bluuebunny/crossref_metadata_2025 huggingface dataset:
0564 Assessment of Tongue and Soft Palate Muscles Mechanical Properties in Patients with OSA
Authors: Li W , Gakwaya S , Sériès F
Published: May 2020

Introduction

Soft palate muscles are crucial in the maintenance of UA patency. Different contraction tasks have been used to investigate tongue mechanical properties, but not to soft palate muscles. This study aimed to investigate the mechanical consequences of tongue and soft palate muscles fatigue in moderate-severe OSA patients.

Methods

12 moderate and 8 severe patients with OSA were enrolled. Measurements include strength, endurance, and fatigue indices. During the soft palate fatiguing protocol, subjects were asked to develop repetitive intra-oral positive pressure during cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened. Tongue mechanical properties were also assessed using protrusion tasks with similar protocol. Subjects were encouraged to develop sustained maximal bulging pressure or tongue protrusion force for 5 sec every 10 sec until the peak pressure did not reach 85% of baseline maximal pressure for 2 consecutive times. The influence of age and BMI were also investigated.

Results

The sex, age were not significantly different between the 2 OSA groups. BMI was significantly higher in severe OSA patients (p<0.05). Overall, the tongue maximal voluntary contraction force (MVC), endurance time and total muscle work were respectively positively associated with the ones obtained from the soft palate fatiguing task (rs=0.51, 0.43, 0.66, respectively). The MVC of both tongue and soft palate muscles were positively correlated with BMI in all subjects (rs=0.43, 0.5 respectively). The recovery time from soft palate fatigue was significantly longer in moderate than severe OSA patients (270s ± 192.3s and 120s ± 0, p =0.02). Interestingly, the recovery time was positively correlated with AHI in tongue fatiguing task, while negatively correlated with supine AHI and age in soft palate fatiguing task (p<0.05). In both tasks, MVC was negatively correlated with the endurance time (p<0.05).

Conclusion

Moderate patients are less likely to recover from soft palate muscle fatigue. A more severe apneic disease is associated with longer recovery time from tongue fatigue, but with shorter recovery time from soft palate fatigue. Our results suggest that alteration in tongue and velopharyngeal muscles function may differ according to the severity of disease.

Support

SBD from IUCPQ Foundation.
0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users
Authors: Zhu R , Carlson G , Kelly M , Song Y , Fung C H , Mitchell M N , Josephson K R , Zeidler M R , Badr M S , Alessi C A , Washington D L , Yano E M , Martin J L
Published: May 2020

Introduction

Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment.

Methods

A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests.

Results

1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p<.001), likely to be employed (p=.013), more likely to snore loudly (p<.001) and to have breathing pauses while asleep (p<.001). They also had higher ISI (p<.001), were more like to report RLS (p<.001) nightmares (p=.027), and had higher PHQ-4 (p<.001) and PC-PTSD (p<.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p<.001) and those with observed breathing pauses were more likely to use PAP (p<.001).

Conclusion

One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans.

Support

Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).
0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study
Authors: Xue J , Zhao R , Li J , Zhao L , Zhou B , Dong X , Han F
Published: May 2020

Introduction

To evaluate the utility of the ring pulse oximeter for screening of OSA in adults.

Methods

87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15).

Results

Among the 87 participants, 18 cases were AHI<5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P>0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p<0.05). Although MSpO2 correlated significantly (r=0.448, P<0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p<0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively.

Conclusion

The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA.

Support

The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).
0589 Arrhythmia Detection in Obstructive Sleep Apnea (ADIOS)
Authors: Geil E S , Ramos A R , Abreu A R , Lambrasko L K , Dib S I , Wallace D M , Junco B , Torre B C , Chediak A D , Chaturvedi S
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a recognized risk factor for ischemic stroke; however, there is a paucity of studies devoted to modifying stroke risk factors in patients with OSA. We aimed to evaluate the prevalence and treatment of stroke risk factors in newly diagnosed OSA patients.

Methods

We evaluated consecutive patients with an OSA diagnosis made within 12 months and CHADS2 score of >2, consistent with high risk for atrial fibrillation. The patients completed polysomnography, sleep questionnaires, and systematic assessments for demographic variables, vascular risk factors, and medication use. Participants also completed up to four weeks of ambulatory cardiac monitoring. A six-month follow-up visit screened for new hospitalizations associated to vascular events and use of new anticoagulants or antiplatelet therapy.

Results

The sample consisted of 87 patients, mean age 59±8 years, 53% women, and 69% of Hispanic/Latino background. The mean BMI was 35±9. Hypertension was seen in 57% and diabetes mellitus in 33% of the sample. The mean apnea-hypopnea index was 41±27 events/hour. Atrial fibrillation was detected in 3% of the sample through prolonged monitoring. At six-month follow-up, 9% of the sample was hospitalized due to stroke, transient ischemic attack, or coronary artery disease, while 13% reported use of anticoagulants and 38% antiplatelet therapy.

Conclusion

In this high risk sample of OSA patients, there was a high prevalence of cerebrovascular events and use of medical treatment for secondary stroke prevention. Future studies evaluating the treatment of vascular risk factors in OSA can provide strategies to minimize stroke occurrence.

