bluuebunny/crossref_metadata_2025 huggingface dataset:
0469 Efficacy of In-Person vs Telehealth Positive Airway Set-Up in Veterans
Authors: Gomez Alexander , Sarmiento Kathleen , Ryden Armand , Mitchell Michael , Lee Diane , Smith Connor , Seo Jiyeon , Bhattacharyya Sarathi , Harris Brian , Mempin Roberto , Moghtaderi Isabel , Jawed Yameena , Martin Jennifer , Zeidler Michelle
Published: May 2023

Introduction

The SARS-CoV-2 pandemic necessitated a transition to sleep telehealth, including for positive airway pressure (PAP) set up. Prior to this change, the standard of care for initiation of PAP therapy included a face-to-face visit with education. This study sought to evaluate whether telehealth set-up was non-inferior to in-person set-up for veterans initiating PAP therapy.

Methods

VA patients were identified through prosthetic inventory package orders at two large VA systems. The telehealth PAP set-ups occurred between March, 2020 and December 2021. The in-person PAP set ups occurred between January and December, 2019. PAP data was extracted for days 1-30 (month 1) and 60-90 (month 3). PAP use was compared between in-person and tele-medicine utilizing hours used per night, days used (out of 30 days), and residual AHI (among compliant users). Non-inferiority analyses were performed, using the following non-inferiority margins: 45 minutes for hours used, 4 days for days of usage, and 5 events per hour for residual AHI.

Results

432 VA patients (93.5% male) who underwent PAP set up were included (224 in person; 208 telehealth). Average age and BMI (SD) were 55.9±15.8 years and 31.9±5.6. Race and ethnicity identification was 60.7% White; 15.7% Black; 6.9% Asian and 15.5% Hispanic/Latino. 76.2% of participants resided in urban locations. Non-inferiority was established for PAP usage at month 1 (90% CI=-0.31,0.53) and month 3 (90% CI=-0.18, 0.71), days used at month 1 (90% CI=-2.28, 1.33) and month 3 (90% CI=-1.75, 2.20), and residual AHI at month 1 (90% CI=-0.40, 1.62) and month 3 (90% CI=-0.69, 2.30).

Conclusion

Initiation of PAP therapy via telehealth was non-inferior to in-person set up visits in terms of PAP adherence among Veterans who use VA care. Findings suggest that veteran preference and structural factors should be considered in determining which approach is most appropriate for a given patient.

Support (if any)

VA Office of Connected Care QI; VA HSR&D RCS-20-191 and NIH/NHLBI K24HL143055 (Martin).
0476 Peripheral Arterial Tonometry-Based Home Sleep Apnea Test vs. Polysomnography in Detection of Central Disordered Breathing Events
Authors: Jenad Hussam , Junna Mithri , Selim Bernardo , Park John
Published: May 2023

Introduction

In-laboratory polysomnography (PSG) is the gold standard diagnostic test for sleep-disordered breathing (SDB). WatchPAT® is a type of home sleep apnea testing (HSAT) that utilizes peripheral arterial tone (PAT) signals and other sensors to evaluate for SDB. There is an abundance of data to support the use of a PAT-based HSAT for obstructive sleep apnea (OSA), though data to support its use in central sleep apnea (CSA) in the general population undergoing PSG is lacking. We therefore aimed to compare the agreement of a PAT-based HSAT and PSG in detecting central disordered breathing events in the general population undergoing PSG.

Methods

A prospective cross-sectional study was conducted in eligible adult participants with suspected sleep apnea who were scheduled to undergo diagnostic or split-night PSG at the Center for Sleep Medicine at Mayo Clinic in Rochester, MN, between May 2021 and October 2022. The PAT-based HSAT was applied during the night of PSG to obtain simultaneous recording. Subjects were excluded if they had chronic atrial fibrillation, permanent pacemaker, or finger deformity precluding finger probe use or if they were on alpha- antagonists or short-acting nitrates. The PAT-based HSAT data were automatically scored with the use of proprietary software, and the PSG data were manually scored by registered polysomnography technologists. All studies were reviewed by board-certified sleep medicine providers.

Results

A total of 147 subjects (53% female) were included in the final analysis after excluding 18 subjects due to malfunction of the PAT-based HSAT. The subjects had a mean age of 58±15 yrs and BMI of 34±9 kg/m². 95 (65%) subjects underwent split-night studies. OSA was diagnosed in 81% with a mean PSG AHI of 28±27 events per hour. CSA was diagnosed in 3% of subjects with a mean PSG AHI of 33±27 events per hour. Of the total 2120 central disordered breathing events reported by the PAT-based HSAT (mean pAHIc 3±5 events per hour), 365 (17%) correlated with central apneas and 78 (3.7%) correlated with central hypopneas found on PSG.

