bluuebunny/crossref_metadata_2025 huggingface dataset:
0557 Possible Contributory and Protective Factors in Medication Associated Obstructive Sleep Apnea (OSA): Results from the US Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS)
Authors: Gupta M A , Vujcic B
Published: May 2020

Introduction

There are conflicting opinions regarding the role of medications in OSA. A Vigibase (WHO pharmacovigilance database) study (Linselle M, 2017) has suggested several drug groups in OSA pathogenesis. Sodium oxybate, benzodiazepines and opioids are most consistently associated with OSA. We examined the adverse drug reaction (ADR) of OSA with the ‘primary suspect’ drugs for the ADR, in the US Food and Drug Administration Adverse Events Reporting System (FAERS) database.

Methods

The FAERS database from January 1, 2004-March 31, 2019 (total ISR =12,330,939) was examined for Individual Safety Reports (ISR) with OSA as ADR and associated ‘primary suspect (PS)’ medications. Reporting odds ratios (ROR) were calculated to assess disproportionality signals with the ‘PS’ drug and OSA versus the ‘PS’ drug associated with all other ADRs in the database.

Results

15,316 ISR were associated with OSA [mean±SD age: 49.21 ± 21.76 years (based on 10,311 ISR); 53.78% female (based on 12,274 ISR]. Increased disproportionality signals for OSA were detected with some of the following ‘PS’ drugs/drug groups: sodium oxybate [ROR=31.75, (95% CI 30.36-33.20)]; rofecoxib [ROR=7.85 (95% CI 7.40-8.32)], alendronate [ROR=3.60 (95% CI 3.37-3.84)], zoledronic acid [ROR=24.70 (95% CI 21.88-27.89)], omalizumab [ROR=2.36 (95% CI 2.09-2.68)], quetiapine [ROR=3.78 (95% CI 3.32-4.30), finasteride [ROR=6.03 (95% CI 5.17-7.04), pregabalin [ROR=1.19 (95% CI 1.01-1.41), isotretinoin [ROR=1.49 (95% CI 1.23-1.80)], ondansetron [ROR=3.35 (95% CI 2.77-4.06), olanzapine [ROR=2.64 (95% CI 2.17-3.20), sitagliptin [ROR=3.46 (95% CI 2.82-4.24, digoxin [ROR=2.83 (95% CI 2.24-3.57), benzodiazepines [ROR=1.80 (95% CI 1.33-2.42), and opioids [ROR=1.34 (95% CI 1.09-1.67)]. A decreased disproportionality signal was detected with several biologics including: adalimumab [ROR=0.87 (95% CI 0.79-0.95)], etanercept [ROR=0.55 (95% CI 0.49-0.61)], and infliximab [ROR=0.51 (9% CI 0.40-0.65)].

Conclusion

The FAERS data supports many of the earlier findings suggesting the heterogeneity of medications associated with OSA. Biologics (mainly TNF-alpha antagonists) were associated with the previously unreported finding of a decreased OSA risk.

Support

None.
0600 Automated Oximetric Versus Standard Sleep Polygraphy Scoring
Authors: Skjodt N M , Pahwa V , Platt R S
Published: May 2020

Introduction

Agreement between automated standard respiratory event scoring and a novel, validated, and patented oximetry-based algorithm was assessed.

Methods

The standard apnea-hypopnea index (AHI) was derived by adding apneas (flow drop >= 90% for 10 to 30 s) and hypopneas (flow drop >= 30% for 10 to 60 s with oxygen saturation (SpO2) dropping >=3%). The novel oxygen index (ODI4) was derived by scoring events where SpO2 dropped in each of three successive samples and cumulatively by >= 4%. Agreement was assessed by Bland-Altman analysis

Results

AHI versus ODI4 and Bland-Altman plots showed a high prevalence of AHI > ODI4 when AHI was< 30/h. Negative difference outliers were frequent when mean index difference was > 30/h. There was a bias of 2.83/h in the difference between AHI and ODI4 with upper and lower confidence limits of 22.0/h and -16.3/h.

Conclusion

Standard respiratory event scoring overestimates respiratory disturbance compared to a novel oximetric index. Standard automated scoring frequently over scores events when basal flow amplitude is low.

Support

None.
0601 Use of The Epworth Sleepiness Scale, the NoSAS, and the STOP-BANG Questionnaire to Identify Patients with Moderate-to-Severe Obstructive Sleep Apnea
Authors: Yin S , Xu H , Zhang C , Zou J , Guan J , Yi H
Published: May 2020

Introduction

A variety of scales and questionnaires regarding sleep and sleep-related disorders have been widely used in scientific research and clinical practice, as important tools for differential diagnosis and rapid screening of complex sleep disorders, especially obstructive sleep apnea (OSA). However, the diagnostic efficacy of different scales and questionnaires for patients with different severity of OSA and of different demographic characteristics has not been clearly described. In this study, we evaluated the ability of the most popular scales, including the Epworth Sleepiness Scale (ESS), the NoSAS, and the STOP-BANG questionnaire in predicting moderate-to-severe obstructive sleep apnea (OSA) by gender.

