bluuebunny/crossref_metadata_2025 huggingface dataset:
0587 Adherence and Quality of Life of Patients with Sleep Disordered Breathing Treated with Automatic Servo-Ventilation
Authors: Bass Sarah , Jasko Jeff , Hardy William , Cain Chuck , Arzt Michael , Randerath Winifried
Published: April 2024

Introduction

Automatic servo-ventilation (Auto SV) treats Central sleep apnea (CSA) and obstructive sleep apnea (OSA) by monitoring airflow and intervening with changes or pauses in airflow patterns. Evidence on adherence to Auto SV therapy and its effects on symptoms, sleep quality and quality of life (QOL) in real world Auto SV users is sparse. The aim of this registry study was to describe the adherence to Auto SV (Philips DreamStation BiPAP auto SV) and to evaluate Auto SV therapy effects on sleepiness, sleep quality and QOL.

Methods

Data were collected at six sites across Germany from 2018 through 2023 at 6, 12, and/or 24 months. Auto SV adherence data were collected through Philips EncoreAnywhere™ (EA) software and examined according to intent-to-treat and subgroup analyses accounting for data gaps. Average adherence was calculated from the first to the final date of first device usage. Sleepiness, sleep quality and general QOL were assessed with the Epworth Sleep Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and the European Quality of Life-5 level questionnaire (EQ 5D-5L), respectively. Changes from baseline (CFB) were calculated for questionnaires collected at enrollment and at visits at 6, 12 and 24 months (Mixed-Models including Sidak adjustment).

Results

One hundred and twenty-five participants were enrolled. Average age was 65 ± 12 years; 106 (85%) were males. Average adherence over days used was 6.0 ± 1.9 hours/day (n = 103) and 5.0 ± 2.4 hours/day (n = 103) among all days (average follow-up 478 days). Percent days used averaged 78.5 ± 27.1%. ESS and global PSQI scores showed significant improvement from baseline at 24 months in completed-cases and last-observation-carried-forward analyses (ESS [Mean difference: CC -1.9 ± 3.9 (N=57), LOCF -1.8 ± 4.5 (N=103), p ≤0.001], PSQI [Mean difference: CC -1.7± 3.5, LOCF (N=55), -1.6 ± 3.5 (N=98), p < 0.001]). The EQ-5D-5L did not significantly differ from baseline.

Conclusion

Auto SV use averaged 5 hours per night and Auto SV significantly improved sleepiness and sleep quality, but not general QOL, in a real-world sleep clinic population. ESS approached clinical significance (MCID 2.0) while the PSQI did not (MCID 3).

Support (if any)
0589 Evaluating the Impact of Sleep Position on Efficacy of Hypoglossal Nerve Stimulation
Authors: Castillo Horacio Romero , Jain Nikhita , Ren Jennifer , Oby Brandon , Lin Fred , Chou Courtney , During Emmanuel
Published: April 2024

Introduction

Current literature supports hypoglossal nerve stimulation (HNS) as a treatment option for select patients with moderate-to-severe obstructive sleep apnea (OSA). However, in about a third of implanted patients, HNS is ineffective. To date, few publications have investigated how sleep position impacts HNS efficacy. In 2019, the Stanford group found that HNS had a greater impact on non-supine AHI vs supine AHI; the data was limited to eleven patients monitored in the sleep lab and did not incorporate full-night data. We explored the effect of sleep position on HNS efficacy in a larger sample by comparing pre- and post-operative overnight sleep studies.

Methods

We performed a retrospective chart review of 136 patients implanted at Mount Sinai Hospital from 2016-2023. Patients were included if they tolerated therapeutic voltage and completed pre- and post-operative sleep studies with at least 30 minutes of supine and non-supine sleep. Mean differences in pre- and post-operative overall AHI4% (DeltaAHI), supine AHI4% (DeltaSupine) and non-supine AHI4% (DeltaNon-supine) were calculated. Paired T-Test was then performed to compare AHI4% percent reduction when supine versus non-supine. Secondary outcomes included mean difference in pre- and post-operative ODI4 (DeltaODI) and ESS (DeltaESS). We also calculated our cohort’s surgical success rate, as defined by Sher’s criteria.

Results

Seventeen patients met inclusion criteria. Mean age was 60.2+/-11.2 years, and 15 patients were male (88.2%). Mean BMI was 29.1+/-3.0 kg/m2. Mean preoperative AHI4% was 29.4+/-14.8 events/hour; mean preoperative supine AHI4% and non-supine AHI4% were 44.6 events/hour and 13.3 events/hour respectively. Overall DeltaAHI was 15.2 events/hour (p=0.0004), DeltaSupine was 21.4 events/hour (p=0.0071), and DeltaNon-supine was 6.2 events/hour (p=0.0486). Despite the difference in absolute reduction, there was no statistically significant difference (p=0.3242) between the percent reduction of supine AHI4% (41.7%) versus non-supine AHI4% (10.0%). Mean differences for DeltaODI and DeltaESS were 11.5 (p=0.0051) and 2.9 (p=0.2) respectively. Overall success rate was 58.8% (10 of 17 patients), which is similar to other studies in the literature.

Conclusion

In our sample, we found no difference in AHI percent reduction between supine and non-supine position, suggesting that HNS is effective in improving OSA regardless of positionality.

