Exploratory Analysis of Liraglutide Effects on Obstructive Sleep Apnea and Health-Related Quality of Life in Individuals With Obesity and COPD: A Secondary Analysis of a Randomised Controlled Trial
Wolsing SK, Dogan ADA, Juhl CB, Hess S, Jensen TT, Bladbjerg EM and Hilberg O
Exploratory Analysis of Liraglutide Effects on Obstructive Sleep Apnea and Health-Related Quality of Life in Individuals With Obesity and COPD: A Secondary Analysis of a Randomised Controlled Trial
Wolsing SK, Dogan ADA, Juhl CB, Hess S, Jensen TT, Bladbjerg EM and Hilberg O
Obstructive sleep apnea (OSA) is associated with chronic obstructive pulmonary disease (COPD) and obesity, and all three are linked to reduced health-related quality of life (HRQoL). Coexistence of OSA and COPD increases morbidity and mortality compared to each condition alone. Liraglutide, a glucagon-like peptide 1 receptor agonist, may influence respiratory and HRQoL outcomes. In this secondary exploratory analysis of a randomised controlled trial including individuals with overweight or obesity and COPD, we evaluated effects of liraglutide on OSA prevalence and severity, daytime sleepiness (Epworth Sleepiness Scale, ESS), and HRQoL (Short Form-36 version 2, SF-36v2). In a double-blinded randomised controlled trial, 40 participants with overweight or obesity and COPD from two outpatient clinics were randomised to liraglutide (3.0 mg, subcutaneous) or placebo for 40 weeks. Cardiorespiratory monitoring, SF-36v2 and ESS questionnaires were conducted at baseline and end of treatment. OSA was diagnosed in 84% of participants (70% in the liraglutide group and 85% in the placebo group). Compared to placebo, liraglutide significantly reduced OSA severity, with mean baseline-adjusted differences of -9.87 events/h (β 95% CI -19.5; -0.247, p = 0.044) in Apnea-Hypopnea Index and -10.16 events/h (β 95% CI -19.29; -1.03, p = 0.029) in Oxygen Desaturation Index. ESS scores did not change significantly. Significant improvements were observed in the SF-36v2 subdomains General Health Perception and Role Physical. OSA is common among individuals with overweight or obesity and COPD. Forty weeks of liraglutide treatment were associated with reduced OSA severity and improvements in selected HRQoL domains in this population.
Mucus Fishing Syndrome: Case Series and a Narrative Review of Literature
Cooper CM, Sitto MM, Azar NS, Hoopes PC and Moshirfar M
Mucus Fishing Syndrome: Case Series and a Narrative Review of Literature
Cooper CM, Sitto MM, Azar NS, Hoopes PC and Moshirfar M
Mucus fishing syndrome (MFS) is a self-induced mechanical ocular surface disorder characterized by compulsive removal of mucus strands from the conjunctival fornices. MFS is frequently underrecognized and misdiagnosed because of its poorly characterized pathophysiology and discreet behavioral trigger. We present a case series of MFS and review the current literature addressing its epidemiology, pathophysiology, psychiatric associations, and management.
Dynamic Relationship Between Sleep Patterns and Behavioral and Psychological Symptoms of Dementia: Longitudinal Observational Study
Cho E, Hwang S, Yang M, Kim E, Cho J and Park C
Dynamic Relationship Between Sleep Patterns and Behavioral and Psychological Symptoms of Dementia: Longitudinal Observational Study
Cho E, Hwang S, Yang M, Kim E, Cho J and Park C
A higher prevalence of behavioral and psychological symptoms of dementia is associated with a greater caregiver burden and increased mortality in people with dementia. Considering the possibility of a reciprocal relationship between sleep disturbances and these symptoms, time series analyses are necessary to explore the associated temporal dynamics.
