bluuebunny/crossref_metadata_2025 huggingface dataset:
0484 The association between obstructive sleep apnea, energy balance and body composition: a clinical cohort
Authors: Lee Pei-Lin , Lai Shang-Ru , Gooley Joshua , Feng Hsin-Chun , Chen Shih-Kuo , Chien Meng-Yueh , Lin Ming-Tzer , Chen Yung-Hsuan , Chiu Hung-Chih , Liu Po-Kang , Ku Bo-Wen , Chang Chin-Hao , Yang Wei-Shiung , Yu Chong-Jen
Published: May 2023

Introduction

A couple of studies investigated the energy balance in patients with obstructive sleep apnea (OSA) but the results were inconclusive. Moreover, OSA have been associated with visceral adiposity but the mechanism has not been fully elucidated. We hypothesized that OSA was associated with lower basal metabolic rate (BMR) and increased nutrition intake which further attributed to body adiposity. The aim of the present study is to determine the association between OSA, and BMR, nutrition intake, and body composition (BC).

Methods

Patients were recruited from referrals to sleep lab for suspect OSA. Measurement of the BMR with indirect calorimetry and BC with bioelectrical impedance analysis, and blood sampling were conducted in the morning next to the overnight polysomnography. Afterward, participants were evaluated with short -form IPAQ, 3-day intake dietary, 7-day sleep log, and wore Actiwatch for 7 days. The outcomes are resting energy expenditure (REE) and respiratory quotien (RQ), total fat mass (TFM), fat free mass (FFM), nutrition intake, daily total activity count, nightly sleep hour, and hormone. The association between OSA □apnea hypopnea index (AHI) >=15/h□ and REE, RQ, TFM, and FFM was analyzed with multivariable linear regression.

Results

85 patients were enrolled with median age 41.7 y/o, 78.6% male, body mass index (BMI) 25.4 kg/m2, and AHI 28.8/h. Compared to no OSA, patients with OSA had higher BMI, RQ, TFM, activity count, and similar age, gender, REE, FFM, nutrition intake, sleep hour, cortisol, leptin, and Ghrelin. OSA was independently associated with RQ (coefficient 0.031; 95% CI 0.004-0.057, p=0.022) with adjustment of age, gender, BMI, and activity count but not associated with REE, TFM, and FFM.

Conclusion

Though OSA may be associated with metabolic dysregulation, it was not associated with energy balance and BC. Further validation of the findings in a large scale and multi-ethnicity cohort to validate the findings of the present study is warranted.

Support (if any)

National Science and Technology Council, Taiwan (NST 111-2314-B-002-293; MOST 109-2314-B-002-252); Ministry of Education (NTU-107L900502, 108L900502, 109L900502)”, National Taiwan University Hospital (NTHU 108-S4331, 109-42, 111-S0298, 111-X0033); MediaTek Inc. (201802034 RIPD), and LARGAN Health AI-Tec CO., Ltd (202003021 RIPB)
0489 Two Years Of Experience Managing OSA Patients Using Remote Patient Monitoring
Authors: Simmons Jerald , Sadeghian Hesam , Lavender Maggie , Hua Olivia , Hernandez Patricia , Cordero Clifford
Published: May 2023

Introduction

Remote-Patient-Monitoring(RPM) is gaining implementation but to date, nightly-monitoring of OSA other than PAP devices, has not become a standard of care. We have taken the lead on OSA-RPM and developed a platform that imports data from a FDA-approved technology based on Cardiopulmonary-Coupling software linked to a ring oximeter (SleepImage) worn at night. Last year we presented on the practicality and patient adherence of our approach. Here we are presenting our experience over the past two years of using our platform to assist in the management of a wide range of OSA treatment approaches.

Methods

We developed software to manage the work-flow involved with nightly RPM of sleep. Patients wear a ring oximeter at night designed to provide data to a cloud-based platform for retrieval by our staff using our tracking software platform. Inclusion criteria: OSA with an abnormal baseline AHI. Also included are narcolepsy patients on oxybate, known to enhance OSA. Patient self-reported inputs regarding therapy are captured. Treatment approaches range from PAP (CPAP/BiLevel), Inspire-HGNS, Oral-Appliance-Therapy, Surgical-Interventions (i.e. MMA), orthodontics and combinations of the above.

Results

Since 1-1-2021, 140pts enrolled, 85 since 1/1/2022, and 87 currently monitored (12/1/2022). Ave 59yrs +/- 13, 64% Males. Discontinuation resulted for reasons ranging from clinical improvement, financial limitations, lack of compliance and other. Numerous treatment modifications have been guided without repeat NPSG/HSAT testing. OSA-RPM has influenced management of PAP, Inspire-HGNS, Oral-Appliance, orthodontics, and surgical therapies, as well as combination of the above. Detailed outcomes to be furnished. In brief, OSA-RPM with our system has provided extensive insight into efficacy of treatment approaches. Additionally, night to night variability can be better appreciated with this RPM technique, implying the limitation of single-night sleep studies.

Conclusion

Using this approach has allowed direct ongoing assessment of the impact of therapy modifications directed by both the clinician and the patient. There are currently no established protocols or guidelines for the use of this type of OSA-monitoring. It is important that guidelines be implemented to provide an improved level of care and not abused to just increase reimbursements with little added value, as abuse could hinder the growth of this type of care.

