Purpose: Due to the possible interplay of factors predisposing to severe COVID-19 outcomes and negative health consequences of poorly controlled OSA, adherence to continuous positive airway pressure (CPAP) therapy among OSA patients might be crucial during COVID-19 pandemics. Lockdown-related changes in CPAP adherence were investigated in CPAP users willing to participate in this study. Pre-lockdown adherence, age, gender, comorbidities and anxiety were analyzed as predictors of COVID-19 lockdown adherence. Patients and Methods: A cross-sectional study performed at Split Sleep Medicine Center included 101 severe OSA patients (78.2% male). CPAP memory cards were assessed during 6 months of pre-lockdown and 40 days of lockdown (March/April 2020) period. A total of 81 patients in pre-lockdown met good CPAP adherence criteria (≥ 4 hours/night on 70% nights). Results: CPAP adherence improved during COVID-19 lockdown in the total sample of severe OSA patients. The percentage of adherent nights and CPAP usage hours per night increased during lockdown in good pre-lockdown CPAP adherers (p=0.011 and p=0.001, respectively), women (p=0.003 and p=0.001, respectively) and respondents younger than 58 years (p=0.007 and p< 0.001, respectively). Out of 20/101 poor pre-lockdown CPAP adherers, 9 have shifted to good lockdown adherence. When comorbidities, BMI and anxiety were taken into account, older and male respondents were recognized as less likely to improve CPAP usage hours during lockdown (R²=9.4%; p=0.032). Conclusion: The lockdown-related CPAP adherence improved in severe OSA patients, with a shift in almost half of poor pre-lockdown adherers towards good lockdown CPAP adherence. Women, younger and good pre-lockdown CPAP adherers were more adherent during lockdown. Despite being vulnerable groups for both OSA and COVID-19, no expected adherence improvements were observed in men and older patients.

Obstructive sleep apnea (OSA) often goes unrecognized despite common symptoms, such as excessive daytime sleepiness, fatigue, and impaired quality of life (QoL). Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA, but optimal daily usage and time needed for observable effects remain unclear. This study aimed to investigate the short-term effects of CPAP on daytime sleepiness and QoL in patients with severe OSA. Medical records were collected from 87 patients with severe OSA who initiated CPAP therapy. Also, validated questionnaires were used before and after one month of CPAP to analyze QoL—the Calgary Sleep Apnea Quality of Life Index (SAQLI), the Cues to CPAP Use Questionnaire (CCUQ), and daytime sleepiness—the Epworth Sleepiness Scale (ESS). Multiple regression analysis was conducted to identify predictors of CPAP usage. Of the total participants aged 55.6 ± 12.5, 77% were males, and 62% were CPAP adherent. Reductions in daytime sleepiness (ESS) were noted, as well as improvements in both overall QoL (SAQLI) and specifically in the domains of daily functioning, social interactions, emotional well-being, and symptom perception. Important cues for CPAP usage recognized by patients were physicians’ instructions and physicians’ concern regarding their patients’ condition. Furthermore, multiple regression revealed higher SAQLI scores and lower ESS scores as positive predictors of CPAP usage, along with lower AHI after one month of CPAP being associated with sufficient adherence.