Conclusion

In our prospective study, the PAT-based HSAT demonstrated low positive predictive value in detecting central disordered breathing events when compared to PSG.

Support (if any)
0482 Sleep Apnea Diagnosis Disparities from Serious Mental Illness in a Veteran Cohort
Authors: May Anna , Carter Isabelle
Published: May 2023

Introduction

Sleep apnea (SA) diagnosis requires multiple steps including an office visit and testing. People with serious mental illness (SMI) may require a longer time from referral to diagnosis and be less likely to complete the full diagnostic pathway because of functional limitations.

Methods

A retrospective cohort of VA Northeast Ohio Healthcare System Veterans referred for sleep medicine consultation (1/1/2010-12/31/2020). Dates of consultation, sleep clinic visits, and testing was collected in addition to demographics, past medical history, and medications at the time of initial consultation. SMI was defined as a composite of schizophrenia, schizoaffective disorder, and bipolar diagnosed disorder before the initial consultation. The outcome was defined as the time until fulfilling minimal SA diagnostic pathway defined as completing both a sleep clinic appointment and at last one sleep test. Relationships between SMI and pathway completion were tested using survival analyses. Analyses were adjusted for age, sex, race, insurance status, service connection percent, Medicare eligibility, marital status, alcohol use, and drug use to account for other potential sources of health disparities. Sensitivity analyses evaluated differences in time to pathway completion via the Wilcoxon-Mann-Whitney test.

Results

The cohort (n=11,030) was primarily male (91.1%), with mean age of 55.8 ±14.4 yrs, with mean body mass index of 32.9 ± 6.4 kg/m2, and a mean pathway completion in 71 days, interquartile range (IQR): [33, 135]. Those with SMI had similar pathway completion rates (89.9% in SMI vs. 90.2% without), but a longer time to completion (83 days, IQR = [35.5, 185.5] in SMI vs. 70 days IQR: [32, 132]). Pathway completion time was significantly higher in those with SMI (Wilcoxon rank sum test difference = 9.0 days, 95%CI: [4.0, 14.0]. ]SMI was associated with a lower hazard of time to pathway completion (HR = 0.87, 95% confidence interval (CI): [0.91, 0.94] in unadjusted and HR = 0.87, 95%CI:[0.81, 0.94].

Conclusion

Although pathway completion rates were similar, Veterans with SMI were more likely to take longer before pathway completion. Additional investigation of factors that delay pathway completion may offer tailored avenues to improve the time to diagnosis.

Support (if any)

VA CSR&D IK2CX001882
0486 The Effect of Acoustic Resonance Therapy on CPAP Adherence
Authors: Munafo Dominic , Gopi Paramesh , Mohan Vivek , Hwang Peter , Lin Bryant , Hekier Elan , Lane Bretton , Guerrero Christy , Dauphin Betsy , Kushida Clete
Published: May 2023

Introduction

CPAP is the gold standard therapy for OSA. Unfortunately, a significant percentage of patients do not tolerate CPAP therapy. Of those who struggle, a significant portion state that nasal congestion is a limiting factor. Acoustic Resonance Therapy (ART) is a new non-medication based treatment for nasal congestion. We sought to determine if patients struggling with Medicare CPAP adherence and reporting nasal symptoms would benefit by the addition of ART.

Methods

This was an IRB approved, prospective, non-randomized, controlled pre-/post-treatment study. Twenty-five adult participants with an OSA diagnosis (AHI>5) were enrolled by BetterNight (OSA management, San Diego, CA). Participants were new to CPAP within the previous 90 days and were not Medicare adherent. Participants self-reported nasal congestion as a significant contributor to non-adherence. After struggling with CPAP for varying durations, participants began the Sonu vibrational headband system (SoundHealth Systems, Los Altos, CA) for 15 minutes each evening, immediately prior to wearing CPAP, on 28 sequential nights. The Sonu headband is worn circumferentially just above the eyebrows. It utilizes a smartphone application and the self-facing camera to capture a facial scan and estimate sinonasal volume which determines the appropriate resonant frequencies and harmonics. Two vibrational transducers produce a signal in the audible acoustic range, from 80 Hz to 16 KHz. Total nasal symptom scores (TNSS) were obtained at baseline and self-reported daily during Sonu use.

Results

Participants were 64% male, age 48.2±12.9, AHI 31.6±22.7, BMI 32.5±6.6 (mean±SD). On days the 25 participants used CPAP, mean hours (h) of use increased during the intervention from 2.7h±1.9 to 4.0h±2.2 (48%,p=0.004). On a subset of 12 participants for whom 28 days of pre/post data was available, mean total hours of CPAP use increased from 64.8h±51.6 to 94.0h±59.4 (45%,p=0.0107). CPAP Medicare adherence increased from 30.0%±27.4 to 45.8%±35.0 (53%,p=0.0175). TNSS decreased from 4.8±2.2 to 2.1±1.9 (-56%,p=0.0016).