Support (if any)
0491 Use of Neuromuscular Stimulation device of Tongue to treat Mild obstructive sleep apnea in Veteran population
Authors: Kallamadi Rekha , Kumar Kelash , Gravely Amy , Henry Amber , Khalil Wajahat , Irfan Muna , Zebrosky Teri
Published: May 2023

Introduction

Approximately 30 million adults in United States suffer from obstructive sleep apnea (OSA), with much higher prevalence in veterans. However, the treatment options of sleep apnea are currently limited due to CPAP device shortage, hence, unravelling a significant gap for alternative user-friendly therapeutic options. Neuromuscular stimulation device of the tongue is a novel FDA approved therapy becoming more relevant with the ongoing CPAP device shortage.

Methods

Neuromuscular stimulation device of tongue procured through regulatory process at VA Minneapolis, is offered to veterans with Mild OSA( AHI 5-15) on home sleep apnea testing.Baseline and post therapy data including patient's snoring, Epworth sleepiness score(ESS),Apnea - Hypopnea Index(AHI) was collected. Post therapy data was collected after initial 6 weeks of at least 20-minute daily followed by maintenance of 2 weeks of twice weekly use.

Results

A total of 112 patients with Mild OSA were offered the device as an alternative option of treatment during the period of December 2021 to August 2022. Of these, 39 patients completed therapy with mean age of 54.5 years (age ranging from 28y-80y), 36 were males and 3 were females. Among a total of 31 patients who completed their ESS pre and post questionnaire, and 22 patients who had pre and post AHI available, a paired t-test was obtained. In the 31 patients with pre and post ESS, the results of paired t- test showed a mean difference in ESS score of 1.90 with 95% CI (0.55 -3.25) with statistically significant P value of 0.0073. In the 22 patients with pre and post AHI, results of paired t -test showed Mean difference in AHI score of 2.54 with 95% CI (0.24-4.84) with statistically significant P value of 0.0316.

Conclusion

Findings suggest that the alternative treatment to CPAP provided to patients did result in improvement of Mild OSA both in subjective sleepiness symptoms and objective degree of residual apnea, and hence can be used as a feasible alternative therapy. However, the study is limited by small size (112) with a relatively low response rate from the participants (39), and availability of matched data (ESS -31, AHI -22). Therefore, larger studies are warranted.

Support (if any)
0492 Variability in High Altitude Sleep Disordered Breathing and Impact of Acclimatization
Authors: Jiwa Farzin , DeYoung Pamela , Pham Kathy , Frost Shyleen , Nasr Ledia , Malhotra Atul , Heinrich Erica , Orr Jeremy
Published: May 2023

Introduction

Individuals who travel to high altitude experience variable levels of poor sleep quality and sleep disordered breathing, which can have neurocognitive and other systemic impacts. Past studies by our group and others have shown that the apnea hypopnea index (AHI) increases, and nocturnal oxygen saturation decreases at higher altitude. This may change over time with acclimatization to environmental hypoxemia. The aim of this study was to examine the trajectory and variability in high altitude sleep disordered breathing effects in healthy young adult volunteers.

Methods

Twenty healthy volunteers were recruited from a local university (35% women), mean age 23.5(20.0, 32.2) years and BMI of 30.0(28.0, 35.9) kg/m2. Peripheral Arterial tonometry based home sleep apnea tests (HSAT; WatchPat One) was performed on all subjects at sea level up to three days prior to transportation via car to high altitude (3800m White Mountain Research Center - Barcroft Station, CA). Participants continued HSAT testing for three consecutive nights at high altitude sleeping in any position, without oxygen, acetazolamide, or use of any other medications impacting sleep or breathing. Mixed effects modeling was used to compare sleep parameters across nights.

Results

Subjects' characteristics: median (IQR)[range] age 23(20,32)[19,39] years, BMI 30(28, 36)[23,48] kg/m2, 35% women. AHI at altitude night 1 (67±4 events/hour) was significantly higher than sea level (7±4 events/hour; P< 0.001). Mean sleep SpO2 at altitude night 1 (79±1%) was significantly lower than sea level (95±1%; P< 0.0001). There was no statistically significant change in AHI or mean sleep SpO2 on nights 1-3; however substantial variability was noted between individual trajectories.

Conclusion

Healthy young adults exhibit severe Sleep Disordered Breathing when traveling to high altitude. Despite acclimatization, the severity of Sleep Disordered Breathing remained relatively unchanged overall. However substantial differences in individual trajectories were apparent. Larger studies are needed to understand how differences in genetics, sex, and other factors might impact Sleep Disordered Breathing at altitude. In addition, the impacts of (or tolerances to) altitude are likely to be broadly informative towards Sleep Disordered Breathing, hypoxemia, and other areas.

Support (if any)

N/A
0494 Early Feasibility Study on Use of Noninvasive Temporal Interference Stimulation of the Hypoglossal Nerve in the Treatment of OSA
Authors: Shangold Lee , Hanes William , Solomon Wyle , Williamson Adam , Missey Florian , Ejneby Malin Silvera , Trajilinek Jan
Published: May 2023

Introduction

Hypoglossal nerve stimulation has proven effective as an alternative to Positive Airway Pressure (PAP) machines in treating obstructive sleep apnea (OSA). The only currently FDA-approved hypoglossal nerve stimulator requires surgical implantation. Somnial Inc. is developing a noninvasive nerve stimulator based on temporal interference (TI), such that multiple supra-kHz-modulating electrical fields overlap to create a hyper-localized field modulating at a lower, nerve-stimulating frequency equal to the offset between the original fields. Bilateral stimulation reduces lateral movement of the tongue and requires less energy applied to the individual nerves. In early studies, transcutaneous, bilateral TI stimulation showed strong forward and central tongue movement with long-term tolerability.