Support

Boehringer Ingelheim
0620 Characteristics Distinguishing Special Operational Forces (SOF) Personnel from Non-SOF Peers with TBI: Retrospective Analysis From the VA TBI Model Systems
Authors: Kretzmer T , Bajor L , Silva M A , Eapen B , McKenzie-Hartmann T , Garcia A , Belanger H , Richardson R
Published: May 2020

Introduction

Special Operations Forces (SOF) is an umbrella term which encompasses over a dozen specialized communities across all military branches. Little is known about potential differences in demographic and health characteristics, including sleep, between SOF vs. non-SOF service members. We leveraged existing longitudinal studies of those with history of TBI to examine differences between SOF and non-SOF in the dataset.

Methods

We conducted a retrospective analysis of data from the VA TBI Model Systems, a multi-center longitudinal study of outcomes following TBI rehabilitation. Participants were included if SOF status was known (N = 261). Differences between groups on variables of interest were then classified as “Immaterial”, “Minor,” and “Important” based on either prevalence (categorical data) or degree of difference (continuous data).

Results

Of included participants, 68 (26%) were identified as SOF and 193 (74%) as non-SOF. SOF were more highly educated and more likely to have history of mild TBI. There were multiple “important” differences in co-morbidity prevalence. SOF participants were more likely to be diagnosed with sleep apnea (36% SOF vs 12% non-SOF). They were also more likely to have been diagnosed with chronic pain, a cardiac condition, high blood cholesterol, and/or osteoarthritis.

Conclusion

SOF participants differed from non-SOF in a multiple important ways, suggesting this is a different and medically complex population. The most striking finding was that SOF personnel had a significantly greater rate of sleep apnea, relative to non-SOF. The mechanism underlying this difference is not known but may relate to training, blast exposure, weapons use, and mission demands. Further investigation regarding mechanisms, prevalence, and treatment of OSA in the SOF community is needed.

Support

This research was sponsored by VHA Central Office VA TBI Model Systems Program of Research; Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015; HT0014-19-C-0004).
0635 Effects of Donepezil in Patients with Residual Excessive Sleepiness of Obstructive Sleep Apnea: A Double Blind; Randomized Placebo; Controlled Study
Authors: Sousa K M , Piovezan R D , e Silva L , De melo C , Poyares D , Tufik S
Published: May 2020

Introduction

Residual excessive sleepiness (RES) is presented by 6% of obstructive sleep apnea patients despite effective CPAP therapy. Few interventions have been tested for this condition and are focused on daytime stimulants. Recently, cholinergic activity decline was suggested as a potential mechanism in the pathophysiology of RES. This study aimed to investigate the effects of donepezil, an anticholinesterase inhibitor, in patients with RES.

Methods

This double-blind, randomized, placebo-controlled crossover study included participants with RES (35-65 years). Neuropsychiatric disorders, alcoholism, smoking, shiftwork, psychoactive drugs, other sleep disorders were exclusion criteria. Participants were assigned to one intervention arm (donepezil 5 mg for 15 days followed by donepezil 10mg for 15 days or placebo in the morning). After a 20-day wash-out, the same procedure was repeated following the crossover design. Somnolence measured by the Epworth sleepiness scale (ESS) and Maintenance of Wakefulness Test (MWT) were the primary endpoints. PSG, cognitive (trail test, continuous performance test) and Beck’s depression scale parameters were secondary endpoints. General Linear Models for repeated measures compared interventions responses. Cohen’s d measured effect sizes. Adverse events (AEs) were assessed by questionnaire.

Results

The study enrolled eight individuals. ESS was lower in the donepezil arm than in the placebo arm (8.9±4.4 vs 15.7±4.1, p<0.05). Effect size for ESS was high (d 1.61). Other endpoints were not different among study arms. Randomization order didn’t affect the results. No AEs were reported.

Conclusion

Donepezil improved subjective sleepiness in individuals with RES. To our knowledge, this is the first study to report the effects of a cholinergic intervention in patients with RES. Effect size was high for self-reported sleepiness, which may impact on quality of life and risk of disability in people with RES. Agents acting on the cholinergic system are potential targets for treating RES.

Support

Acknowledgements Brazilian National Council for Scientific and Technological Development (CNPq) This study is supported by AFIP (Associacao Fundo Incentivo a Pesquisa).
0641 Effects of Weight Loss During Long-Term Solriamfetol Treatment on Cardiometabolic Indices
Authors: Malhotra A , Strollo P , Pepin J , Schweitzer P , Lammers G , Hedner J , Redline S , Chen D , Chandler P , Bujanover S , Menno D , Strohl K
Published: May 2020

Introduction

Increased prevalence of obesity has been reported in patients with narcolepsy and obstructive sleep apnea (OSA). Results from a 1-year open-label extension (OLE) study showed ≥5% weight loss in 4.5%, 17.3%, and 32.4% of participants with narcolepsy or OSA receiving solriamfetol 75, 150, or 300mg/d. We examined whether clinically significant weight loss (≥5%) in this population had favorable effects on biomarkers of cardiometabolic risk compared to no such weight loss.

