bluuebunny/crossref_metadata_2025 huggingface dataset:
0428 Taiep Rats Had Normal Levels of Orexin Neurons in the Lateral Hypothalamus But Their Cataplexy Attacks are Sensible to Specific Orexin B Agonist
Authors: Eguibar J R , Cortes C , Espinoza K , De Ovando C I
Published: May 2020

Introduction

Narcolepsy is characterized by sleep fragmentation, sleep paralysis, hypnagogic hallucinations and cataplexy. The cataplexy is a sudden loss of muscle tone triggered by emotions in humans, as well as in animal models. It is stablished that most of the patients had a significant decrease of orexin neurons in the lateral hypothalamus. Taiep rats had a mutation in tubulin TUBB4A and suffer immobility episodes (IE′s) that had a desynchronized activity in the cortex associated with theta rhythm in the hippocampus similar to narcolepsy patients. The aim of this study was to analyze the effects of central administration of an orexin B agonist and determination by immunohistochemistry of the number of orexin neurons on adult male taiep rats.

Methods

We used 14 male taiep rats of 9 months of age. The subjects (Ss) lived 3-4 in acrylic cages with water and food pellets ad libitum, under a 12:12 light-dark cycle (lights on at 0700), whit-controlled temperature and humidity in the recording room. All Ss were implanted to record EEG, EMG and EOG to characterize immobility episodes (IE′s) in a control 8 h recording and after i.c.v. administration of [Ala 11, D-Leu 15]-orexin B with 1, 3 and 10 nmol/1 μL. We measured the number, mean duration and latency to the first IE′s.

Results

The administration of [Ala 11, D-Leu 15]-orexin B significantly reduced the number of IE′s (P<0.01), from 4.28 ± 1.5 IE′s to just 0.25 ± 0.17 with 10 nmol/1 μL dose, but did not change the amount of awakening, slow wave or rapid eye movement sleep. Importantly, the number or orexins neurons were similar between taiep and Sprague-Dawley rats.

Conclusion

The myelin mutant taiep rats is a model of narcolepsy with cataplexy with normal number of orexin neurons in the lateral hypothalamus. Additionally, a specific orexin B agonist reduced IE′s without any effect the sleep pattern. This could be useful for the design of new treatments.

Support

CONACYT grants 243333 and 243247 to CC and JRE, respectively. Grants from VIEP-BUAP 2019 and CA in Neuroendocrinología BUAP-CA-288.
0433 Targeting Light Sensitivity Parameters to Optimize Circadian Phase Predictions
Authors: Stone J E , McGlashan E M , Cain S W , Phillips A J
Published: May 2020

Introduction

Existing models of the human circadian clock accurately predict phase at group-level but not at individual-level. Interindividual variability in light sensitivity is not currently accounted for in these models and may be a practical approach to improving individual-level predictions. Using the gold-standard predictive model, we (i) identified whether varying light sensitivity parameters produces meaningful changes in predicted phase in field conditions; and (ii) tested whether optimizing parameters can significantly improve accuracy of circadian phase prediction.

Methods

Healthy participants (n=12, 7 women, aged 18-26) underwent continuous light and activity monitoring for 3 weeks (Actiwatch Spectrum). Salivary dim light melatonin onset (DLMO) was measured each week. A model of the human circadian clock and its response to light was used to predict the three weekly DLMO times using the individual’s light data. A sensitivity analysis was performed varying three model parameters within physiological ranges: (i) amplitude of the light response [p]; (ii) advance vs. delay bias of the light response [K]; and (iii) intrinsic circadian period [tau]. These parameters were then fitted using least squares estimation to obtain optimal predictions of DLMO for each individual. Accuracy was compared between optimized parameters and default parameters.

Results

The default model predicted DLMO with mean absolute error of 1.02h. Sensitivity analysis showed the average range of variation in predicted DLMOs across participants was 0.65h for p, 4.28h for K and 3.26h for tau. Fitting parameters independently, we found mean absolute error of 0.85h for p, 0.71h for K and 0.75h for tau. Fitting p and K together reduced mean absolute error to 0.57h.

Conclusion

Light sensitivity parameters capture similar or greater variability in phase as intrinsic circadian period, indicating they are a viable option for individualising circadian phase predictions. Future prospective work is needed using measures of light sensitivity to validate this approach.

Support

N/A
0462 Identifying and Characterizing Insomnia Symptom Groups Across the Deployment Cycle in Current Army Soldiers
Authors: Miller K E , Boland E M , Klingaman E A , Gehrman P R
Published: May 2020

Introduction

Most research conducted on insomnia and its development in military personnel focuses on cross-sectional data, precluding examination of the course of sleep changes over time. The present study characterized Army Soldiers based on insomnia symptom status trajectory from pre to post-deployment and explored baseline factors predictive of these trajectories in a sample of 7,245 soldiers across 3 Brigade Combat Teams.

Methods

Data were analyzed from the Army Study to Assess Risk and Resilience in Service members (STARRS)-All-Army Study (AAS) Pre Post Deployment Study, using surveys that captured 1-2 months pre-deployment, during deployment, and 6-months post-deployment. Insomnia symptom status was defined at each timepoint as insomnia symptoms that interfered with one or more domains of functioning at least some of the time in the past month. Theoretically-derived variables linked to sleep disturbance were selected as predictors of insomnia symptom trajectory and evaluated using a general linear selection model.

