bluuebunny/crossref_metadata_2025 huggingface dataset:
0409 Is insomnia with objective short sleep duration related to insufficient sleep drive or physiological hyperarousal?
Authors: Yang Chien-Ming , Huang Ya-Chuan , Kao Yu-Hsuan , Lee Hsin-Chien
Published: May 2023

Introduction

IInsomnia with objective short sleep duration (OSSD) was found to be associated with higher risks of cardiometabolic disorders, and was therefore proposed to be a phenotype associated with higher physiological hyperarousal. Previous studies further reported that insomnia with OSSD had higher autonomic arousal as measured by heart rate variability (HRV) during sleep. Since sleep duration could be determined by the interplay of arousal and sleep drive and HRV during sleep could be influenced by sleep staging and quality, the present study examined the level of arousal and sleep drive prior to sleep with EEG power and HRV to further understand the phenotyping of insomnia.

Methods

Ninety-four insomnia patients participated in the study and went through one night of 8-hour PSG recording. They were divided, with a cut-off of PSG total sleep time of 6 hours, into two groups: an OSSD group (N=26; mean age=37.0 ±10.3; M:F=7:19; TST=286.21±87.21 min) and an objective normal sleep duration (ONSD) group (N=68, mean age=32.95 ±10.05, M:F=12: 56, TST=414.4±28.9 min). Resting-state EEG and EKG were recorded for a 6-min period, 3-min eye-opened (EO) with fixation focus and 3 mins eye-closed (EC), prior to bedtime.

Results

T-tests showed no significant difference in HRV measures (SDNN, RMSD, LF, HF, LF/HF) between the two groups, but shorter R-R interval for OSSD group than ONSD group. Mann-Whitney tests for EEG power showed significantly lower theta power at F3, F4, C3, C4, and O2, and higher sigma power at F3, C3, C4, O1, and O2 during EC, as well as lower theta power at C3 and higher sigma power at O2 during EO for OSSD group in comparison to ONSD group.

Conclusion

The results partially support that insomnia with OSSD is associated with physiological hyperarousal as indicated by faster heart rate and higher high frequency EEG power prior to sleep. However, the lower EEG theta power prior to sleep suggest that lower homeostatic sleep drive may also play a role for the insomnia with short objective sleep duration.

Support (if any)

Supported by Taiwan National Science and Technology Council
0410 Lavender essential oil and sleep hygiene as therapeutic options for insomniac postmenopausal women: a randomized clinical trial
Authors: Hachul Helena , Lucena Leandro , Santos-Junior Jair , Tufik Sergio
Published: May 2023

Introduction

Menopausal transition and postmenopause often bring sleep complaints and insomnia, a common sleep disorder. In addition, women at this stage also experience vasomotor symptoms, which can compromise sleep maintenance and quality of life. This study aimed to observe the effect of an intervention with aromatherapy and sleep hygiene in the quality of life, self-related sleep pattern and hot flashes record in postmenopausal women with insomnia diagnosis.

Methods

This pilot study is a double-blind randomized clinical trial. Of the 135 women interested in participating in the study, 34 postmenopausal women met the inclusion criteria and completed the protocol. Volunteers were clinically diagnosed with insomnia and distributed in two groups: Aroma Group (Lavandula angustifolia essential oil) (n=17) and Placebo Group (sunflower oil) (n=17), both inhaled before bedtime for 29 days. The groups received sleep hygiene guidelines and were monitored weekly. To assess the effect of the intervention, the Menopause-Specific Quality-of-Life Questionnaire, intervention version (MENQOL-I), and Epworth Sleepiness Scale (ESS) were used. With data from the sleep diary, we evaluated sleep onset latency (SLO), total sleep time (TST) and sleep efficiency (SE) daily. Additionally, participants who complained of vasomotor symptoms were invited to fill out a hot flashes form, reporting the presence or absence of these symptoms, daily amount, and its intensity.

Results

The therapeutic approaches in this study benefited participants in both groups in almost all domains of quality of life and self-rated sleep patterns such as TST and SE. Particularly, the lavender essential oil intervention provided significant improvement in the overall quality of life score over time. No differences were observed considering the hot flashes record and sleepiness.

Conclusion

The aromatherapy intervention was effective in improving overall quality of life in the Aroma group. Furthermore, strategies such as sleep hygiene and a sleep diary helped participants to self-assess their sleep routine and improve it.

Support (if any)

This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, and Conselho Nacional de Pesquisa (CNPq). Laszlo (essential oils, books, foods, and aromatherapy products) donated the necessary oils for this project.
0416 Preliminary Study of the Effects of Continuous Theta Burst Stimulation of the Default Mode Network on Subjective Sleepiness
Authors: Franca Gabriela , Hildebrand Lindsey , Jankowski Samantha , Henderson-Arredondo Kymberly , Trapani Christopher , Reich-Fuhrer Melissa , Patel Salma , Chen Yu-Chin , Chou Ying-Hui , Dailey Natalie , Killgore William
Published: May 2023

Introduction

Repetitive transcranial Magnetic Stimulation (rTMS) is a noninvasive intervention commonly used to treat clinical depression by modulating brain activity in specific regions. We investigated rTMS of the default mode network (DMN) as a potential treatment for insomnia. The DMN is associated with internally focused cognition and rumination. Therefore, we expected that modulation of this network would improve sleep. As reported elsewhere, this trial showed that active cTBS to the DMN improved polysomnographically (PSG) measured sleep. Here, we hypothesized that participants who were treated with active continuous theta burst stimulation (cTBS) rTMS over the DMN versus sham cTBS would report reduced subjective sleepiness following post-treatment sleep.

