bluuebunny/crossref_metadata_2025 huggingface dataset:
0459 Restriction of Breathing in OSA Does Not Affect Sleep Spindle Density
Authors: Harding Christian , Holloway Breanna , Schmickl Christopher , DeYoung Pamela , Kwan Crystal , Ancoli-Israel Sonia , Banks Sarah , Malhotra Atul
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is associated with major neurocognitive sequalae including impaired memory. OSA patients are deficient in NREM sleep spindles (11 Hz to 16 Hz electroencephalography (EEG) sigma oscillations) which have been shown to promote memory. This finding is a result of less time spent in deeper sleep states in which most spindles occur but also a reduction in spindle density, particularly during the later portion of the night. We tested the hypothesis that spindle density deficiencies are driven by restriction of breathing preventing spindle generation.

Methods

109 adults (ages 65-83, 53% female) with normal cognition underwent overnight polysomnography (PSG). Presence of sleep apnea was defined using AASM recommended criteria (apnea-hypopnea index >15, n=81[OSA] vs 28[controls]). The right occipital channel EEG was bandpass filtered between 0.3-35Hz. Following rejection of movement artifacts, spindles were detected in NREM sleep stages 2 and 3 (N2/N3) using complex demodulation to extract high sigma activity signals from background sigma noise. Spindles were classified depending on whether the patient was in eupnea or apnea-hypopnea.

Results

Overall spindle density in OSA patients did not differ from overall spindle density in controls (2.86 vs 3.17 spindles/minute, t(57.4)=0.49, p=0.14). Apnea-hypopnea spindle density in OSA patients did not differ from eupnea spindle density in controls (3.10 vs 3.17 spindles/minute, t(70.8)=0.31, p-value=0.76). Eupnea spindle density in OSA patients was significantly lower than eupnea spindle density in controls (2.57 vs 3.17 spindles/minute, t(54.4)=2.94, p-value< 0.01).

Conclusion

Contrary to our hypothesis, sleep spindle density was not reduced in OSA patients during apnea-hypopnea compared to healthy controls during eupnea, suggesting restriction of breathing does not affect spindle generation, but was reduced in OSA patients during eupnea. Whilst we did not observe an overall OSA-related spindle density deficit, our results suggest that previous findings of lower spindle density in OSA patients may in fact result from changes in spindle behaviour during eupnea. This observation raises the interesting possibility that using OSA interventions to prevent apnea-hypopnea occurring may not recover normal spindle density. Alternatively, our results could suggest that undetected N2/N3 sleep disruptions are occurring when OSA patients are breathing, skewing eupnea spindle density estimates.

Support (if any)

1R01AG063925-01A1
0460 Dose-response Relationship Between Thalamic Activity During Sustained Attention and Excessive Daytime Sleepiness
Authors: Azad Dishari , Valencia Daphne , Wickramaratne Sajila , Kam Korey , Fleysher Lazar , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is characterized by sleep fragmentation and intermittent hypoxia. Both are known causes of sleepiness and poor sustained attention, i.e., lapses in vigilance, which can be measured using the psychomotor vigilance test (PVT). Crucial to vigilance, the thalamus plays a key role by regulating sensory information essential for sustaining attention. However, to date, the relationship between thalamic activity underlying PVT and its relationship to sleepiness in OSA has not been investigated systematically.

Methods

A total of 5 newly diagnosed OSA subjects (mean AHI4% = 51±24, 5M, age 42±3 yrs., ESS [Epworth Sleepiness Scale] 11 ± 3.4), 3 healthy controls (1M/2F, age 35±2 yrs., ESS 3±3) and 9 PAP treated OSA subjects (diagnostic AHI4% = 15±12, 6M/3F, age 57±10 yrs., ESS 8±5) who demonstrated >4 hours nightly PAP adherence were studied. Participants performed a PVT during fMRI after an in-lab nocturnal polysomnography. Each fMRI session consisted of 4 runs: two PVT runs interleaved with two control runs. Analyses in AFNI were restricted to the bilateral thalamus with percent signal change used as the primary metric of thalamic activity.

Results

There was a dose response relationship of ESS to thalamic activity during PVT such that subjects with lowest levels of sleepiness (ESS) exhibited the greatest thalamic activity: untreated OSA (3±2%), CPAP treated OSA subjects (7.2±1.9%), healthy controls (21.8±1.1%); χ2(3) = 7.13, p< 0.05. CPAP treated OSA subjects with persistent sleepiness (ESS≥10) exhibited lower thalamic activity than those without persistent sleepiness (ESS< 10), however it did not reach statistical significance (5.3±3.4% vs. 6.9±2.9%).

Conclusion

Based on the collected data, the thalamic activity underlying PVT shows a dose response relationship with level of sleepiness. The lower degree of thalamic activity in CPAP treated patients with persistent sleepiness as compared to those without suggesting a level of irreversible injury to the thalamus due to OSA. Our findings should be further validated with a larger sample size with varying degrees of sleep apnea severity.

Support (if any)

NIH K25HL151912, NIH R01HL171813, NIH R21HL165320
0464 The Impact of Fatigue and Sleepiness on Patients with OSA: A Closer Look with Patient Reported Outcome Measures
Authors: Emsellem Helene , Colwell Hilary , Cronin John , Farkas Ron , Mathias Susan
Published: April 2024

Introduction

Qualitative interviews were conducted to understand experiences of individual with OSA by evaluating the content validity and relevance of 5 patient reported outcome (PRO) measures (PROMIS-Fatigue-8a, the PROMIS-Sleep Impairment-8a, the Epworth Sleepiness Scale (ESS), Patient-Global Impression of Severity (PGI-S)-Fatigue, and Patient-Global Impression of Change (PGI-C)-Fatigue).