Support (if any)

NCATS: TL1TR004420;
0591 Improving Efficiency & Patient Outcomes Using Longitudinal Monitoring via a HSAT with Hypoglossal Nerve Stimulation
Authors: Patel Ruchir , Gunn Stacey , Messner Stephanie , Rodriguez Haley , Casselman Erica , Reuveny Amir , Rohrscheib Chelsie
Published: April 2024

Introduction

Hypoglossal Nerve Stimulation (HGNS) is an increasingly prevalent treatment for moderate-severe obstructive sleep apnea (OSA). HGNS therapy requires titration to identify the optimal stimulation parameters for patient comfort and OSA improvement. The recommended post-activation care protocol is long, typically taking 90-120 days to complete. The purpose of this study was to evaluate an optimized protocol utilizing a home sleep apnea test (HSAT) capable of long-term longitudinal monitoring to frequently assess treatment efficacy as stimulation amplitude adjustments were being made.

Methods

The study included 30 adults undergoing titration of an HGNS implant at a Sleep Clinic in Arizona, USA from January-October 2023. The revised protocol: The device was activated 3-weeks post-op and the stimulation amplitude was increased by 0.1V every 4 days following device activation. Patients were advised to test their sleep with a HSAT for 1 night on the 2nd night after every amplitude increase to minimize the risk of “1st night effect” after the initial amplitude increase. Follow-up visits were scheduled every 2 weeks post-activation, where the HSAT data was reviewed. Apnea/Hypopnea Index (AHI) and SPO2 were used to evaluate OSA severity. An in-lab titrations study was conducted 10-12 weeks post-activation if the patient was asymptomatic and adherent, and the HSAT showed significant improvement in OSA parameters.

Results

The updated care protocol took an average of 63.76 (SD 41.14) days from activation to completion 86.6% (n=26) of patients completed the program in < 90 days and 60% (n=18) completed the program in ≤60 days. The mean percent reduction in AHI was 68.09% (SD 21.89; mean -15.21 AHI). The mean increase in minimum SPO2 was 4.31% (SD 5.11).

Conclusion

A new HGNS titration protocol that included frequent testing with a HSAT allowed for objective, longitudinal assessment of the effectiveness of each amplitude/output adjustment. Monitoring OSA parameters minimized over-titration of the device amplitude, improving patient comfort, and allowed for earlier identification of the need to try a different electrode configuration if the AHI was not improving. This study demonstrated that a shorter program length was possible while still maintaining good treatment efficacy.

Support (if any)

Employees of Wesper contributed to the data analysis.
0594 Novel Device to Simulate Hypoglossal Nerve Stimulation Response to Predict Surgical Success
Authors: Glick Aaron , Singh Supriya
Published: April 2024

Introduction

Hypoglossal Nerve Stimulation (HGNS) is a surgical procedure to treat obstructive sleep apnea (OSA). The procedure involves placing an electrical cuff around the hypoglossal nerve to electrically stimulate the nerve during inspiration to anteriorly position the tongue thus treating the obstructive event. Currently, a drug induced sleep endoscopy is completed prior to the HGNS surgery to investigate if implantation would be predictably successful. Yet, treatment failures continue to exist despite current VOTE classifications, concentric collapse identification, and other methods used to improve patient selection for HGNS implantation.

Methods

A pilot study was conducted to investigate the potential of a non-invasive hypoglossal nerve stimulator to evaluate the potential of predicting surgical success during DISE. The non-invasive stimulator activates the hypoglossal nerve without direct contact with the nerve and therefore does not require surgery. Ten adult patients (≥ 18 years of age) presenting at Michael E. DeBakey Department of Veterans Affairs Medical Center with moderate to severe OSA (15-60 AHI) and BMI less than 40 that were undergoing DISE procedure participated. The stimulator device was used during the DISE procedure to identify reduction of collapse during hypoglossal stimulation prior to implantation. Endoscopy videos were collected during standard procedure and during use of the stimulation device and shown to three blinded board-certified sleep physicians to score likelihood of success with HGNS implant based on absence of concentric collapse identification, presence of anterior-posterior collapse using the VOTE classification, and stimulation device method.

Results

Patients will be followed to identify percentage AHI reduction, patient reported tolerance of implanted HGNS, and provider reported overall success of implanted HGNS.

Conclusion

The novel non-invasive HGNS device has the potential to improve prediction of implantation AHI reduction success and understand likelihood of tolerance.

Support (if any)

Ember Sleep provided the stimulation device at no cost.
0600 Baseline Decisional Conflict and 3-Month Decision Regret Among Patients Considering Sleep Surgery
Authors: Ikeda Allison , Weaver Edward
Published: April 2024

Introduction

Sleep surgery has a role as secondary or adjunctive treatment of obstructive sleep apnea (OSA) after unsuccessful trial of CPAP therapy. In the shared decision-making process, patients are informed of the potential benefits, expected course, and potential risks of surgery. We believe that the careful consideration of these competing issues can increase decisional conflict initially but reduce decision regret subsequently. We hypothesized that patients considering sleep surgery who have higher baseline decisional conflict will have lower 3-month decision regret after making a choice, whether or not they proceed with surgery.

Methods

This prospective cohort study enrolled consecutive adult patients considering sleep surgery for OSA after difficulty with CPAP therapy. After surgery consultation, patients completed the validated Decisional Conflict Scale (16 items, score range 0-100, higher worse, >20 clinically important). At 3-months after surgery (surgery group) or 3-months after the consultation (control group), patients completed the validated Decision Regret Scale (5 items, score range 0-100, higher worse). Records were extracted for other variables. Linear regression analyses tested the associations between baseline Decisional Conflict and 3-month Decision Regret after adjusting for age, sex, race, Functional Comorbidity Index, type of sleep surgery, and history of sleep surgery.

