bluuebunny/crossref_metadata_2025 huggingface dataset:
0458 Cranial Blood Flow. Arteriovenous Anastomoses (AVAs) Shunting in Obstructive Sleep Apnea
Authors: Govindan Srini
Published: April 2024

Introduction

To analyze our data on the effect of CPAP on vascular shunt mechanisms involving intra and extra cranial blood flow.

Methods

Daytime testing. A) Intracranial rCBF (regional Cerebral Blood Flow, Xenon133 inhalation, hemispheric mean, ml/100 mg/minute). During rCBF for the integrity of the Xenon loaded spirometer EPAP was used. B) Extracranial face blood flow, infrared imaging, at baseline, post CPAP immediate, for temperature increase (vasodilation) or decrease (vasoconstriction). Temperature change of 0.5oC is significant. The protocols were in compliance with CARE and TISEM. Participants 12. Group 1: Intracranial. Seven (2 OSA patients, 5 nonapneic controls). Group 2: Extracranial. Five (3 OSA patients, 2 nonapneic controls).

Results

Group 1. Patient #1. PSG: 1) Pre-CPAP, 2) CPAP 10 cm 3) Post tracheostomy CPAP. AHI: 1) 83.3, 2) 98.25, 3) 0.00. SE%: 1) 70%, 2) 70%, 3) 74%. SaO2: 1) 56%. 2) 76%. 3) 90%. Pre tracheostomy EPAP 10 cm, rCBF flow increase of 4.35% Left and decrease of 0.62% Right hemisphere. Patient #2. PSG: AHI 48.5. SE 67%. SaO2 83%. CPAP 10 cm, PSG: AHI 0.00. SE 78%. SaO2 92%. EPAP 10 cm, rCBF increase 13.59% on Left. Increase 13.43% on Right hemisphere. In controls: 4 out of 5, EPAP increased rCBF by 21.43% left and increased 12.85% on the Right hemisphere. Group 2: Five (3 OSA patients on home CPAP and 2 non apneic controls). All given CPAP for 15 minutes. Patient #1. AHI moderate to severe. ETCO2: Baseline 37, CPAP 38 mm Hg. CPAP 12.5 cm caused face vasoconstriction. Patient # 2. AHI 63. ETCO2: Baseline 41 and during CPAP was 40. CPAP 15 cm caused face vasoconstriction. Control: Controls CPAP 10 cm caused face vasoconstriction. ETCO2 Baseline: 34 and during CPAP was 35.

Conclusion

In obstructive sleep apnea patients and controls: EPAP increased Intracranial blood flow. CPAP decreased external carotid/face blood flow/ vasoconstriction i.e., closing of AVAs- microvascular shunts. The term microcirculation applies to blood vessels smaller than 300 µm. Infrared technology images the effect of CPAP on extracranial/face blood flow in obstructive sleep apnea. This has clinical research applications.

Support (if any)

None.
0461 Parietal EEG Slow Activity During NREM Is Associated with Overnight Spatial Memory Performance in CPAP-treated OSA
Authors: Mullins Anna , Parekh Ankit , Kam Korey , Valencia Daphne , Wickramaratne Sajila , Ayappa Indu , Rapoport David , Varga Andrew
Published: April 2024

Introduction

Sleep disturbance from obstructive sleep apnea (OSA) impairs overnight memory processing which may be mediated by changes to slow wave sleep. Indeed, reduced region-specific EEG slow activity during non-REM sleep has been associated with worse overnight declarative, motor and spatial memory. Using a polysomnologically (PSG)-verified model of SWS-specific CPAP-withdrawal to create three conditions of 1) stable-SWS on CPAP, 2) SWS-fragmentation with intermittent hypoxemia (OSAsws), and 3) SWS-fragmentation with reduced hypoxemia (OSAsws+O2), we investigated whether CPAP withdrawal during SWS induces acute changes in EEG slow wave activity that is associated with overnight spatial navigational memory performance.

Methods

19 channel EEG, re-referenced to average mastoids from 72 PSGs in 24 CPAP-adherent patients (7 female, average age 56yrs) with moderate-to-severe OSA was inspected visually for artifact removal prior to analysis using an automatic algorithm (DETOKS) for detection of relative slow wave (0.5-4Hz, SWA) and slow oscillation (0.6-1Hz, SOA) activity. During each PSG visit, participants explored one of three 3D maze environments, performing 3 timed trials before and after each of 3 randomized and counterbalanced SWS disruption conditions, 1)CPAP, 2)OSASWS & 3)OSASWS+O2. Frontal (Fz), central (Cz) and parietal (Pz) relative SWA, SOA and overnight change in maze completion times were compared according to PSG condition using Friedman Rank Sum and Conover’s tests. The relationship between SWA and maze performance was tested using Pearson’s correlation coefficient.

Results

No significant differences were observed between the three conditions for non-REM EEG slow activities or overnight change in maze completion times. In the CPAP condition only, greater EEG slow activity at Pz (SWA, r=0.57, p=0.01 and SOA, r=0.67, p=0.002) was associated with larger improvements in overnight maze completion times.

Conclusion

EEG slow wave activity and maze performance were not influenced by the recapitulation of OSA during SWS in CPAP-treated individuals. There was, however, a positive relationship between parietal-specific EEG slow oscillation activity and overnight maze performance during stable CPAP-treated slow wave sleep. These observations suggest that OSA of sufficient severity to impact SWA or SOA may negatively impact spatial navigational memory, but the selective withdrawal of CPAP in SWS only was not sufficient to do so.