Methods

We evaluated changes in weight and BP (parent study baseline to OLE week 40) and clinical laboratory assessments (OLE baseline to week 40) in participants with narcolepsy (n=124) or OSA (n=250) from the OLE study.

Results

Of 374 participants, 96 (25.7%) had ≥5% weight loss and 34 (9.1%) had ≥5% weight gain. Demographics were similar in those with and without (n=278) ≥5% weight loss. From baseline to week 40, among participants with weight loss, there were decreases in percentage with high (ie, >ULN) serum glucose (36.6% to 28.1%) or triglycerides (26.6% to 21.9%), whereas among participants without weight loss, there was an increase in percentage with high glucose (43.3% to 50%) and no change in percentage with high triglycerides (37.1% to 37.2%). The percentage of participants with high total cholesterol was stable among participants with weight loss (22.3% to 22.9%) and increased (32.7% to 37.2%) in participants without weight loss. Participants with weight loss had mean±SD reductions in SBP (-2.6±11.4mmHg) and DBP (-1.0±9.0mmHg), whereas participants without weight loss had increases of +0.65±12.5mmHg and +1.2±8.7mmHg, respectively.

Conclusion

Among solriamfetol-treated participants with ≥5% weight loss, there

were decreases in BP and percentage of participants with high glucose and triglycerides. Further research is required to examine prospective long-term effects of solriamfetol on specific biomarkers of cardiometabolic risk.

Support

Jazz Pharmaceuticals
0642 A Novel Daytime Intra-Oral Neuromuscular Stimulation Therapy in Simple Snorers: Objective Improvement in Snoring
Authors: Kotecha B
Published: May 2020

Introduction

The reduction in pharyngeal muscle tone in the upper airway is a pivotal factor in snoring and obstructive sleep apnoea (OSA).There is accumulative evidence that pharyngeal exercises can reduce snoring and OSA. We present a novel device SnooZeal® that uses daytime awake neuromuscular electrical stimulation (NEMS) as an application to induce toning of the tongue muscles. This study investigates objective changes in snoring and respiratory parameters with this device.

Methods

Prospective cohort study of 100 simple snorers was conducted. Objective snoring and respiratory parameters were recorded with 2 consecutive WatchPat sleep studies before and after treatment. SnooZeal® device was used for 20 minutes once a day for a 6 week period. Secondary outcome measures using visual analogue scale reporting of snoring by patient and Epworth Sleepiness Score (ESS) were recorded.

Results

Objective reduction of snoring was noted on the sleep studies in 95% with an average reduction of 48%. Subjectively, the visual analogue scale reported by partners similarly demonstrated reduction in 95% of the patients with an average reduction of 40%.

Conclusion

This prospective cohort study demonstrates a notable improvement in both objective and subjective parameters of snoring and respiratory indices. SnooZeal® offers a novel approach to reduce snoring by utilising intra-oral neuromuscular electrical stimulation. This could be a preferred option for patients as it alleviates the need of using an oral device during sleep.

Support
0645 The Association of Hypoglossal Nerve Stimulator Adherence and Insomnia
Authors: Sharma M , Chacko A , Rosenthal M , Khan M
Published: May 2020

Introduction

The gold standard for treatment of Obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, CPAP adherence is less than 50%. An alternative treatment is the hypoglossal nerve stimulator (HNS) which displaces the tongue anteriorly to treat upper airway obstruction. Difficulties tolerating HNS are related to stimulation discomfort. In this study, we investigated insomnia as a barrier to adherence.

Methods

Patients implanted and activated with HNS at The Ohio State University Wexner Medical Center between 2015 and 2019 were eligible. Patient usage data from the previous six months was obtained and subjects were asked to complete an Insomnia Severity Index (ISI). Participants were divided into adherent (defined as use ≥28 hours/week) and non-adherent (use <28 hours/week).

Results

32 subjects were enrolled, 22 in the adherent group and 10 in the non-adherent group. There was a significant decrease in mean treatment AHI in both groups: 36.25 to 11.14 in the adherent group and 36.30 to 15.69 in the non-adherent group (p<0.0001). The mean ISI score in the adherent group was 6.84 which is consistent with no clinically significant insomnia and 8.67 in the non-adherent group consistent with subthreshold insomnia. However, there was not a statistically significant difference between the two groups (p=0.441). There was a statistically significant higher score for the question “Do you worry about your sleep problems?” in the non-adherent group (1.78, SD1.39 vs 0.74. SD 0.81) (p =0.018).

Conclusion

This study suggests that patients who have difficulty with sleep may have more difficulty with HNS adherence than those who do not. In particular the question stating “Do you worry about your sleep problems” had a statistically higher score in the non-adherent group. Prospective studies are needed to further explore a possible relationship between insomnia and HNS adherence.

