bluuebunny/crossref_metadata_2025 huggingface dataset:
375 Thought Control Strategies and Insomnia Severity in young-adult urban residing African Americans
Authors: Stokes Alicia , Bell Kimberly , Mellman Thomas
Published: May 2021

Introduction

Poor sleep is common in our society, particularly for African Americans. Unwanted, intrusive thoughts at bedtime contribute to sleep disturbances, and the nature of intrusive thoughts may be influenced by perception of threat among people living in stressful urban environments. Research has suggested that strategies to control intrusive thoughts vary in their adaptiveness and may be modifiable. These findings need to be confirmed in populations residing in stressful urban environments where perceived threats contribute to intrusive thoughts.The present study attempts to replicate prior research examining the relationship between thought control strategies and insomnia in urban residing young-adult African Americans.

Methods

Sixty-three young-adult African Americans completed the Thought Control Questionnaire for Insomnia-Revised and the Insomnia Severity Index (ISI).

Results

Thought control strategies previously associated with insomnia were significantly correlated with the ISI (aggressive suppression r=0.51, p<0.01 social avoidance r=0.32, p<.01, behavioral distraction r=0.386, p<0.01 and worry r=0.51, p<0.01). We did not find significant associations between the thought control strategy previously associated with healthy sleep and the ISI (cognitive distraction r= 0.20, p>0.05). In a grouped comparison between good sleepers and those with insomnia worry was the only subscale that was endorsed significantly greater among those with insomnia (t(61)=-2.91, p<.05)

Conclusion

These preliminary data replicate prior findings that suggest that aggressive suppression and worry are maladaptive thought control strategies. in a young-adult African American sample. Future research with a larger sample is needed to identify strategies that can improve sleep in this population.

Support (if any)

5R01HL136626 from the National Heart Lung and Blood Institute
377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings
Authors: Godzik Cassandra , Sorscher Adam
Published: May 2021

Introduction

Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia.

Methods

We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months.

Results

Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%).

Conclusion

Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting.

Support (if any)

Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553
387 The moderating effect of emotion regulation strategies in the relationship between insomnia severity and bedtime procrastination
Authors: Jeon Huisu , Jeoung Sonhye , Kim Goeun , An Hyeyoung , Nam Hyojin , Suh Sooyeon
Published: May 2021

Introduction

Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, despite the absence of external factors. Bedtime procrastination is also prevalent among insomnia patients, and is associated with various sleep problems. Recent studies suggest emotional regulation as a mechanism of the procrastination behavior that is the conceptual foundation of bedtime procrastination. Emotional regulation difficulties are also associated with insomnia, but there is still a lack of research on the relationship between insomnia, emotional regulation strategies and bedtime procrastination. Thus, the study assumed that severity of insomnia would affect bedtime procrastination, and examined the moderating effect of the emotional regulation strategies in this relationship.

Methods

This study was conducted in 376 adults (mean age 23.73 ±2.14 years, 84.6% females). Participants were asked to answer Bedtime procrastination scale (BPS), an emotional regulation strategy checklist, and the Insomnia severity scale (ISI).

Results

As a result, a significant positive correlation was found between insomnia severity and bedtime procrastination (r=.286, p<.01), and avoidant/distractive regulation style (r=.101, p<.05). active regulation style (r=-.172, p<.01) and support seeking regulation style (r=-.102, p<.01) showed a significant negative correlation with the severity of insomnia. Bedtime procrastination behavior showed significant negative correlation only with active regulation style (r=-.151, p<.01). Support seeking regulation style moderated the relationship between insomnia and bedtime procrastination behavior (B=.0165, 95%, CI=.0014, .0316). The interaction effect between insomnia and support seeking regulation style was also significant (∆R^2=.0112, p<.05), indicating that the effect of insomnia on bedtime procrastination depends on the level of use of the support seeking regulation style.

Conclusion

These findings suggest that the level of support seeking regulation style is meaningful in terms of how insomnia affects bedtime procrastination.

Support (if any)

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea(NRF-2018S1A5A8026807)
389 The Association between Arousals and Neurochemical Biomarkers Accumulation in Obstructive Sleep Apnea with Low Arousal Threshold
Authors: Liu Yi-Shin , Tsai Cheng-Yu , Majumdar Arnab , Lin Shang-Yang , Lin Yin-Tzu , Ho Shu-Chuan , Cheng Wun-Hao , Liu Wen-Te , Wu Dean , Lee Hsin-Chien , Kuan Yi-Chun , Wu Cheng-Jung , Lo Chen-Chen
Published: May 2021

Introduction

Previous studies indicated the accumulation of neurodegenerative protein may be caused by higher Obstructive sleep apnea syndrome (OSAS) severity. However, the association between arousal-related parameters induced by OSAS and the amyloid burden remains unclear. The aim of this study is to investigate the association between arousal threshold (ArTH) and neurochemical protein accumulation in OSAS patients.