Support (if any)

R01AG056682,R21OH012623,K24HL109156
0463 Sleep Disruption and Longitudinal Cognitive Aging
Authors: Khazaie Sepideh , Bena James , Ryan Delaney , Pao Winnie , Mehra Reena
Published: April 2024

Introduction

Aging is often accompanied by sleep disturbances and cognitive impairment. However, the relationship between specific sleep parameters and cognitive decline remains unclear. This study investigates the longitudinal association of objective measures of sleep disruption including sleep architecture and hypoxia in relation to levels of cognitive function, as ascertained by the Montreal Cognitive Assessment (MoCA) scores. We hypothesize that certain sleep characteristics, including degree of hypoxia, significantly influence cognitive aging trajectories.

Methods

This study involved an analysis of patients with mild cognitive impairment (MCI) in Alzheimer's Disease (AD) between 2011 and 2023. The main predictor variables were various sleep study parameters, including the Apnea-Hypopnea Index (AHI), mean SpO2 levels, arousal index, and sleep stage percentages. Covariates in the analysis were sex and age. To assess cognitive function, we used the MoCA which is a comprehensive tool scoring (range 0-30; assesses visuospatial, executive function, memory, attention, etc.), where higher scores indicate better cognitive function. Our statistical approach involved multivariable linear mixed models, adjusted for the covariates, to evaluate the MoCA scores over time (-1 to +3 years from sleep study) with sleep parameters.

Results

The study included 275 patients with MCI-AD, across 816 observations with an average age of 69.6 ± 8.7 years. Among them, 65.1% were male, 85.1% white with median 16 (IQR:12-17) years of education. Over 21 months mean follow-up among those with repeat MoCA testing, scores declined by -0.06 points/month (95% CI -0.08, -0.04; p< 0.001). A significant finding was the association of higher mean oxygen saturation with a more rapid cognitive decline, at -0.10 points per month for each 1% increase in oxygen levels (95% CI -0.19, -0.01; p=0.033). Other sleep measures including sleep architecture showed no significant associations with MoCA score changes.

Conclusion

This study sheds light on the intricate relationship between sleep quality, oxygen saturation, and cognitive aging. Our findings reveal a novel association between higher sleep-related oxygen saturation levels and accelerated cognitive decline in MCI-AD patients is biologically plausible given reports of altered EEG activity with task-evoked potentials in response to hyperoxia. Future investigation should clarify effects of hyperoxia on neural activity and oxidative stress in neurodegeneration.

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0465 Increased All-cause Mortality and Associated Factors in Korean OSA Patients
Authors: Seo Won Woo , Seo Mincheol , Shin Jiyoon , Lee Kyung Hwa , Jeon Jeong Eun , Lee Ha Young , Yoo Jin Hyuk , Kim Sun-Young , Lee Yu Jin
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) has been known to be associated with increased cardiovascular, metabolic diseases and mortality. As few studies reported associated factors on relationship between OSA and mortality, we aimed to investigate all-cause mortality and associated factors in OSA patients.

Methods

We performed retrospective study in group of 1547 subjects who referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from June 2004 to December 2013. Subjects who had other sleep disorders including parasomnia, restless legs syndrome, possible periodic limb movement disorder (PLMI>15), narcolepsy, etc were excluded (N=331) and a total of 1216 subjects was included for analysis. Deaths out of final subjects that occurred up to December 31, 2020 from Statistics of Korea, the national bureau of statistics were examined. We divided subjects into four groups: no-sleep disorder (N=276, AHI< 5), mild (N=268, 5≤AHI< 15), moderate (N=275, 15≤AHI< 30) and severe OSA groups (N=397, AHI≥30). We employed cox proportional hazard regression analysis to estimate hazard ratios (HRs) against no-sleep disorder and 95% confidence intervals adjusted for age, sex, hypertension, diabetes, dyslipidemia and longest apnea duration on polysomnography.

Results

HR of all-cause mortality was increased in the severe, moderate and mild OSA groups (HR=5.515, 95% CI=1.337-22.425, p-value=0.017, HR=5.443, 95% CI=1.555-19.054, p-value=0.008, HR=4.179, 95% CI=1.305-13.382, p-value=0.016, respectively). Longest apnea duration showed a significant association with decreased mortality (HR=0.955, 95% CI=0.932-0.979, p-value< 0.001). Age was associated with increased mortality (HR=1.103, 95% CI=1.071-1.136, p-value< 0.001). However, sex, diabetes, hypertension and dyslipidemia showed no significant association with mortality (All p-values > 0.05).

Conclusion

Current results suggest increased mortality in patients with OSA. In particular, severity of OSA based on AHI was related with increased mortality. We found longest apnea duration was associated with decreased mortality as well. Previous notion on adverse effect of shorter apnea duration associated with frequent arousal might attribute to these results. Since CPAP compliance was not considered in this study, association between CPAP use and apnea duration also can be considered as another possible cause. We need further study to confirm the associated factors on mortality in OSA including apnea duration.

Support (if any)

National Research Foundation (RS-2023-00242754).
0467 Effect of Hypoxia on Ventilatory Responsiveness in Opioid-Related Sleep Disordered Breathing
Authors: Rastogi Ruchi , Greig Danny , Johnston Ian , Miryala Chandra , Mishra Poonam , Zhao Lili , Badr M Safwan , Chowdhuri Susmita
Published: April 2024

Introduction

Ventilatory control mechanisms mediating opioid-associated sleep disordered breathing (SDB) are unclear, with reduced hypoxic ventilatory response (HVR) observed acutely with opioids, but increased HVR with chronic methadone use. Increased chemoresponsiveness may contribute to breathing instability during sleep. Aim: Determine the effects of chronic oral prescription opioids on HVR in individuals with opioid-associated SDB. Hypothesis: Compared to controls without opioid use, individuals with chronic prescription opioids-associated SDB will have increased HVR during wakefulness.

