bluuebunny/crossref_metadata_2025 huggingface dataset:
0527 Is Inpatient Polysomnography Associated with Limited Healthcare Access, and Economic and Social Deprivation?
Authors: Povitz Marcus , Nguyen Phuong Uyen , D'Souza Adam , Pendharkar Sachin , Kendzerska Tetyana
Published: April 2024

Introduction

In Alberta Canada care and funding models for sleep-disordered breathing (SDB) are fragmented, which may delay treatment particularly for socio-economically deprived individuals and contribute to the frequency and length of hospitalization. We assessed for economic and social deprivation as well as multimorbidity among adults undergoing diagnostic polysomnography (PSG) during hospitalization compared to age and sex-matched hospitalized and ambulatory controls.

Methods

In this retrospective health administrative data study, we included all individuals undergoing PSG during a hospitalization (SDB inpatients) from January 1, 2019, to December 31st, 2021, in a large, academic hospital-based sleep center in Calgary, Canada. We created time, age- and sex-matched control groups, each with a 2:1 ratio: 1) individuals referred to the sleep center (non-acute control); 2) hospitalized individuals who did not undergo PSG (acute control). Clinical records were linked to health administrative databases of routinely collected health variables, using validated algorithms to define comorbidities, social and economic deprivation, marginalization, and rurality. Between-group differences were assessed for statistical significance using paired analysis with a significance level of 0.05.

Results

We matched 275 individuals who underwent PSG during hospitalization with 550 acute and 550 non-acute controls. At baseline, SDB inpatients had greater health care utilization and a higher prevalence of comorbidities with a median [IQR] Charlson Comorbidity index of 3 [2, 5] vs 1 [0,3] for acute controls and 1 [0,2] for non-acute controls. Compared to the acute controls, SDB inpatients did not have higher rates of social deprivation or median marginalization (3 [2, 5] vs 3 [2,5]); however, they were more likely to be receiving social assistance (24% vs 12 %) and live in urban areas (88% vs 76%). Compared to non-acute control, SDB inpatients had a higher median rate of marginalization (3[2,5] vs 3[1,4]), lower median income (48925$ [38677,61632] vs 55252$ [44745,71310], and were more often receiving social assistance (24% vs. 14%).

Conclusion

SDB inpatients have a greater burden of multimorbidity and are more socially disadvantaged by several metrics. Follow-up studies are needed to determine if an earlier diagnosis could reduce the development of medical and social complications of untreated SDB.

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0528 Use of Inpatient Sleep Studies Decreases Time to Treatment in Patients with Obstructive Sleep Apnea (OSA)
Authors: Molin Nicole , Schonewald Brian , Lev Yair , Fast Zhanna
Published: April 2024

Introduction

OSA remains underdiagnosed in the general population and when left untreated, can have an effect on chronic illnesses including exacerbation of disease processes, potentially increasing hospitalization. The diagnosis of OSA in patients admitted to the hospital is important, however the time from hospital discharge to sleep study and then to OSA treatment can be prolonged. We aim to assess differences in outcomes between hospital admitted patients who undergo OSA workup during admission vs in the outpatient setting .

Methods

retrospective chart review with prospective component

Results

65 patients included all seen by sleep medicine service while admitted to the hospital and required workup for OSA; 57 received outpatient workup- 11/57 completed their sleep study (19%), all of which were prescribed PAP therapy for OSA. 2/57 (3.5%) had subsequent follow up by 6 months. Average time to diagnosis was 46 +/- 48 days and time to CPAP prescription was 56 +/- 53 days. 8 patients underwent inpatient OSA workup. All obtained a sleep study while in the hospital within 1 day of the consult; 6/8 were diagnosed with OSA all of which had the process started for CPAP set up within 2 days of sleep study. The time to diagnosis and start to treatment process was significantly less than the outpatient group (p< 0.05). We are currently collecting data on long term health outcomes for these patients.

Conclusion

Inpatient sleep studies for OSA work up has the potential to decrease time to OSA diagnosis and time to treatment for patients. This new workflow may have the potential to improve long term health outcomes.

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0530 Rem-dependent Obstructive Sleep Apnea: Prevalence, Associated Comorbidities and Polysomnographic Characteristics
Authors: Rosa Cintia Felicio Adriano , Boldt Marcela Souza , Borgio João Guilherme , Zanatta Alessandra , Passos Pedro Henrique Vicari , Soares Victor Henrique Dominiak , Alves Matheus Roberto Schetz , Minniti Enrico Guido Oliveira , Rosa Ordival Augusto
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) in the REM phase is a phenotype whose prevalence varies between 10% and 36% of patients with OSA, it is more common in women, especially those under 55 years of age. Characterized by muscle relaxation, sympathetic activation, hypoxemia and sleep deprivation, this type of OSA can increase metabolic and cardiovascular risks. This study seeks to understand, through a large population sample, how gender influences REM OSA and its relationships with other comorbidities and risk factors.

Methods

The study performed a retrospective epidemiological analysis on patients who underwent polysomnography type 1 between January and December 2020. Participants were grouped based on the presence of REM OSA or NREM OSA, considering female gender. REM-OSA was defined by an AHI ≥ 5, with the REM AHI being twice or more of the NREM AHI, with a NREM AHI < 15. Comorbidities such as hypertension, diabetes, among others, were identified through medical history. The analyzes used statistical tests such as correlations, Chi-square and Student's T test for different variables, with a significance level of 5%.