Results

Four trajectories characterized the majority of the sample: ‘good sleepers’ (no insomnia symptoms across time; 44.4%), ‘non-remitting new onset insomnia’ (no pre-deployment insomnia, developed insomnia symptoms during deployment that remained at 6 months; 22.8%), ‘deployment-only insomnia symptoms’ (no pre-deployment insomnia, developed insomnia during deployment but recovered by follow-up; 12.8%), and ‘chronic insomnia’ (insomnia both pre- and post-deployment; 7.4%). Several pre-deployment factors predicted insomnia trajectory, the strongest of which were past six-month attention deficit disorder symptoms, number of lifetime exposures to potentially traumatic events, and past month depression symptoms.

Conclusion

Insomnia is one of the most common reasons that military personnel seek behavioral health treatment and is associated with poorer military readiness. Better characterization and identification of insomnia symptoms over time can improve intervention during post-deployment transitions, particularly for those with new onset insomnia that does not remit.

Support

Cooperative agreement U01MH087981 (Department of the Army; U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health); U.S. Department of Veterans Affairs, Clinical Science Research and Development-IK2CX001874-PI:Katherine E. Miller, IK2CX001501-PI:Elaine M. Boland; Rehabilitation Research and Development-1IK2RX001836-PI:Elizabeth A. Klingaman. The views expressed here are those of the authors and do not represent the Department of Veterans Affairs.
0469 Perceptions of an Education Only Control Group in the Osteoarthritis and Therapy for Sleep (OATS) Study: An Ongoing Statewide, Telephone-Delivered CBT for Insomnia (CBT-I) Randomized Trial
Authors: McCurry S M , Vitiello M V , Pike K C , Thakral M , Morin C M , Von Korff M
Published: May 2020

Introduction

Comorbid osteoarthritis (OA) and insomnia is common in older adults. CBT-I is efficacious for improving sleep in older persons with OA but not widely accessible. We examined treatment process data from OATS, a large ongoing clinical trial of telephone-delivered CBT-I.

Methods

327 Kaiser Permanente Washington members aged 60+ with OA, Insomnia Severity Index scores of 11+, and Brief Pain Inventory scores of 9+ were randomized to individual CBT-I vs. education only control (EOC). Six telephone sessions of CBT-I or EOC were offered over eight weeks. Participants rated their perceptions of treatment (credibility, acceptability, suitability, perceived effectiveness, adherence, and therapeutic relationship) on a 7-point Likert scale after session 1 and at 2-month post-test.

Results

Participants (mean age=70.2 years, 74.6% female) were randomized to the two treatment arms (CBT-I=163, EOC=164). Participants did not differ significantly across arms by age, gender, education, or by sleep, pain, or mood (depression, fatigue) outcome measures at baseline. CBT-I had significantly (p=.03) more white participants (90% CBT-I, 78% EOC). Study retention was 82% and 88% at post-test for CBT-I versus EOC, respectively. There was no difference in number of sessions attended (median=6). CBT-I sessions were somewhat longer than EOC (24.2 vs. 22.8 minutes; p=.005). Most participants in both groups at both time points gave high rankings (5+/7 points) on all six treatment perception ratings (CBT-I range: 75.9-99.3%; EOC range: 69.0-97.9%). Average summed treatment perception ratings improved between Session 1 and post-test for both conditions (mean=5.9 and 6.1, respectively, for CBT-I; mean=5.6 and 5.8, respectively, for EOC).

Conclusion

The OATS EOC group was credible and acceptable to participants, resulting in equivalently high levels of participation and retention compared to CBT-I. Findings suggest the ongoing trial has adequately controlled for nonspecific participant treatment effects that might confound interpretation of efficacy outcomes.

Support

This work was supported by PHS grant 5R01AG053221.
0483 Predictors of Cognitive Behavioral Therapy for Insomnia (CBT) Outcomes in Active Duty U.S. Army Personnel
Authors: Pruiksma K E , Hale W , Mintz J , Peterson A , Young-McCaughan S , Wilkerson A , Nicholson K , Dondanville K , Fina B , Borah E , Roache J , Litz B T , Bryan C , Taylor D J
Published: May 2020

Introduction

Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged.

Methods

The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active duty service members who received in-person CBTi in a randomized clinical trial.

Results

Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI).

Conclusion

Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes.

Support

This study was conducted with support from the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program award W81XWH-10-1-0828 (PI: Dr Taylor).
0515 Durability of Effects of Forehead Cooling on EEG Sleep Measures in Insomnia Patients from 2- to 30-Nights Use and 6-Month Safety Results
Authors: Rippole D , Schirm J , Nofzinger E
Published: May 2020

Introduction

Forehead cooling has previously been shown to improve EEG sleep measures in insomnia patients when applied for 2 nights. The current study assessed the durability of these effects after 30 days in home use as well as safety over 6 months in home use.

Methods

This was a prospective, open label trial involving 32 adults meeting diagnostic criteria for primary insomnia who previously had participated in a 2 night in lab EEG sleep study. In the current study, participants received an additional 30 nights in home treatment, then had repeat EEG sleep studies performed to determine if effects noted at 2 nights remained durable after 30 days. Subjects also participated in an open label 6-month in-home use safety study.