Methods

Suspected OSAS participants were performed Mini-mental status examination (MMSE) and full-night polysomnography (PSG) in the sleep center of Taipei Medical University Shuang Ho Hospital, Taiwan. On the same morning, the blood samples were obtained from the participants. The concentrations of total Tau (T-Tau) and amyloid beta peptide 42 (Aβ42) were quantified by ultra-sensitive immunomagnetic reduction assays. An overall of 23 participants were enrolled and classified into Low ArTH group (n=12) and High ArTH group (n=11) based on low ArTH criteria. Regarding the statistical methods, for categorical variables and continuous variables, Fisher’s exact test and Mann-Whitney U test were performed to investigate the differences between groups, respectively. The associations between biomarkers concentrations and PSG parameters were assessed by Spearman’s correlation.

Results

Regarding the demographic characteristics in two subgroups, significantly lower body-mass index and OSAS severity were noted in Low ArTH group (p<0.05). The MMSE was in normal range in both groups and had no significant differences in subgroups. For PSG parameters, there were significantly lower desaturation index, AHI and higher spontaneous arousals index in each sleep stage in Low ArTH group (p<0.01). Nevertheless, in the plasma neurochemical biomarkers, Aβ42 and Aβ42 X T-Tau were significantly higher in Low ArTH group (p<0.05). Moreover, in Low ArTH group, T-Tau was positively correlated with respiratory arousals index (r=0.61, p<0.05) and all arousals index (r=0.76, p<0.01), respectively. The positive correlations between Aβ42 X T-Tau and respiratory arousals index (r=0.62, p<0.05), all arousals index (r=0.75, p<0.01) could also be observed. There were no significant correlations noted in High ArTH group.

Conclusion

OSAS patients with low ArTH have higher neurochemical biomarker levels. Also, the significantly positive correlations between arousals and biomarkers were observed in that group.

Support (if any):
394 A convolutional neural networks model for the detection of cortical arousals from heart rate
Authors: Lockyer Brandon , Wellman Andrew , Zitting Kirsi-Marja
Published: May 2021

Introduction

Cortical arousals are transient events of disturbed sleep that occur frequently in sleep disordered breathing (SDB) and can be used as an indicator of sleep quality. While cortical arousals are typically scored from the electroencephalogram (EEG), arousals are associated with increased sympathetic activity and could therefore be detected from measures of sympathetic activity such as heart rate. Most home sleep test and consumer wearable devices enable continuous recording of heart rate via the electrocardiogram (ECG) or optical heart rate sensors without the inconvenience of EEG electrodes. In this preliminary study, we developed a deep learning-based convolutional neural networks (CNN) model to detect arousals from heart rate.

Methods

This study included 1,083 polysomnograms (PSGs) from five independent studies (Tucson Children’s Assessment of Sleep Apnea, Mechanisms of Pharyngeal Collapse in Sleep Apnea, Impact of the Arousal Threshold in Obstructive Sleep Apnea, Predicting Successful Sleep Apnea Treatment with Acetazolamide in Heart Failure Patients, Combination Therapy for the Treatment of Obstructive Sleep Apnea) that were scored for arousals according to American Academy of Sleep Medicine scoring rules. These studies included PSGs from both children and adults (ages 6 and above), with most data coming from participants with evidence or diagnosis of SDB. We used the Pan-Tomkins algorithm to detect R-peaks from the raw ECG signal, transformed the peaks into normalized instantaneous heart rate at 1 Hz frequency, and produced arousal probability in 1-second resolution using a simple CNN model. Due to slight asynchrony between the appearance of arousals in the EEG versus the heart rate, all overlaps between model-predicted arousals and manually scored arousals were considered true-positives.

Results

We evaluated the model on a validation set (n=216). The model achieved a gross area under precision-recall curve score of 0.67 and a gross area under receiver operating characteristics curve of 0.91 Correlation between the number of model-detected and manually scored arousal events was r=0.76.

Conclusion

This preliminary study demonstrates that a deep learning approach has the potential to accurately detect arousals in home sleep tests and consumer wearable devices that measure heart rate.

Support (if any)

The study was supported by grant #207-SR-19 from the American Academy of Sleep Medicine Foundation.
398 Agreement and reliability of a new respiratory event and arousal detection algorithm against multiple human scorers
Authors: Magalang Ulysses , Keenan Brendan , Staley Bethany , Ross Marco , Anderer Peter , Cerny Andreas , Vasko Raymond , Kuna Samuel , Bakker Jessie
Published: May 2021

Introduction

Scoring algorithms have the potential to increase polysomnography (PSG) scoring efficiency while also ensuring consistency and reproducibility. We sought to validate an updated event detection algorithm (Somnolyzer; Philips, Monroeville PA USA) against manual scoring, by analyzing a dataset we have previously used to report scoring variability across nine center-members of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC).