Results

The study involved 1,313 patients, 444 women and 869 men, with an average age of 47.28 years. The prevalence of REM OSA was 21.7%, women represented 50.7% of the sample. The average age of women in the REM OSA group was 48.8 years. BMI analysis showed a predominance of overweight and obesity. In the NREM OSA group, there was greater severity of apnea, associated with conditions such as obesity, hypertension and stroke, and a prolonged time with low saturation. On the contrary, the OSA-REM group showed less severity of apnea, fewer associations with comorbidities and distinct characteristics in REM sleep. However, the presence of diabetes was significantly higher in women with REM-OSA, regardless of AHI and age (9,10% versus 3,65% p 0,018).

Conclusion

The increased prevalence of diabetes in women subgroup witnh REM-OSA suggests potential implications and highlights the importance of evaluating both the presence of REM OSA and glycemic metabolism, even in female cohorts with less pronounced OSA.

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0531 Identifying Airway Collapse Patterns in OSA Using Nasal Pressure Signal as a Surrogate for Airflow Shape
Authors: Shum Axel , Pinto João Viana , Woodson B
Published: April 2024

Introduction

Identification of the site(s) and characteristics of upper airway collapse is important for treatment selection and optimization in patients with obstructive sleep apnea (OSA) for whom an alternative to PAP therapy is indicated. The most widely accepted approach to reliably evaluate the location and severity of upper airway collapse is through drug-induced sleep endoscopy (DISE). Analysis of airflow shapes has emerged as a potential future alternative to DISE. Specifically, prior investigations have identified associations between the contours of objective airflow measurements and DISE findings from simultaneous endoscopy. Since objective airflow measurements are not obtained during standard polysomnography, this study sought to evaluate for associations between DISE findings and nasal pressure measurements as a surrogate for airflow.

Methods

Nasal pressure measurements were obtained using a type III home sleep testing device during DISE for patients at a single institution as part of their workups for non-PAP therapy. Nasal pressure data were synchronized to endoscopic video recordings, and segments of airflow waveforms corresponding to specific DISE findings were visually screened.

Results

Twenty four adult study subjects with OSA were ultimately included in this investigation. Only a subset of previously-described airflow shape correlations were found to retain associations to DISE findings. Four airflow shape surrogates were found to consistently correlate with specific DISE findings. Findings that relied on flow amplitude were not able to be detected using other nasal pressure signal characteristics.

Conclusion

Nasal pressure signal shape has potential as a limited surrogate for airflow shape, and in this investigation it was found to retain associations to upper airway collapse patterns obtained via DISE in patients with OSA .

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0536 Patient Profiles and Treatment Patterns for Obstructive Sleep Apnea (OSA) in Germany: A Real-world Data Analysis
Authors: Shinde Shraddha , Lin Xiaoyu , Yin Can , Pettine Meghan , Adam Atif , Khare Swarna
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) impacts approximately 30% of 30–69-year-olds in Germany, however comprehensive real-world data on patient demographics, diagnostic pathway, and treatment patterns, remains limited. This study aims to analyze real-world data to characterize OSA patient profiles and their treatment journey within Germany.

Methods

Retrospective longitudinal analysis of German Statutory Health Insurance claims data, including 146,227 adults (≥18 years) diagnosed with OSA between 2012-2022. Data included patient demographics, clinical diagnoses, sleep study history, and treatments. Patients had a minimum six-month enrollment prior to OSA diagnosis or treatment.

Results

An analysis of 146,227 OSA-diagnosed patients reported a mean age of 58.6 years at the time of diagnosis, with males constituting 70.3% of this population. Although a majority had missing BMI data, among those recorded, approximately one-third had obesity category II-IV. Most common OSA-related comorbidities were hypertension, dyslipidemia, cardiovascular diseases, and type 2 diabetes. Majority underwent OSA diagnostic procedures like polygraphy (89.2%) and polysomnography (29.4%). Delving into treatment sequences for 84,246 patients, PAP emerged as the predominant initial therapy in 88% of patients. Alternatives like upper airway surgery (4.1%) and lifestyle modifications (0.8%) played a secondary role in the treatment landscape. Adherence patterns, evaluated among 74,605 patients on PAP therapy, showed that 95.7% were non-adherent within 12 months post-initiation. Lastly, intervals between sleep studies, diagnosis, and treatment commencement were analyzed for 80,931 patients. On average, there was a 23.3-month gap from the initial sleep study to OSA diagnosis. However, the subsequent gap from diagnosis to treatment was shorter, averaging 8.2 months, hinting at improved efficiency in care post-diagnosis.

Conclusion

These results reveal a substantial burden of OSA , particularly in older males with metabolic comorbidities. While PAP therapy is the predominant initial treatment modality, its effectiveness is undermined by a high non-adherence rate within the first year of treatment. This high rate of non-adherence coupled with the lengthy diagnostic delays underscores critical unmet need in the current OSA treatment paradigm.

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0541 Impact of Sleep Apnea Treatment on Cardiometabolic Parameters in a Large National Multi-Center Alliance Registry
Authors: Cardenas Wendy , Davis Lisa , Patel Shachi , Kosiborod Mikhail , Magwire Melissa , Aistrope Daniel , Fialkow Jonathan , Iluyomade Adedapo , Walia Harneet
Published: April 2024

Introduction

There is paucity of real-world data regarding the association of Sleep Apnea (SA) treatment and cardiometabolic parameters. We examined the association of SA subgroup (CPAP vs. non-CPAP users) and cardiometabolic factors in the Cardiometabolic Center Alliance multi-center registry.