Methods

3 US sites identified individuals with OSA. Once consented, participants completed an interview containing concept elicitation and cognitive debriefing questions. Interviews were recorded, transcribed, and analyzed using qualitative software. Symptoms and impacts were mapped to the PROs, and a gap analysis was conducted. The study was approved by WCG IRB.

Results

30 individuals with OSA (20 current non-PAP users [mean age=55; 50% male] and 10 current PAP users [mean age=52, 80% male]) were interviewed. Non-PAP and PAP users viewed fatigue and feeling sleepy as separate, distinct symptoms. Among non-PAP users the most common symptoms were fatigue (100%), difficulty concentrating (85%), feeling sleepy (75%), dry mouth (60%), interrupted sleep (50%), and headaches (50%). Fatigue (63%) was most bothersome, while 5% rated feeling sleepy as most bothersome. Among PAP users the most common symptoms were fatigue (100%), feeling sleepy (90%), difficulty concentrating (60%), dry mouth/throat (60%), headaches (50%), and interrupted sleep (50%). Fatigue (63%) was most bothersome, while 25% rated feeling sleepy as most bothersome. Non-PAP and PAP users reported negative impacts on daily activities (50% both), physical (60% and 50%, respectively), social (50% both), and emotional functioning (80% and 60%), and relationships (75% and 70%). Impacts on ability to work for pay and work productivity (45% and 70%) were also common. PAP users reported improvements on their ability to do daily activities (80%) and all areas of functioning after initiating PAP (range: 80-100%). In general, participants found these PROs to be clear and appropriate. Fatigue and sleepiness were two of the most common symptoms cited; these concepts are comprehensively covered by these PROs.

Conclusion

Fatigue and sleepiness should both be assessed in OSA trials and clinical practice. This study provides evidence to support the content validity, clarity, and relevance of the PROMIS-Fatigue-8a, PROMIS-Sleep Impairment-8a, ESS, PGI-S-Fatigue, and PGI-C-Fatigue PROs in an adult OSA population.

Support (if any)

Funded by Apnimed.
0466 Benzodiazepines and Opiates Shorten Exacerbation-Free Time in COPD Patients on Long-Term Non-Invasive Ventilation
Authors: Chai Andrew , Csoma Balazs , Bentley Andrew , Bikov Andras
Published: April 2024

Introduction

Benzodiazepines and opiates are taken by patients with very severe COPD to relieve breathlessness. There is a growing concern that these medications can depress the respiratory drive and could contribute to worsening respiratory failure. However, the relationship between exacerbation rate and medication taken is poorly understood in patients with chronic respiratory failure.

Methods

As part of a retrospective service evaluation project, we analysed 383 patients with COPD (pre-setup 64±9 years, 143 men, FEV1 38.1±15.9 %pred, mMRC 3.7±0.6, 3 /2-5 interquartile range/ exacerbations/year, capillary blood pH 7.39±0.08, pO2 7.9±1.6 kPa, pCO2 8.2±2.1 kPa) who were established on long-term non-invasive ventilation at our tertiary centre. We analysed associations with medication usage, pre-setup overnight and daytime gas exchange as well as symptoms and pre- and post-setup annualised exacerbation rate.

Results

Seventy-seven patients took benzodiazepines (0.65±0.58 mg/day clonazepam equivalent), 185 patients took opiates (34.1±42.6 mg/day morphine equivalent). Neither benzodiazepine nor opiate usage was associated with overnight hypoxaemia (as measured by oxygen desaturation index or time spent with saturation below 90%), daytime hypercapnia, hypoxia or the number of annual exacerbations before NIV setup. The mMRC scores were higher in patients taking both benzodiazepines (3.9±0.2 vs. 3.7±0.7, p=0.02) and opiates (3.9±0.4 vs. 3.6±0.7, p< 0.01) compared to those who did not. Long-term NIV significantly reduced the number of yearly exacerbations in this cohort (from 3 /2-5/ to 2 /1-5/, p< 0.05). However, the time to the next exacerbation post-NIV setup was shorter in patients who took benzodiazepines (5.7±8.9 vs. 6.5±7.4 months, p=0.04) and opiates (4.4±6.2 vs. 6.2±8.7 months, p=0.03).

Conclusion

Benzodiazepines and opiates are commonly taken in this cohort, especially in those with a high symptom burden. Whilst they do not seem to contribute to impaired gas exchange or exacerbation rate pre-setup, they may limit the benefit of long-term NIV in reducing exacerbation rate.

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0470 Real-time Data Showing Immediate Improvement of Obstructive Sleep Apnea Following Renal Transplant
Authors: Sedar Cole , Andre Aguillon
Published: April 2024

Introduction

There is a well-documented correlation between end stage renal disease (ESRD) and obstructive sleep apnea (OSA). Prevalence of OSA in the ESRD population has been show to be as high as 51%. There is a complicated interrelation between the two pathologies. Hypertension, is a major contributing factor to the progression chronic kidney disease and subsequently ESRD. It is a consequence of the cascade of increased sympathetic tone, vasoconstriction, and oxidative stress caused by the hypoxic episodes of OSA. Volume overload and fluid shifts during recumbence leads to an increase in tissue fluid around the upper airway in patients with ESRD and has been shown to worsen OSA4. Data on improvement in OSA after renal transplantation has been mixed, with some case reports of OSA resolution after transplantation, but a greater number of studies showed no significant improvement of OSA following transplantation. Most studies review long term SDB in relation to transplant, few studies measure sleep disordered breathing in the immediate post-op period

Methods

Our patient is a 54-year-old African-American male with ESRD secondary to systemic lupus erythematosus on HD since 2017. He had been treated with methotrexate, hydroxychloroquine, mycophenolate mofetil, and corticosteroids prior to transplant. Medical history other than the above includes rheumatoid arthritis, pericarditis, hypertension, osteoporosis, and OSA treated with CPAP. The patient had been compliant with CPAP prior to transplant. OSA was diagnosed in 2014 with AHI of 26.1 events/ hour, with a nadir Sao2 of 60%.