Methods

This cross-sectional study screened 2,031 consecutive subjects referred with suspected OSA from 2012 to 2016. Anthropometric measurements, polysomnographic data, ESS, NoSAS scores and STOP-BANG scores were recorded. Receiver operating characteristic curve analyses were performed, and the final predictive models were verified in a validation cohort.

Results

A total of 1,840 adults were finally included. The STOP-BANG questionnaire afforded a better diagnostic accuracy than did the ESS, with different cutoffs for the two genders: 3 in males and 1 in females. A predictive model based on STOP-BANG yielded an area under the curve (AUC) of 0.918 (0.897-0.935), a sensitivity of 79.89%, and a specificity of 89.19%, in males; and an AUC of 0.951 (0.914-0.975), a sensitivity of 80.52%, and a specificity of 95.92%, in females. In the validation cohort, the sensitivity and specificity were respectively 85.44 and 93.00% in males and respectively 83.02 and 87.60% in females.

Conclusion

The STOP-BANG questionnaire was moderately effective when used to screen for moderate-to-severe OSA. A STOP-BANG-based predictive model afforded excellent diagnostic efficacy, which could be applied in clinical practice. However, gender differences must be considered.

Support

This study was supported by Grants-in-aid from Shanghai Municipal Commission of Science and Technology (Grant No.18DZ2260200).
0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Wu B , Tarraf W , Wallace D M , Stickel A , Schneiderman N , Redline S , Patel S R , Gallo L C , Mossavar-Rahmani Y , Daviglus M , Zee P C , Talavera G A , Sotres-Alvarez D , Gonzalez H M , Ramos A R
Published: May 2020

Introduction

Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias).

Methods

Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality.

Results

Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 <90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2<90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2<90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2<90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2<90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds.

Conclusion

We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities.

Support

5R01AG048642-05; R21AG056952; R21HL140437.
0611 Screening for Obstructive Sleep Apnea in the Bariatric Surgery Population
Authors: Kreitinger K , Lui M M , Owens R , Schmickl C , Grunvald E , Horgan S , Malhotra A
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is prevalent in the bariatric surgery population and has been associated with increased perioperative risk, especially if OSA is moderate-severe (apnea-hypopnea index ≥ 15/h). Consequently, screening for OSA is recommended as part of the preoperative evaluation. Several screening tools for OSA have been developed; however, some tools lack validation and their relative performance is unclear. The purpose of this study was to compare four existing screening tools (Epworth Sleepiness Scale (ESS), STOP-BANG, NO-OSAS, and No-Apnea) with regards to the ability to identify patients with moderate-severe OSA among bariatric surgery patients.

Methods

We retrospectively reviewed data from Jan 2015 to Mar 2019 for adult patients presenting consecutively to UC San Diego for first-time bariatric surgery who had undergone a home or in-lab sleep study (within one year of the initial encounter for bariatric surgery), which is our standard of care. We compared the accuracy of the four screening tools for detecting moderate-severe OSA based on the area under the receiver operating characteristic curves (AUC). Subgroup analyses were explored based on sex, BMI, and ethnicity (Hispanic/Latino vs non-Hispanic/Latino).

Results

Of the 214 patients (83.2% female, median age 39 years) included in the study, 45.4% had moderate-severe OSA. STOP-BANG (AUC 0.75 [95%CI: 0.68 to 0.81]) and NO-OSAS (AUC 0.76 [95%CI: 0.69 to 0.82]) had similar performance (p 0.62); both performed significantly better than the ESS (AUC 0.61 [95%CI: 0.54 to 0.68]; p 0.02 for both). STOP-BANG and NO-OSAS tended to perform better in the female vs male subgroup, but this finding did not reach statistical significance.

Conclusion

STOP-BANG and NO-OSAS are superior to the ESS when screening bariatric surgery patients for moderate-severe OSA. In future analyses we will further explore if adjustments of standard cut-offs improve test characteristics (i.e. sensitivity/specificity) when screening bariatric surgery patients (analyses ongoing).

Support

None.
0623 Respiratory Profiling of Community-dwelling Individuals Many Years After Polio Infection
Authors: Li X , Wang M , Wang J , Sun T , Sun Y , Dong X , Li J , Zhao L , Zhang X , Lv C , Strohl K , Han F
Published: May 2020

Introduction

To determine the presence of respiratory impairment in community-living subjects with a history of poliomyelitis.