Methods

Out of 1575 patients, baseline characteristics of 683 patients with SA stratified by CPAP use were compared using Student’s t-tests/Wilcoxon rank-sum test for continuous variables and chi-square/Fisher’s exact tests for categorical variables. Logistic regression model was used to assess the association of CPAP-use and cardiometabolic factors (Hb A1c, systolic blood pressure and diastolic blood pressure (SBP and SDB mmHg)), Triglycerides (TG) and BMI in unadjusted (Model 1) and after adjusting for age, sex, ethnicity, race, BMI (Model 2) and cardiac co-morbidities, medications, and medication adherence (Model 3).

Results

Overall, median (IQR) age was 65 years (58.0-71.0). 683 (43 %) had sleep apnea, and of those 447 (65%) were CPAP-users. Median age of CPAP-users compared to non-users was 66 years (60-71) vs, 63 years (55.5-71), and they were more likely to be male (275 (61.5%) vs. 112 (52.8%)), and white (398 (89%) vs. 163 (76.9%) (all p < 0.05). Among CPAP users HbA1c, SBP, and DBP were 7.2% ± 1.5%, 128.2 ± 18.2, 72.9 ± 11.5; in non-CPAP users the corresponding values were 7.6% ± 1.9% (p=0.002), 131.1 ± 19.4 (p = 0.064), 76.0 ± 12.1 (p =0.002) respectively. Logistic regression showed that CPAP-use was associated with lower HbA1c (-0.31% (95% CI -0.59%, -0.04%), p =0.025) in Model 2 but not in Model 3 (-0.19% (95% CI -0.46%,0.08%), p=0.165). CPAP use was associated with lower SBP (-3.99 (95% CI -7.18, -0.8), p =0.014) and DBP (-2.52 (95% CI -4.45, -0.6), p=0.010) even after adjusting for multiple confounders in Model 3. Higher TG were observed (23.02 mg/dL (95% CI 1.03,45.01), p=0.04) in CPAP-users compared to non-CPAP users (Model 2). CPAP-users compared to non-users had higher BMI (1.14 (95% Cl 0.17, 2.65) p=0.026) Model 3.

Conclusion

In this multi-center registry of patients with cardiometabolic disease, sleep apnea was common, and CPAP use was associated with better control of several key risk factors.

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0545 Hypoglossal Nerve Stimulation: Does Higher Pre-Implantation PAP Pressure Result in Less Successful Outcomes?
Authors: Hodge Evan , Baran Caroline , Santiago Louis , Lee Ryan , Kaur Parampreet , Guglielmello Giuseppe , Narla Gowtham , Cohen David , Zheng Matthew , Ramzy Joseph
Published: April 2024

Introduction

Despite hypoglossal nerve stimulation (HNS) being an approved therapy for moderate to severe OSA, some patient’s do not have a favorable outcome despite meeting the inclusion criteria for the procedure. This study investigates whether higher pre-implantation optimal PAP pressure results in less successful HNS outcomes.

Methods

This is a single-center retrospective study of consecutive patients with moderate to severe OSA who underwent implantation of HNS at an academic medical center. The optimal pre-implantation pressure setting was derived from either PAP titration studies (optimal CPAP or EPAP pressure) or PAP therapy compliance reports (90th or 95th percentile CPAP pressure or 95th percentile EPAP pressure). Pre-implantation AHI was obtained from either a home sleep study or diagnostic sleep study. Post-implantation apnea/hypopnea index (AHI) was derived from polysomnography performed 3 months or later after device activation in all subjects. Success of HNS therapy was defined as either a reduction of the pre-implantation AHI by equal to or greater than 50% or a residual AHI < 15. A Mann-Whitney nonparametric test was used to compare the distribution of pre-implantation PAP pressure between successful and unsuccessful HNS therapy.

Results

Fifty-one patients with HNS implanted between December 2021 and July 2023 were evaluated. 74.7% were male with a median age of 65 years (25th percentile 57 and 75th percentile 72) and median body mass index (BMI) of 29.4 (25th percentile 27.2 and 75th percentile 31.6). Median BMI of the HNS success group was 29.4 (n = 45, 25th percentile 27.4 and 75th percentile 31.6) and median BMI of the HNS not success group was 30.0 (n = 6, 25th percentile 26.8 and 75th percentile 33.2). Median pre-implantation optimal PAP pressure of the HNS success group was 11.2 cm H2O (25th percentile 8.7 and 75th percentile 14.25). Median pre- implantation optimal PAP pressure of HNS not success group was 9.2 cm H2O (25th percentile 5.6 and 75th percentile 15.5). There was no significant difference between optimal pre- implantation PAP pressure and HNS outcome (p = 0.3).

Conclusion

There was no statistically significant difference between optimal pre-implantation PAP pressure and HNS outcome.

Support (if any)

none
0547 Vil-tra
Authors: Aishah Atqiya , Kim Molly , Norman Daniel , Ojile Joseph , Gell Laura , Pho Huy , Taranto-Montemurro Luigi , Vena Dan , Azarbarzin Ali , Esmaeili Neda , Wellman Andrew , Sands Scott , Messineo Ludovico
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) poses deleterious health consequences. Pharmacotherapy is a promising alternative to the current standard of care; recently, a combination of the noradrenergic atomoxetine, with the antimuscarinic aroxybutynin reduced OSA severity. Atomoxetine has also proven to be efficacious in combination with the anti-depressant trazodone. However, atomoxetine is wake-promoting especially in the subgroup of poor CYP2D6 metabolizers, which may contribute to apnea cycling and reduced drug tolerability. Therefore, we investigated the effect of a potentially more manageable noradrenergic, viloxazine, with and without trazodone, on OSA severity.