Results

Baseline, 2-night and 30-night EEG sleep measures for sleep latency were 80.7 ± 73.8, 25.3 ± 22.6, 26.2 ±25.8 minutes (2- to 30-night difference p=0.81, NS) and for sleep efficiency were 67.4 ± 15.7, 81.4 ± 11.2, 83.2 ± 13.6 (2- to 30-night difference p=0.18, NS). Subjective sleep quality (0-100 scale with 100=best) at baseline, 2-night and 30-nights were 29.8 ± 15.2, 48.3 ± 20.2, 57.2 ± 21.1 (linear improvements significant over time p<0.001). No adverse effects were seen across 6-months use.

Conclusion

Forehead cooling demonstrated durability of effects on EEG sleep measures from 2- to 30-nights use. Continuing improvements in subjective sleep quality when measured over time from baseline assessments to the end of the 30-night in-home use period were noted. Forehead cooling was safe over 6 months use in the home as evidenced by no serious device related adverse events.

Support

Ebb Therapeutics, Pittsburgh, PA 15222
0526 Objective Total Sleep Duration Do Not Predicting the Effectiveness of Cognitive-Behavioral Therapy for Insomnia (CBT-I)
Authors: Galbiati A , Sforza M , Leitner C , Filice A , Manconi M , Ferini Strambi L , Castronovo V
Published: May 2020

Introduction

Several studies investigated the role of objective sleep markers, in particular of Total Sleep Time (TST) in identifying different subtypes of Insomnia Disorder (ID) and in evaluating the efficacy of treatments. Based on objective TST two phenotypes of ID are usually distinguished in the literature: normal sleepers (objective sleep duration ≥ 6 hours) and short sleepers (objective sleep duration < 6 hours). Aim of our study was to evaluate in normal and short sleepers (objective sleep duration was assessed by both Polysomnography and Actigraphy) possible different response to Cognitive-Behavioral Therapy for Insomnia (CBT-I).

Methods

53 ID patients (females = 50.9%; mean age = 56.53±11.43) were divided into “Short Sleep duration” and “Normal Sleep duration” groups. All patients underwent 7-sessions group CBT-I. Main clinical outcome was Insomnia Severity Index questionnaire (ISI); secondary outcomes were Sleep Efficacy (SE), Sleep Latency (SL), Wake After Sleep Onset (WASO), Number of Awakenings (N°awk) according to sleep diaries.

Results

All ID patients showed significant improvements after treatment for all clinical outcomes. Non-significant effects of CBT-I between “Short Sleep duration” and “Normal Sleep duration” measured by patients were found in terms of ISI, SE, SL, WASO and N°awk, neither using Polysomnography nor Actigraphy. Furthermore, no accordance between these two objective measurements was found for the identification of the two subgroups.

Conclusion

Our findings suggest that the use of objective TST (both by Actigraphy and Polysomnography) is not a consistent predictor for CBT-I effectiveness. Moreover, only a small percentage of patients were classified as short or normal sleepers according both to Polysomnography and Actigraphy. These findings underline the instability and poor reliability of using objective TST in subtyping insomniacs.

Support

No
0543 Implementing Insomnia Care Paths for Older Adults and People with Dementia
Authors: Benca R , Ferziger R , Wickwire E M , Bertisch S , Biddle J , Boustani M , Culpepper L , Gooneratne N , Lett J , Manderscheid R , Mehra R , Reynolds C , Grandner M A
Published: May 2020

Introduction

Despite the high prevalence of insomnia in older adults and those with dementia, screening and treatment remain inconsistent and suboptimal. Implementing a care path in a health system, though, is difficult. To determine what issues are relevant for implementation, a consensus meeting was convened, which included discussion, voting on components, and further consensus-building.

Methods

All N=20 participants, representing a wide range of stakeholders including research, industry, sleep, primary care, implementation science, and others, voted whether they agreed or disagreed with 36 different statements regarding what issues are important for implementing geriatric insomnia care paths. These represented a range of items addressing strategies for identifying and incentivizing stakeholders, identifying patients in most need and who would receive benefit, addressing comorbidities and multiple specialties, understanding how specific organizations make decisions about and changes to care, size and scope of the care path, determining the process for implementation, how it will improve outcomes, addressing specific needs of primary care, and addressing costs, reimbursements, and liabilities. Items were scored as 0=strongly agree, 1=agree, 2=disagree, and 3=strongly disagree. Mean scores were evaluated and responses were dichotomized to agree/disagree).

Results

Despite the diversity among attendees, median rate of agreement for was 95% (IQR=90-95%). All items were endorsed by >=80% of respondents. Mean score was 0.48 (SD=1.85). 95%CIs were computed for each proportion and compared to the mean. The only item that significantly differed from the mean score indicated that understanding benefits of a care path to the general community is less important of an issue than others (M=0.85).

Conclusion

Implementing an insomnia care path for older adults in an institution will likely require addressing a wide range of issues, including questions about stakeholders, the health system/context, patients, and practical considerations.

Support

Merck Research Labs provided support
0550 Insomnia is Associated with Greater Arterial Stiffness and Cardiac Dysfunction
Authors: Petrov M E , Youngstedt S D , Mookadam F , Jiao N , Lim L M , Wong B , Angadi S S
Published: May 2020

Introduction

Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls.