Results

He underwent deceased donor renal transplant on 11/11/2018. During this hospitalization he was using his home CPAP, which recorded his compliance and treatment data. Evaluation of his downloaded CPAP compliance report revealed a dramatic improvement in respiratory events starting the day of transplant. AHI improved from 0.6 events/hour to 0.2 events/hour immediately following transplant.

Conclusion

Although recent studies have not shown resolution of obstructive sleep apnea in ESRD patients following transplantation, this case does show a dramatic improvement in the degree of sleep-disordered breathing immediately following surgery. This case also provides real time data regarding the effects of renal transplantation on sleep disordered breathing.

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0477 Impact of Socioeconomic Disparities on CPAP Compliance
Authors: Shing Samuel , Molin Nicole , Perlov Natalie , DeKloe Jefferson , Grewal Ritu
Published: April 2024

Introduction

Social disparities is known to have a significant impact on health outcomes including those related to obstructive sleep apnea (OSA). More recently a metric known as area deprivation index (ADI) which combines 17 social determinants of health has been used to better quantify this impact. We aim to examine the relationship between socioeconomic disparities and CPAP adherence among adults with OSA using ADI.

Methods

Retrospective chart review of patients with diagnosis of OSA and prescribed CPAP from Oct-Dec 2022. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). 30 day CPAP compliance was collected. CPAP compliance was defined using Medicare criteria (>4hrs/night 70% of the nights). Long term CPAP data is currently being collected.

Results

452 patients included. Patients from the most deprived areas as determined by ADI had significantly lower CPAP compliance than those from the most advantaged areas (34% compared to 56%) (p< 0.05). Patients from areas with lower rates of high school graduates had lower CPAP compliance (p< 0.05). In multivariate regression non-English speaking appeared to be a significantly negative predictor of CPAP compliance.

Conclusion

Socioeconomic disparities appear to have a significant impact on CPAP compliance. In particular, those from areas that are considered more deprived, areas with lower rates of high school graduates and non English speakers seem to be impacted the most. Patients within these groups may benefit from additional resources and/or closer follow up to improve compliance with treatment.

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0478 The Association of Obstructive Sleep Apnea with Metabolic Syndrome Is Modified by Age
Authors: Vgontzas Alexandros , Pejovic Slobodanka , He Fan , Fernandez-Mendoza Julio , Bixler Edward
Published: April 2024

Introduction

It has been proposed that there is a bi-directional, feed forward, pernicious association between obstructive sleep apnea (OSA) and metabolic syndrome, all promoting atherosclerosis and cardiovascular disease. However, the cardiometabolic comorbidities associated with OSA tend to diminish with age. The goal of this study is to examine whether the association of OSA with MetS is modified by age.

Methods

We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority) who underwent a 1-night polysomnographic evaluation, clinical history, and physical examination. The presence of OSA was defined as an apnea/hypopnea index ≥15 events/hour. Outcome variables include the five MetS components as defined by the National Heart, Lung, and Blood Institute/American Heart Association modified criteria, i.e., obesity (BMI≥30 kg/m2), hypercholesterolemia (≥200 mg/dL), hypertriglyceridemia (≥150 mg/dL), diabetes (fasting glucose ≥100 mg/dL and/or treatment), and hypertension (blood pressure ≥130/85 mm Hg and/or treatment). Logistic regression models examined the association of OSA with MetS components in the entire cohort and divided by age (< 60 and ≥ 60 years) adjusting for race, sex, smoking, alcohol and sampling weight.

Results

There was a significant interaction between MetS components and age. In individuals younger than 60 years old, OSA was significantly associated with increased risk of diabetes (OR=5.619, 95%CI=2.74-11.53, p=<.001), hypertension (OR=3.85, 95%CI= 1.95-7.63, p=<.001), hypercholesterolemia (OR=5.99, 95%CI=2.36-15.21) and hypertriglyceridemia (OR=4.75,95%CI=2.30-9.90, p=<.001). There was no association of OSA and these four components of MetS syndrome (i.e., hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia) in individuals 60 years or older. The association of OSA with BMI was stronger in those younger than 60 vs. those older than 60 (OR=6.03, 95%CI=3.08-11.78, p<.001 vs, 2.47, 95%CI= 1.23-4.94, p=.011, respectively).

Conclusion

The association of MetS components with OSA is strong in young and middle-aged adults, but not in older adults. These findings suggest that MetS is key to the pathogenesis of OSA in young and middle-aged adults whereas other mechanisms such as airway anatomy and collapsibility play a greater role in older adults. This suggest different treatment strategies may be needed for this highly prevalent sleep-related breathing disorder among different populations.

