bluuebunny/crossref_metadata_2025 huggingface dataset:
0428 Comparative Analysis of Sleep Physiology Using Qualitative and Quantitative Criteria for Insomnia Symptoms
Authors: Lee Ruda , Larson Olivia , Younes Magdy , Gerardy Bethany , Pack Allan , Keenan Brendan , Gehrman Philip
Published: April 2024

Introduction

Insomnia is diagnosed based on subjective difficulty falling asleep, staying asleep, and early morning awakenings. Evidence of objective EEG abnormalities is mixed, in part due to small sample sizes and variable definitions of insomnia. This study aimed to explore these issues by comparing the insomnia case group and the control group on sleep physiology objectively measured depending on separate qualitative and quantitative self-reported insomnia symptoms.

Methods

Analyses are based on questionnaires and PSG data from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Two distinct insomnia case groups were defined. A qualitative insomnia case was defined as self-reported difficulty falling or staying asleep at least 3 nights/week for more than 3 months and moderate or greater impairment in daytime function due to poor sleep (n=350, 58% female; 48.47±14.38 years). The quantitative case definition required average self-reported sleep latency or wakefulness after sleep onset >30 minutes combined with the frequency and impairment criteria. (n=196, 62% female; 48.77±13.74 years). We also defined control groups without insomnia. Participants were excluded if they had sleep apnea (apnea-hypopnea index [AHI] > 5 events/hour) or were shift workers. Multivariate analysis of variance (MANOVA) models, adjusted for age and sex, were separately conducted to compare the insomnia and control groups. The focus was on traditional sleep architecture variables, EEG power within specific frequency bands, and odds ratio product (ORP, representing sleep depth) metrics.

Results

The MANOVA analysis indicated significant group differences, with post-hoc tests identifying key variables responsible for these distinctions. In qualitative criteria, sleep onset latency, sigma, beta1, and beta2 in EEG1 and EEG2, along with REM and NREM ORP, were significant contributors to the observed differences. In quantitative criteria, besides the same result in qualitative criteria, REM stage and alpha in EEG1 and EEG2 played significant roles. Effect sizes were consistent across both qualitative and quantitative criteria.

Conclusion

While the analyses depending on qualitative and quantitative criteria did not have different effect sizes, some variables contributed to the group differences. As such, the results of this study support the idea that qualitative and quantitative criteria measure the same dimensions for physiological differences related to insomnia.

Support (if any)
0430 Odds Ratio Product as a Biological Marker of Hyperarousal in Insomnia with Short Sleep Duration
Authors: Lambing Kari , Guadagni Veronica , Gerardy Bethany , Bender Amy , Younes Magdy , Bastien Celyne
Published: April 2024

Introduction

Odds-Ratio-Product (ORP) is an objective, continuous index of sleep depth and wake propensity ranging from 0 (very deep sleep) to 2.5 (full wakefulness) and measured in consecutive 3-second epochs. We investigated differences in ORP metrics in 69 insomnia patients with objectively short and normal sleep duration, and 50 controls.

Methods

Participants were recruited from the community and were screened with the Insomnia Severity Index and clinical interviews and assigned to either control or insomnia groups. Participants completed three nights of in-laboratory overnight polysomnography and the Odds Ratio Product (ORP) was computed from central EEG signals. Using average total sleep time (TST) of nights 2 and 3, patients with insomnia were divided into those with short sleep duration (< 6 hours; ISSD; n=20) or normal sleep duration (INSD, n=49). Percent of TRT spent in different ORP deciles was calculated along with average ORP over wake time (ORPWAKE, higher values reflect greater alertness), and NREM sleep (ORPNREM, higher values reflect lighter sleep). We also measured the frequency of wake intrusions (transient increases (>2.0) in ORP per hour of NREM sleep).

Results

Patients with ISSD had higher ORPwake than controls (p=.017) when controlling for age, spent more time in full wakefulness (decile 10, ORP>2.25) than the other groups (p<.001), less time in deep sleep (ORP< 0.5) than INSD (p=.018), and had a higher wake intrusion index than patients with INSD (p=.015). Absolute misperception of sleep onset latency was associated with ORPNREM (p=.003), ORPTRT (p=.008), and wake intrusions (p=.012) in ISSD, and ORPTRT (p=.009) and wake intrusions (p=.025) in controls, such that a greater degree of misperception was associated with elevated ORP and greater disruption to sleep.

Conclusion

Patients with insomnia and short sleep duration had evidence of physiological hyperarousal in EEG measured by ORP compared to controls and patients with insomnia and normal sleep duration. Sleep fragmentation, measured with ORP, was also associated with misperception of sleep onset latency in patients with short sleep duration and controls. These results can assist with the characterization of insomnia phenotypes. Differences in physiological hyperarousal within phenotypes of insomnia could suggest more targeted treatment pathways.

Support (if any)
0439 Analysis of Responders to Self-Help Sleep Interventions in a Stepped-Care Clinical Trial Among Schoolteachers
Authors: Yu Yee Man Branda , Chan Christian S
Published: April 2024

Introduction

Schoolteachers often struggle with inadequate sleep or poor sleep quality, placing them at a heightened risk of depression and other mental health conditions. Cognitive behavioral treatment for insomnia (CBTi) has been found to be effective for alleviating depression while bypassing the associated stigma toward mental illnesses. Given the potential of CBTi, we tested the efficacy of delivering CBTi using a stepped-care approach among schoolteachers.