Conclusion

The use of the Sonu headband was associated with increased hours of CPAP use, improved CPAP adherence and reduced nasal symptoms.

Support (if any)
0488 The Relationship between Myocardial Blood Flow and Diastolic Function in a Clinical Population with Obstructive Sleep Apnea
Authors: Aneni Ehimen , Saeed Gul jana , Thorn Stephanie , Miller Edward , Sinusas Albert , Yaggi H
Published: May 2023

Introduction

Emerging evidence links abnormal myocardial blood flow reserve (MBFR), a marker of coronary microvascular dysfunction (CMD), and heart failure with preserved ejection fraction (HFpEF). However, the relationship between CMD and diastolic dysfunction (DD) in patients with OSA remains unclear. We analyzed the relationship between OSA, abnormal MBFR and markers of DD in a patient cohort.

Methods

Using healthcare records, we generated a cross-sectional database of 231 individuals who had sleep testing, echocardiogram(s), and cardiac PET stress test. Abnormal MBFR was defined as the stress-to-rest ratio of myocardial blood flow < 2.0. We created DD score with a point each given to a) left atrial volume index (LAVI) ≥34, b)average E/e’ ratio>14/lateral e’>10/medial e’>7, and in a subgroup of 122 individuals with available data we added c)tricuspid regurgitation jet (TR) velocity > 2.7m/s. Higher scores suggest greater likelihood of DD. Models were adjusted for demographics and cardiometabolic risk factors.

Results

The mean (SD) age and BMI was 60(11) years and 39.5(8.7) kg/m2; 61% were female. Eighty-four participants had severe OSA (apnea-hypopnea index ≥ 30/hr). Compared to non-severe OSA, severe OSA was associated with 2-fold odds of abnormal MBFR (adjusted OR [aOR) 2.1, 95%CI:1.1–4.0). However, there was no association with abnormal LAVI, abnormal E/e’ (average E/e’>14 vs. < 9), or elevated TR velocity. In the adjusted model, abnormal MBFR was associated with abnormal E/e’ (aOR 4.4 [95% CI: 1.6-11.8]) and elevated TR velocity (aOR: 3.7 [95%CI: 1.3-10.9]). Abnormal MBFR was associated with increase in DD score (range 0–2; aOR per-unit increase = 1.7 [95% CI: 1.0-3.0]. In the subset with data on TR velocity, abnormal MBFR was associated with a three-fold increase in the odds of a unit increase in DD score (range 0–3; aOR 3.3 [95% CI: 1.5,7.4]). The association between abnormal MBFR and DD was present regardless of OSA severity. Severe OSA was not associated with DD.

Conclusion

Abnormal MBFR/CMD may be implicated in the development of DD and HFpEF in patients with OSA. MBFR assessment may be useful in HFpEF risk stratification in non-severe OSA. Larger studies are required to determine the role of CMD in the development of DD/HFpEF in OSA.

Support (if any)
0496 Factors Associated with the Report of Trouble Sleeping to Healthcare Providers in Adults at High Risk for Obstructive Sleep Apnea
Authors: Orbell Staci , Scott Paul , Baniak Lynn , Chasens Eileen , Godzik Cassandra , Jeon Bomin , Morris Jonna , Luyster Faith
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) is often underdiagnosed and untreated partially because only one-third of adults with symptoms of OSA talk to a healthcare provider (HCP) about their sleep. It is unclear how sociodemographic and clinical factors may influence communication with HCPs regarding sleep difficulties in adults at risk for OSA. This analysis examined associations between sociodemographics, comorbidities, and OSA-related symptoms and reporting trouble sleeping to an HCP in adults at high risk for OSA.

Methods

The sample comprised adults at high risk for OSA (STOP-Bang of >=5 or STOP >=2 + body mass index (BMI) >35 kg/m2 or male sex) from the 2015-2018 National Health and Nutrition Examination Survey (n=2009). Participants were asked, “Have you ever told a doctor or other health professional that you have trouble sleeping?” OSA-related symptoms included daytime sleepiness, fatigue, insomnia, nocturia, snoring, and snorting/gasping/breathing cessation during sleep. Weighted binomial logistic regression models were employed.

Results

Participants were middle aged (mean age = 53.21 years + 0.5), obese (mean BMI = 34.76 + 0.25 kg/m2), and primarily male (71.9%) and white (65.2%). Half of the sample (50.8%) never reported trouble sleeping to an HCP. Female sex, former smoking, and diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and/or snorting/gasping/breathing cessation during sleep were associated with higher odds of reporting trouble sleeping to an HCP. Snoring was not a significant predictor. Mexican American and non-Hispanic Asian race, having less than a high school education, and male sex were associated with lower odds of reporting trouble sleeping to an HCP.