Methods

Fifteen PSGs collected at a single sleep clinic were scored independently by technologists at nine SAGIC centers located in six countries, and auto-scored with the algorithm. Arousals, apneas, and hypopneas were identified according to the American Academy of Sleep Medicine recommended criteria. We calculated the intraclass correlation coefficient (ICC) and performed a Bland-Altman analysis comparing the average manual- and auto-scored apnea-hypopnea index (AHI), arousal index (ArI), apneas, obstructive apneas, central apneas, mixed apneas, and hypopneas. We hypothesized that the values from auto-scoring would show good agreement and reliability when compared to the average across manual scorers.

Results

Participants contributing to the original dataset had a mean (SD) age of 47 (12) years, AHI of 24.7 (18.2) events/hour, and 80% were male. The ICCs (95% confidence interval) between average manual- and auto-scoring were almost perfect (ICC=0.80–1.00) for AHI [0.989 (0.968, 0.996)], ArI [0.897 (0.729, 0.964)], hypopneas [0.992 (0.978, 0.997)], total apneas [0.973 (0.924, 0.991)], and obstructive apneas [0.919 (0.781, 0.972)], and moderately reliable (ICC=0.40–0.60] for central [0.537 (0.069, 0.815)] and mixed [0.502 (0.021, 0.798)] apneas. Similarly, Bland-Altman analyses supported good agreement for event detection between techniques, with a mean difference (limits of agreement) of only 1.45 (-3.22, 6.12) events/hour for AHI, total apneas 5.2 (-23.9, 34.3), obstructive apneas 1.8 (-45.9, 49.5), central apneas 1.8 (-9.7, 13.4), mixed apneas 1.6 (-14.8, 17.9), and hypopneas 4.3 (-12.4, 20.9).

Conclusion

Results support almost perfect reliability between auto-scoring and manual scoring of AHI, ArI, hypopneas, total apneas, and obstructive apneas, as well as moderate reliability for central and mixed apneas. There was good agreement between methods, with small mean differences; wider limits of agreement for specific type of apneas did not affect accuracy of the overall AHI. Thus, the auto-scoring algorithm appears reliable for event detection.

Support (if any)

Philips
415 Risk of Obstructive Sleep Apnea after Treatment of Head and Neck Squamous Cell Carcinoma
Authors: Gavidia Ronald , Dunietz Galit Levi , O’Brien Louise , Schütz Sonja , Spector Matthew , Swiecicki Paul , Chervin Ronald
Published: May 2021

Introduction

Head and neck cancers (HNC) or their treatment may be associated with an increased risk of obstructive sleep apnea (OSA). Small studies that examined OSA risk factors in adults with HNC reported conflicting results. This study examined associations between tumor characteristics and risk of OSA among patients at least one year free of head and neck squamous cell carcinoma (HNSCC).

Methods

For this cross-sectional study of HNSCC patients at a large academic medical center, inclusion criteria were age ≥18 years, with absence of tracheostomy or mental impairment. The STOP-BANG questionnaire, with a threshold ≥3, was used to identify high risk for OSA. Descriptive statistics were used to compare demographic and health characteristics between OSA risk groups. Logistic and linear regression models adjusted for age and gender were used to examine associations between demographics, anthropometric measures, and OSA risk.

Results

Among 67 participants, 57 (85%) were male, mean age was 62.0±8.0 (s.d.) years, mean body mass index (BMI) was 28.7±4.6 Kg/m2, and mean neck circumference (NC) was 16.3±1.2 inches. A total of 50 (75%) participants received chemoradiation only. High OSA risk was observed in 40 (60%) of the participants. Tumor location, tumor stage, and type of cancer treatment were not different between OSA risk groups. Body mass index and NC were greater in the high OSA risk group (BMI 29.6±4.5 Kg/m2 vs. 27.3±4.1 Kg/m2, p=0.03; NC 16.5±1.3 inches vs. 15.8±0.5 inches, p=0.01). In age and gender-adjusted logistic regression models, BMI (OR=1.2, 95% CI 1.0, 1.4) and NC (OR=2.9, 95% CI 1.1, 7.3) were associated with high OSA risk. Adjusted linear regression models showed that BMI (β=0.10, 95%CI 0.04, 0.17) and NC (β=0.64, 95%CI 0.32, 0.96) were associated with STOP-BANG scores.

Conclusion

High OSA risk was quite common after HNSCC treatment. However, measured HNSCC characteristics were not different between high and low OSA risk groups. Instead, OSA risk factors included BMI and NC, as often reported in non-HNSCC patients as well. Prospective studies before and after cancer treatment will be needed to further elucidate potential roles of HNSCC and its treatment in subsequent OSA incidence.

Support (if any)

Dr. Gavidia’s work was supported by an NIH/NINDS T32-NS007222 grant.
418 The Berlin Questionnaire in Pregnancy Predominantly Identifies Obesity
Authors: O’Brien Louise , Levine Rivkah , Dunietz Galit Levi
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, it performs poorly in this population, likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity-related. Therefore, this study examined associations between each of the three BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP).