Methods

We studied 5 males on prescription opioids with SDB (age: 55±15 years, BMI: 33±7 kg/m2, apnea hypopnea index (AHI): 30±24/hr; CAI 3±6/hr, morphine equivalent dose: 31±12 mg , serum opiate levels: 23±22 ng/ml), and 5 control males with SDB, not on opioids, (age: 48±11 years, BMI: 28±2 kg/m2, AHI 37±15/hr, CAI 0.2±0.5/hr; urine drug screen negative for opioids). Opioid-SDB and controls underwent multiple trials with exposure to 2-minute episodes of isocapnic hypoxia (Hypoxia PetO2: 5-7%), each trial interspersed with room air, during wakefulness. Isocapnia was maintained by bleeding in CO2. Number of hypoxia (Hx) trials: opioid-SDB: 8.2±1.3; controls 7.0±0.7. All ventilatory parameters were analyzed breath by breath. For each trial, the ventilatory parameters during hypoxic exposure were compared with the room air baseline period immediately preceding the exposure. HVR was calculated as the change in minute ventilation during nadir hypoxia compared to control breaths for a corresponding change in PetO2.

Results

Minute ventilation (VI) during hypoxia trial was 99.1±28.5% of baseline Vi in opioid-SDB vs. 105±16% baseline Vi in control participants. The coefficient of variation of Vi was 29% in opioid-SDB vs. 15% in control-SDB (p=0.05). Opioid-SDB: PetCO2 37±4 mmHg at baseline and 37±3 mmHg during Hx trials; Control: PetCO2 37±4 mmHg at baseline and 41±3 during Hx trials. Opioid-SDB: PetO2 100±6 mmHg at baseline and 33±6 mmHg during Hx trials; Control: PetO2 101±5 mmHg at baseline and 46±7 during Hx trials. HVR: 0.6±2.4 L/min/mmHg vs. 1.4±4.2 L/min/mmHg in opioid-SDB vs. controls.

Conclusion

HVR tended to be reduced in opioid-SDB vs. controls during wakefulness. There was variability in minute ventilation in opioid users. Additional studies in a larger sample are required to delineate hypoxic ventilatory responsiveness in opioid-SDB.

Support (if any)

VHA CSR&D:1I01CX001938-02A0
0469 On-road Driving Performance the Morning After Bedtime Seltorexant in Major Depressive Disorder and Healthy Elderly
Authors: Devineni Damayanthi , Li Lingjue , Zhou Xianhuang , Pinter Christine , Flossbach Yanina , Pandina Gahan , Buntinx Erik
Published: April 2024

Introduction

Seltorexant, a potent and selective orexin-2 receptor antagonist is being developed as an adjunctive treatment for major depressive disorder (MDD). On-road driving performance was evaluated in adults and elderly with MDD taking an antidepressant (SSRI/SNRI) and in healthy elderly participants following bedtime administration of seltorexant.

Methods

This was a randomized, double-blind, placebo- and positive-controlled 4 way crossover study in 37 adults with MDD taking an antidepressant (SSRI/SNRI) and 26 elderly participants (n=19 with MDD; n=7 healthy). Study treatments were administered at bedtime for eight consecutive days: 2 dose levels of seltorexant (20-or 40-mg), zopiclone 7.5-mg on Days 1 and 8, or placebo. Driving performance was assessed on days 2 and 9 (9h post-dose) using a 1-hour standardized highway driving test (~100 km) in normal traffic, measuring standard deviation of lateral position (SDLP, weaving of car). Drug–placebo difference in SDLP of ≥2.4 cm was considered to reflect clinically meaningful driving impairment.

Results

Mean SDLP differences between drug and placebo following seltorexant 20-mg and 40-mg on days 2 and 9 were very small and the upper limits of the 2-sided 95%CI were below the threshold of 2.4 cm (least-square mean [95%CI] 20 mg: −0.1 [−0.80, 0.57] cm, Day 2; −0.2 [−0.81, 0.46], Day 9; 40-mg: 0.4 [−0.27, 1.12], Day 2; 0.6 [−0.14, 1.25], Day 9), suggesting no clinically relevant changes in driving performance in adults and elderly with MDD. Similar results for SDLP were noted for other populations (adults with MDD, elderly, all participants). Assay sensitivity was demonstrated using the positive control, zopiclone, which caused impaired on-road driving performance as measured by the SDLP (least-square mean [95%CI] Day 2: 2.8 [1.99, 3.59] cm, Day 9: 2.7 [1.76, 3.60] cm; lower limits of the 2-sided 95% CI were >0 cm). Most TEAEs were mild or moderate in severity and no new safety issues emerged.

Conclusion

Seltorexant 20-mg and 40-mg administered as single and multiple doses had no clinically meaningful negative effects on next morning driving performance in adults and elderly with MDD taking an antidepressant (SSRI/SNRI) and healthy elderly participants as assessed by mean changes in SDLP relative to placebo.

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0471 Simplified Endotyping Using Home Sleep Study Data to Inform Targeted Therapy for Obstructive Sleep Apnea
Authors: Eckert Danny , Dutta Ritaban , Levendowski Daniel
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) pathogenesis is heterogenous with important contributions from at least 4 key endotypes: 1) impaired pharyngeal anatomy, 2) unstable breathing control (high loop gain), 3) poor pharyngeal dilator muscle responsiveness and 4) waking up too easily to minor airway narrowing (low respiratory arousal threshold). Gold standard physiology assessments in a relatively small number of well-characterized participants indicate wide interindividual variability in pharyngeal collapsibility (impaired upper airway anatomy) and that ~30% of people with OSA have impairment in each of the three non-anatomical endotypes. Overall, ~70% have impairment in one or more non-anatomical endotypes which has implications for targeted therapy decisions. We recently developed a simplified model to estimate OSA endotypes from standard in-laboratory polysomnography and clinical data (Dutta et al, Annals ATS, 2021). In this study, we applied this model to estimate OSA endotypes in a large clinical population.

