bluuebunny/crossref_metadata_2025 huggingface dataset:
0617 Optimization of OSA Screening in a Black Population
Authors: Fossum M , Najimi N , Whitesell P
Published: May 2020

Introduction

Racial disparities in the prevalence and severity of Obstructive Sleep Apnea (OSA) in Black Americans may play an important contributory role in the increased burden of cardiometabolic disease experienced by this population. Effective screening for OSA could permit early recognition and treatment, thereby preventing future the adverse cardiovascular outcomes which contribute to a decreased life expectancy. The STOP-BANG questionnaire is a validated screening tool for OSA as demonstrated in many populations and settings. Unfortunately, Blacks have typically been underrepresented in studies evaluating the sensitivity and specificity of the tool. Potentially unique biologic and psychosocial factors may affect the phenotypic expression of OSA and influence the performance of the STOP-BANG. Data are needed regarding the reliability of the tool for this population and potentially modifications to optimize its usefulness.

Methods

Data were from 204 patients evaluated at the Howard University Hospital Sleep Disorder Center between April 2018 and June 2019. Records were reviewed for demographic information, body mass index (BMI), neck circumference, and medical history, including the presence of snoring, tiredness/sleepiness, observed apneas, and hypertension and results of sleep study testing. Data were analyzed using SPSS software. Subcomponents of the STOP-BANG scoring criteria were adjusted to improve performance.

Results

Mean age was 48.5. 62% of subjects were female and mean BMI was 40.2 The mean ESS was 9.9. The mean AHI was 27.7 with a prevalence of mild or greater OSA (AHI >5) of 80%. Scoring of the STOP-BANG using a criterion of 3 or greater as indicating increased risk demonstrated a sensitivity of 90%, specificity of 8%, PPV of 80%, and NPV of 17%. Performance was worse for women then men. Multiple adjustments to scoring were evaluated to improve accuracy.

Conclusion

Similar to its performance in other populations, the STOP-BANG demonstrated high sensitivity but very poor specificity and overall poor accuracy in a Black population referred for Sleep Medicine Consultation to an urban university hospital. Performance was worse for women than men. Modifications are presented to try to improve performance and the clinical utility for this population.

Support

Howard University RCMI
0622 In-Depth Surveillance of Central Sleep Apnea in Patients with Stable Heart Failure
Authors: Ibrahim S , Wharton R , Harmon E , Bonner H , Davis E , Cho Y , Mazimba S , Kwon Y
Published: May 2020

Introduction

Central sleep apnea (CSA) is unique sleep breathing phenotype in patients with advanced chronic heart failure (HF) and portend poor prognosis. The prevalence of CSA in HF patients under contemporary therapy is uncertain.

Methods

We reviewed consecutive HF patients on optimal medical therapy who underwent clinically indicated diagnostic in-lab polysomnography at a single academic center. Age, sex and BMI matched patients without HF were selected from sleep clinic as a control. Patients with atrial fibrillation were excluded from this study. Apnea subtypes were determined after careful scoring and confirmation by sleep physicians. ‘Any CSA’ was defined by central apnea index (CAI) >5 and >1/hr. ‘True CSA’ was defined if met both CAI≥5/hr and > obstructive apnea index (OAI). Obstructive sleep apnea (OSA) was defined if apnea hypopnea index >15 and OAI>CAI. Multivariate analysis was performed using logistic regression adjusting for age, sex, HF and systolic dysfunction as appropriate.

Results

In patients with HF (N=95, mean age 59, female: 50%), CSA was low and was comparable to control group (N=94) (HF vs. Non-HF; CSA: 5.3 vs. 4.3%, P=NS; Any CSA 14.7 vs. 17%, P=NS). Only 3 patients with HF had true CSA. In contrast, OSA was common in both groups regardless of obesity status (52.3 vs. 55.3%). In patients with HF, Cheyne Stokes respiration was more frequent in patients with Any CSA vs. without Any CSA (13.3 vs. 3.8%, p=0.04). In multivariate analysis, presence of OSA, but not HF, was associated with Any CSA in entire cohort (Any CSA OR: 3.1 [1.3, 8.1], p=0.02). In patients with HF, male sex was associated with Any CSA (OR: 5.3 [1.1, 40.8], p=0.05). Exclusion of patients with high BMI did not change the results.

Conclusion

CSA was rare in patients with stable HF on contemporary optimal medical therapy.

Support

None
0637 Comparison of AHI and ESS Outcomes Between Patients with Obstructive Sleep Apnea Undergoing Sleep Surgery versus Upper Airway Stimulation
Authors: Huntley C , Doghramji K , Tschopp K , Tschopp S , Jardin P B , Heiser C , Schwab R , Thaler E , Jenks C , Walia H , Kominsky A , Kezirian E , Waxman J , Lin H , Boon M
Published: May 2020

Introduction

Single or multi-level soft tissue surgical interventions are common options for CPAP-intolerant patients with OSA. Upper Airway Stimulation (UAS) is an alternative option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS.

Methods

We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. For both groups, post-op AHI was collected, including full-night UAS efficacy studies. Data are presented as mean and standard deviation.

Results

The TSS group (n=284) and UAS group (n=541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p<0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p=0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p=0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p<0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p=0.01). Using the Sher response criteria of 50% AHI reduction and ≤ 20 events/hour, UAS had a 70% response rate vs 51% for TSS.