Methods

To determine the clinical impact of TI on the treatment of OSA, 11 patients recently diagnosed with moderate to severe OSA (AHI 15-50/hour) based on in-lab polysomnography (PSG) and BMI < 35 were subjected to bilateral TI stimulation of the hypoglossal nerves during another PSG. Two pairs of electrodes were placed on either side, medial to the inferior aspect of the mandible overlying the genioglossus muscle. The frequencies were modulated in a 4-second-on, 2-second-off pattern. Initial power settings were determined as sufficient to move the tongue without discomfort and were increased throughout the night in an approach similar to a CPAP titration study.

Results

5 of the 11 patients analyzed in the study, including 4 out of 4 women, responded to the therapy (AHI reduction from baseline by >50% and an AHI of < 20/hour). Patient questionnaires indicate the treatment was well tolerated throughout the night.

Conclusion

These promising proof of concept results after a single night indicate the potential for the use of TI in the treatment of OSA. Transcutaneous application of stimulation energy via TI energy could be used to determine the efficacious does required to reduce AHI events in the at-home healthcare setting. This justifies future research in long-term, chronic-treatment studies with TI stimulation and the advancement of a home-based device.

Support (if any)
0498 Home automated OSA quantification of night-to-night short term variability: analysis of the associated conditions
Authors: Pépin Jean-Louis , Martinot Jean-Benoit , Bailly Sebastien , Tamisier Renaud , Le-Dong Nhat-Nam
Published: May 2023

Introduction

Single night in-lab polysomnography (PSG) is still the conventional procedure for making obstructive sleep apnea (OSA) diagnosis, or alternatively a home sleep apnea test (HSAT) in patients free from comorbidity. Recent publications drew attention to considerable internight within-subject variability in OSA clinical status, notably but not only with HSAT. Taking benefit of multiple nights recording in home-based setting using measurements of mandibular jaw movement (MJM) combined with automated machine learning analysis, this study aimed to investigate the effect of change in sleep parameters on the internight variability of the apnea hypopnea index (VAHI).

Methods

160 adults suspected of having OSA successfully completed 3 sleep tests at home with the Sunrise device (Sunrise, Namur, Belgium). Data analysis implied generalized estimating equation (GEE) regression.

Results

Even though the internight variability of AHI was not statistically significant at the population level with a mean VAHI of -1.1 ± 7.8 events/h, such variability could lead to misdiagnosis and wrong therapeutic decisions based on a single night. After adjusting for effects of gender, body mass index (BMI), age, total sleep time (TST) and time interval between sleep tests, regression models indicated that sleeping in supine position was positively and independently associated with VAHI, the AHI increased by 0.95 event/h for each 10% of increase in sleeping time in supine position. VAHI was negatively and significantly (p < 0.01) associated with sleep efficiency and deep sleep; VAHI decreased of 0.16 event/h (0.04 to 0.28) and 0.29 event/h (0.17 to 0.42) for each % of increase in sleep efficiency and proportion of deep sleep, respectively.

Conclusion

At the individual level, position, sleep efficiency and deep sleep are associated with short-term internight variability in AHI. Clinical decision based on a single-night testing may lead to errors in OSA diagnosis with delayed or wrong therapeutic decisions.

Support (if any)
0501 Manganese and sleep health outcomes in U.S. adults: analysis of the NHANES 2017-2020
Authors: Yang Chia-Lun , Jansen Erica , Seo Young Ah
Published: May 2023

Introduction

Manganese (Mn) is an essential trace mineral required for normal growth and physiological processes. However, inadequate or excess Mn can have a detrimental impact on human health. Despite the essentiality, little is known about the relationship between Mn and sleep. The objective of this study is to examine the relationships between blood Mn levels and sleep patterns (duration, midpoint of sleep, obstructive sleep apnea [OSA] symptoms, and trouble sleeping) in U.S. adults.

Methods

Data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) was used for the analysis. Adults aged 18 or older with both blood Mn levels and sleep parameters were included (n=8356). Self-reported fall asleep time and wake up time in the past week were used to calculate sleep duration and midpoint. Trouble sleeping and symptoms of OSA were also collected. Blood Mn levels were divided into quintiles for analysis. Multivariable logistic regressions that accounted for complex study design were used.

Results

The mean (SE) blood Mn concentration was 9.7 (0.1) µg/L, and was higher among participants who were younger, female, identified as non-Hispanic Asian, had lower income, were non-smokers, and had lower iron levels (P< 0.05, for all). About 25% of adults had short sleep duration (< 7 hours) on weekdays. OSA symptoms were noted in 49% of adults. In men, the odds of short sleep duration on weekdays were higher among those with the lowest Mn level (Q1: < 7.0 µg/L) than the reference group (Q3: 8.5-10.0 µg/L) after adjusting for age, race, income, smoking, and iron (OR: 1.5, 95% CI: 1.1-2.1, P=0.03). Among women, Q2 (7.0-8.4 µg/L) was the related to the lowest odds of OSA symptoms compared to all other groups after adjusting for covariates (P=0.049).

Conclusion

Lower or higher Mn levels in blood were related to poor sleep health in U.S. adults, which suggests that inadequate or excessive Mn intake might be harmful to sleep. Future studies on the mechanisms of these relationships are needed.