Methods

Twenty-five patients with OSA (apnea-hypopnea index [AHI4] 10-45) aged 18-75 years were randomized to viloxazine 500mg, viloxazine/trazodone 500/75mg or placebo according to a double-blind, placebo-controlled, crossover study. Drugs were taken before bed, for two weeks each period, with a first week of run-in (viloxazine 200mg and/or trazodone 50mg) and a 1-week washout between periods. In-laboratory polysomnography was performed at the end of each crossover period. Mixed model analyses compared the effect of the combination vs. placebo on AHI4 (primary outcome), hypoxic burden, total sleep time (TST) and wake-after-sleep-onset (WASO; secondary outcomes). Tertiary analyses explored differences between the parameters above across all treatment arms, in addition to sleep architecture and subjective outcomes. Safety endpoints were also assessed.

Results

Viloxazine-trazodone reduced AHI4 (13 [6, 19] events/h] vs. placebo (53 %min/h, 28 events/h) and hypoxic burden (mean reduction (95% CI): 26 [14, 34] %min/h). The combination reduced TST [37 [13, 61] min) and increased WASO (26 [2, 49] min) vs. placebo. Viloxazine alone had a similar effect on OSA severity vs. placebo. However, its impact on sleep quality (TST -61 [-85, -37] min; WASO 41 [18, 64]) was accentuated vs. placebo. Both viloxazine and the combination worsened patient-reported outcomes vs. placebo; these changes seemed more pronounced on viloxazine alone vs. placebo. 6 patients terminated the study early, 5 due to adverse events. Commonly reported adverse events were insomnia, constipation, headache, and xerostomia. Both treatments slightly increased heart rate.

Conclusion

Viloxazine-trazodone combination may reduce OSA severity. Potential deleterious effects of viloxazine on sleep quality appear partly attenuated by concurrent trazodone.

Support (if any)

This study was funded by Apnimed.
0548 A 5-year Multi-center Real-world Study Evaluating the Effectiveness and Use of CAD/CAM 3D-printed OAT to Treat OSA
Authors: Woidtke Robyn , Gagnadoux Frederic , Kün-Darbois Jean-Daniel , Forcioli Jérôme , Ferret Claude , Clavel Robert , Griffet Benoît , Le Balc’h Morgan , Dupuy-Bonafé Isabelle , Recart Didier , Toubal-Biret Mirentchu , Micoulaud-Franchi Jean-Arthur , Fortin Martine , Sedki Mohammed , Trevillot Vincent
Published: April 2024

Introduction

Oral appliance therapy (OAT) treats a wide range of obstructive sleep apnea (OSA). This prospective, collaborative (physician/dentist) study will assess the primary endpoint of at least a 50% reduction in baseline apnea-hypopnea index (AHI) at five years with initial objective efficacy evaluation at three to six months. The Panthera D-SAD is a CAD/CAM, 3D-printed OAT. Patient- matched for fit and comfort. Changeable rods provide the mechanism for protrusion. This study fulfills French reimbursement requirements.

Methods

OAT naïve individuals with an AHI 15-30 or those with an AHI ≥ 30 who decline CPAP will be considered, meeting all other entry criteria. Fifteen centers in France will enroll an estimated 217 participants. Consecutive sampling will be used. Participants will be medically and dentally evaluated. The initial fitting will be at Visit 1 (V1). Standard of care for the study duration will be followed. Evaluation time points are three-six months (sleep testing/medical), six months (dental), and five years (both). Secondary endpoints include OAT side effects, oxygenation status, quality of life, self-reported adherence, and subjective symptoms at the aforementioned time points.

Results

Between April, 2022, and December, 2023, 171 subjects have had their sleep and orthosis evaluation for entry into the study (V0). The demographics for those who have completed V0 (n=171): averages (SD) age 49.7 (13.0); BMI 26.75 (4.81); baseline AHI of 22.2 (8.7), ODI 17.16 (11.92), SpO2 91.7 (2.18). This update summarizes data from the subset (n=76) with sleep testing (V2). At baseline, 92% of participants had moderate OSA. Sixty-three percent of all participants achieved at least a 50% AHI reduction. Sixty-two percent achieved an AHI < 10. At V2, 84% severe and 87% moderate transitioned to a lower severity category. For moderate, 21% reached the normal category. Eighty-seven percent reported weekly use at V2 (n=62) for seven nights/week, and 97% indicated they used the device for ≥ 4 hours a night. Only 2.3% of participants stopped wearing the device.

Conclusion

This updated data demonstrates a high OAT acceptance and comfort rate for patients. Preliminary data are tracking well for reducing total AHI and migrating to a less severe AHI category.

Support (if any)

Panthera Dental Inc
0549 Non-Permanent Oral Appliance Treatment of Severe Obstructive Sleep Apnea
Authors: Kushida Clete , Cozean Colette , Alexander Jonathan
Published: April 2024

Introduction

The FDA recently cleared the first OSA treatment by oral appliances (mRNA, mmRNA, and DNA, Vivos Therapeutics, Littleton, CO). These appliances are designed to be worn 6-24 months and use slow maxillary expansion (DNA) combined with mandibular advancement (mRNA/mmRNA) to increase upper airway volume and improve OSA.

