Systemic inflammation often accompanies obstructive sleep apnea (OSA), along with higher chances of heart-related metabolic issues. Although oral appliances serve as an accepted option instead of continuous positive airway pressure (CPAP), their influence on markers of systemic inflammation lacks clear evidence. The aim of this systematic review and meta-analysis was to assess changes in systemic inflammation markers following oral appliance therapy (OAT) among individuals diagnosed with OSA. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, a systematic review and meta-analysis was conducted. Databases such as PubMed, Embase, Scopus, Web of Science, and Cochrane Library were examined. Studies assessing inflammatory markers before and after therapy among adults with OSA undergoing OAT formed part of the selection. For pooling results, reliance was made upon a random-effects framework. The present research was registered in PROSPERO with the ID CRD420261340212. From a total of 1,974 records screened, six studies qualified for inclusion in the qualitative analysis; among them, two contributed data for each outcome assessed through meta-analysis. Despite pooling outcomes across trials, no meaningful changes emerged in tumor necrosis factor-alpha levels (p = 0.536), nor in C-reactive protein (p = 0.061), or interleukin-6 concentrations (p = 0.230). Consistency between study findings showed minimal variation (I[2] = 0%). Despite improved clinical results in OSA, OAT shows minor impact on markers of systemic inflammation. To confirm these findings, broader trials with rigorous and uniform designs are needed.

This review synthesizes current evidence describing the systemic implications of metabolic dysfunction-associated steatotic liver disease (MASLD), with emphasis on its extrahepatic complications and underlying pathophysiological mechanisms. A narrative literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. The search included studies published between 1999 and 2025 using terms related to MASLD, systemic inflammation, insulin resistance, lipotoxicity, and extrahepatic diseases. MASLD is strongly associated with multiple extrahepatic conditions, including type 2 diabetes mellitus, polycystic ovary syndrome, chronic kidney disease, cardiovascular disease, obstructive sleep apnea, asthma, psoriasis, and various malignancies. Central mechanisms linking MASLD to systemic disease include chronic low-grade inflammation, insulin resistance, adipose tissue dysfunction, dysregulated hepatokine signaling, and lipotoxicity. The severity of liver fibrosis correlates closely with increased morbidity and mortality from both hepatic and non-hepatic causes. MASLD should be considered a systemic metabolic disease rather than an isolated hepatic disorder. Early recognition, multidisciplinary assessment, and proactive management of both hepatic and extrahepatic manifestations are critical to improving long-term patient outcomes. Future research should prioritize mechanistic clarification and integrated care models.

Acute disseminated encephalomyelitis (ADEM) is a rapidly progressive autoimmune demyelinating condition that primarily affects the central nervous system. The exact pathogenesis is not well understood, but current literature suggests roles for both environmental triggers and genetic predispositions. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an increasingly recognized autoimmune demyelinating disorder that can present with an ADEM-like phenotype, particularly in adults. We report the case of a 53-year-old Asian-American female patient of Taiwanese ancestry with a past medical history of obstructive sleep apnea and no prior autoimmune disease or family history of demyelinating disorders who presented to the emergency room (ER) with left-sided numbness and weakness, ataxia, vertigo, and slurred speech in the context of a three-month long history of headaches that started one day after she received her first dose of Pfizer COVID-19 vaccine. Brain imaging studies showed findings most suggestive of ADEM. Initial pre-treatment cerebrospinal fluid (CSF) analysis showed markedly elevated protein (473 mg/dL, reference 15-45 mg/dL) with a normal glucose level and mild pleocytosis (6 WBC/µL). Extensive workup was negative for infectious, oncologic, and autoimmune etiologies including negative serum and CSF anti-MOG antibody testing during the acute presentation. The initial treatment of a five-day intravenous methylprednisolone course (250 mg every six hours, total 1,000 mg/day) did not result in significant clinical improvement. The patient was then started on plasma exchange therapy and successfully recovered by the end of the last session with objective improvement in ambulation, dysarthria, and limb strength. The patient tested positive for anti-myelin oligodendrocyte glycoprotein antibody in serum six months after hospital discharge at a titer of 1:32 by live cell-based assay. This case provides an example of a rare but serious event temporally associated with the SARS-CoV-19 mRNA vaccine and MOGAD presenting as ADEM in a previously healthy adult. The absolute risk of demyelinating events following COVID-19 vaccination is extremely low, and the benefit of vaccination vastly outweighs these rare risks.

Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder that is closely associated with cardiovascular morbidity and mortality. Although the apnea-hypopnea index (AHI) remains the conventional metric for diagnosing and grading OSA severity, it inadequately reflects the heterogeneous pathophysiological burden of the disease and has limited predictive value for cardiovascular outcomes. This review summarizes recent advances in cardiovascular risk assessment indicators in OSA, with a focus on mechanisms of OSA-related cardiovascular injury, limitations of traditional metrics, emerging physiological indices, circulating biomarkers, phenotype-based stratification, and risk evaluation in patients with specific cardiovascular comorbidities. Intermittent hypoxia, sleep fragmentation, and intrathoracic pressure swings jointly contribute to sympathetic activation, oxidative stress, systemic inflammation, endothelial dysfunction, hypercoagulability, metabolic dysregulation, and cardiac remodeling. Novel physiological indicators, including hypoxic burden, heart rate response, pulse wave amplitude drop index, and respiratory effort-related metrics, may better quantify OSA-related cardiovascular stress than AHI alone. In parallel, biomarkers reflecting inflammation, endothelial dysfunction, coagulation activation, myocardial injury, and microRNA-mediated regulation show potential for identifying high-risk subgroups. Phenotype-based approaches, such as classifications integrating symptoms, hypoxic patterns, and cardiovascular risk, provide a promising framework for precision management. Future research should standardize these novel indicators, validate their associations with hard cardiovascular outcomes, and develop multimodal prediction models to guide individualized therapeutic strategies.

Obstructive sleep apnoea is a common sleep disorder affecting 5%-15% of the population, with many going undiagnosed due to accessibility issues and long waiting lists. This is due to the bottleneck method of diagnosis, which is polysomnography. The implementation of machine learning, particularly when applied to a reduced set of physiological signals, has the potential to enhance accessibility and to mitigate the demands associated with conventional polysomnography, a procedure that is inherently time-consuming and labour-intensive. In this preliminary study, 10 clinicians were interviewed to gather their perspectives on the use of machine learning in the domain. Using thematic analysis, key themes were identified, highlighting important considerations on the deployment of machine learning. Findings suggest the need for guidelines and approvals to regulate the use of machine learning, the importance of including medical experts in the process to ensure the best healthcare service is provided and that clinicians lead and not machine learning. The aim is to further the understanding of the complexities of machine learning and understand how to better tailor machine learning to allow for the adoption of machine learning and increase the trust in machine learning by clinicians.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is frequently associated with cardiac arrhythmias; however, the clinical factors associated with concurrent arrhythmia in this population remain incompletely characterized. This study investigated factors associated with arrhythmia in patients with OSAHS, with particular focus on the monocyte-to-high-density lipoprotein cholesterol ratio (MHR). In this retrospective cross-sectional study, 451 patients with polysomnography (PSG)-confirmed OSAHS were enrolled and classified into arrhythmia and non-arrhythmia groups according to 24-hour Holter monitoring. Demographic characteristics, laboratory variables, PSG parameters, and echocardiographic indices were collected. Comparative analyses, correlation analyses, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were performed. Arrhythmias, mainly premature atrial or ventricular contractions, were detected in 256 of 451 patients (56.8%, 256/451), and their prevalence differed significantly across OSAHS severity categories (P = 0.014). Compared with patients without arrhythmia, patients with arrhythmia had higher MHR and neutrophil-to-lymphocyte ratio (NLR) values and lower high-density lipoprotein cholesterol (HDL-C) levels. Multivariable analysis showed that MHR, apnea-hypopnea index (AHI), and HDL-C were independently associated with concurrent arrhythmia. Among the individual variables evaluated, MHR showed weak standalone discriminatory performance, with an area under the curve (AUC) of 0.656. MHR is a blood-derived inflammatory and lipid-related index associated with concurrent arrhythmia in patients with OSAHS. Its standalone discriminatory performance was weak; therefore, MHR should be interpreted only as an adjunctive marker for cross-sectional characterization rather than as an independent screening tool.

Individuals with Down syndrome (DS) have a high risk of obstructive sleep apnea (OSA), likely driven by craniofacial and upper airway abnormalities. However, three-dimensional upper airway morphology and its association with OSA severity remain poorly characterized. Here, we provide the first comprehensive three-dimensional characterization of upper airway volume and shape in adults with DS and euploid controls (EU). Three-dimensional upper airway models were reconstructed from T1-weighted MRI scans of 164 adults (63 EU, 101 DS). Upper airway, nasal cavity, and pharyngeal morphology were quantified using volumetry and geometric morphometrics (23 landmarks). OSA associations were assessed in a DS subsample (n = 91) using the apnea-hypopnea index and OSA severity categories. Adults with DS exhibited significantly reduced upper airway, nasal cavity, and pharyngeal volumes and distinct shape alterations relative to EU controls, with sex-specific patterns. In DS, increasing OSA severity was associated with reduced upper airway and nasal cavity volumes, particularly in males. OSA-related shape differences were confined to the nasal cavity of males with severe OSA, characterized by bilateral constriction and anteroposterior shortening. These findings identify upper airway morphology, particularly nasal cavity volume and shape, as imaging-derived anatomical biomarkers associated with OSA severity in adults with DS.