Methods

Pregnant third-trimester women aged at least 18 years with a single fetus were recruited from a tertiary medical center. All women completed the BQ, which includes three domains: snoring; sleepiness; and obesity/high blood pressure (BMI/BP). The latter domain was further examined as two separate sub-domains: obesity or chronic hypertension. A positive response in 2-of-3 domains identifies high OSA risk. Medical records were accessed for diagnoses of GDM and HDP.

Results

Of 1,588 women, 44% had a positive BQ. Women with positive domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk of GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the BMI/BP domain had increased odds of GDM (OR 2.0, 95%CI 1.3–3.3) and HDP (OR 2.9, 95%CI 1.6–5.5). Any positive score in domain combinations that included BMI/BP had increased odds of GDM and HDP compared with negative scores in all domains. A positive score in BMI/BP-alone, BMI/BP-and-sleepiness, BMI/BP-and-snoring, and an intersection of all three domains, had increased HDP odds compared with controls: OR 2.9 (95%CI 1.6–5.5), OR 2.2 (95%CI 1.1–4.4), OR 2.9 (95%CI 1.5–5.7), and OR 4.6 (95%CI 2.6–8.6), respectively. Women absent of positive BMI/BP domain but with a positive score in the other two domains (or their combination) had similar odds of GDM and HDP as controls.

Conclusion

The poor performance of the BQ in screening for OSA risk in pregnant women may be attributed to its predominant reliance on identification of obesity.

Support (if any)

NIH NHLBIHL089918
420 Evaluating the Rate of Referral for Obstructive Sleep Apnea in a Pre-Doctoral Dental Clinic Using the STOP-Bang Questionnaire
Authors: Guess Nathan , Fischbach Henry , Ni Andy , Firestone Allen
Published: May 2021

Introduction

The STOP-Bang Questionnaire is a validated instrument to assess an individual’s risk for obstructive sleep apnea (OSA). The prevalence of OSA is estimated at 20% in the US with only 20% of those individuals properly diagnosed. Dentists are being asked to screen and refer patients at high risk for OSA for definitive diagnosis and treatment. The aim of this study was to determine whether patients in a dental school student clinic who were identified as high-risk for OSA, were referred for evaluation of OSA.

Methods

All new patients over the age of 18 admitted to The Ohio State University - College of Dentistry complete an “Adult Medical History Form”. Included in this study were 21,312 patients admitted between July 2017 and March 2020. Data were extracted from the history form to determine the STOP-Bang Score for all patients: age, sex, BMI, self-reported snoring-, stopped breathing/choking/gasping while sleeping-, high blood pressure-, neck size over 17” (males) or 16” (females)-, and tiredness. Each positive response is a point, for a maximum of 8 points possible. Additionally, any previous diagnosis of sleep apnea, and the patient’s history of referrals were extracted from the health record. According to clinic policy, if the patient did not have a previous diagnosis for OSA noted in the health history, and scored 5 or more on the STOP-Bang Questionnaire, they should receive a referral for an evaluation for OSA. Notes and referral forms were reviewed to determine if the appropriate referrals occurred for patients at high risk without a previous diagnosis.

Results

Of the 21,312 patients screened; 1098 (5.2%) screened high-risk for OSA, of which 398 had no previous diagnosis of OSA. Of these 398 patients, none (0%) had referrals for further evaluation for OSA.

Conclusion

The rate of appropriate referrals from a student dental clinic with an electronic health record was unacceptably low. Continued education and changes to the electronic health record are needed to ensure those at high-risk for OSA are appropriately referred and managed.

Support (if any):
424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy
Authors: Bazalakova Mihaela , Wiedmer Abigail , Rice Lauren , Bajaj Sakshi , Jacobson Natalie , Antony Kathleen
Published: May 2021

Introduction

Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals.

Methods

We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing.

Results

The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing.

Conclusion

We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy.

Support (if any)

None
427 Comparison of PAP Interface Pressure on the Nasal Bridge: Soft Cloth vs. Traditional Masks
Authors: Anastasi Matthew , Pasquale Maria , Tubbs Andrew
Published: May 2021

Introduction

Pressure between a CPAP mask and the skin is a significant contributor to irritation and pressure ulcers, an area of localized soft tissue ischemic necrosis caused by prolonged pressure over bony prominences that exceeds supra capillary pressure (70 mmHg). We hypothesized that cloth masks (CM) would exert a lower nasal bridge pressure than traditional mask (TM) products constructed of silicone and plastic.

Methods

We evaluated the pressure exerted by seven types of nasal masks in three trials onto the nasal bridge of two healthy adult volunteers, one female, one male, while they received 10 cm H₂O of CPAP. Five commercially available CMs (SleepWeaver® 3D, SleepWeaver® Advance Pediatric, SleepWeaver® Élan, and SleepWeaver® Prevent, Circadiance®, LLC) were tested as were three TMs constructed primarily of silicone and plastic (DreamWisp™, Philips Respironics, Inc.; Mirage™, ResMed; Zest™, Fisher & Paykel Healthcare). Pressure was detected using a texsens®-g low pressure sensor force measuring device. Pressure data from each 30 second trial were summarized as the median value after confirming that pressure did not vary by time (one-way ANOVA, p = 0.7393). Median values were then compared across trials, subjects, and masks using one-way ANOVAs and student’s t-tests.