Support

N/A
0652 A Novel Cognitive-Behavioral Therapy to Increase PAP Adherence in Veterans With Posttraumatic Stress Disorder: Preliminary Results
Authors: Kinoshita L , Blank E , Chen M , Doudell K , Day Y , Alipio Jocson V , Lazzeroni L , Noda A , Hernandez B , Holty J , Kuschner W , Kushida C , Yaffe K , Cheng J , Yesavage J A
Published: May 2020

Introduction

The occurrence of obstructive sleep apnea (OSA) is high in veterans with posttraumatic stress disorder (PTSD). Our previous research on OSA in Vietnam-era veterans found that 69% had an AHI≥10 (Yesavage, 2012). Efficacious treatments are available for OSA, PAP therapy; however, veterans with OSA frequently fail to use them (Yesavage, 2012; Kuna, 2011). Of the veterans diagnosed with OSA, 63% were not using their prescribed PAP device. The reasons for low PAP adherence include discomfort using PAP and psychological barriers. We developed a novel cognitive-behavioral therapy (CBT) intervention to increase PAP adherence in veterans with PTSD and OSA, called CBT-OSA.

Methods

Participants included 37 veterans age 18+ from clinics at VA Palo Alto. Participants were randomly assigned to CBT-OSA or an education arm. All participants received treatment as usual in VA Pulmonary Service or a community-based Sleep Medicine Center. Participants in CBT-OSA received therapy from a Clinical Psychologist. The other veterans received education sessions. All participants received weekly, individual sessions during the first four weeks of PAP treatment. Average mask on time was calculated for each participant during week 1-4 of PAP use.

Results

An independent samples t-test was conducted to compare average mask on time in the CBT-OSA and education conditions. There was a significant difference in the average mask on time for CBT-OSA (M=235.33, SD=139.22) and education (M=136.68; SD=149.19); t(35)=-2.08, p=0.045. These results suggest that veterans who received the CBT treatment increased their PAP use compared to the veterans in the education condition.

Conclusion

CBT-OSA has shown early efficacy. CBT-OSA increased PAP adherence in veterans with PTSD compared to veterans in the education condition. Veterans receiving CBT-OSA demonstrated a longer average mask on time compared to veterans in the education condition. We are following the participants for one year to examine if CBT-OSA fosters long-term PAP adherence.

Support

This research is supported by the Research Service of the Department of Veterans Affairs (Grant Number 1I01RX001799-01A2).
0655 CBT-I and CPAP in Comorbid Insomnia and Sleep Apnea: Effects on Daytime Functioning
Authors: Tu A Y , Crawford M R , Dawson S C , Fogg L F , Turner A D , Wyatt J K , Crisostomo M I , Chhangani B S , Kushida C A , Edinger J D , Abbott S M , Malkani R G , Attarian H P , Zee P C , Ong J C
Published: May 2020

Introduction

This study examines the effects of treatment sequences using cognitive-behavioral therapy for insomnia (CBT-I) and continuous positive airway pressure (CPAP) therapy on daytime functioning in people with comorbid insomnia and sleep apnea (COMISA).

Methods

118 participants with COMISA (Age=49.99±13.12; 53.4% female) were randomized to one of the three study arms: Arm A- CBT-I followed by CPAP, Arm B- CBT-I concurrent with CPAP, and Arm C- CPAP only. Participants were assessed at four time points [baseline/ start of phase 1 (A1), CPAP titration/ start of phase 2 (A2), 30 days (A3) and 90 days (A4) after CPAP initiation]. This study examined secondary outcome measures of daytime functioning, including the Functional Outcomes of Sleep Questionnaire (FOSQ), Epworth Sleepiness Scale, and Flinders Fatigue Scale (FFS).

Results

Linear mixed model analyses showed a main effect of time on improving functional outcomes in all measurements, with all p< 0.001. There were also arm by time interactions on FOSQ [F(6, 105.36)=4.21, p=0.001] and FFS scores [F(6, 106.95)=3.10, p=0.008]. Pairwise comparisons with Bonferroni adjustment showed improved FOSQ scores in Arm A from A1 to A2 (p=0.011) and A2 to A3 (p=0.005), Arm B from A2 to A3 (p< 0.001), and Arm C from A2 to A3 (p=0.006). For FFS scores, improvements were shown in Arm A from A1 to A2 (p=0.003), and Arm B from A2 to A3 (p < 0.001).

Conclusion

The results show daytime functioning improvements in patients with COMISA following CPAP and CBT-I. In addition, CBT-I appears to facilitate improvement in sleepiness-related functional status and daytime fatigue. The findings suggest that the combination of CBT-I and CPAP may have a beneficial effect on daytime functioning in patients with COMISA.

Support

This study was supported by the National Institutes of Health (R01HL114529).
0657 Impact of Treatment With Mandibular Advancement Oral Appliance on Respiratory Parameters, Sleep and Cardiometabolic Risk Factors of CPAP Non-Adherent Patients With Severe Obstructive Sleep Apnea
Authors: Giannasi L , Gomes M , Oliveira L , Nacif S , Oliveira E , Rezende T , Dutra M , Bacigalupo E , Soviero L , Nazário L , Oliveira W , Rode S , Amorim J , Salgado M , Meira e Cruz M
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) may trigger systemic changes linked to important cardiometabolic risk factors such as hypertension, stroke and diabetes II. As a life-threatening, multifactorial disorder, OSA demands a multiprofessional approach. The most common worldwide treatments are Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Oral Appliance (OAm). The aim of this study was to evaluate the impact of OAm treatment on CPAP non-adherent patients with severe OSA, comparing objective and subjective data between baseline and follow up.

