bluuebunny/crossref_metadata_2025 huggingface dataset:
0523 Screening for Prevalence and Pattern of Sleepiness and Obstructive Sleep Apnea Among Nigerian Population
Authors: Olaoye Olatunji , Bolarinwa Oladimeji , Alatishe-Muhammad Bilqis , Fasiku Mojirola , Aibinuomo Oluwatoyosi , Adejoro Ige , John Godwin , Kayode Gladys , Adeyemi Motunrayo , Omelu Louritta , Omokanye Habeeb , Olaoye Olanrewaju
Published: April 2024

Introduction

Significant sleepiness and Obstructive Sleep Apnea (OSA) burden can be effectively managed in Sub-Saharan Africa (SSA) if population-based data are available. To fill this study gaps, this study piloted a screening survey in an African country using the two popular tools (Epworth and Stop Bang), translated and validated among a Yoruba-dominated diverse population of the North-Central region of Nigeria

Methods

This was a household survey among rural, urban and semi-urban populations in North-Central Nigeria. A total of 2388 eligible permanent adult residents were selected through a 4-level multistage sampling process. Epworth Sleepiness Scale (ESS) and Stop Bang Questionnaire (SBQ) were adapted, translated into the Yoruba language, and validated (face, content and construct validity). Both Descriptive and inferential analyses were presented to report the prevalence, pattern and factors associated with sleepiness and OSA. The level of significance was set at a p-value of < 0.05 and a 95% confidence interval. Ethical approval was obtained from the Kwara State Ministry of Health

Results

More than a quarter of the respondents were 50 and older, with almost equal gender representation and Yoruba tribe preponderance (87.5%). The urban (34.4%), semi-urban (33.5%) and rural (32.1%) locations were equally distributed. Using the ESS, 15.7% had average sleepiness while 29.4% reported abnormal sleepiness. With the SBQ, 24.2% had a moderate risk of OSA while 5.6% had a high risk of OSA. The geographical pattern of OSA showed no significant distribution with ESS. Still, SBQ shows a significant (p< 0.0001) moderate (38.8%) and high risk (3.9%) of OSA among urban population than semi-urban (moderate: 25.8% vs high: 0.9%) and rural population (moderate:18.9% vs high: 0.3%). Female gender, increasing age, occupation type, low-income earning and obesity were significantly associated with average and abnormal sleepiness using ESS. While being a widow, a large household and obesity were significantly associated with OSA using SBQ.

Conclusion

Both the ESS and SBQ tools revealed a moderately high prevalence of sleepiness and OSA, with the urban Nigerian population reporting a higher prevalence. However, the two tools reported slightly varied factors associated with sleepiness and OSA

Support (if any)
0524 BASET Scoring: A Novel Simple Biometric Score for Screening and Grading Obstructive Sleep Apnea
Authors: saleh Abdelbaset , Ahmed Magda , Said Eman El , Awadalla Nabil , Attia Amira
Published: April 2024

Introduction

Polysomnography (PSG) is the gold-standard diagnostic tool for Obstructive Sleep Apnea (OSA). There is no diagnostic validated simple tool with clear cutoff point for predicting and roll out patient with OSA in primary care clinics significantly alters clinical outcomes. Our study aimed to assess the validity of BASET scoring as a new potential tool for screening and grading the severity of OSA patients.

Methods

After institution review board approval and formal patient consent, 144 subjects for suspected OSA and their relatives were enrolled. All subjects were subjected to a full night PSG study after history taking, sleep questionnaires, and physical examination, including BASET score components: B= Body Mass Index (BMI), A= Abdominal circumference (AC), S = Snoring, E= Epworth Sleepiness Scale, and T= Tongue teeth imprint. ROC analysis that used to assess the optimal cutoff point of the BASET score and to compare its accuracy for predicting OSA with Berlin and STOP-Bang scores.

Results

This study included 63 OSAS patients, 33 (52.38%) males and 30 (47.62%) females, and 81 controls; 22 (27.16%) males and 50 (72.84%) females. The Cronbach's alpha for the 5 BASET score components was 0.846, indicating the internal consistency reliability of the scale. Moreover, BASET score has a moderately strong positive significant correlation (r = 0.778, p< 0.001) with AHI. By ROC analysis, the accuracy of the three measures was generally high, with BASET score predicting OSA most accurately (AUC=0.984, 95%CI: 0.956–0.999), followed by STOP-Bang (AUC=0.939, 95%CI: (0.887–0.972) and Berlin (AUC=0.901, 95%CI: 0.841–0.945). The AUC of BASET score was significantly higher compared to the Berlin score (difference= 0.0825, 95%CI: 0.039–0.125) and STOP-Bang score (difference= 0.0447, 95%CI: 0.011–0.078). On the other hand, there was no difference between the AUC of Berlin and STOP-Bang scores (difference=0.0378, 95%CI: 0.006 - 0.081 4). BASET score was significantly (p< 0.001) associated with OSA grades,

Conclusion

BASET score is a convenient, reliable, and valid tool for diagnosing OSA. BASET score is more accurate for predicting OSA than Berlin and STOP-Bang scores, while there is no difference between Berlin and STOP-Bang scores. BASET score indicates OSA grades.

