bluuebunny/crossref_metadata_2025 huggingface dataset:
0667 The effect of tinnitus on sleep architecture in patients with depression
Authors: Dewhurst Samuel , Reid Matthew , Abishek Dave , Haythornthwaite Jennifer , Smith Michael
Published: May 2022

Introduction

There is an established link between tinnitus (an auditory symptom affecting sound in the ear or head, in the absence of auditory stimulus) and depression in adults. However, there is a lack of research into the effect of tinnitus on sleep architecture in this depression.

Methods

Female participants (n=149) with sleep disturbance and temporomandibular joint (TMJD) pain were recruited as part of a treatment trial. Data were used to identify a cohort of participants with clinically significant depressive symptoms (CES-D >16), with and without tinnitus. We examined the pre-randomization polysomnography (PSG) dataset, and calculated sleep architecture, and relative spectral power (Alpha, beta, theta, delta). We compared cohorts using independent t-tests, testing for differences in architectural and spectral sleep parameters, controlling for anxiety symptoms.

Results

14 females (mean age = 41.76) reporting current tinnitus were age and depression severity matched with 14 females reporting no tinnitus (mean age = 41.27). Groups did not differ significantly in age (p = 0.91), BMI (p = 0.868), race (p = 0.328) or severity of depressive symptoms (CES-D: 23.93 No tinnitus vs 25.07 Tinnitus, p = 0.540), but the tinnitus group reported significantly higher anxiety (GAD-7: 9.43 no tinnitus vs 13.36 Tinnitus, p = 0.016). Data indicated TMJD patients with tinnitus had greater N2 sleep percentage (24.243% no tinnitus vs 57.200% Tinnitus, p = 0.033) compared with controls. There were no significant differences in N1% (4.2% No tinnitus vs 3.7% Tinnitus, p = 0.874), SWS% (23.164% No tinnitus vs 17.236% Tinnitus, p = 0.217) or REM% (26.386% No Tinnitus vs 21.88% Tinnitus, p = 0.238) between groups. Analysis of spectral data showed no significant differences in relative alpha (0.129 No tinnitus, 0.143 Tinnitus, p = 0.099), beta (0.186 No tinnitus vs 0.188 Tinnitus, p = 0.814), theta (0.123 No Tinnitus vs 0.125 Tinnitus, p = 0.069), or delta power (0.360 Tinnitus vs 0.346 Tinnitus, p = 0.399).

Conclusion

Our results indicate an association between tinnitus and increased N2% in TMJD participants reporting sleep disturbance and depressive symptoms. The effect of tinnitus on objective sleep parameters, in the context of depressive symptoms warrants further study.

Support (If Any)

This research study was supported financially by the NIH Grant R01 DE019731 (Haythornthwaite, JA and Smith, MT).[MR1] [MR1]Don’t include this in the main body, it’ll use too many words. If there’s a section on the submission portal to include this, add it. If not can just put the grant reference (as one word) in brackets after “treatment trial”
0670 The role of social vigilance and hindrance-challenge stress in predicting nightmares among nurses
Authors: Jordan Saylor , Slavish Danica , Dietch Jessica , Messman Brett , Taylor Daniel , Kelly Kimberly , Ruggero Camilo , Haynes Patricia , Ruiz John
Published: May 2022

Introduction

Increased exposure and reactivity to daytime stressors may heighten the frequency and severity of nightmares. Although research has examined the role of personality traits such as neuroticism in nightmares, it is unknown if other hypervigilance-related characteristics predict nightmares. Social vigilance, or monitoring one’s social environment for potential threats, is one factor that may influence stress reactivity and sleep. Nurses are one population who may be particularly susceptible to social vigilance and nightmares given their stressful work environments. The current study had two aims: 1) to examine the association between social vigilance and nightmares (assessed via retrospective questionnaire and via daily sleep diaries), and 2) to examine if perceived job stress strengthened the association between social vigilance and nightmares.

Methods

Participants were 464 nurses (mean age = 39.03 years, SD = 11.07 years, 91% female) recruited from two Dallas-area hospitals. At baseline, nurses completed the Social Vigilance Questionnaire (SVQ), the Nightmare Disorder Index (NDI; a newly validated scale measuring past-month nightmare frequency and severity), and the Challenge- and Hindrance-Related Self-Reported Stress Scale (CHRSS). Nurses then completed 14 days of sleep diaries to assess daily nightmare frequency, which were then summed across the 14 days. Multiple linear regression models were run to assess main effects of social vigilance and hindrance or challenge stress, as well as their interactions, on nightmares.

Results

Greater social vigilance (β = 0.10, p = 0.041) and greater hindrance stress (β = 0.13, p = 0.031) each predicted more nightmare symptoms as measured by the NDI, but not nightmare frequency as measured by the daily surveys. Only greater hindrance stress predicted greater daily nightmare frequency as measured by the daily surveys (β = 0.14, p = 0.015). Social vigilance did not interact with either hindrance or challenge stress to predict nightmares.

Conclusion

Results indicate nurses who report higher levels of social vigilance or hindrance stress at work experience more nightmare symptoms. Although more research is needed, supporting nurses who report high levels of stress and vigilance may help reduce their arousal and improve their sleep.