Methods

Persons with insomnia (met ICSD-III criteria) and good sleeping controls (<8 Insomnia Severity Index, mean 8-night SOL and WASO<31min) were recruited from the community. Twenty-two adults (21-39y; 55% women) with no history of CVD, diabetes, inflammatory conditions, significant hypertension, or current sleep-disordered breathing (WatchPat200, Itamar Medical) were enrolled and underwent fasting cardiovascular testing. Testing included: Central augmented aortic pressure (AP) and carotid-femoral pulse wave velocity (cfPWV) for vascular stiffness; brachial artery flow mediated dilation (FMD) to assess endothelial function; and 2D echocardiography to assess ejection fraction (EF%), left ventricular global longitudinal strain (LVGLS), left atrial volume index (LAVI), mitral valve E/e’ ratio (E/e’), and lateral e’. ANCOVA models, adjusting for age, comparing persons with insomnia (n=6) to good sleeping controls (n=16) on each cardiovascular measure were conducted.

Results

AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’.

Conclusion

Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning.

Support

American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18
0565 Obstructive Sleep Apnea, But Not Short Sleep Duration, is Independently Associated with Insulin Resistance: A Large-Scale Cohort Study
Authors: Yin S , Xu H , Zou J , Zhang C , Guan J , Yi H
Published: May 2020

Introduction

Both short sleep duration and obstructive sleep apnea (OSA) seem to be associated with insulin resistance. However, the majority of previous studies addressing the relationship between OSA and insulin resistance did not evaluate short sleep duration, and vice versa. In this study, we used a large-scale hospital-based cross-sectional dataset, including 5,447 participants, to examine 1) whether objectively measured short sleep duration and OSA are independently associated with insulin resistance, and 2) whether the presence of OSA modulates the association between sleep duration and insulin resistance.

Methods

Participants were consecutively enrolled from our sleep center during the period from 2007 to 2017. The index of homeostasis model assessment insulin resistance (HOMA-IR) was calculated from insulin and glucose. Sleep duration was determined by standard polysomnography. The associations between sleep duration and insulin resistance were estimated by logistic regression analyses.

Results

A total of 5,447 participants (4507 OSA and 940 primary snorers) were included in the study. In comparison to primary snorers, OSA combined with extremely short sleep duration (< 5 hours) increased the risk of insulin resistance by 34% (OR, 1.34; 95% CI, 1.01-1.77) after adjusting for confounding factors that are frequently associated with insulin resistance and OSA. In subgroup analysis stratified by sleep duration, the risk of insulin resistance in patients with a short sleep duration (5-6 hours or < 5 hours) was increased in those with OSA compared to primary snorers, but not in the other three sleep duration groups (6 - 7, 7 - 8, and > 8 hours).

Conclusion

OSA, but not short sleep duration, was independently associated with insulin resistance. It is worth noting that OSA combined with extremely short sleep duration showed a greater detrimental effect than OSA itself with regard to insulin resistance.

Support

This study was supported by grants-in-aid from Shanghai Municipal Commission of Science and Technology (Grant No.18DZ2260200).
0566 Assessment of Soft Palate Muscle Fatigue and its Effect on Velopharyngeal Upper Airway (UA) Mechanical Properties
Authors: Li W , Gakwaya S , Masse J , Series F
Published: May 2020

Introduction

Soft palate muscles are crucial in the maintenance of UA patency. This study aimed to investigate the fatigability of soft palate muscles and to quantify its effects on velopharyngeal UA dynamic properties in OSA patients and control subjects.

Methods

8 control (AHI ≤ 10 /h), 21 OSA patients (13 with mild/moderate disease: 10 /h < AHI ≤ 20 /h and 8 with moderate/severe: AHI > 20/h) were included in the study. Subjects were asked to develop repetitive intra-oral positive pressure during cheek-bulging maneuvers while wearing a mouth piece to keep the jaw opened. Subjects were asked to develop sustained maximal bulging pressure for 5 sec every 10 sec until the peak pressure could not reach 85% of baseline maximal pressure for 2 consecutive times. UA dynamic properties were assessed by measuring instantaneous airflow and velopharyngeal pressure in response to phrenic nerve magnetic stimulation (PNMS) performed before, immediately and every 3 minutes after the fatiguing protocol for a maximum of 30 minutes’ recovery time. UA closing pressure (Pcrit) was estimated by modeling the flow/pressure relationship in response to PNMS.

Results

The sex, age, BMI and the soft palate mechanical properties (including the baseline strength, endurance time, total muscle work) did not significantly differ between the 3 groups. Maximal peak bulging pressure measured using cheek-bulging maneuver significantly changed following the fatigue task (p < 0.05). Baseline velopharyngeal Pcrit were less negative in moderate/severe OSA group compared to mild/moderate OSA (-6.5±2.6 vs. -11.9±3.2, p < 0.05). In mild/moderate OSA patients, PNMS-induced drop in maximal instantaneous airflow tend to increase 3 mins after the fatiguing trial compared to baseline (22.7±21.1 l.s-1vs. 9.6±5.8 l.s-1, p < 0.1), and their Velopharyngeal linear resistance 3 mins after the fatiguing trial tend to be higher than the moderate/severe OSA group (3.9 ± 5.0 cmH2O·l−1·s−1 vs. 1.8 ± 1.1 cmH2O·l−1·s−1, p< 0.1).