Support (if any)

No financial support
0525 Can Intra Oral and Facial Photos Predict Obstructive Sleep Apnea in the General and Clinical Population ?
Authors: Vidigal Tatiana , Haddad Fernanda , Guimarães Thaís , Silva Luciana , Andersen Monica , Schwab Richard , Cistulli Peter , Pack Alan , Tufik Sergio , Bittencourt Lia
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is associated with upper airway soft tissue and craniofacial skeletal alterations, but if these abnormalities, using quantitative facial and intraoral photographic analysis, differ between in the general population and clinical samples were not tested yet. This study aimed to evaluate and compare measurements of standardized craniofacial and intraoral photographs between clinical and general population samples, between groups of individuals with an apnea-hypopnea index (AHI) ≥15 and AHI< 15, and the interaction between them, as well as the relationship with the presence and severity of OSA.

Methods

We used data from 929 participants from Sleep Apnea Global Interdisciplinary Consortium (SAGIC): 309 patients from a clinical setting and 620 volunteers from a general population sample.

Results

Moderate and severe OSA (AHI≥15) were observed in 30.3% of the total sample and there were some interactions between facial/intraoral measures with OSA and both samples. Mandibular volume (p< 0.01), sternomental distance (p=0.04), and lateral face height (p=0.04) were higher in the AHI≥15 group in the clinical sample compared to the AHI≥15 group in the general population and AHI< 15 group in the clinical sample. Multivariate regression suggests photography-based variables capture independent associations with OSA in both samples. When adjusted for sex and age, greater mandible width (p< 0.01) differed both in the clinical and in the general population samples, reflecting AHI severity and the likelihood of OSA; the measure of smaller tongue curvature (p< 0.01) reflected the severity and probability of OSA in the clinical sample; and the higher posterior mandibular height (p=0.04) showed a relationship with higher AHI and higher risk of moderate to severe OSA in the general population sample. However, when adjusted for sex, age, and BMI, only smaller tongue curvature (p< 0.01) was associated with moderate/severe OSA.

Conclusion

Quantitative standardized facial photographs indicated that the measures of greater tongue and mandible were associated with increased OSA risk in the clinical sample and higher facial height measurement was associated in the general population sample.

Support (if any)

Acknowledgments: AFIP, CNPq, CAPES, and SAGIC group.
0529 Feasibility of the REST Tracker Platform to Monitor Obese Pregnant Woman for the Onset of OSA Throughout Pregnancy
Authors: Simmons Jerald , Thomas Robert , Ivins Renee , Kirshon Brian , Adam Karolina , Saade George , Sadeghian Sam , Paige Ashley , Mann Chris
Published: April 2024

Introduction

OSA during pregnancy is associated with increased risk for gestational-diabetes, hypertension, preeclampsia, and eclampsia, contributing to maternal and neonatal morbidity and mortality. Furthermore, OSA increases risk of chronic cardiovascular disease, well beyond pregnancy. Studies suggest the prevalence of OSA increases during pregnancy, as maternal BMI rises. Continuous evaluation is necessary as the risk increases throughout the course of the pregnancy, however this is not currently a standard practice. Sleep specialists have not provided a specific approach to assist obstetricians addressing the OSA concern, leaving a gap in our maternal health management. REST Technologies has developed the REST-Tracker, a Remote Patient Monitoring platform for the management of OSA patients and has been funded by the NIH to assess the feasibility of using this platform in the obese pregnant population at risk of developing OSA. Here, we present preliminary data using the REST-Tracker to assess for OSA throughout pregnancy in an at-risk population.

Methods

The REST-Tracker system manages data obtained from a Ring-Oximeter worn nightly by subjects whos data is processed through the FDA cleared SleepImage ™ system, assessing for OSA, providing sAHI3%/sAHI4% metrics. Subjects recruited from a high-risk obstetrics clinic. Inclusion-criteria: BMI >27, entry < 16 weeks gestational-age, Target=30 subjects monitored nightly into and through the third trimester.

Results

To date, 23 reliable subjects, two drop-outs from miscarriages, 21 currently providing data, 9 left to recruit. Initial-BMI Ave=38 (+/-6.6), Ave Initial-GA=8.9wks(+/-2.4), Initial sAHI3%/4%= 5.3 (+/-3.1) sAHI4%=2.3(+/-2.0) average monitoring to-date=12.4(+/-5) with 0 subjects demonstrating sustained moderate (sAHI4% > 15) or severe (sAHI4% >30) OSA. None of the subjects to-date demonstrate SaO2 < 90% to any significant degree, 3 subjects had the SaO2 drop < 90% >5 min on 3 nights, only 1 had 1 night with SaO2 < 88% >5 minutes (19 minutes).

Conclusion

If successful the REST-Tracker may provide new approach, improving maternal care for this at-risk population. Additionally, it allows expedited OSA management with longitudinal guidance to assess treatment modifications, necessary in a evolving medical scenario such as the third-trimester of pregnancy. Furthermore, this approach will allow insight into the pathophysiologic relationships between OSA and conditions such as gestational diabetes and hypertension.

Support (if any)

Research-supported-NIH#R43HL166038
0532 An Exploration of Targeted Metabolites and Their Associations with Sleep Latency in Persons with OSA
Authors: Zhou Sirui , Han Xue , Shi Zhenzhen , Zhang Qiang , Cox John , Pak Victoria
Published: April 2024

Introduction

Inflammation and oxidative stress are important pathways in the associated downstream obstructive sleep apnea (OSA)-related diseases such as cardiovascular disease and Alzheimer’s. Aspartic acid, an endogenously produced amino acid with anti-inflammatory and anti-oxidative properties, may potentially impact inflammation associated outcomes. This study explored associations between sleep latency (from the Pittsburgh Sleep Quality Index) and aspartic acid. Other targeted metabolites with similar anti-inflammatory and anti-oxidative properties as aspartic acid were also explored in persons with OSA.