Support (if any)

This work was supported by National Institutes of Health R01DK123022, R21NS112974 to YAS, and K01HL151673 to ECJ.
0503 Respiratory Effort During Sleep And Prevalent Diabetes In Obstructive Sleep Apnea
Authors: Martinot Jean-Benoit , Malhotra Atul , Le-Dong Nhat-Nam , Pépin Jean-Louis
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) and type 2 diabetes (T2Dia) is a frequent clinical association. Beyond OSA-related hypoxic burden, increased respiratory effort (RE) is one of the main features of OSA and contributes to sympathetic overactivity that in turn might participate to glucose homeostasis dysregulation. The independent contribution of RE to the OSA-T2Dia pathogenesis remains to be demonstrated. The study aims to determine the impact of metrics assessing sleep RE derived from the sleep mandibular jaw movements (MJM) signal on the prevalence of T2Dia in a large cohort of patients addressed for in-laboratory conventional polysomnography (PSG) with suspicion of OSA.

Methods

An interpretable machine learning model was built to predict T2Dia from clinical data, PSG indices, and MJM-derived parameters (including the time spent with increased RE, expressed in % of TST). The analysis included 1128 subjects, randomly assigned to training (n=853) and validation (n=275) subsets with equal T2Dia prevalence of 11%.

Results

The risk stratification model based on 19 input features including increased RE showed good performance for predicting prevalent T2Dia (sensitivity=0.81, specificity=0.89). Post-hoc interpretation using the Shapley additive explanation (SHAP) method revealed that increased RE was the most important risk factor of T2Dia after other clinical factors for T2Dia (i.e., sex, BMI and average SpO2), ahead of standard PSG metrics (including the apnea-hypopnea index and oxygen desaturation index).

Conclusion

These findings suggested that the proportion of sleep time spent with increased RE automatically derived from MJM is a potential new reliable metric to predict prevalent T2Dia in patients with OSA.

Support (if any)
0504 STOP BANG FAN, A Novel Screening Tool of OSA in Sleep Clinic
Authors: Gohar Ashraf , Cheng An-lin , Bhat Abid
Published: May 2023

Introduction

We noticed that patients with OSA when admitted to hospital requested a fan even in winter. We explored the literature and did not find any reports about fan use in OSA. STOP-Bang questionnaire has been widely used in preoperative clinics [4-6], sleep clinics [7-8] to detect patients at high-risk of OSA. STOP Bang score 5 or more has high risk of OSA. We did a pilot study to explore if adding the use of FAN, especially in winter, would increase the sensitivity of STOP Bang questionnaire in the sleep clinic.

Methods

We screened 350 consecutive patients referred to our sleep clinic for suspected OSA in the period of March 2021 to April 2022, with STOP Bang FAN questionnaire. The questionnaire added if they use FAN during sleep in addition to the air condition and if they still use it in winter.

Results

255 (73%) used FAN during sleep and 210 (60%) used the fan in winter. 247 patients had PSG, the others did not for variable reasons, including refusing COVID test before the study, insurance issues or no insurance. In the 247 patients who had the PSG the sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for OSA AHI 5 or more were 78%, 83% and 89%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for moderate and severe OSA AHI 15 or more were 65%, 74% and 79%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for severe OSA AHI 30 or more were 55%, 64% and 71%.

Conclusion

Adding the use of the FAN and especially FAN in winter during sleep to STOP Bang would increase the sensitivity of the questionnaire for suspected OSA in sleep clinic.

Support (if any)
0505 3-Year follow-up of patients with OSA on telemonitoring
Authors: Guimarães Maria , Silva Elisabete , Costa Catarina , Silva Andreia
Published: May 2023

Introduction

Obstructive Sleep Apnea (OSA) is a highly prevalent respiratory disease. In the subgroup of OSA patients on Positive Airway Pressure (PAP), telemonitoring for CPAP (Continuous Positive Airway Pressure) have emerged as follow-up option to monitor and detect poor compliance to treatment. We aimed to understand whether telemonitoring is an independent factor in the therapeutic adherence of OSAS patients.

Methods

A retrospective assessment was carried out in patients followed in the Sleep Medicine consultation between March 2019 and June 2022. A total of 312 patients with Resmed® model S10 CPAP devices with residual apnea detection algorithm, mean therapy pressure, and the number of hours of daily use ware included. After placement of the PAP patients were reassessed by consultation at 3, 6, 12, 24 and 36 months of therapy.

Results

A total of 312 patients were evaluated, 203 men and 109 women, with a mean daily use of 6 hours and 43 minutes, with a standard deviation of 1 hour and 52 minutes. The residual AHI of averaged 2.58/hour. In June 2022, 30 patients were included at 3 months, 30 at 6 months, 41 at 12 months, 84 at 24 months and 127 at 36 months, with a mean daily use of respectively: 4.29 (median 5.17), 4.33 (median 4.44), 3.52 (median 4.45), 5.05 ( median 5.59) and 4.40 hours (median (5.28), with no statistical significance and adherence being similar from the first trimester, as well as in the divisions of patients per group. This analysis shows that adherence did not decrease over the months of telemonitoring, which may mean that patients felt permanently monitored. The mean Residual AHI was respectively: 4.64, 2.08, 2.33, 2.33 and 2.37/hour, we found that the disease remained controlled and without much variation. We obtained an excellent adaptation to therapy in 262 patients (84%), and 16% (50 patients) abandoned therapy.

Conclusion

In patients with a confirmed diagnosis of OSA treated by PAP, telemonitoring has proven to be a helpful tool for a better follow-up and therapeutic adjustment, promoting ideal compliance to therapy, which is effective as early as the first three months.