The association between obstructive sleep apnea and symptoms of anxiety and depression: An 8-year follow-up using data from a Brazilian population-based EPISONO study
Ferruzzi A, Alvarenga TA, Galduróz JCF, Ferruzzi A, Moysés-Oliveira M, Tufik S and Andersen ML
The association between obstructive sleep apnea and symptoms of anxiety and depression: An 8-year follow-up using data from a Brazilian population-based EPISONO study
Ferruzzi A, Alvarenga TA, Galduróz JCF, Ferruzzi A, Moysés-Oliveira M, Tufik S and Andersen ML
The interplay between obstructive sleep apnea (OSA) and psychiatric disturbances has gained increasing attention in Sleep Medicine. This study investigated the relationship of OSA with symptoms of anxiety and depression, as well as changes in these symptoms from baseline to the 8-year follow-up. Data were derived from the São Paulo Epidemiologic Sleep Study (EPISONO), a longitudinal population-based cohort with baseline assessment conducted in 2007 (N = 1042) and follow-up in 2015 (N = 712). OSA diagnosis was defined by the apnea-hypopnea index (AHI) obtained through full-night polysomnography, and OSA severity was classified according to American Academy of Sleep Medicine criteria. Anxiety and depressive symptoms were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-I in 2007 and BDI-II in 2015). Paired analyses using Wilcoxon signed-rank tests indicated that anxiety symptoms increased significantly between baseline and the 8-year follow-up in participants with OSA (p = 0.035). No change was observed in those without OSA (p = 0.110). Depressive symptoms did not change significantly in either group over the course of the assessments. In multiple linear regression models restricted to participants with OSA (n = 347), OSA severity was inversely correlated with anxiety symptoms (β = -0.14, p = 0.014) and depressive symptoms (β = -0.13, p = 0.023) after adjustment for demographic and anthropometric covariates. Within the OSA group, male sex was independently associated with lower anxiety (β = -0.24, p = 0.003) and depressive symptom levels (β = -0.273, p < 0.001). This longitudinal study showed increased anxiety over time in individuals with OSA, while depressive symptoms remained stable. Emotional symptoms were inversely correlated with OSA severity, suggesting influences beyond respiratory disturbance severity.
Diagnostic accuracy of the STOP-Bang questionnaire for obstructive sleep apnea in pregnancy: A systematic review and meta-analysis
Muhaisen AHM, Assaf A, Aleidi M, Al-Rabba F, Al-Nayef M, Al-Natsheh I and Qasaymeh M
Diagnostic accuracy of the STOP-Bang questionnaire for obstructive sleep apnea in pregnancy: A systematic review and meta-analysis
Muhaisen AHM, Assaf A, Aleidi M, Al-Rabba F, Al-Nayef M, Al-Natsheh I and Qasaymeh M
Obstructive sleep apnea (OSA) in pregnancy is associated with adverse maternal and perinatal outcomes, yet timely diagnostic testing can be limited. Screening questionnaires such as STOP-Bang are therefore used to triage patients for objective testing.
Sleep stages affect low-gamma range effective cortical connectivity for 40-Hz auditory steady-state responses
Leśniewska A, Górska-Klimowska U, Wyczesany M, Hołda M, Chojnacki B and Binder M
Sleep stages affect low-gamma range effective cortical connectivity for 40-Hz auditory steady-state responses
Leśniewska A, Górska-Klimowska U, Wyczesany M, Hołda M, Chojnacki B and Binder M
The 40-Hz auditory steady-state response (40-Hz ASSR) is a sensitive marker of changes in arousal level, and declines during slow-wave sleep. However, sleep-related changes in directional connectivity underlying 40-Hz ASSR remain insufficiently characterized. We examined how wakefulness, NREM (N1, N2, N3) and REM sleep modulate the direction and extent of cortical signal propagation. EEG was recorded during overnight 40-Hz auditory stimulation in 29 normal-hearing human subjects (including 16 females). A source reconstruction identified cortical generators, and effective connectivity was quantified using the Directed Transfer Function (DTF) in the low-gamma band (37-43Hz). Analyses focused on the connections between primary auditory cortical regions, prefrontal and temporo-parietal regions. We hypothesized that (1) feedback connections from associative to primary auditory cortex would be preferentially impaired by reduced arousal, and (2) associative connectivity between prefrontal and temporo-parietal cortices would decline progressively across NREM sleep, with partial restoration during REM sleep. Results showed that during sleep (NREM N2 and N3, as well as REM sleep), both feedforward and feedback connectivity were comparably reduced. At sleep onset (NREM N1), feedforward disruptions were already robust but spatially restricted, whereas feedback reductions were initially weaker and increased progressively across N2, N3, and REM sleep, contradicting the first hypothesis. The second hypothesis was confirmed: reciprocal associative prefrontal-parietal connectivity decreased significantly with increasing sleep depth. Overall, 40-Hz ASSR signal propagation during sleep is characterized by a widespread breakdown of intracortical effective connectivity emerging at sleep onset and becoming fully expressed in deeper sleep stages.