Methods

This cross-sectional study included 88 participants newly diagnosed and untreated for OSA that underwent an overnight in-lab or at home sleep study recruited from the Emory Mechanisms of Sleepiness Symptoms Study (EMOSS). Fasting morning blood plasma samples were collected after an overnight sleep study. A multiple linear regression model was utilized to examine the association between metabolites of interest and sleep latency, controlling for baseline covariates of age, sex, body mass index (BMI), race, smoking status, and apnea hypopnea index (AHI).

Results

The mean age was 50.1 (13.1), the mean BMI was 36.2 (9.2), mean AHI was 33.2 (26.2), and 56% were male. Almost half (43%) reported hypertension, and 6.8% reported heart failure; other demographics include 5.7% and 1.1% for stroke and myocardial infarction, respectively. We observed no statistically significant associations between aspartic acid and sleep latency. Other targeted metabolites of interest with similar properties to aspartic acid that were explored included C16 ceramides, sphinganine, and sphingosine-1-phosphate, which were also not associated with sleep latency.

Conclusion

Targeted metabolites within the inflammatory and oxidative stress pathways were not associated with sleep latency in persons with OSA. Future work should explore whether or not other inflammation or oxidative-stress related metabolites or pathways may have a role in order to improve sleep.

Support (if any)
0533 Sleep Spindle Features in Obstructive Sleep Apnea: Results from the Sleep Heart Health Study
Authors: Chen Daniel , Reid Kathryn , Knutson Kristen , Grimaldi Daniela
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is associated with altered cognitive function and dementia, but the mechanisms underlying these associations remain unclear. One proposed mechanism is that OSA, by chronically fragmenting sleep, decreases the number and activity of sleep spindles, which are important for memory consolidation. Few studies have examined sleep spindle characteristics in people with OSA and with conflicting results. This study aims to examine sleep spindle characteristics in people with and without OSA from a multicenter community-based prospective cohort study, the Sleep Heart Health Study (SHHS).

Methods

The analysis was conducted on 5804 subjects of which 2830 had no OSA (apnea-hypopnea index (AHI) < 5, 61±12 years, 65% women), and 2974 had OSA (AHI ≥5, 65±11 years, 39% women). Spindle density (n/min) and frequency (Hz) were measured during non-rapid eye movement stage 2 from the left central electroencephalographic derivation. Arousal index (AI, n/hr) was used as a measure of sleep fragmentation and Epworth Sleepiness Scale (ESS) as a measure of subjective daytime sleepiness. Linear regression models adjusted for age, sex, BMI and education level were used to compare spindle features in OSA vs non OSA, and to examine the association between spindle features with AHI, oxygen desaturation degree and duration, AI and ESS in OSA group.

Results

In fully adjusted models, spindle density was lower in OSA compared to no OSA (-0.067 spindles per minute, p=< 0.001). In OSA group, lower sleep spindle density was associated with higher AHI (β= -0.003, p=< 0.001), higher AI (β= -0.002, p=0.020) and higher ESS score (β= -0.007, p=0.007) indicating higher daytime sleepiness. Spindle density was not associated with oxygen desaturation degree or duration. Spindle frequency was similar between OSA and non OSA.

Conclusion

These findings indicate that spindle density is reduced in people with OSA compared to those without OSA, and this reduction correlates with OSA severity (AHI) and levels of daytime sleepiness. Reduced spindle density in OSA might contribute to OSA-related cognitive impairment and future work is needed to investigate the relationship between reduced spindle density and cognitive function in OSA.

Support (if any)

Center for Circadian and Sleep Medicine
0534 The Accuracy of Predicting Snoring Frequency Using Snoring Surveys
Authors: Tracy Emma , Ediger Tatiana , Kumar Ajay Karthick Senthil , Song Xin , Maidens John , He David , Moyen Nicole
Published: April 2024

Introduction

Frequent snoring can be an indicator of sleep apnea and if left untreated, can lead to cardiovascular disease and other chronic conditions. Thus, it is crucial for health professionals to easily identify frequent snorers. Many questionnaires attempt to predict snoring frequency; however, they are lengthy, require manual scoring, and/or do not have data showing snoring predictability. Therefore, we investigated which questions from various snoring surveys best predict snoring frequency.

Methods

Seventy-two adults (60 male, 12 female; 42 ± 11 y) completed the Snore Outcomes Survey (SOS; 8 items), Pittsburgh Sleep Quality Survey (PSQI; 19 items), and the STOP-Bang survey (STOP; 8 items) before starting the study. To determine snoring frequency, subjects slept with SnoreClock, an audio-based app, for 1-7 nights (241 total nights). SnoreClock reports snoring frequency based on the cumulative minutes spent snoring out of the total recording time. Stepwise multiple linear regressions were used to identify the survey questions that best predicted mean snoring frequency.

Results

The single question that was the best predictor of average snoring frequency was from the SOS: “Please describe when you snore” [I don’t snore, I snore very rarely, I snore in only certain positions, I snore most of the time, I snore all of the time] (y=9.9x+0; R2=0.62; P< 0.001). PSQI had two significant questions regarding sleep quality and enthusiasm to get things done (R2=0.45; P< 0.001). STOP had three key predictors: daytime sleepiness, age over 50, and observed choking/gasping during sleep (R2=0.51; P< 0.001). The model including all survey questions identified two questions as most important in predicting snoring: the STOP choking question (β=23.07) and the SOS describe snoring question (β= 8.15; R2=0.64; P< 0.001).

Conclusion

Subjects can potentially be rapidly screened for snore-related health issues by asking the singular question “Describe when you snore.” This one question has an R2=0.62 in terms of predicting snoring frequency compared to three separate snoring surveys, and therefore may be used to accelerate patient care.