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0479 The Association of Positional Obstructive Sleep Apnea with Blood Pressure
Authors: Chow Christine , Kang Hyojung , Logan Jeongok , Liu Xiaoyue , Kwon Younghoon
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is associated with hypertension and adverse cardiovascular (CV) outcomes. Sleep position plays a critical role in the pathophysiology of OSA. Generally, positional OSA (POSA) refers to OSA that mostly occurs in the supine position, the most vulnerable position for upper airway obstruction. It is unclear whether POSA has CV risk implications. The purpose of this study was to compare blood pressure (BP) and BP variability (BPV), two well-established CV risks between the patients with POSA and non-POSA.

Methods

We included patients who had at least three separate BP measurements taken during office visits within one year prior to clinically indicated polysomnography at a single center. Systolic BP (SBP), diastolic BP (DBP), SBP coefficient of variation (SBP-CV) and DBP coefficient of variation (DBP-CV) were measured. POSA was defined by patients with an apnea-hypopnea index (AHI) ≥5 events/hour as well as supine AHI at least twice as high as non-supine AHI. ePOSA consisted of the previously mentioned criteria with the additional requirement that non-supine AHI normalize to < 5 events/hour. Independent two sample t-tests were performed for comparison.

Results

We included 1,750 patients with OSA (age 54 years and 59.5% female). Patients with POSA or ePOSA had a lower BMI than those with non-POSA or non-ePOSA. Those with POSA or ePOSA were more likely to have mild OSA (AHI 5-15 events/hour) compared to patients with non-POSA or non-ePOSA (52.7% vs. 48.2%; 71.8% vs 44%). Patients with POSA or ePOSA had a significantly lower SBP-CV compared to non-POSA and non-ePOSA (9.7 [ 4] vs 10.2 [4.2], p=0.014; 9.5 [SD 4.2] vs. 10.1 [SD 4.1], p=0.005). There were no significant differences in mean SBP, mean DBP, or mean DBP-CV in the comparison of POSA vs non-POSA. However, patients with ePOSA had a lower mean SBP (128.8 vs 131.2 mmHg, p=0.003) and mean DBP (73.6 vs 75 mmHg, p=0.004) than those with non-ePOSA.

Conclusion

POSA is associated with lower BP risk profile. This may have implications for this subgroup of OSA patients and their risk for hypertension and cardiovascular outcomes. Future studies should consider the positional component in studying CV risks of OSA.

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0480 Less Is More? A Study Comparing Outcomes Between 4% vs 3% Hypopnea Scoring Rules
Authors: Tu Xinhang , Morgenthaler Timothy , Baughn Julie , Herold Daniel , Reckward Dennis , Fenske Chris , Brown Jennifer , Becker Stephanie , Erickson Melanie , Lipford Melissa
Published: April 2024

Introduction

The definition of respiratory events has evolved over decades. The current American Academy of Sleep Medicine scoring manual recommends hypopneas be defined by a ≥ 30% airflow reduction with either ≥ 3% desaturation or an arousal, while the prior “recommended” criteria of a ≥ 30% airflow reduction and associated ≥ 4% oxygen desaturation (with no requirement of arousal) was changed to “optional”. Consequently, events previously characterized as a respiratory effort related arousal (RERA) may now be defined as a 3% hypopnea. We hypothesized that while the 3% apnea-hypopnea index (3%AHI) will be higher than the 4%AHI, the 3%AHI will be similar to the 4% respiratory disturbance index (4%RDI), and that the measurement of RERAs under 3% scoring criteria will be clinically insignificant.

Methods

We prospectively collected 70 consecutive in-lab polysomnography results in 4 adult age groups. We re-scored the respiratory events utilizing the 3% hypopnea rule, and compared the differences between 3% and 4% scoring criteria.

Results

Among the 70 studies (mean age 50, males 46%), the 3%AHI was significantly higher than the 4%AHI (+9.247 ± 1.161, p< 0.001). This was mainly due to increased hypopnea events (+10.313 ± 1.617, p< 0.001). The 3%AHI was significantly different from the 4%RDI (+7.096 ± 1.133, p< 0.001). There were no significant differences between the 3% and 4% RERA indices, with both values being minimal. Results were similar in both diagnostic and titration phases of testing.

Conclusion

As previously shown, utilizing the 3% hypopnea rule results in an increased AHI. Most of this difference is related to hypopneas with negligible influence of RERAs. This may lead to increased diagnosis and severity of sleep-disordered breathing in the adult population, and potentially be associated with payer ramifications. Our findings demonstrated negligible RERA indices on average with either rule, thus calling into question the clinical significance of this index in most patients.

Support (if any)

NA
0484 Heart Rate Variability and Deep Learning Analysis of Obstructive Sleep Apnea Using ECG from Polysomnography
Authors: Kim Kiyong , Yang Tae-Won , Kim Ji Yoon , Choi Woo Ri , Kwon Kyung Won , Lee So Young , Kim Seung Hwan , Jeon Byeong Gu , Ko Nak Gyeong , Kim Young-Soo , Kwon Oh-Young , Kim Do-Hyung
Published: April 2024

Introduction

Previous studies suggested that obstructive sleep apnea (OSA) can affect the autonomic nervous system. Patients with OSA appear to have a higher sympathetic component, a lower parasympathetic component, and greater autonomic nervous system (ANS) imbalance. We compared heart rate variability (HRV) with existing studies and confirmed classification accuracy through deep learning analysis (DLA), using electrocardiogram (ECG) data extracted from polysomnography (PSG).

