AECOPD.