Support (if any)
0506 5-year, multi-center, observational study to assess safety, effectiveness and use of CAD/CAM patient-matched OAT for OSA treatment
Authors: Woidtke Robyn , Gagnadoux Frederic , Fortin Martine
Published: May 2023

Introduction

Oral appliance therapy (OAT) is used for the treatment of obstructive sleep apnea in mild to moderate patients. First-time fit is important for treatment burden and dental economics. This prospective, “real-world” collaborative (physician/dentist) study will assess the primary endpoint of at least a 50% reduction in baseline apnea-hypopnea index (AHI) at five years. Additionally, this study will assess fit during initial delivery. The Panthera D-SAD is a CAD/CAM, 3D-printed OAT. Updated design and comfort features have been integrated. Changeable rods (mechanical hinge) provide the mechanism for protrusion. This study fulfills French reimbursement requirements.

Methods

OAT naïve individuals with moderate OSA (AHI 15-30) or those with severe OSA (AHI 30 or greater) who decline CPAP will be included, meeting all other criteria. An estimated 337 participants will be enrolled at 11 centers in France. Consecutive sampling will be used. Participants will be medically assessed, a prescription for OAT obtained, dental assessment and then, the initial fitting will be at Visit 1 (V1). Standard of care for the study duration will be followed. Evaluation time points are three months (medical), six months (dental), two years (both), and five years (both). Secondary endpoints include OAT side effects, oxygen desaturation indices, quality of life, self-reported adherence, and subjective symptoms at the aforementioned time points

Results

To date, a total of 56 subjects have been enrolled. This report is focused on the 24 subjects who have had V1, OAT fit, and titration visits. The demographics are as follows:(F=8); Averages (and standard deviation) for the following are age 51.2 (1.5).; baseline AHI of 20.5 (6.07); ODI 14.71(8.9); SpO2 93.46 (1.06), BMI 25.73 (3.13), and rod length of 26.6mm (1.05). 91.6% of dentists reported at V1 that no rod changes were required. 82.6% of patients indicated the OAT was comfortable, three patients had dental or muscle pain, and one, the device was too tight.

Conclusion

V1 is a crucial step in the therapeutic journey. This early data demonstrate a high OAT acceptance rate for dentists and patients while reducing the time required for first-time fit, thus lowering practitioner and patient burden and costs.

Support (if any)

Panthera Dental Inc, Quebec City, Quebec Canada
0507 A wireless patch-based polysomnography system for conducting in-lab sleep studies
Authors: Schneider Hartmut , Mueller Syuyumbeki , Oloo Maryanne , Haisma Nicola , Knoops-Borm Martine , Stockhoff Mariele , Tijssen Marij , Ermers Pieter , DeFrancisco Ruben , Coughlin Steven
Published: May 2023

Introduction

Current attended in-lab polysomnographic sleep studies are time-consuming and costly, primarily due to the time required to “hook-up” a patient to multiple electrodes and sensors and meet the quality assurance and safety requirements of an in-lab study. We developed a wireless PSG system (Onera STS - Onera Health, NL) consisting of four disposable patches and reusable pods to record full polysomnography that may reduce hook-up time while preserving standards of an attended polysomnography in the lab.

Methods

We used the Onera STS system for monitoring EEG, EOG, EMG, forehead reflectance SaO2, ECG, bioimpedance derived respiratory airflow and effort, airflow via nasal cannula, snoring sounds, body position, actigraphy, and leg movements, and accessory online monitoring of finger SaO2, ECG, nasal cannula airflow and video via RemLogic 4.0 or REM logic MPR system for Q/A and safety monitoring. Seventeen subjects (8 male, 9 female, age 18-to-75 yrs, BMI 29.9±6.0 kg/m2) were monitored for the evaluation of sleep apnea. We measured hook-up times and observed oxygen saturation and cardiac rhythm throughout the night.

Results

Mean hook-up time for the Onera STS was 5:22±1:17 minutes and for the additional on-line sensors (Finger SaO2, ECG and nasal cannula) was 3:15±1:10 minutes, resulting in an average hook-up time of less than 10 minutes. Onera PSG data revealed a mean oxygen desaturation event rate of >3% (ODI3) of 8.8 (SD 18.6) and a mean fall of oxygen saturation (ΔSaO2/event) of 4.4 (SD 1.2). The accessory online SaO2, ECG and video monitoring showed that no subjects demonstrated sustained nocturnal hypoxia, severe cardiac arrhythmia or parasomnia events that would have required interventions.

Conclusion

The Onera STS system substantially lowers the burden to conduct attended polysomnographic sleep studies. In combination with standard monitoring of SaO2, ECG and video, it meets the safety requirements for attended sleep studies while reducing the overall operational and capital equipment costs. The ease of application together with the reduced hook-up time makes it now possible to implement polysomnographic sleep studies in the hospital setting, particularly in addition to conventional bedside monitoring units such as ICU-, step-down unit- or hospital beds.

Support (if any)
0508 Adherence with Transoral Neuromuscular Electrical Stimulation Therapy in Veterans with Mild OSA
Authors: Stepnowsky Carl , Zamora Tania , Cervantes-Gameros Cesar , Nokes Brandon
Published: May 2023

Introduction

Mild obstructive sleep apnea (OSA) is increasingly common in the VA. The first-line therapies are medical devices worn each night while asleep to control or manage OSA. These devices are burdensome for our patients with mild OSA. Stronger oral musculature can help reduce mild OSA. A new transoral Neuromuscular Electrical Stimulation (NMES) device was recently approved by the US FDA called eXciteOSA (Signifier Medical Technologies, Needham, MA). The eXciteOSA device provides gentle, low-frequency electrical stimulation intraorally to the tongue muscle and is efficacious for mild OSA.