Support (if any)

This study was funded by Eight Sleep, Inc.
0538 Healthcare Resource Utilization in Treated Obstructive Sleep Apnea Patients with Comorbid Insomnia
Authors: Pépin Jean-Louis , Malik Anita , Woodford Caleb , Malhotra Atul , Sterling Kimberly , Cistulli Peter , McConnell Will , Alpert Naomi , Cole Kate
Published: April 2024

Introduction

Insomnia and obstructive sleep apnea (OSA), comorbidly known as COMISA, are the two most common sleep disorders, with each impairing treatment efficacy for the other. Real-world studies on treatment of patients with COMISA are lacking, thus this study aimed to examine the clinical and economic impact of treating OSA with positive airway pressure (PAP) therapy in this population.

Methods

This retrospective study linked administrative claims data to PAP device usage data for newly diagnosed OSA patients initiating PAP (index date) between January 2015 and April 2019. Adults with evidence of insomnia (insomnia prescription fill or insomnia ICD-9/10 diagnosis code) in the year prior and in the two-year period after index were included. Inverse probability of treatment weighting and Wilcoxon rank-sum tests were used to compare healthcare resource utilization (HCRU) over 2 years across varying levels of PAP adherence.

Results

From a sample of 26,965 COMISA patients, 28% met the criteria for consistently-adherent, 44% were intermediately-adherent, and 28% were non-adherent to PAP therapy over 2 years after index. The majority of intermediately-adherent patients had consistent PAP use in the first year of therapy, with decreased use in the second year. Consistently-adherent patients had fewer emergency room (ER) visits per patient than intermediately-adherent patients or non-adherent patients (year 1: 0.49 vs 0.59 [P< 0.001], vs 0.68 [P< 0.001]; year 2: 0.46 vs 0.54 [P< 0.001], vs. 0.60 [P< 0.001]). Consistently-adherent patients also had fewer all-cause hospitalizations per patient than intermediately- and non-adherent patients in both follow-up years (year 1: 0.10 vs 0.15 [P< 0.001], vs. 0.14 [P< 0.001]; year 2: 0.09 vs 0.12 [P< 0.001], vs. 0.13 [P< 0.001]). Based on major diagnostic category (MDC) codes, consistently-adherent patients saw the largest reductions in hospitalizations related to the respiratory, circulatory, nervous, and hepatobiliary systems, as well as those for alcohol/drug use or induced mental disorders.

Conclusion

This study showed reductions in all-cause hospitalizations and ER visits for COMISA patients who were consistently-adherent to PAP therapy over 2 years compared to those with lower adherence. PAP therapy is one facet of COMISA treatment that, if adhered to, can improve health outcomes.

Support (if any)

ResMed
0539 Predictors of Driving Risk in CPAP-treated OSAS: A French Multicenter Prospective Cohort
Authors: Julien Coelho , Bailly Sébastien , Baillieul Sébastien , Micoulaud-Franchi Jean-Arthur , Taillard Jacques , Sagaspe Patricia , Tamisier Renaud , Pépin Jean-Louis , Philip Pierre
Published: April 2024

Introduction

Continuous Positive Airway Pressure (CPAP) therapy is effective in reducing Excessive Daytime Sleepiness (EDS) and driving risk in the vast majority of Obstructive Sleep Apnea Syndrome (OSAS) patients. There is a need to identify predictors of residual driving risk in CPAP-treated patients. We aimed to investigate the determinants of persistent driving risk related to sleepiness in CPAP-treated OSAS patients.

Methods

Longitudinal analysis of a prospective national database including 5,308 patients with OSAS and an indication of CPAP treatment. Near-misses, accidents, and sleepiness at the wheel were assessed before initiation and after ≥ 90 days of CPAP treatment. Multivariate associations with the cumulative incidence of near-misses and accidents on CPAP were calculated using Cox models adjusted for age, sex, obesity, sleep duration, sleepiness at the wheel, accidents/near-misses history, depressive symptoms, residual apnea-hypopnea index, and adherence to treatment.

Results

Residual sleepiness at the wheel on CPAP was associated with eight-fold higher incidence of near-misses (HR=8.63 [6.08-12.2]) and five-fold higher incidence of accidents related to sleepiness (HR=5.24 [2.81-9.78]). Adherence ≤4h/night was also a significant contributor of persistent driving risk (HR=1.74 [1.12-2.71] for near-misses and HR=3.20 [1.37-7.49] for accidents).

Conclusion

Residual sleepiness at the wheel and CPAP-adherence ≤4h/night are easy-to assess markers to detect persistent driving risk during the follow-up evaluations of patients on CPAP. Health professionals, but also policy makers, should be aware of the crucial importance to systematically evaluate these elements during the follow-up evaluations of the patients with OSAS treated by CPAP therapy to improve driving risk.

Support (if any)
0543 The Utility of the PAP NAP for Increasing Patient Utilization of Positive Airway Pressure Therapy
Authors: Creighton Erin , Markov Dimitri , Grewal Ritu
Published: April 2024

Introduction

While highly effective, compliance of positive airway pressure (PAP) therapy remains a barrier to treating obstructive sleep apnea (OSA) in many patients. PAP NAP is a brief, reimbursable sleep study, designed to help patients with insomnia and OSA acclimate to PAP therapy. Studies have shown increased utilization after the study.