Methods

OSA endotypes were estimated using standard sleep study outputs and clinical data (i.e., age and BMI) from >6,500 consecutive home-based diagnostic studies (Sleep Profiler PSG- Advanced Brain Monitoring). All participants had an apnea/hypopnea index (AHI) >5 events/h. The proportion of participants who were estimated to have impairment in one or more OSA endotypes was calculated according to previously published physiological cutoffs.

Results

On average, participants (39% female) had moderately severe OSA (AHI=28±23 events/h ([Mean±SD]), were middle aged (49±15 years) and obese (BMI=32±7 kg/m2). 29% were estimated to have only mild anatomical compromise (Pcrit< -2cmH2O). 23% had poor dilator muscles, 31% high loop gain and 29% had a low arousal threshold. 62% of participants had impairment in one or more non-anatomical endotypes.

Conclusion

These data highlight the feasibility for simplified OSA endotyping using home sleep study recordings at scale. In addition, consistent with smaller, more detailed physiology studies, a substantial proportion of the clinical OSA patient population have only minor anatomical impairment. Furthermore, approximately two thirds have impairment in one or more non-anatomical endotypes. These findings highlight the potential for simplified OSA endotyping to inform targeted non-CPAP therapy selection for a large proportion of people diagnosed with OSA.

Support (if any)

DJE is funded by a National Health and Medical Research Investigator Grant (1196261).
0473 Homocysteine as a Predictor of Apnea-hypopnea Index in Obstructive Sleep Apnea: Longitudinal Epidemiological Study
Authors: Morelhão Priscila , Cavalcante-Silva Vanessa , Fernandes Guilherme , D'Almeida Vania , Tufik Sergio , Andersen Monica
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) affects nearly 1 billion people globally, and has established links with cardiovascular and neurocognitive complications. Although it has some limitations, the apnea-hypopnea index (AHI) is commonly used to gauge OSA severity and therapeutic response. Our objective was to investigate homocysteine (Hcy) levels as a predictor of AHI values and as a risk factor for OSA.

Methods

This is a prospective longitudinal cohort study with 8 years follow-up based on a subsample of the São Paulo Epidemiological Sleep Study (EPISONO). Data from polysomnography and blood analysis were used, data from the AHI and plasma Hcy, cobalamin and folic acid levels were extracted from dataset. The generalized estimation equation was used to estimate the predictive value of Hcy levels, and logistic regression was performed to estimate the risk.

Results

Our findings showed that Hcy was a predictor for an increased AHI, and AHI increased over time. Individuals with plasma Hcy levels ≥15 µmol/L experienced an average AHI increase of 7.43 events/hour ([beta coefficient] β=7.43; 95%CI: 2.73 to 12.13) over time, compared to those with plasma levels < 10 µmol/L. A similar trend was apparent in those with plasma Hcy levels between 10≥ to < 15 µmol/L, who had an AHI increase with an average beta coefficient of 3.20 events/hour (95%CI:1.01 to 5.39) compared to those with plasma Hcy levels < 10µmol/L. Our results revealed that increased plasma Hcy levels could be considered a risk factor for the development of OSA. Those with higher plasma Hcy levels have a greater risk of developing OSA (odds ratio=1.098 95%CI: 1.022 to 1.181).

Conclusion

In conclusion, the results suggest that plasma Hcy levels can predict the severity of OSA, highlighting their association with AHI.

Support (if any)

This study was supported by the Associação Fundo de Incentivo à Pesquisa (AFIP), São Paulo, Brazil. MLA and VDA are recipients of CNPq fellowships. MLA is supported by the São Paulo Research Foundation (FAPESP #2020/13467-8).
0474 The Impact of Neck Circumference and Body Mass Index on Upper Airway Collapsibility
Authors: Hutz Michael , Patel Harsh , Chapman Thomas , Whitehead Russell , Zhang Yanyu
Published: April 2024

Introduction

Drug-induced sleep endoscopy (DISE) is the most commonly utilized diagnostic tool for determining sites of upper airway collapse in patients with obstructive sleep apnea (OSA) seeking alternative treatments to continuous positive airway pressure (CPAP). Drug-induced sleep endoscopy with positive airway pressure (DISE-PAP) is a new technique that allows for both the qualitative visualization of upper airway collapse as well as a quantitative measure of collapsibility. In this study, we sought to determine if the anatomic features of neck circumference and body mass index (BMI) impact the degree of upper airway collapsibility, also known as the pharyngeal opening pressure (PhOP), during DISE-PAP.

Methods

This was a retrospective, consecutive cohort study of adult sleep surgery patients referred to a CPAP-alternatives clinic and evaluated by a single, experienced sleep surgeon at a tertiary care center from July 2021 to September 2023. Inclusion criteria were adults greater than 18 years of age with a history of OSA (apnea hypopnea index > 5) and a history of CPAP-intolerance. All patients underwent DISE-PAP in a standardized fashion as previously described by the senior author. The primary outcome sought to determine the relationship between neck circumference and the degree of upper airway collapsibility (PhOP), while the secondary outcome evaluated the relationship between BMI and PhOP.