Methods

Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants completed two overnight visits; one where they received active cTBS treatment and one where they received sham TMS treatment. We analyzed the Karolinska Sleepiness Scale (KSS), which was administered six times throughout each visit. KSS 1-3 were administered prior to treatment and KSS 4-6 were post TMS treatment. We used a repeated measures ANOVA to analyze effects of TMS on reported daytime sleepiness.

Results

There was no main effect of condition on sleepiness score F(1,18 )=1.165, p=0.295, ηp 2=0.061. There was a significant interaction effect of condition and pre/post intervention on reported subjective sleepiness F(1,18)=3.079, p=0.013, ηp 2 = 0.146, although follow-up analyses did not reveal significant differences. Nonetheless, there was a continuous negative trend toward reduced sleepiness for post TMS administration after overnight sleep in active cTBS (M = 4.8, SD = 1.96) compared to the sham cTBS session (M = 5.2, SD = 1.91) (p = 0.366).

Conclusion

As reported elsewhere, this trial of a single administration of cTBS showed improved PSG sleep. Here we saw that there was no significant change in subjective sleepiness following a night of sleep with or without the trial of cTBS, but there was a nonsignificant trend toward declining sleepiness for the active cTBS group relative to the sham condition. This preliminary study is encouraging and suggests that further research into this approach is warranted.

Support (if any)

W81XWH2010173
0417 Pre-sleep wakefulness in patients with insomnia: heart rate variability during sleep onset
Authors: Ma Yan , Wayne Peter , Yeh Gloria
Published: May 2023

Introduction

Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. However, physiological alterations during the sleep onset period are not well-understood. We aimed to characterize heart rate variability (HRV) in patients with insomnia during sleep onset.

Methods

Using data from the Sleep Heart Health Study at National Sleep Research Resource, we conducted a secondary analysis exploring HRV during the sleep onset period (defined as the time between lights-off and sleep onset) in patients with insomnia (IS group; n = 68) and comorbid obstructive sleep apnea (IS + OSA group; n = 135), compared with normal sleep controls (NSC group; n = 122). Overall group differences were tested using ANOVA. Post-hoc pairwise comparisons were conducted using the least significant difference (LSD) tests.

Results

During sleep onset, mean heart rates of the IS group (74.4±15.0 beats/min) and IS+OSA group (72.6±11.5 beats/min) were both significantly higher than the NSC group (69.7±9.4 beats/min, p=0.007 and p=0.044 respectively). Both the IS and IS+OSA groups showed lower heart rate variability compared to the NSC group, with significant differences in both time and frequency domains of HRV analysis including SDNN (p=0.002), RMSSD (p=0.035), pNN20 (p< 0.001), pNN50 (p=0.008), LnLF (p< 0.001), LnHF (p< 0.001). For all these measures, IS+OSA group had lower HRV compared to the IS group, although differences were not significant. When controlling for age, gender and BMI, and compared to the NSC group, IS group had significantly higher heart rates (β=4.8, p=0.008), and the IS+OSA group had significantly lower pNN20 (β=-0.039, p=0.002), pNN50 (β=-0.031, p=0.017) and LnHF (β=0.007, p=0.007).

Conclusion

Patients with insomnia had lower vagal activity during the sleep onset period, reflected in higher heart rates and lower heart rate variability. Such altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress.

Support (if any)

This research project was made possible by a grant from the American Academy of Sleep Medicine Foundation (PI: Yan Ma). We acknowledge the National Sleep Research Resource as the resource through which the Data/Datasets were obtained.
0418 Racial disparities in patient engagement and treatment outcomes in digital cognitive behavioral therapy for insomnia
Authors: Ruprich Melissa , Bayoneto Alec , Kalmbach David , Cheng Philip , Reffi Anthony , Fellman-Couture Cynthia , Iqal Justin , Sagong Chaewon , Peterson Edward , Roth Thomas , Drake Christopher
Published: May 2023

Introduction

Cognitive behavioral therapy for insomnia (CBTI) is gold standard for insomnia care. However, recent data suggest Black CBTI patients may complete fewer sessions and experience poorer outcomes relative to white CBTI patients. The present study examined whether racial disparities in CBTI engagement mediated group differences in treatment outcomes on insomnia symptoms.

Methods

We conducted a secondary analysis of pretreatment and posttreatment data from 569 Black and white patients with clinical insomnia symptoms (Insomnia Severity Index [ISI] ≥ 15) who were randomized to digital CBTI in a large-scale RCT. Study outcomes included number of sessions completed (≥4 sessions considered an adequate dose) and insomnia symptoms (ISI).

Results

Black CBTI patients completed fewer CBTI session than white patients (M±SD: 2.81±2.36 vs 3.79±2.45; t(561)=4.06, p<.001). Consequently, Black patients were 1.53 times more likely than white patients to prematurely discontinue CBTI before receiving an adequate dose (premature discontinuation rates: 62.5% vs 40.7%, Χ2=19.28, p<.001). A multivariate linear regression showed that Black patients reported higher ISI scores than white patients after CBTI (b=1.28, p=.009) while controlling for pretreatment ISI (p=<.001). However, race became non-significant in the multivariate model (b=.55, p=.248) when sessions completed was entered as a predictor (b=-.60, p<.001). The PRODLIN method estimated the indirect to be αβ=2.27 with a 95% Confident Interval of 1.59 to 2.96, thereby supporting a significant mediation. We estimated that 55.5% of racial disparities in posttreatment ISI outcomes were mediated through group differences in number of sessions completed. Notably, posttreatment insomnia remission (ISI≤9) rates did not differ between Black and white patients (36.9% vs 39.6% remission, p=.613), whereas insomnia remission rates were nearly twice as high among CBTI patients who received an adequate dose relative to those who discontinued prematurely (46.7% vs 24.9% remission, Χ2=23.46, p<.001).