Results

The cohort (N=157) characteristics include mean age 41+/-13 years, 60% males, and apnea-hypopnea index 26+/-22. For the whole cohort, baseline Decisional Conflict was 20+/-17 (borderline conflict), 3-month Decision Regret was 19+/-20 (mild regret), and there was no association between the two variables (adjusted R2=0.001, p=0.2). The surgery group had lower baseline Decisional Conflict and lower 3-month Decision Regret compared to the control group, but there was no association between baseline Decisional Conflict and 3-month Decision Regret in either group (R2=0.01 and 0.02).

Conclusion

Baseline decisional conflict was not associated with 3-month decision regret, whether or not surgery was chosen. The lack of association may be due to the low baseline decisional conflict, low 3-month decision regret, or other factors impacting decisional conflict (eg, choice predisposition, prior knowledge, risk aversiveness) or decision regret (eg, clinical outcome, adverse effects). Future work includes testing predictors of baseline decisional conflict and subsequent decision regret independently.

Support (if any)

American Academy of Otolaryngology Resident Research Award
0601 Hispanic Ethnicity Is Associated with Decreased Adherence to Hypoglossal Nerve Stimulation
Authors: Mayo Meagan , Abreu Alexandre , Suurna Maria , Wallace Douglas
Published: April 2024

Introduction

Hypoglossal nerve stimulation (HGNS) is an alternative therapy for patients with obstructive sleep apnea intolerant to positive airway pressure (PAP). Psychosocial variables proven to influence PAP adherence, such as race, ethnicity, and baseline insomnia, have not been well studied with HGNS. This study evaluates HGNS use based on ethnicity and baseline comorbid insomnia (COMISA).

Methods

We conducted a retrospective analysis of patients implanted with HGNS at the University of Miami and Miami VA sleep centers (2017-2023) who were seen for initial follow-up within one year post-implantation. Patient demographics, baseline sleep characteristics, comorbidities, and polysomnography variables were extracted from the electronic medical record. Comorbid insomnia was defined by sleep onset latency or wake after onset time > 30 mins. Comparisons between Hispanic and non-Hispanic patient characteristics were performed with Chi-square or Student t-tests, as appropriate. Objective HGNS adherence data and stimulation parameters were extracted from the Inspire cloud or tablet monitoring system at the most recent visit. Adjusted linear regression models were constructed to determine if COMISA and Hispanic ethnicity were associated with mean nightly HGNS use. Analyses were adjusted for age, gender, sleepiness, AHI, and time to follow-up.

Results

The cohort included 68 patients (18% female, 97% White, 53% Hispanic, 38% US Veterans) with mean age of 62 +/- 11 years, mean body mass index of 29 +/- 3 kg/m2, and baseline apnea hypopnea index of 37 +/- 19 events/hour. Mean duration since implantation was 35 +/- 30 months and mean HGNS use was 274 +/- 147 min/night. In unadjusted comparisons there were no differences in demographics, sleep characteristics, treatment parameters, time since implantation, or follow-up between Hispanics and non-Hispanics. In adjusted analyses, Hispanic ethnicity was associated with 81.7 (p=0.035) fewer minutes of nightly HGNS use compared to non-Hispanic individuals. COMISA was not significantly associated with HGNS adherence.

Conclusion

Ethnicity influences HGNS adherence, while COMISA does not significantly affect usage. Hispanic patients used HGNS more than one hour less per night compared to non-Hispanic individuals. Further evaluation of potential contributing factors, such as socioeconomic status and referral biases, is warranted.

Support (if any)
0603 Transforming Obstructive Sleep Apnea Treatment: Telehealth and Mandibular Advancement Devices
Authors: Chilukuri Priyanka , Patel Imran , quan Stuart , Rothers Janet , Sans-Fuentes Maria , Patel Salma
Published: April 2024

Introduction

Effective obstructive sleep apnea (OSA) treatment can potentially reduce the risk and the public health burden of OSA. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treating OSA, long-term adherence is suboptimal. Although adherence to mandibular advancement devices (MADs) is higher, long-term data is lacking. This study explores the potential of MAD to i) improve patient symptoms and clinically relevant parameters and ii) evaluate telehealth as a platform to increase MAD accessibility and address the public health burden of OSA.

Methods

The electronic medical records of patients administered a MAD for OSA at an academic medical facility from 2019 to 2023 were evaluated. Patient demographics and mode of healthcare delivery were extracted. For patients who received a MAD, variables from their diagnostic polysomnography, like the Epworth Sleepiness Scale (ESS) and the apnea-hypopnea index (AHI), were compared with those from follow-up polysomnography with the MAD. These variables were also compared between the in-person and telehealth cohorts.

Results

176 patients received a MAD for OSA treatment (56 ± 16 years of age, BMI 31 ± 7 kg/m2, 59% female, 82 White, 20% Hispanic/Latino). 37% and 59% of initial visits used telemedicine or teledentistry, respectively. Insurance coverage included AHCCS (26%), Medicare (20%), and commercial insurance (79%) as primary or secondary. The baseline ESS was 8 ± 4 (range 1-24). Initial diagnostic sleep study noted an AHI of 18 ± 15/hour (range 5-109.9/hour; supine 22±18/hour, lateral 14±25/hour), minimum oxygen saturation of 81 ± 7, sleep efficiency of 74 ± 16/hour, and an arousal index of 24 ± 19/hour. In the follow-up polysomnography with the MAD, significant differences were noted in AHI (p=0.0062) regardless of the frequency of in-person or telehealth encounters. While significant differences were not noted in ESS for the overall cohort (p=0.11), ESS improvement was significant in the telemedicine (p=0.03) and teledentistry (p=0.018) cohorts.