Methods

In a study conducted from July 2013-January 2014, we used a national database to recruit individuals (212 males, 86 females) from north and south provinces in China with a known prior poliomyelitis infection >25 years previously. 298 subjects (96.8%) completed overnight oximetry to collect the number/hr of drops in oxygen saturation >4% (ODI4) and Epworth Sleepiness Scale (ESS); many completed a metabolic and lipid panel, arterial blood gas analysis, chest x-ray (CXR), spirometry and maximal voluntary ventilation (MVV). Some completed risk profiling for OSA.

Results

Age was 47.8 ± 6.7 years (M±SD) and, when known, the age of infection was 2.3 ± 1.8 yrs. As defined by ODI4 ≥ 5/hr, the frequency of sleep-disordered breathing (SDB) was 37.2%; 9% (n = 27) had an ODI4 ≥15/hr. Those with vs. those without SDB differed by male gender (81% vs 65%, p = 0.004) and BMI (25.9 vs 23.0kg/m2, p < 0.001). ESS was within the normal range, but was higher in those with 6.8 ± 5.0 vs. without 5.2 ± 4.0 (p < 0.01) SDB. Spirometry and MVV revealed no differences among groups. Scoliosis on the CXR was present 26.1% of those with and 14.4% of those without SDB. ODI4 correlated weakly with body mass index (r = 0.40). Glucose levels or hyperglycemia were not different. A triglyceride level > 1.7 mmol/L was present in 47.2% of those with and 21.3% of those without SDB (p < 0.001).

Conclusion

Mild (28%) and to a smaller extent moderate-severe (9%) SDB is present many years after surviving poliomyelitis in infancy. In most, sleepiness is low but scoliosis is often present, and associations to hyperlipidemia and obesity are not reflected in fasting glucose levels.

Support

no
0627 Cognitive Perceptions Impact Short-Term CPAP Adherence in Asian Patients with Obstructive Sleep Apnea
Authors: Png C A , Liang J , Mok Y , Chang J
Published: May 2020

Introduction

Adherence for the gold standard Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea (OSA) is poor worldwide. Studies have explored factors impacting CPAP adherence but data is limited for Asian patients where cultural and social norms differ. This study aimed to examine the role of disease and treatment-related perceptions in short-term CPAP adherence among patients from a multi-ethnic Southeast Asian country.

Methods

34 patients with newly diagnosed OSA were recruited from Changi General Hospital, a 1000-bed tertiary hospital in Singapore between September 2018 and February 2019. Psychological factors of self-efficacy, risk-perception and outcome expectancies were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. The SEMSA questionnaire has been previously validated for the evaluation of adherence-related cognitions. Patients were administered the SEMSA questionnaire before commencement of CPAP treatment and 1 month after.

Results

73.5% (25/34) of the patients were male (82.4% Chinese, 11.8% Malays, 2.9% Indians, 2.9% others). Mean age was 43.3 ± 11.8 years, mean apnea hypopnea index (AHI) was 45.2 ± 29.6 events/hr and mean CPAP usage at one month was 3.6±2.0 hours. 47% were adherent to CPAP, defined as average device use > 4 hrs/day. Pre-treatment self-efficacy was significantly correlated with CPAP adherence (r = 0.498, P<0.01). Outcome expectancies and self-efficacy measured after one-month CPAP use were significantly correlated with CPAP adherence (r = 0.702, P<0.01; r = 0.467, P<0.01, respectively). However, no association between risk perception and CPAP adherence was noted at either time points.

Conclusion

Consistent with previous literature in Western population, our study demonstrated that patients’ cognitive perceptions of outcome expectancies and sense of self-efficacy have an impact on CPAP adherence in a Southeast Asian population. Strategies targeting these aspects would be important in designing patient education programs.

Support
0629 Feasibility of Observed but Physically Unaided Continuous Positive Airway Pressure Set Ups
Authors: Hevener W , Barnes F , Munafo D A
Published: May 2020

Introduction

We sought to determine if an observed but physically unaided CPAP set up, utilizing only a detailed set of CPAP instructions without direct involvement of a Respiratory Therapist, could yield similar Medicare compliance rates when compared to the conventional method of hands-on instruction.

Methods

This was a single center, prospective trial. All patients were CPAP naïve. A total of 393 patients completed the physically unaided set ups utilizing a starter kit designed by Resmed (Airsense 10 Autoset, instructions and 3 mask options, P10,N20,F20). Patients were asked to set themselves up under observation with only verbal assistance provided if requested. No patient required conversion to conventional set up. 5287 completed the conventional set ups. We compared the success of observed but unaided CPAP set ups to the success rate for conventional CPAP set ups performed with physical assistance. The primary success endpoint was Medicare compliance within 90 days.

Results

The two groups were not significantly different with regard to gender, age, baseline AHI, and initial mask selection. The Medicare compliance of the unaided set ups was not significantly different from the conventional set ups (75% vs. 77% respectively, p=NS). Similarly, adherence at ten days (65% vs. 69%, p=NS) and thirty days (65% vs. 68%, p=NS) was no different between the two groups and the percentage of mask re-fits required at ten and thirty days was similarly no different.