Conclusion

Black patients reported greater insomnia symptoms after CBTI relative to white patients, but these racial disparities in insomnia outcomes were largely attributable to lower rates of CBTI engagement among them. No racial disparities in CBTI outcomes were observed among those who completed ≥4 sessions. Enhancing treatment engagement among Black patients may improve dCBTI efficacy in this group.

Support (if any)

This RCT (NCT03322774) was supported by NIMH R01-MH122636.
0419 Sensitivity of ORP to classify individuals with insomnia based on subjective complaints
Authors: Bender Amy , Guadagni Veronica
Published: May 2023

Introduction

The diagnosis of insomnia is currently based on subjective complaints. Previous research has demonstrated limited benefits of polysomnography in improving diagnostic accuracy with no evident differences in sleep macro-architecture and traditional indices of sleep quality. In this study, we aimed to assess the ability of a novel index of sleep quality, the Odds Ratio Product (ORP), to correctly identify individuals with insomnia, based on subjective complaints.

Methods

We analyzed responses to a custom sleep survey from 510 participants (age 46.2±12.4; 229 females). We entered 13 outcomes to a principal component analysis (PCA). These included age, body mass index (BMI), Epworth Sleepiness Scale (ESS) scores, sex, questions about snoring, subjective hours of sleep, satisfaction with own sleep, movement symptoms, problems falling asleep, staying asleep and waking up early. Based on the correlations between the original outcomes, the PCA extracted 3 factors that were interpreted as 3 different phenotypes: 1) insomnia (e.g., sleep initiation and maintenance complaints, satisfaction with sleep, lower subjective sleep duration); 2) OSA (e.g., bed partner snoring complaints, snoring self-awareness, sleepiness, respiratory complaints); 3) movement disorder (e.g., movements, female, lower age, higher BMI). We then computed the pre-test probability of insomnia (factor 1 scores >80%) and conducted a series of ROC analyses to assess specificity of PSG indices traditionally used to evaluate the presence of insomnia, and of ORP metrics.

Results

The AUC values assessing the ability of ORP metrics to predict 80% pre-test probability of insomnia were: ORPwake (0.592, 95% CI 0.499-0.685), ORPNREM (0.465, 95% CI 0.362-0.558), ORPREM (0.542, 95% CI 0.447-0.636), and ORPTRT (0.567, 95% CI 0.475-0.659). When looking at traditional indices like total sleep time (TST), wake after sleep onset (WASO), and number of awakenings, the AUC values were 0.471 (95% CI 0.385-0.556), 0.612 (95% CI 0.528-0.697) and 0.509 (95% CI 0.421-0.597), respectively.

Conclusion

WASO, ORPwake and ORPTRT have the highest sensitivity to detect insomnia in participants with >80% pretest probability measured by subjective complaints. These analyses indicate the value of EEG metrics of sleep quality to correctly identify individuals with insomnia and the need to investigate both sleep and wake states.

Support (if any)
0422 The relationship between EEG spectral analysis and pre-sleep cognitive arousal in insomnia disorder
Authors: Dressle Raphael , Riemann Dieter , Spiegelhalder Kai , Frase Lukas , Perlis Michael , Feige Bernd
Published: May 2023

Introduction

The hyperarousal model suggests that insomnia is characterized by increased cortical, cognitive, and physiological arousal. However, the relationship between these domains of arousal remains insufficiently studied. The aim of the current observational study was to investigate pre-sleep cognitive arousal, cortical arousal during the night, and the relationship between these domains.

Methods

109 patients with insomnia disorder (ID) and 109 age-and gender matched healthy controls (GSC) were investigated on two sleep laboratory nights. As a measure of cortical arousal, EEG spectral power was analyzed during NREM and REM sleep. In addition, participants completed the Pre-Sleep Arousal Scale (PSAS), which consists of a subscale for cognitive arousal (PSAS-CA) and another subscale for self-reported somatic arousal (PSAS-SA). The relationship between the subscale scores and EEG spectral power was calculated by multivariate and univariate analyses of variance.

Results

The total sample consisted of 218 participants. ID patients had a mean age of 44.7 years (± 10.6 years) and GSC had a mean age of 44.4 years (± 12.6 years). Both groups consisted of 78 women and 31 men.During NREM and REM sleep, patients with ID showed significantly increased spectral power in the EEG gamma band (NREM: p < .001; REM: p = .002). In addition, patients with ID showed significantly increased scores on the PSAS-SA (ID: M = 12.4, SD = 4.4; GSC: M = 10.7, SD = 3.3; t(216) = 3.34, p = .001, d = 0.45) and the PSAS-CA (ID: M = 18.3, SD = 7.2; GSC: M = 10.6, SD = 2.9; t(216) = 10.33, p < .001, d = 1.40). The PSAS-CA score was significantly associated with increased NREM (p = .001) and REM gamma power (p = .004), whereas PSAS-SA was associated with significant decreases in NREM (p < .001) and REM gamma power (p = .001).

Conclusion

In line with our hypothesis, patients with ID showed increased cortical and cognitive arousal. Moreover, there was a relationship between pre-sleep cognitive arousal and high-frequency EEG activity during the night. This might suggest that the latter is caused (at least in part) by pre-sleep worry and rumination.

Support (if any)
0426 A real-world exploration of non-CPAP therapies for mild obstructive sleep apnea in the veteran population
Authors: Pillai Shanta , Jacobs Roberta , Starks Helene , He Ken , Mccall Catherine , Palen Brian , Sharma Rahul , Parsons Elizabeth
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is a common sleep disorder that is characterized by repetitive episodes of upper airway obstruction during sleep. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for OSA, but it is not always well-tolerated by patients. As a result, alternative treatment options for mild OSA have been investigated. This study aims to explore the usage of non-CPAP alternatives in the veteran population.