Conclusion

This study represents largest and first international, multicenter comparison of UAS to traditional surgical interventions for OSA, albeit with limitations of potential differential patient selection. While both TSS and UAS show similar improvement in symptoms, upper airway stimulation has a larger reduction of AHI with higher rates of therapy response than traditional sleep surgery

Support

ADHERE data assistance from Inspire Medical (Minneapolis, MN)
0639 Long Term Oral Appliance Therapy Decreases Stress Symptoms In Upper Airway Resistance Syndrome Patients
Authors: Godoy L B , Sousa K M , Palombini L O , Guimarães T M , Poyares D , Tufik S , Togeiro S
Published: May 2020

Introduction

Upper Airway Resistance Syndrome (UARS) is suspected in individuals with excessive daytime sleepiness, fatigue and sleep fragmentation due to increased respiratory effort. UARS can negatively impact daytime function and decrease quality of life. Cognitive impairment in UARS patients has not been well stablished yet. The objective of the study was to evaluate the long-term effects of a mandibular advancement device (MAD) on cognitive function in patients with UARS compared with placebo.

Methods

This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and MAD groups. UARS criteria were the presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Rey Auditory-Verbal Learning Test (RAVLT), the Logical Memory Test, the Stroop Color Test, the Trail Making Test, the Digit Symbol Substitution Test and Inventory of Stress Symptoms (Lipp test). Cognition protocol was defined based on most used neuropsychological tests in the literature. Evaluations were performed before and after 1.5 years of treatment.

Results

There was no statistically significant difference in RAVLT, Logical Memory Test, Stroop Color Test, Trail Making Test, Digit Symbol Substitution Test before and after 1.5 year of treatment in both groups. The Lipp test score decreased at alarm phase (p = 0.05) and at resistance phase (p = 0.01) after 1.5 year of MAD treatment compared to placebo.

Conclusion

Mandibular advancement device was effective in decreasing stress symptoms in alarm and resistance phases of Lipp test in UARS patients after 1.5-years of MAD treatment.

Support

The authors would like to thank for the support by grants from Associação Fundo de Incentivo a Pesquisa (AFIP), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
0644 An Educational and Behavioral Intervention Failed to Improve PAP Use Among Veterans With Spinal Cord Injuries and Diseases: Results of a Randomized Controlled Trial
Authors: Martin J L , Sankari A , Salloum A , Zeineddine S , Arvai K , Henzel M K , Shamim-Uzzaman Q , May A , Fung C H , Mitchell M N , Strohl K P , Badr M S
Published: May 2020

Introduction

Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adherence among Veterans with SCI/D over the first 3 months of use.

Methods

63 Veterans (mean age=60.7(10.2) years; 92% male) with SCI/D (33 SCI, 30 SCD; 25 cervical involvement; 38 thoracic and below) and SDB (23 with AHI 5-15; 40 with AHI≥15) who received PAP treatment (CPAP or BPAP) were randomly assigned to receive a comprehensive 3-month intervention (INT) or an equal attention control (EAC). INT and EAC both included 1 face-to-face session (week 1) and 5 additional telephone sessions (weeks 2, 3, 4, 8 and 12). Main outcome measures were PAP use over the first 3 months: nights of use, nights of use ≥4 hours, and mean hours of use per night. Repeated measures ANCOVA models were used to test the differences between INT and EAC over the first 3 months of treatment.

Results

Number of nights with ≥4 hours of use in months 1-3 was 9, 7, and 6 nights in the INT and 8, 5 and 4 nights in the EAC (p’s≥.37), respectively. There were no significant differences between INT and EAC for number of nights with any use (p’s≥.24), or mean hours of use per night (p’s≥.30). All 3 PAP use variables declined over time in both groups.

Conclusion

Sustained use of PAP therapy was difficult to achieve among those with SCI/D, and a 6-session behavioral intervention did not lead to significant improvements in use. Even when relatively high levels of initial use are achieved, this is difficult to sustain over time. Future studies should explore whether SCI/D patients experience significant symptom relief with PAP, and if so, whether home-based interventions or more intensive face-to-face PAP adherence programs will be effective.

Support

VA Rehabilitation Research and Development Service, Merit Review (1RX002116; PI: Badr); NIH/NHLBI K24 HL143055 (Martin).
0646 Evaluation of Increased CPAP Compliance After Electronic Learning Video Aimed at Troubleshooting Common CPAP Related Problems
Authors: Slota K A , Wasey W , Dredla B K , Castillo P
Published: May 2020

Introduction

Obstructive sleep apnea(OSA) is a common diagnosis associated with immediate and long-term health consequences. Due to increasing awareness, the demand for treatment with CPAP is increasing. However, CPAP compliance remains a problem, and may be improved by initial patient education targeted at common CPAP problems

Methods

A 10 min video depicting common CPAP related problems was created in the Mayo Clinic Florida Simulation Center using standardized patients. Newly diagnosed patients with OSA requiring CPAP were randomized into two arms: (i) the intervention arm was shown the video and received standard of care; or (ii) in the “placebo” or standard of care alone. Our standard of care includes a review of the sleep study, discussion of diagnosis and recommendation for CPAP therapy along with Mayo OSA information packet, followed by compliance visit at 3 months. Compliance is defined as >4 hours of CPAP use per night gathered from machine’s SD card. The two groups were compared for statistically significant difference in compliance at 3 months.