Methods

A retrospective review of the data of the 71 patients prescribed the eXciteOSA device at the VA San Diego was analyzed. The device is prescribed for use over two phases: (1) one 20-minute session per day over 42 consecutive days and then (2) one 20-minute session on two days out of each week. Respiratory therapists performed 1-2 phone call visits to assess symptoms and address device concerns.

Results

68 of the 71 patients used the device for at least one 20-minute session over the first 42 days. Three patients (4.2%) did not use the device. Adherence was 60% for all 71 patients and 63% for the 68 patients who used it at least once. This means that, on average, our Veteran patients completed one 20-minute session on 25 of the first 42 days.

Conclusion

Recent non-Veteran data showed an adherence rate of ~80% (percentage of days with one completed 20-minute session over the first 42 days). Our analysis found an adherence rate of ~60%, suggesting significant room for improvement in eXciteOSA device use in Veterans. Future adherence studies should look at methods to improve device use over the first 42 days. In addition, more research may be needed to understand better what amount of use is efficacious on an individual basis. Some patients may obtain an adequate response with fewer sessions, while others may need more. It is unknown which endotypes of OSA most benefit from NMES, but further research is ongoing.

Support (if any)

VA RR&D D2651-R and the Sleep Medicine Section of the VA San Diego Healthcare System supported this project.
0516 Biopsychosocial intervention using virtual multidisciplinary group with improved PAP adherence after 1 year post intervention
Authors: Baker Nataliia , Saxby Dyani , Frigge Lauren , Khalil Wajahat , Irfan Muna
Published: May 2023

Introduction

Prevalence of untreated sleep apnea among veterans is 22.2 %. Untreated patients are at risk for multiple adverse outcomes including chronic sleep deprivation, excessive day time sleepiness, chronic fatigue, depression, and cardiovascular complications including hypertension, coronary artery disease, cerebrovascular accidents, pulmonary hypertension as result of increased sympathetic activity during apnea episodes. Nonadherence to PAP therapy within the first week of treatment are up to 50 % of patients who use PAP device during the first week between 12-25 % discontinue by PAP use by year 3. Barriers to PAP use include physical problems with PAP hardware, knowledge gaps, and psychological issues.

Methods

Veterans from sleep medicine and sleep apnea clinics as well as multiple primary care clinics participated in the PAP adherence group following 6 weeks biopsychosocial model. The intervention included weekly synchronized video encounters of behavior sleep specialist, respiratory therapist and sleep clinic nurse with the targeted group of veterans with sleep apnea and poor PAP adherence. This approach has multiple benefits, including being patient centered, cost effective and efficient with ability to help veterans at various motivational levels, assist 6-10 veterans virtually in 6 one-hour group sessions and easy care coordination.

Results

A total of 21 veterans with sleep apnea participated in virtual multidisciplinary group to improve PAP adherence between September 2020 and January 2021. Patients PAP adherence before intervention, post intervention and 1year after intervention was evaluated. Percent of patients using PAP >2 hours before intervention was 5 %, immediately after intervention it increased to 20 %, and there was further increase up to 33% after 1 year post.

Conclusion

A structured multidisciplinary biopsychosocial intervention demonstrated statistically significant improvement in PAP adherence which persisted up till 1 year post intervention. In fact additional improvement of >2 hours of PAP usage was noted in this patient group suggesting possible long term benefit of psychosocial multidisciplinary intervention on PAP adherence. This study also demonstrated efficiency of utilization of virtual/telemedicine platform for psychosocial intervention and brief behavioral therapy.

Support (if any)
0518 Characteristics of obstructive sleep apnea among pregnant Japanese woman and their birth outcomes
Authors: Suzuki Takumi , Hosomichi Jun , Miyasaka Naoyuki , Miyazaki Yasunari , Taki Atsuko , Zaitsu Takashi , Morioka Chikako , Sato Noriko , Moro Manaka , Ono Takashi
Published: May 2023

Introduction

Pregnant women are at an increased risk for obstructive sleep apnea (OSA) due to pregnancy-related weight gain. However, a detailed clinical study on OSA and birth outcomes among pregnant women in eastern Asia has not been conducted. This study, therefore, aimed to investigate characteristics of OSA among pregnant Japanese women and their birth outcomes.

Methods

Subjects were selected from pregnant women who underwent a polysomnography (PSG) during 28–36 weeks gestation at Tokyo Medical and Dental University Hospital. Diagnosis of OSA was based on sleep history and PSG with an apnea-hypopnea index (AHI) ≥ 5 (OSA+ group). Those with AHI < 5 were regarded as the OSA- group. The body height, weight, head circumference, and chest circumference of all offspring were measured at birth and 1 month of age. Data were analyzed statistically using unpaired t test and Pearson correlation and logistic regression analyses.

Results

Of 102 pregnant Japanese women, 13.7 % were diagnosed with OSA during the third trimester. PSG data showed significant differences in AHI between the OSA- (1.2 ± 1.0) and OSA+ (14.8 ± 16.7) groups. Moreover, there were significant differences in the oxygen desaturation index, mean and minimum SpO2, and mean and maximum heart rate between the OSA+ and OSA- groups. The logistic regression analysis revealed that AHI was associated with body mass index (OR, 1.274; p = 0.001), but not with age, gestational age, and body height, suggesting that high BMI is a risk factor for OSA in Japanese pregnant women. The Epworth sleepiness scale score was comparable between the two groups. A comparison of body weight between the pregnant mothers and their offspring showed that the maternal weight during the third trimester was negatively associated with offspring’s weight at birth and at 1 month of age in the OSA+ group.