Results

After confirming that pressure did not vary by trial (one-way ANOVA, p=0.4585) or subject (t-test, p=0.0938), pressure data were summarized by mask. On average, CMs exerted 37.0 (17.7) mmHg of nasal bridge pressure, although there was significant variation across masks (one-way ANOVA, p < 0.0001). Conversely, TMs averaged 112 (38.5) mmHg of nasal bridge pressure without significant variation across masks (one-way ANOVA, p=0.1291). CMs averaged 75.26 mmHg less pressure than TMs (p < 0.0001), a difference of 67 percent.

Conclusion

The data supports the hypothesis that pressure from CMs on the bridge of the nose are significantly lower than a sample of TMs with similar shape and style, and the null hypothesis was rejected. Furthermore, the average CM was below the threshold for capillary closing, in contrast to the average TM. Therefore, for CPAP users with predicted or existing skin sensitivity, comfort and/or compliance concerns, CM should be considered as a first choice in mask selection.

Support (if any):
431 Outcome of Positive Airway Pressure Therapy Combined with Telemonitoring in Patients with Obstructive Sleep Apnea Syndrome
Authors: Panjapornpon Kanlaya , Luekitinun Narumol , Luengwattanakit Puncharat , Denthet Manatsanan , Wonsa-Ardsakul Tanadol , Tongkien Wanlana , Pungtaway Sunsanee , na Mahasarakam Siwaporn Pawaphutanon , Singpeam Rungridee , Pinthong Pairaya
Published: May 2021

Introduction

The rate of positive airway pressure (PAP) adherences in obstructive sleep apnea (OSA) patients with PAP therapy has remains persistently low. Telemonitoring is a promising wireless technology to early detect of usage trouble and solve them simultaneously. We compare PAP compliance, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-10), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients with PAP therapy for 12 weeks between telemonitoring and protocol-based groups.

Methods

This is a prospective simple randomization (1:1) study, allocated into the telemonitoring and protocol-based groups, at Central Chest Institute of Thailand since June to November 2020. We recruited adult patients, who underwent split-night polysomnography (PSG), met diagnostic criteria of OSA by ICSD-3 and achieved optimal or good pressure. Demographics data, physiological sleep parameters and differences between groups were analyzed by using descriptive, paired t-test, and ANOVA.

Results

A total of ten OSA patients with PAP therapy were attended. Baseline characteristics between groups were compared, and it is apparent that among telemonitoring and protocol-based groups, most patients were male (60% in each group), the average age of patients were (45.60 ± 9.86 vs 41.60 ± 12.38, p = 0.588) years, body mass index (BMI) (24.66 ± 3.39 vs 30.21 ± 6.13, p = 0.114) km/m2, Epworth Sleepiness Scale (ESS) was (10.00 ± 2.92 vs 9.40 ± 3.57, p = 0.779), apnea-hypopnea index (AHI) of (60.06 ± 31.08 vs 77.98 ± 43.17, p = 0.473) events/hour, and PAP pressure usage (10.20 ± 3.71 vs 10.00 ± 3.67, p = 0.933) cmH2O. There was no significant difference between groups in clinical parameters, sleep questionnaires and PAP compliance of obstructive sleep apnea (OSA) patients with PAP therapy for 12 weeks. However, in telemonitoring group, PSQI compared among baseline, fourth and twelfth week were significantly improved (7.60 ± 2.71 vs 5.00 ± 2.00 vs 4.00 ± 1.00 respectively, p = 0.041).

Conclusion

Using telemonitoring-guided intervention causes significantly improved in Pittsburgh Sleep Quality Index in severe obstructive sleep apnea patients with PAP therapy for 12 weeks. There was no significant difference in PAP compliance between telemonitoring and protocol-based groups.

Support (if any):
442 Feasibility of a Sleep Technologist Driven Intervention Protocol to Address CPAP Adherence in Hospitalized Patients
Authors: Cheng Shan , Rivera Elizabeth , Beauchamp William , Cabral Laiheng , Calero Karel , Nallu Sagarika , Holderman Deborah , Schoonover Doris , Johnson Linda , Anderson William
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) is associated with development of high blood pressure, diabetes, pulmonary hypertension, heart attack, stroke, atrial fibrillation, motor vehicle accidents, and death. These comorbidities may result in hospital admissions. Much of the therapy has been directed towards outpatient treatment with CPAP. Unfortunately, patient adherence to CPAP therapy is not optimal. We conducted a feasibility study to determine if a sleep technologist driven intervention protocol could address CPAP adherence in hospitalized patients.