The “commando operation” is an extensive surgical procedure used to treat patients with oral squamous carcinoma and metastasis in the cervical lymph nodes. While the procedure can be curative, it is also very mutilating, which consequently has a major impact on the patient’s quality of life. Several studies showed that the procedure is associated with loss of certain functions, such as impairments in speech, chewing, swallowing, and loss of taste and appetite. Furthermore, some of these impairments and their degree depend on the reconstruction method. However, the data regarding the functional impairments and aesthetic results in patients who underwent the “commando operation” along with the pectoralis major myocutaneus flap reconstruction are still inconclusive. This study included 34 patients that underwent partial glossectomy, ipsilateral modified radical neck dissection, pectoralis major myocutaneus flap reconstruction, and adjuvant radiotherapy. A structured questionnaire was used to evaluate aesthetical results and functional impairments as well as to grade the level of satisfaction with the functional and aesthetic outcomes both by the patients and by the operator. Most of the patients stated that their speech (N = 33; 97%) and salivation (N = 32; 94.2%) severely changed after the operation and that they cannot chew (N = 33; 97%) and swallow (N = 33; 97%) the same as before the operation. Moreover, almost half of the patients (N = 16; 47%) reported that they have severe sleep impairments. However, only few of the included patients stated that they sought professional help regarding the speech (N = 4; 11.7%), eating (N = 5; 14.7%), and sleeping (N = 4; 11.7%) disturbances. Additionally, there was a statistically significant difference between the operator and the patients in the subjective assessment of the aesthetic results (p = 0.047), as operators gave significantly better grades. Our results imply that this procedure and reconstructive method possibly cause impairments that have an impact on the patients’ wellbeing. Moreover, our outcomes also suggest that patients should be educated and rehabilitated after the “commando operation” since most of them were reluctant to seek professional help regarding their impairments. Lastly, sleep deficiency, which was observed after the procedure, should be further explored.

Obstructive sleep apnea (OSA) has become major public concern and is continuously investigated in new aspects of pathophysiology and management. Urotensin II (UII) is a powerful vasoconstrictor with a role in cardiovascular diseases. The main goal of this study was to evaluate serum UII levels in OSA patients and matched controls. A total of 89 OSA patients and 89 controls were consecutively enrolled. A medical history review and physical examination of the participants was conducted, with polysomnography performed in the investigated group. UII levels and other biochemical parameters were assessed according to the standard laboratory protocols. The median AHI in the OSA group was 39.0 (31.4–55.2) events/h, and they had higher levels of hsCRP when compared to control group (2.87 ± 0.71 vs. 1.52 ± 0.68 mg/L; p < 0.001). Additionally, serum UII levels were significantly higher in the OSA group (3.41 ± 1.72 vs. 2.18 ± 1.36 ng/mL; p < 0.001), while positive correlation was found between UII levels and hsCRP (r = 0.450; p < 0.001) and systolic blood pressure (SPB) (r = 0.317; p < 0.001). Finally, multiple regression analysis showed significant association of UII levels with AHI (0.017 ± 0.006, p = 0.013), SBP (0.052 ± 0.008, p < 0.001) and hsCRP (0.538 ± 0.164, p = 0.001). As UII levels were associated with blood pressure and markers of inflammation and OSA severity, it might play an important role in the complex pathophysiology of OSA and its cardiometabolic complications.

Obstructive sleep apnea (OSA) often goes unrecognized despite common symptoms such as excessive daytime sleepiness, fatigue, and impaired quality of life (QoL). CPAP is the gold standard treatment for OSA, but optimal daily usage and time needed for observable effects remain unclear. This study aimed to investigate the short-term effects of CPAP on daytime sleepiness and QoL in patients with severe OSA. Medical records were collected from 87 patients with severe OSA who initiated CPAP therapy. Also, validated questionnaires were used before and after one month of CPAP to analyze QoL - the Calgary Sleep Apnea Quality of Life Index (SAQLI), the Cues to CPAP Use Questionnaire (CCUQ), and daytime sleepiness - the Epworth Sleepiness Scale (ESS). Multiple regression analysis was conducted to identify predictors of CPAP usage. Of the total participants aged 55.6±12.5, 77% were males, and 62% were CPAP adherent. Reductions in daytime sleepiness (ESS) were noted, as well as improvements in both overall QoL (SAQLI) and specifically in the domains of daily functioning, social interactions, emotional well-being, and symptom perception. Important cues for CPAP usage recognized by patients were physicians’ instructions and physicians’ worry regarding patients' condition. Furthermore, multiple regression revealed higher SAQLI scores and lower ESS scores as positive predictors of CPAP usage, along with lower AHI after one month of CPAP being associated with sufficient adherence.