Methods

A prospective study was carried out including non-adherent severe OSA patients, which were referred to OAm therapy evaluation. Patients presenting with snoring, gasping/choking during sleep, fatigue and daily sleepiness were evaluated by a sleep medicine specialist and the diagnosis of severe OSA with a basal polysomnography (PSG). All the patients were treated with a standard OAm (PMPositioner®). Baseline and Follow up (6 months) sleep parameters (PSG and Epworth Sleepiness Scale - ESS) were compared to assess treatment efficacy.

Results

Seventeen patients (9 with hypertension and 8 with hypertension + diabetes) met the inclusion criteria and 13 finished the protocol. After treatment with OAm the following parameters improved significantly: OSA severity (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05)) and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001), ESS (p<0.005). Ten patients (58%) reported a reduction either in systolic and diastolic blood pressure with 3 of them (30%) reduced the hypertensive drug dose.

Conclusion

Our findings show that OAm is a safe and effective treatment option to CPAP non-adherent severe OSA patients. Furthermore OAm therapy had also a positive impact on cardiometabolic risk factors which are particularly relevant outcomes in OSA patients.

Support

State of Sao Paulo Research Support Foundation (FAPESP).
0678 Objective Efficacy Of Oral Appliance Therapy In An Integrated Care Model
Authors: Stothard E R , Deol L I , Hickey M G , McCarty D E , Wertz A T
Published: May 2020

Introduction

Custom-fabricated Oral Appliance (OA) therapy is a recommended alternative to positive airway pressure for the treatment of obstructive sleep apnea (OSA). However, objective efficacy outcomes are limited as dental sleep medicine professionals often work independently of sleep clinics. The integrated care model (ICM) of sleep medicine includes a full-time dentist (diplomate of the American Academy of Dental Sleep Medicine), making it uniquely positioned to examine the efficacy of OA therapy in reducing apnea-hypopnea index (AHI) and creating individualized, patient-centered treatment plans.

Methods

All patients who completed initial consult for OA therapy with the ICM from 2014-2018 were considered. Patients who declined OA were excluded. Diagnostic testing for sleep apnea was completed prior to OA therapy initiation and efficacy testing was prescribed post-OA therapy.

Results

795 patients met inclusion criteria. Efficacy testing was completed in 482 patients (60.6%; 33.9% of patients with treatment follow-up but no efficacy testing reported clinical improvement). 99 were excluded due to insufficient data. 383 patients (55% male; 48.4±0.6 years (±SEM), BMI 28.4±0.3) were included in final analyses. AHI improved in 82.5% of patients (12.5±0.5 to 7.0±0.4, p<0.0001). AHI was reduced <5 in 47.5% of patients (9.9±0.4 to 2.6±0.1, p<0.0001); AHI was reduced by >50% in 51.4% of patients (13.9±0.7 to 3.5±0.2, p<0.0001). 32.1% of patients completed more than one efficacy test to reevaluate adjustment of OA therapy, which significantly reduced final treatment AHI (13.7±0.9 to 7.6±0.8, p<0.0001). Among patients with treatment AHI <5 or >50% reduction in AHI, 28.6% and 32.0% of patients, respectively, required multiple adjustments and efficacy tests to achieve optimal results.

Conclusion

Custom-fabricated OA therapy through the ICM significantly reduced AHI and approximately half of patients achieved AHI <5 and/or >50% reduction in AHI as demonstrated by objective efficacy testing. To optimize therapy response, multiple adjustments were required to significantly improve AHI in a subset of patients. This demonstrates the variability of objective efficacy of OA therapy in the management of OSA, and the necessity of repeated objective testing for treatment optimization.

Support

N/A
0679 Effects Of Cannabimimetic Enhancement On Subjective Sleep Quality And Function In Obstructive Sleep Apnea
Authors: Yin G - , Reid K , Carley D , Prasad B , Zee P
Published: May 2020

Introduction

We previously reported that dronabinol a tetrahydrocannobinol, reduced the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA) in a dose-dependent manner. The aim of this report is to assess the effects of dronabinol on subjective sleep quality and daytime function in the Pharmacotherapy of Apnea by Cannabimimetic Enhancement (PACE) II trial.

Methods

By random assignment, 73 adults with moderate or severe OSA received either placebo (N = 25), 2.5 mg dronabinol (N = 21), or 10 mg dronabinol (N = 27) daily, 1 hour before bedtime for 6 weeks. Participants completed the Pittsburgh sleep quality index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ-10) at baseline and at the end of intervention.

Results

Between group comparisons were performed using a one-way ANOVA. At baseline, there were no significant difference between groups in the PSQI or FOSQ-10. When compared to placebo, the 10 mg group had a significant reduction in the global PSQI score (p=0.039). Paired t-test analysis showed, in comparison to the baseline, the subscale and total score of the FOSQ-10 were significantly increased (P=0.005); the global PSQI score, subjective sleep quality score, habitual sleep efficiency score and daytime dysfunction score were significantly reduced (p<0.001, p<0.001, p=0.024, p=0.007 respectively) in the 10 mg group, while no improvement was found in the 2.5 mg or placebo groups. Bivariate correlational analysis was used to identify the relationship between the changes of variables. Both ∆ global PSQI and ∆ total FOSQ were correlated with ∆ESS, but not with change in AHI or sleep parameters such as sleep stage percentage, sleep efficiency, arousal index, minutes of wake after sleep onset, time and duration of oxygen saturation below 90% percent.