Results

97 patients were included for neck circumference and 264 patients were included in analysis of BMI. On average, the cohort was middle-aged, obese (BMI 30.3), male (70.5%), White (64.8%), and with moderate-severe obstructive sleep apnea (AHI 33.3). In terms of our primary hypothesis, a mild positive correlation was observed between neck circumference and PhOP (Spearman correlation coefficient = 0.310, p = .002). In regards to our secondary hypothesis, a mild positive correlation was observed between BMI and PhOP (Spearman correlation coefficient = 0.237, p = 0.0001).

Conclusion

This study found a weak but statistically significant correlation between both neck circumference and BMI and the degree of upper airway collapsibility. These findings contribute to the current understanding of the impact on neck circumference and BMI on OSA. Further research is required to determine the clinical impact of these outcomes in the management of CPAP-intolerant patients.

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0475 Differences and Risk Factors Related to Hypoxic Burden in Non-Hispanic Black/African and White Older Adults
Authors: Cesar Justin Oliver , Figueredo Luisa , Arthur Matthew , Sogade Anamarie , Weisgerber Elizabeth , Gonzalez Moses , Gills Joshua L , Bernard Mark A , Parekh Ankit , Williams Natasha , Jean-Louis Girardin , Osorio Ricardo , Bubu Omonigho
Published: April 2024

Introduction

Obstructive Sleep Apnea (OSA) is as a prevalent sleep-related breathing disorder. The apnea-hypopnea index (AHI), used for the diagnosis of OSA, captures only the frequency of respiratory events and has demonstrable limitations. Measurements such as total arterial oxygen saturation < 90% (T90) and Hypoxic Burden (HB) have demonstrated utility for predicting cardiometabolic diseases, and other adverse health outcomes. Additionally, OSA has been associated with differential effects across racial/ethnic categories. In this cross-sectional study, we evaluate a community-dwelling healthy cohort of non-Hispanic Black and White older adults participating in studies on sleep, memory, and aging.

Methods

The study included a two-day clinical visit evaluation and one-night polysomnogram (PSG). Hypoxic burden was calculated as the area between the baseline and the SpO2 trace for any episode with >= 3% desaturation. Black and White older adults were relatively matched by age, gender, BMI and AHI4%. Multiple regression analyses with HB as the dependent variable and Age, Race, Sex, HTN, AHI4%, and BMI as the independent variables, and t-test was performed for group comparisons with a p-value < 0.05 defined as significant.

Results

Of the 140 subjects, 88 (62.85%) were females, 52 (37.15%) were males, 70 (50%) were non-Hispanic Black, and 70 (50%) were non-Hispanic White. The mean age was 67 (CI=63-71) years, BMI was 25 (CI=23-32) kg/m**2, and education was 16 (CI=14-18) years. Overall, male subjects had higher HB compared to females, p<.001. A significant difference in the HB was observed between blacks and whites regardless of hypertensive status, p<.008 for all. Black males and females had higher HB than white males and females, respectively, p<.0009 for all. Furthermore, age was negatively correlated with HB and this correlation was stronger in blacks compared to whites (r=-.43 vs. r=-.38, p<.05).

Conclusion

Hypoxic burden is a better predictor of cardio metabolic effects, compared to the AHI. Our findings indicate a more pronounced impact, particularly among blacks, with factors such as sex, hypertension, and BMI influencing this association. Future studies should examine the effects of modifiable factors, and how these may contribute to these observed sex/racial differences.

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0476 SPLIT-Polysomnography Parameters and Auto-CPAP Adherence Factors in Hispanic and Non-Hispanic-White Patients
Authors: Vazquez itzel Vazquez , Park Moon , Ferri Raffaele , DelRosso Lourdes
Published: April 2024

Introduction

Studies on Hispanic patients (HP) in the US have highlighted a higher prevalence of obstructive sleep apnea (OSA) compared to non-Hispanic White patients (WP). However, the role of obesity or body mass index (BMI) as a confounding factor remains unclear. Few studies have investigated the success of titration in split-night polysomnography (PSG) and factors affecting continuous positive airway pressure (CPAP) adherence. This study aims to assess OSA severity and PSG parameters in HP vs. WP, differences in treatment during split-night PSG studies, and CPAP adherence factors during follow-up.

Methods

We conducted a retrospective clinical chart review, split-night PSG studies, and CPAP adherence on adults at the University of California, San Francisco, in Fresno, from 3/1/2023 to 9/11/2023. Participants were categorized based on self-reported ethnicity as HP or WP.

Results

The study included 50 WP (15 women, 35 men, mean age 60.5±13.60 years, mean BMI 34.2±7.48) and 45 HP (24 women, 21 men, mean age 54.9±13.06 years, mean BMI 37.3±7.88). The mean apnea-hypopnea index (AHI) in HP was 51.1±33.67, saturation nadir 77.8±10.19, and time spent with saturation < 88% was 16.9±23.50 minutes. In WP, the mean AHI was 39.2±24.49, saturation nadir 81.6±9.04, and time spent < 88% was 7±11.36 minutes. All differences were statistically significant (p< 0.05). Titration data did not vary between groups. Auto CPAP was prescribed to all patients, with adherence at 3-4 months in HP at 75%±30, usage of 5.5±2.2 hours, and residual AHI 3±3.5. In WP, adherence was 79%±30, usage 5.9±2.1 hours, and residual AHI 3.6±6.2. None of these differences were statistically significant. Among HP, 37% missed follow-up appointments compared to 12% of WP. More HP used full-face masks, while more WP used nasal masks.

Conclusion

HP exhibited significantly worse OSA parameters during the diagnostic portion of PSG than WP. However, both groups demonstrated similar treatment outcomes in the split study. HP had a significantly higher no-show percentage than WP. CPAP adherence and residual AHI were not statistically different among those with follow-up, but more HP missed follow-up appointments than WP. Mask preferences differed between groups, with HP favoring full-face masks and WP preferring nasal masks.