Conclusion

We conclude that for the CPAP equipment used, observed but physically unaided CPAP set ups can yield similar Medicare compliance rates when compared to physically aided CPAP set ups. Further, we speculate that because these techniques yielded similar success rates the principal factor determining ultimate success is patient follow up and support once therapy is initiated.

Support

None.
0651 Longitudinal Effects of CPAP Adherence on Changes in PTSD Symptoms and Subscales: The Importance of Hyperarousal on Adherence and Outcomes
Authors: Colvonen P J , Lizbeth G , Sarmiento K
Published: May 2020

Introduction

Comorbidity of posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) is staggeringly high, with rates of 75.7% when using criteria of apnea/hyponea index (AHI) > 5. Continuous positive airway pressure (CPAP) therapy can decrease PTSD symptoms, however, no study has used advanced mixed-modeling to examine which cluster of PTSD CPAP therapy effects.

Methods

Participants were 59 veterans with PTSD and undiagnosed OSA. Apnea/Hypopnea index (AHI) was scored according to AASM criteria. Auto-titration CPAP devices were prescribed with pressures empirically selected by the sleep physician based on BMI, overall AHI, and dominant event type; maximum pressures was set at 20cm H2O. Analyses used hierarchical linear modeling to examine changes in PTSD symptoms clusters as a function of CPAP use over 6-months. Measures include PTSD checklist (PCL) and clusters (reexperiencing, avoidance, and hyperarousal), percentage of nights CPAP used, weight, and BMI.

Results

Baseline scores were high: PCL (M=60.02; SD=15.03) and AHI (M=28.18 per hour; SD=20.35). Average number of nights CPAP use in the last 6-months was 59.3%, with 3.5 hours each night with clear adherent and non-adherent groups emerging. The adherent group showed a 15-point drop in PCL scores and the non-adherent group had a 3-point drop. More days of CPAP use in the last 6-months predicted larger decreases in hyperarousal (d=0.56) and re-experiencing (d=0.47)

clusters, but not avoidance. The intercept was significant in the hyperarousal analyses suggesting individuals with higher hyperarousal at baseline had less CPAP adherence.

Conclusion

The need for PTSD clinicians to screen and refer for OSA is necessary, but may not be sufficient, in treating PTSD. Change in hyperarousal symptoms accounted for most of the effects from CPAP use. Higher hyperarousal symptoms at baseline predict lower CPAP adherence, suggesting a higher clinical need to address these individuals as they will get the most positive effects from CPAP.

Support

This work is supported by a VA RR&D CDA (1lK2Rx002120-01) to Peter Colvonen.
0653 Positive Effects of Long Term Continuous Positive Airway Pressure Therapy on Blood Pressure in Obstructive Sleep Apnea Patients
Authors: Shirahama R , Tanigawa T , Tomooka K , Fan Yun L , Ikeda A , Wada H , Kales S N
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is one of the common causes of hypertension. Therefore, we examine the longitudinal effect of continuous positive airway pressure (CPAP) therapy and its adherence on blood pressure among OSA patients.

Methods

One thousand two hundred ninety-three (male 1,130, female 163) patients, who were diagnosed with OSA and underwent CPAP therapy were investigated for longitudinal changes (24 months observation period) in the levels of blood pressure and body weight. The longitudinal analyses were performed by mixed effect model. Multiple Imputation with Chained Equations was also used to impute missing data. Good CPAP adherence is defined as more than 70% of the time using CPAP more than 4hours at all the measuring. Poor CPAP adherence is defined as less than 70% of the time using CPAP more than 4hours at all the measuring time points.

Results

The patient group with good CPAP adherences), compared to poor CPAP adherence, showed significant diastolic blood pressure reduction in 24 months follow-up period (β=-0.13, p=0.03) despite a lack of significant weight loss (β=-0.02, p=0.59). However, no significant associations were found between systolic blood pressure and CPAP adherence (β=-0.14, p=0.11).

Conclusion

CPAP therapy was found to have a longitudinal effect on diastolic blood pressure despite a lack of significant weight loss.

Support
0656 Mortality and Hospitalization in Patients With Heart Failure and Sleep Apnea: A Retrospective Study of Positive Airway Pressure Therapy in Medicare Beneficiaries
Authors: Huang F , Patel S L , Combs D , Parthasarathy S
Published: May 2020

Introduction

Sleep apnea is common in patients with heart failure (HF) and can be treated with positive airway pressure (PAP) therapy. In patients with both HF and sleep apnea, whether treatment of PAP therapy is associated with reduction in hospitalization or mortality is unclear.