Methods

Informed consent was obtained from the participants. The desired target cohort included veterans newly diagnosed with mild obstructive sleep apnea (OSA) on home sleep study (HSAT) or primary snoring on polysomnography (PSG). Specifically, mild OSA was considered pAHI < 15, pRDI < 15, and ODI < 15 and primary snoring was diagnosed if snoring is a primary symptom on e-consult, technically adequate study and pAHI < 5 and pRDI < 5. During a one-week period, sleep medicine providers assigned to sleep study interpretations determined eligible veterans that met inclusion criteria. Veterans who had nocturnal hypoxemia (5% sleep time with saturation 88%), active home oxygen order, commercial driver, significant heart disease (e.g., heart failure, atrial fibrillation) or other sleep concern (parasomnia) were excluded from this study. Upon meeting selection criteria, eligible subjects were cosigned to nursing staff to discuss and choose non-CPAP treatment altervatives. A second point of contact was made 90 days later (T=90) to evaluate progress of the initial intervention. A standardized script was use for both communications.

Results

There were 62 subjects that were ultimately included in the study, of which 3 chose weight loss/lifestyle therapy, 5 chose positional therapy, 17 chose oral appliance, 19 chose nasal EPAP and 12 chose oral stimulator. Analysis of the treatment pathways is pending.

Conclusion

Data analysis is pending with conclusions to follow.

Support (if any)
0427 Airway Pressures Define Collapsibility of Specific Pharyngeal Sites of Obstruction during Drug-induced Sleep Endoscopy
Authors: Tangutur Akshay , Seay Everett , Thuler Eric , Parekh Manan , Dedhia Raj , Schwartz Alan
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal obstruction at one or more collapse sites. Multilevel collapse is a negative predictive factor for PAP-alternative surgical treatments. Pharyngeal manometry during drug-induced sleep endoscopy (DISE) permits an objective evaluation of anatomical obstruction sites and mechanisms, and may play a role in patient selection for PAP alternative therapies. We hypothesized that patients with multilevel collapse would have primary velopharyngeal collapse and secondary, downstream sites.

Methods

This prospective cohort of twenty consecutive patients with diagnosed OSA underwent DISE with nasal airflow monitoring and pharyngeal manometry. Two pressure catheters were placed at the (1) distal margin of the soft palate (Pus) and (2) retroepiglottic space (Pds). We sought to delineate site(s) of collapse by evaluating dissociations in airflow and air pressure during inspiratory flow limitation and/or complete obstruction. The primary site of collapse was defined by the initial segment at which inspiratory airflow and pressure dissociated (the critical pressure, Pcrit). Secondary site(s) were defined as the pressure at which the Pus and/or Pds signals subsequently dissociated (beyond the initial point of maximal flow).

Results

Twenty-one patients were evaluated of which signal quality and catheter placement in twenty were sufficient for analysis. Participants were elderly (58.3±14.3yrs, mean±SD), overweight (BMI 28.7±2. kg/m2), and had moderate-severe OSA (AHI 28.2±14.2 events/hour). Six patients had a single site of collapse, of which one was naso-palatal (Pcrit -2.6cmH2O) and five were infra-palatal (mean Pcrit -1.3cmH2O). In the patients with multilevel collapse (N=14), all had primary naso-palatal collapse (mean Pcrit 0.17±2.0cmH2O) and secondary infra-palatal sites of collapse (mean Pcrit -11.7±5.8cmH2O). Pcrit differed between the primary and secondary site by 11.9±6.5cmH2O (p< 0.01).

Conclusion

These findings suggest that single-site pharyngeal collapse is usually infra-palatal. In contrast, multilevel collapse is primarily due to velopharyngeal collapse with varying degrees of instability in downstream pharyngeal segments. When secondary infra-palatal sites readily collapse with minimal additional respiratory effort, laxity of the tongue and/or lateral walls may be strongly implicated in the pathogenesis of pharyngeal obstruction. Future studies can utilize pharyngomanometry to further target specific pharyngeal structures for OSA therapy.

Support (if any)

National Institutes of Health 1R01HL144859 (PIs: Schwartz, Dedhia)
0429 ASSOCIATION BETWEEN HEALTHCARE COSTS AND CONTINUOUS POSITIVE AIRWAY PRESSURE ADHERENCE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA
Authors: Kim Joseph , Hwang Dennis , Shi Jiaxiao M , Arguelles Jessica , Klimper Matthew T , Becker Kendra , Sekhon Anupamjeet , Zhang Jing , Sawyer Amy , An Jaejin
Published: May 2023

Introduction

The impact of positive airway pressure (PAP) therapy on healthcare cost among patients with obstructive sleep apnea (OSA) requires further exploration. This study evaluated the associations between PAP adherence and cost in a large integrated healthcare system.

Methods

The study included adult patients with OSA (apnea-hypopnea index (AHI) ≥5) with available PAP therapy data between 1/1/2015 to 8/31/2019 from Kaiser Permanente Southern California. We followed the identified patients from the date of highest AHI before PAP use (index) up to 2 years. Each patient had PAP usage and cost organized into 6-month intervals, and mean hours/night and cost was calculated for each interval. Patients were stratified into the following adherence groups: (a) high adherence (≥4 hours/night consistently across all intervals); (b) moderate adherence (2–3.9 hours/night or ≥4 hours/night in some but not all intervals); (c) low adherence (< 2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs associated with PAP adherence were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Stratified analyses based on age (< 65, ≥65 years) and AHI (< 15, ≥15) were conducted.