Conclusion

The cheek-bulging maneuver could induce soft palate muscle fatigue, with no difference observed in soft palate mechanical performances among patients with different OSA severity. The fatiguing maneuver could further alter velopharyngeal UA mechanical properties in patients with mild/moderate OSA.

Support

SBD from IUCPQ Foundation
0569 Soft Palate Fat Between Lean Adults with Obstructive Sleep Apnea and Healthy Control
Authors: Xu L , Keenan B T , Wiemken A S , Pack A I , Schwab R J
Published: May 2020

Introduction

Previous studies have shown that obese patients with obstructive sleep apnea (OSA) have a significantly greater percentage of fat tissue in soft palate than normal subjects. However, the influence of soft palate fat is not clear in non-obese adults with OSA. This study compared the volume of fat in the soft palate between lean adults with OSA and lean controls.

Methods

We examined soft palate fat in 21 lean OSA cases and 16 lean controls with body mass index (BMI) <25 kg/m2. All subjects underwent a magnetic resonance imaging (MRI) with three-point Dixon scan. We used volumetric reconstruction algorithms to quantify the amount of soft palate fat, which was compared between apnecis and controls. Analysis reproducibility was quantified using intraclass correlation coefficients (ICC) from repeated analyses of 20 randomly-chosen MRIs.

Results

Analysis of soft palate fat was highly reproducible, with an ICC (95% confidence interval) of 0.968 (0.923, 0.987). Lean apneics were younger than lean controls (45.3±13.0 vs. 62.1±10.4 years; p<0.0001). No significant differences between apneics and controls were observed in the average BMI (23.4±2.2 vs. 23.5 ± 2.6 kg/m2; p=0.824), the fat pads volume (4198±1728 vs. 3880±1544 mm3; p=0.646), and the proportion of males (61.9% vs. 68.8%; p=0.666). In unadjusted analyses, the lean OSA group showed significantly higher soft palate fat volume than lean controls (7605±2109 vs. 5327±1783 mm3; p=0.003). When adjusting for age, gender and BMI, no differences was observed between groups in soft palate fat volume (p=0.122) and fat pads volume (p=0.702).

Conclusion

Analysis of soft palate fat volume from Dixon MRI is highly reproducible. Our results indicate no significant difference in deposition of fat at soft palate between lean patients with OSA and lean controls when accounting for age, gender and BMI.

Support

This study is supported by National Institutes of Health Grant: 2P01HL094307-06A1. LX is supported by Young Elite Scientists Sponsorship Program of China Association for Science and Technology.
0574 Prevalence and Characteristics of Rapid Eye Movement Obstructive Sleep Apnoea (REM OSA) in a Multi-Ethnic OSA Cohort
Authors: Wong H , Poh Y , Mok Y
Published: May 2020

Introduction

Recent studies have shown that REM OSA is associated with increased incidence of hypertension and insulin resistance. However, there is a lack of Asian data on REM OSA. Our study aimed to examine the prevalence and characteristics of REM OSA in a multi-ethnic OSA cohort.

Methods

This was a retrospective observational study of all patients who underwent an overnight diagnostic polysomnography at a Singapore tertiary hospital from 1st August 2017 to 31st August 2018. All patients with a diagnosis of OSA (Apnoea Hypopnea Index (AHI) ≥5) were included in the study. REM OSA is defined as an overall AHI≥5, REM AHI/Non REM (NREM) AHI>2, NREM AHI<15 and at least 15 minutes of REM sleep.

Results

457 OSA subjects were included in the analysis. 19% (87/457) had REM OSA. Univariate analysis showed that REM OSA was more prevalent among female OSA than male OSA [34/115 (29.6%) versus 53/342 (15.5%) respectively, p<0.001]. Compared to non REM OSA, REM OSA had milder OSA severity [mean AHI 12.74±4.71 versus 45.34±28.38, p<0.001] and lower prevalence of hypertension [21/87 (24.1%) versus 138/370(37.3%), p=0.02]. No differences were found between both groups for age (p=0.273), ethnicity (p=0.615), Body Mass Index (p=0.336), diabetes mellitus (p=0.245) and Epworth Sleepiness Scale (0.06). Gender and OSA severity differences between both groups remained statistically significant in multivariate analysis (higher prevalence of REM OSA in female, p=0.043 and milder disease severity in REM OSA, p=0.006).

Conclusion

REM OSA was common in our OSA cohort and had higher prevalence in female and milder disease severity compared to non REM OSA. However, we did not find an increased prevalence of hypertension or diabetes mellitus in REM OSA. Further population-based study on REM OSA is needed to understand this phenotype better.

Support

NIL
0578 Incident Hypertension Rates in OSA Identified Using American Academy Of Sleep Medicine (AASM) Hypopnea Criteria, but Misclassified by Medicare (CMS) Hypopnea Definition
Authors: Budhiraja R , Javaheri S , Berry R B , Parthasarathy S , Quan S F
Published: May 2020

Introduction

The impact of not treating OSA identified using AASM standards (hypopneas scored using a minimum 3% O2 desaturation or arousal), but misclassified by CMS standards (hypopneas scored only if minimum 4% O2 desaturation) remains unclear. This analysis determined the ~5 year incident hypertension rates using the new 2018 ACC/AHA blood pressure (BP) guidelines in these individuals.