Methods

This is a retrospective study at a single institution of patients who underwent a PAP NAP procedure at our sleep laboratory between 2019 and 2022. The electronic medical record and PAP provider interfaces were queried for demographics, medical and sleep history, sleep study data, and PAP usage. Initial follow-up and most recent available follow-up data was collected. Paired t-test was used to compare utilization before and after intervention.

Results

Twenty-four patients underwent PAP NAP. Average apnea hypopnea index was 34.1 (median 26.3, range 5.3 - 111.6). The average length of PAP NAP was 2 hours 10 minutes (range 50 min - 3 hours 55 minutes). The median initial follow-up time after PAP NAP was 33 days. The median long-term follow-up was 1.2 years. Prior to PAP NAP, 5 patients (20.8%) were compliant with PAP therapy as per Medicare criteria. After PAP NAP, 6 (25%) and 7 (29%) patients were considered compliant at initial and long-term follow-up, respectively. There were statistically significant increases in the percentage of nights with PAP usage at least 4 hours, with mean pre-PAP NAP nights over 4 hours averaging 27% and post-PAP NAP averaging 37% (p=0.02). There was no difference at long term follow-up nor were there significant differences in the percentage of total days used at initial or long-term follow-up.

Conclusion

While an initial increase in the percentage of nights PAP was used at least 4 hours, this does not represent a clinically meaningful difference as few patients increased usage enough to meet the standards of adequate PAP use, and there was no difference at long term follow up. There may be a role for PAP NAP in patients who are already compliant but have problems with tolerance, mask fit, or high residual disease. This area should be further explored as it was a small portion study.

Support (if any)
0544 The Impact of Telemedicine on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea Patients
Authors: Morales Sulimar , Baranowski Amanda , Garbioglu Pinar , Ali Mazen El , Patel Sanjay , Krishnamurthy Venkatesh B
Published: April 2024

Introduction

Telemedicine has grown in popularity among patients for initial sleep medicine consultation following the COVID-19 pandemic. We sought to evaluate whether initial telemedicine consultation adversely impacted CPAP adherence over the initial 90 days of use among patients diagnosed with obstructive sleep apnea (OSA).

Methods

We reviewed the medical records of all patients initiated on CPAP therapy between January and May of 2023 at three academic sleep clinics at the University of Pittsburgh Medical Center. We compared CPAP adherence at 90 days between patients whose initial evaluation was done via telemedicine versus an in-person visit. Logistic regression was used to compare the odds of achieving Centers for Medicare & Medicaid Services (CMS) adherence criteria for long-term coverage accounting for age, sex, and race.

Results

A total of 289 patients were initiated on CPAP during the period studied with 141 (48.8%) having a telemedicine consult and 148 (51.2%) having an in-person visit. The cohort had a mean age 52 +/- 15 yrs, 38% were women, 76% were White and 18% were Black with no significant differences between the two groups. There was no difference in the percentage of patients achieving CMS criteria for long-term coverage (72.4% with telemedicine vs. 69.3% with in-person, p=0.95). Similarly, mean nightly usage over 90 days (261 ± 12 min with telemedicine vs. 243 ± 13 min with in-person, p=0.31) and percent of nights with more than 4 hours of CPAP use (60.0 ± 2.8% with telemedicine vs. 55.4 ± 2.9% with in-person, p=0.26) did not differ between groups. Results were similar when stratified by sex and did not change when adjusted for age, sex, and race.

Conclusion

Clinical outcomes in the treatment of OSA are not inferior in patients evaluated via telemedicine. Given the convenience of telemedicine for many patients, particularly those living in rural areas and those with limited ability to take time off from work or access transportation, greater use of telemedicine can expand access to OSA care without reducing the quality of care.

Support (if any)

none
0546 Aroxybutynin and Atomoxetine for the Treatment of OSA: Rationale and Design of the SYNAIRGY Phase 3 RCT
Authors: Strollo Patrick , Taranto-Montemurro Luigi
Published: April 2024

Introduction

There are no FDA-approved drugs available for the treatment of obstructive sleep apnea (OSA). The relaxation of upper airway muscles at sleep onset and insufficient muscle reactivation during obstructive events are the key pathophysiological determinants of OSA. Pharmacotherapy targeting the activation of upper airway muscles is a promising strategy for the alleviation of OSA.

Methods

AD109 is a combination of the antimuscarinic aroxybutynin 2.5 mg, the R-enantiomer of oxybutynin, and the norepinephrine reuptake inhibitor atomoxetine 75 mg. In the phase 2b Mariposa trial, AD109 demonstrated a clinically significant reduction of -47.1% (95% CI: -61.2 to -27.9) in the apnea-hypopnea index (AHI) compared to a placebo, along with an important decrease in subjective fatigue, measured using the Patient Reported Outcome Measurement Information System (PROMIS) scale, at one month of treatment. The ongoing SYNAIRGY study, a placebo-controlled 26-week phase 3 clinical trial, is designed to investigate both the efficacy and safety of AD109 2.5/75 for the treatment of mild to severe OSA. Eligible participants include adults with AHI4 (4% desaturation definition for hypopneas) ≥5, and a BMI < 42kg/m2 for women and < 40 kg/m2 for men who either decline or are unable to tolerate continuous positive airway pressure treatment. Approximately 640 participants will be randomized in a 1:1 ratio to receive either placebo or AD109. We hypothesize that AD109 treatment will provide a clinically meaningful AHI decrease compared to placebo-treated participants with OSA.

Results

The primary endpoint is the response rate in the AD109 arm vs. placebo arm, where response is defined as >50% reduction in AHI4 from baseline to 26-week polysomnogram (PSG). Participants will have a PSG on treatment at week 4. Secondary endpoints include changes from baseline in PROMIS-Fatigue, PROMIS-Sleep Impairment, hypoxic burden, Patient Global Impression of Severity (PGI-S) for fatigue, and the Epworth Sleepiness Scale. Safety assessments will include multiple in-office measurements of heart rate and blood pressure throughout the treatment period.