Engineering framework for curiosity-driven and humble AI in clinical decision support
Arslan J, Benke K, Cajas Ordones SA, Castro R, Celi LA, Cruz Suarez GA, Delos Reyes R, Engelmann J, Ercole A, Hilel A, Kinyera L, Lange M, Lunde TM, Meni MJ, Ocampo Osorio F, Premo AE, Sedlakova J and Vig P
Engineering framework for curiosity-driven and humble AI in clinical decision support
Arslan J, Benke K, Cajas Ordones SA, Castro R, Celi LA, Cruz Suarez GA, Delos Reyes R, Engelmann J, Ercole A, Hilel A, Kinyera L, Lange M, Lunde TM, Meni MJ, Ocampo Osorio F, Premo AE, Sedlakova J and Vig P
We present BODHI (Balanced, Open-minded, Diagnostic, Humble, and Inquisitive), an engineering framework for curiosity driven and humble clinical decision support artificial intelligence (AI) systems. Despite growing capabilities, large language models (LLMs) often express inappropriate confidence, conflating statistical pattern recognition with genuine medical understanding. BODHI addresses this through a dual reflective architecture that: (1) decomposes epistemic uncertainty into task specific dimensions, and (2) constrains model responses using virtue based stance rules derived from a Virtue Activation Matrix. We validate the framework through controlled evaluation on 200 clinical vignettes from HealthBench Hard, assessing GPT-4o-mini and GPT-4.1-mini across 5 random seeds (2000 total observations). Statistical analysis included bootstrap resampling, paired t tests, and effect size computation. BODHI improved overall clinical response quality (GPT-4.1-mini: +16.6 pp, p<0.0001, Cohen's d=11.56; GPT-4o-mini: +2.2 pp, p<0.0001, Cohen's d=1.56) and achieved very large effect sizes on curiosity (context seeking rate: Cohen's d=16.38 and 19.54) and humility (hedging: d=5.80 for GPT-4.1-mini) metrics. Crucially, 97.3% of GPT-4.1-mini responses and 73.5% of GPT-4o-mini responses included appropriate clarifying questions, compared with 7.8% and 0.0% at baseline, demonstrating the framework's effectiveness in eliciting information gathering behaviour. Findings suggest LLMs can be reliably constrained to operate within epistemic boundaries when provided with structured uncertainty decomposition and virtue aligned response rules, offering a pathway towards safer clinical AI deployment.
Combined variations in sleep, physical activity, and nutrition and the risk of major adverse cardiovascular events
Koemel NA, Biswas RK, Simpson SJ, Rezende LFM, Wang T, Bauman A, Raubenheimer D, Allman-Farinelli M, Cistulli PA, Ahmadi MN and Stamatakis E
Combined variations in sleep, physical activity, and nutrition and the risk of major adverse cardiovascular events
Koemel NA, Biswas RK, Simpson SJ, Rezende LFM, Wang T, Bauman A, Raubenheimer D, Allman-Farinelli M, Cistulli PA, Ahmadi MN and Stamatakis E
Sleep, physical activity, and nutrition (SPAN) are major lifestyle behaviours that influence cardiovascular disease risk. We examined the multi-behaviour associations of SPAN with risk of major adverse cardiovascular events (MACE) and its subtypes (myocardial infarction (MI), heart failure (HF), and stroke).
Towards a better understanding of residual sleep apnoea: the role of quantitatively assessed ventilatory control instability
Zhou L and Parekh A
Towards a better understanding of residual sleep apnoea: the role of quantitatively assessed ventilatory control instability
Zhou L and Parekh A
Validation and cross-cultural adaptation into Spanish of the Richards-Campbell sleep questionnaire for the pediatric critical population: RCSQ-PED
Gomez-Merino A, Luna-Castaño P, Lobato-López R, Núñez-Yebra PM, Piqueras-Rodríguez P, Martín-Velasco M, González-Martínez N, Carrasco-San José A, Castro-Cedeño AP, López-Cabrejas M, Alcaraz-Blanco D, Romeral-Jiménez M, Calleja-Uzquiza M, Perales-Arroyo PG, González-Rodríguez ME, García-Gonzalez E, Bosch-Alcaraz A and Moreno-Casbas MT
Validation and cross-cultural adaptation into Spanish of the Richards-Campbell sleep questionnaire for the pediatric critical population: RCSQ-PED
Gomez-Merino A, Luna-Castaño P, Lobato-López R, Núñez-Yebra PM, Piqueras-Rodríguez P, Martín-Velasco M, González-Martínez N, Carrasco-San José A, Castro-Cedeño AP, López-Cabrejas M, Alcaraz-Blanco D, Romeral-Jiménez M, Calleja-Uzquiza M, Perales-Arroyo PG, González-Rodríguez ME, García-Gonzalez E, Bosch-Alcaraz A and Moreno-Casbas MT
To adapt and validate the original version of the Richards-Campbell Sleep Questionnaire (RCSQ) for the Spanish context, and to assess its psychometric properties for use in the pediatric population aged 7-17 years admitted to a Pediatric Intensive Care Unit (PICU).