Methods

We used 5% Medicare limited-dataset (LDS) from 2013-2015 to perform a retrospective study of hospitalizations and mortality in HF patients with sleep apnea who received or did not receive PAP therapy over an 18-month time period. All-cause mortality during post-treatment period, any and HF-related hospitalizations in baseline, pre-treatment and post-treatment periods were measured and compared. Propensity score matching, generalized estimating equations (GEE) model for repeated measures analysis and COX-survival analysis adjusted by multiple covariates were used for longitudinal comparisons and mortality.

Results

We have identified 281,161 patients with at least two distinct HF onsets and 62,800 of them had sleep apnea diagnosis (22%). Of these patients, 5,540 of them had initiated their PAP therapy while 12,129 of them only had their sleep apnea diagnosis during the selection time frame from Jan 1st, 2014 to June 30th, 2015 without PAP treatment (control group). After adjusting for various confounders and propensity score matching, bilevel PAP was strongly associated with lower hospitalization and HF-associated hospitalization (Bilevel-PAP vs. Control: Any hospitalization, OR=0.62, 95%CI=0.53-0.74, p<0.0001; HF-associated hospitalization, OR=0.65, 95%CI=0.55-0.78, p<0.0001). Cox proportional hazards survival analysis revealed that all of the PAP-treated groups had a better 6-month survival after treatment initiation when compared to controls (any PAP therapy vs. Control: HR=0.32, 95%CI=0.28-0.37, p<0.0001).

Conclusion

In a retrospective analysis, PAP therapy was associated with lower 6-month all-cause mortality among Medicare beneficiaries with HF and sleep apnea. Bilevel-PAP therapy was consistently associated with significant reduction in hospitalization among these patients. Our observational findings warrant confirmation by future prospective intervention trials.

Support

NIH (HL126140; MD011600; HL138377; HL140144; IPA-014264-00001), PCORI (PPRND-1507-31666; PCS-1504-30430), American Academy of Sleep Medicine Foundation (169-SR-17), and Philips Healthcare/ Philips-Respironics Inc.
0670 The Outcome Of Cpap Titration Under Drug-induced Sleep Endoscopy: A Randomized Controlled Crossover Trial
Authors: Wang T , Lin T , Ni Y , Lo Y
Published: May 2020

Introduction

The titration pressure of continuous positive airway pressure (CPAP) is an important issue for patients with obstructive sleep apnea (OSA). The aim of this study was to understand the impact of drug-induced sleep endoscopy (DISE)-guided CPAP pressure and doctor-guided CPAP pressure on patients with OSA.

Methods

In this randomized controlled single-blinded crossover trial, we compared the effects of 1 month CPAP treatment on patients with OSA. Twenty-four patients with OSA were recruited and completed this study. They all underwent polysomnography, DISE-guided CPAP titration and accommodation. Doctor-guided CPAP pressure was determined before DISE. Patients were randomly assigned to receive DISE-guided or Doctor-guided CPAP pressure treatment for 1 month. Then, they switched to another CPAP pressure for another 1 month. Epworth sleepiness scale (ESS) will be recorded at baseline, 1 month and 2 months.

Results

The DISE-guided CPAP pressure and Doctor-guided CPAP pressure had no significant difference (13.9±0.7 cm H2O vs 13.5±0.5 cm H2O; P=0.92). In addition, residual AHI and compliance were also no significant difference between two groups. The ESS was significantly improved from baseline to 1 month CPAP treatment in both groups. Epiglottis (anterior-posterior collapse) was significant associated with AHI (P < 0.001, by Spearman correlation). Both Epiglottis (anterior-posterior collapse) and tongue base collapse were significant associated with 95% CPAP pressure (P = 0.031 and 0.038). After multivariate regression analyses, epiglottis (anterior-posterior collapse) is the independent factor for 95% CPAP pressure.

Conclusion

The DISE-guided CPAP pressure and Doctor-guided CPAP pressure had no significant difference on the improvement of ESS. Epiglottis (anterior-posterior collapse) is the independent factor for AHI and 95% CPAP pressure.

Support

Chang Gung Memorial Hospital and Chang Gung University
0674 Association Between Lateral Wall Collapse On Drug-induced Sleep Endoscopy And MRI Findings In Hypoglossal Nerve Stimulator Patients
Authors: Liu Y , Wiemken A , Steffen A , Schwab R , Dedhia R
Published: May 2020

Introduction

Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients.

Methods

Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings.

Results

Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE.

Conclusion

In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study.

Support

Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)
0675 Nocturnal Oxygen Supplementation With Positive Airway Pressure Therapy For Obesity Hypoventilation Syndrome: Clinical Predictors And Liberation From Oxygen
Authors: Quintos A , Grewal R , Lee A
Published: May 2020

Introduction

Obesity hypoventilation syndrome (OHS) is associated with a high morbidity and mortality. Many patients require nocturnal supplemental oxygen on top of positive airway pressure (PAP) therapy for hypoxemia independent of apneic events. We need to clinically identify patients likely to require nocturnal oxygen supplementation. Follow up is essential as with adequate control of sleep apnea, hypoxia improves and liberation from nocturnal oxygen supplementation may be achievable.