Methods

This study utilized preliminary data from a group of schoolteachers (N = 118) who received stepped care sleep treatment in an on-going assessor-blinded, randomized, waitlist-control trial. We examined the factors associated with clinical remission in sleep problems following self-help interventions (i.e., receiving sleep hygiene education as Step 1, and, if necessary, following with a 6-week self-help app-based CTBi (“proACT-S”) as Step 2). Remission was defined based on their responses after treatment (i.e., at the end of Step 1 or Step 2), classifying participants as responders (i.e., good sleepers) and non-responders (i.e., poor sleepers) using a cutoff value of 5 points on the Pittsburgh sleep quality index (PSQI).

Results

At baseline, participants reported mean scores of 10.7 on PSQI and 9.5 on The Kessler Psychological Distress Scale (K6), indicating poor sleep quality without noticeable mood symptoms. Out of 94 participants who completed end-of-treatment assessment, 16.0% achieved good sleep quality after receiving sleep hygiene education, while an additional 11.7% achieved good sleep quality through the completion of app-based self-help CBTi. Multivariate logistic regression with multiple imputations indicated that participants who reported poor sleep at baseline but without clinical-level insomnia (scored < 8 on Insomnia Severity Index) had a higher odds of good sleep quality at the post-treatment follow-up (aOR = 13.2, 95% CI = 5.0–152.9, p = .04) compared to those with moderated insomnia symptoms. This association was controlled for teachers’ mood and stress symptoms, along with other demographic factors.

Conclusion

For teachers who had poor sleep but without clinical-level insomnia, offering online psychoeducation and, if necessary, self-help CBTi may prevent them from developing clinical insomnia.

Support (if any)

This project is supported by the Health and Medical Research Fund from the Food and Health Bureau,HKSAR (project no: 18191811).
0440 An Internet of Things Cognitive Behavioral Therapy-based Device Reduces Insomnia Severity and Increases Sleep Time
Authors: Kim Jean , Gartenberg Daniel , Bitonte Eben , Kushida Clete
Published: April 2024

Introduction

An estimated 34-million U.S. adults suffer from chronic insomnia. The first-line treatment for this disease is Cognitive Behavioral Therapy for Insomnia (CBT-I). However, poor access, high cost, and low adherence prevent its widespread use. Full Sleep is a novel Internet of Things (IoT) device that includes an intelligence-sensing radar to passively track sleep patterns and deliver in the moment behavioral prompting to promote adherence to CBT-I directives.

Methods

The effect of the IoT device was examined on participants with moderate to severe insomnia symptoms (n = 65). Participants were recruited through a website and consented to a 6-8 week program. The IoT device was hypothesized to improve the Insomnia Severity Index (ISI) (primary outcome), evaluated at baseline and post-treatment. The IoT device was also hypothesized to improve consensus sleep diary metrics. Exploratory hypotheses included increasing total sleep time and reducing depression and anxiety on survey assessments.

Results

A within-groups paired-comparison t-test showed significant improvements in the ISI from baseline 19.3 (SD = 2.5) to post-treatment 7.4 (SD = 4.6), t(43) = 16.89, p < .001, d = 2.5, a 62% decrease. A clinically significant change is 6-points, demonstrating a dramatic improvement, and a larger effect than reported by digital therapeutics like Somryst, which found a 45% decrease in the ISI. There was also evidence of a causal relationship between improvements in the ISI and the use of the IoT device, where the more that participants engaged with the feature that promoted getting out of bed during restless nights, the greater the improvement in the ISI score r(42) = .37, p < .05. Importantly, the intervention also increased total sleep time, from 6.3 hours (SD = 1.4) to 6.8 hours (SD = 1.4), t(51) = 4.14, p < .05, and sleep efficiency from 73.6% (SD = 13.7%) to 88.6% (SD = 8.9%), t(51) = 9.9, p < .05. Participants had a reduction in dysfunctional beliefs about sleep, depressive symptoms, and anxious symptoms (ps < .05).

Conclusion

These results support that innovative technologies that work alongside CBT-I directives can reduce insomnia severity and increase total sleep time.

Support (if any)

This research was supported by Koko Home Inc.
0446 Improving Adherence to Sleep Restriction in Digital CBT-I
Authors: Bayoneto Alec , Treger Marleigh , Fellman-Couture Cynthia , Batra Arjun , Drake Christopher , Cheng Philip
Published: April 2024

Introduction

Treatment adherence has been a proposed barrier to the success of digital CBT-I (dCBT-I). Adherence to sleep restriction may be particularly important for treatment gains. One model of improving treatment adherence is to enhance dCBT-I with a nurse coach. This study compared adherence to sleep restriction between those with and without access to a nurse coach.

Methods

288 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions: enhanced dCBT-I (access to a nurse coach: n=148) and control (online program only: n=140). Those in the coaching model had an initial consult with the nurse coach focused on motivational enhancement, and then received feedback via email after each session based on sleep diary reports. Those who miss two consecutive sessions were stepped-up to telehealth coaching focused on implementing sleep restriction. All participants included in this preliminary analysis completed at least 3 sleep diary entries per week throughout the study. Sleep restriction was measured with sleep diary data, operationalized as the change in standard deviation of time in bed and wake time before and after the introduction of sleep restriction.

Results

Results indicate that those in the coaching group showed a greater mean reduction in the standard deviation of time in bed (coaching group: -53.3 min, control reduction: -35.9 min; Cohen’s d = 0.23). Similarly mean changes in standard deviations of wake time was greater in the coaching group compared to the control group (coaching group: -19.0 min, control reduction: 1.2 min; Cohen’s d = 0.22).

Conclusion

Results provide preliminary support that enhancing dCBT-I with nurse coaching may produce better adherence to sleep restriction. Future research should include sensitivity analyses, and examine the relationship between adherence to sleep restriction and improvements in symptoms.