Results

47 patients diagnosed between 10/2018-5/2019 were included in the study(21:intervention, 26:placebo). 7 (33%) and 7 (26%) patients in the intervention and the placebo came back for follow up visit (p=0.63). Among them, median CPAP usage was 362.5 min (236.0, 480.0) in intervention arm vs 351.0 min (125.0, 466.0) in placebo group and the difference was not significant. Average nightly use of >than 4 hours was 12(57.1%) in the intervention group and 17(65.4%) in placebo group.

Conclusion

In this group addition of an educational video to standard of care did not show benefit in CPAP compliance. There was a tendency toward greater median nightly usage. Patients receiving the video had a higher likelihood of making their follow up appointment which is pivotal, as it provides an opportunity for further intervention and enhancement of adherence.

Support

Mayo Clinic Jacksonville
0659 A Safe and Precise Tongue Base Surgery for Obstructive Sleep Apnea: Real-Time Intraoperative Ultrasound-Assisted Transoral Robotic Surgery
Authors: Lin C , Chang C , Hsiao J , Wu J , Tsai H
Published: May 2020

Introduction

Lingual artery (LA) injury is a devastating complication of tongue base surgery. Compared with the anatomic findings of computed tomography angiography (CTA), intraoperative blade of mouth gag might change the thickness of base of tongue (BOT) and anatomy of LA. We aimed to investigate the position of LA in the BOT with intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS), and evaluate the bleeding complications when assisted with / without IOU.

Methods

Adult obstructive sleep apnea (OSA) patients who received TORS in BOT resection were recruited since 2016. Assessment tools were pre-op over-night hospital polysomnography (PSG) and anatomy-based Friedman Staging System. Ultrasound imaging was utilized to identify anatomic parameters of LA in BOT, including distance to midline, arterial depth and diameter.

Results

Ninety-three OSA patients (82 male, 88.2%) were analyzed. The mean age was 42.2±10.0 years old and body mass index was 29.2±4.5 kg/m2. The average apnea hypopnea index (AHI) was 58.1±21.4 events/hour. There were 66 (71.0%), 24 (25.8%) and 3 (3.2%) patients in Friedman stages II, III and IV, respectively. Seventy patients underwent TORS with IOU had shorter operation time (191.7±3.8 minutes) than 23 patients without IOU (220.1±6.6 minutes), less total blood loss (11.3±10.8 versus 19.6±26.7 ml), and more BOT tissue reduction volume (7.1±2.5 versus 3.9±1.6 ml). Significant predictors of arterial depth were higher AHI level during rapid-eye-movement (REM) sleep stage (p=0.038), bigger tonsil size (p=0.034) and more elevated Friedman tongue position (p=0.012). Postoperative complication associated with LA injury was not found in the patients with use of IOU.

Conclusion

When tongue retracted with blade, the distance to midline and depth of LA were altered in BOT. With IOU assisted, surgeon could identify LA position confidently. It is expectable to maximize efficiency and minimize catastrophic bleeding complications when OSA patients received TORS in BOT resection.

Support

nil
0691 Comparison Of Odds Ratio Product And Other Polysomnographic Metrics Among Responders And Non-responders To Upper Airway Stimulation Treatment Of Obstructive Sleep Apnea
Authors: Yu J L , Keenan B T , Kuna S T , Younes M
Published: May 2020

Introduction

Upper airway stimulation (UAS) is a surgical method of treating obstructive sleep apnea (OSA). UAS involves an implantable neuro-stimulator that stimulates the hypoglossal nerve to protrude the tongue during sleep. OSA fails to improve in 22% of patients who receive UAS as defined by a > 50% reduction in Apnea-Hypopnea Index (AHI) and an AHI <20 events/hour. Light sleep may predict UAS failure in that it may limit the stimulus strength that can be applied. The odds ratio product (ORP) is a novel polysomnographic (PSG) metric of sleep depth. We hypothesized that ORP values prior to surgery will be higher (lighter sleep) in non-responders. Having markers that predict surgical success can help reduce unnecessary surgeries.

Methods

This is a retrospective cohort study of 126 patients (83 responders vs. 43 non-responders) who received UAS implantation for the treatment of OSA. PSG data was obtained from the Stimulation for Apnea Reduction (STAR) trial. Raw baseline PSG data were analyzed and ORP values calculated using Michele Sleep Scoring Software (Cerebra Medical, Winnipeg, CA). In addition, 13 PSG metrics that were considered possibly relevant to surgical outcome were calculated as an exploratory analysis. The measurements included: spindle density, spindle power, spindle frequency, alpha intrusion, Right/Left sleep depth correlation coefficient, respiratory duty cycle, respiratory flow limitation, and arousal intensity. Statistical Analysis: Comparisons between responders and non-responders used parametric t-tests for continuous data and chi-squared or Fisher’s exact tests for categorical data. Statistical significance was based on a Bonferroni-corrected p<0.00357.

Results

Differences in ORP values and other PSG metrics between responders and non-responders were not statistically significant. Of all PSG metrics only differences in spindle density approached statistical significance (Responders = 2.33 spindles/minute vs Non-Responders = 1.39 spindles/minute, p=0.00360).

Conclusion

The findings suggest that differences in sleep depth and several other sleep characteristics do not play a significant role in determining response to UAS therapy.