Conclusion

The SynAIRgy phase 3 randomized, controlled clinical trial aims to assess the efficacy and safety of AD109 in in the treatment of OSA by targeting key pathophysiologic mechanisms of upper airway muscle relaxation during sleep.

Support (if any)

Apnimed
0553 Changes in QTc and QT Variability in Patients with OSA with and Without Heart Failure with PAP Based on Sleep Stage
Authors: Perez Karolina , Zareba Wojciech , Woosley Raymond , Quan Stuart , Xia Jean , Shah Misty , Rothers Janet , Patel Imran , Patel Salma
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete collapse of the upper airway. OSA has been associated with increases in QTc interval and QT variability—risk factors for ventricular arrhythmias and death. This study explores how QTc and QT Variability change with positive airway pressure therapy (PAP) in patients without heart failure (HF), HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF) based on sleep stage.

Methods

Consecutive patients with OSA undergoing diagnostic and PAP titration polysomnography (PSG) were included for analysis. Electrocardiogram (ECG) analysis during PSG was performed using Comprehensive Analysis of Repolarization Signal (COMPAS) software for the longest apnea/hypopnea events in NREM and REM for the diagnostic period as well as on the highest CPAP or BPAP pressure delivered for the titration PSG. Both Bazett’s (QTbc=QT/RR1/2) and Fridericia’s (QTfc=QT/RR1/3) corrections were used to calculate corrected QT. QT variability measures included the standard deviation of QT intervals (SDQT), normalized QT interval variance (QTVN), short-term interval beat-to-beat QT variability (STVQT) and QT Variability Index (QTVi). Sleep stages were characterized as Non-Rapid eye movement (NREM) vs. REM.

Results

Ninety two patient diagnostic and 92 titration PSG were reviewed (54% male, age 54 ± 15 years, BMI 38.5 ± 8.9, AHI 51.8/hr ± 39.0, minimum spO2 74.9% ± 14.4). Only eight percent of the patients had HF. There were no significant differences in QTfc and QTbc in NREM and REM. In the no HF cohort, QTVi decreased significantly in REM (n=31) during titration (0.78 ±1.79) when compared to baseline (1.64 ± 1.65), p=0.0026. In the no HF cohort, no significant changes were noted in QT variability during NREM (n=66) in the titration PSG when compared to the diagnostic PSG. No other findings in QT variability were statistically significant including the HFrEF and HfpEF cohorts however those sample sizes were very small.

Conclusion

PAP in patients with no HF may result in decreased QT variability and the effects may be varied based on sleep stage. Our findings need to be verified in larger cohorts.

Support (if any)

American Academy of Sleep Medicine Foundation, National Institutes of Health , The University of Arizona
0562 Evaluation of Habitual Sleep Duration and PAP Adherence to Quantify Effective AHI Reduction at Home in Older Adults
Authors: Licona Diego Quintana , Kam Korey , Valencia Daphne , Roberts Zachary , Parekh Ankit , Schoenholz Reagan , Adawi Ayham , Martillo Katarina , Tolbert Thomas , Wang Jing , Guevarra Jay , Ayappa Indu , Rapoport David , Varga Andrew
Published: April 2024

Introduction

Any consequence of OSA treatment with PAP is likely to depend on baseline OSA severity and adherence to PAP in relation to habitual sleep duration. These variables can be combined to evaluate 1) the degree of effective residual AHI and 2) the degree of effective reduction in the AHI. We sought to characterize both of these outcomes in older adults newly diagnosed with OSA.

Methods

We recruited 19 patients (ages 55-85) from the Mount Sinai Integrative Sleep Center with a diagnostic PSG or WatchPAT showing AHI4% > 15/hour and willing to initiate PAP therapy. PAP adherence was obtained via remote monitoring after 3 months of use, and habitual sleep duration was obtained with 3-19 days of wrist actigraphy (ActiGraph). To account for differences between the AHI4% and the PAP-generated residual AHI, the AHI4% on PAP was considered 0/hour when the PAP-generated AHI was ≤5/hour or 5 units below the PAP-generated AHI when >5/hour. The effective residual AHI was defined as: ([AHI4% on PAP x usage hours] + [diagnostic AHI4% x (habitual sleep duration – usage hours)]) / (habitual sleep duration). Effective AHI4% reduction = diagnostic AHI4% - effective residual AHI4%. Wilcoxon signed rank tests were used to compare diagnostic AHI4% to the effective residual AHI4%.

Results

Mean age was 63±1.4 years, 37% were female, with mean BMI 33±1.7 and mean Epworth Sleepiness Score 6.5±0.7. Average habitual sleep duration was 5.8±0.3 hrs and average PAP use duration was 3.4±0.6 hrs. The median effective residual AHI4% was 9±20/hour, which was significantly lower than the diagnostic AHI4% (27±20/hour, p=0.002). The median effective AHI4% reduction was 15±23/hour, reflecting a mean 54±9% reduction from the baseline diagnostic AHI4%. Patients using PAP ≥ 6hrs (n=4) had an effective residual AHI4% of 1±2/hour (median diagnostic AHI4%: 29±24/hour), whereas patients using PAP < 2hrs (n=7) had an effective residual AHI4% of 24±17/hour (median diagnostic AHI4%: 24±37/hour).