Methods

We retrospectively surveyed people who underwent PSG at our hospital from January 2015 to March 2023. The diagnosis of OSA was classified into normal, mild, moderate, and severe based on AHI, and whether arrhythmia was identified during the test was also investigated. HRV analysis performed by frequency domain analysis of the tachogram. For DLA, the tachogram was converted to a Mel-spectrogram and a Convolutional Neuronal Network (CNN) was used to confirm the confusion matrix.

Results

Of a total of 1,806 PSG, 1,554 cases were selected, excluding 252 cases of arrhythmia. OSA confirmed by PSG was normal in 282 patients, mild in 334, moderate in 293, and severe in 645. When comparing the results of HRV divided into AHI below 15 and above, VLF power (ms2/Hz) was 940.78 ± 763.72 vs 1132.75 ± 1104.50 (p < 0.001), LF power (ms2/Hz) was 719.26 ± 734.71 vs. 724.46 ± 945.26 (p = 0.908), HF power (ms2/Hz) was 763.61 ± 1058.92 vs 595.53 ± 1386.75 (p = 0.011), and LF/HF ratio was 1.27 ± 0.74 vs 1.63 ± 1.02 (p < 0.001). As a result of DLA, the ROC AUC Score was confirmed to be 0.7077 and the F1 Score was 0.67.

Conclusion

As a result of HRV using ECG from PSG, OSA patients were found to have low HF power and high LF/HF ratio, similar to previous studies. Additionally, if tachogram's DLA accuracy can be improved through preprocessing and deep learning model improvements, it is expected that it can be used as a screening tool in various place.

Support (if any)

This work was partly supported by Institute of Information & Communications Technology Planning & Evaluation grant funded by the Korea government No.RS_2023_00227552, Development of artificial intelligence video background removal SaaS service using domestic semiconductor 64 TOPS.
0487 Polysomnography Associations with All-cause Hospitalization Following TBI Neurorehabilitation Discharge
Authors: Zayed Randa , Martin Aaron , Almeida Emily , Silva Marc , Pinto Shanti , Beaulieu Cynthia , O’Connor Kristen Dams , Anderson William , Nakase-Richardson Risa
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) is prevalent in neurorehabilitation admissions in patients with traumatic brain injury (TBI). OSA is independently associated with hospital readmission within 30 days of discharge in the general population. Prior studies showed rates of rehospitalizations in TBI patients are estimated at 28%. The most common rehospitalization causes are infection, neurologic issues, neurosurgical procedures, injury, psychiatric, and orthopedic. While older age, history of seizure, and greater physical and mental health comorbidities have been associated with rehospitalization following TBI, early objective measures of OSA have not been examined.

Methods

This is a retrospective analysis of TBI Model Systems (TBIMS) participants enrolled in a multicenter comparative effectiveness trial followed over the first two years post-discharge (n=175). Participants received level I polysomnography (PSG) during inpatient neurorehabilitation. Differences in PSG indices were examined by rehospitalization rates to determine associations. Mean age of 43.4 (SD 17.6), mostly of white ethnicity (74%). Multiple regression was used to examine rates of hospitalizations across PSG indices controlling for age.

Results

102 patients (58%) had no hospitalization in the first 2 years of follow-up while 73 (42%) had at least 1 hospitalization (28 had 1 hospitalization, 45 had >1 hospitalization). While the apnea hypopnea index between the re-hospitalized (15.7) vs non-re-hospitalized (14.8) was not significantly different, the mean O2 nadir was 84.8% and 86.9%, respectively (r2=-2.49, p < 0.02, CI: -4.53, -0.45).

Conclusion

This is the first study looking at rehospitalization in patients with TBI and OSA, showing that re-hospitalized patients were more likely to have a worse O2 nadir warranting further exploration of PSG indices and the role of sleep apnea in rehospitalization following neurorehabilitation discharge after TBI.

Support (if any)

The research reported in this abstract was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award. The TBI Model Systems is a funded collaboration between the Department of Veterans Affairs and the Department of Health and Human Services: National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
0490 Sleep Apnea Severity Has a U-shaped Association with All-cause Mortality
Authors: Azarian Mehrnaz , Ramezani Amin , Sharafkhaneh Amir , Maghsoudi Arash , Jones Melissa , Razjouyan Javad
Published: April 2024

Introduction

Sleep apnea (SA) severity is determined by apnea hypopnea index (AHI). The interaction between SA and mortality is debated. We explored the relationship between severity of SA and mortality. We further investigated the effect of age on this relationship.

Methods

We developed an Natural Language Processing program (evaluated with 972 notes manually annotated notes) to extract apnea hypopnea index (AHI) from text of physician interpretation of sleep studies, i.e., polysomnograms and home sleep apnea testing, performed at the veteran health administration (VA) from 2000-2022. We grouped the participants to no-SA (n-SA, AHI< 5), mild to moderate SA (m-SA, 5 < AHI < 30) and severe SA (s-SA, AHI>30). We further stratified the cohort based on age: Young, < 40; Middle, >40 and < 65; and older, >65 adults. Using logistic regression, we estimated odds ratio (aOR) for mortality adjusted for age, sex, race, ethnicity, and Charlson-Comorbidity Index using m-SA as reference.

Results

427,587 patients (age, 55.1±14.6 years; BMI, 32.7±6.2; male, 90.5% and 65% male) had at least one documented AHI. The NLP algorithm achieved to high recall (89%), specificity (91%) and F1-score (88%). Mortality rates were 10.8%, 7.7%, and 13.4% in the n-SA, m-SA, and s-SA, respectively. aOR for all-cause mortality rates in Young for n-SA was 1.08 (0.94-1.20) vs s-SA 1.20 (1.08-1.26); in Middle Age for n-SA was 1.40 (1.33-1.41) vs s-SA 1.20 (1.15-1.24); and in Older was for n-SA 1.49 (1.45-1.52), s-SA 1.04 (1.00-1.08).