Conclusion

These findings indicate that in addition to its ability to reduce the AHI, dronabinol can improve subjective sleep quality and daytime function in patients with moderate to severe OSA.

Support

This study was funded by National Institutes of Health, National Heart Lung and Blood Institute Grant Number UM1-HL112856 and National Center for Advancing Translational Sciences, Grant Numbers UL1TR001422 and UL1TR002003.
0692 Difference In Improvement Of ESS Score After CPAP Use In Patients From Different Workforces
Authors: Mehta T R , Gurung P , Digala L , Nene Y , Bollu P C
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is characterized by recurrent occurrences of apnea and hypopnea throughout the night during sleep. Reported to prevail in 23.4% women and 49.7% men aged 40 years or older, OSA is considered to be the most preventable cause of excessive daytime sleepiness.

Methods

After obtaining approval from the institutional review board (IRB) for this retrospective study, a total of 825 patient records from a prospective registry of obstructive sleep apnea from our sleep lab affiliated with the University of Missouri Hospital were searched for variables including but not limited to age, race, gender, occupation, medications any sleep-related comorbidities, psychiatric comorbidities, cardiovascular comorbidities, pre CPAP ESS score and post CPAP ESS score. The mean improvement score of ESS in both these populations was compared and possible causes for the difference in these groups were analyzed.

Results

Initial analysis from 22 patients belonging to the white-collar and 22 patients belonging to the blue-collar workforce with a mean age of 49.27 (±14.28) years and a mean BMI of 37.60 (±9.41) showed a mean improvement of -1.27 and 0.63 respectively with no significance statistically. Statistical analysis will be performed after gathering data from a larger sample size.

Conclusion

Although insignificant, the blue-collar workforce showed more improvement than the white-collar workforce in the initial analysis.

Support

No support, financial or otherwise was used for this study.
0693 Effects Of Solriamfetol On 24-hour Blood Pressure Patterns In Participants With Excessive Daytime Sleepiness Associated With Obstructive Sleep Apnea
Authors: Strollo P J , Malhotra A , Strohl K , Pepin J , Schweitzer P , Lammers G , Hedner J , Baladi M , Carter L , Bujanover S , Menno D , Dauvilliers Y
Published: May 2020

Introduction

Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with obstructive sleep apnea (OSA; 37.5-150 mg/d) or narcolepsy (75-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of OSA patients with a non-dipping BP profile.

Methods

Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with OSA (n=474).

Results

At week 8, increases in BP were apparent in the 75 and 300 mg dose groups from ~6 AM until 8 PM. At baseline, 58% (placebo) and 55% (combined solriamfetol) of participants were non-dippers (defined as <10% decrease in mean arterial pressure [MAP] during sleep). There was no increase in the percentage of non-dippers at week 8 relative to baseline (placebo, 56%; combined solriamfetol, 53%). Results were similar when dipping was defined by changes in systolic BP and diastolic BP.

Conclusion

The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with OSA at any dose studied.

Support

Jazz Pharmaceuticals
0696 The O2VERLAP Study: High Cpap Use Levels Found In Overlap Syndrome (OSA And COPD) Patients
Authors: Martinez S , Deering S , Sullivan J , Pasquale C , Shumard T , Clark B , Amdur A , Malanga V , Malanga E , Yawn B , Stepnowsky C
Published: May 2020

Introduction

CPAP therapy is prescribed to help manage disordered breathing during sleep time periods. Most users, especially those with non-severe obstructive sleep apnea (OSA), use it only for some portion of their sleep period. Patients with Overlap Syndrome have both OSA and chronic obstructive pulmonary disease (COPD). While there has been some research on CPAP use levels in this patient population, there has been little indication that they use CPAP any differently than those with OSA only.

Methods

The O2VERLAP Study was a large comparative effectiveness trial enrolling people with COPD and OSA and using two different methods of providing information and support to current users of CPAP therapy. The study utilized an electronic national recruitment strategy and 332 participants were enrolled. CPAP data from the 12-week study period was analyzed. The Pittsburgh Sleep Quality Index was used to determine both estimated total sleep period (TSP) and total sleep time (TST). Because participants were all current users of CPAP, data from the total sample was combined and used. The percentage of TST and TSP that CPAP was used was calculated as CPAP use divided by either TST or TSP.

Results

The mean TST was 6.8 hours, TSP was 8.1 hours, and CPAP use was 6.7 hours. CPAP was used during 98.5% of the TST and during 82.7% of the TSP. Over 35% of the sample used CPAP at a level that was equal to or greater than their total sleep period.

Conclusion

Most OSA study populations use CPAP for some fraction of their night’s sleep. This COPD/OSA study population used CPAP to a markedly high level, including over one-third of the sample (n=~100) who used CPAP more than their self-reported sleep period. Further research on the extent and reasons for non-sleep period (i.e., daytime) CPAP use in COPD patients is warranted.