Methods

Data were analyzed from all Sleep Heart Health Study exam 2 study participants (N=1219) who were normotensive (BP≤120/80) at exam 1. The apnea hypopnea index (AHI) at exam 1 was classified into 4 categories of OSA severity: <5, 5 ≤15, 15 ≤30 and ≥30/hour using both the AASM or CMS definitions. Three definitions of hypertension were used: Elevated BP (>120/80), Stage 1 (>130/80) and Stage 2 (>140/90) to determine incidence rates at exam 2.

Results

Five year follow-up data were available for 476 participants classified as having OSA (AHI ≥5) by AASM criteria, but not by CMS standards at exam 1. Incident hypertension rates in these misclassified participants for ACC/AHA defined BP categories were 15% (Elevated BP), 15% (Stage 1) and 6% (Stage 2). 4% of normotensive participants used hypertensive medications. Overall incidence rate of at least an elevated BP was 40% (191/476) in those with OSA defined using AASM, but not by CMS criteria and 17% (191/1219) of the overall population at risk. In comparison to those with incident hypertension and OSA identified by CMS standards, BMI (27.7 vs 30.1 kg/m2, p<.001) and % men were lower (45 vs 58%, p=.012), but age and race were not different.

Conclusion

Use of the CMS hypopnea definition as a component of the AHI resulted in the failure to identify a significant number of individuals with OSA who eventually developed hypertension and could have benefited from earlier diagnosis and treatment.

Support

HL53938
0586 Advanced Tree Models to Predict Moderate-to-Severe Obstructive Sleep Apnea
Authors: Kim S , Yang K
Published: May 2020

Introduction

The aim of this study was to develop a predicting model for the moderate-to-severe obstructive sleep apnea (OSA) by using advanced tree models.

Methods

We retrospectively investigated the medical records of patients who undertaken overnight polysomnography (PSG) at our sleep disorders center. We divided the data to a training set (70%) and a test set (30%), randomly. We made a random forest and a XGBoost model to predict the moderate-to-severe OSA (apnea hyponea index [AHI] ≥ 15/h) by using the training set, and then applied each models to the test set. To compare the fitness of the models, we used an accuracy, and an area under curve (AUC).

Results

Finally, 1,426 patients (AHI < 5:AHI ≥ 15= 464:962) were enrolled. The random forest model showed an accuracy of 0.79, and AUC of 0.82. In the random forest model, the sleep apnea scale of the sleep disorders questionnaire (SA-SDQ), age, neck circumference, male sex, body mass index (BMI), hypertension, and hyperlipidemia appeared in order of a variance importance. The XGBoost model showed an accuracy of 0.75 and AUC of 0.79.

Conclusion

The random forest model to predict moderate-to-severe OSA showed better performance compared to the XGBoost model. The further study for validation is required.

Support

None
0591 The Significance of Body Mass Index in Varying Sleep Apnea Levels for Men and Women
Authors: Jones A M , Rogers A E , Hertzberg V S , Bliwise D L , Lewis T T
Published: May 2020

Introduction

A BMI increase, in men and women, is associated with an increased severity and progression of OSA. This study will examine the impact of BMI on varying levels of OSA severity and progression.

Methods

Participants, divided by sex, included 2728 (47%) men and 3076 (53%) women over the age of 40 that were in the Sleep Heart Health Study (SHHS). Participants were separated into 1 of 10 groups based on initial OSA levels at SHHS time point 1 (SHHS1) and ending OSA levels at SHHS time point 2 (SHHS2) as measured by RDI. A Kruskall-Wallis test examined the BMI median differences in the groups. Post-hoc tests, including pairwise comparisons and Wilcoxon rank sum test with Holm adjustment, were conducted to further examine results.

Results

Significant differences existed between certain groups (Men: Chi-Square=146.87, p<.001, df=9; Women: Chi-Square=128.59, p<.001, df=9). For men and women, those in the group with normal OSA levels at SHHS1 and SHHS2 had significant BMI differences compared to those in all 9 other groups where mild, moderate, or severe OSA levels exist at SHHS1 or SHHS2. Additionally, in men, BMI is significantly different for those with normal or mild OSA levels at SHHS2 compared to those with moderate or severe OSA levels at SHHS2. Also, a significant BMI difference exists in men maintaining mild OSA levels throughout SHHS compared to those maintaining severe OSA levels.

Conclusion

Although BMI is a known influential factor in OSA progression, this study demonstrated that those maintaining normal OSA levels over time have a significant BMI difference compared to those reaching even mild OSA levels over time. Additional implications were also found for men. These findings may coincide with recent research suggesting that one needs to progress only to moderate OSA levels to reach a tipping point of significantly increasing and impacting many health risks.

Support

Robert Wood Johnson Foundation Future of Nursing Scholars Program
0592 Prevalence of Sleep Apnea in Patients with Tracheobronchomalacia
Authors: Chopra S , Luthra S , Dalal L , Blattner M , August J , Thomas R , Heckaman E
Published: May 2020

Introduction

Tracheobronchomalacia (TBM) is a pathologic weakness in the trachea and bronchi leading to excessive dynamic narrowing of the airway. A relationship between sleep disordered breathing (SDB) and TBM has been observed before. SBD may be an important contributor to development or progression of TBM. The objective was to determine the Prevalence and characteristics of sleep disordered breathing in patients with tracheobronchomalacia.