Results

A total of 25,700 patients (63.3% male; 41.6% with AHI ≥30) were included in the study. Among those, 53.2% (n=13,684) categorized as having low PAP adherence, 24.2% (n=6221) as moderate adherence, and 22.5% (n=5795) as high adherence. High adherence was associated with the lowest average multivariable adjusted 6-month healthcare cost ($3,586, 95% CI: $3,428, $3,745) compared with moderate ($4,035, 95% CI: $3,859, $4,211) and low ($4,232, 95% CI $4,110, $4,355) adherence. The cost differences between “high vs low” and “moderate vs low” adherence were $646 (p< 0.001) and $197 (p=0.050), respectively. The cost differences between “high vs low” adherence were $999 (p< 0.001) for those with ≥65 years and $657 (p< 0.001) for those with AHI ≥15.

Conclusion

Better PAP adherence was associated with significantly lower healthcare costs in patients with OSA although further understanding of the relationship is needed.

Support (if any)

KPSC Regional Research Committee Grant: KP-RRC-20210506.
0432 Estimating the Prevalence of Obesity Hypoventilation Syndrome in a Rural Appalachian Inpatient Cohort
Authors: Del Prado-Rico Christine , Seol Calvin , Olgers Kassandra , Sharma Sunil , Stansbury Robert , Pham Christopher
Published: May 2023

Introduction

Patients with Obstructive Sleep Apnea (OSA) and concomitant Obesity Hypoventilation Syndrome (OHS) have been shown to have excess morbidity and mortality and higher healthcare expenditure when compared with patients with OSA only. Despite this, OHS is typically underdiagnosed and untreated. These effects may be more pronounced in rural Appalachian patients in whom rates of obesity, cardiovascular disease, metabolic disease, smoking, and COPD exceed the national average, yet poverty and challenging geography undermine access to healthcare.

Methods

Eligible patients from Sept 2019-Jan 2022 were evaluated for sleep disordered breathing under our hospital sleep medicine program. These patients were screened using high-resolution pulse oximetry, or a portable Type III sleep testing device, or both. Their data was recorded onto our program registry and retrospectively analyzed.

Results

Of 1676 hospitalized patients evaluated through our hospital sleep medicine program, we determined that 1345 (80.2%) of patients had a BMI >/=30 kg/m2. Of these patients, 823 (49.1%) had an arterial or venous blood gas collected during screening. Excluding patients with other potential causes for hypercapnia, 178 (10.6%) met criteria for OHS. 119 (66.8% of this subgroup) met criteria for OSA/OHS, while 33% did not have OSA (AHI/ ODI< 5). Patients with OSA/OHS overlap in our cohort typically had mild OSA.

Conclusion

When compared estimates in urban populations, our cohort is underrepresented. As such, many more patients with potential OHS and OSA/OHS overlap are discharged home without any treatment or plan for follow-up. One possible solution is suggested by the fact that only 49.1% of our initial cohort had an arterial or venous blood gas (ABG/VBG) collected during the admission. We recommend additional screening with serum bicarbonate and subsequent blood gases as part of an inpatient screening program for OSA/OHS. Early identification of these patients may facilitate early treatment while in-hospital and help reduce health disparity.

Support (if any)
0434 Long-Term Positive Airway Pressure Usage Disparities in Black or Hispanic of any Race Adults with OSA
Authors: Sawyer Amy , Mazzotti Diego , Keenan Brendan , Schutte-Rodin Sharon , Staley Beth , Schwab Richard , Maislin Greg , Kuna Samuel T , Watach Alexa , Bae Charles , Mowery Danielle , Saconi Bruno , Shi Jiaxiao M , Hwang Dennis , Pack Allan
Published: May 2023

Introduction

Black or African American and Hispanic of any race (B/H) adults are disproportionately affected by obstructive sleep apnea (OSA). Positive Airway Pressure (PAP) treatment may reduce disparities, but short-term PAP outcomes are worse among under-represented minority (URM) adults compared to other, mainly White, adults. No studies have examined if adherence disparities persist/worsen long-term. We evaluated disparities in PAP usage between B/H adults and other race/ethnicities.

Methods

We defined a clinical cohort of adults with moderate-severe OSA (apnea-hypopnea index [AHI]≥15 events/h) that underwent diagnostic sleep studies and initiated PAP between 01/2015-03/2018. Logistic regression was used to examine differences in the likelihood of still using PAP or meeting adherence threshold of ≥4 hours/night at 18-24 months. We performed mixed model for repeated measures to examine differences in h/night of PAP use over two years. Analyses were controlled for age, sex, BMI, AHI, and 3-month PAP usage to understand whether disparities emerged independent of short-term differences.

Results

Analyses included 1,518 individuals (694 [45.7%] B/H) with PAP usage at 3 months, who were middle-aged (53.4±14.1 years-old), majority men (64.4%), obese (38.2±9.8 kg/m2) and had severe OSA (46.6±30.2 events/h). B/H adults had 70% higher odds (OR [95% CI] = 1.70 [1.33-2.17]) of no longer using PAP 18-24 months after initiation. B/H adults using PAP had ~2 hours/night less usage than other race/ethnicities at 18-24 months (2.72 [2.49-2.97] vs. 4.52 [4.31-4.73] hours/night; p< 0.0001). This difference was attenuated but remained significant after accounting for 3-month usage (mean [95% CI] difference = -0.64 [-0.92, -0.37] hours/night). B/H adults using PAP were also 3-times more likely to be non-adherent at 18-24 months (OR [95% CI] = 3.00 [2.28-2.95]), and remained 2-times more likely to be non-adherent controlling for 3-month usage (2.14 [1.56-2.92]).

Conclusion

At 18-24 months, Black or Hispanic of any race adults with moderate-severe OSA were less likely to use PAP, had less usage when still using PAP, and were less likely to achieve adherence thresholds. Long-term PAP disparities exist, even after accounting for short-term differences. Promoting longer-term PAP adherence for URM is a priority to reduce these disparities and address healthcare inequities.