Conclusion

Findings suggest that a high BMI is a major risk factor for OSA among pregnant Japanese women.

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0521 Correlation Between Socio-Demographic Risk Factors and Self-Reported Apnea
Authors: Alla Rupini , Thakur Bhaskar , Khan Safia
Published: May 2023

Introduction

Apnea, pauses in breathing, is a chronic and rising condition in the US and is itself a risk factor for various conditions such as hypertension, cardiovascular disease, and stroke. This study aims to analyze the National Health and Nutrition Examination Survey (NHANES) dataset to see if certain socio-demographic risk factors contribute to the prevalence of apnea.

Methods

From 2015 to 2018 (using two consecutive cycles), a secondary dataset from NHANES was obtained. All 11,759 community dwelling individuals 16 years and older who responded to the sleep disorder questionnaire in the above survey were considered as study subjects. Questions were asked in the home by trained interviewers regarding sleep trouble including if they recalled episodes where they stopped breathing during sleep. In this study, we sorted the data to see the mean chance of “snort or stop breathing” amongst various categories such as gender, age, ethnicity, marital status, education, smoking history, alcohol consumption, income, physical activity, and obesity.

Results

The following socio-demographics were identified as having a higher association with apnea (p< 0.0001); male gender, ages 41 – 50, smokers, and obesity. Unusually, those with higher physical activity self-reported more frequent episodes of stop breathing (p< 0.00001). No significant association was noted for stop breathing events when looking at income, educational level, Hispanics vs. non-Hispanics, frequent alcohol consumption and health insurance.

Conclusion

These results confirm some of the established risk factors for apnea such as male sex, obesity and age. Oddly, those with higher self-reported physical activity had higher stop breathing events. Self-reported responses in the NHANES data could be associated with recall bias and treated as one of the current study limitations. Of note, there appears to not be an economic factor in terms of income or health insurance in the incidence of stop breathing events. Further awareness of these risk factors and knowing which sociodemographic groups have higher incidences of apnea can help with primary prevention of serious health outcomes.

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0522 CPAP Improves Cognition in Brain-Healthy Males: Secondary Analysis of a Randomized Trial
Authors: Sun Haoqi , Zinchuk Andrey , Locascio Joseph , Kushida Clete , Thomas Robert , Westover M Brandon
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is associated with cognitive impairments. However, in many adequately powered randomized trials, there is weak or no evidence for the causal effect of treating OSA on cognition. A common characteristic of these randomized trials is heterogeneous participants. We hypothesize that there is a subset whose cognition could be improved by OSA treatment using CPAP.

Methods

This is a secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized, double-blind, two-arm, sham-controlled, multicenter trial. The primary analysis had adult participants with baseline AHI ≥10/hour. We restricted to those with both baseline polysomnogram and outcome available: n=787. The outcome is 6-month Sustained Working Memory Overall index at mid-day, which was not significantly different in the primary analysis. The original exposure is randomized active- or sham-CPAP. However, the adherence rate (≥4 hours for >70% nights in 1-month) is higher for active than sham (chi2 p< 0.001). Therefore, we re-defined a non-randomized exposure as both under active-CPAP and being adherent (n=165) vs. all others (n=622). To account for confounding, covariates were clustered into 17 groups, plus age, sex, education, and baseline cognition. Individual treatment effect (ITE) was estimated using matching, which finds a matched group for each individual with similar covariates but opposite exposure. The ITE is the difference between two potential outcomes: the counterfactual outcome from the mean outcome of the matched group, and the factual outcome as observed.

Results

The overall ITE was non-significant compared to 0 (t-test p=0.4). A subset of 285 (Group 1) could have improved cognition if under active-CPAP and adherent (average ITE 0.68, p< 0.001); another subset of 328 (Group 2) could have worsened cognition (average ITE -0.64, p< 0.001). Group 1 is characterized by more males, higher baseline cognitive scores, lower EEG-derived brain age index, and slightly more depression; the opposite for Group 2.

Conclusion

Assuming the ITE is unbiased, relatively brain-healthy males with OSA can improve their cognition once OSA is treated by CPAP.

Support (if any)

MBW was supported by NIH (R01NS102190, R01NS102574, R01NS107291, RF1AG064312). RT received support from RF1AG064312. AVZ received the Parker B. Francis Fellowship award. JJL was supported by NIH UL1TR002541.
0523 Disparities in Discussion of Sleep-related Breathing Disorders with a Physician
Authors: Johnson Solomon , Nouraie S Mehdi
Published: May 2023

Introduction

Race, immigration status and healthcare access have known associations with sleep health in socially disadvantaged groups. The prevalence and severity of sleep disorders, such as obstructive sleep apnea (OSA) are higher among non-whites and underdiagnosed in socially disadvantaged groups. Associations between sleep health and country of birth have also been identified. Certain minority groups are known to be less likely to report symptoms of OSA or insomnia to a physician. It's therefore possible that propensity for sleep disorder self-report plays a role in disparities of sleep health in socially disadvantaged groups. To our knowledge the predictors of sleep disorder self-report have yet to be studied. We aim to assess the predictors of sleep disorder self-report and analyze for associations with race, immigration status and healthcare access.