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0481 A Novel Phenotype Classification for Obstructive Sleep Apnea Based on Hypoxic Burden
Authors: Park Soo Ryun , Park Hea Ree , Yook Soonhyun , Kim Hosung , Joo Eun Yeon
Published: April 2024

Introduction

Currently, we rely on the apnea-hypopnea index (AHI) to diagnose and quantify the severity of obstructive sleep apnea (OSA). However, AHI does not reflect the severity of respiratory events and does not capture the heterogeneity of patients with OSA. This study aimed to establish a novel phenotype classification based on a refined hypoxic burden (HB) and investigated its associations with a wide range of OSA-related health outcomes.

Methods

We retrospectively recruited 250 participants in each of four groups: normal (AHI < 5), mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30) OSA. To calculate HB, we adopted the method developed by Ali et al.,1 and we further divided HB into apnea-specific HB and hypopnea-specific HB, defined as HB calculated only based on apnea and hypopnea events, respectively. Hierarchical cluster analysis was performed based on the log scale of apnea-specific HB and hypopnea-specific HB to explore OSA phenotypes. We compared demographics and clinical outcome variables, including the prevalence of cardiometabolic disorders, comorbidity scores, and brain age index (BAI) based on sleep-EEG among these subtypes.

Results

After excluding participants with poor data quality, 954 participants were analyzed. These participants were classified into five clusters (Figure): subgroup #1 (n=177, ‘normal sleepers’), subgroup #2 (n=211, ‘mild hypopnea-driven HB’), subgroup #3 (n=225, ‘moderate HB’), subgroup #4 (n=225, ‘severe HB’), and subgroup #5 (n=116, ‘extreme HB with apnea-dominance’). Compared to subgroup #1, all other groups (subgroup #2-5) had a higher risk of hypertension and total comorbidity scores. By contrast, BAI was increased only in subgroups #4 and #5, with a significant correlation between apnea-specific HB and BAI. Different health outcomes were observed among subgroups even within the same AHI severity category.

Conclusion

This novel phenotype classification of OSA revealed significant associations with clinical outcomes, surpassing the limitations of the traditional categorization based on AHl. These insights could be used for risk stratification and the design of future OSA-related studies.

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0483 Real-world Study of Heart Rate Variability During Sleep Using Under-mattress Sensors in over 30,000 Individuals
Authors: Leng Yue , Cotton-Clay Andrew , Baron Susan , Fava Laura , Johnson Kyle , Easwar Venkat , Kinsolving Arthur , Kahn Philippe , Zitser Jennifer , Kushida Clete
Published: April 2024

Introduction

Heart rate variability (HRV), the beat-to-beat variation of the heartbeat signal, is a quantitative marker of Autonomic Nervous System (ANS) balance that may be influenced by obstructive sleep apnea (OSA) if measured during sleep. Notably, little is known about overnight HRV, and how this metric may differ by age, gender, or severity of OSA.

Methods

We used a commercially available home monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies Inc., California, USA) that measures HRV non-invasively and continuously during sleep using under-mattress piezo-electric sensors. We focus on two key HRV time domain metrics, the root mean square of successive RR interval differences (RMSSD, a measure used to estimate parasympathetic activity) and standard deviation of RR intervals between normal heartbeats (SDNN, a measure of overall variability influenced by both sympathetic and parasympathetic activity).

Results

We included data from 38,475 subjects [20712 males, 46.9±12.7 years; 17763 females, 46.7±12.6 years; 1575 with moderate to severe OSA (AHI≥15) and 30,816 without OSA (AHI< 5)] with 2,720,720 recorded nights, collected from 08/16/2023 to 12/15/2023. Both HRV metrics decreased with age, whereas SDNN was lower in females. For both females and males, individuals with moderate to severe OSA had significantly lower RMSSD than those without OSA, though these differences decreased with age and were only significant among those aged 20-39 years [mean difference (MD)=-5.21, standard error (SE)=1.66 for females; -6.57, 0.97 for males] or 40-59 years [MD=-2.33, SE=0.60 for females; -2.43, 0.33 for males]. Meanwhile, individuals with moderate to severe OSA had significantly higher SDNN than those with no OSA, and these differences increased with age and were only significant among those aged 40-59 years [MD=2.39, SE=0.82 for females; 2.33, 0.42 for males] or 60-79 years [MD=2.14, SE=0.89 for females; 1.91, 0.56 for males]. For all age groups, men with moderate to severe OSA had significantly higher heart rate (HR) compared to those without OSA.

Conclusion

HRV during sleep varies with age, gender, and severity of OSA. OSA severity had different associations with HRV metrics relevant to sympathetic vs. parasympathetic activity. Emerging sleep technologies provide new opportunities for clarifying the association between HRV during sleep and OSA.

Support (if any)

Support from Fullpower Technologies.
0486 Performing Polysomnography in the Acute Post-stroke Setting
Authors: Masroor Kiran , Schwarz Joshua , Radulescu Radu , Tsang Sui , Sheth Kevin , Redeker Nancy , Yaggi Henry , Geer Jacqueline
Published: April 2024

Introduction

Despite being the leading cause of disability in adults, there are still limited treatments for ischemic stroke due to its narrow therapeutic window. Thereby, it is imperative to develop new strategies to prevent recurrent strokes and improve stroke recovery. Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is disproportionately prevalent among the stroke population, with prevalence estimates around 70%. Furthermore, many studies have established OSA as an independent risk factor for future stroke. We examined the potential benefit of bringing OSA diagnosis and therapy to the inpatient hospital setting by offering polysomnography (PSG) to stroke patients in the acute post-stroke environment.