Conclusion

MAD use can improve clinically relevant parameters in OSA. Telehealth can deliver clinically effective treatment of OSA.

Support (if any)

American Academy of Dental Sleep Medicine, American Academy of Sleep Medicine Foundation, National Institutes of Health, The University of Arizona.
0604 Substantial Cost Savings with Novel Oral Appliance O2Vent Optima Compared to CPAP Therapy in Canada
Authors: Metwali Rami Al , Rana Shahzad , Sharma Vivek , Bloomfield Lisa
Published: April 2024

Introduction

There is a common perception that oral appliance therapy (OAT) is more expensive than the continuous positive airway pressure (CPAP) therapy. This may be a prohibitive factor for many clinicians and patients to choose a less intrusive therapy with better compliance. Private insurance payers in Canada offer preferential approvals for CPAP over OAT. While oral appliance costs vary and encompass high dentistry fees, CPAP costs are standard. The novel Oral appliance O2Vent Optima also has standard pricing in Canada. The purpose of this investigation is to examine the costs associated with O2Vent Optima versus the CPAP.

Methods

CPAP costs are partially offset by the governments in Canada, the consumables are paid by the users or private insurance. The replacement schedule for the consumables is manufacturer recommended, followed by the CPAP vendors and insurance payers. These include: mask, hose, filters, wipes, mask replacement cushions, water reservoir, tubing and distilled water. The O2Vent Optima also has additional costs for consumables: connector bands, antibacterial tablets for cleaning and ExVent valves.

Results

Initial CPAP price is $1,500; $1,085 with government subsidy. Yearly expenditure for the CPAP consumables is $1,330. Total cost for a 3- year and 5- year CPAP therapy is: $5,075 and $7,735 respectively. O2Vent Optima retails at $2,500 with the insurance payment, and $2,000 if paid out of pocket. The consumables cost $200/year. Total cost of O2Vent Optima at 3- year and 5- year is: $3,100 or $2,600 and $3,500 or $3,000 respectively. Over a 3- and 5- year period, O2Vent Optima resulted in a net saving of $1,975 and $4,235 over CPAP. Daily cost burden of CPAP at 3- and 5- year is $4.63 and $4.24 compared to $2.83 and $1.92 at 3- and 5- year with O2Vent Optima.

Conclusion

Therapy with CPAP compared to OAT with O2Vent Optima costs 165% more at 3 years and 220% more at 5 years. Based on this analysis, it is anticipated that private insurance payers in Canada will endorse a cost-effective and better tolerated therapy with novel oral appliance O2Vent Optima, in addition to the CPAP.

Support (if any)

This investigation was sponsored by Open Airway Dental Solutions Ltd. (OADS)
0605 Temporomandibular and Oral Parafunction as Risk Factors for Jaw Pain Related to Oral Appliance Therapy
Authors: Hamza Amina , Giri Subha , Morgenthaler Timothy
Published: April 2024

Introduction

Oral Appliance Therapy (OAT) is a management option for patients with Obstructive Sleep Apnea (OSA). A reported drawback to OAT is symptoms relating to Temporomandibular Joint Disorder (TMD), including post-procedure jaw pain. Some studies reported TMD in over 50% of patients prior to OAT. The aim of this study was to evaluate the prevalence of TMD and oral Parafunction Habits (PFH) in patients with OSA referred for OAT, and determine any relationship between patient characteristics, demographics, medical history, and degree of OAT advancement with post-procedure jaw pain.

Methods

A retrospective analysis was conducted, reviewing the electronic health records of 125 patients with OSA referred to the division of dental sleep medicine in Mayo Clinic Rochester, for OAT. Records reviewed included patient demographics, TMD-PFH symptoms and signs before and after initiation of OAT, self-reported history of, and signs of PFH, AHI pre-initiation of OAT, presence of fibromyalgia, SSRI use, and percent advancement of appliance at time of re-evaluation.

Results

The median age of patients reviewed was 58 (Interquartile Range (IQR) 20), median BMI 30.5 (IQR 7), median AHI 11.3 (IQR 9.5). 57% were male, 43% female. 20.8% patients had TMD history, 37.6% had TMD signs, 47.2% had PFH history (jaw clenching, lip biting, and/or thumb sucking). 96% had signs of PFH. 15.2% reported post-procedure jaw pain. There was a statistically significant relationship between both TMD history and TMD signs, with post-procedure jaw pain (p value 0.002 and 0.013 respectively), although after multi-variate analysis, only TMD history remained associated with post-procedure jaw pain (Odd’s Ratio 3.385, 95% Confidence Interval 1.081 – 10.601, p value = 0.036). Age, BMI, gender, PFH signs and history, SSRI use, fibromyalgia history, % advancement of OA had no statistical association with post-procedure jaw pain.

Conclusion

Having a history of TMD symptoms prior to OAT is a risk factor for post-OAT jaw pain. A thorough oral and maxillofacial history in patients being considered for OAT is important to identify patients with TMD history, to establish a clear path to initiate OAT and to closely monitor, reduce or potentially eliminate the reported side effect.