Support

This project was supported by a Sleep Research Society Career Development Award #023-JP-19
0699 Effect Of Kidney Transplantation On Sleep Apnea Severity: A Prospective Controlled Polysomnographic Study
Authors: Forni Ogna V , Ogna A , Haba-Rubio J , Heinzer R
Published: May 2020

Introduction

Renal failure-associated fluid overload has been associated with a high prevalence of sleep apnea (SA) in patients with end-stage kidney disease (ESKD). Kidney transplantation has been shown to restore a normal renal function but its effect on SA remains unclear. In this prospective study, we hypothesized that improvement of kidney function and hydration status after kidney transplantation (Tx) may result in an improvement of SA severity.

Methods

A total of 196 patients on kidney transplant waiting list were screened for SA using home nocturnal polysomnography (PSG) to measure the Apnea-Hypopnea Index (AHI) and underwent bioimpedance to assess body composition. Polysomnography and bioimpedance were repeated 6 months after kidney transplant. Patients still on the waiting list after 6 months underwent same investigations as a control group.

Results

Of 88 participants (44.9%) with SA (AHI ≥15/h) at baseline, 42 patients were reassessed 6 months post-Tx and were compared to 27 control patients remaining on the waiting list after 6 months. There was a significant, although partial, post-Tx improvement in SA severity as measured by the AHI (from 44.2±24.3/h to 34.7±20.9/h, p=0.02), with a concomitant reduction in body water (from 54.9% to 51.6%, p=0.003), suggesting a causal implication of fluid overload. A post-Tx increase in body fat mass (from 26% to 30%, p=0.003) may have blunted the beneficial impact of kidney Tx on SA. These parameters remained unchanged in the control group.

Conclusion

SA is a frequent condition in ESKD patients. Kidney transplantation is associated with a reduction of fluid overload but an increase in fat mass, yielding only a partial improvement in SA severity. These results suggest that SA should be systematically assessed before and after kidney Tx

Support

Swiss Kidney Foundation, the Pulmonary League and the Organ Transplant Foundation of Lausanne
0700 Prediction Of Surgical Outcome Using Respiratory Pattern Clafification
Authors: Chiba S
Published: May 2020

Introduction: Introduction

A diagnosis of the surgical indication is important in Sleep surgery. In otolaryngology regions, it is usually considered that a site of occlusion diagnosis by DISE. However, for OSA patients with aging, heart failure and neurologic disease, the effect with the surgical treatment is still low. In these OSA patients, it is a reason that a functional factor is associated as well as an anatomical factor. Similarly, without clear complications including Aging etc, there are a lot of the OSA patients whom a functional factor is associated with. OSA is multi-factorial disease according to Wellman model, OSA is associated with the functional factor including loop gain and the ability of the upper airway to dilate associated with ventilatory drive, arousal threshold only other than the anatomical factor of the upper airway. By normal PSG, the respiratory event is classified as obstructive, mixed and central. However, there are a lot of events that a functional factor is associated with, even if it is a respiratory event to be diagnosed as an obstructive respiratory event. An effect of sleep surgery is expected only for an anatomical factor. Therefore, in the case of sleep surgery, we must diagnose a pure obstructive respiratory event precisely. Purpose of this study: To clarify a respiratory pattern to influence surgical success.

Methods: Methods

26 surgical patients with Pharyngeal surgeries diagnosed as OSA by PSG + Pes measurements were enrolled. We distinguish respiratory event as Pure obstructive event or not, using Pes signal pattern and EEG arousal timing.

Results: Results

Rate of pure obstructive event of all respiratory event varied by an individual patient. Mean rate of pure obstructive event is 57.3%. We find significant difference of AHI improvement rate between two groups which Rate of pure obstructive event shows more than 55% or less than 55%.

Conclusion: Conclusion

Breathing pattern is variety and pure obstructive event is few than ever considered. Respiratory pattern influence surgical success.

Support

Non
0709 Using The Sleep Adjusted Residual Apnea Hypopnea Index In The Real-World Monitoring Of Obstructive Sleep Apnea
Authors: Viteri E , McGhee V , Tackett J V , Freire A X
Published: May 2020

Introduction

Treatment efficacy of obstructive sleep apnea (OSA) depends on controlling respiratory events for the majority of sleep time. Apnea-hypopnea index (AHI) and adherence are frequently used to determine efficacy of continuous positive airway (CPAP) therapy, but fail to capture the effect of residual events during untreated sleep-time. The Sleep Adjusted Residual AHI (SARAHI) consolidates treated and untreated AHI and CPAP use into a single number: SARAHI = [(Untreated AHI × Hours Untreated) + (Treated AHI × Hours Treated)] / (Total Sleep Hours). We attempted to determine the clinical applicability of this index as a determinant of OSA control and its relation with sleepiness improvement.

Methods

As part of a quality assessment project, a convenience sample was haphazardly collected from a database of patients initiated on CPAP in a Veteran’s Affairs Hospital. Patients initiating treatment after OSA diagnosis by polysomnogram or portable sleep study were included. Information from a CPAP-download within a year of diagnosis and Epworth Sleepiness Scale (ESS) at diagnosis and follow-up were collected. SARAHI was calculated using two different measures of “total sleep hours”: 8 hours (SARAHI-8hrs) or recorded sleep time during sleep study (SARAHI-PSG).