Methods

We conducted a cross-sectional analysis of 9,163 adult (age >18) patients in the National Health and Nutrition Examination Survey 2017-2020 database who answered the sleep disorders questionnaire and had race, immigration status and healthcare access data. Any answer to “How often do you snort or stop breathing (during sleep)?” was used as a surrogate endpoint for symptoms of OSA. “Yes” to “Ever told a doctor that you had trouble sleeping?” was used as a surrogate endpoint for sleep disorder self-report. We analyzed this cohort for associations between demographic characteristics, symptoms of OSA and sleep disorder self-report with survey sampling weights in STATA 17.0.

Results

In patients with symptoms of OSA (24%), measures of limited healthcare access, such as lack of health insurance (OR=1.59, p=0.030), or lack of location routinely visited for healthcare needs (OR=1.77, p=0.024), predicted higher likelihood of sleep disorder symptom non-disclosure, after adjustment for sex, age, and BMI. Non-white race (OR=1.70, p< 0.001) and being an immigrant (OR=2.40, p< 0.001) predicted higher likelihood of sleep disorder symptom non-disclosure in patients without symptoms of OSA, but not in patients with symptoms of OSA, after adjustment for sex, age, and BMI.

Conclusion

Our findings indicate that patients with limited healthcare access should be considered more strongly for sleep health evaluation and that non-white and immigrant patients are less likely to discuss sleep health with a physician.

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0525 Effect of Body Position and Sleep State on Obstructive Respiratory Events Distribution in Children with Down syndrome
Authors: Boopathy Surya , El-Kersh Karim , Jawad Kahir , Senthilvel Egambaram
Published: May 2023

Introduction

The influence of body position and sleep state on obstructive respiratory events distribution in children with Down syndrome (DS) need further studies.

Methods

This was a single center, retrospective study that included children younger than 18 years old with DS who were evaluated for suspected sleep disordered breathing and underwent a full overnight polysomnography in an academic sleep disorders center over a period of 10 years. DS children with Obstructive apnea hypopnea index (OAHI) ≥ 1.5 were included in this study. Total OAHI, apnea hypopnea index (AHI) in different body positions and in different sleep stages including rapid eye movement (REM) and Non-REM (NREM) sleep were collected.

Results

A total of 158 children with DS met the inclusion criteria. The median age was 5 years (IQR 8.0---), 53.2% were male with a median BMI z-score of 1.2. Median times (%) spent in REM and NREM sleep were 17 % and 83% respectively. Median times (minutes) spent in different body positions were supine 194.1, left side 53.5, right side 39 and prone 32. The overall median OAHI was 7.6, respiratory obstructive events were more common in REM sleep and in supine position. The median REM obstructive AHI was 20 events per hour (IQR: 10.1-34.5), whereas the median NREM AHI was 5.2 events per hour (IQR: 2.4-15 p < 0.0001). Similarly, supine obstructive AHI was 9.4 (IQR-4.15 – 24.1) and off supine AHI was 2.4 (IQR 0-8.9 p < 0.0001). Only 24 out of 158 subjects had NREM predominant OSA. Age was a significant predictor of NREM predominant OSA (P= 0.012) compared to other factors such as gender, race, BMI, tonsillar grade, hypothyroidism and congenital heart disease. For every one year increase in age, the odds of having NREM predominant OSA was 14% higher than having REM predominant OSA.

Conclusion

Obstructive respiratory events in children with DS occur predominantly in REM sleep and in supine position. Non-REM predominant distribution of respiratory events was seen in older children with DS.

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0531 Excessive mask leak and its association with poor PAP compliance in women. A secondary analysis of the AWARE study
Authors: Lamboy-Hernández Ilean , Scott Paul , Patel Sanjay , Morris Jonna
Published: May 2023

Introduction

Studied have shown that continuous positive airway pressure(CPAP) adherence is lower in women. However, understanding of the specific challenges faced by woman when starting therapy remains poor. Specifically, is there any relationship between leak and women’s characteristics that could influence adherence?

Methods

The AWARE-study is a longitudinal pilot-study with the objective to identify in women modifiable barriers to initiating/adhering to treatment over 3-months. Adherence was considered when using CPAP for a minimum 4-hours 70% of the nights. But, is there any association between leak, mask type and other patient’s characteristics that could influence adherence in women? This is a secondary analysis looking at leak as a consequence of poor adherence in women within the AWARE-study. We gathered data directly from the PAP-data-base and evaluated adherence within the first 3-months after starting therapy and usage at-present-time. We investigated leakage (>25 L/min) and gathered information about severity of OSA, age, BMI, and race. Our aims: to evaluate for leak as a cause of poor adherence and to identify characteristics that could potentiate leak in women.

Results

Data from 49 women from the AWARE-study between the ages of 28-85, with a recent diagnosis of OSA who started CPAP was analyzed. Adherence, leakage, age, OSA severity, and mask type was gathered. Chi-squared test of independence suggests a relationship between leakage and present adherence, Chi2(1)=11.34, p=0.001. Of those women experiencing high leakage, 83% were non-adherent to therapy. Logistic regression was run to compute an odds ratio with 95% CI. Those experiencing high leakage have about 92% times lower odds to still be compliant than those not experiencing high leakage [OR=0.08, 95% CI: 0.007, 0.478]. Overall, mask type relates to adherence, 72% of nasal mask wearers were still being adherent versus 38% when using facial masks. The prediction of adherence from leakage does not significantly differ across mask type. Age was found to be related to adherence; 57% of women under 50-years were not adherent to CPAP versus 26% in women over 50-years.

Conclusion

This information could guide us in suggesting strategies for better mask choosing and possibly to implement more specific strategies that can increase adherence in women.

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