Support (if any)
0609 Improved Sleep Quality with Expiratory Positive Airway Pressure Enhanced Mandibular Advancement Device in OSA
Authors: Sharma Sat , Metwali Rami Al , Conflitti Antonella , Reiter Hilary
Published: April 2024

Introduction

The ExVent is an optional accessory to the O2Vent Optima mandibular advancement device (MAD) and provides oral Expiratory Positive Airway Pressure (EPAP). Oral EPAP with the ExVent is designed to provide upper airway support via similar mechanisms of action of nasal EPAP devices in commercial distribution, e.g., passive dilatation of the airway, which reduces flow limitation. The oral EPAP provided by the ExVent accessory augments the OSA therapy provided by the O2Vent Optima. Long-term benefits on sleep quality and daytime functioning with combination therapy have not been studied.

Methods

We conducted a retrospective survey of all patients who were prescribed O2Vent Optima mandibular device and oral expiratory positive pressure accessory in Canada and Australia from 2019 to November, 2022. A study investigator contacted the participants via telephone and obtained consent to participate. Data collected included: demographics, duration of use, frequency of use, daytime sleepiness, bed partner reported snoring, sleep satisfaction, morning and daytime functioning, daytime tiredness/fatigue and bed partner’s sleep.

Results

Out of the patient data base of 480 subject, 168 (35%) participated. 31 (18%) stopped using the appliance. Out of 137 (81%) subjects, 118 (86%) were still using the ExVent Accessory, 92% medium strength (Yellow). Age 53±7 yrs, 76% Male. Data showed mean duration of use 2.7±0.9 years, mean frequency of use - most nights (91%), use >6 hours/night (86%). Sleep quality was compared from before to after therapy. Daytime sleepiness improved to none/mild from moderate/severe (96%). Bed partner reported snoring improved to none/mild from moderate/severe (94%). Participants slept very well/reasonably well compared to not well/not well at all (82%), woke up more refreshed most mornings compared to some/rare mornings (86%), functioned very well/reasonably well to not well/not well at all (88%), felt fatigue and tiredness none of the time compared to some/all the time (83%), bed partner’s sleep interruption was none/some of the time from all the time (95%).

Conclusion

This retrospective study demonstrated that majority of subjects prescribed EPAP enhanced MAD with O2Vent Optima and ExVent were compliant, experienced improved sleep quality, daytime functioning and their partner’s sleep was significantly less interrupted.

Support (if any)

Centre for Sleep and Chronobiology, Toronto, Canada
0610 Mouth Taping, Nighttime Exercises, Acupuncture and More: Who Seeks out Solutions to Stop Snoring?
Authors: Gorovoy Suzanne , Grandner Michael
Published: April 2024

Introduction

Snoring affects roughly 90 million Americans. Although snoring may indicate a serious health condition such as obstructive sleep apnea, most people attempt to manage snoring using alternative over-the-counter strategies. The present study examined the use patterns of alternative strategies across sociodemographic factors.

Methods

Data were obtained from households in the USA, UK, and Australia that had attempted to stop snoring using alternative strategies (N=4,346). Variables of interest included age, sex, race/ethnicity, country, employment, urban environment, and prior diagnosis of sleep apnea, chronic pain, depression, or anxiety.

Results

Older age was generally associated with using extra pillows, humidifier, cutting alcohol, nasal strips/stents, nasal sprays, saline rinses, and sewing a tennis ball into a shirt. Males were more likely to use honey/lemon, change sleeping position, Vaseline on the nose, snoring exercises, tennis ball, and nighttime exercise, and less likely to use extra pillows. Hispanics/Latinos were more likely to use honey/lemon, anti-snore pillows, snoring exercises, mouth taping, saline rinses, nighttime exercise and cutting alcohol; Blacks/African-Americans were less likely to use nasal strips/stents or sprays and more likely to use nighttime exercise; Asians were more likely to use mouth taping; Native/Indigenous groups were more likely to change sleeping position, use snoring exercises, and increase water intake at night. Australians were more likely to use extra pillows, hot showers, and nighttime showers and exercise. People from the UK were less likely to use humidifiers, nasal strips/stents, nighttime showers, or hot showers. Urban individuals were more likely to use acupuncture, Vaseline, snoring exercises, mouthguards, and mouth taping. Rural individuals were less likely to employ nearly all of the approaches. Employed individuals and those with a history of sleep apnea, chronic pain, depression, and/or anxiety were more likely to employ nearly all of the strategies.

Conclusion

Alternative strategies for managing snoring varied across demographic groups. Males, older adults, and those with a history of chronic pain, obstructive sleep apnea, depression, and/or anxiety were more likely to utilize a wider array of strategies. Future work should explore whether people who use specific alternative strategies are more likely to have an undiagnosed condition such as obstructive sleep apnea.

Support (if any)

Rhinomed Ltd; #R01DA051321
0611 Gamification of Digital Oropharyngeal Exercises Improves Therapy Adherence in OSA Patients
Authors: Goswami Umesh , Krohn Brian
Published: April 2024

Introduction

OSA is caused by the interaction of impaired upper airway anatomy and dysfunctional upper airway muscle response to airway narrowing during sleep. Oropharyngeal exercises focused on training upper airway muscles are effective in reducing OSA severity and symptoms. However, similar to other physical therapy programs, oropharyngeal exercises require patients to complete multiple therapy sessions which affects patient compliance. To address this, we developed a smartphone application to provide oropharyngeal exercise and tested the effect of adding gamification and habit formation techniques on therapy adherence.

Methods

The experimental app which included oropharyngeal exercise therapy administered using voice-controlled games, a reward system, a reminder system, and supportive video content was compared to the control app that included text-based exercise therapy instructions and limited video content. Participants with mild to moderate OSA were randomly assigned (1:1) to either group. Demographics, sleep apnea variables, therapy progress, self-reported snoring severity questionnaires were collected for both groups. Appropriate descriptive statistics were used to summarize baseline and outcome data.