Support (If Any)

1R01AI128359
0675 Vagal Activity in REM Sleep Is Associated With Extinction Recall in Trauma Exposed Individuals but Not in Individuals With Post-Traumatic Stress Disorder
Authors: Yuksel Cagri , Watford Lauren , Mendelsohn Augustus Kram , Oliver Katelyn , Martinez Uriel , Pace-Schott Edward
Published: May 2022

Introduction

Post-traumatic stress disorder (PTSD) is characterized by impaired fear extinction memory. Sleep, and especially REM sleep, facilitates consolidation of fear extinction. Therefore, it is postulated that abnormal sleep physiology in PTSD may contribute to its persistence. Recent studies suggest that vagal activity may support the memory benefit of sleep. In addition, a separate line of studies shows reduced vagal activity during sleep in PTSD. However, the link between extinction memory and vagal activity during sleep has not been investigated in PTSD. We examined the association of extinction recall with vagal activity, measured as heart rate variability (HRV), during REM sleep, in PTSD and matched controls.

Methods

Participants included individuals with PTSD (n=70) and trauma exposed controls (TEC; n=69). All participants completed 3 nights of ambulatory polysomnography that included ECG. After acclimation and baseline PSG nights, fear conditioning and extinction learning were carried out in the evening after which they completed a third ("consolidation") PSG night. Extinction recall was tested 24h later. During fear conditioning, partial reinforcement with a mild electric shock produced a conditioned skin conductance response (SCR) to the image of a colored lamp, which was immediately extinguished by un-reinforced presentations in a different room. Extinction recall was indexed by the degree to which SCR remained suppressed 24h later. HRV indices were calculated using Kubios software.

Results

Preliminary analyses included 20 individuals with PTSD and 37 TEC participants. In the TEC group, extinction recall was significantly correlated with REM sleep HRV measures that reflect vagal activity, including high frequency (HF) absolute power (Rs=0.51, p =0.009), HF normalized units (Rs=0.54, p =0.005) and RMSSD (Rs=0.40, p =0.046). In hierarchical regression models which included extinction recall as the dependent variable, HF absolute power accounted for a significant proportion of the variance, over and above a model that included %REM sleep, %N3 sleep, REM density and average duration of REM epochs (R2=0.50, F=5.06, p=0.04). These associations were not present in the PTSD group

Conclusion

Our preliminary results suggest that vagal activity during REM sleep is involved in the consolidation of extinction memory and that this mechanism may be impaired in PTSD.

Support (If Any)

R01MH109638 K23MH119322
0676 Increased Depression Symptoms are Associated with Higher Nightmare Frequency within the Wisconsin Sleep Cohort
Authors: Gratton Matthew , Mazzotti Diego , Hamilton Nancy
Published: May 2022

Introduction

Nightmare frequency has been suggested as a strong clinical indicator of psychiatric disorders. Additionally, frequent nightmares are a possible underrepresented outcome of depression. As nightmares may increase the risk of negative health outcomes, such as suicide attempts, understanding possible sources of nightmare frequency is imperative. This study sought to examine the association between depression and anxiety on the incidence of high frequency of nightmares.

Methods

Using cross-sectional and longitudinal data from the Wisconsin Sleep Cohort, accessed through the National Sleep Research Resource, we conducted an analysis of demographics, co-occurring sleep disturbances, and mental health measures of participants experiencing ordinal frequencies of nightmares. The study sample included 758 Wisconsin state employees with a baseline and follow-up assessment (mean 4.46 years between visits; standard deviation 1.7). All participants were screened for depression and anxiety symptoms using the Zung Depression Scale (SDS), and the State-Trait Anxiety Inventory. Sleep disturbances, medication use, nightmares and insomnia were based on self-report. Nightmare frequency was categorized as high (≥2 per month) and low (<2 per month). Logistic regression was used to determine the association of baseline anxiety and depression scales (in the same model) with incidence of high nightmare frequency at follow-up, adjusted by age, sex, body mass index, hypertension medications, use of narcotics and caffeine.

Results

After adjusting for covariates, SDS scores at baseline were associated with an increased incidence of higher frequency of nightmares at follow-up (OR=1.05; 95%CI=1.01-1.10, p = 0.026), while anxiety at baseline was not (OR=1.03; 95%CI=0.99-1.07; p = 0.165). An increase in one unit of the SDS was associated with a 5% increase in the odds of presenting higher frequency nightmares at follow-up.

Conclusion

Participants with higher SDS scores had higher incidence of high frequency of nightmares upon follow up, however, those with anxiety did not. Further research should be targeted at gaining better understanding of the role of psychiatric conditions on the onset of nightmares.

Support (If Any)

NIH NHLBI (R01HL62252), NIA (R01AG036838, R01AG058680), and National Center for Research Resources (1UL1RR025011). The National Sleep Research Resource was supported by NIH-NHLBI (R24 HL114473, 75N92019R002).
0684 Improving Psychological Distress for Better Sleep During the Covid-19 Pandemic: Analyses of Data From a Pilot Randomized Controlled Trial
Authors: Benasi Giada , St-Onge Marie-Pierre
Published: May 2022

Introduction

Psychological distress has been associated with sleep problems. Emerging evidence suggests positive psychological well-being is associated with better sleep. However, most of these studies are cross-sectional and do not provide information on the effect that changes in psychological outcomes have on sleep. The aim of this secondary analysis was to test whether changes in distress and well-being following a 7-week intervention to improve sleep and mental health were associated with changes in sleep among adults reporting poor sleep quality (Pittsburgh Sleep Quality Index [PSQI]>5) and moderate distress (Perceived Stress Scale [PSS]≥14) during the COVID-19 pandemic.