Methods

This retrospective analysis used a research database initiated in 2018 incorporating real world data from treating dentists for these devices to September 2023. Database contains pre-/posttreatment (without the oral appliance) AHI, transpalatal width (TPW), airway volume (AV) via cone beam computed tomography, and safety data. Study inclusion criteria were adults with severe OSA (AHI>30), mRNA (includes mmRNA)/DNA treatment, and pre-/posttreatment AHI > 6 months apart; exclusion criterion was no safety data. Co-primary endpoints were pre- to posttreatment AHI and TPW improvement; secondary endpoints were pre- to posttreatment AV improvement and safety measures.

Results

Seventy-three severe OSA patients (36 mRNA/37 DNA) were compared to 35 moderate OSA patients (12 mRNA/23 DNA). Severe OSA: 38 men/35 women, Age 56.3±10.8years, Treatment Duration 15.6±7.2months, Appliance Adherence 11.9±2.6hours. Moderate OSA: 15 men/20 women, Age 48.9±11.7years, Treatment Duration 13.0±6.0months, Appliance Adherence 12.4±2.5hours. For severe OSA patients, pre-treatment vs. posttreatment AHI, TPW, and AV were found to significantly decrease 46.1±15.1 to 21.7±14.8 (-50.8%, p<.00001), increase 33.2±3.5 to 35.5±3.7mm (+7.2%, p<.00001), and increase 20479±7991 to 23767±9191mm3 (+16.6%, p<.00001), respectively. For moderate OSA patients, pre-treatment vs. posttreatment AHI, TPW, and AV were found to significantly decrease 21.6±4.5 to 12.0±10.5 (-44.4%, p<.00001), increase 32.9±2.8 to 35.1±2.9mm (+6.6%, p<.00001), and increase 21598±6260 to 24364±6033mm3 (+12.8%, p<.005), respectively. Severe OSA patients who wore mRNA and DNA appliances decreased their AHI by 55.6% and 46.2% and reduced their AHI classification by 1 or improved their AHI by 50% were 81% and 78%, respectively. No significant safety issues were observed.

Conclusion

Historically, oral appliances were indicated for those with mild-moderate OSA; this study showed that severe OSA patients had more improvement in AHI, TPW, and AV vs. those with moderate OSA. Results were slightly better for patients with DNA vs. mRNA, demonstrating that the primary improvement mechanism is maxillary expansion with persistent treatment effects without the appliance in place.

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0550 Empiric ASV Settings for Central Sleep Apnea Following HSAT During SARS Covid-19 Pandemic- a Retrospective Analysis
Authors: Appalla Surya Deepika , Cutrufello Nicholas , Begay Melissa
Published: April 2024

Introduction

Adaptive servo-ventilation (ASV) uses noninvasive ventilator to treat hyper ventilatory central sleep apnea (CSA)by delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure. ASV devices appear to be effective for treatment of Central sleep apnea and Combined sleep apnea syndromes that are resistant to CPAP [1]. All the studies to date recommend ASV settings following in lab titration. However, during the SARS Covid-19 pandemic given the significant limitation of in lab studies, empiric ASV were prescribed for CSA following home sleep apnea studies. We retrospectively analyzed the empiric ASV settings and patient adherence in correlation to the BMI.

Methods

Retrospective chart review of 1582 pts (patients de-identified) who underwent HSAT at the NM VA clinic during 2021-2023 was done. Among the 1582 pts who underwent HSAT, 113 pts had predominant Central Sleep Apnea (CAI >10) . 21 pts were placed on empiric ASV. We retrospectively analyzed the adherence to ASV therapy in 2 week and 3 years follow up period.13 of the 21 pts did not meet the 2 week and 3-year compliance. The EPAP data is derived from the 8 pts who continued on the empiric ASV settings and success is based on their 2 week and 3-year adherence.

Results

Median EPAP ranged between 5-7 cwp for pts with BMI less than 30, EPAP of 7-8 cwp with BMI between 30-40 and an EPAP 10 for BMI>40. 8 pts had good compliance (>70% use of >4 hours every night) in 2 week download with median Apnea Index 0.1(SD 2.6), median pressure support used 4.6(SD1.1). Patients with cardiac concern had echocardiogram documented LVEF >45% prior to starting empiric ASV. Serum Bicarbonate ranged between 17-26.

Conclusion

Though not the most efficient way compared to in lab titration study, empiric ASV settings based on the BMI may be utilized in resource limited settings or inability to perform in lab studies due to patient limiting factors. Providers should also be cognizant about hypo ventilatory concerns and respiratory depression given ASV therapy utilizes minute ventilation. Caution must be exercised in patients with heart failure due to the potential increased mortality on ASV.

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0552 Analysis of Autonomic Activity After Continuous Positive Airway Pressure Therapy Using Heart Rate Spectral Analysis
Authors: Costello Elizabeth , Crasta Maxim , Clum Alicia
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is estimated to affect 29.5 million people living in the United States. OSA patients experience repeated airway occlusions leading to numerous episodes of apnea nightly, increasing their risk for heart disease, stroke, and diabetes. Patients benefit from CPAP because it restores processes that promote recuperation of the autonomic nervous system (ANS). Several studies have investigated the health consequences using different measurements of ANS activity like heart rate variability (HRV). HRV can be analyzed using frequency domains such as the low-frequency (LF) to high-frequency (HF) ratio, or with time domains like the exhalation to inhalation (E:I) ratio. HF and exhalation are associated with parasympathetic activity, while LF and inhalation are associated with sympathetic activity. Here, we aimed to better understand the relationship between ANS activity in OSA CPAP-compliant versus CPAP non-compliant patients using HRV analysis. We hypothesized that compliant patients will have lower LF/HF ratios and greater E:I ratios compared to noncompliant patients during various ANS test maneuvers.