Support (if any)

Support for this study was provided from the National Heart Lung and Blood Institute R01HL159180 awarded to Dr. Philip Cheng.
0449 Pilot Study: AI-Enhanced COMISA Diagnosis in Hong Kong Public Hospitals Using Objective Sleep and HRV Metrics
Authors: Young Betty Hai Ka , Kwok Isaac Chak Yan , Tsai Chih-Wei , Leung Lydia , Cheung Cynthia , Chan Po Shan , Kwok Amy Pui Ling
Published: April 2024

Introduction

The underdiagnosed and high overlapping prevalence of comorbid insomnia and obstructive sleep apnea (COMISA) often suffer worst cardiovascular outcomes than patients with either OSA or Insomnia. The scarcity of multi-disciplinary clinics addressing both conditions may impede timely COMISA diagnosis and treatment efficacy. This study explored the feasibility of leveraging objective sleep and HRV metrics through Belun Ring (BR), the AI-powered wearable, to facilitate COMISA diagnosis and personalized treatment.

Methods

Consecutive suspected OSA or Insomnia cases were co-screened by clinical psychologist and pulmonologist. Participants were categorized into the OSA group if PSG-AHI ≥ 15 events/h, insomnia if Insomnia Severity Index (ISI) ≥ 15 or diagnosed based on the International Classification of Sleep Disorders, third edition (ICSD-3), or COMISA if meeting both conditions. All subjects completed a 3-night (≥ 100 mins/night) sleep assessment using the BR. Kruskal-Wallis tests and PCA analyses were conducted for comparative analyses among the three groups.

Results

Among 54 subjects, 31 had insomnia, 13 had OSA, and 10 had COMISA. Marked discrepancies between subjective and AI-generated sleep statistics (concordance rate= 0.07) COMISA exhibited the highest wake after sleep onset (median, mins) compared to insomnia and OSA (76.5 vs. 48.1 vs. 21.2, P< 0.001). COMISA and insomnia had upregulated wakefulness (median, count) compared to OSA (14.9 vs. 15.2 vs. 8.3, P< 0.05). Moreover, COMISA exhibited the lowest SDNN (median, ms) and RMSSD (median, ms) compared to insomnia and OSA (SDNN: 49.0 vs. 63.8 vs. 92.9, P< 0.01; RMSSD: 44.9 vs. 53.8 vs. 79.8, P< 0.01). COMISA had dropped PRR50 (median, %) compared to OSA (6.6 vs. 24.8, P< 0.05). Normalized LF and LF/HF did not differ across the three groups. The novel workflow reduced waiting time for consultation from 104 to 45 weeks.

Conclusion

This is the first study to demonstrate the use of AI-assisted sleep and HRV parameters to single-out COMISA for better personalized treatment and efficient workflow. The worst cardiovascular outcomes in COMISA patients were objectively reflected by the lowest SDNN and RMSSD findings. This novel study elucidated the potential how AI can assist to identify COMISA patients even in monodisciplinary settings for better patient care.

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0454 In Cognitively Normal Elderly, Obstructive Sleep Apnea Worsens Spatial Navigational Memory Performance
Authors: Valencia Daphne , Datta Anjona , Mullins Anna , Wickramaratne Sajila , Bubu Omonigho , Kam Korey , Parekh Ankit , Osorio Ricardo , Ayappa Indu , Rapoport David , Varga Andrew
Published: April 2024

Introduction

Normal sleep has a favorable effect on the consolidation of spatial navigational memory. Previous work suggests normal overnight sleep enhances spatial navigation performance in a hippocampus-dependent manner. Our group has previously demonstrated post-sleep spatial navigational performance may be affected by obstructive sleep apnea (OSA). Here we aim to replicate these findings in a much larger sample size.

Methods

Using a virtual 3D Maze, 162 subjects (66.8 ± 6.5 years, 88 female) completed spatial navigational encoding and recall across their nocturnal polysomnography visit. Participants were instructed to find the maze exit within a ten-minute period and were given three trials pre- and post-sleep. We compared overnight changes and trial-by trial completion times between participants with and without OSA (AHI4% > 5) using Wilcoxon signed-rank test.

Results

Of the 162 participants, 76 had OSA (10.5± 16.12 AHI4). There was no statistically significant difference in overnight change in completion time (%) between OSA/non-OSA groups (OSA: 2.5 ± 58.3, non-OSA: 9.9 ± 52.1). However, the average completion time worsened with each successive trial during encoding (pre-sleep) in OSA [T1: 305 ± 18, T2: 328 ± 21, T3: 345 ± 23 seconds] as compared to non-OSA [T1: 369 ± 20, T2: 324 ± 19, T3: 320 ± 20 seconds]. Further, we observed that the average completion time worsened with each successive trial during recall (post-sleep) in the OSA group [T4: 306 ± 20, T5: 296 ± 20, T6: 332 ± 20 seconds] as compared to the non-OSA group [T4: 331 ± 19, T5: 312 ± 20, T6: 277 ± 18 seconds], such that, in the final post-sleep trial (T6), OSA patients had significantly slower completion times than the those without OSA (p = 0.034).

Conclusion

Despite no difference in overnight change in completion time between non-OSA and OSA, the pattern of performance during encoding and recall was different; These observations suggest OSA may be creating a working memory deficiency more strongly than an offline processing deficiency. Future analyses evaluating PVT performance in the OSA and non-OSA groups may be instructive to probe whether a different domain of executive is also impacted and its relationship to subjective sleepiness.