Methods

Thirty individuals (age 40.7±12.9y, 80% female, 50% racial/ethnic minority) completed a pilot study testing a well-being and sleep hygiene intervention vs. sleep hygiene alone. Questionnaires were administered at baseline and post-intervention to assess distress (PSS and the Symptom Questionnaire), well-being (Psychological Well-Being scales), and sleep (PSQI and Insomnia Severity Index). A sleep diary was administered to collect information on total sleep time (TST), variability in TST, sleep onset latency, wake time after sleep onset, bedtime, and variability in bedtime. Change scores were calculated for each variable as the difference between post-intervention and baseline. Separate linear regression models were estimated with psychological variables as predictors and sleep variables as outcomes. Analyses were adjusted for intervention group, baseline scores of predictors and outcomes, age, and sex.

Results

Reductions in anxiety were associated with improvements in insomnia (B=0.6±0.2 (SE), p=0.008) and TST (B=-10.1±3.5, p=0.009); reductions in depression, somatization, and hostility were each associated with improvements in sleep quality (B=0.2±0.1, p=0.007), TST (B=-10.3±4.5, p=0.03), and earlier bedtime (B=8.8±3.0, p=0.008), respectively; and reductions in perceived stress were associated with improvements in sleep quality (B=0.2±0.1, p=0.005) and insomnia (B=0.3±0.1, p=0.02). No associations were found between changes in well-being and sleep.

Conclusion

Our findings suggest that reductions in distress following well-being and sleep hygiene or sleep hygiene alone interventions predict improvements in sleep. Focusing interventions on improving distress may be relevant to ameliorate sleep quality in the context of psychological distress. The association between well-being and sleep should be further delineated to determine the role of well-being in sleep promotion.

Support (If Any)
0686 Cognitive Behavioral Therapy for Insomnia to Reduce Cannabis Use: Results from a Pilot Randomized Controlled Trial
Authors: Arnedt J Todd , Conroy Deirdre , Stewart Haylie , Bohnert Kipling , Ilgen Mark
Published: May 2022

Introduction

Cannabis use, including use for insomnia, has increased significantly in the United States over the past decade. Cannabis use disorders and/or heavy cannabis use have been linked to numerous negative outcomes, including poor work performance, other substance use, increased risk of psychosis, and neurocognitive deficits. In a pilot randomized controlled trial, we compared telemedicine-delivered CBT for insomnia tailored to individuals regularly using cannabis for sleep (CBT-CB-TM) to sleep hygiene education (SHE-TM) for improving sleep and daytime functioning and for reducing cannabis use.

Methods

Adults with chronic insomnia who reported using cannabis for sleep at least three times weekly were recruited through advertisements and at local cannabis dispensaries and screened for disqualifying sleep, medical, and mental health disorders. Fifty-seven eligible participants (43 women, mean age 37.6 ± 12.8 years) were randomized to 6 sessions of CBT-CB-TM (n=30) or SHE-TM (n=27). Participants completed self-reported measures of insomnia (Insomnia Severity Index, primary outcome), daytime functioning (sleep beliefs, depression, and overall functioning) and cannabis use before and after treatment and at 8-week follow-up.

Results

Mixed models showed that scores improved more on the Insomnia Severity Index (β=-2.83, se=0.62, p<.001) and Dysfunctional Beliefs and Attitudes about Sleep scale (β=-0.73, se=0.25, 9<.006) in the CBT-CB-TM compared to SHE-TM condition. Small pre- to post-treatment reductions in the daily frequency of cannabis use were evident for CBT-CB-TM compared to SHE-TM participants (pre-post change: 0.60 ± 0.94 vs. -0.04 ± 0.35, p<.007). Depression symptoms (PHQ-8: CBT-CB-TM 8.5 ± 0.7 to 6.8 ± 1.0 vs. SHE-TM 9.1 ± 0.7 to 7.0 ± 0.9, p<.004), and overall functioning (SF-12 MCS: CBT-CB-TM 43.3 ± 1.9 to 50.8 ± 2.9 vs. SHE-TM 39.8 ± 2.0 to 51.6 ± 2.5, p<.0005) improved in both conditions from pre-treatment through follow-up.

Conclusion

Telemedicine-delivered CBT for insomnia improved sleep and reduced cannabis use more than a matched behavioral placebo control in this pilot trial of adults using cannabis regularly for insomnia. These preliminary findings support the need for adequately-powered randomized controlled trials with longer follow-up periods to evaluate the efficacy of targeting insomnia to reduce problematic cannabis use.

Support (If Any)

R34 DA047466 (MPI: MA Ilgen, JT Arnedt)
0687 The circadian misalignment is associated with reduced slow-wave sleep in individuals with autism spectrum disorder
Authors: Ishii Toru , Chen Jenny , Parker-Fong Kai , Kawai Makoto , O'hara Ruth
Published: May 2022

Introduction

Sleep disturbances are one of the key features among individuals with autism spectrum disorder (ASD). Many studies have uncovered critical developmental links between cognition, behavior, and sleep. It is suggested that the circadian system desynchronization plays a vital role in the development of ASD. While research on sleep disruption and circadian disturbance has accumulated, only a few studies have investigated a relationship between sleep architecture and circadian rhythm of individuals with ASD to date. We aim to elucidate the relation using the methods of dim light melatonin onset (DLMO) and ambulatory PSG.

Methods

Eleven individuals with autism (3 females, age: 13.07 ± 4.76 years; age range: 8-23 years) were recruited. After a week of systematic desensitization, an ambulatory overnight PSG was conducted in the participant’s home. Participants collected saliva samples independently at home on two consecutive days. The first evening sample took place 3 hours before the average sleep onset time and continued each 30-minute interval afterward for a total of 5 evening samples. The DLMO was calculated for each day by plotting melatonin levels against the time of saliva sampling. Linear regression was used to determine the best-fit line equation for each plot to calculate when melatonin levels first reached 4 pg/mL and continued to rise.