Results

Thirteen patients (12 male) with a mean age of 53.3 years were included. At diagnosis, mean AHI was 26.0 events/hour and ESS was 14.6. At follow-up, CPAP mean adherence was 338 min and average use was 61.8% of days; mean residual AHI was 4.4 events/hour and mean ESS 13.7. SARAHI-8hrs was 16.0 events/hour and SARAHI-PSG was 13.8 events/hr. Simple linear regression did not show a significant correlation between ESS improvement and either of these indexes or with improvement in AHI.

Conclusion

SARAHI showed no correlation with ESS in this small sample. We recommend further research as SARAHI is simple to use and provides more information than currently used parameters.

Support

None
0710 Hypoglossal Neurostimulation In Rem- Vs. Nrem-predominant Obstructive Sleep Apnea
Authors: Cabrera C I , Szelestey B , Strohl K , Schell A
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a chronic condition that requires appropriate treatment strategies to optimize outcomes while minimizing risk. In addition to anatomy, physiologic factors such as arousal threshold and loop gain (i.e. “endotypes”) play a known role in the disease process. Because loop gain tends to be higher and arousal threshold lower in NREM sleep, we hypothesize that patients with NREM-predominance may achieve less success with anatomical therapy such as upper airway stimulation (UAS). Our study aims to evaluate baseline characteristics and objective results related to NREM-predominance in patients treated with UAS.

Methods

Using data from the STAR trial, we identified patients (n=103) with at least 20 minutes of REM on baseline testing and complete demographic and disease data at baseline and month 18. Baseline NREM-predominant disease (percent NREM events > 50) was defined as a binary variable. We created two cohorts: 1) patients with REM-predominant disease and 2) those with NREM-predominant disease. ODI and AHI were evaluated at month 18.

Results

Overall 62% (n=64) of patients had NREM-predominant disease at baseline. Other baseline characteristics were similar between both groups. In univariate analysis, age was significantly associated with lower AHI in the NREM-predominant population (p<0.05) but not in the REM-predominant group (p>0.05). Results were similar for ODI. For both groups, increasing age was correlated negatively with increasing AHI; this correlation was stronger in the NREM-predominant group

Conclusion

A majority of patients in the STAR trial had NREM-predominant OSA at baseline. There appears to be an interaction between NREM-predominance and age as predictors of UAS outcomes.

Support
0725 PRESHYON: The Prevalence On The Risk Of Obstructive Sleep Apnea Among Patients With Uncontrolled Hypertension Seen At The Out-Patient Department Of The University Of The Philippines- Philippine General Hospital
Authors: Tojino A G , Jorge M C , De Leon L F , Chua J R , Dela Cruz A V
Published: May 2020

Introduction

Obstructive Sleep Apnea (OSA) is a breathing disorder linked to increased morbidity and mortality, 1 and associated with decreased quality of life and functional impairment of daily living.2 OSA has been established to be associated with hypertension wherein the prevalence of OSA is 30%, 24,25 however, local prevalence has been lacking. The gold standard for OSA is polysomnography but this is expensive and has limited availability. Questionnaires provide risk stratification to determine if the patient needs further sleep evaluation. Recognition and treatment of OSA could lead to improving long term outcomes of patients with uncontrolled hypertension. 31-33

Methods

This is a cross-sectional study that enrolled 325 adult Filipino HTN patients seen at the outpatient department (OPD) of UP-PGH from January 2019 to July 2019. Participants also answered Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS) and the St. Lukes Medical Center-Obstructive Sleep Apnea Clinical Score (SLMC-OSACS) for their OSA risk. Descriptive statistics were used to summarize the clinical characteristics of the patients. Chi-square test was used to analyze categorical data univariately. Logistics regression analysis was used to determine the association of the different independent variable with the outcome (dependent) variable.

Results

The risk of OSA was significantly high among uncontrolled HTN patients: 106 (60.7%) based on BQ (p<0.0001) and 68 (69.4%) based on SLMC-OSACS (p<0.0001). OSA risk among uncontrolled HTN was 6x higher (OR=5.69; 95% CI=3.49-9.28;p<0.0001) using the BQ and 4x higher (OR=3.70; 95% CI=2.19 - 6.26;p=<0.0001) using the SLMC-OSACS than those with controlled HTN. Other variables significantly associated with high risk OSA were BMI and other comorbidities.

Conclusion

The risk of OSA was significantly high among uncontrolled HTN patients. In utilizing these sleep questionnaires and determining the risk for OSA among patients with uncontrolled hypertension will lead for early evaluation of OSA and complications. Locally this will aid in improving detection and provide a more strategic management of uncontrolled hypertension to decrease associated cardiovascular events. This will guide our clinicians to prioritize patients who would benefit referral to sleep specialists

Support
0766 Safety And Tolerability Of Pitolisant In The Treatment Of Adult Patients With Narcolepsy: Final Analysis Of An Open-label, Expanded Access Program In The United States
Authors: Bauer E D , Davis C W , Patroneva A , Dayno J M , Thorpy M J
Published: May 2020

Introduction

Pitolisant Expanded Access Clinical Evaluation (PEACE) provided adult patients with narcolepsy access to treatment with pitolisant while it was an investigational medication in the United States.

Methods

Pitolisant was titrated to 35.6 mg/day (or the highest tolerable dose) over a 3-week period. Dose adjustments were permitted at the discretion of the treating physician based on patient response. Treating physicians followed their standard of care and were required to report adverse events (AEs). Demographic and baseline information for all enrolled patients, and safety results available through October 30, 2019, are reported here (presentation will include final data from the PEACE program).