Support (if any)

R01AG066870,R01AG056682,R01HL118624,R01AG056531,R01AG056031,U01OH011852
0456 Impact of Hypertension and Sleep-disordered Breathing on Cognitive Decline in Older Adults
Authors: Noda Akiko , Okuda Masato , Iwamoto Kunihiro , Miyata Seiko , Yasuma Fumihiko
Published: April 2024

Introduction

Hypertension is a major risk factor for cardiovascular diseases. Sleep disruption, circadian dysfunction, sleep-disordered breathing (SDB), and cognitive decline are increased with aging. Repeated episodes of end-apneic arousal or hypoxia and consequent sleep fragmentation are associated with increased nocturnal blood pressure, possibly leading to sustained hypertension and atherosclerosis. The relationship between blood pressure levels and cognitive function differs across the lifespan in observational studies. However, the roles of hypertension and SDB on the pathogenesis of age-related cognitive decline remain unclear. We investigated the effect of hypertension and SDB on cognitive decline in older adults.

Methods

The participants were 50 consecutive volunteers aged 60 years or older (mean age 69.2 ± 4.7 years) without impairment in daily living activities. Sleep apnea screenings were conducted using a portable monitor. We evaluated the respiratory event index (REI) as the number of apnea and hypopnea events per hour during the recording time, with the minimum oxygen saturation. Sleep complaints were assessed using the Pittsburg sleep quality Index (PSQI). Excessive daytime sleepiness was evaluated by the Epworth sleepiness scale (ESS). Cognitive performance was assessed using the Wisconsin card sorting test (WCST), continuous performance test-identical pairs (CPT-IP), and N-back task. Hypertension and diabetes mellitus were evaluated via questionnaire. We measured systolic and diastolic blood pressure using pulse wave test.

Results

The percentage of correct answers on the 1-back tasks was significantly lower in the hypertension group than the non-hypertension group. The WCST category achievement was significantly lower in the participants with minimum oxygen saturation < 90% than those with minimum oxygen saturation ≥ 90%. Minimum oxygen saturation was correlated with category achievement on the WCST. Multiple regression analysis including age, REI, minimum oxygen saturation, ESS, hypertension, and diabetes mellitus revealed that hypertension was the most significant factor for percentage of correct answers on the 1-back tasks. There were no significant correlations between the REI or ESS and the parameters of WCST or N-back tasks.

Conclusion

Hypertension and SDB may negatively affect cognitive function in older adults. Our findings suggest that the appropriate management of hypertension and SDB is important in mid- and late-life.

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0462 Polysomnographic Biomarkers of Sleep Disruption and Incident Migraine in a Large Clinical Cohort
Authors: Khazaie Sepideh , Bena James , Ryan Delaney , saab Carl , Mehra Reena
Published: April 2024

Introduction

The relationship between sleep disruption characterized by polysomnography and migraine development remains unclear. This study elucidates this association, examining whether indices of sleep disturbance could serve as predictors of migraine.

Methods

In this longitudinal study, 132,705 participants (2000 to 2023) without pre-existing migraines were analyzed. Predictors included Apnea-Hypopnea Index (AHI), Mean SaO2, arousal index, and Epworth Sleepiness Scale (ESS) scores. Covariates for adjustment comprised age, sex, body mass index (BMI), race, neck size, end-tidal CO2, sleep stage percentages, and household income. Migraine incidence was ascertained using ICD diagnosis codes. Analysis employed univariable and multivariable Cox regression models.

Results

The cohort averaged 50.2 ± 19.0 years, was 54% male, and 76% Caucasian. Mean follow-up was 4.8 ± 4.1 years until migraine incidence. Adjusted regression showed higher AHI (per 5 units) was associated with a 1% reduction in migraine risk (HR=0.989, 95% CI 0.986-0.992). Also, higher mean SaO2 predicted a 4% increase in migraine incidence (HR=1.04, 95% CI 1.03-1.06). Reduced N1 percentage (HR=0.993, 95% CI 0.988-0.999), lower arousal index (per 1 unit, HR=0.993, 95% CI 0.991-0.996), and higher income (per $10,000, HR=0.96, 95% CI 0.94-0.98) also decreased migraine development. However, elevated ESS scores (HR=1.04 per unit increase) and larger neck sizes (HR=1.005 per 1 cm) augmented migraine risk (both p< 0.001).

Conclusion

More severe sleep disruption correlated with reduced migraine incidence, contrasting expectations. Apnea-induced vasoconstriction may trigger protective vascular changes in calcitonin gene-related peptide (CGRP)/serotonin pathways. Further study on mediating mechanisms is warranted.

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0468 CRASH: Cancer Reoccurrence Is Accelerated by Episodic Hypoxemia
Authors: Rodriguez Fernando Figueroa , Lim Kaiser , Peikert Tobias , Escalante Patricio , Morgenthaler Timothy
Published: April 2024

Introduction

Several studies have shown a positive association between Obstructive Sleep Apnea (OSA) and malignancies such as lung cancer. However, the effects of intermittent hypoxemia in cancer-free survival following curative therapy are not known. We propose that OSA-related episodic hypoxemia and hypoxic burden are independent risk factors for accelerated lung cancer reoccurrence (< 2 years).

Methods

We performed a retrospective record review of patients 18 years and older from January 2016 to September 2023 with history of non-small cell lung cancer who received an overnight oximetry study (OXY) within three years prior to undergoing curative malignancy treatment. Subjects with history of central sleep apnea, baseline oxygen saturation (SpO2) below 90%, receiving supplemental oxygen or treatment for OSA were excluded.