Results

The percentage of Stage N3 sleep across the night was significantly negatively associated with phase angle (time between DLMO and sleep onset), revealing that Stage N3 percentage decreases as the phase angle increases. The Phase angle showed a significant positive association with REM percentage across the night. Additionally, a significant difference was found between the mean phase angle for the ASD subjects in this study and the mean phase angle expected from a group of age-matched, typically developing (TD) individuals.

Conclusion

Our data revealed that circadian misalignment in individuals with ASD is associated with sleep architecture characterized by reduced slow-wave sleep and increased REM sleep. Given the importance of slow-wave sleep for memory and cognitive functions, this finding may contribute to understanding the relationship between sleep alterations and brain development in ASD.

Support (If Any)
0690 Greater variability of sleep disturbance is associated with executive functioning among people with schizophrenia
Authors: Patapoff Molly , Lee Ellen
Published: May 2022

Introduction

Sleep disturbance is common among people with schizophrenia (PwS) and has been found to be related to poorer cognition in both PwS and non-psychiatric comparison participants (NCs). However, previous findings have been inconsistent on which aspects of executive functioning are most impacted by sleep. Additionally, the relationship of sleep variability to cognition in PwS has yet to be explored. This study aims to further understand the link between cognitive dysfunction and disturbed sleep in PwS and inform future sleep interventions to improve functioning and disability in PwS.

Methods

The current sample includes 36 participants (18 PwS, 18 NCs) from the San Diego area who completed executive functioning assessments (Delis-Kaplan Executive Function System, D-KEFS). Participants wore a wrist-worn Fitbit activity tracker for a 7-day period to monitor their sleep and activity. Independent samples t-tests were used to examine differences in mean and variability of sleep measures (total sleep time or TST, wake after sleep onset or WASO, and efficiency) and cognitive function between patients and controls. Spearman correlations were run to identify preliminary relationships between cognitive performance and sleep in both groups.

Results

The PwS and NCs were comparable on sex (50% female, age (mean 53 ± 10 years) and race (majority Caucasian). PwS and NCs were similar in mean sleep and variability of sleep measures. PwS had significantly poorer performance in all cognitive domains (p < 0.05). In the PwS, more variable WASO and sleep efficiency were significantly correlated with worse performance on visual-motor sequencing and motor speed tasks (rs = -0.56 to -0.66). Additionally, trending relationships were found between better executive function composite scores with both longer mean TST (rs = 0.43) and higher mean sleep efficiency (rs = 0.30) over the monitoring period. Data collection is ongoing, and updated results will be presented at the conference.

Conclusion

Poor sleep is a prominent problem in PwS and has been associated with deficits in various cognitive domains. The present study examines the relationships of mean and variability of sleep with executive functioning. Preliminary results found strong associations between worse and more variable sleep and cognitive performance that may strengthen as sample size increases.

Support (If Any)

National Institutes of Health [NIMH K23MH119375-01 (PI: Ellen E. Lee), NIMH R01MH094151-01 (PI: Dilip Jeste)]
0696 The Application of a QTc Risk Score in Patients with Obstructive Sleep Apnea
Authors: Patel Salma , Zareba Wojciech , Parthasarathy Sairam , Perez Karolina , Wendel Chris , Xia Xiaojuan , Patel Imran , Quan Stuart , Grandner Michael , Youngstedt Shawn , Miller Jerod , Woosley Raymond
Published: May 2022

Introduction

Evidence suggests that patients with obstructive sleep apnea (OSA) are at risk for QTc prolongation which, is a known risk factor for arrhythmias, sudden cardiac death and all cause mortality. QTc risk scores have been implemented widely to help physicians identify patients at risk for mortality however, these risk scores have not been routinely implemented in patients undergoing sleep studies or those diagnosed with OSA. The goal of this study was to evaluate the distribution of pro-QTc risk scores for patients with and without OSA diagnosed at our facility and its relationship to mortality.

Methods

Medical records of all patients undergoing a sleep study at our sleep center from 2/2012 through 8/2020 were analyzed. Patients were identified with or without OSA based on polysomnography or Type III home sleep study. The pro-QTc risk score was calculated with 1 point assigned for: female sex, QT-prolonging diagnoses and conditions, QT-prolonging electrolyte abnormalities, and QT-prolonging medications defined as medications with known and possible risk of torsades de Pointes based on the CredibleMeds website. Mortality was determined if a death date was noted in the electronic medical record.

Results

A total of 2,834 patient records (54% male, age 58 ± 16 years, n=106 dead) were evaluated. A total of 2,265 patients (age 58 ±15, 54% male, 89 dead) were identified as having OSA and 428 patients (age 54 ± 18, 41% male, 17 dead) did not have OSA. The remaining patients (n=141) had either central sleep apnea or a combination of both obstructive and central sleep apnea. A higher pro-QTc score was associated with greater mortality regardless of presence of OSA (HR 1.3, p<0.0001, 95% CI 1.12 -1.46) after adjusting for age. The association of pro-QTc with mortality was not increased in the moderate or severe OSA groups compared to those without OSA or mild OSA (p=0.36).

Conclusion

Increased pro-QTc scores were associated with greater mortality in all patients undergoing sleep studies. OSA status did not affect this association.

