These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.

The present findings suggest that OSAS may have an increasing effect on salivary IL-6 and IL-33 concentrations regardless of OSAS severity. Additional investigation is required to elucidate a potential bidirectional relationship between OSAS and periodontal disease.

Objectives: To assess salivary, serum biomarkers, and subgingival bacteria as putative candidates in the potential association between obstructive sleep apnea syndrome (OSAS) and periodontal disease. Materials and methods:Fifty-two patients were grouped according to the severity of OSAS: 13 participants served as controls, 17 patients had mild-to-moderate OSAS, and 22 severe OSAS. Serum, saliva, and subgingival plaque samples were collected, clinical periodontal parameters recorded. Salivary, serum concentrations of interleukin-6 (IL-6), tumour necrosis factor (TNF-α), osteoprotegerin, sRANKL, and apelin were analysed by enzyme-linked immunosorbent assay. Bacterial counts were determined by real-time QPCR on plaque microbial DNA preparations.Results: There was a significant change in the composition of microbes in plaque particularly in severe OSAS samples (p<0.01). Statistical analyses indicated significantly higher salivary IL-6 levels in both OSAS groups compared to controls (p<0.05). Salivary apelin levels were significantly higher in Serum levels of these biomarkers and salivary osteoprotegerin, sRANKL levels were similar in the study groups. The incidence and duration of apnea positively correlated with clinical periodontal parameters (p<0.05). Conclusion:OSAS appeared to alter the tested bacteria in plaque, correlate with increasing periodontal disease severity, have additive effect on salivary IL-6.Clinical relevance: OSAS is likely to interact with periodontal disease.

In this large cohort, the prevalence of GERD was significantly increased in those with primary snoring and OSAS compared to the general population, but severity of OSAS did not influence GERD prevalence. The present results suggest that OSAS was not likely a causative factor but female gender, obesity, and sleepiness were related with prevalence of GERD in OSAS patients.

It was shown that OHS patients have increased rate of hypertension, daytime sleepiness and HCO3 , and decreased lung functions and PaO2 levels than OSAS patients. The present results support that elevated bicarbonate levels and decreased oxygen saturations in obese OSAS patients should prompt clinicians to predict OHS.