Results

30 participants (13 male), mean age 60.7 ± 11.1 years were randomized equally to the experimental and control groups. 9 participants (6 in the experimental group and 3 in the control group) were unable to complete the study due to technical challenges with the apps and were excluded from analysis. No statistically significant differences were noted in either group’s baseline demographic and OSA measures. 7/9 (78%) participants in the experimental group vs 7/12 (58%) in the control group met the prespecified compliance thresholds for the 8 weeks therapy period. Self-reported snoring severity mean scores were significantly reduced in the experimental group (from 2.86 to 1.43, p-value 0.04) compared to the control group (from 2.14 to 1.77, p-value 0.21).

Conclusion

Addition of gamification and therapy monitoring techniques improve compliance to the prescribed oropharyngeal exercises in patients with OSA. Further studies are needed to establish the efficacy of gamified oropharyngeal therapy in the treatment of OSA.

Support (if any)

Research reported in this abstract was supported by NHLBI of the NIH under award number: R43HL152948-01.
0613 Referral Patterns for Sleep Surgery in Patients with Obstructive Sleep Apnea
Authors: Ramprasad Vaibhav , Tsai Sheila , Schell Amy , Green Katherine
Published: April 2024

Introduction

Surgical management of Obstructive Sleep Apnea (OSA) is utilized in patients unable to tolerate positive airway pressure (PAP). The American Academy of Sleep Medicine (AASM) recently published guidelines for referral for surgical consultation. The aim of this study was to characterize surgical referrals from an academic sleep medicine practice.

Methods

A retrospective chart review was conducted of 249 patients referred for sleep surgery from a sleep medicine practice from 01/01/2016 to 01/01/2023. All patients were initially evaluated by a sleep medicine provider at National Jewish Hospital. All patients considering sleep surgery were referred to the University of Colorado. A total of 142 patients (57.0%) completed at least one visit for surgical consultation. Demographics, polysomnographic parameters, details from evaluation in sleep surgery clinic and eventual surgical treatment were assessed. Pearson chi-square test, fisher exact test were utilized for ordinal variables. Analysis of variance and student t tests were utilized for continuous variables to determine statistically significant relationships with P< 0.05.

Results

Those completing a surgical visit were older at time of referral with mean (SD) age 59.0 (14.0) compared to 54.4 (14.5). Of patients referred for surgery, 24 (8.4%) had BMI>40, 43 (19.7%) had AHI< 15 and 27 (10.8%) had AHI>65. The majority, 107 of 142 (75.4%), of patients completing surgical evaluation did not undergo eventual surgery. Of the non-surgical cohort, 49 (45.8%) underwent a repeat trial of PAP, 22 (20.6%) had repeat sleep testing and 10 (9.3%) underwent trial of oral appliance therapy.

Conclusion

Sleep surgery is a viable alternative to management of OSA. In this study, a large proportion of patients originally referred for surgical evaluation did not complete follow up. Furthermore, the majority of patients seen in surgical clinic did not necessarily undergo surgery for OSA. Non-surgical modalities remained an option for patients with sleep surgery referral and likely enhanced decision-making by informing patients of risks and benefits of both surgical and non-surgical management. Further efforts should be made to understand reasons for incomplete follow-up or pursuit of non-surgical options to optimize surgical referrals for OSA.

Support (if any)
0618 Phrenic Nerve Stimulation for Central Sleep Apnea: A Single Institution Experience
Authors: Knapp Sarah , Van Dongen Kimberly , Khan Meena , Mease Julie , Augostini Ralph , McKane Scott
Published: April 2024

Introduction

Central sleep apnea (CSA) is a form of sleep disordered breathing where there is a lack of drive to breathe during sleep. CSA has been associated with symptoms of poor sleep and daytime sleepiness. Moderate to severe CSA (central apnea index (CAI) >=15 central apneas/hour of sleep) has been associated with increased risk of heart failure, depressed heart rate variability, and higher incidence of nonsustained ventricular tachycardia [2-4]. Treatment of CSA has mainly centered around positive airway pressure (PAP) therapy. Phrenic nerve stimulation (PNS) was approved in 2017 for moderate to severe CSA. PNS is an implantable device that transvenously stimulates the phrenic nerve in order to stimulate the hemidiaphragm. PNS therapy was approved after the remedē System Pivotal trial that showed a ≥ 50% reduction in AHI and improvement in patient global assessment scale in patients with moderate to severe CSA [12].

Methods

This is a retrospective analysis of patients ≥ 18 years of age who had PNS implanted for moderate to severe CSA at the OSUWMC. Patient data was gathered prior to implant and at a follow-up visit one year after implant to assess efficacy and safety. Data collection including sleep study results, Epworth Sleepiness Scale (ESS) scores, and Functional Outcomes of Sleep Questionnaire (FOSQ) scores were assessed at baseline and one-year post-implant.

Results

Twenty-two patients were implanted with PNS at OSU between February 1, 2018 and May, 31, 2022. The AHI improved from a median of 40 events/hour at baseline to 18 at follow-up (p-value =0.003). This improvement in AHI was primarily from a reduction in the CAI, which was reduced from 16 events/hour to 2 events/hour (p-value of 0.001). The obstructive apnea index, mixed apnea index, and hypopnea index did not significantly change. The ESS scores improved from a median score of 12 to 9 (p-value =0.028). The FOSQ, improved from 15.0 to 17.8 but was not significant (p-value of 0.086).