Support (If Any)

American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140, 2L30HL154400-023), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)
0700 Prospective and Cross-sectional Associations Between Sleep Apnea and Disease in a Phenome-wide Analysis of a Clinical Biobank
Authors: Cade Brian , Hassan Syed , Dashti Hassan , Kiernan Melissa , Pavlova Milena , Redline Susan , Karlson Elizabeth
Published: May 2022

Introduction

The potential contributions of sleep apnea (SA) to the risk of developing many diseases remain unidentified due to survey limits in cohort studies. We aimed to identify novel associations between common comorbidities in participants with SA compared to matched controls in a clinical biobank by leveraging electronic health record (EHR) information informed by natural language processing (NLP)-based phenotyping. We also investigated the relationship between polysomnography (PSG) statistics and these diseases.

Methods

The sample from the Mass General Brigham Biobank was comprised of 4,876 NLP-defined SA adult cases and 12,314 controls matched on age, biological sex, BMI, race/ethnicity, and healthcare utilization with a “data floor” of minimal EHR information. Prospective (>1 year post SA diagnosis) and cross-sectional analyses considered 527 merged PheCode groups of NLP-defined diseases with ≥1% prevalence. Sex-stratified analyses were also performed. Associations with case/control status were further analyzed using rank-normalized Apnea-hypopnea Index (AHI3p) and the percentage of sleep with hypoxemia <88% (Per88) in 4,544 participants, adjusting for age, biological sex, BMI, and race/ethnicity in a smaller single-night clinic sample (57% with AHI3p ≥15).

Results

In prospective analyses, 170 diseases had significant odds ratios (OR) when comparing participants with SA versus controls following Bonferroni adjustment (p < 3.3 × 10-5), 8 of which were confirmed using PSG. Lead associations included a broad range of pathophysiology (e.g. chronic pulmonary heart disease, tension headache, and chronic fatigue syndrome). Diseases with higher ORs in women compared to men included chronic pulmonary heart disease, chronic renal failure, congestive heart failure not otherwise specified (NOS), and gout (p for sex interaction ≤3.2 × 10-3). Significant associations with PSG traits included hypertensive heart disease, fluid overload, and heart failure NOS (p ≤7.8 × 10-5). 281 diseases significantly differed in cross-sectional analyses, 41 of which were confirmed using PSG. 37 of these 41 associated diseases had lower p-values for Per88 compared to the AHI3p.

Conclusion

Sleep apnea may contribute to disease risk across a broad range of pathophysiology, with increased sex-specific risks for multiple common comorbidities. Future work should investigate the specific role of hypoxemia in these associations.

Support (If Any)

NIH (K01-HL135405, R35-HL135818, U01-HG008685 and P30-AR070253).
0705 Association of high risk obstructive sleep apnea with atherosclerotic plaque, coronary stenosis and coronary artery calcium score in asymptomatic young and middle-aged adults in The Miami Heart (MiHeart) Study at Baptist Health South Florida
Authors: Walia Harneet , Saxena Anshul , Ali Shozab , Feldman Theodore , Fialkow Jonathan , Elizondo Javier Valero , Achirica Miguel Cainzos , Nasir Khurram
Published: May 2022

Introduction

Obstructive Sleep Apnea (OSA) is associated with clinical cardiovascular disease (CVD). There are limited data evaluating association with subclinical CVD measured by cardiac computed tomography (CT). We hypothesized there would be significant association between high OSA risk and atherosclerotic plaque, coronary stenosis, and coronary artery calcium (CAC) score in Miami Heart Study cohort free of CVD.

Methods

Data from CVD free 2359 participants, age 40-65 years (May 2015-Sept 2018) from greater Miami were analyzed. Cardiac CT measured CAC, coronary plaque burden and stenosis. High OSA risk was defined as either OSA diagnosis and/or a high risk from Berlin questionnaire. Logistic regression examined association between high OSA risk (reference low OSA risk) and any plaque, coronary stenosis >50%, and CAC (> 0 and > 100 vs 0) in unadjusted models, and after accounting for age, sex, race/ethnicity (model 2), and BMI, diabetes, high cholesterol, and smoking (model 3).

Results

800 (34%) participants had high OSA risk; were more likely to be male, Hispanic, with higher CVD risk factor burden compared to low OSA risk. High OSA risk had higher prevalence of any plaque (60% vs 44%), coronary stenosis ≥ 50% (8.3% vs 4.8%), CAC scores >0-99 (34% vs 26%), and CAC score ≥ 100 (16% vs 12%), compared to low OSA risk (all p < 0.05). High OSA risk was associated with higher odds of any plaque, coronary stenosis ≥ 50%, high-risk plaque features, CAC > 0 and CAC ≥ 100 in univariable models. When adjusting for age, sex and race/ethnicity, these patterns persisted, with 1.58 higher odds of any plaque (95% CI 1.31, 1.91), 1.54 higher odds of coronary stenosis ≥ 50% (95% CI 1.08, 2.20), 1.37 higher odds of having CAC > 0 (95% CI 1.13, 1.66). Associations became non-statistically significant when adjusting for CVD risk factors, except any plaque, which was independently associated after fully adjusted (OR 1.31 (1.05, 1.63).

Conclusion

Individuals with high risk for OSA, significantly prone for CVD risk factor, have higher likelihood for presence of any plaque, significant stenosis and CAC scores > 0, with these associations mostly mediated by CVD risk factors.