Methods

OSA patients were divided into CPAP-compliant (n= 20) and non-compliant groups (n= 18). Patients had to have been CPAP compliant for at least 8 weeks. HRV was determined using a wireless ECG device and IntelleWave HRV Analyzer software. Data was collected while patients were supine, sitting upright, performing a Valsalva maneuver with handgrip, and deep breathing.

Results

Significant differences in the LF/HF ratio were found between groups when patients were supine (p< 0.001), standing (p< 0.001), and during normal breathing (p< 0.006). No significant difference was found between groups when performing the Valsalva maneuver. A significant difference in E:I ratios was observed only during deep breathing, 1.36±.15 in CPAP non-compliant patients versus 1.59±.24 in CPAP compliant patients; t (36) = -3.578, p < .001.

Conclusion

A greater restoration of sympathovagal activity was observed during activities with a parasympathetic predominance (lying down, standing, and normal breathing) compared to maneuvers requiring significant physiological effort (Valsalva maneuver) following CPAP therapy. This suggests a greater duration of CPAP therapy may be required to restore autonomic balance during strenuous activities.

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0555 Treatment Responses in US Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea
Authors: Mysliwiec Vincent , Brock Matthew , Gomes Kimberly , Pruiksma Kristi , Li Xueying , Gerwell Kelsi , Powell Tyler , Mithani Sara , Straud Casey , Young-McCaughan Stacey , Peterson Alan
Published: April 2024

Introduction

Comorbid insomnia and obstructive sleep apnea (COMISA) is the most prevalent sleep disorder in military sleep clinics. While there is no established COMISA treatment regimen, patients frequently receive cognitive behavioral therapy for insomnia (CBTI) and positive airway pressure (PAP) therapy. The aims of this study were to examine treatment responses in military personnel with COMISA and determine if there were differential responses to therapy in male and females.

Methods

In an observational study, 130 participants (38.5% females) were diagnosed with COMSIA and received CBTI and PAP therapy in a routine clinical setting. Treatment responses were assessed by changes from baseline to 12 weeks with the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, parametric and non-parametric pairwise comparisons were used to assess differences between sexes at baseline. Linear mixed effects models for longitudinal data were used to examine differences between sexes in treatment responses overtime.

Results

There were significant decreases from baseline to 12 weeks in the ISI among males (-5.45 (95% CI, −6.94 to −3.96), p <.0001), and females (-6.25 (95% CI, -8.18 to -4.31), p <.0001), ESS among males (-2.52 (95% CI, -3.67 to -1.36), p <.0001) and females (-2.21 (95% CI, -3.71 to -0.72), p = .0017), and PSQI among males (-3.94 (95% CI, -4.96 to -2.91), p <.0001) and females (-3.64 (95% CI, -4.98 to -2.31), p <.0001). PAP Adherence was 8.5% in women and 23.1% in men (p = .053). Treatment responses were not significantly differences between genders.

Conclusion

Although the majority of military personnel with COMISA were non-adherent to PAP, there were significant responses on the ISI, ESS, and the PSQI. This suggests the insomnia may have greater clinical significance than OSA. CBTI could be considered first line COMISA therapy in a military population that primarily has mild sleep disordered breathing.

Support (if any)

This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).
0556 Comorbid Insomnia & Sleep Apnea Is Linked to Worse Sleep & Function vs OSA Alone in Older Veterans with No PAP Use
Authors: Kelly Monica , Fung Constance H , Ryden Armand , Stepnowsky Carl , Erickson Alexander , Zeidler Michelle , Ganz David , Mitchell Michael , Barretto Bronson , Partch Lisa , Pearson Lori , Rodriguez Ariana , Josephson Karen , Martin Jennifer , Alessi Cathy
Published: April 2024

Introduction

Many patients with obstructive sleep apnea (OSA) discontinue positive airway pressure (PAP) over time. Insomnia symptoms frequently co-occur with OSA and are common in older adults. Comorbid insomnia and sleep apnea (COMISA) is associated with greater sleep disturbance, impaired daytime functioning, and worse quality of life vs OSA (or insomnia) alone. Whether COMISA vs OSA alone is associated with greater impairment in sleep quality and sleep-related function among older patients and no /limited PAP use is unknown.

Methods

Veterans with moderate or severe OSA (apnea-hypopnea index [AHI] >15) and no/limited objective current PAP use (prescribed >1 year ago) completed Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep (FOSQ-10) questionnaires. T-tests and age-adjusted regression analyses were used to compare participants who met DSM-5 diagnostic criteria for chronic insomnia disorder and sleep apnea (COMISA) vs OSA alone.

Results

In 128 veterans (Mage=64.6 years, 89% male, 19.5% Hispanic, 35.9% Black, 9.4% American Indian/Alaska Native, mean comorbidity index=5.5, BMI=32.2) with no/limited PAP use, COMISA (n=77, mean ISI=13.3) was associated with worse PSQI [7.8 vs 10.9], ESS [7.6 vs 9.6] and sleep-related function (FOSQ-10 15.6 vs 14.1) vs OSA alone (n=51, mean ISI=8.9) (all P<.05) despite no differences in AHI.

Conclusion

Among veterans with moderate-to-severe OSA and no/limited current PAP use, those with comorbid insomnia disorder (COMISA) have worse sleep quality, more daytime sleepiness and worse sleep-related function. These findings suggest that efforts to address insomnia disorder in addition to PAP use may be particularly important among older veterans with COMISA who do not use their prescribed PAP.