Methods

Tampa General Hospital Sleep Center developed a quality improvement protocol that would address inadequate CPAP adherence. The components include: 1. Education on the cause and need for treatment of OSA based on comorbidities, 2. Choosing a patient preferred mask, 3. Mask desensitization while awake. These criteria were used to test the feasibility of implementing this protocol in hospitalized patients: 1. Completion of the protocol within 48 hours of receiving a consult, 2. Implementation of various components of the protocol, 3. Obtaining outcome measures to evaluate efficacy. Outcome measures include patient willingness to retry CPAP (on a scale from 0–10) and CPAP smartcard download. Additional outcome data included: patient reasoning for CPAP noncompliance and self-administered questionnaires (ESS, ISI, GAD-7, PHQ-9, SF-26).

Results

During November 2020, 31 inpatient consults were placed to the TGH Sleep Center. Within 48 hours of consult, the technologists implemented the protocol in 19 patients – 17 received mask fittings, 3 received education, and 3 had CPAP setting adjustments. 9 patients indicated their willingness to retry CPAP with an average rating of 9.1. 7 compliance downloads were obtained the following morning and usage ranged from 0:52 to 11:07 hours. 12 consults were not completed due to not meeting inclusion criteria (5), patient refusal (4), or other reasons (3).

Conclusion

This study demonstrates feasibility of a sleep technologist driven intervention protocol to address CPAP adherence in hospitalized patients. However, there were inconsistencies in protocol execution and obtaining outcome measures. We speculate that protocol improvement will require: 1. More consistent patient education, 2. Better correction of patient specific adherence issues, 3. Obtaining all smartcard downloads, 4. Compiling outcome measures using a convenient digital interface.

Support (if any):
443 Intervention Among PAP Users Newly Diagnosed with OSA Improves Long-term Adherence in Veterans with Sleep Apnea and PTSD
Authors: Gretler Julie , Noland Madeline , Jocson Valerie Alipio , Chen Marcel , Dominguez Christopher , Hernandez Beatriz , Noda Art , Holty Jon-Erik , Kuschner Ware , Yesavage Jerome , Kinoshita Lisa
Published: May 2021

Introduction

Obstructive sleep apnea (OSA) and PTSD are commonly comorbid in veterans. While PAP is the first line treatment for sleep apnea, adherence is low among veterans (Collen et al, 2012). Studies have shown early adherence predicts later adherence (Budhiraja et al, 2007). The current study investigates the impact of intervention on PAP adherence over time.

Methods

Thirty-seven veterans with comorbid OSA and PTSD from VA Palo Alto clinics were randomly assigned to either cognitive behavioral therapy (CBT-OSA) or an education arm and also received usual treatment at VA or outside clinics. Twenty-six completed the study. Participants received weekly, individual visits during the first four weeks of PAP treatment, three subsequent quarterly booster sessions, and a final visit at 12 months. PAP data was downloaded at each time-point; prior PAP use was coded.

Results

Significant mean differences in mask-on time between treatment arms after weekly treatments (Kinoshita et al., 2020) were not maintained at 12 months. Linear mixed modeling showed weekly improvement in mean mask-on time (minutes) over the treatment period (Education: estimate = 13.7, SE = 3.2, 95% CI 7.3, 20.1; CBT-OSA: estimate = 11.4, SE = 3.6, 95% CI 4.3, 18.5); no significant difference between arms (estimate = -2.3, SE = 4.7, 95% CI -11.5, 6.9). Newly diagnosed participants had significantly higher mean mask-on time than prior-PAP users at the end of weekly treatments (F[1, 35] = 17.86, p < 0.001) and at 12-months (F[1, 24] = 19.60, p < 0.001). Average mask-on time following weekly treatments was significantly correlated with average mask-on time at 12-months (r = 0.75; p < 0.001).

Conclusion

Consistent with prior research, findings suggest that newly diagnosed individuals benefit from weekly individual treatments, regardless of type, and maintain higher mask-on times at 12 months relative to prior PAP users. Early intervention when starting PAP treatment is important to support adherence, especially in patients with comorbid PTSD, a barrier to adherence in the veteran population.

Support (if any)

RR&D Merit Grant, Department of Veterans Affairs (Grant Number 1I01RX001799-01A2); Sierra Pacific MIRECC
446 Acute effect of acetazolamide in high loop gain sleep apnea
Authors: Ni Yuenan , Thomas Robert
Published: May 2021

Introduction

Obstructive sleep apnea is a disease with different driver phenotypes, including high loop gain (HLG). Acetazolamide (AZT) reduces HLG through multiple mechanisms. The acute effect of AZT used during titration polysomnography in HLG sleep apnea (HLGSA, predominantly obstructive) is described here. HLGSA is a NREM-dominant disease.

Methods

HLGSA was identified by one or more of the following: 1) baseline or titration CAHI of 5 or more, baseline or titration periodic breathing, or high residual apnea on CPAP in the absence of large leak. Retrospective analysis of polysomnograms from patients with HLGSA who underwent a PAP titration study and took ATZ (125 or 250 mg) after a baseline component of PAP titration. A responder was defined as a minimum reduction of the AHI3% of 50%. Multivariable logistic regression model estimated responder predictors.