Results

403 patients met inclusion criteria (52% female vs 48% males; median age 74 y). The most common histologic subtypes were adenocarcinoma (68%) followed by squamous cell carcinoma (22%). Most patients fell into Stage IA1 (35%) followed by IA2 (24.1%) and IB (19%) as per TNM 8th edition classification. Over this period, 68 patients (22%) had lung cancer recurrence (median 19 months). A 4% oxygen desaturation index (ODI) of >15 and time spent in desaturation events were found to be a risk factor for cancer reappearance in less than 2 years (p< 0.001). Measures of hypoxic burden such as time spent below 89% SpO2, average SpO2 value below 89%, and single nadir oxygen levels, showed a similar association (p< 0.001). This was irrespective of histologic subtype, stage at diagnosis, and all studied demographic variables. Basal SpO2 demonstrated no correlation. A multivariate proportional hazard survival model showed that ODI>15 was no longer significant, however average SpO2 below 89% and single minimum oxygen level remained strongly correlated with accelerated recurrence.

Conclusion

This study showed a strong, positive association between accelerated lung cancer recurrence and OSA-related episodic hypoxemia and hypoxic burden on our univariate analysis. The multivariate model demonstrated correlation with hypoxic load measures only, suggesting the need for a larger sample to elucidate the involvement of this highly treatable risk factor. To our knowledge, this is the first study revealing this potential link.

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0472 Association of U.S. Military Burn Pit Smoke Exposure with Polysomnography Extracted Oxygen Saturation
Authors: Kokonda Manasa , Sharafkhaneh Amir , Razjouyan Javad , Helmer Drew , Nowakowski Sara
Published: April 2024

Introduction

Burn pits (BPs) have been widely utilized by the U.S. military for waste disposal. Due to toxic nature of the BP emissions, exposure may contribute to adverse health conditions, including nocturnal breathing problems. This study aimed to examine the association between self-estimated amount of BP emission exposure and oxygen (O2) levels during sleep.

Methods

Using polysomnography reports in the Veteran Affairs electronic medical records, oxygen saturation (SaO2) measures were extracted for 4940 Veterans and active-duty personnel (age 39.7±9.2 y, BMI 29.3±4.6 kg/m2, 16% female, 66% white) registered on the VA/DoD Airborne Hazards and Open Burn Pit Registry. Outcomes included nadir and mean SaO2. Cumulative BP exposure (BPe) variable was calculated by multiplying the response (in hours) to a question about burn pit exposure by number of deployment days, summing across deployments, and categorized into quartiles by ranking (Q1-Q3, with Q0 as reference). Inverse probability treatment weighing method was used to adjust the imbalances of covariates age, BMI, sex, race, ethnicity, military branch, and duty status between treatment groups. We performed separate weighted logistic regression models to determine the association between cumulative BPe days and SaO2 (≤90%). Additional analyses were performed on current smoking subgroup.

Results

We observed higher odds of nadir (OR:1.2, p=.045) and mean (OR:1.29, p<.0001) SaO2 in prolonged BPe quartile (Q3). Subgroup analyses revealed similar findings as prolonged BPe quartile in current smokers predicted higher odds of nadir (OR:1.69, p=0.02) and mean SaO2 (OR:1.97, p=.0003)

Conclusion

Higher levels of BP emission exposure was associated with lower oxygen saturation during sleep. Compared to former and never smokers, veterans with current smoking status and higher BPe had significant lower SaO2. Hence, smoking may exert a synergistic effect with BPe on nocturnal SaO2.

Support (if any)

This work is supported by the Department of emi Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E DeBakey Veteran Affairs Medical Center Bridge Grant, and the VA Airborne Hazards and Burn Pit Center of Excellence Pilot Grant (PI:Nowakowski).
0482 Prevalence and Demographic Characteristics of Triple Overlap Syndrome Among Adults in the United States
Authors: Luyster Faith , Baniak Lynn , Edmiston Elizabeth , Imes Christopher , Jeon Bomin , Morris Jonna , Orbell Staci , Scott Paul
Published: April 2024

Introduction

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) often coexist, forming the “overlap syndrome”, which is associated with a worse prognosis than either disease alone. With the anticipated rise in the prevalence of severe obesity (body mass index ≥ 40), it can be projected that more patients will present with "triple overlap syndrome" (i.e., presence of severe obesity, COPD, and OSA), a distinct phenotype requiring complex disease management. This study determined the prevalence of triple overlap syndrome among U.S. adults and evaluated its prevalence over time and across demographic characteristics.

Methods

Cross-sectional analysis of 2005-2006, 2007-2008, 2015-2016, and 2017-2018 National Health Nutrition Examination Survey (NHANES) waves using self-report data. High risk of OSA was determined with an adapted multivariable apnea prediction (MAP) index score of > 0.5. Survey-based Rao-Scott corrected χ2 test or t-test was used to compare prevalence rates between NHANES waves and to examine differences in age, sex, race/ethnicity, education, and health insurance status between those with triple overlap syndrome and overlap syndrome.

Results

A total of 8373 participants (mean age 57.2 ± 0.3; 69.8% women; 70.9% non-Hispanic White) were included in the overall sample. The prevalence of triple overlap syndrome was 1.9% and increased from 1.1% in 2005-2008 to 2.7% in 2015-2018 (a nearly250% increase, p< 0.001), driven by increased rates of OSA, COPD, and severe obesity of 6.5%, 1.8%, and 2.3%, respectively. Overlap syndrome prevalence increased from 5.6% to 7.5%. Those with triple overlap syndrome were predominately middle-aged women of racial/ethnic minority, with at least a high school education and health insurance. As compared to those with overlap syndrome, those with triple overlap syndrome were younger (56.7 vs. 64.2 years, p< 0.001), more likely to be women (62.4% vs. 29.2%, p< 0.001), and less likely to be non-Hispanic White (43.4% vs. 61.9%, p< 0.001). Education and health insurance status were similar between groups.