Results

In all, 623 patients (67.9% female; 84.6% white; mean age, 40.0 years; narcolepsy type 1, 51.5%) were treated with pitolisant in the PEACE program. Nearly all patients (98.4%) had been previously treated with other narcolepsy medications (88.1% with ≥2 narcolepsy medications). Overall, 35.2% of patients discontinued from the program; 16.7% due to an AE and 12.2% for lack of effect. At Month 1, 97.3% of patients remained in the study, 88.2% at Month 3, 76.5% at Month 6, 66.9% at Month 9, and 55.0% at Month 12. In all, 256 (41.1%) patients experienced ≥1 AE; majority (52.5%) of these AEs occurred early in treatment (by Week 3). The most commonly reported AEs were headache (9.8% of AEs), nausea (6.6%), anxiety (5.6%), and insomnia (4.7%).

Conclusion

In the PEACE program, patient characteristics were generally reflective of the US narcolepsy patient population. The safety and tolerability profile of pitolisant was similar to that seen in the clinical development program, with no new safety signals identified. The program ceased enrollment in August 2019 after the US approval of pitolisant for the treatment of excessive daytime sleepiness in adult patients with narcolepsy.

Support

Harmony Biosciences, LLC.
0769 FDG-PET Imaging In Narcolepsy Type 1, Idiopathic Hypersomnia, And Non-Sleepy Controls
Authors: Trotti L , Meltzer C , Rye D , Nye J
Published: May 2020

Introduction

Functional imaging of narcolepsy type 1 (NT1) has shown disparate results, with evidence for both regional hyper- and hypo-metabolism. A FDG-PET study of idiopathic hypersomnia (IH) demonstrated regional hypermetabolism within the salience network.

Methods

Patients with NT1 (n=14) or IH (n=16) were recruited, with age-matched, non-sleepy controls (HC, n=8). Patients discontinued treatment for ≥5 half-lives. Participants underwent injection of 18F-fludeoxyglucose (FDG) in a dimly-lit room and were asked to remain awake, seated quietly. Simultaneous 6-channel EEG, EOG, and EMG were collected. Participants were alerted by a loud noise if sleep onset was observed. Thirty minutes after injection, patients underwent 36-minute PET scan. Images were spatially normalized to MPRAGE images and analyzed for group differences using SPM8.

Results

Groups were similar in age (NT1: 30.0 (+/-SD 8.3), IH: 36.3 (+/-12.4), HC: 33.2 (+/-16.2), p=0.29) and gender (%women, NT1: 71%, IH: 87.5%, HC: 62.5%, p=0.37). Patients were sleepier than controls by Epworth (NT1: 18.2 (+/-3.5), IH: 15.8 (+/-3.2), HC: 5.0 (+/-2.7), p<0.0001) and MSLT mean latency (NT1: 2.0 (+/-1.4), IH: 5.1 (+/-1.7), HC: 14.6 (+/-2.6), p<0.0001). Despite attempts to remain awake, NT1 patients had difficulty maintaining wakefulness during uptake, obtaining 6.2 (+/-5.9) minutes sleep versus <1 minute for the other groups. Compared to controls, NT1 patients demonstrated increased activation in bilateral precentral gyri, left postcentral gyrus, left middle frontal gyrus, right insula, right inferior and superior temporal gyri, right fusiform gyrus, and bilateral inferior frontal gyri. Compared to controls, IH patients demonstrated increased activation in bilateral precuneus, bilateral inferior and middle frontal gyri, left middle and superior temporal gyri, left inferior parietal lobule, and left anterior cingulate.

Conclusion

Different patterns of metabolic activity are seen in two hypersomnia disorders, implying disease-specific activity rather than non-specific sleepiness. Inadvertent sleep during uptake is more common in NT1.

Support

K23 NS083748
0775 Effects of Stress, Sleep and Depression on Resilience of Female Nurses Working in Shift and Fixed Work Schedules in General Hospital
Authors: Eun H , Shin H
Published: May 2020

Introduction

Healthy sleep is important and can have a positive effect on resilience. The aim of the present study was to compare the differences in resilience between two group nurses in rotating shift and daytime fixed work schedules and to investigate stress perception, coping factors, social and psychological health, and sleep factors that may affect resilience.

Methods

A total of 400 female nurses having rotating shift and daytime fixed work schedules at two hospital were surveyed from June 12, 2017 to June 12, 2018. Perceived stress scale(PSS), stress coping short form(Brief COPE), psycho-social wellbeing Index short form(PWI-SF) or general health questionnaire-18(GHQ-18), center for epidemiologic studies depression scale(CES-D), STAI-X-1 in state-trait anxiety inventory(STAI), Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), insomnia severity index(ISI), Conner Davidson resilience scale(CD-RISC) applied. Independent t-test, paired t-test, Pearson correlation analysis, and multiple regression analysis were applied to the results of the final 373 questionnaires of 400 nurses in two general hospitals.

Results

As a result of comparing the variable statistics between the two groups of rotating shift and daytime fixed work nurses, there were statistically significant differences in all variables except perceived stress, sleep quality, and daytime sleepiness. Factors that had a significant correlation with resilience were stress coping strategies, depression, and insomnia severity(p<0.001). In multiple regression analysis, the larger positive reframing1(β=0.206, p<0.001), the less depression (β= -3.45, p<0.001), and the higher psychosocial health level(β=0.193, p <0.001). As acceptance coping2 increases(β=0.129, p<0.05), as daytime sleepiness decreases(β=-1.17, p<0.05), and as active coping2 increases(β=0.118, p<0.05), as the positive reframing2 increases(β=0.110, p<0.05), the resilience increased.