Conclusion

Not reporting trouble sleeping to an HCP among adults at high risk for OSA is common. Differences in sex, race, education, smoking status, comorbidities, and OSA-related symptoms exist between whose who have and have not reported trouble sleeping to an HCP. Insomnia and snorting/gasping/breathing cessation during sleep were the strongest symptom-related factors associated with reporting trouble sleeping to an HCP. It is important for HCPs to ask all adults about sleep problems, recognizing that men, racial minorities, and persons with lower educational attainment may be less likely to initiate a conversation about trouble sleeping.

Support (if any)

None
0499 Identifications of symptoms clusters by the Quebec Sleep Questionnaire in sleep apnea patients
Authors: Series Frederic , Lajoie Annie , Lacasse Yves
Published: May 2023

Introduction

Sleep apnea (SA) patients may present different symptom clusters. The clinical importance of such clustering is supported by the differences in the incidence of cardiovascular diseases between hypersomnolent and non hypersomnolent patients. The Quebec Sleep Questionnaire (QSQ) has been elaborated 20 years ago that documents quality of life in SA patients by measuring the impact of the disease on five different domains (nocturnal and diurnal symptoms, hypersomnolence, emotions and social interactions). Previous cluster analyses took into account the frequency of typical SA symptoms. Many, but not all symptoms selected in these studies are addressed in the QSQ. The objective of this study is to determine if quality of life clusters can be identified using responses collected from the QSQ in SA patients.

Methods

A cluster analysis was completed in symptom scores collected from the QSQ+ Epworth scores in147 patients who filled in the questionnaire during its validation (75.5 % males, age: 53 ± 11 y, BMI: 30.4 ± 4.7 Kg.m2, AHI 31.3 ± 14.8 /h). For each item, patients were considered as symptomatic for scores ≤ 4 (the lowest the score the higher the impact) and for ESS > 10.

Results

Three clusters were identified: patients in cluster 1 (20.4 % of patients) can be identified as minimally symptomatic in each domain. In the cluster 2 (32.6 %), quality of life was mainly impacted by hypersomnolence with disturbed sleep. Patients in cluster 3 (46.9 %) reported important impacts on their quality of life in each domain of the QSQ. Gender, BMI and AHI did not differ between the three clusters. However, patients in cluster 1 were significantly younger than those of cluster 2 (50.5 ± 9.9 and 57.6 ± 11.9 years, respectively, p = 0.01).

Conclusion

Different clusters of quality of life can be identified by the QSQ in SA patients. These clusters seem to have close similarities with previously reported symptom frequency driven clusters. The relationship between quality of life symptom clusters and long-term clinical outcomes should be explored in a large prospective cohort of sleep apnea patients.

Support (if any)
0502 Number of Nights to Achieve High Sensitivity/Specificity for Detecting OSA Using a Large US Sample by Home Under-Mattress Devices
Authors: Kushida Clete , Cotton-Clay Andrew , Fava Laura , Easwar Venkat , Kinsolving Arthur , Kahn Philippe
Published: May 2023

Introduction

Clinical sleep studies typically rely on one night for OSA detection and diagnosis. However, uncertainty exists regarding the degree of AHI stability across different nights. Population studies collecting continuous nightly data on a large scale enable detection of night-to-night variability in OSA severity; this study is the largest to date for evaluation of the number of nights to achieve high sensitivity/specificity for OSA detection.

Methods

Sleep-disordered breathing was analyzed by a commercially available home monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies Inc., California, USA) that passively monitors sleep using piezo-electric sensors. Validated sleep/respiratory parameters were derived from device data. De-identified data were analyzed, following review and exemption of the study (#57681) from Stanford University IRB. Data from 10/01/2021 to 09/30/2022 were reviewed in 96,228 individuals with 19,148,323 recorded nights. Individuals with at least 300 nights with a computed AHI (TST≥4hrs) were included in the analytic dataset.

Results

A total of 23,105 individuals (10,711 men, 49.6±12.93 years; 9,430 women, 49.4±12.85 years; 2,964 no gender provided, 50.4±14.37 years) with 7,947,840 recorded nights met the inclusion criteria. Maximum (but not mean) AHIs for each individual for 3 randomly-selected (vs. consecutive) nights revealed sensitivities (≥95%)/specificities [and CIs] of 94.9%[94.8,95.1]/82.5%[82.2,82.7], 95.2%[95.0,95.5]/94.3%[94.1,94.5], and 96.2%[95.8,96.6]/97.9%[97.8,98.0] for detecting any, moderate-to-severe, and severe OSA, respectively, as categorized by mean AHI over 1 year. Sensitivities for a single night were in the low 70s, and, for maximum AHI over two randomly-selected nights, near 90%, with a tradeoff for decreased specificities for 3+ nights. For moderate-to-severe and severe OSA subjects over 1 year, means of 5.1±7.7% and 5.4±7.3% nights, respectively, showed OSA severity decreases by 2+ categories (i.e., moderate to normal, severe to mild/normal).