Conclusion

This pilot study presents a characterization of the effective residual AHI and degree of effective AHI reduction in older sleep clinic patients prescribed PAP therapy. These values may be useful when considering health-related consequences of OSA treatment.

Support (if any)

R01AG066870, RF1AG083975, R01AG080609, R01AG082278, R01AG056682
0565 Utilization of Pap Titration as Indicator for Prediction of Pap Adherence
Authors: Tran Jenny , Park Justin , Modi Jhalak , Faryad Shujaa , Prasad Bharati
Published: April 2024

Introduction

Patient characteristics like self-efficacy, daytime sleepiness, and obstructive sleep apnea (OSA) severity are associated with positive airway pressure (PAP) treatment adherence. We examined the association of changes in sleep architecture with PAP titration on split-night polysomnography (PSG) with PAP adherence in an urban, racially diverse population.

Methods

PSG conducted between January and December 2019 were reviewed for sleep architecture data. The main variables were change in sleep efficiency (SE), arousal index (AI), N1, N3, and REM sleep. Changes were assessed as ratios and differences (therapeutic/diagnostic and therapeutic-diagnostic). Demographic data, body mass index (BMI), social vulnerability index (SVI), apnea hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and the initial 90-day adherence data from PAP download were collected. PAP adherence was defined as ≥4 hours/day use for ≥70% days. Stata v17 was used for analysis.

Results

PSG was conducted in 381 patients, and 239 patients had complete data for PAP use. The baseline characteristics of analyzed patients (N=239) were not significantly different from the missing sample (N=143). The PAP adherent group (N=109) were similar to the non-adherent group (N=130), except for a higher baseline ESS was noted in the adherent group (p=0.01). The logistic regression model showed that increasing age and lower ESS were associated with greater likelihood of PAP adherence (Odds Ratio, OR 1.02,95% confidence interval, CI 1.00-1.05 and OR 0.94, CI 0.89-0.99). Regarding the changes in sleep architecture with PAP titration, increases in SE and N3 sleep during the titration portion of the PSG were associated with higher likelihood of PAP adherence (OR 1.01, CI 1.00-1.03 for each). Changes in AI, N1, and REM sleep were not associated with PAP adherence.

Conclusion

Improvements in SE and an increase in N3 sleep during PAP titration on split-night PSG are associated with a higher likelihood of PAP adherence.

Support (if any)
0571 Impact of CPAP Adherence on Objective and Subjective Sleepiness Measures
Authors: Schwab Allison , Keenan Brendan , Staley Beth , Basner Mathias , Bae Charles
Published: April 2024

Introduction

Sleepiness, a common symptom of various sleep disorders, has been subjectively measured using the Epworth Sleepiness Scale (ESS) and objectively quantified using the Psychomotor Vigilance Test (PVT). The relative merit of these two measures of sleepiness has been debated, and both have shown inconsistent relationships with severity of obstructive sleep apnea (OSA) and responses to treatment. We report the relative associations of ESS and PVT with hours of CPAP use within a clinical sample.

Methods

Patients being evaluated for sleep disorders at the University of Pennsylvania’s Sleep Center competed both the ESS and PVT measurements in a single clinical visit. Thirty-nine patients had a diagnosis of OSA and were currently using CPAP. Pearson’s correlations were utilized to examine the association between CPAP adherence and both the ESS and PVT measures (transformed lapses [sum of square root of number of lapses and square root of lapses+1]) and mean reciprocal response time (RRT).

Results

total of 39 patients (64.1% males; 52.6% White, 39.5% Black) were studied, with a mean (SD) age of 61.1 (16.4) years and BMI of 35.2 (9.5) kg/m2; residual apnea-hypopnea index (AHI) was 6.5 (10.8) events/hour (23 [63.9%] had residual AHI < 5 events/hour). Participants used CPAP an average of 5.87 (2.27) hours/night in the past 30 days, 5.87 (2.47) hours/night over the past 7 days, and 5.91 (2.86) hours/night the day prior to ESS/PVT measurement. Overall, we observed a strong correlation between less subjective sleepiness based on ESS and more CPAP usage at 30-days (rho = -0.48, p=0.002), 7-days (rho = -0.43, p=0.006) and the prior day (rho = -0.38, p=0.017). However, there was no correlation between hours/night of CPAP adherence and objective function as measured on PVT.

Conclusion

Among patients with OSA using CPAP evaluated at University of Pennsylvania’s Sleep Center, greater amounts of CPAP use were significantly associated with lower ESS scores (e.g., less sleepiness). Conversely, no significant correlations were observed between CPAP use and objective data on PVT. Larger studies examining the causal effects of CPAP on subjective and objective sleepiness, including with repeat assessments of ESS and PVT during therapy, are warranted.

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0573 Morning Questionnaire Post-PAP Titration as a Prediction Tool of Early PAP Adherence
Authors: Abdallah Tarek , Bertschy Calli , Sargsyan Lilit , Majid Ruckshanda , Mathew Reeba
Published: April 2024

Introduction

Positive airway pressure (PAP) therapy is first line treatment for obstructive sleep apnea (OSA). Challenges however exist in regard to optimal PAP adherence. Patterns of PAP adherence in the first month of device use can predict long-term adherence. We investigated the corelation between immediate PAP acceptance, measured by the morning PAP titration questionnaire (MPQ), administered immediately after the titration, and the initial 90-day PAP adherence.