Results

Two hundred and thirty-six patients with a median age of 60 (50.25–68) years and 189 (80.1%) males, were included. 69 patients were given 125 mg ATZ and 157 patients took 250 mg after about 3 hours of initial drug-free titration. Compared to PAP alone, PAP plus ATZ reduced the breathing related arousal index (8.45[3.03–15.60] vs. 4.8[2.1–10.15], p<0.001), AHI3% (19.09[7.34–37.28] vs. 10.63[4.46–20.56], p<0.001), AHI4% (1.89[0.23–8.58] vs. 1.19 [0.42–4.70], p=0.001), RDI (24.01[10.55–41.46] vs. 13.55[7.24–25.66], p<0.001). ATZ minimally improved the Min SpO2 (90[87–92] vs. 91[88–92], p=0.014). 101 patients were responders. Multiple logistic regression analysis showed that the NREM AHI3% was the only predictor for responder status with ATZ exposure (OR 1.022, 95%CI [1.004–1.041], p=0.018)

Conclusion

ATZ acutely improves PAP efficacy in HLGSA. The NREM AHI3% is a predictor for the ATZ responders.

Support (if any)

This study was supported by American Academy of Sleep Medicine Foundation, category-I award to RJT
456 Esomeprazole Use in Upper Airway Stimulation Patients Associated with Lower Functional Threshold
Authors: Klug Theodore , Sagalow Emily , Ananth Ashwin , Huntley Colin , Boon Maurits
Published: May 2021

Introduction

Proton pump inhibitors (PPIs) are widely used for gastroesophageal reflux disease (GERD) despite possible side effects including increased susceptibility to infections, secondary hypergastrinemia, and incomplete absorption of micronutrients. Upper airway stimulation (UAS) surgery involves delivering an electrical impulse to the distal hypoglossal nerve for the management of obstructive sleep apnea.. The functional threshold (FT) is the minimum stimulation required to achieve bulk tongue motion. The minimum therapeutic amplitude (MTA) is the lowest voltage required to achieve clinical benefit during titration at postoperative attended overnight polysomnography. We sought to analyze the effect of perioperative PPI use upon patients who had undergone upper airway stimulation (UAS) surgery. We hypothesized that the ion transport-related effects of PPIs would impact the amplitude necessary for tongue protrusion (FT) and clinical benefit (MTA).

Methods

A retrospective chart review was conducted at a single tertiary care facility. Baseline demographic data, medication history, and comorbidities were collected from December 2014 through August 2019 on patients undergoing UAS surgery. Patients that were taking a PPI at the time of surgery and postoperatively were included.

Results

167 patients that underwent UAS surgery between 2014 – 2019 were studied. 74 patients were found to be taking a PPI perioperatively. Specifically, 38 patients were found to be on omeprazole, compared to 17 on pantoprazole, 13 on esomeprazole, 4 on lansoprazole, and 2 on rabeprazole. Overall, esomeprazole was a statistically significant predictor (p=0.0359) of a lower functional threshold amplitude: 1.58 mV in controls as compared to 2.09 mV for omeprazole, 2.12 mV for pantoprazole, 2.14 mV for lansoprazole, and 2.7 mV for rabeprazole. Use of PPI, while associated with lower FT voltage, was not a predictor of statistically significant changes in initial UAS minimum therapeutic amplitude settings.

Conclusion

The functional threshold amplitude for patients taking esomeprazole was significantly different compared to patients not on a PPI. However, the use of PPI overall was not a statistically significant predictor of initial difference in UAS mean therapeutic amplitude settings. Future studies examining tolerance of therapy and voltage changes over time in patients on proton-pump inhibitors are needed.

Support (if any):
457 The Impact of PAP Therapy on Hematocrit in OSA and Polycythemia: A Pilot Study
Authors: Jafri Mustafa , Rosa-Acosta Gabrielle , Martinez Jose Flores , Schofield Elizabeth , Wilkins Cy , Mulhall John , Tan Miranda
Published: May 2021

Introduction

Untreated polycythemia leads to complications including thrombosis. Obstructive sleep apnea (OSA) is commonly associated with secondary erythrocytosis, which testosterone therapy can perpetuate. Effects of positive airway pressure (PAP) on elevated hematocrit (HCT) is unknown. We hypothesize PAP adherence can reduce HCT in men with OSA and polycythemia.

Methods

Retrospective chart review of male outpatients with newly diagnosed OSA and HCT≥45% at or 3 months before polysomnography (PSG) was conducted. Intervention group consisted of patients initiating PAP for OSA. HCT within 6 months of PAP initiation and PSG were recorded for intervention and control groups, respectively. Primary endpoint was time-to-HCT reduction of HCT<50% plus 3% decrease. Cox proportional-hazards analysis was used to assess time-to-HCT response. Demographics, smoking history, testosterone administration, STOP-Bang score, AHI, and PAP compliance data were obtained. Patients excluded if PAP not indicated, or if PSG, PAP compliance, or repeat HCT were unavailable.