Conclusion

All-cause mortality rate relates to the severity of SA in a U-Shaped appearance. The U-shape appearance increases markedly with age. Further investigations into mechanisms of the U-Shaped appearance is needed.

Support (if any)

Supported by NIH-NHLBI-K25 funding (#1K25HL152006-01 [J.R.]); seed funding by AHBPCE (#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0492 US Veterans with COMISA, Sleep Apnea, and Insomnia: Chronotype Prevalence and Patient-reported Outcomes
Authors: Wallace Douglas , Sweetman Alexander , Wohlgemuth William
Published: April 2024

Introduction

Among US veterans, it is unclear whether insomnia, obstructive sleep apnea (OSA), and comorbid insomnia in sleep apnea (COMISA) carry disproportionate burden to patient-reported functional outcomes (PROs). Furthermore, whether chronotypes vary among these sleep disorders groups and contribute independently to PROs has not been explored.

Methods

Veterans at risk for OSA evaluated at the Miami VA Sleep Center evaluated over one year. Veterans completed home polysomnography (PSG) and questionnaires (demographics, insomnia severity index [ISI], patient-reported outcomes [PROMIS-29]). OSA diagnosis was per AHI ≥ 5 on PSG while insomnia was per ISI ≥ 15. Those with COMISA fulfilled both of these criteria. Chronotype was self-reported as “morning [M]”, “more morning than evening [M>E]”, “more evening than morning [E>M]” or “evening [E]” type. Sleep group characteristics were compared by ANOVA or Chi-square. Then, regression models were constructed to determine the association of COMISA and insomnia disorder reference to OSA alone on PROMIS domain T-scores. Finally, to explore whether chronotype was associated with PROs within each sleep group, regression models stratified by sleep disorder group were constructed.

Results

The cohort consisted of 387 veterans (85% male, mean age 52 ± 15 years ) where 60 participants (16%) had OSA alone, 68 (18%) had insomnia alone, and 259 (67%) met COMISA criteria. Participants in the insomnia group were significantly more likely to be female, have lower mean BMI and were younger than the OSA alone and COMISA groups. The chronotype prevalence of morning, M>E, E>M, and evening were 33%, 24%, 26%, 16%, respectively. These did not vary across sleep disorder groups (p=0.15). In regression analyses, participants with insomnia alone and COMISA had worse anxiety, depression, fatigue, sleep disturbance, social disruption, physical function, and pain interference than veterans with OSA alone. However, in analyses stratified by sleep disorder groups, chronotype was not associated with any of these PROs

Conclusion

Veterans with COMISA and insomnia alone were more functionally impaired than those with OSA alone. However, chronotype prevalence was similar across veterans with OSA, insomnia, and COMISA and chronotype itself was not associated with PROs. Larger studies with objective measures of chronotype are needed to replicate these findings.

Support (if any)

None
0496 A Narrative Review of the Relationship Between Head and Neck Cancer and OSA
Authors: Sharma Abhay , Le Trung
Published: April 2024

Introduction

Cancer patients with comorbidities have suboptimal treatment outcomes and lower survival rate. Obstructive sleep apnea (OSA) is an underdiagnosed and undertreated cancer comorbidity, especially within the head and neck cancer (HNC) population. There are complex, bidirectional associations between OSA and HNC. Refining HNC-OSA management necessitates an improved grasp of the HNC-OSA relationship. This study reviews the current course of HNC therapy, causal and associative relationships before and after treatment, and statistical methods quantifying HNC-OSA interactions.

Methods

A review of the literature was conducted using PubMed, Google Scholar, Web of Science, Microsoft academic, Semantic, Europe PMC, Scopus, and Crossref databases to collect articles related to OSA in patients with HNCs.

Results

The search yielded 3122 articles, which was narrowed to 26 articles using PRISMA guidelines. There was a total of 382 patients in this review. The investigation confirms a positive correlation between the apnea-hypopnea index and primary tumor size. The associate and causal relationship between OSA and HNC treatment was complex and requires further study.

Conclusion

The paper provides an overview of existing statistical models, offers suggestions for model selection, framework for designing experiments that delve into research questions surrounding the link between OSA and HNC across various stages of cancer treatment. Despite progress, understanding of the HNC-OSA interplay remains incomplete due to limited histological, molecular, and clinical data. Future studies with longitudinal data are crucial for comprehensive insights.

Support (if any)

T. Le, P. Huynh, A. Sharma, A. Setty, Blanchard, and T. Le.” A narrative review of the relationship between head and neck cancer and obstructive sleep apnea: Clinical studies and statistical analysis.” Sleep Medicine Reviews Journal, 2023 (Under Review)
0503 The Impact of Health Disparities on Access to Care for Obstructive Sleep Apnea Patients: A Retrospective Study
Authors: Saltsgaver Megan , Thambi Rakhi , Zhan Weihai
Published: April 2024

Introduction

Health disparities among sleep medicine patients can further worsen sleep-related breathing disorders. Sex, race, and insurance were analyzed to find association with access to care in patients with obstructive sleep apnea (OSA).

Methods

Inclusion criteria resulted in 11,896 adults aged 18 years or older through the years of 2015-2019 with diagnosis of OSA, snoring, hypersomnia, sleep related hypoventilation, or central sleep apnea. Multiple logistic regression models were used to examine significant correlates of outcomes.