Conclusion

Women and ethnic/racial minorities may represent high-risk groups that should be targeted for assessment of the growing triple overlap phenotype. Further research is needed to explore social and environmental determinants of health disparities in the prevalence of triple overlap syndrome.

Support (if any)

No support
0485 Can Hypoxic Burden Predict Improvement in Sleepiness and Cognition in Response to CPAP Treatment in OSA Patients?
Authors: Gaynor-Sodeifi Kaveh , Greenberg Dylan , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) affects more than 10% of older Americans and is associated with future comorbid conditions. The current method for measuring OSA severity, the apnea-hypopnea index (AHI), is poorly correlated to symptom burden and clinical improvement. Hypoxic burden (HB), which quantifies and characterizes OSA-related hypoxemia, has been suggested as an alternative OSA measure. However, more research is needed to understand HB’s predictive ability. Thus, this study investigated whether HB could predict which OSA patients, prescribed CPAP, will have the greatest improvement in measures of sleepiness and cognition.

Methods

This is a secondary analysis from a trial that investigated the effects of CPAP versus sham treatment on sleepiness [Epworth Sleepiness Scale (ESS), psychomotor vigilance test (PVT)] and cognition [Buschke Selective Reminding Test (BSRT), Sustained Working Memory Test (SWMT), Cogscreen Pathfinder Number (PN)]. Using the SpO2 signal, HB was calculated as the area under the desaturation curve during all desaturation events (sustained >3% dip in SpO2). For categorical analyses, we classified “sleepy” and “not sleepy” in two different ways: ESS≥10 or < 10 and PVT lapses≥4 and < 4, respectively.

Results

Of the 426 (66% male) participants included, ESS and PVT significantly decreased after two months of treatment; 10.2±4.2 vs 8.0±4.2 (p< 0.001) and 2.5±1.6 vs 2.3±1.4 (p< 0.01), respectively. After correcting for BMI, age, sex, and AHI, baseline HB was associated with a change in sleepiness after treatment (∆ESS R2=0.04, p< 0.001; ∆PVT R2=0.01, p< 0.05). Moreover, having higher baseline HB increased odds for transitioning from “sleepy” to “non-sleepy” based on ESS (1.006 [1.001, 1.012]) or PVT (1.07 [1.003, 1.011]). HB was not associated with change in cognitive variables at follow-up (p>0.05), before correcting for any covariates.

Conclusion

HB had a significant yet weak effect on subjective (ESS) and objective (PVT) measures of sleepiness after correcting for covariates. HB did not significantly explain changes in any cognitive measure after two months of CPAP treatment. Whether this lack of an association is due to the absence of an overall improvement in cognition or the inability of HB to explain variability remains to be tested.

Support (if any)

NIH K25HL151912 NIH R01HL171813 NIH R21HL165320
0488 Exploring Study Recruitment Trends in the Acute Post-Stroke Setting
Authors: Schwarz Joshua , Masroor Kiran , Radulescu Radu , Tsang Sui , Sheth Kevin , Redeker Nancy , Yaggi Henry , Geer Jacqueline
Published: April 2024

Introduction

Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing due to intermittent upper airway closure causing hypoxia, sympathetic activation, and hemodynamic changes that impact cerebral blood flow during sleep and predispose to ischemia. OSA is a well-established independent risk factor for acute ischemic stroke (AIS) with a prevalence estimate ranging from 60-80%. The Recovery in Stroke Using Positive Airway Pressure (RISE-UP) clinical trial is an ongoing study designed to investigate the influence of OSA treatment with continuous positive airway pressure (CPAP) on post-stroke functional recovery in both the subacute and acute post-AIS setting.

Methods

The RISE-UP trial recruits patients admitted to Yale-New Haven Hospital, a large academic medical center in an urban location. Over a period of three years, 3507 patients have been screened for the study. Preliminary data was analyzed for trends in recruitment. Exclusion criteria included being unable to consent for themselves, past use of CPAP, and an estimated life expectancy of less than six months. Passive refusal can be defined as when patients choose not to enroll or participate without actively expressing a refusal.

Results

Of the 1109 (31.6%) patients deemed eligible for the study, 705 (63.6%) were approached, 171 (24.2%) consented to participate, and 489 (69.3%) refused. Among those who refused, the most common reasons were lack of interest (58.8%), passive refusal (21.7%), feeling overwhelmed (12.3%), and family discouragement (4.1%).

Conclusion

The recruitment data presented provides useful insight into the potential challenges of recruitment in the immediate post-stroke setting. In particular, the most common reasons for refusal included lack of interest, passive refusal, and feeling overwhelmed. Based on these findings, more robust education regarding the pertinence of OSA screening in those at risk for cardiovascular disease, such as stroke, and the relationship between OSA and AIS may increase enrollment among this patient population in the future. By understanding patient’s concerns and collaborating with the healthcare system, this analysis serves as a valuable opportunity to aid in recruitment efforts within this domain.

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0498 Driving Performance of OSA Referrals Is Not Correlated with ODI or ESS: Preliminary Results from the ODESA Study
Authors: Lee Kieran , Bekinschtein Tristan , Smith Ian
Published: April 2024

Introduction

Untreated obstructive sleep apnoea (OSA) is associated with 3-fold increased risk of a motor vehicle collision. To date research in this area has focused on driving simulators, crash records and emergency room reports each of which has limitations. Predictors of poor on road driving performance with OSA are not well developed.