Conclusion

PNS therapy shows improvement in overall AHI, primarily from the reduction of central apnea events. There was also significant improvement in ESS and a trend to improvement in FOSQ at one-year follow-up. Minimal safety concerns were reported.

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0620 Effect of Tirzepatide on Weight Loss in Patients with Obstructive Sleep Apnea and Obesity from SURMOUNT-1
Authors: Grunstein Ronald R , Taylor Rebecca , Shinde Shraddha , Dunn Julia P , Bednarik Josef , Stefanski Adam , Falcon Beverly
Published: April 2024

Introduction

Obesity has been estimated to be prevalent in 70% of patients with obstructive sleep apnea (OSA). In SURMOUNT-1, phase 3, 72-week, randomized, double-blind clinical trial in participants with obesity or overweight, those treated with tirzepatide achieved significantly greater weight reduction than placebo. Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. The current post-hoc analysis assessed efficacy of tirzepatide versus placebo on weight reduction in participants with OSA and obesity or overweight.

Methods

MMRM analysis was conducted in SURMOUNT-1 participants reporting a baseline medical history of “apnoea”, “positive airway pressure therapy” or “sleep apnoea syndrome”. Weight loss measures were assessed in participants on treatment (efficacy estimand) using the modified intention-to-treat analysis set (participants who received at least one dose of study drug (tirzepatide 5mg, 10mg, 15mg, or placebo)).

Results

There were 197 participants with OSA included in this analysis (tirzepatide 5mg n=41, 10mg n=51, 15mg n=46, and placebo n=59), with baseline age of 48-53 years, body weight 110-122 kg, BMI 39-43kg/m2, presence of hypertension 48-73%, and proportion of females 42-53%. At week 72, estimated treatment difference between tirzepatide and placebo in mean percent weight change was -11.2% (5mg), -18.2% (10mg), and -20.7% (15mg), all P< 0.001. Significantly more participants treated with tirzepatide achieved ≥5% body weight reduction (83-98% treated with tirzepatide, 25% with placebo) and ≥10% body weight reduction (46-93% treated with tirzepatide, 15% with placebo) than those treated with placebo (all P< 0.001). 27-62% of participants treated with tirzepatide achieved ≥20% body weight reduction compared to 0% in the placebo group (tirzepatide 5mg P=0.006, 10mg and 15mg P< 0.001). All doses of tirzepatide significantly reduced waist circumference from baseline to week 72 (-10.6cm, -18.2cm, -18.9cm, all P< 0.001). Placebo did not significantly reduce waist circumference at week 72 compared to baseline (-3.5cm, P=0.053).

Conclusion

Participants with OSA and obesity or overweight treated with tirzepatide had significantly greater weight reduction than those treated with placebo in the SURMOUNT-1 trial. This degree of weight loss would be expected to have a clinically meaningful impact on OSA severity and is being investigated in the SURMOUNT-OSA trial.

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Eli Lilly and Company.
0623 Effects of Nasal and Upper Airway Surgery on Pharyngeal Collapsibility in People with Obstructive Sleep Apnea
Authors: Osman Amal , Eckert Danny , Carney Andrew , Ooi Eng , Joshi Himani , Nguyen Phuc , Catcheside Peter
Published: April 2024

Introduction

Upper airway surgery reduces obstructive sleep apnea (OSA) severity. However, therapeutic efficacy varies between patients and inter-individual effects on upper airway physiology post-surgery are not well characterized. Nasal surgery alone may help facilitate breathing and CPAP delivery but would not be expected to yield major reductions in upper airway collapsibility per se. Accordingly, this study aimed to assess changes in upper airway collapsibility following nasal and upper airway surgical procedures.

Methods

People with OSA attended the sleep laboratory prior to and ≥3 months following nasal or upper airway surgery. At each visit, airway collapsibility via the upper airway collapsibility index (UACI) technique was assessed just prior to sleep and OSA severity was quantified during overnight polysomnography. To quantify the UACI, participants were instrumented with pressure sensors at the choanae and epiglottis, a sealed nasal mask and pneumotachograph. They were studied awake (verified via EEG) and supine. Brief (250ms) negative pressure pulses were delivered during early inspiration and early expiration (~-12cmH2O at the mask) every 2-10 breaths. The UACI, which correlates well with the critical closing pressure (Pcrit) during sleep, was quantified as the percent difference between nadir choanal and the corresponding epiglottic pressure to ~20 negative pressure pulses.

Results

7 participants (2 female), aged 47±12years, BMI 29±2kg/m2 with severe OSA had either upper airway surgery (uvulopalatopharyngoplasty combined with coblation channelling of the tongue, n=4) or nasal surgery alone (n= 3). Participants with upper airway surgery had a 58% reduction in upper airway collapsibility (40±18 vs. 17±22%, p=0.049) during early inspiration with similar improvements during expiration (63±9 vs. 38±30%, p=0.01). For nasal surgery only, upper airway collapsibility was not systematically different during early inspiration or expiration.

Conclusion

These preliminary findings indicate major improvements in upper airway collapsibility during wakefulness following upper airway surgery but no systematic changes with nasal surgery alone. Further application of these physiological measures may help explain between patient differences in therapeutic efficacy with upper airway surgery and assist with patient selection to improve treatment success rates.