Support

PPRND #1507-31666.
0698 A Comparison Of Two Visual Hypopnea Classification Methods
Authors: Dupuy-McCauley K , Mudrakola H V , Morgenthaler T I
Published: May 2020

Introduction

The rules for classifying apneas as either obstructive or central using usual polysomnography (PSG) channels are well established, but classification of hypopneas is less straightforward without special sensors. Visual scoring methods have been proposed by the American Academy of Sleep Medicine (AASM) and by Randerath, et al. These two scoring methods have never been compared. We evaluated these two scoring methods for clinical use.

Methods

We selected 50 hypopnea segments from patient’s PSGs with very clear obstructive physiology (average total AHI 48.6, central AI 0), assumed to be obstructive hypopneas, and from patient’s PSGs with very clear central physiologies (average total AHI 34.3, obstructive AI 0.3), assumed to be central hypopneas. These 100 hypopnea-containing PSG segments (HCPS) were deidentified, placed in randomized order, and sent to two groups of 6 PSG scorers (2 RPSGTs, 2 sleep medicine fellows, 2 sleep medicine specialists). One group scored using the AASM criteria and the other used the Randerath algorithm. After a washout period, re-randomized HCPS were sent to be scored using the alternative method. We used Fleiss’ kappa to determine inter-rater reliability—i.e., how consistently multiple scorers came to the same conclusion about a given hypopnea segment using each method, and accuracy—how often the scorers rated the HCPS in a manner consistent with the assumed physiology. We also recorded the time it took to score.

Results

Overall accuracy of both methods was 68%. Among 12 scorers, Fleiss’ Kappa coefficient was 0.32 and 0.27 for the AASM and Randerath scoring methods, respectively. Average scoring time (24.3 minutes for AASM and 26.2 minutes for Randerath) was similar (p=0.79).

Conclusion

Inter-rater agreement was only fair using these methods, and accuracy was only 68%. More work is needed to discover a convenient, non-invasive way to reproducibly and accurately characterize hypopneas.

Support

This project does not have any funding support.
0706 Comparing the Dose-Response Curves of Upper Airway Stimulation and CPAP Usage on Changes in Epworth Sleepiness Scale
Authors: Kazaglis L , Hsia J , Green K , Iber C
Published: May 2020

Introduction

Upper Airway Stimulation (UAS) and Continuous Positive Airway Pressure (CPAP) are trackable therapies for obstructive sleep apnea. We used recent big-data cohorts to compare changes in sleepiness versus usage.

Methods

ADHERE is an international registry of real-world UAS outcomes from 2016 to date. General UAS criteria are CPAP intolerance, AHI 15-65 (<25% central+mixed), and suggested BMI≤35. Baseline ESS is collected from the medical record, and follow-up ESS and usage is collected 2-4 months after therapy activation. M Health Fairview maintains a database of cross-linked CPAP and EHR data. All new adult sleep patients from 2015 onward were included paralleling ADHERE: BMI≤35, AHI 15-65, and daily CPAP-EHR data starting at least 60 days prior to 2nd ESS measurement. Baseline ESS was collected at consult, and follow-up ESS was collected approximately 6 months later. Device-reported usage hours were compared with the changes in ESS from baseline.

Results

UAS (n=690) and CPAP (n=514) groups were similar: age 59.7±10.8 versus 59.7±13.6, 78% versus 75% male, and AHI 35.3±14.4 versus 33.8±14.0. UAS group was slightly less obese, BMI 29.3±3.9 versus 30.0±3.4 (p=0.001), with higher baseline ESS, 11.4±5.6 versus 8.6±5.3 (p<0.001). UAS usage was higher at 6.4±2.0 hours/night versus 5.2±2.0 hours/night with CPAP (p<0.001). UAS group average ESS decreased 2.5 points for patients with 0-4 hours of use (n=81), decreasing to 3.8 points with at 4 or more hours of use (n=609). CPAP group average ESS decreased 2.5 points for patients with 0-4 hours of use (n=125), decreasing to 3.3 points with at 4 or more hours of use (n=389).

Conclusion

Compared to prior works and the UAS cohort, this CPAP cohort was more likely to have normal ESS at baseline. UAS and CPAP both demonstrate a dose-response curve associating increasing hourly usage with larger ESS reductions.

Support

Kent Lee of Inspire Medical Systems provided background information and access to a de-identified ADHERE data set for analysis.
0708 A Study To Determine Efficacy Of A Device In Anticipating Obstructive Sleep Apnea Events
Authors: Rechul D , Rechul K
Published: May 2020

Introduction

Current treatment options for obstructive sleep apnea pose multiple challenges ranging from issues with therapy adherence (i.e. PAP) to partial effectiveness (i.e. MAD) or invasiveness (i.e. implantable nerve stimulation devices). SleepMethods, Inc. designed a device that proposed to solve these issues. It consisted of two integrated mechanisms; one to anticipate the development of an obstructive event and the other to deliver therapeutic intervention to abort the process of airway collapse before it ensued. A clinical trial was conducted to test the efficacy of the system designed to anticipate obstructive sleep apnea events.