Methods

We are recruiting to a study (ODESA), to assess on-road driving performance, collected through a smartphone app developed by our industry partner (Sentiance). Participants are recruited from referrals for investigation of possible OSA. Here, we present preliminary data from the first participants to assess if our measures of driving distinguish varying levels of performance between drivers, and if any measure is correlated with levels of oxygen desaturation (ODI), and Epworth Sleepiness Scale (ESS). Driving scores of Hard Events, Hard Acceleration and Hard Turning were compared across participants using one-way ANOVA’s, and tests of correlation with ODI and ESS were computed using Spearman's Rho.

Results

10 participants (51 +/- 12 years [mean +/- SD], 4 female), have recorded 683 journeys (68 +/- 36 [mean +/- SD]). Significant effects of driving scores between participants, were found for Hard Events (F[9,533]=16.3, p< 0.00001), and Hard Acceleration (F[9,592]=5.64, p< 0.00001), but not Hard Turning (F[9,590]=1.48, p= 0.15). There was no reliable relationship between either ODI (10.2 +/- 15.6 [mean +/- SD]) and Hard Events (rs=.18, p=.63), Hard Acceleration (rs=.25, p=.49) and Hard Turning (rs=-.14, p=.7), or EES (10.9 +/- 4.8 [mean +/- SD]) and Hard Events (rs= .08, p=.83), Hard Acceleration (rs=.31, p=.39) and Hard Turning (rs= -.02, p=.96).

Conclusion

This preliminary analysis shows that despite finding variation in driving performance measures of Hard Events and Acceleration between participants, neither OSA severity or subjective sleepiness (EES), was correlated with the current data configuration. The ODESA study plans to test if neurophysiological measures (EEG), and temporal experience traces (TET), are more informative measures of driving behaviour in patients with suspected OSA.

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0500 Sleep Disordered Breathing in Children with Sanjad-Sakati Syndrome
Authors: Saleh Dana , Katwa Umakanth
Published: April 2024

Introduction

Sanjad-Sakati syndrome (SSS) is a rare, autosomal-recessive disorder with an estimated incidence of 1: 600,000 live births. 1 It has been primarily described in patients of Arab descent and manifests with extreme growth and developmental delays, hypoparathyroidism, scoliosis, risk for hypoglycemia, restrictive lung disease (RLD), and craniofacial abnormalities (infantile facies, depressed nasal bridge, micrognathia).1,2 RLD and low pulmonary reserve place affected children at high risk for sleep disordered breathing (SDB). To date, there are no reports of the pattern of SDB in these children.

Methods

We describe 2 female siblings with SSS who underwent polysomnogram (PSG) to evaluate for SDB.

Results

Patient one was 14 years old at time of PSG; she had severe short stature and RLD and presented with daytime fatigue and oxygen desaturation. She had baseline tachypnea and small oral and chest cavities. PSG demonstrated central sleep apnea (CSA) cAHI of 3.4/hr and REM dominant hypoventilation (CO2 52 - 67 torr), with 55% of total sleep time (TST) spent with CO2 > 50 torr. She was treated with BiPAP of 20/6 cw, with back up rate (BUR) 20/min to stabilize hypoventilation. Patient two had a similar clinical presentation; PSG at 19 years of age demonstrated severe REM-dominant CSA (cAHI 10.9/hr, REM cAHI 63.4/hr) with recurrent oxygen desaturations to a nadir of 67% and sleep hypoventilation (CO2 52-60 torr), 63% of TST was spent with CO2 > 50 torr. She was treated with BIPAP 19/5 with BUR 20/min.

Conclusion

Children with SSS are at high risk of SDB which is typically characterized by sleep hypoventilation that is worse in REM sleep, with severe REM hypoxemia and frequent CSA. They also tend to have poor sleep patterns, predominantly due to RLD and respiratory control dysfunction. Hence children with SSS should be screened for SDB and early treatment with bi-level positive pressure ventilation is recommended. In addition, these children are at high risk to study in sleep labs as they are at risk for seizures, rapid desaturations and/or hypoglycemia (due to low physiological reserve) and hence should be studied in the in-patient setting.

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Included 2 references 1. doi:10.7759/cureus.8770 2. doi:10.3390/children9040448
0505 Empowering OSA Care: Patient Profiles and Treatment Patterns in Japan
Authors: Khare Swarna , Lin Xiaoyu , Yin Can , Pettine Meghan , Adam Atif , Shinde Shraddha
Published: April 2024

Introduction

In Japan, the estimated prevalence of OSA is around 15%, and about 20% of adult males and 10% of postmenopausal women are estimated to have moderate-to-severe OSA. Despite the high prevalence, few studies have assessed the patient journey from sleep test to diagnosis and treatment initiation. This study aims to assess the patient journey and the associated real world treatment pathways.

Methods

This study utilized the retrospective longitudinal real-world Japan Claims database, standardized to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) from January 1, 2017, to May 31, 2022. The data encompassed patient demographics, OSA diagnoses, sleep study records, and treatment details. Adults over 18 with a minimum of 6 months of enrollment pre-diagnosis or treatment initiation were included.