Support (If Any)

Baptist Health South Florida
0709 The Efficacy of Home Sleep Apnea Tests Alone in Determining Optimal Treatment Modality for Sleep Disordered Breathing During the Height of the COVID-19 Pandemic
Authors: Tomkinson James , Cutrufello Nicholas , Grigg-Damberger Madeleine
Published: May 2022

Introduction

Home sleep studies have shown strong accuracy and reliability in diagnosing obstructive sleep apnea compared to PSG. Recent studies have suggested they can accurately detect central sleep apnea as well. The combination of better technology, stricter insurance requirements for in lab polysomnograms, and a rise in telemedicine has seen their utilization rapidly increase. Specifically, at the height of the COVID pandemic many sleep practices had to shut down their labs and rely on HSATs alone to evaluate patients with potential sleep disordered breathing.

Methods

The Albuquerque VA Sleep Center was one of these, which provided an opportunity to reflect on the effectiveness of this diagnostic modality over that timeframe. A total of 780 patients with suspected sleep disordered breathing were studied using ResMed ApneaLink II Machines from 3/16/21 to 7/1/21 while in lab PSGs were unable to be completed due to health and safety guidelines.

Results

Of these 780 patients, only 34 were determined to need further evaluation with an in lab titration study once the lab reopened. Given how few of these patients ended up with titration studies, no additional criteria were used to categorize them other than a provider deciding they needed the study. The charts of these patients were reviewed in detail to identify any common characteristics that could have contributed to them needing a more detailed evaluation with an in lab polysomnogram. This provided further information about the accuracy and reliability of HSATs, as well as traits of patients who would have been ideally studied with an in lab PSG instead.

Conclusion

Overall such a small percentage of patients, only 4%, needing further titration speaks to both the reliability of HSATs as diagnostic studies, and the effectiveness of remote titration through cloud based monitoring systems like AirView.

Support (If Any)
0716 Risk for Heart Failure with preserved Ejection Fraction in patients with or without Obstructive Sleep Apnea
Authors: Schütz Sonja , Nguyen-Phan Andy , Konerman Matthew , Chervin Ronald , Hummel Scott
Published: May 2022

Introduction

Approximately two out of three patients with Heart Failure with preserved Ejection Fraction (HFpEF) have co-morbid sleep apnea, but the risk of HFpEF in patients who test positive for obstructive sleep apnea (OSA) is unknown.

Methods

Referred subjects (n=228) over the age of 18 underwent a diagnostic in-lab polysomnogram at the University of Michigan Sleep Laboratories between 1/8/2019-3/11/2020 and an echocardiogram within 12 months of their sleep study. Individuals with a known history of HFpEF were excluded (n=44). OSA was defined as an apnea-hypopnea-index (AHI) ≥ 5/hour. Clinical and echocardiogram variables were abstracted from the electronic medical record and used to determine H2FPEF scores (ordinal scale, range 0-9). The H2FPEF score is a validated predictor of HFpEF risk in patients with dyspnea. In the presence of dyspnea, a H2FPEF score ≥ 3 indicates a >50% risk of HFpEF, though dyspnea was not assessed in this study. HFpEF probability (continuous variable) was determined using the corresponding online calculator. Linear regression was used to predict HFpEF probability based on AHI.

Results

The 184 subjects without a known diagnosis of HFpEF had a median age of 65 years (interquartile range (IQR) 51, 71). Seventy subjects (38%) were male, 150 (82%) had OSA, and the median AHI was 15 (7, 35). The median H2FPEF score was 3 (2, 5). Among 34 participants without OSA, 10 (29%) had an H2FPEF score ≥ 3, whereas among 150 participants with OSA, 59 (39%) had an H2FPEF score ≥ 3. Linear regression indicated that higher AHI is associated with a higher probability of HFpEF (β = 0.39, p=0.0001).

Conclusion

Many patients referred for polysomnography may be at high risk for HFpEF. Sleep-study-referred subjects without clinically-indicated echocardiograms were not assessed, but patients at sleep disorders centers who test positive for OSA may have a particularly high rate of undiagnosed HFpEF. Sleep physicians should consider a cardiology referral in appropriately screened patients.

Support (If Any)
0717 Obstructive Sleep Apnea Symptom Subtype Transitions over Five Years are Associated with Increased Cardiovascular Disease Incidence Risk
Authors: Mazzotti Diego , Scott Paul , Morris Jonna
Published: May 2022

Introduction

Efforts to characterize clinical heterogeneity of obstructive sleep apnea (OSA) resulted in the identification and replication of symptom-based subtypes. Individuals with moderate-severe OSA that are excessively sleepy are at increased risk of cardiovascular disease (CVD). There is limited evidence about whether OSA patients that worsen their symptom presentation over time are at increased cardiovascular burden. This study aimed to assess the association between five-year transitions among OSA symptom subtypes and incidence of CVD in a community-based cohort.

Methods

Participants of the Sleep Heart Health Study with complete baseline and 5-year follow-up data on symptom presentation, polysomnographic data and CVD outcomes were included (N=2,643). We used latent transition analysis on 14 symptom items to determine symptom subtype transitions in participants diagnosed with OSA (apnea-hypopnea index [AHI]≥5) across both visits. The primary outcome was incidence of CVD, defined as first occurrence of a composite of coronary heart disease, heart failure or stroke after the follow-up visit (median CV follow-up: 6.7 years). Cox proportional hazards models were used to assess the association between symptom subtype transitions and CVD incidence, adjusted by relevant demographic and cardiovascular risk factors.

Results

Four OSA symptom subtypes were identified at baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy. When compared to participants without OSA at baseline and follow-up visits, those with OSA that transitioned from moderately sleepy to excessively sleepy had increased CVD incidence risk (HR=2.09; 95%CI=1.27-3.45; p=0.004), independent of other CV risk factors. Increased CVD incidence risk was also observed in participants who transitioned from moderately sleepy to excessively sleepy when compared to those that remained moderately sleepy (HR=2.02; 95%CI=1.20-3.40; p=0.008) and in participants who transitioned from disturbed sleep to excessively sleepy when compared to those that remained with disturbed sleep (HR=3.25; 95%CI=1.03-10.23; p=0.044).