Conclusion

Use of a noninvasive in-home monitoring device enabling collection and analysis of a large sample of sleep/respiratory data on a continuous nightly basis showed that a single night yields low sensitivity for detection of OSA and on average OSA severity decreased by 2 categories on 5% or more nights. Maximum (but not mean) AHI across 3 non-consecutive nights yields good sensitivities/specificities for moderate-to-severe and severe OSA detection. Ongoing work explores statistics for nights beyond 3 to further improve sensitivity/specificity.

Support (if any)
0510 Altered functional connectivity of the ascending reticular activating system in obstructive sleep apnea
Authors: Shin Won Chul , Byun Jung-Ick , Jahng Geon-Ho , Jung Ki-Young
Published: May 2023

Introduction

Recurrent arousals in obstructive sleep apnea (OSA) may lead to alteration in functional connection involving in the ascending reticular activating system (ARAS). We aimed to evaluate resting-state functional connectivity (FC) between eight ARAS nuclei and 105 cortical/subcortical regions in OSA patients and matched controls.

Methods

Total of 50 patients with moderate to severe OSA and 20 controls without OSA underwent overnight polysomnography (PSG) and resting-state functional magnetic resonance imaging in the following morning. Seed to voxel analysis of ARAS-cortical FC was compared between the patients and controls. The ARAS nuclei included dorsal and median raphe nucleus, locus coeruleus (LC), laterodorsal tegmental nucleus (LDTg), pedunculopontine tegmental nucleus, pontine nucleus oralis, parabrachial complex, and ventral tegmental area (VTA). Correlations between average FC values of significant clusters and PSG parameters were calculated in the patients.

Results

FC values in the three of the ARAS nuclei (LC, LDTg, and VTA) were significantly different between the group. The FC value between the LC and the precuneus cortex, posterior cingulate gyrus, and right lateral occipital cortex (LOC) was increased in OSA patients compared to the controls. The FC value between the LDTg and right LOC was enhanced, but the FC one between the VTA and right LOC was reduced in the patients. The average LC-cortical FC values positively correlated with the arousal index(r=0.282, p=0.047), apnea index(r=0.325, p=0.021), or apnea-hypopnea index (r=0.302, p=0.033) in OSA patients.

Conclusion

The results of this study support alteration in ARAS-cortical FC in OSA patients. Degree of the noradrenergic LC-cortical FC may be related to arousal or OSA severity in the patients.

Support (if any)
0514 Association of muscle distribution and insomnia severity in COMISA
Authors: Kim Jae Rim , Kim Dong Yeop , Song Pamela , Joo Eun Yeon
Published: May 2023

Introduction

Insomnia and obstructive sleep apnea(OSA) may co-exit, and it is now named comorbid insomnia and OSA(COMISA). Such combined condition is associated with increased morbidity, and impairment, which requires treatment for both insomnia and OSA. Bioelectrical impedance analysis(BIA) is a widely used convenient method of body composition. In OSA patients, muscle and fat distribution are different among different sex, and severity of OSA. We hypothesized that the muscle distributions in COMISA were different from OSA, which can help early identification COMISA to optimize treatment.

Methods

All the patients aged 18 or older with symptoms of sleep disturbances who visited single tertiary sleep clinic in Korea were enrolled from December 2017 to September 2022. All patients underwent structured sleep evaluation, insomnia severity index (ISI), overnight polysomnography and BIA. All patients with apnea-hypopnea index (AHI) 15 or greater were enrolled. The COMISA were classified by insomnia symptoms based on the ISI score greater than 15.

Results

Total of 3328 subjects were finally enrolled(79.7% males and 20.3% females), and among them 29.5%(n=981) was COMISA. Compare to OSA without insomnia symptoms COMISA were older(COMISA,56.6 ± 12.9, OSA,54.3 ± 13.3; p< 0.001), and were more likely to be female(COMISA,27.5%, OSA,17.3%; p< 0.001). Although AHI had no significance, apnea was lower, and hypopnea was higher in COMISA than OSA. The muscle distribution in COMISA was different compared to OSA in non-obese groups(BMI< 25). In both male and female, total muscle mass(MM), skeletal muscle mass(SMM), Rt and Lt arm(RAMM, LAMM), Rt and Lt leg(RLMM, LLMM), and trunk(TMM) muscle mass, and fat free mass(FFM) were significantly different between non-obese COMISA and OSA. The correlation analysis in non-obese COMISA group revealed that ISI is negative correlated with muscle masses in both sex (M:F); MM(M,F:rho:-0.09*,-0.16*), SMM(rho:-0.01*,-0.17*), RAMM(rho:-0.07*,-0.15*) LAMM(rho:-0.07*,-0.16*), RLMM(rho:-0.09*,-0,15*), LLMM(rho:-0.09*,-0.16*), TMM(rho:-0.08*,-0.17*), FFM (rho: -0.1*,-0.16*)[*p< 0.05].