Methods

Researchers obtained a list of patients with coding diagnosis of OHS, seen at the Jefferson Sleep Center between November 2016 and September 2019. Patients with BMI of ≥ 30 and evidence of hypoventilation were included. Hypoventilation was defined as an elevated CO2 level of ≥ 45 mmHg on blood gas analysis, elevated serum bicarbonate level of ≥ 27 mmol/L or by evidence of nocturnal hypoventilation by AASM criteria on polysomnography. Patients with pulmonary and neuromuscular disorders were excluded

Results

Out of 189 patients reviewed, 36 met the inclusion and exclusion criteria. Nineteen patients (53%) required nocturnal oxygen supplementation. A higher serum bicarbonate level of 33 mmol/L against 30 mmol/L (p=0.0078) and a lower resting awake SaO2 of 89% versus 95% (p <0.01) were observed in the oxygen supplementation group. In polysomnographic data, the oxygen supplementation group had lower SaO2 nadir of 67% versus 73% (p=0.026) and had a longer time with SaO2 <88% at 238.2 minutes versus 65.5 minutes (p <0.01). Nine out of the 19 patients (47%) underwent nocturnal oximetry on PAP and room air. Of these, 4 patients (44%) were liberated from oxygen.

Conclusion

Fifty three percent of patients with OHS required nocturnal oxygen supplementation on top of PAP therapy. Higher serum bicarbonate level and lower resting awake SaO2 are potential clinical predictors of nocturnal oxygen supplementation. After nocturnal oximetry on PAP, 44% were successfully liberated from supplemental oxygen.

Support
0689 Use Of An Automated Scanning System To Select A Patient Interface
Authors: Hardy W , Jasko J , Bogan R
Published: May 2020

Introduction

There is no universal process for selecting mask style, size, and fit, and there is considerable variance in clinician and patient mask preference and patient anatomy. Poor mask fit may negatively affect adherence. A three-dimensional (3D) facial scanner and proprietary analytical software were developed to bring efficiencies to mask selection. This study explored the impact of that system on initial mask success compared to standard practice.

Methods

This was an open-label, randomized-controlled study. Participants provided written informed consent. 3D Scanner Arm (3DA): Participants answered questions about sleeping habits then had 3D facial images taken. Proprietary software recommended a hierarchy of up to four Philips Respironics masks and sizes. Traditional Fitting Arm (TFA): A designated clinician selected and fit masks using their standard methods. Mask selection was assessed by applying therapy and soliciting patient and clinician feedback. Mask refits and adherence were tracked through 90 days. Five sleep centers recruited 115 participants into the 3DA (61 males, 51.1±13.4 years, BMI 35.2±7.0, diagnostic AHI 26.2±21.9) and 123 into the TFA (79 males, 51.1±11.9 years, BMI 35±7.9, diagnostic AHI 26.9±22.6).

Results

A significantly higher percentage of 3DA patients required only one mask fitting (with no refits) compared to TFA during the initial setup (89.6% vs. 54.5%, p<0.001) and through 90 days (62.6% vs 37.4%, p<0.001). 3DA subjectively rated confidence in and satisfaction with the scanner-selected mask significantly higher than TFA. Mask leak was lower in the 3DA compared to TFA (29.4±10.6 vs 32.3±11.4 L/M, p= 0.043). The CMS adherence rate tended to favor 3DA vs. TFA (66.7% vs. 55.3, p=0.083). There were no significant differences in AHI or other adherence metrics.

Conclusion

The 3D scanner system was successful in mask selection with lower mask leak and greater patient satisfaction and confidence. This tool may bring about operational efficiencies to the mask selection process.

Support

This study was sponsored by Philips Respironics
0694 Positive Airway Pressure Use In The Context Of Total Sleep Time
Authors: Saconi B , Watach A J , Sawyer A M
Published: May 2020

Introduction

Positive airway pressure (PAP) adherence definitions are independent of total sleep time (TST). When PAP efficacy is examined by biophysiologic outcomes in adults with obstructive sleep apnea (OSA), sensitivity and specificity of the measurement of PAP adherence/non-adherence is important.

Methods

A post-hoc analysis of experimental data: 1) investigated agreement among concurrently-measured objective PAP use, objective and subjective TST; 2) assessed untreated TST among adherers and non-adherers defined by CMS PAP adherence criterion and separately by proportion of TST on PAP criteria (≥65%, ≥75%, ≥85%). Objective TST was measured with wrist actigraphy and concurrent sleep diary on the first five days of PAP use. Objective five day PAP use (hours/night) was abstracted from full record. Analyses included descriptive and exploratory correlations.