Methods

Patients were recruited from the Yale New Haven Hospital, a large academic urban hospital, specifically within the following departments: Emergency Departments, Stroke units, and Neurology services. The electronic medical record was used to screen patients for various inclusion and exclusion criteria. Over the three years of active recruitment, 3,507 patients were screened. To assess the potential efficacy of this study design, the percentage of patients who were deemed eligible, who were enrolled, who received PSG, and who demonstrated a positive OSA diagnosis, were analyzed. For this study, OSA was defined as at least 15 apneas or hypopneas per hour.

Results

Of the 3,507 patients that were screened, 1,109 (31.6%) were deemed eligible for the study and 705 (63.6%) were approached for recruitment. Among those approached, 171 consented to participate and 107 underwent PSG testing with 97 (90.7%) demonstrating moderate or severe OSA.

Conclusion

The proportion of patients with sleep apnea in this study is higher than previously seen. One of the strengths of this study is the high ascertainment of PSG in the post-stroke acute setting. Additionally, the AHI cutoff of 15 events per hour likely led to an underestimation of OSA prevalence, further strengthening our findings. Limitations of this study include (1) selection bias, as patients with existing symptoms of OSA were more likely to enroll, and (2) the intentional timing of the PSG in the acute setting. This study demonstrates high rates of OSA in the acute post-stroke setting, paving the way for future interventions.

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0489 Age Modifies the Association Between Severe Sleep Apnea and Mortality
Authors: Ramezani Amin , Azarian Mehrnaz , Sharafkhaneh Amir , Maghsoudi Arash , Jones Melissa B , Penzel Thomas , Razjouyan Javad
Published: April 2024

Introduction

Prevalence of sleep apnea (SA) increases with age. However, data on severity of SA and aging and its impact on health outcomes is not known. We assessed the interaction between severity of SA and all-cause mortality in different age categories using large, longitudinal data.

Methods

We used Natural Language Processing program to extract apnea hypopnea index (AHI) from text of physician interpretation of sleep studies, i.e., polysomnograms and home sleep apnea testing, performed at the veteran health administration (VA) from 2000-2022. We grouped the participants to no-SA (n-SA, AHI< 5) and severe SA (s-SA, AHI>30) and excluded AHI range of 5-29. We further stratified the cohort based on age: Young, < 40; Middle, >40 and < 65; and older, >65. We calculated odds ratio (aOR) for mortality adjusted for age, sex, race, ethnicity, and Charlson-Comorbidity Index using n-SA as reference.

Results

We identified 209,374 participants (age, 54.7 ±14.4; BMI 32±5.25; male 90%, White 67%). Prevalence of s-SA increased with age categories as well as CCI. However, increases in BMI between n-SA and s-SA differed with the age categories (30.0 vs 34.1; 30.8 vs. 34.3; and 29.8 vs 32.2, for young, middle-age and elderly, respectively). All-cause mortality rates were higher in s-SA, compared to n-SA independent of age (young, 1.7% vs 1.2%; middle age, 10.41% vs 10.62%; and older adults, 23.04% vs 30.10%). However, the aOR of mortality among s-SA compared to no-SA reversed as the age categories increased (young, 1.14,95%CI:1.04,1.23; middle age, 0.90,95%CI:0.88,0.92; and older adults, 0.83,95%CI:0.59,0.84).

Conclusion

Although the prevalence of severe SA increases by age, the odds of all-cause mortality compared to no-SA diminished. The data suggests that older adults may be protected against harmful OSA outcomes. A causality analysis is warranted to assess the relationship between sleep apnea, aging, and mortality.

Support (if any)

Supported by NIH, NHLB Institute K25 funding (1K25HL152006-01 [J.R.]); Airborne Hazards and Burn Pits Center of Excellence (AHBPCE#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0491 Exploring COMISA, Sleep-related Symptoms, and Healthcare Utilization in Military Personnel
Authors: Thomas Connie , Collen Jacob , Capaldi Vincent , Zhao Zhiwei , Williams Scott , Assefa Samson , Chen Shuo , Albrecht Jennifer , Wickwire Emerson
Published: April 2024

Introduction

Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders seen in clinical practice. Comorbid insomnia and OSA (COMISA) is a very common clinical presentation. The purpose of this study was to estimate the effect of COMISA on sleep, daytime symptoms, and healthcare resource utilization compared to OSA or insomnia alone among military personnel.

Methods

Military personnel with sleep problems were recruited from two military treatment facilities. Insomnia and OSA were defined using validated cutoffs on the Insomnia Severity Index and Berlin Questionnaire, respectively, and COMISA was defined as comorbid insomnia and OSA. Subjective and objective sleep were measured via standardized sleep diaries and a commercial wearable (Fitbit Inspire 2) over ten days. Daytime symptoms (e.g., sleepiness, depression, anxiety, pain) were assessed using standardized self-report questionnaires. Subjective cognition was assessed via three Likert items. Healthcare resource utilization (HCRU) was assessed using an established questionnaire tailored for this study. To compare differences between COMISA, OSA, and insomnia groups, one-way ANOVA was performed.

Results

The final sample included 201 participants (n=113, 43.8[%] men, mean age=44.5 [SD=12.7]) who self-reported being of White (111, 55.2%), Black (50, 24.9%), Hispanic (21, 10.5%) or Other (19, 9.5%) race. Of these, 22 (10.9%) were categorized as insomnia alone, 98 (48.8%) as OSA alone, and 81(40.3%) as COMISA. Relative to individuals with OSA, individuals with COMISA demonstrated worse subjective (but not objective) sleep; worse subjective daytime symptoms; worse subjective memory, attention, and executive function; and increased healthcare utilization including total HCRU and outpatient visits to internal medicine, neurology, emergency department, and urgent care. Some but few significant differences were observed between participants with insomnia relative to those with COMISA.