Results

41 men with OSA had HCT≥45%, of which 16 had HCT≥50%. Median age was 60 years and median BMI was 32 kg/m2. 28 started PAP. 21 met definition for PAP compliance within 6 months. Median AHI of intervention and control groups were 23 and 19 events/hr, respectively. Mean baseline HCT of both groups were 49 and 50, respectively. No significant difference in age, BMI, smoking history, testosterone therapy, and baseline HCT between both groups noted. 39% of intervention group exhibited HCT response at 1 or more longitudinal assessments, versus 38% of control. Intervention group had higher mean STOP-Bang than control (mean 5.9 vs. 4.6, p=0.01) and trended towards higher mean baseline AHI (27.4 vs. 19.0, p= 0.06). Time-to-event analysis controlling for STOP-Bang and AHI demonstrated PAP was not associated with time-to-HCT response (HR = 1.3, 95% CI = 0.4–4.4). In moderate-severe OSA patients, 40% of intervention group had HCT response compared to 14% of control, though difference was not significant (HR = 2.5, 95% CI = 0.3–20.0).

Conclusion

Moderate-severe OSA patients trended towards reduction in HCT with PAP, although not statistically significant. Testosterone administration did not affect HCT response to PAP in this cohort. Larger studies are required to determine HCT response to PAP in these patients.

Support (if any):
464 Long term effects of Continuous Positive Airway Pressure on the weight of Obstructive Sleep Apnea patients in the southeast USA
Authors: Joseph Carmel , Puthenveetil Noel , Joe Allen , Therattil Jaya
Published: May 2021

Introduction

Obesity has been linked to exacerbating Obstructive Sleep Apnea in patients. Paradoxically however, effective CPAP therapy has been noted to lead to weight increases even while improving hypersomnia and daytime neurocognitive functioning. Prior studies have demonstrated inconsistent results regarding weight changes while on CPAP therapy. Our study aims to clarify these inconsistencies and provide specific recommendations for CPAP compliant patients to prevent weight gain.

Methods

393 OSA patients were seen for multiple follow ups since initiation of CPAP therapy at a single center sleep clinic. Every visit their weight would be updated along with CPAP compliance. Data was assessed on 1 month, 6 month, and 12 month intervals. Exclusion criteria include diuretic use, diet/exercise additions, and discontinuation of CPAP therapy before the full observation window.

Results

Patients with long term use of their CPAP devices had an average increase of 2.68±11.29 lbs after a year. 233 participants gained weight (an average of 9.8±7.3 lbs) while 141 participants lost weight (an average of -8.5±7.2 lbs) with 19 participants showing no weight change. This weight change could be observed starting as early as one month after CPAP initiation.

Conclusion

CPAP therapy is most likely linked to a lasting increase in weight. Recommendations and patient education for OSA patients should be modified to include an exercise component (10,000 steps/day) and/or caloric restriction (2200 low carb diet) to offset this weight increase. Further study is needed to assess the impact such recommendations could have in long term OSA care beyond the southeast USA.

Support (if any)

Pulmonary Allergy & Sleep Center of Augusta
470 Maternal Habitual Snoring and Blood Pressure Trajectories in Pregnancy
Authors: Dunietz Galit Levi , Hao Wei , Shedden Kerby , Holzman Claudia , Chervin Ronald , Lisabeth Lynda , Treadwell Marjorie , O’Brien Louise
Published: May 2021

Introduction

Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic versus pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined.

Methods

In a cohort study of 1,305 pregnant women from a large Midwestern medical center, participants were asked about habitual snoring (≥3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic and BP data throughout pregnancy, systolic (SBP) and diastolic (DBP) were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories.

Results

Thirty percent of women reported snoring before pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Overall, women with pregnancy-onset snoring had higher mean SBP and DBP compared to those with chronic habitual snoring or controls (non-habitual snoring). In gestational week-specific comparisons with controls, SBP became significantly higher around 20 weeks’ gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. Pairwise mean differences in DBP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks’ gestation.

Conclusion

In a large cohort of pregnant women, those with pregnancy-onset or chronic habitual snoring had significantly elevated systolic BP in comparison to non-habitual snoring controls, in the second and third trimester, respectively. The findings of divergent BP trajectories suggest the two groups of women with habitual snoring in pregnancy should be considered separately when evaluating gestational ‘windows’ for increased BP monitoring and provide insight into pathophysiologic changes.

Support (if any)

Dr. Dunietz was supported by an F32 National Research Service Award from the National Institute of Child Health and Development (NIH/NICHD F32 HD091938); Dr. O’Brien was supported by the following during the course of this study: the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grants UL1RR024986 and UL1TR000433, MICHR seed pilot grant F021024, the National Heart, Lung, and Blood Institute (R21 HL089918 and K23 HL095739) and in part by R21 HL087819.