Conclusion

Five-year transitions across OSA symptom subtypes are associated with increased CVD incidence risk when adjusted by other relevant cardiovascular risk factors. Participants that transitioned from moderately sleepy or from disturbed sleep to excessively sleepy were at higher CVD risk. Results of this study might inform the role of symptom progression on CVD risk in OSA.

Support (If Any)

American Heart Association (20CDA35310360), National Institutes of Health (U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL53938, U01HL53940, U01HL53941, U01HL64360 R24 HL114473, 75N92019R002).
0723 Elucidation of Obstructive Sleep Apnea-Related Heart Rate Response Using a Novel Continuous Beat to Beat Blood Pressure Monitoring Technology
Authors: Roth Robert , Stafford Patrick , Mazimba Sula , Bonner Heather , Baruch Martin , Cho Yoonsik , Cho Yelim , Kwon Younghoon
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) episode related sympathetic surge may mediate the association of OSA with cardiovascular disease. Heart rate (HR) response (HRR) to OSA events may reflect magnitude of sympathetic surge but is expected to be variable between individuals. We investigated the variability of HRR to OSA events and its relation to degree of oxygen desaturation.

Methods

We included patients undergoing clinically-indicated polysomnography (PSG). We calculated HRR by deriving inter-beat interval (IBI) from a novel continuous beat-to-beat (b-b) blood pressure (BP) monitoring technology (Caretaker™) that was concurrently recorded during PSG.HRR from respiratory (apnea, hypopnea and desaturation alone events) and non-respiratory events (spontaneous or leg movement-related arousals) were compared. We also examined the association of degree of oxygen desaturation with HRR in a given respiratory event combining all events accounting for the counts of the number of events. In the sub-cohort who underwent split night sleep study, we compared the hourly HR surge events (HRR> 20 pm) between diagnostic and CPAP phases.

Results

A total of 17 patients(12 men, mean 52 years old, 9 diagnostic and 8 split night PSGs) were included after excluding one patient with poor signal quality due to excessive movement. The device was well tolerated by patients and IBI and BP data were successfully aligned with PSG data. Mean respiratory HRR ranged from 1.0 to 44.0 (Median [IQR]= 11.00[2.0, 20.0]) mmHg. Mean HRR was more pronounced during the non-respiratory events than respiratory events (12.5[7.2] vs. 11.9[6.6] mmHg, p=0.034).Accounting for the count distribution of desaturation/HRR data pair events, there was a moderately positive correlation between the degree of oxygen desaturation and HRR(R=0.63). Hourly HR surge events were significantly reduced during CPAP phase compared to diagnostic phase (11 events/hr vs 126 events/hr, p=0.032).

Conclusion

We demonstrated highly variable OSA-related HRR patterns between individuals with OSA. There was moderate correlation between degree of oxygen desaturation and HRR to respiratory events. HRR to non- respiratory events was more pronounced than to respiratory events. Future studies should evaluate the clinical implications of the OSA specific HRR.

Support (If Any)
0731 What is HSAT Missing? A Comparison of Respiratory Events and OSA Diagnosis Across Type 2 and Type 3 Studies
Authors: Lambing Kari , Chalmers Eric , Gerardy Bethany , Younes Magdy , Bender Amy
Published: May 2022

Introduction

The need for having in-home sleep testing has grown due to the COVID-19 pandemic. While Type 3 Home Sleep Apnea Tests (HSAT) are frequently used, their accuracy remains questionable. This study aimed to compare respiratory events and diagnosis of obstructive sleep apnea between Type 2 and Type 3 studies.

Methods

550 participants completed overnight Type 2 sleep studies using the Cerebra Sleep System. Files were autoscored as a type 2 acquisition and were manually edited by a RPSGT. On a second auto-score, mapped file channels were reduced to nasal cannula, chest belt, SpO2, position, heart rate, and audio channels to simulate a Type 3 study. The respiratory disturbance index (RDI) in the Type 2 tests was compared to the apnea-hypopnea index (AHI) in the simulated Type 3 files using a 4% desaturation threshold. Diagnosis of severity of OSA was classified based on indices of <5 as “None”, 5-14.99 as “Mild”, 15-29.99 as “Moderate”, and above 30 as “Severe”.

Results

5 records were removed for having a TST <4 hours. Type 2 sleep tests detected significantly more respiratory events (21.0±21.2/hr.) compared to Type 3 tests (13.4 ±17.2; t(549) = 26.8, p<.0001). The use of the Type 2 RDI resulted in 104 patients (18.9% of patients; 39.4% of treatable patients) with moderate OSA falling into the mild category under the Type 3 AHI. The number of treatable patients was thus 71% higher with a Type 2 study. Overall, the diagnoses of Type 2 RDI and Type 3 AHI were only in agreement for 263 out of the 550 records, or 47.8% of the time.

Conclusion

The use of a Type 2 study detected more respiratory events than the Type 3 device. Consequentially, 104 patients received a higher severity of obstructive sleep apnea when the EEG information was included. Our results provide support for the use of Type 2 devices for in-home detection of obstructive sleep apnea to provide more accurate diagnostic detection than the more frequently used Type 3 home sleep apnea tests.