Methods

We performed a retrospective review of patients who completed a PAP titration between January and June 2023 at Memorial Hermann Sleep Disorders Center - Texas Medical Center. Initial 90-day adherence (defined as usage ≥4 hours/night for ≥70% of nights) was obtained on each patient. The patients were grouped based on optimal adherence (Group 1) versus non-adherence (Group 2). The MPQ score was obtained for each patient (completed on the morning after the titration). The MPQ included 4 questions (sleep quality, morning alertness, PAP tolerance, likelihood of device usage) with each affirmative response receiving 1 point. An MPQ score of ≥3 was established as significant for PAP acceptance.

Results

A total of 20 subjects were analyzed with the following characteristics: Group 1 - N 10 (7 men, 3 women), mean age 66 years, mean AHI 43/hour of sleep. Group 2 - N 10 (8 men, 2 women), mean age 63 years, mean AHI 35/hour of sleep. In Group 1, 80% (8 patients) had a score ≥3 compared to 50% patients (5 patients) in Group 2. MPQ scores of 3 and 4 conferred the highest 90-day adherence (62% and 81% respectively). A significant MPQ score also translated into an 82% positive predictive value for PAP adherence in the initial 90 days.

Conclusion

Our results show that patients with a significant MPQ score of ≥3 post-PAP titration are more likely to adhere to PAP therapy than those with non-significant scores and this can hence be used to predict immediate (and potentially long-term) adherence patterns. This simple questionnaire can be implemented to guide strategically timed early follow up and interventions (amongst those who score < 3) to best utilize limited sleep resources and reduce the prevalence of PAP non-adherence.

Support (if any)
0580 Predictors of PAP Compliance One Month After Bariatric Surgery
Authors: Badhwar Ankita , Shakaroun Dania , Bugazia Seif , Carlin Arthur , Roehrs Timothy , Skiba Virginia
Published: April 2024

Introduction

Obesity is a major risk factor for Obstructive sleep apnea (OSA). Bariatric surgery is a popular treatment modality for sustainable weight loss in obese patients with OSA. Meta-analysis of several randomized controlled trials and observational studies showed that bariatric surgery led to improvement in OSA severity but not cure. These patients will likely need continued treatment for OSA to minimize its complications. It is unclear what factors influence positive airway pressure (PAP) therapy adherence and compliance postoperatively. Our study aims to identify predictors of PAP compliance 1 month after bariatric surgery.

Methods

Patients who underwent bariatric surgery at our institution between April and October 2023 and had diagnosed obstructive sleep apnea were identified. The 140 patients were followed prospectively through surgery and 30-day post-surgery. Medical health records, polysomnography or home sleep study results, and on-line databases of PAP use were reviewed for each patient. We used Pearson correlation coefficient testing and t-test to examine potential predictors of PAP use in the 30-day post-operative period.

Results

There are statistically significant correlations (p < 0.05) between post-surgical PAP use and use during 7 days of initial set up (r = 0.642), time spent below 90% SpO2 during sleep testing (r = 0.425), time spent below 88% SpO2 (r = 0.246), pre-operative STOP-BANG (r = 0.200), and time from sleep testing to surgery (r = 0.242). Pre-surgical AHI and having been evaluated by a sleep physician pre-operatively did not show statistically significant association with post-operative PAP use.

Conclusion

PAP use during 7 days of initial set up is highly predictive of 1-month post-operative PAP use and may serve as a valuable marker to intervene on those patients with low use to improve long-term PAP use. Patients who were diagnosed with OSA close to their surgery had lower PAP use, suggesting patients may benefit from more time to get used to the treatment before having surgery.

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0584 Influence of Comorbidities and Apnea-Hypopnea Index on CPAP Compliance in Patients with Obstructive Sleep Apnea
Authors: Raafat Amr , Ali Ibrahim Sultan
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent nocturnal breathing interruptions, often resulting in debilitating symptoms and a substantial cardiovascular burden. Continuous positive airway pressure (CPAP) remains the gold standard therapy for OSA, but its long-term effectiveness and the influence of comorbidities on treatment compliance require ongoing investigation.

Methods

In this retrospective study, we assessed the efficacy of CPAP therapy in a cohort of 201 OSA patients, using data collected from 2017 to 2023 in an outpatient sleep apnea clinic. The study population comprised 125 males and 76 females, with an average age of 66 years. The severity of OSA was categorized based on Apnea-Hypopnea Index (AHI) levels, and patients were prescribed CPAP therapy with tailored pressure levels. Compliance was evaluated by the percentage of nights with over 4 hours of CPAP usage, with results ≥70% considered compliant. The impact of comorbidities, including hypertension, diabetes mellitus, obesity, cardiac diseases and severe OSA, on treatment compliance was also assessed.

Results

Among the patients, 80.5% exhibited good compliance with CPAP therapy, while 19.5% demonstrated poor compliance. AHI values significantly improved, with the mean AHI at diagnosis 37.08 reducing to 3.41 at follow-up. Among patients with an AHI greater than 30, 90% exhibited good compliance, whereas those with an AHI less than 30 demonstrated good compliance in 69% of cases. Notably, the standard deviation of AHI values reduced from 29.01 to 4.35, underscoring a significant reduction in variability. Interestingly, patients with multiple comorbidities (61.6% of the patients) displayed a higher compliance rate compared to those with one or fewer comorbidities (17.9%).

Conclusion

This study reaffirms the enduring effectiveness of CPAP therapy as the gold standard for OSA treatment. High compliance rates with substantial reductions in AHI values support its continued use in managing patients with different comorbidities. Our findings indicate that increased compliance with CPAP is linked to the presence of multiple comorbidities and higher severity of AHI.

Support (if any)

In future research, there is a need for concentrated research endeavors to formulate strategies aimed at improving compliance, particularly among patients with a lower number of comorbidities.