Conclusion

In this study, it was found that resilience was higher in daytime fixed workers than in shift workers. In addition, specific stress coping strategies and sleep, depression, and anxiety factors were found to be associated with resilience.

Support

Key words: Shift work · Female nurse · Resilience · Sleep · Stress · Depression
0781 Impact Of Suvorexant On Total Daytime Sleep Hours In Shift Workers: A Randomized, Double-blind, Placebo-controlled Clinical Field Trial
Authors: Zeitzer J M , Joyce D S , Sterkel A L , Quevedo Y L , Hernandez B , Holty J
Published: May 2020

Introduction

Many shift workers have an inability to sleep during the daytime following a night shift not due to insomnia or lack of sleep pressure, but because a circadian signal promoting wakefulness is hampering their ability to maintain sleep. We have previously hypothesized that the neuropeptide hypocretin-1 is, in part, responsible for the physiologic expression of this circadian wake signal. As such, it was our intent to determine whether a pharmacologic blockade of hypocretin would enable shift workers to obtain more daytime sleep.

Methods

Nineteen shift workers took part in a placebo-controlled, double-blind field study of suvorexant. Following two weeks of baseline, participants received 10 mg suvorexant/placebo for one week and were titrated upward to 20 mg suvorexant/placebo for an additional two weeks. Subjective (diaries) and objective (actigraphy) sleep were monitored throughout. No restrictions were placed on participants’ schedules.

Results

Both subjective and objective measures of total sleep time significantly improved in the active vs. the placebo condition, increasing by 2.08 ± 0.47 hours (diary) or 1.04 ± 0.53 hours (actigraphy) by the end of the 10 mg condition, and increasing by 2.97 ± 0.56 hours (diary) or 2.16 ± 0.75 hours (actigraphy) by the end of the 20 mg condition. Physician ratings of change in the severity of symptoms similarly improved in the active group. There were no adverse events reported in the active condition.

Conclusion

Robust changes in total sleep time were observed after administration of suvorexant, a dual-hypocretin antagonist, prior to daytime sleep in a field study of shift workers. The very large changes in total sleep time, coupled with the permissive nature of the therapeutic mechanism (i.e., suppressing wake rather than inducing sleep) indicate that this could be a viable and important therapy for shift workers.

Support

Merck Sharpe and Dohme investigator-initiated study #53236
0784 Associations Of Sleep Regularity And Chronotype With Hypertension Among African Americans In The Jackson Heart Sleep Study
Authors: Johnson D A , Guo N , Redline S
Published: May 2020

Introduction

Emerging evidence suggests that disparities in sleep regularity, a marker of circadian disruption, contributes to hypertension disparities; however, data among African Americans are limited. We examined associations of sleep regularity and chronotype with hypertension among African Americans in the Jackson Heart Sleep Study (JHSS).

Methods

Participants underwent 7-day actigraphy, completed questionnaires, and had seated blood pressure (BP) measured as part of the JHSS (2012 - 2016). Sleep regularity was defined as the standard deviation (SD) of actigraphy-measured sleep onset timing or sleep duration. Chronotype was assessed by the Morningness-Eveningness Questionnaire. Prevalent hypertension was defined as either a systolic BP ≥ 130 mmHg or diastolic BP ≥ 80mmHg, antihypertensive medication use, or self-report of diagnosed hypertension. Multivariable logistic regression models were fit to estimate the prevalence odds ratio (OR) and 95% confidence intervals for the associations of hypertension with sleep regularity measures (SD of sleep onset timing and sleep duration) and chronotype adjusted for covariates.

Results

Participants (n=830) on average were 63.4 years (SD:10.7), mostly female (66.3%) and hypertensive (85.8%). Compared to individuals with sleep onset SD < 30 minutes, higher adjusted odds of hypertension was observed with increasing variability: OR:1.87 (CI:0.99-3.56); OR:2.16 (1.06-4.39), and OR:2.41 (1.12-5.20), for SD > 30 & ≤ 60, > 60 & ≤ 90 and > 90 minutes, respectively. Among non-shift workers, definite morning and evening types compared to intermediates had higher adjusted odds of hypertension, OR:1.71 (1.04-2.83) and OR:2.56 (1.12-5.84), respectively. There were no observed associations for the SD of sleep duration with hypertension.

Conclusion

Increased sleep onset variability and extreme chronotypes were associated with prevalent hypertension, supporting interventions targeting sleep hygiene recommendations promoting regular sleep. Future research is needed to understand sleep patterns and risk of cardiovascular disease according to chronotype.

Support

NHLBI K01HL138211 and HL110068-03S1
0786 Non-24 Hour Sleep Wake Syndrome: A Cohort Analysis
Authors: Dalal L , Yuenan N , Pogach M , Thomas R J
Published: May 2020

Introduction

Although commonly described in the blind population, diagnosis in sighted individuals can be difficult due to perceived rarity and underlying co-morbid conditions. Our objective was to identify the characteristics of N24 rhythm individuals, and responses to varied treatments.