Results

PAP-naïve adults (n=36; 76% male, 84% white) were middle-aged (51±10 years), with severe OSA (median AHI 31.1 events/hr), mean PAP use (371.5±85.4 min), mean objective and subjective TST (417.5±50.6 min, 439.6±58.1 min, respectively) from a single sleep center. Objective TST was correlated with concurrent objective PAP use (r=0.46) and with subjective TST (r=0.78). Eight percent (39mins) of objective TST was untreated among CMS-defined adherers, and 54.1% (216.8mins) of TST was untreated among CMS-defined non-adherers. When TST-on-treatment criteria were imposed (≥65%, ≥75%, and ≥85%, respectively), the percentage of untreated TST decreased among adherers, 5.2% (23 min), 4.3% (19 min), 0% (0 min) and among non-adherers, 42.8% (168 min), 41.2% (162 min), and 28.7% (118 min). From CMS to ≥85% of TST-on-treatment criteria, categorization as an adherer decreased from 89% (n=34) to 58% (n=22); non-adherer categorization increased from 5% (n=2) to 37% (n=14).

Conclusion

In the context of understanding biophysiological responses to PAP treatment, more sensitive and specific criteria for adherence and non-adherence is necessary. PAP use based on untreated TST is an opportunity to address this gap.

Support

The parent clinical trial was supported by NIH/NINR (R00NR011173; Sawyer PI)
0717 Peer-intervention Can Reduce Health Disparities In Patients With Obstructive Sleep Apnea
Authors: Patel S I , Combs D , Provencio-Dean N , Mashaqi S , Bhattacharjee S , Quan S F , Morton C J , Wendel C , Parthasarathy S
Published: May 2020

Introduction

In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response system (PDI-IVR) can improve CPAP adherence, whether such an intervention can improve adherence to sleep study testing is unknown. Also, there remain health disparities with greater levels of CPAP nonadherence disproportionately affecting individuals of lower socioeconomic status. We aimed to determine whether PDI-IVR can improve adherence to sleep study testing and CPAP adherence in a lower income population.

Methods

We performed a prospective, randomized, parallel group, controlled trial wherein patients with suspected OSA were randomly assigned to receive PDI-IVR or provided with educational information regarding OSA and CPAP therapy (attention-control group) while both groups received usual care. The PDI-IVR interactions aimed at promoting adherence to sleep study testing and in patients diagnosed with OSA the peer-intervention was focused on improving CPAP adherence. In the PDI-IVR group, trained peers (peer-buddies) with OSA were paired with randomized patients over a 6-month period combined with an ability to meet in-person, email, text message, or phone an inter-disciplinary team of providers.

Results

In this pilot study, there were 63 patients (48.4 ± 12.5 years; 30 men) who were randomized to intervention (n=31) and attention-control (n=32) arms. There were 36 peer-buddies who mentored the patients in the intervention group. Intention to treat analysis revealed that failure to undergo sleep study testing was 15.6% of patients in the attention-control arm and 9.7% in the PDI-IVR arm (P=0.7). Per protocol analysis revealed that failure to undergo sleep study testing was 18.4% of patients in the attention-control arm and 4% in the PDI-IVR arm (P=0.13). At 6 months, CPAP adherence was greater in PDI-IVR arm (290 ± 45 min [SE]) than attention-control arm (181 ± 43 min; P=0.01).

Conclusion

In a lower income population, PDI-IVR improved CPAP adherence with a tendency for better adherence to sleep-study testing. Peer-intervention can reduce sleep health disparities.

Support

HL138377
0728 Impulsivity Is Related To Osa Severity But Not With Excessive Daytime Sleepiness
Authors: Marelli S , Somma A , Castelnuovo A , Mombelli S , Gialdi G , Barranca M , Fossati A , Ferini Strambi L
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is associated with cognitive deficits in vigilance, attention, and executive functions (EFs). To date, the mechanisms that characterize the impairment cognition in OSA remain partially uncertain. The dominant theories have mostly concentrated on hypoxia/hypercarbia, and sleep disruption and consequent excessive daytime sleepiness. Moreover, hypoxemia affects global cognitive functioning, but it is not clear whether and how the severity of the disease influences the EFs.

Methods

The current study aimed at assessing the relationships among OSA severity, daytime sleepiness, and EFs and self-reported impulsivity in a sample of OSA subjects who were classified according to Apnea-Hypopnea Index (AHI) in mild/moderate OSA (AHI<30) or severe OSA (AHI≥30). All OSA participants were consecutively admitted to the Sleep Disorders Center of the San Raffaele Turro Hospital. After OSA assessment, patients were administered the Italian translation of the Psychology Experiment Building Language EFs tasks and the Epworth Sleepiness Scale (ESS) and UPPS-P Impulsive Behavior Scale (UPPS-P). Participants’ sleepiness was considered severe if a score of 10 or higher on the ESS was observed.