Results

About 56% female and 57% black patients had a revisitation within one year, while 52% male (51.8%) and 49% white patients did so. Patients with Medicaid insurance (59%) had a higher percentage of revisitation within one year than those with HMO/PPO/EPO insurance (51%, p <.0001). These factors remain significant in the multiple logistic regression model. The average gap between visits for Medicaid patients was 72 days whereas the gaps for HMO/PPO/EPO and Medicare patients were 82 and 88 days, respectively. The odds of having a shorter gap between visits were 20% higher among Medicaid patients (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.06 - 1.35), and 17% lower among Medicare patients (OR, 0.83, 95% CI, 0.73-0.94), when compared to the odds among HMO/PPO/EPO patients. No significant differences in the average gap between visits were observed across different sex and race groups.

Conclusion

Sex, race, and insurance type were significantly associated with repeated visits within one year of initial visit; insurance type was further found to be associated with a shorter gap between visits. Policy to promote access to OSA care shall address these disparities. Ethnicity, age, and surgical procedure data will be additionally analyzed.

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0508 Age-Related Disparities in Sleep Apnea Diagnosis: Implications of 4% vs. 3% Hypopnea Scoring Criteria
Authors: Abbasimoradi Farnaz , Ferri Raffaele , Mogavero Maria P , Palomino Melissa , DelRosso Lourdes
Published: April 2024

Introduction

The distinction between mild, moderate, and severe apnea is crucial, as it classifies patients into different categories of modifiable risk factors. In hypopnea scoring, Centers for Medicare and Medicaid Services use the 4% criterion, differing from American Academy of Sleep Medicine 's 3%, affecting AHI measurement and the assessment of apnea severity. This study examines age-related differences in the application of these two criteria leading to different apnea severity diagnosis and to potential under-treatment, especially in the elderly.

Methods

An FDA-cleared home sleep test (SleepImage Ring 2.3.0) was utilized with clinical diagnosis involving a comprehensive review by a Board-Certified Sleep Medicine Physician. Descriptive statistics and the chi-square test were employed to assess differences in frequencies. The Bland-Altman method was used to evaluate the difference in AHI estimation between the two scoring criteria, calculating the mean difference (bias) and 95% limits of agreement.

Results

In total, 1,021 subjects (mean age 53.3±14.7 years) were analyzed. The Bland-Altman plot revealed the average bias was 8.76 (95% CI: 8.46-9.06), with the 3% criterion yielding higher values. In subjects aged 18-30 years, the most significant discordance was for the diagnosis of mild OSA (35.8%), diagnosed as normal by the 4% criterion. Interestingly, this criterion classified 2.5% of subjects as normal who were moderate by the 3% criterion. Similarly, in subjects aged 41-50 years, the greatest discordance was for mild OSA (29.8%), and 24.9% were classified as having moderate OSA by the 3% criterion but mild by the 4% criterion. For subjects aged 51-60 years, the greatest discordance was in subjects classified as having moderate OSA by the 3% criterion but mild by the 4% criterion (29.4%), and the agreement on normality was very low (6.3%). The last two age groups (61-70 and >70 years) showed a pattern of concordance/discordance very similar to that of subjects aged 51-60 years.

Conclusion

Our study unveils notable disparities in hypopnea scoring criteria (4% vs. 3%). Over 20% of individuals aged 70 and above with OSA may be under-treated using the 4% criterion, emphasizing the necessity for nuanced OSA diagnosis in older individuals to ensure precise care.

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0512 ABED: Automatic Sleep-Disordered Breathing Event Detection
Authors: Kjaer Magnus Ruud , Hanif Umaer , Brink-Kjaer Andreas , Mignot Emmanuel
Published: April 2024

Introduction

Sleep disordered breathing (SDB) affects more than 10% of the global population and is associated with cardiovascular diseases. Manual annotation of SDB events is time consuming and suffers from inter-rater variances and biases. We propose Automatic Sleep-Disorder Breathing Event Detection (ABED), a method capable of localizing and classifying obstructive apneas (OA), central apneas (CA), and hypopneas (HYPO).

Methods

ABED was trained on 5,456 PSGs and evaluated on 1,099 PSGs from 4 different cohorts. The respiratory modalities included measures of nasal flow, oral thermistor, thoracoabdominal plethysmography, and blood oxygen saturation. These were passed directly as input for ABED. EEG and EOG were passed through another automated detector to ascertain arousals and wake probabilities, which was also passed as input. ABED uses an end-to-end deep learning architecture based on state-of-the-art object detection methods Unified-Real-Time-Object-Detection, ResNet for feature extraction and bi-directional long-short-term-memory layers for temporal processing. ABED was trained on 240 second windows and apnea classes were balanced by sampling less prevalent classes (OA, CA) multiple times during training. ABED was optimized based on event class (cross-entropy loss) and position (Huber loss) weighted towards the class. At the point of inference, non-maximum suppression was used to remove overlapping predictions.

Results

Results show that the apnea-hypopnea index (AHI) values based on ABED’s predictions correlate well with experts (R^2=0.86;β_0=0.95,β_1=3.29 ) and predict sleep apnea diagnosis (AHI≥15) and severity (no, mild, moderate, severe) with a mean accuracy of 89% and 76%, respectively. ABED was able to predict the central apnea index (CAI) with a high correlation (R^2=0.82;β_0=1.16,β_1=0.51 ). When inferring individual events, ABED achieved an overall F1 score of 0.78 in distinguishing between the presence of an event or regular breathing. For specific event types, the F1 scores were: 0.72 OA, 0.51 for CA, and 0.66 for HYPO.