Support (If Any)
0734 Examining the diagnostic validity of the WatchPAT in a preliminary sample of cognitive normal Black/African-American older adults
Authors: Bubu Omonigho , White Payton , Gross Jordan , Pehel Shayna , Azad Dishari , Briggs Anthony , Parekh Ankit , Kam Korey , Mullins Anna , Rapoprt David , Varga Andrew , Ayappa Indu , Willaims Natasha , Jean-Louis Girardin , Osorio Ricardo
Published: May 2022

Introduction

The WatchPAT®️ is an innovative Home Sleep Apnea Device (HSAT) that utilizes the peripheral arterial signal (PAT®️) for OSA diagnosis. We examined the diagnostic validity of the WatchPAT and assessed the correlation between its sleep indices and those measured by PSG in a cognitive normal predominantly older Black/African-American sample.

Methods

Preliminary data analysis on a limited sample of 26 participants without a prior diagnosis of OSA who underwent HSAT and 2-nights of nocturnal polysomnography (NPSG). An apnea-hypopnea index (AHI) ≥ 15 events/h characterized moderate to severe OSA. Pearson correlation statistics (Fisher's z Transformation) for PAT/NPSG indices including respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (Spo2), REM Latency (min), awake period during sleep (WASO), and sleep onset latency (SOL) were determined.

Results

Of the 26 participants, 17 (65.4%) were Black/African-American, 9 (34.6%) were non-Hispanic White, and 19 (73.1% [13/19 (68.4%) Black/African-American]) were female. Mean (SD) age, BMI and education was 66.3 (4.5) vs. 69.9 (3.7) years, 29.6 (6.4) vs. 26.6 (5.5) kg/m2 and 15.6 (3.1) vs. 17.6 (1.3) years for Black/African-American vs. non-Hispanic White, respectively. 35.3% vs. 33.3% and 17.7% vs. 22.2% of participants met criteria for moderate to severe OSA based on HSAT and NPSG, for Black/African-American vs. non-Hispanic White, respectively. The HSAT had a sensitivity and negative predictive value of 100% for both races, specificity of 78.6% vs. 85.7%, and positive predictive value (PPV) of 50% vs. 66.7%, for Black/African-American vs. non-Hispanic White, respectively. Analyses stratified by sex suggested that the WatchPAT had better diagnostic validity in Black/African-American women than men, with specificity of 83.3% vs. 75.0%. Among Blacks/African-Americans, the correlation for PAT/NPSG AHI, ODI and RDI were modest ranging from r = 0.65 to 0.70 P = .004, and mild for Spo2 and Nadir oxygen desaturation (r = 0.53 [95%CI, 0.04-0.79]; P = .03 for both). WASO, REM Latency and SOL showed no significant correlations.

Conclusion

Our preliminary data show HSAT having lower specificity, PPV, insights on sleep architecture for OSA diagnosis, and respiratory indices’ correlations with those from PSG, in Blacks/African-Americans compared to general population samples. The measure performed better among women.

Support (If Any)

AASM 231-BS-20, AARGD-21-8488397, NIH/NIA/NHLBI (K23AG068534, L30-AG064670, CIRAD P30AG059303 Pilot, NYU ADRC P30AG066512 Developmental Grant, R25HL105444 SRG, R01AG12101, R01AG022374, R01AG13616, RF1AG057570, R01HL118624, R01AG056031)
0737 Factors Influencing Arousal Thresholds
Authors: Prasad Yashneel , Miller Stuart
Published: May 2022

Introduction

Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder with an estimated prevalence of approximately 15-30 percent in males and 10-15 percent in females. A low respiratory arousal threshold (ArTH) is one of several traits involved in OSA pathogenesis. This has been shown to be reliably predicted using an Arousal Score which is calculated using the patients overall Apnoea-Hypopnoea Index (AHI), nadir SpO2 and Hypopnoea:Apnoea ratio where a score of 2 or more predicts a low arousal threshold, and a score of 1 indicates a high arousal threshold. Our objective was to describe factors associated with high arousal thresholds in patients with OSA as determined by the Arousal Score in a metropolitan population.

Methods

208 unselected, consecutive, adult, overnight polysomnography with prospectively calculated arousal scores were assessed from 2019 – 2020. Demographic and anthropometric data including Age, Sex, BMI, Epworth Sleepiness Score (ESS), AHI, SpO2 nadir, Hypopnoea:Apnoea ratio and arousal index was recorded. The arousal score was calculated by assigning one point for meeting each of the following requirements: AHI <30; SpO2 nadir > 82.8%; Hypopnoea:Apnoea ratio > 58.3, with a score <2 considered low. Spearmann correlation was performed to determine the factors associated with the Arousal Score.

Results

208 patients were included in the study. 35.6% of patients had mild sleep apnoea, 23.1% moderate sleep apnoea, 22.6% severe sleep apnoea with 18.8% of patients with no sleep apnoea. Mean arousal score was 2.47 (Std Dev 0.839). Spearman correlation indicated that disease severity, BMI (rs -.374, p-value < 0.01) and STOP-BANG (r2 -0.419, p-value < 0.01) had a statistically significant relationship with Arousal Score. That is, a higher AHI, BMI and STOP-BANG was associated with a low arousal score. Moreover, Gender and Epworth Sleepiness Score exhibited an insignificant association with arousal score. We found increasing severity of disease was associated with lower arousal score and therefore a higher arousal threshold

Conclusion

Our study demonstrates that worsening sleep apnoea severity, higher BMI and higher STOP-BANG are associated with a lower arousal score and therefore higher arousal threshold. Gender and ESS do not appear to be significantly associated.

Support (If Any)