Support (if any)

AHA (20CDA35310360), NIH P01 HL094307, AHRQ K12HS026372
0438 Obstructive sleep apnoea in patients with stroke verses those with refractory hypertension search for common pathogenic mechanism
Authors: Gupta Anupama , Shukla Garima , Sharma Gautam , Roy Ambuj , Goyal Vinay , S Vivekanandhan , Bhargava Balram , Behari Madhuri
Published: May 2023

Introduction

Obstructive sleep apnea [OSA] is a risk factor for stroke and refractory hypertension [RH]. OSA causes disrupted sleep, intermittent hypoxia, and hypoxia-induced systemic inflammation and sympathetic activation are potential pathogenic mechanisms for the first ever stroke and refractory hypertension. The aim of the present study was to evaluate sleep quality among OSA among patients with first ever stroke, as compared to RH and to assess markers of sympathetic activation and systemic inflammation in patients with either stroke or RH.

Methods

All patients with stroke and RH were recruited from the Departments of Neurology and Cardiology, respectively at the All India Institute of Medical Sciences, New Delhi. All patients were interviewed for demographic details, clinical history and were scheduled for polysomnography. Fasting blood samples were collected during morning hours, to estimate biochemical markers [Norepinephrine, CRP, TNF-∞, VGEF and IL6] . CRP, TNF-alpha, and IL-6], measured by the chemiluminescence method. Nor-adrenaline and VEGF were measured using ELISA techniques.

Results

A total of 114 stroke patients and 56 refractory hypertension patients were included. The prevalence of OSA among stroke and RH patients was found to be 86.85 and 81% respectively. The mean number of wake after sleep onset periods (WASOs) [45±19.22 vs 29.8±11.14, p< 0.01]was significantly higher in patients with stroke. REM AHI [240.04±24.65 vs 33.20±22.35, p< 0.01] was significantly higher in patients with RH.CRP and VEGF values were higher than normal, in both groups. The median value of early morning serum nor-adrenaline was higher in the RH group[407 (66.6-1000) vs 515 (240-1250), p = 0.05].

Conclusion

OSA is highly prevalent among the patients in both groups. Systemic inflammation is a common pathogenic mechanism linking OSA with RH and stroke, whereas early morning sympathetic activation appears significantly important in the pathogenesis of refractory hypertension.

Support (if any)

This study was funded by Indian council of Medical Research, New Delhi, India.
0441 Positive airway pressure therapy associated changes in ventricular repolarization in patients with heart failure
Authors: Patel Salma , Zareba Wojciech , Woosley Raymond , Perez Karolina , Xia Xiaojuan , Wendel Chris , Patel Imran , Miller Jerod , Quan Stuart , Parthasarathy Sairam
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is associated with prolonged ventricular repolarization at baseline that further increases during sleep when an apnea/hypopnea event occurs. Aggressive treatment of OSA with positive airway pressure therapy (PAP) may further prolong ventricular repolarization during apnea/hypopnea events particularly in patients with heart failure (HF). The goal of this study was to evaluate how ventricular repolarization changes during apnea/hypopnea events in patients with heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction and in those patients without HF.

Methods

Thirty patients with OSA in each of the following groups were randomly selected from a dataset of 2,817 patients: HFrEF, HFpEF and no HF failure. Overnight polysomographies (PSG) for these patients were reviewed and beat-to beat measurements during apnea/hypopnea events were obtained at baseline (without PAP) and on the highest PAP setting attempted. Fridericia’s heart rate corrections were used to calculate QTc. QT variability was measured as the standard deviation of QT intervals (SDQT).

Results

The electrocardiogram was analyzable for n=11 with HFrEF (age 71± 17 years , 91% male) , n=28 with HFpEF (age 71± 12 years , 43% male) and n=30 without HF (age 57± 12 years , 50% male). In those with HFrEF, the mean (SD) QTc increased from 442(12)ms to 452(13)ms and SDQT increased from 9(2) to 13 (2) from baseline to the highest level of PAP attempted. In those with HFpEF, the mean (SD) QTc decreased from 448 (8) to 436 (8) ms and SDQT increased from 10 (1) to 11 (1) from baseline to the highest level of PAP attempted. In those without HF, the mean (SD) QTc increased from 429(37) to 439(56) and SDQT was stable from 8(6) to 8(8) from baseline (no PAP) to the highest level of PAP attempted. There were significant differences noted between the groups in changes in QTc (p=0.002) and SDQT (p=0.048) on PAP when compared to baseline.

Conclusion

Patients with HFrEF had increases in both QTc and SDQT with PAP at high pressures placing them at greater risk for ventricular arrhythmias.

Support (if any)

AASM Foundation (203-JF-18), NIH (HL126140, 2L30HL154400-023), University of Arizona (5299903; 5833261; 4258021)
0442 Progress in the SUPRA Trial for the Treatment of CPAP-intolerant OSA patients: AHI and Safety
Authors: Strohl Kingman , Mehra Reena , Patel Sanjay , Pena-Orbea Ciythya , Bogan Richard , Magalang Ulysses
Published: May 2023

Introduction

An external collar with ~30cmH2O vacuum applied to the anterior neck can expand the oro- and naso-pharynx and improve Pcrit (Kato et al 2015- PMID: 25614595. The hypothesis of SUPRA (Study Using Negative Pressure to Reduce Apnea - NCT04861038) is that the self-contained vacuum device (aerSleep® II) can treat obstructive sleep apnea (OSA) in those unable to use CPAP.

