Live Recordings (Sleep Medicine Trends 2026)-10 Atypical Associations with OSA

Video Transcription

Video Summary

The speaker presents a series of clinical vignettes showing how obstructive sleep apnea (OSA) can manifest through nontraditional complaints and how treatment may improve them. First, a postmenopausal obese woman developed adult-onset nocturnal enuresis after surgery; a home sleep apnea test revealed severe, positional OSA (AHI 33, 70/hr supine). With excellent CPAP adherence, her bedwetting stopped within a week and remained resolved a year later. The speaker explains three proposed links between OSA and nocturnal urinary symptoms: neuroendocrine effects (increased ANP/BNP suppressing ADH and increasing nocturnal urine), sleep fragmentation increasing awakenings/urination, and increased abdominal pressure while breathing against an occluded airway.<br /><br />Next, the talk highlights metabolic dysfunction–associated steatotic liver disease (MASLD, formerly NAFLD/NASH) as common in OSA and possibly worsened by hypoxemia. Screening can be simplified using the noninvasive FIB-4 index (age, AST, ALT, platelets), with higher scores prompting elastography/hepatology referral. CPAP may lower transaminases and stabilize progression over 3–12 months.<br /><br />Additional associations include floppy eyelid syndrome (often in older men; bidirectional link with OSA, sometimes improved by CPAP/weight loss) and gastroesophageal reflux (GERD), where CPAP reduces reflux episodes and symptoms. The overarching message is to broaden OSA assessments to catch comorbidities early and coordinate with primary care and specialists.

Keywords

obstructive sleep apnea

CPAP adherence

nocturnal enuresis

atrial natriuretic peptide

metabolic dysfunction-associated steatotic liver disease

FIB-4 index

floppy eyelid syndrome

gastroesophageal reflux disease