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DJE reports funding from the National Health and Medical Research Council, Australia (1065571).
0625 Prevalence of Subjective Longer Sleep Times and Sleepiness in Patients Evaluated at a Tertiary Medical Center
Authors: Chen Xindi , Ruoff Chad , Buras Matthew , Carvalho Diego
Published: April 2024

Introduction

The ICSD-3-TR defines idiopathic hypersomnia in terms of objective sleep times as sleeping at least 11 hours using 24-hour polysomnography or wrist actigraphy averaged over at least 7 days. Published studies on sleep duration are generally limited by lower sleep duration cut-offs (e.g., ≥ 9 hours), so prevalence data on longer sleep durations are missing. This study used clinical questionnaire data from Mayo Clinic patients to characterize longer sleep times and excessive daytime sleepiness in this population.

Methods

We retrospectively identified patients who answered questions about subjective sleep times and excessive daytime sleepiness, using the Epworth Sleepiness Scale (ESS), as part of their evaluation in a sleep clinic across the Mayo Clinic Enterprise from 2017 to 2023. Demographic data and sleep disorder diagnoses were then analyzed.

Results

Patients (N=25,480) with subjective nocturnal sleep times of ≥ 9 (n=2721, 10.7%), ≥ 10 (n=1059, 4.2%), and ≥ 11 hours (n=349, 1.4%) had an ESS ≥ 10 in 33.5%, 41.0%, and 51.3% of the time, respectively. 3.6% (age 53.2±19.7; 58.9% female), 1.7% (age 53.1±20.4; 58.1% female), and 0.7% (age 49.8±19.9; 58.1% female) of the patients reported an ESS ≥ 10 and subjective nocturnal sleep times of ≥ 9, ≥ 10, and ≥ 11 hours per night, respectively. After adjusting for age and sex, patients with more than one diagnostic entry compared to those with one or fewer diagnostic entries for idiopathic hypersomnia with long sleep time (OR=12.75, 95% CI [6.09, 24.52], p< 0.001) and narcolepsy with cataplexy (OR=5.53, 95% CI [1.31, 15.84], p=0.005) were significantly more likely to report ESS ≥ 10 and subjective nocturnal sleep times ≥ 11 hours per night.

Conclusion

Less than 1% of patients presenting to a Mayo Clinic sleep specialist have self-reported metrics (i.e., ESS ≥ 10 and subjective nocturnal sleep times ≥ 11 per night) consistent with basic clinical features of idiopathic hypersomnia with long sleep time. Additional data analyses (e.g., comorbid conditions, social history, and laboratory results) are underway.

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0629 The Lehigh Valley Health Network Narcolepsy Cohort: Clinical and Polysomnographic Analysis of 303 Cases
Authors: Chu Irene , Jiang Rena , Rochart Roger , Duka Shae , Vendrame Martina
Published: April 2024

Introduction

Narcolepsy has been associated with several psychiatric, cardiovascular and metabolic disorders. This study aimed to analyze the clinical and polysomnographic characteristics of narcolepsy patients within the Lehigh Valley Health Network (LVHN).

Methods

We performed a chart-review of all narcolepsy cases seen between 2000 and 2022. Bivariate analysis highlighted differences between narcolepsy-type I (NT1) and narcolepsy-type II (NT2).

Results

Among 3.3 million patients, 303 (0.0001%, 9 per 100,000) were diagnosed with narcolepsy (51 with NT1, 252 with NT2), based on ICDS-3 diagnostic criteria. Age at symptom onset was 20.5±6.8 years. Diagnostic delay was 4.1 (2.0-8.9) years. Average Epworth Sleepiness Scale (ESS) was 16.9±2.9. Concomitant symptoms were refreshing naps [226(74.6%)], hypnagogic hallucinations [87(28.7%)], disrupted sleep [86(28.4%)], sleep paralysis [77(25.4%)]. Compared to NT2, NT1 patients had earlier age at diagnosis (24.3±8.0 versus 27.6±9.1, p=0.02), shorter diagnostic gap (3.0 vs 4.6 years, p=0.001), more frequent sleep paralysis [27(52.9%) vs 50(19.8%) p< 0.0001], hygnagogic hallucinations [22(43.1%) vs 65(25.8%), p=0.01], higher ESS (17.6±3.3 versus 16.7±2.8, p=0.04). Comorbid sleep disorders were breathing disorders (17.5%), insomnia (15.5%), restless legs syndrome (3.6%), periodic limb movements (2.3%), and REM parasomnias (1.3%). Migraine was the most common neurological disorder (29.7%). Frequent mood disorders included depression (34.7%) and anxiety (32.3%). Depression was more common in NT2 [11 (21.6%) vs 94 (37.3%) p=0.03]. Hypertension, diabetes, and obesity prevalence were not different between the two groups (overall 24.1%, 8.3%, 12.5% respectively). The most common treatments were modafinil (66.3%), methylphenidate (31.3%), armodafinil (28.1%), dextroamphetamine (28.8%), sodium oxybate (8.7%), pitolisant (4.5%), solriamfetol (5.2%). Review of overnight-polysomnography showed an average sleep efficiency of 93%, sleep latency of 12.3 minutes, REM latency of 98.8 minutes, with no differences between NT1 and NT2. Multiple sleep latency test showed an average sleep latency of 3.7 (2.4-5.0) minutes, and more SOREMPs in NT1 (≥3 in 28 (58.3%) vs 64 (27.1%), p< 0.0001).

Conclusion

This study is one of the largest monocentric studies to date of patients with narcolepsy and confirms the frequent comorbidity of narcolepsy with many other disorders. Specific clinical characteristics and comorbidities may help differentiate NT1 from NT2. Further analysis on this dataset is in progress and will be presented.

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