Methods

Conducted at 15 sleep centers in the United States, CPAP–intolerant subjects meeting eligibility (age >18 yrs, BMI < 42, and an untreated AHI4% by Nox T3 HSAT of 15-50/hr) were fitted to one of three collar sizes. After a 7-day acclimatization trial, those that showed a >50% reduction in AHI4% to less than 20/hr (“Responders”) and accepted therapy agreed to 6 months of supervised treatment, with final assessments at 6 months. 7-day and 6-month end-points reported here are AHI and safety.

Results

Of screened subjects, 50.2% were excluded, most frequently due to baseline AHI being too high or, mostly, too low (72%). 110 subjects (59±SD11 years, 43% Female, 84% Caucasian) met study criteria. Following device acclimation, 28 (50%) did not meet 7-day pre-selected on-treatment AHI criteria. In 23 subjects (41%), AHI reduced from 26.6±8.5 to 8.1±5.6 (p=0.001), and these Responders differed from non-responders (AHI from 32.7±13.1 to 26.7±9.4, p=0.06) in regard to reductions in apneas and hypopneas and ODI; non-responders had converted to hypopneas. During the 6-month phase, 7 withdrew consent. In all, local irritation occurred in 29 instances in 28 participants, resolving with 1-3 days of discontinuation, and therapy resumed. Eight have completed 6 months without safety issues, and 7 continued to exceed AHI efficacy endpoints.

Conclusion

We conclude that the aerSleep II device, with current collar sizes and pressure, can reduce the AHI burden at 7 days and continues for 3-6 months without major safety concerns.

Support (if any)

Presented for the SUPRA Study Group, supported by Sommetrics Inc, San Diego CA
0443 Proposing a ‘projected apnea-hypopnea index (AHI)’ to mitigate intrinsic pitfalls of conventional AHI and testing its validity
Authors: Im SangHyuk , Lee Chang-Hoon , Im KyoungBin
Published: May 2023

Introduction

The night-to-night variability of apnea-hypopnea index (AHI) can be explained by the fact that a person with OSA tends to spend less time in supine position and potentially less REM sleep, during which obstructive events could be a lot worse than in the other form. The primary aim of this study is to propose and test a “projected AHI” (pAHI) with which AHI can be mathematically adjusted for sleep position and sleep stage spent in a night of recording.

Methods

Using mathematical modeling explained in a separate abstract, a final pAHI formula was generated from polysomnography data of 337 subjects who exhibited all four sleep-types [combination of REM vs NREM and supine (SUP) vs non-supine (nSUP)] in one overnight study. A confusion matrix was generated using cutoffs of (p)AHI of 5 and hypothesizing pAHI being the gold standard and AHI being the test. Among subjects with borderline results (AHI of 5±3), sleep-type time and sleep-type AHI were compared between 4 groups of the confusion matrix to test the validity of the pAHI model.

Results

Out of 337 subjects with all four sleep-types, 119 subjects with AHI of 5±3 were identified and classified into a confusion matrix of no-OSA (43 TN, 10 FP), and OSA (13 FN, 53 TP). Actual sleep-type AHIs were in the order of increasing pAHI (TN, FP, FN, TP): 15.3, 29.2, 32.0, 34.8 for REMSUP; 4.00, 4.53, 4.73, 9.40 for REMnSUP; 2.83, 2.87, 9.38, 10.0 for NREMSUP; 0.44, 0.1, 1.06, 1.98 for NREMnSUP. Sleep time parameters were significantly different between no-OSA and OSA groups only when pAHI was used for diagnosis: %REMSUP (9.32 vs 5.39, p = 0.000009), %REMnSUP (8.08 vs 11.31, p = 0.002), %NREMSUP (48.13 vs 36.53, p = 0.001). %NREMnSUP (34.46 vs 46.77, p = 0.0002).

Conclusion

Without having to repeat a sleep study, projected AHI, by taking the effect of sleep position and sleep stages into account, can produce an AHI that mitigates night-to-night variability stemming from position and stage differences between nights. Projected AHI can be particularly useful in interpreting a sleep study with a borderline AHI result.

Support (if any)
0444 Racial Differences in Positive Airway Pressure Requirements Amongst Obstructive Sleep Apnea Patients (The RACE-PAP Study)
Authors: Cai Yi , Parekh Manan , Rodin Julianna , Tangutur Akshay , Yu Jason , Keenan Brendan , Schwartz Alan , Dedhia Raj
Published: May 2023

Introduction

Prior studies of patients with obstructive sleep apnea (OSA) show racial differences in clinical presentation. When compared with White patients, Black patients present with more severe OSA and greater sleepiness. Racial differences in upper airway collapsibility could explain these differences. Here, we investigated whether mean positive airway pressure (PAP) levels, a clinically accessible measure of upper airway collapsibility, differed by race in a cohort of patients adherent to PAP.

Methods

We conducted a retrospective analysis of White and Black adults with OSA who were prescribed auto-adjusting PAP (aPAP) therapy at a single academic center between January 2018 and January 2020. The analysis included adherent patients (usage on >70% of nights for ≥4 hours per night) with well-controlled OSA (defined as ≥50% reduction in apnea-hypopnea index [AHI] on aPAP and residual AHI< 10). Mean PAP level was compared between White and Black patients using linear regression controlled for age, gender, body mass index (BMI), AHI, O2 nadir, and mask type (full face, nasal, or unknown).