Methods

Ten adults (7M;3F) aged 18-80y/o (avg. 54.7y/o) with a known AHI ≥ 15/hr (avg. AHI = 42.6/hr) underwent 1 overnight PSG recording while wearing the device. Patients were required to forego their usual CPAP therapy on the night of study in efforts to expose the device to an adequate number of total obstructive events (defined as apneas and hypopneas; RERAs and snores were excluded). Standard PSG analysis was performed. Scoring rules were applied to determine whether signals were true/false positives and/or true/false negatives based on pre-clinical data showing anticipation accuracy for up to 45 seconds prior to an obstructive airway event.

Results

Preliminary results suggest the device functions with 96.9% sensitivity and about 67.1% PPV. Data analysis is ongoing to determine specificity, statistical significance, etc.

Conclusion

The device has shown promise in pre-clinical and clinical trials to accurately and consistently anticipate airway collapse; a possible breakthrough in designing more targeted therapies aimed at aborting obstructive sleep apnea events before they ensue to a clinically significant degree.

Support

N/A
0714 Effect of One-Week Velopharyngeal-Task Training on Genioglossus Corticomotor Excitability and Sleep Apnea Severity
Authors: Li W , Wei Z , Wang W , Frédéric S
Published: May 2020

Introduction

The effectiveness of the contraction of the UA dilator muscles plays a crucial role in the maintenance of UA patency. This study aimed to assess the effects of one-week velopharyngeal-task training (VTT) on sleep apnea severity and its genioglossus (GG) corticomotor excitability.

Methods

Ten patients with sleep apnea underwent 1 h VTT on seven consecutive days. During the VTT protocol, subjects were asked to develop repetitive intra-oral positive pressure using cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened and maintaining an exclusive nasal breathing. They were encouraged to generate approximately 4% of Max pressure by maintaining the pressure inside the corresponding pre-set pressure target window for 2 sec every 10 sec. PSG recording and GG transcranial magnetic stimulation (TMS) response was obtained before and after the one-week VTT.

Results

One-week VTT was associated with a global AHI decrease by 33.8% (pre-VTT: 34.5±31.9 n/h; post-VTT: 25.5±26.7 n/h; p< 0.05) and progressed from moderate/severe to mild/moderate in 40% of patients. Although the bulging pressure remained unchanged (pre-VTT: 17.1±5.6 kPa, post-VTT: 19.4±5.4 kPa, p> 0.05), the amplitude of GG motor evoked potential in response to TMS significantly increased after the one-week VTT (pre-VTT: 639.4±380.9mV; post-VTT: 1128.5±623.9mV; p< 0.05).

Conclusion

One-week VTT is sufficient to confer clinical benefits on patients with sleep apnea. VTT protocol is not oriented toward strength gain, but rather toward an enhancement in the upper airway muscle cortical excitability and improvement in the coordination of their contraction. The authors consider these results to be potentially clinically relevant and worthy of further investigation in a large randomized trial.

Support

National Natural Science Foundation of China, Grant/Award Number: 81670085.
0723 Associations Between Opioids, Non-Opioids and Central Sleep Apnea: A Case-Control Study
Authors: Gavidia R , Meng A L , Emenike A , Hershner S , Jansen E , Goldstein C , Dunietz G L
Published: May 2020

Introduction

Opioids are known to contribute to central sleep apnea (CSA), as they depress responsiveness to carbon dioxide and hypoxia. However, the role of non-opioid medications (antihistamines, myorelaxants, neuroleptics, antidepressants, and hypnotics) in CSA remains unclear. Given the hypothesized impact of non-opioids on the central nervous system, we examined associations between opioid and non-opioid medications and CSA.

Methods

Among all adults who underwent polysomnography testing at the University of Michigan’s Sleep Center between 2013-2018 (n=10,479), we identified 105 cases of CSA. Of these patients, we randomly selected 300 controls. Demographic and health characteristics, use of medications were obtained from medical charts. We classified study participants into three categories based on medication use: non-opioids only, opioids alone or in combination with non-opioids, and none. CSA was defined as a binary outcome using polysomnographic criteria as per the International Classification of Sleep Disorders-Third Edition. We used logistic regression to examine associations between medication use and CSA.

Results

Among participants, male:female ratio was 1:1 with a mean age of 49 (±14.3 SD) years. Opioid use alone was rare (4%), but more common in combination with non-opioids (17%), while the exclusive use of non-opioids was found among 38%.

In adjusted analyses for age and sex, those who used non-opioid alone were less likely to have a CSA diagnosis (OR=0.88, (95% CI 0.5-1.6); however, the use of opioids (alone or in combination with non-opioids) was associated with a 4-fold higher odds of CSA.

Conclusion

These data suggest that non-opioids have a protective influence on CSA. Conversely, opioids, alone, or in combination with non-opioids, were associated with increased CSA risk, that may be attributed to opioids alone, or to opioids and non-opioids interactions. However, as opioids were mostly co-prescribed with non-opioids, the sole effect of opioids from the synergistic effect with non-opioids are difficult to disentangle.

Support

Dr. Gavidia was supported by a T32 Post-Doctoral Fellowship in Neuroscience NIH/NINDS T32 NS 007222