Methods

Patients were identified to have non-24-hour sleep wake syndrome (N24) via history, sleep diaries or digital logs, paired melatonin profiling as well as actigraphy through retrospective chart review at the Beth Israel Deaconess Medical Center, Sleep Disorders Clinic.

Results

37 patients were identified from 2007 to 2019 with N24 syndrome, BMI of 28, and 67% male. The mean age of onset was within the teenage years (16), and age at diagnosis of 35 years. Paired melatonin profiles (24-hour salivary melatonin, 3-hourly, separated by 7 days, in the subject’s own home) showed “movement”. Depression and anxiety were seen in 54% and 29% of the cohort respectively. 75% (28) of the patients had a treatment strategy involving light, and 54% (20) included melatonin. The combination of melatonin and light led to a clinical improvement in 41% of individuals under that regimen (17). Low dose lithium (8 subjects) enhanced melatonin/light responses. A strategy of combining the orexin antagonist suvorexant with melatonin or ramelteon (3 subjects) helped stabilize the circadian rhythm. Tasimelteon treatment has been initiated in 4 subjects.

Conclusion

These data suggest that while comorbid psychiatric conditions are prevalent, a significant proportion of the cohort did not have associated psychiatric disease. Patients reported onset of symptoms in the teenage years, however there was significant delay to diagnosis. Besides light/melatonin, orexin antagonism and low dose lithium may have benefits, but require more systematic assessments. Paired melatonin estimations could be considered as a definitive testing strategy.

Support
0800 Posttraumatic Stress Disorder and REM Sleep Without Atonia in Veterans
Authors: Lee E , Yoon I , Choi H
Published: May 2020

Introduction

In veterans, the prevalence of rapid eye movement (REM) sleep behavior disorder(RBD) is higher than the general population, and there is some evidence that this is related to posttraumatic stress disorder(PTSD). In addition, trauma related nightmares (TRNs) interfere with REM sleep and are often accompanied by motor activity. (rem sleep without atonia; RSWA). The purpose of this study is to determine whether the frequency of dream enactment behavior(DEB) and RSWA is different according to the presence of PTSD or trauma.

Methods

The patients (n = 2262) who underwent video assisted polysomnography (PSG) and sleep-related questionnaire surveys at Veteran Health Service Medical Center in Republic of Korea were reviewed retrospectively and cross-sectionally. Based on patients diagnosed with PTSD (N = 20; 100% male; 67.9 ± 8.5 years of age), those exposed to trauma but not diagnosed with PTSD (N = 23; 100% male; age 64.0 ± 13.4) and trauma unexposed controls (N = 21; 100% male; age 59.86 ± 10.9) were matched.

Results

In the PTSD group, patients who reported self-reported DEB tended to be more than the traumatic exposure group and the control group (P = 0.022). In-lab video assisted PSG showed no differences in DEB between the three groups, but RSWA. (p = 0.026) After adjusting for age, hypnotics, apnea hypopnea index (AHI), Beck depression inventory (BDI), and periodic limb movement (PLM) arousal factors, RSWA was significantly higher in the PTSD group than in the traumatic exposure group. (p = 0.006)

Conclusion

The result that RSWA was significantly higher in the PTSD group than in the traumatic exposure group suggests that there may be an associated pathophysiology between PTSD and RBD. Longitudinal studies are needed to establish the link between RBD with PTSD and neurodegenerative diseases associated with synucleinopathy.

Support

This study was supported by a VHS Medical Center Research Grant, Republic of Korea. (grant number: VHSMC 19033)
0801 Sleep, Nightmares, and the Maintenance of Posttrauma Symptoms
Authors: Meysing A , Schulte M , Youngren W , Hamilton N
Published: May 2020

Introduction

Most individuals will experience at least one traumatic event in their lifetime. Although most individuals who experience a trauma will exhibit some posttrauma symptoms, only a small subset will experience long-lasting symptoms. In fact, most research suggests that posttrauma symptoms will gradually reduce over time. However, some individuals can exhibit posttrauma symptoms for an extended period of time. Although research has demonstrated that poor overall sleep quality may explain why some people have trouble gradually recovering from posttrauma symptoms, research has yet to examine specific aspects of sleep that can impair the gradual remission of posttrauma symptoms. This study examined how individual facets of sleep quality (such as nightmares and sleep duration) impact posttrauma symptoms over time.

Methods

944 college students completed an online survey battery that included measures of traumatic experiences, time since trauma (TST), posttrauma symptoms, sleep quality, and the presence of nightmares. Regression analyses were used to examine the interaction of sleep quality sub-facets and time since trauma on posttrauma nightmares (PNMs).

Results

Out of 944 participants, 637 (67%) reported at least one trauma. Of those students, time since trauma (TST) and all other sleep variables significantly predicted posttrauma symptoms (p < 0.05). However, the only significant interaction was nightmares and TST (p < 0.01) where individuals who experienced PNMs had significantly (p < 0.01) higher posttrauma symptom intercept (48.19) than individuals who did not experience PNMs (31.19). Furthermore, individuals who experienced PNMs demonstrated statistically significant flatter slopes than those without nightmares (p < 0.01).

Conclusion

The results reveal that time since trauma predicts a decrease in posttrauma symptoms, whereas nightmares impede this symptom reduction. Interestingly, the interaction finding suggests that nightmares play a critical role in initial symptom expression and recovery. These results demonstrate the importance of identifying and treating nightmares immediately following a trauma.

Support

“none”