Conclusion

This study revealed that the muscle distribution is different in non-obese, male and female, moderate to severe COMISA population. And insomnia symptom severity has negative relation with trunk and limb muscle masses. Our study suggests possible insomnia symptoms among OSA patients have different pathomechanisms in relation to body muscle distribution.

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0515 Awake endoscopy optimizes tolerance and effectiveness of hypoglossal nerve stimulation
Authors: Oster Joel , Grover Aarti
Published: May 2023

Introduction

Hypoglossal nerve stimulation(HGNS) which has been available and FDA approved since 2014 in the US may allow for effective treatment of obstructive sleep apnea(OSA) in patients without concentric collapse on Drug induced Sleep Endoscopy and other clinical parameters who have failed CPAP. Tolerance of the stimulation parameters may be problematic in a subset of patients not allowing them to adhere to the therapy. Although there are not currently clinically authoritative studies regarding the role of awake endoscopy in management of such patients, visualizing what comfortable settings that allow for effective tongue protrusion while awake potentially allowing for effective treatment of upper airway obstruction in the office setting might serve as a surrogate for ensuring optimization of such treatment during patients' sleep and this is a retrospective review of such patients at Tufts Medical Center in Boston MA.

Methods

A retrospective chart review of patients who were implanted with a HGNS device (Inspire TM) who did not tolerate therapy and proceeded to awake endoscopy to optimize therapy settings that allowed tolerance or comfort of stimulation were analyzed. Patients who had HGNS and awake endoscopy as part of clinical assessment at any time during the course of their clinical evaluations were included in the review.

Results

Out of 129 patients implanted at Tufts Medical Center in Boston, MA, 13 such patients (Approximately 10 % of the total number of HGNS implanted patients) proceeded to awake endoscopy to optimize therapy as noted above. A subset of these patients had improved adherence to therapy and treatment of OSA with HGNS therapy subsequently to such management.

Conclusion

A subset of patients may remain adherent to HGNS therapy after strategically performing awake endoscopy for ensuring comfort and adequacy of tongue protrusion during awake endoscopy in the outpatient setting. This retrospective review indicates that awake endoscopy may optimize tolerance and adherence of HGNS therapy for treatment of OSA in selected patients.

Support (if any)

None
0517 Changes in AutoCPAP Settings as a Function of Weight Loss Over Time in Bariatric Surgery Patients with Obstructive Sleep Apnea
Authors: Potarazu Deepika , Panahi Armon , Hung Chen-min , Koizumi Naoru , Lee Juliet , Vaziri Khashayar , Jackson Hope , Ahari Jalil
Published: May 2023

Introduction

Positive pressure remains the main treatment for obstructive sleep apnea (OSA). Compared to traditional continuous positive airway pressure (CPAP) machines with fixed pressure settings, AutoCPAP machines can titrate settings based on user requirements and transmit data to the pulmonologist. While bariatric surgery has been associated with improvement in OSA, there is little data examining associations between postoperative weight loss and positive pressure requirements longitudinally. The purpose of this study was to evaluate changes in AutoCPAP pressure settings as a function of weight loss over time.

Methods

A retrospective review of bariatric surgery patients at a single institution from 2018-2022 was performed. Participants included patients with OSA who used an AutoCPAP machine and had at least one appointment within the first 18 months postoperatively. Preoperative BMI, postoperative BMI and percent excess weight loss were analyzed. AutoCPAP parameters used as markers of OSA severity included 95th or 90th percentile pressure depending on the machine and apnea-hypopnea index (AHI). Paired t-tests were performed to evaluate changes in BMI and 90th/95th percentile pressures. Linear regressions with fixed effects were performed to investigate changes in pressures and BMI over time.

Results

345 patients with OSA who underwent bariatric surgery and were prescribed AutoCPAP were evaluated. Of those, twenty-eight (8%) were compliant with their AutoCPAP and were included in this study. Overall, 90th/95th percentile pressures improved postoperatively by 1.32 cmH2O± 0.33 (P= 0.003). Patients with a preoperative BMI ≥40 demonstrated improved 90th/95th percentile pressures over time by 1.22 cmH2O± 0.34 (P=0.002) while those with a preoperative BMI < 40 did not (-1.7 cmH2O ± 0.86; P= 0.106). Reduction in BMI was associated with reduction in 90th/95th percentile pressures at 2-6 weeks and 2-6 months postoperatively.