Conclusion

Among military personnel with sleep problems and relative to OSA alone, COMISA was associated with worse subjective sleep, worse daytime symptoms, worse subjective cognition, and greater HCRU. Future research should seek to seek to improve health and economic outcomes among individuals with COMISA.

Support (if any)

DoD (W81XWH1990006 via the Medical Technology Enterprise Consortium)
0493 Characteristics of Middle-Aged and Older Adults with Comorbid Insomnia and Sleep Apnea vs. Sleep Apnea Alone
Authors: Tseng Chien-Yu , Wickwire Emerson , Albrecht Jennifer , Malhotra Atul , Spira Adam , Roth David , Gross Alden , Amjad Halima , Blinka Marcela D , Sekhon Vishaldeep , Kaufmann Christopher
Published: April 2024

Introduction

Sleep apnea and insomnia often co-occur in older adults, complicating treatment and worsening outcomes. More research is needed to characterize sleep apnea patients with and without co-morbid insomnia. We characterized differences in demographic and clinical characteristics between individuals with co-morbid insomnia and sleep apnea (COMISA) and those with sleep apnea alone in a national sample of U.S. middle-aged and older adults.

Methods

Data came from the 2018 interview of the Health and Retirement Study, a nationally representative cohort of approximately 20,000 U.S. older adults. Participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder, including sleep apnea. Participants reported frequency of insomnia symptoms (difficulty falling asleep, waking during the night, waking too early, and feeling rested in the morning), and were categorized as having each symptom if they reported experiencing the symptom “most of the time” for the first three symptoms and “rarely or never” for the latter. Employing bi-variate logistic regression, we compared demographic and clinical characteristics of participants with sleep apnea who reported ≥1 insomnia symptom (COMISA) to those reporting 0 symptoms (sleep apnea alone).

Results

Among N=1,816 respondents reporting sleep apnea, 47.2% also had insomnia symptoms (COMISA). Compared to those with sleep apnea alone, participants with COMISA were younger (65.3±9.61 years vs. 66.4±9.25, p=0.015), and more likely to be female (51.5% vs. 40.3%, p< 0.001), but did not differ by race and ethnicity. They also were more likely to report several health conditions, including a markedly higher prevalence of mental health problems (43.1% vs. 24.8%, p< 0.001), dementia/cognitive impairment (4.9% vs. 2.7%, p< 0.001), and also have greater depressive symptomatology as measured by CES-D (2.8±2.44 vs. 1.1±1.67, p< 0.001).

Conclusion

Notable differences were identified between participants with COMISA and those with OSA alone. Of note, COMISA patients were more likely to have several health conditions, especially mental health, which suggests COMISA patients may benefit from psychosocial interventions aimed at improving treatment adherence and preventing poor health outcomes.

Support (if any)

This study was supported by the National Institute on Aging (R01AG079391, K01AG061239, P30AG028740) and the Sleep Research Society Foundation (23-FRA-001).
0494 Sleep Related Respiratory Events on Buprenorphine Compared to Naltrexone
Authors: Glidewell Geoffrey , Walker Nathan , Roth Heidi , Vaughn Brad , Fan Zheng , Bricker Katelyn
Published: April 2024

Introduction

Opioid medications are associated with an increased risk of sleep related respiratory events, especially central apneas. However, the potential impact of partial agonists (buprenorphine) and full antagonists (naltrexone) is less well known. In this study we hypothesize that patients using buprenorphine will have a greater prevalence of central apneas and require more frequent use of bilevel PAP therapy than those using naltrexone.

Methods

We performed a retrospective chart review of patients in a sleep laboratory database identifying patients who were prescribed naltrexone or buprenorphine at the time of a diagnostic PSG or PAP titration between 2019 and 2023. We only included initial diagnostic studies and initial titrations. The patients were split into four groups (buprenorphine/diagnostic, buprenorphine/titration, naltrexone/diagnostic, naltrexone/titration). Polysomnograms (PSG) were performed and scored in accordance with AASM guidelines. The Epworth Sleepiness Scale (ESS) and standard PSG variables were collected, and group differences were analyzed. Statistical significance was determined using a two-tailed T test.

Results

A total of 87 patients and 114 studies were included (n= 43 buprenorphine/diagnostic, n=25 buprenorphine/titrations, n=22 naltrexone/diagnostic, n=24 naltrexone/titration). Overall average age was 48 years, with 60.5% female. No significant difference of age or gender was found between the groups. All groups had high rates of underlying hypertension, depression, anxiety, and substance use disorders. Patients on buprenorphine were subjectively sleepier and demonstrated more frequent sleep-related respiratory events. Patients on buprenorphine presenting for initial diagnostics had higher ESS scores (11.1 vs. 7.14, p=0.017), and higher sleep efficiency (87.3% vs. 78.6%, p=0.045). The buprenorphine group had higher mean AHI (18.0 vs. 8.62, p=0.008) and more central apneas per hour, but this did not meet statistical significance (5.21 vs. 1.81, p=0.12). In the PAP titrations, patients on buprenorphine had more difficult titrations and a greater proportion of the buprenorphine group failed CPAP and required bilevel PAP.

Conclusion

Our cohort demonstrates a higher degree of subjective sleepiness, a tendency toward more central apneas, and increased likelihood to fail CPAP and require bilevel PAP in patients prescribed buprenorphine. We believe clinicians should have a higher degree of suspicion for central apnea in patients who are prescribed partial opioid agonists.

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