Conclusion

ABED was trained and tested on a multi-cohort dataset and demonstrates generalizing properties on intra-cohort variability along with consistent scoring, making ABED suitable as support for medical experts in SDB annotation. Overall apnea event detection performance demonstrates that ABED can discern between apneic events and regular breathing. Additional work will involve integration of additional cohorts.

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0515 Demographic Study of Inpatient Polysomnograpy from 2019 Through 2022
Authors: Williams George , Ascencio Claudio Gomez , Wani Anna
Published: April 2024

Introduction

Sleep disordered breathing (SDB) refers to abnormalities in ventilation and oxygenation that occur during sleep. Common etiologies of SDB include obesity, craniofacial abnormalities, neuromuscular disorders, and adenotonsillar hypertrophy. The gold standard for diagnosis of SDB is polysomnography (PSG) which evaluates for obstructive sleep apnea, central apnea, persistent desaturations, nocturnal hypoxia, or to determine readiness for decannulation from tracheostomy, and can be performed in either the outpatient or inpatient setting. The primary objective of this study is to determine any temporal changes in patient demographics, PSG parameters, and prevalence of airway comorbidities among pediatric patients receiving at least one inpatient PSG during the COVID19 pandemic, from 2019 through 2022.

Methods

Retrospective analysis of medical records from 422 pediatric patients admitted to Children’s Hospital in Dallas from 2019 through 2022 who received at least one PSG was conducted. Parameters from PSG were recorded and analyzed. Values and demographics from each year were compared against each other and analyzed.

Results

A total of 422 children had 467 PSGs from 2019 through 2022. Demographically, there was no difference in age, gender, height, weight, race, ethnicity, language spoken at home, or primary insurance over these years. In terms of PSG parameters, there was a significant difference in AHI between 2019 12.83(95%CI 9.33-16.32) and 2022 19.04(95%CI 12.39-25.69, p< 0.05) as well as percentage of total sleep time spent hypercapnic between 2020 9.78%(95%CI 5.09-14.48%) and 2022 4.90%(95%CI 1.55-8.24%, p< 0.01). There was no difference among prevalence of airway comorbidities. There was also a significant difference in hospital stay between children hospitalized in 2019 15.29(95%CI 12.06-18.52 days) compared to 2020 25.98(95%CI 18.10-33.85 days, p< 0.05), 2021 29.74(95%CI 19.00-40.48 days, p< 0.05), and 2022 31.24(95%CI 24.04-38.44 days, p< 0.001).

Conclusion

Hospitalized pediatric patients in 2019 prior to the onset of COVID19 pandemic had shorter hospital stays compared to 2020, 2021, and 2022. The longer length of hospital stay observed in 2020-2022 likely reflected initiatives to limit inpatient PSGs in favor of performing them in the outpatient setting. Further research comparing the specific management by PSG metrics would provide insight on changes in treatments for SDB throughout the COVID19 pandemic.

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0521 Validation of Deep Learning Algorithm Model in Automatic Scoring of the Respiratory Events in Adult Polysomnography
Authors: Park Marn Joon , Choi Ji Ho , Ha Tae Kyoung , Lee Ho Dong , Lee Young Jun
Published: April 2024

Introduction

Background: Polysomnography (PSG) has several benefits as a conventional diagnostic tool for identifying and assessing a range of sleep disorders, with particular emphasis on obstructive sleep apnea (OSA). Nevertheless, the process of scoring raw data requires a significant amount of effort and time. Hence, the objective of this research was to assess the precision of a recently devised automated scoring system for respiratory events, using a deep learning algorithm model, in the context of people afflicted with sleep-disordered breathing (SDB).

Methods

A total of 1,000 case PSG data were enrolled to develop a deep learning algorithm. Of the 1,000 data, 700 were distributed for training, 200 for validation, and 100 (simple snoring, mild, moderate, and severe OSA; n = 25 in each group) for testing. The respiratory events scoring deep learning model is composed of five sequential layers: an initial layer of perceptrons, followed by three consecutive layers of long short-term memory cells, and ultimately, an additional two layers of perceptrons.

Results

The PSG data of 100 patients (mean age 50.59 ± 14.01 years; 55 men and 45 women; body mass index 26.30 ± 3.98) were selected for validation and testing of the deep learning model, which included simple snoring, mild, moderate, and severe OSA groups (n = 25 each). Our deep learning algorithm had a sensitivity (95% confidence interval [CI]) of 98.06 (96.64-99.53), 98.12 (96.68-99.87), 98.23 (96.75-99.72), and 98.51 (96.2-95.91) for identifying apnea or hypopnea events. The specificity (95% CI) of simple snoring, mild OSA, moderate OSA, and severe OSA was 97.79 (92.84-99.95), 96.84 (93.6-99.95), 96.7 (93.32-99.59), and 95.46 (93.71-99.08) compared to a manually graded PSG report. The deep learning model's area under the curve values for predicting OSA in apnea-hypopnea index ≥ 5, 15, and 30 groups were 0.9402, 0.9388, and 0.9442, respectively, showing no significant differences between each group.

Conclusion

The deep learning algorithm used in our work demonstrated a notable accuracy in recognizing apnea/hypopnea episodes and subsequently categorizing the severity of OSA.

Support (if any)

This work was supported by the Technology Development Program (S2718665), which is funded by the Ministry of SMEs and Startups of Korea and Soonchunhyang University Research Fund.