Conclusion

Patients with a higher preoperative BMI demonstrated improved positive pressure requirements postoperatively compared to patients with a lower preoperative BMI. This suggests that there may be a critical BMI after which further weight loss is not associated with significant improvements in OSA. Further, positive pressure requirements may decrease most significantly within the first several months postoperatively.

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0519 Comparing the delta power during titration of INSPIRE therapy and PAP therapy
Authors: Kranthi Bhavana , Naha Sowjanya , Sahota Pradeep , Thakkar Mahesh
Published: May 2023

Introduction

Delta power is a known indicator of sleep drive and sleep pressure. Non-REM sleep delta power is increased in patients with sleep-disordered breathing. Treatment of sleep-related breathing disorder reduces delta power. The purpose of this study is to investigate and compare delta power between individuals on INSPIRE therapy and individuals on PAP therapy.

Methods

A retrospective review was performed by selecting nine patients who underwent INSPIRE titration study at the MU HealthCare Sleep Disorders Center, between 8/1/2021 and 8/1/2022. Nine patients with similar age and gender who underwent PAP titration study were selected from the database (PolySmith®). Spectral analysis was performed using F4-M1 leads, and delta power was calculated for Stage N3 portion during the last sleep cycle.

Results

There were 3 patients on INSPIRE who did not have any N3 sleep and those were excluded. Thus, average delta power in 6 patients during INSPIRE titration was 541.88. In contrast, the average delta power for 9 patients during PAP titration was 554.93.

Conclusion

Results showed that there was minimal difference in patients’ delta sleep during titration of INSPIRE therapy as compared to patients during titration of PAP therapy. However, there were limitations including the amount and timing of N3 sleep, success of titration study, patient’s medications - which may have altered the sleep architecture, and comorbidities such as PLMS (which untreated can affect sleep).

Support (if any)

The authors have no sources of support to declare.
0520 Comparison of Upper Airway Stimulation Outcomes in STAR and ADHERE sub-populations: Narrow AHI Range vs Broad AHI Range
Authors: Bosschieter Pien , DeVries Nico , Vanderveken Olivier
Published: May 2023

Introduction

Upper Airway Stimulation is an approved technology for the treatment of moderate to severe obstructive sleep apnea. Differences exist among specific indications for use and/or coverage limits, with certain geographies supporting a broader AHI range (15-65 events/hr) compared to others that are limited to a narrower range (AHI 20-50 events/hr). This study provides a comparison of the outcomes related to these two groups.

Methods

This is a retrospective analysis of two data sets: (1) STAR pivotal data set, including only patients with a baseline AHI (average of pre-implant and post-implant/pre-activation AHIs) between 20 - 50 event/hr; compared to (2) ADHERE Registry data set, including only patients with a baseline AHI (pre-implant) between 15 -65 events/hr. Baseline demographics, as well as AHI and Epworth Sleepiness Scale (ESS) at 12 months post-implant, were compared between the two groups.

Results

A total of 94 STAR subjects (AHI 20-50) were compared to 1604 ADHERE subjects (AHI 15-65; with AHI 15-20 in 192 subjects and AHI 50-65 in 208 subjects). The STAR group had a significantly lower age (54.6±10.2 vs 60.2±10.9, p< 0.001), lower baseline AHI (31.8±7.6 vs 34.7±12.6, p< 0.001) and more males (85.1% vs 75.5%, p=0.03) compared to the ADHERE group. At 12-months post-implant, there were no significant differences in AHI (15.2±15.5 vs 15.7±14.7, p=0.33), change in AHI from baseline (16.5±14.7 vs 18.5±20.3, p=0.23), Sher Responder Rate (67.7% vs 63.4%, p=0.47) or ESS (7.0±4.2 vs 6.9±4.6, p=0.53) between the STAR and ADHERE groups.

Conclusion

While subjects implanted under the narrower AHI range (20-50 events/hr) were younger and had a significantly lower AHI at baseline, results in these patients were comparable to patients implanted under the broader range of AHI 15-65.

Support (if any)

The STAR study and ADHERE Registry were sponsored by Inspire Medical Systems, Inc.
0527 Effectiveness of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea at a Major Tertiary Academic Sleep Center
Authors: Patel Rutwik , Wang Hannah , Landsness Eric
Published: May 2023

Introduction

The use of hypoglossal nerve stimulation (HGNS) for treatment of obstructive sleep apnea (OSA) has been reported to be efficacious in up to 75% of patients with a 68% improvement in the 3% apnea hypopnea index (AHI). Based on these results, HGNS is an increasingly widespread alternative treatment for OSA patients who are intolerant of Positive Airway Pressure (PAP) treatment. It is unknown if HGNS is equally efficacious outside of the highly controlled setting of a clinical trial. Here, we performed a retrospective cohort study from patients who underwent implantation of a hypoglossal nerve stimulator at our academic institution and report the efficacy based on improvement in AHI.