Results

Of the 17,631 adults with OSA, 70.5% were aged 40-59, and 83.6% were male. Overnight polysomnography was used to diagnose 91% of the cases. All patients had at least one BMI reported within 1 year of OSA diagnosis with 9,185 adults (52.1%) having BMI >=25.0 kg/m². Dyslipidemia and hypertension were present in 19.2% and 18.5% of patients, respectively. The mean time from the first sleep study to OSA diagnosis was 7 months (SD: 16.8). 9,522 patients received OSA treatment, with 75% aged between 40-59 years and a male predominance of 92.8%. Mean time from OSA diagnosis to treatment was 3.5 months (SD: 5.1). Majority (98.6%) received Positive Airway Pressure (PAP) therapy as the primary treatment. Bariatric and upper airway surgeries were less common. PAP adherence within the first year after treatment initiation was higher amongst patients with obesity (93.1%) compared to those without (82.7%), with mean time on therapy being approximately 11.8 months (SD:0.2).

Conclusion

Our study highlights a significant prevalence of OSA, especially among middle-aged males and individuals with higher BMI. PAP therapy emerges as the primary OSA treatment with consistent adherence within the first year of treatment. Further research is needed to better understand the treatment outcomes and the unmet needs with the current standard of care for people living with OSA and Obesity.

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0516 Alice NightONE™ vs WatchPAT ™: How Do These Two Home Sleep Apnea Tests Compare to One Another?
Authors: Abbas Sayeda , Naik Sreelatha
Published: April 2024

Introduction

Home sleep apnea testing allows patients to test and receive prompt treatment for obstructive sleep apnea (OSA). We wanted to compare a traditional device such as the Alice NightOne™ to a newer device called WatchPAT™.

Methods

We looked at 119 studies using Alice NightOne™, as well as 120 studies using WatchPAT™. We compared the results of the two devices with the goal of calculating the total positive and negative results, the severity of sleep apnea, and the number of patients who were started on treatment. Sleep apnea severity was classified as mild, moderate, and severe.

Results

Of the 119 patient who underwent Alice NightOne™, 78.15% (93/119) had OSA. There were 66 females and 53 males, with an average age of 49.08 years, BMI of 35.20 kg/m2 and ESS of 8.2. Of the patients diagnosed with sleep apnea, 48.39% (45/93) were diagnosed with mild OSA, 22.58% (21/93) with moderate OSA and 29.03% (27/93) with severe OSA. 54.84% (51/93) patients were treated with CPAP therapy, while 21.51% (20/93) patients were recommended to have a titration study and 23.66% (22/93) patients were lost to follow up. Of the 120 patients who underwent WatchPAT™ study, 70.83% (85/120) had OSA. There were 56 females and 64 males, with an average age of 46.04 years, BMI of 35.99 kg/m2 and ESS of 9.1. 42.35% (36/85) were diagnosed with mild OSA, 21.18% (18/85) with moderate OSA and 36.47% (31/85) with severe OSA. Of the 85 patients who were diagnosed with sleep apnea, 87.06% (74/85) patients were treated with CPAP therapy, while 3.53% (3/85) patients refused therapy and 9.41% (8/85) patients were lost to follow up.

Conclusion

Based on the results of testing, we found that the diagnostic utility between the two modalities was comparable. WatchPAT™ was able to identify 70.83% of patients with OSA, while NightOne™ was able to identify 78.15%. Of the patients identified with sleep apnea, 54.84% of patients undergoing NightOne™ were started on CPAP therapy and 87.06% of patients undergoing WatchPAT™ were started on PAP therapy.

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0535 The Relationship Between Position-dependent Snoring and Sleep Apnea in Heavy Snorers
Authors: Song Xin , Tracy Emma , Ediger Tatiana , Kumar Ajay Karthick Senthil , Maidens John , He David , Moyen Nicole
Published: April 2024

Introduction

Snoring can often be one of the first signs of sleep apnea. Earlier research suggested that apneic snorers tend to be position-dependent (snore more when sleeping on their back); however, existing literature is inconsistent. Moreover, the prevalence of positional dependency among heavy snorers is not well-established. This study aims to assess the prevalence of positional dependency and how positional snoring is associated with sleep apnea in heavy snorers.

Methods

Thirty snorers (43.0 ± 12.1 y) qualified for the study by snoring >10% on one out of two screening nights measured by SnoreClock (an audio-based snore measurement app). For an average of three nights, participants used SnoreClock and wore a Home Sleep Test (HST) device (Zmachine Synergy), which recorded sleep positions using a tri-axial accelerometer and calculated the Apnea-Hypopnea Index (AHI). Snorers were categorized based on their average nightly snoring duration: mild (< 10%), moderate (10–40%), or heavy (>40%). Their nightly AHI was classified as non-apneic or apneic (mild, moderate, or severe). A night was position-dependent if snoring was reduced >50% in the lateral vs. supine position. Final classifications for positional dependency and AHI were based on the subject’s mode across nights. The relationship between positional dependency and AHI was examined.

Results

Of the 30 subjects tested over a total of 81 nights, 24 were classified as heavy snorers, 5 were moderate, and 1 was light. Among the 24 heavy snorers, 83.3% (n=20) were non-positional snorers, 87.5% (n=21) were apneic snorers, and 70.1% (n=17) were both. A Chi-Square Test of Independence revealed no significant association between the apnea severity and positional dependency among heavy snorers (χ²(3, N=24) = 2.4, p = 0.49), suggesting that the severity of sleep apnea, as measured by AHI, shows no strong association with positional dependency in heavy snorers.

Conclusion

This study shows that heavy snorers are more likely to be non-positional, and positional dependency is not associated with apnea severity. Contradicting previous research, our results indicate that the majority of heavy snorers with sleep apnea are not position-dependent, offering more insights into sleep-related breathing patterns.

Support (if any)

This study is funded by Eight Sleep Inc.