Results

Overall, 148 Black (56% women) and 230 White (36% women) patients were included. On average, Black patients were younger (50.7±14.6 vs. 53.8±12.7 years; p=0.037) with higher BMI (40.4±9.5 vs. 34.9±7.6 kg/m2; p< 0.0001). Black patients had less severe OSA on average, but this difference was not statistically significant (AHI of 33.9±25.5 vs 38.6±24.9 events/hour; p=0.077). After adjusting for covariates, Black patients had a 0.62 cm H2O (95% CI: 0.21 to 1.03) higher mean PAP level than White patients (p=0.003). There was a larger racial difference in mean PAP level among men (0.76 [0.16, 1.35] cm H2O; p=0.013) compared to a non-significant difference among women (0.34 [-0.23, 0.91] cm H2O; p=0.242). While statistically significant, differences were < 1 cm H2O and, thus, not clinically meaningful.

Conclusion

Black patients with OSA had a statistically significant but clinically insignificant difference in mean PAP level when compared with White patients. There was evidence of stronger differences in men than women. Further studies are needed to explore other potential mechanisms, including craniofacial anatomy, which may underlie racial differences in OSA presentation and outcomes.

Support (if any)

National Institutes of Health R01 1R01HL144859 (PIs: Schwartz, Dedhia)
0446 Sleep Disordered Breathing Treatment is Associated with Improved Mental Health Symptoms and Quality of Life in Women Veterans
Authors: Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Swistun Dominika , Erickson Alexander , Mitchell Michael , Josephson Karen , Lee Diane , Song Yeonsu , Fung Constance , Washington Donna , Yano Elizabeth , Zeidler Michelle , Alessi Cathy , Martin Jennifer
Published: May 2023

Introduction

Sleep disordered breathing (SDB) is associated with poor mental health and lower overall quality of life (QOL); however, research examining these outcomes after positive airway pressure (PAP) therapy for SDB in women is limited. We studied a 6-session PAP adherence program that included behavioral sleep improvement strategies plus concepts of Acceptance and Commitment Therapy (ACT) to promote sustained PAP use, and evaluated the impact of this ACT-based program on daytime and mental health symptoms and quality of life in a sample of women veterans with SDB who were prescribed PAP.

Methods

Women veterans with SDB (n=90, mean = 53.2 years [range 26-80]) receiving care in an urban VA healthcare system were randomly assigned to a “control” SDB/PAP education program or the “Acceptance and Behavioral Changes to treat Sleep Apnea” (ABC-SA) program. All received PAP therapy. Measures included: Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient-Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder Questionnaire 7-item (GAD), and The World Health Organization Quality of Life Scale, Brief (WHOQOL BREF). Mixed-effect models assessed the main effect of time across groups and between-group changes in these measures at post-treatment and 3 month-follow up compared to baseline.

Results

For the main effect of time, participants in both groups had significant improvements at post-treatment and 3-month follow-up in sleepiness, fatigue, depression, anxiety, and QOL (all p< 0.05). Compared to controls, women who received ABC-SA reported greater improvements in daytime sleepiness (ESS) at post treatment (p=0.04) and in fatigue (FFS) at 3-month follow-up (p=0.008).

Conclusion

PAP treatment in women with SDB was associated with improvements in measures of mental health and QOL. There was some evidence of even greater benefits with ABC-SA. Further work is needed to understand the relationship between SDB treatment and improved mental health outcomes in women and other underrepresented populations.

Support (if any)

VA HSR&D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&D COIN; VAGLAHS GRECC and VA Office of Academic Affiliations
0456 Association of MOCA scores in individuals with Mild Cognitive Impairment-Alzheimer Disease and Obstructive Sleep Apnea
Authors: Khan Wahaaj , Pao Winnie , Mehra Reena
Published: May 2023

Introduction

Mild cognitive impairment (MCI) is considered a transitional stage between normal aging and dementia. Studies have demonstrated an association with rate of progression of MCI and dementia in individuals with OSA compared to those without OSA. The varying degree of hypoxia, sleep fragmentation and poor quality of sleep in OSA patients has been associated with increased risk of stroke, memory impairment, cardiac arrhythmias, dyslipidemia, hypertension, obesity and glucose intolerance. Identifying different variables in sleep study that can be linked with MCI and AD is helpful. We compared patients' MOCA score at the time of sleep study and compared it with multiple macro and micro variables tested on the sleep study.

Methods

Data was presented as mean ± (SD) or median [25th, 75th percentiles] for continuous variables and N (%) for categorical variables. Comparisons were performed between baseline MOCA groups (0-17 vs. 18-30) using two-sample T-test or Wilcoxon rank sum test for continuous variables based on distribution, and chi-square test or Fisher’s exact test for categorical variables. Linear regression was used to assess the relationship between baseline MOCA and sleep measures before and after adjustment for covariates. Covariates included age, gender, race, and BMI.

Results

Patients with smaller MOCA score were older (71.4 ± 8.7 vs. 68.1 ± 9.4, p=0.002), predominantly black (17.8% vs. 10.8%, p=0.013), weigh lower (median [IQR]: 80.5 [69.2, 94.0] vs. 86.2 [74.0, 99.0], p=0.023) and had less prevalence in ADHD, anxiety, depression, GERD and headache (p=0.034,0.024,0.013,0.016,0.040, respectively). After covariates adjustment (age, sex, race and BMI), when percent sleep time with SaO2< 90% increase 10%, MOCA would decrease 0.24 (coefficient -0.21, 95%CI [-0.41,-0.01], p=0.043); when SaO2 nadir increased 10%, MOCA would increase 0.68 (coefficient 0.68, 95%CI [0.05,1.32], p=0.035); when sleep stage %N1 increased 1%, MOCA would decrease 0.04 (coefficient -0.04, 95%CI [-0.08,-0.01], p=0.011).

Conclusion

Changes in oxygen levels during sleep showed direct correlation between MOCA score in individuals with MCI and AD, at the time of sleep study. Decline in MOCA scores were directly associated with degree of hypoxia observed during the sleep studies. The study showed association of worsening MCI and AD with lower oxygen levels in patients with OSA.

Support (if any)