Intrathecal injection of 3D-mesenchymal stem cells attenuates disseminated neuroinflammation and improves cognitive function in controlled cortical impact rats.

Obstructive sleep apnea (OSA) is a chronic and multifactorial respiratory disease with high prevalence characterized by recurrent upper airway collapse during sleep, resulting in intermittent hypoxia and sleep fragmentation []. This disease affects approximately 936 million people worldwide, representing a serious public health problem []. OSA pathophysiology involves complex neurobiological and genetic underpinnings that extend beyond simple mechanical airway obstruction []. Dysregulation of neurotransmitter systems plays a pivotal role, with patients often exhibiting elevated serum dopamine levels that may function as a compensatory mechanism to regulate arousal, respiratory drive, and upper airway muscle tone in response to intermittent hypoxia []. Genetic variations further modulate disease expression; specifically, the T allele of the DRD2 rs1800497 polymorphism has been identified as an independent predictor of higher arousal rates and increased OSA severity []. Additionally, OSA is linked to the disruption of circadian clock genes, such as the down-regulation of neuronal PAS domain protein 2 (NPAS2), which interacts with hypoxia-inducible factors and is associated with the metabolic dysregulation observed in these patients []. OSA causes a spectrum of clinical consequences, including excessive daytime sleepiness (EDS), cognitive impairment, and mood disorders [,]. It also leads to an increased risk of morbidity and mortality and significant healthcare costs, related to its strong association with cardiovascular and metabolic comorbidities, such as hypertension, heart failure, atrial fibrillation and diabetes [,]. Although several international and national guidelines provide recommendations for the follow-up of patients with OSA, the optimal timing, intensity, content, and organization of long-term care remain incompletely standardized and vary across healthcare systems [,]. In particular, evidence supporting personalized, risk-stratified follow-up pathways for patients receiving Continuous Positive Airway Pressure (CPAP) remains limited. In clinical practice, follow-up is guided by data derived from CPAP use, particularly the residual Apnea–Hypopnea Index (AHI), parameters indicative of adherence to therapy and clinical questionnaires such as Epworth Sleepiness Scale (ESS) [,]. However, these data do not include the broader clinical context. Indeed, since OSA is a heterogeneous pathological condition, relying exclusively on CPAP-derived parameters could overlook important features such as symptoms, comorbidities and individual patient characteristics and could limit the ability to personalize treatment. At the same time, new digital technologies such as telemedicine, telemonitoring and artificial intelligence are rapidly growing in the OSA landscape. These tools enable remote data collection, early identification of treatment-related issues and patient adherence difficulties []. These tools thus appear to improve treatment adherence and optimize healthcare resources []. However, they have not yet been incorporated into actual clinical practice protocols.