Results

Confirming and extending previous reports, daytime sleepiness affected both attention performance (U=239.00, p<.05; Vargha & Delaney A=0.66), and inhibition performance (U=199.00, p<.05; A=0.70). No effect of AHI was observed on both variables (U=326.00, p>.05; A=0.55; U=330.00, p>.05; A=0.53, respectively). Conversely, self-reported impulsivity was associated with OSA severity (U=30.50, p<.001; A=0.86), but not with daytime sleepiness (U=84, p>.05; A=0.63).

Conclusion

Our findings showed the importance of considering both OSA severity and sleepiness in order to better understand EFs and impulsivity related to OSA.

Support

none
0736 Self-reported Sleep In OSA Patients: Roles Of Polysomnographic Measures And Depressive Symptoms
Authors: Dubrovsky B , Weingarten J A , Cunningham J , Howladar A , Chin W , Gikashvili L
Published: May 2020

Introduction

Sleep fragmentation is typical in OSA, which is commonly co-morbid with insomnia and depression. A complex interaction between these conditions may be also gender-dependent. Moreover, self-report measures of sleep quality and insomnia, such as PSQI and ISI, may relate to depression symptoms more than polysomnographic sleep disturbance. The present aim is to ascertain relative contributions of polysomnographic variables and depression symptoms to PSQI and ISI in a large sample of OSA patients. The interaction between depressive symptomatology and gender in their relationships with subjective sleep is also analyzed.

Methods

A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI and PSQI. ISI and PSQI were separately regressed onto age, sex and BMI, followed by PSG variables meeting p<0.1 criterion when tested individually, followed by CESDR and CESDR-by-sex interaction.

Results

Mean AHI=29.6±34.7, range 0-167/hr, 72.3% of patients had AHI≥5. The PSQI final model included total sleep time (TST), sleep efficiency (SEF), WASO, PLM index, CESDR and CESDR-by-sex. Only CESDR and CESDR-by-sex were significant (p<0.001, p=0.023, respectively). Higher CESDR predicted higher PSQI in both sexes (both p<0.001), accounting for a greater portion of PSQI variance in men (R2=39%) than in women (R2=29%). The ISI final model included TST, N3%, REM%, SEF, WASO, total arousal index, AHI, PLM index, CESDR and CESDR-by-sex. Higher ISI related to lower TST (p=0.042, R2<1%), higher REM% (p=0.016, R2<1%), and higher CESDR (p<0.001, R2=42%). CESDR-by-sex was not significant.

Conclusion

In this large sample, after controlling for demographic variables, PSG parameters had only minimal relationship with self-report insomnia and sleep quality measures. Higher depressive symptomatology was associated with higher subjective sleep disturbance on PSQI and worse insomnia symptoms on ISI in both sexes, accounting for 29-42% of the variance.

Support

none
0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea
Authors: Neill S E , Majid R
Published: May 2020

Introduction

The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs.

Methods

A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented.

Results

429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA.

Conclusion

Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP.

Support

N/A
0749 Case Simulations in Obstructive Sleep Apnea and Narcolepsy: Patients That Keep You Up at Night
Authors: Bogan R K , Rorie K , Faler W E , Gross T , Perez J , Tordoff S A , Salinas G
Published: May 2020

Introduction

3 CME interventions used online case simulations to facilitate the recognition of residual EDS in patients with narcolepsy and OSA and to improve decision-making when developing strategies for long-term management of residual EDS.

Methods

Outcomes data were obtained from 3, 30-minute case simulations on residual EDS. Surveys assessing knowledge, confidence, and behavior were administered pre- and post-activity. A separate evaluation provided demographics and other variables used in the model. Data from a 2-month follow-up survey were analyzed to determine performance effects on the learner population (n = 30) compared to matched controls (n = 30). Statistical comparisons of data from baseline to post-intervention were made using McNemar’s tests and paired t-tests.

Additionally, predictive modeling was applied to evaluate variables predictive of evidence-based decisions. A longitudinal analysis of results was conducted to evaluate knowledge and performance changes in sleep-related initiatives between 2016 - 2019.

Results

Learners outperformed controls in utilizing the Epworth Sleepiness Scale (ESS) and are more likely to interpret ESS scores to confirm EDS diagnosis and select appropriate treatment options in managing patients with EDS. Further, learners are more likely than controls to engage in shared decision-making with patients.

When given a real-world case, learners are more likely than controls to identify symptoms and order correct tests. Learners were also more likely to select best treatment options for the patient more often than non-learners. Continued education needs to focus on treatment options for patients with narcolepsy.

Conclusion

Follow-up assessments were conducted to understand lasting performance in learners attributable to this education. Using data from learners compared to matched controls, we found the education had an effect size of 23% (Cohen’s d = 0.33). This indicates that for every 100 clinicians exposed to this education, 23 will perform more according to evidence than if they were not exposed.

Support

The educational activity described in this abstract was supported by an educational grant from Jazz Pharmaceuticals, Inc.