Methods

We performed a retrospective chart review of patients who have been diagnosed with tracheobronchomalacia and who also underwent a polysomnogram (PSG) at the AASM - accredited Sleep Center of Beth Israel Deaconess Medical Center.

Results

In our 24 patient cohort of TBM, 71% were females, mean age 55 years (SD ± 12.3 years) and mean BMI 31.7 kg/m2 (SD ± 9.4 kg/m2). In patients with TBM we found a sleep apnea prevalence of 62.5% (n= 15), defined as an apnea-hypopnea index>5/hour (hour) with a desaturation greater than 4%. Of the 15 patients, 73.3% (n = 11) had mild sleep apnea, 20% (n = 3) had moderate sleep apnea, 6.6% (n = 1) had severe sleep apnea, defined per the AASM criteria with oxygen desaturation greater than 4%. The TBM cohort had a mean sleep efficiency of 72.7% (SD ± 22.2%) with a mean REM of 16.3% (SD ± 9.8 %). Other characteristics included a median AHI 3% of 19.9/hour (95% CI 3.9 - 25.0), median AHI 4% of 5.5/hour (95% CI 3.9 - 9.3), Respiratory disturbance index of 22/hour (95% CI 15.1 to 28.4). No unique challenges for treatment with positive airway pressure were noted.

Conclusion

Sleep apnea may be more common in patients with tracheobronchomalacia and could be regularly screened.

Support

none
0599 The Association Between Obstructive Sleep Apnea and Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis
Authors: Sutherland R , Platt J
Published: May 2020

Introduction

Sleep related breathing disorders (SRBD) are common (20% prevalence) in the general population and can have multiple health consequences. There is growing evidence that chronic hypoxia - a key consequence of sleep apnea - is a common feature in solid tumour tissue, therapeutic resistance, tumour progression, and metastasis. However, there is conflicting evidence regarding the association between sleep apnea, cancer incidence, or mortality. A review of all available literature and subsequent meta-analysis was done to clarify these relationships.

Methods

A thorough literature search was completed using Medline, EMBASE and Web of Science databases. The search resulted in 7222 studies, 1551 duplicates were removed, 5552 studies were removed after abstract screening, and full text review was done on 119 studies, yielding 12 full retrospective cohort studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. Review and data extraction were done in duplicate.

Results

In the pooled analysis, 9 studies totalling 2,358405 subjects with OSA and 3.97% cancer incidence and 2,442794 subjects without OSA and 3.35% cancer incidence. A random effects model with inverse-variance weighting analysis yielded an unadjusted OR = 1.32 (95% CI: 0.76 - 2.30). After 2 studies with a moderate risk of bias were removed the pooling yielded an OR = 1.89 (95% CI: 0.99 - 3.50). Heterogeneity was high at 99.9% p-value less than 0.01. Meta-regression was then done to assess for the cause(s) of heterogeneity sex, age, or BMI were not significant contributors. A review of 3 studies, which included cancer mortality, was done. Hazard ratios in 2 studies suggested OSA increased the risk of cancer mortality. Hazard ratios also increased with increasing OSA severity.

Conclusion

Sleep apnea significantly increases cancer mortality and is positively associated with increasing severity. Meta-analysis demonstrated an 86% increase in the unadjusted odds of cancer in those with sleep apnea. However, this result was borderline non-significant with high heterogeneity. Further studies may be helpful in determining the true associations between sleep apnea and cancer.

Support

None.
0605 Comparison of Sleep Specialist vs Primary Care Driven Home Sleep Apnea Testing in Routine Practice
Authors: He K , Mendez M , Atwood C W
Published: May 2020

Introduction

Home sleep apnea testing (HSAT) has largely supplanted diagnostic polysomnography. Primary care (PC) driven HSAT utilization is common especially in rural settings that lack sleep specialist (SS) support. There have been no studies comparing appropriateness of HSAT utilization in veterans managed by SS vs. PC.

Methods

We use hub and spoke model to manage patients with OSA. SS selects testing for hub and PC utilizes HSAT for spoke patients. Testing is interpreted by SS. Patients referred for HSAT using WatchPAT over 4 months were compared on test failure rate, adherence to AASM guidelines for OSA diagnosis, adherence to HSAT use criteria, and diagnostic success rate (AHI ≥5) in high risk patients (STOPBANG ≥5) without significant comorbidities or HSAT contraindications compared to all comers.

Results

There were 125 hub and 170 spoke patients included in the analyses. Baseline characteristics were similar between sites (gender, age, BMI, Epworth sleepiness scale, neck size, STOPBANG, pacemaker dependence, and medication use affecting HSAT). Spoke patients had slightly higher prevalence of comorbidities (hypertension, cardiac arrhythmia, heart failure, COPD, stroke, and long acting opioid use). Complete HSAT failure (no data) was 2% and technical failure (monitoring time <4 hours) was 13% at both sites. Unnecessary studies primarily to confirm OSA in those previously diagnosed on therapy seeking to establish care were 3% (hub) and 21% (spoke). HSAT done in patients without significant comorbidities was 77% (hub) and 68% (spoke). Adherence to HSAT use criteria was 74% at both sites. Diagnostic success rate of prespecified and all comers was 65% vs. 60% at hub and 86% vs. 64% at spoke sites.