Support (if any)

VA, NIH/NHBLI
0558 Could Treatment of Sleep Apnea Worsen Somnolence?
Authors: Balasubramanian Prasanth , Khalil Melissa , Arunthari Vichaya , Colaco Brendon
Published: April 2024

Introduction

Patients presenting with daytime somnolence need to be evaluated for common etiologies including sleep-related breathing disorders, shift work disorder, insufficient sleep, insomnia and disorders of hypersomnolence. Sleep disordered breathing (SDB) is one of the most common causes of daytime sleepiness. We postulate that treatment of SDB may actually worsen symptoms, if associated with poor sleep due to positive airway pressure (PAP) therapy.

Methods

N/A

Results

A 49-year-old female presented to our clinic with increased daytime somnolence. She was diagnosed with obstructive sleep apnea (OSA) at an outside center 3 years ago and was started on auto PAP therapy with pressure settings at 6-10 cmH2O. She had 100% usage, 95th percentile pressure of 9 cm H2O, and a residual Apnea Hypopnea Index (AHI) of 1.1. The patient reported excessive daytime sleepiness, with an Epworth Sleepiness Scale of 16, requiring a daily 3-hour nap. Further sleep history revealed that she had multiple nocturnal awakenings due to discomfort with PAP therapy, including mask related issues causing sleep disruption. Several mask adjustments did not result in any sleep improvement. We decided to re-evaluate her with an in-lab polysomnography. Diagnostic data revealed an overall AHI of 1.6, supine AHI of 12.0, and lateral AHI of 1.5. Mean oxygen saturation was 94.6% with a nadir of 89.0%. The patient was advised to discontinue PAP therapy, and to sleep on her sides, which led to improvement in her sleep quality and daytime sleepiness.

Conclusion

Positional OSA, defined by greater than 50% increase in AHI in supine position compared to non-supine position, with or without AHI less than 5 in non-supine position, is seen in up to 50-60% of patients with OSA. In addition, intolerance to CPAP has been noted in 29-83% of patients. We need to be clinically aware of the potential effect of PAP devices, or oral appliances, on sleep disruption among intolerant patients. Among this group, conservative therapies like positional therapy or weight loss may be more effective for symptom management, especially for mild SDB.

Support (if any)
0560 CPAP Effect on Energy Expenditure, Intake, Body Composition, and Sleep Patterns: A Randomized Controlled Trial
Authors: Lee Pei-Lin , Chien Meng-Yueh , Lai Shang-Ru , Gooley Joshua J , Feng Hsin-Chun , Chen Shih-Kuo , Lin Ming-Tzer , Chen Yung-Hsuan , Chiu Hung-Chih , Liu Po-Kang , Ku Bo-Wen , Chang Chin-Hao , Yang Wei-Shiung , Yu Chong-Jen
Published: April 2024

Introduction

The mechanism of weight gain after continuous positive airway pressure (CPAP) treatment for treating obstructive sleep apnea (OSA) has not been fully elucidated. We hypothesized that CPAP treatment could result in positive energy expenditure through lowering basal metabolic rate (BMR) and increasing nutrition intake which the later associated with delayed bedtime and shorter sleep duration. That led to increase in body weight and fat mass.

Methods

The consecutive patients with untreated moderate-severe OSA assessed with 7-day Actiwatch, 3-day intake dietary, repeated polysomnography, BMR, body composition, and blood check. Participants were randomized to CPAP or usual care and reassessed 12 weeks later. The primary outcome was resting energy expenditure (REE) and respiratory quotien (RQ) while second outcomes were nutrition intake, eating behavior, and fat/fat free mass. Third outcomes were objectively measured mid-sleep time and sleep hour. The APAP effect was assessed with between-group differences in outcome changes.

Results

From 66 patients recruited, 26 patients each were randomized to CPAP and usual care, which 21 patients and 24 patients completed the study, respectively. Compared to usual care, CPAP treatment was not associated with changes in REE and RQ, total caloric intake, fat mass, mid-sleep time and sleep hour, while it was associated with increase in body mass index (mean difference 0.6 kg/m2, 95% confidence interval, 0.07 to 1.19), fat free mass, and fat intake, and less Cognitive Restraint eating.

Conclusion

The short-term CPAP treatment had no effect on energy expenditure and sleep pattern though it increased weight, fat free mass, fat intake, and improve eating behavior.

Support (if any)

NSTC (111-2314-B-002-293), NTU (107L900502, 108L900502, 109L900502), NTHU (109-42, 111-S0298, 111-X0033); MediaTek Inc. (201802034 RIPD)
0561 CPAP Tolerance Scores Are Effective in Predicting CPAP Usage in the Short-Term
Authors: Creighton Erin , DeKloe Jefferson , Tekumalla Sruti , Plawecki Andrea , Kaffenberger Thomas , Alapati Rahul , Doghramji Karl , Boon Maurits , Huntley Colin
Published: April 2024

Introduction

Our group previously presented work demonstrating the value of a 10-question CPAP tolerance survey in predicting therapy compliance at 30-90 days after CPAP prescription. We conducted a follow-up survey in the same cohort 6 months after CPAP prescription to examine the utility of the survey in predicting CPAP compliance.

Methods

This was a prospective study at a single tertiary care hospital. Patients diagnosed with clinically significant OSA (moderate disease, mild disease with symptoms, or mild disease with a comorbidity) between January-March 2023 that had initiated PAP therapy and attended a follow-up visit were provided a 10-question survey regarding symptoms and attitudes related to CPAP at their first follow up visit and again 6-9 months later. Data collected used for statistical analysis included: tolerance survey scores, CPAP usage, attendance of 6-month follow-up visit, demographics, OSA severity, and Epworth Sleepiness Scale (ESS) scores. Univariate and multivariate regression were used to analyze relationships between survey responses and CPAP usage data. Adherence was defined as using PAP therapy for ≥ 4hrs for ≥ 70% of nights in a 30-day period.

