Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea–hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment.

Study Objectives: Menopausal transition is associated with increased dissatisfaction with sleep, but the effects on sleep architecture are conflicting. This prospective 6-year follow-up study was designed to evaluate the changes in sleep stages and sleep continuity that occur in women during menopausal transition. Methods: Sixty women (mean age 46.0 years, SD 0.9) participated. All women were premenopausal at baseline, and at the 6-year follow-up, women were in different stages of menopausal transition. Polysomnography was used to study sleep architecture at baseline and follow-up. The effects of aging and menopause (assessed as change in serum follicle-stimulating hormone [S-FSH]) on sleep architecture were evaluated using linear regression models. Results: After controlling for body mass index, vasomotor, and depressive symptoms, aging of 6 years resulted in shorter total sleep time (B −37.4, 95% confidence interval [CI] −71.5 to (−3.3)), lower sleep efficiency (B −6.5, 95%CI −12.7 to (−0.2)), as well as in increased transitions from slow-wave sleep (SWS) to wakefulness (B 1.0, 95%CI 0.1 to 1.9), wake after sleep onset (B 37.7, 95%CI 12.5 to 63.0), awakenings per hour (B 1.8, 95%CI 0.8 to 2.8), and arousal index (B 2.3, 95%CI 0.1 to 4.4). Higher S-FSH concentration in menopausal transition was associated with increased SWS (B 0.09, 95%CI 0.01 to 0.16) after controlling for confounding factors. Conclusions: A significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but change from premenopausal to menopausal state restores some SWS.

The aims of this study are to clarify whether patients with obstructive sleep apnea syndrome (OSAS) have a decline in verbally or visually-based cognitive abilities and whether the possible decline is related to particular sleep depth changes. In addition, the effect of continuous positive airway pressure (CPAP) on the possible changes is investigated. Fifteen OSAS patients and 15 healthy controls joined two full-night polysomnographies, including a computational measure of deep sleep percentage (DS%) bilaterally from the frontal, central and occipital channels, and a neuropsychological assessment. After a 6-month CPAP the patients underwent one more full-night polysomnography with computational DS% analysis and a neuropsychological assessment. At the baseline, the OSAS patients had poorer performance in the Picture Completion, in the Digit Symbol and in copying the Rey-Osterrieth Complex Figure Test (ROCFT) compared to the controls. The patients also showed reduced DS% in all 6 electrographic (EEG) channels compared to controls. The patients had an inter-hemispheric difference showing less deep sleep in the right hemisphere than in the left hemisphere both frontopolarly and centrally, while the controls showed this inter-hemispheric difference only frontopolarly. After CPAP the patients still had poorer performance in the Picture Completion and in the ROCFT. The patients continued to show reduced DS% in all 3 channels of the right hemisphere and occipitally in the left hemisphere, also the inter-hemispheric difference frontopolarly and centrally remained. OSAS patients have mild visually based cognitive dysfunction and reduced amount of deep sleep in the right hemisphere even after CPAP.