Conclusion

Adherence to AASM guidelines and HSAT use criteria was overall fair with low failure rates. Further improving HSAT protocol for SS and PC with the aim to improve diagnostic success rate and minimize unnecessary studies should be pursued.

Support
0606 Comparative Effectiveness of Sleep Apnea Screening Tools During Inpatient Rehabilitation for Moderate to Severe TBI
Authors: Richardson R , Schwartz D , Drasher-Phillips L , Ketchum J , Calero K , Dahdah M , Monden K , Bell K , Hoffman J , Magalang U , Bogner J , Whyte J , Zeitzer J
Published: May 2020

Introduction

Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions.

Methods

This is a prospective diagnostic comparative effectiveness trial of sleep apnea screening tools (STOPBANG, Berlin, MAPI [Multi-Apnea Prediction Index]) relative Level 1 polysomnography at six TBI Model System Inpatient Rehabilitation Centers. Between 05/2017 and 02/2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The primary outcome was the Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).

Results

Participants were primarily young to middle age (AGE IQR 28,40,59), male (81%), white (74%), and had primarily severe TBI (IQR GCS 3,6,14). A subset (26%) had a history of military service. Results revealed that the Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROCAUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI>5. The pattern was similar across TBI severity subgroups except for delirium or post-traumatic amnesia status wherein the MAPI outperformed the Berlin and STOPBANG. Youden’s Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.

Conclusion

This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for moderate to severe TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.

Support

PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
0631 Respiratory Infection Risk in PAP Users
Authors: Horvat M , Gavidia R , Dunietz G L , Braley T
Published: May 2020

Introduction

Although positive airway pressure (PAP) effectively treats obstructive sleep apnea (OSA), adherence remains suboptimal for many patients. One factor that may influence a patient’s decision to use PAP is a prevailing concern that use of unsanitized PAP equipment may serve as a reservoir for pathogens that cause respiratory tract infections (RTI). Conversely, untreated OSA could also have long-term consequences, including impaired immune function, raising the possibility that PAP therapy could reduce RTI risk. The objective of this study is to compare RTI patterns before and after initiation of PAP in persons with OSA, and examine clinical characteristics that may influence RTI risk.

Methods

Patients with at least 2 years of continuous primary care at Michigan Medicine preceding and following their OSA diagnosis (N=480) were considered eligible for analyses. Medical charts were reviewed to determine pre- and post-PAP RTI frequency and characteristics during this time frame. Change in RTI frequency was examined with paired T-tests.

Results

Male:female ratio was 1:1, mean age 56 years, mean apnea hypopnea index was 10, N=85/480 had documented good PAP compliance (defined as ≥ 4h/night, 70% of the nights). Among 480 patients, total RTI frequency pre and post PAP therapy were 170 and 144 respectively (p=0.11). Data collection is ongoing.

Conclusion

These preliminary data suggest that use of PAP is not associated with increased risk of respiratory infections. Further data regarding clinical characteristics that may influence RTI risk in OSA patients will be informed by ongoing data collection and planned multivariable analyses.

Support

Dr. Gavidia is supported by a Training in Clinical and Basic Neuroscience T32 (NIH/NINDS T32 NS 007222)
0632 The Correlation Between Severity of Obstructive Sleep Apnea and Patient Compliance
Authors: Roberts A C , Bastin G
Published: May 2020

Introduction

Obstructive sleep apnea (OSA) is a prevalent disorder affecting 9-38% of the global population and is linked to multiple health complications. Continuous Positive Airway Pressure (CPAP) is regarded as the gold standard treatment for OSA, but its efficacy is limited by poor patient compliance. Studies have linked many clinical and lifestyle factors to CPAP adherence, but have produced conflicting outcomes. Based on the current literature, it is assumed patients diagnosed with severe OSA are more likely to be compliant with CPAP due to a greater improvement in quality of life. The goal of this study is to compare the compliance rate of CPAP for patients with mild, moderate, and severe OSA, as well as identify other potential predictors of CPAP compliance.

Methods

This study is a retrospective chart review of 100 patients who were newly diagnosed with OSA and started on CPAP between January 1, 2017 and January 1, 2018. Baseline demographic data, past medical history, OSA severity, Epworth sleepiness scale, and compliance to CPAP therapy were recorded. Compliance was defined as CPAP usage greater than four hours per night for at least 21 days per month.

Results

Mean follow-up time after CPAP initiation was 3.19 months. Overall 77% of patients were compliant to CPAP therapy, of which 48% were males and 52% were females (P=0.48). CPAP compliance rates for mild OSA (79.3%), moderate OSA (73.7%), and severe OSA (78.8%) showed no significant difference for independence (P=0.83) or correlation with compliance (P=0.99). Only seasonal allergic rhinitis showed a positive association with CPAP adherence (P=0.031) and depression showed a negative association (P=0.027).

Conclusion

The level of OSA severity is not a significant predictor of short-term CPAP compliance among newly diagnosed patients.

Support

Parkview Physicians Group, Indiana School of Medicine - Fort Wayne, and the Dr. Luis and Anne B Schneider Foundation.