Results

Of the 105 respondents to the initial survey, 56 (53.3%) responded to the 6-month survey. Tolerance scores at 6-months correlated with % adherence at 6-months (p = 0.02) and minutes of CPAP usage at 6-months (p = 0.04). Each point of increase in 6-month survey scores was associated with an additional 2.7 minutes of use, on average. Initial tolerance survey scores did not significantly correlate with compliance 6-months later (p = 0.17). Initial tolerance survey scores did, however, correlate with tolerance survey scores 6 -months later (ß = 0.77, p < 0.001) and there was no significant difference between initial tolerance survey scores and scores at 6-months (mean difference -2.81, p = 0.11). Stepwise regression models showed minimized error when age, ESS at first follow-up, OSA severity and 6-month tolerance scores were used as covariates for an outcome of minutes of CPAP usage at 6-months.

Conclusion

CPAP tolerance surveys have utility in estimating CPAP compliance in the short-term but may not capture important changes in patient attitudes that allow for the prediction of long-term CPAP compliance.

Support (if any)
0563 Exploring Trends of Oronasal versus Nasal Mask Use by Sleep Technologists
Authors: Farishta Mehdi , Neborak Julie , Mokhlesi Babak
Published: April 2024

Introduction

Continuous positive airway pressure (CPAP) therapy is the most prescribed therapy for obstructive sleep apnea (OSA). CPAP therapy has been shown to reduce daytime somnolence as well as reduce the risk of cardiovascular disease and mortality in patients with severe OSA and good adherence. Nasal and oronasal masks are the two main mask interfaces available for CPAP therapy. The oronasal mask is a larger interface and prior research shows that with an oronasal mask higher PAP pressures are needed compared to a nasal mask. These factors may reduce long-term adherence to CPAP when an oronasal mask is initially selected. There are no guidelines for sleep technologists when selecting a mask type during CPAP titration studies, however using an oronasal mask could affect the long-term adherence to CPAP therapy.

Methods

We retrospectively studied mask selection amongst our sleep technologists from 6/15/2023 to 9/30/2023. Our institution employs 12 sleep technologists; 6 work at lab 1 and 6 work at lab 2.

Results

Overall, 368 patients (199 at lab 1 and 169 at lab 2) underwent CPAP titration studies during the study period. There were no significant differences in patient demographics between the two sleep labs, including mean age (57.3±14.8 vs 57.2±14.9, p=0.95), sex (48% female vs 48% female, p=0.97) and mean BMI (39.6±19.4 vs 38.6±10.7, p=0.38). The prevalence of oronasal mask use was significantly higher at the lab 2 compared to the lab 1 (45% vs 30%, p=0.002).

Conclusion

Oronasal masks are still frequently used by our sleep technologists during CPAP titration studies. There was significant variation in the use of nasal versus oronasal masks by sleep technologists, even between two sleep lab sites that are part of the same institution. An educational program geared toward sleep technologists may reduce the use of oronasal masks during CPAP titration studies which may further improve the adherence to CPAP therapy.

Support (if any)
0564 Group Motivational Interviewing to Improve APAP Adherence: A Quality Improvement Project
Authors: Cocozza Victoria , Clay Collin , Ellis Jordan , Tchopev Zahari , Brock Matthew
Published: April 2024

Introduction

Automatic positive airway pressure (APAP) adherence to treat obstructive sleep apnea (OSA) is challenging to many patients. Motivational interviewing in one-on-one sessions has been shown to improve rates of APAP adherence. The goal of our improvement study was to improve APAP adherence and determine whether motivational interviewing is effective in a group setting.

Methods

Patients with a new diagnosis of OSA, regardless of severity, presented to our academic sleep disorders center for a group presentation on OSA and available treatments from November – December 2023. Groups of 5-10 patients received either a standard informative presentation or the same presentation with motivational interviewing techniques. Questionnaires with a Likert scale from 1 to 10 assessed pre- and post-presentation readiness to undergo treatment for their OSA and perceptions of importance to treat. Post-presentation questionnaires also included questions on likeliness to pursue treatment and confidence to pursue treatment.

Results

A total of 41 patients attended the group session with 53.6% (n=22) receiving the motivational interviewing component. For the motivational interviewing group, adherence data post-intervention revealed that the average total days of APAP use was 79%, average total hours used was 232.00 minutes, and average use greater than 4 hours was 51.6%. For the non-motivational interviewing group, adherence data post-intervention showed that the average total days of APAP use was 68.62%, average total hours used was 209.62 minutes, and average use greater than 4 hours was 46.54%. To date, 38% of non-motivational interviewing patients (n=13) were adherent by Medicare definition, compared to 40% of motivational interviewing patients (n=5). Questionnaires had equivocal scores in all categories pre- and post-presentation for the motivational interviewing and non-motivational interviewing groups and indicated a high level of motivation to pursue therapy.

Conclusion

Implementing motivational interviewing in a group setting was a feasible way to improve APAP adherence in our clinic. Patients are motivated to pursue APAP therapy in pre- and post-presentation questionnaires. This preliminary data is limited by ongoing intervention implementation yet promising for the use of motivational interviewing in the group setting. To the authors knowledge, no published improvement projects exist for evaluating the effectiveness of motivational interviewing in a group setting.

Support (if any)