Sleep Medicine

Sleep apnea–specific hypoxic burden predicts 30-day major postoperative events

In 2,286 adults with OSA undergoing major noncardiothoracic surgery, higher sleep apnea–specific hypoxic burden (SASHB) predicted more 30-day cardiovascular events and deaths. Event rates rose from 1.6% in the lowest SASHB category to 5.8% in the highest category at OSA diagnosis. Compared with low SASHB, adjusted odds of the composite outcome increased for intermediate and high SASHB, approaching threefold higher odds at the highest burden. A simple score combining age, emergency admission, and SASHB achieved an AUC of 0.73 for 30-day events, outperforming traditional metrics. A similar association using oximetry-derived SASHB suggests feasibility for routine perioperative risk stratification. 1

Auto-adjusted NIV matches manual titration efficacy and lowers cost in OHS

This multicenter noninferiority trial randomized 205 ambulatory, treatment-naïve OHS patients to auto-adjusted NIV or manually set bilevel ST. Twelve-month PaCO2 reductions were nearly identical between groups, with an adjusted difference of 0.15 mmHg, satisfying noninferiority criteria. Symptoms, quality of life, and other secondary outcomes were similar across modalities. Auto-adjusted NIV generated substantial per-patient cost savings, largely by avoiding polysomnographic titration and simplifying care pathways. 2

COMISA increases 10-year cerebrovascular and thrombotic risk versus OSA alone

Using TriNetX, 165,522 adults with COMISA were propensity-matched to 165,522 with OSA alone on extensive demographic and clinical variables. COMISA was associated with higher 10-year cerebrovascular disease risk, with a hazard ratio of 1.17 compared with OSA-only. Risks were also elevated for arrhythmias, inflammatory and ischemic heart disease, and thrombotic disorders in COMISA. Atrial fibrillation/flutter and heart failure were slightly less frequent, and the major adverse cardiovascular event signal was modest. Risk patterns were broadly consistent across sex, CPAP use, and benzodiazepine or Z-drug exposure subgroups. 3

CBT-I plus positive mood strategies leads nonpharmacologic insomnia care in older adults

This network meta-analysis pooled 34 RCTs including 3,078 adults aged at least 60 years across 21 nonpharmacologic interventions. Eleven interventions significantly improved sleep quality, with CBT-I plus positive mood strategies (CBT-I+) showing the largest PSQI effect size. Standard CBT-I ranked second, still providing large improvements in sleep quality among older adults. Music therapy worked better for participants with baseline PSQI below 10, while CBT-I+ favored PSQI 10 or higher. Traditional Chinese health-promotion exercise performed best in home settings, whereas CBT-I+ was superior in non-home settings, though GRADE certainty was low. 4