Methods

Adult subjects with a diagnosis of OSA, who were intolerant of PAP therapy and underwent implantation of HGNS at Barnes Jewish Hospital in St. Louis, Missouri from 6/4/2019 to 6/28/2022 were included in this retrospective cohort study. Only those who were referred for implantation from Washington University Sleep Medicine Center were included. The efficacy of HGNS was evaluated by comparing the 3% AHI on subjects’ polysomnography before and after the HGNS was implanted and activated. Analysis of the data was done using paired t-tests to determine efficacy of HGNS via a reduction of at least 50% of the 3% AHI and a reduction in 3% AHI to less than 20 events per hour.

Results

45 subjects were implanted of which 1 subject did not tolerate HGNS, and 8 subjects were lost to follow-up. Of the remaining 36 subjects, the median 3% AHI decreased 79% from 29.5 to 6.5 events per hour (p< 0.0001). There was a reduction of at least 50% of the 3% AHI in 83% of subjects and a reduction of 3% AHI to less than 20 events per hour in 86% of subjects.

Conclusion

HGNS achieved significant therapeutic results in the majority of patients with OSA who are intolerant of PAP therapy. These results add to the growing body of evidence reproducing the original clinical trial in a “real-world” setting free of any conflict of interest. Future studies examining predictive factors influencing the effectiveness of HGNS are needed.

Support (if any)
0528 Effects of continuous positive airway pressure on white matter microstructure in patients with obstructive sleep apnea
Authors: Park Hea Ree , Joo Eun Yeon
Published: May 2023

Introduction

Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests.

Methods

Twenty-two male patients with moderate to severe OSA were recruited and underwent DTI scanning before and 6-44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up MRI in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method.

Results

The TSSA analysis showed that FA values in the middle part of the right CST were increased after treatment in the CPAP group. No significant change in FA value was observed between baseline and post-scan in the untreated group. In the CPAP group, the post-treatment FA value in the anterior part of the right ATR was significantly correlated with durations of CPAP therapy after controlling for age, body mass index, and baseline FA value.

Conclusion

Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA.

Support (if any)
0535 Impact of hypoglossal nerve stimulation surgery alone on sleep disordered breathing and sleepiness
Authors: Strollo Patrick , Soose Ryan , Maurer Joachim , DeVries Nico , Vanderveken Olivier
Published: May 2023

Introduction

Hypoglossal Nerve Stimulation (HNS) is an established option for CPAP -intolerant obstructive sleep apnea (OSA) patients, with multiple studies demonstrating safety and effectiveness. There are known nightly variations in OSA severity. We aimed to determine if device implant alone (with therapy off) compared to baseline influenced sleep disordered breathing and daytime sleepiness.

Methods

This was a retrospective analysis of the STAR (Stimulation Therapy for Apnea Reduction) Trial, conducted from 2010-2016, that led to FDA approval HNS. Data was collected at a pre-implant screening, and post-implant prior to device activation (therapy off). Each visit included an attended polysomnography (PSG) and Epworth Sleepiness Scale (ESS). PSGs were scored by a central core lab.

Results

There were 126 participants (83% male), age 55 ± 10 years. The time between pre-implant baseline screening and device activation visit averaged 88 ± 29 days. BMI was 28 ± 3 at baseline and 28 ± 3 post-implant with therapy off. The pre and post-implant Apnea Hypopnea Index (AHI)s were similar (32 ± 9 vs 32 ± 9 events/hour, p=0.82). The two-night AHI ranged from 13 to 65. The average AHI change between pre-implant and post-implant (therapy off) was -0.3 ± 17 events/hour. The Sher 20 response rate between pre-implant and post-implant therapy off was 13%. By comparison, previously published mean AHI with therapy activated was approximately 10-15 events/hour, and Sher 20 response rates ranged between 65%-75%. ESS pre and post-implant (therapy off) were similar (12 ± 5 vs 11 ± 5, p=0.09), compared to ESS previously reported with HNS therapy activated (typically 6-7).

Conclusion

The STAR two-night baseline AHIs ranged between 13-65. While there were nightly differences in AHI in some patients, surgical implant of HNS with therapy off, did not result in meaningfully improvement in the AHI, Sher 20 response rate, or ESS.

Support (if any)

Inspire Medical Systems
0544 Occult Obstructive Sleep Apnea Increases Risk for Depression among Older Adult Medicare Beneficiaries
Authors: Albrecht Jennifer , Wickwire Emerson
Published: May 2023

Introduction

Depression and obstructive sleep apnea (OSA) are highly comorbid, and each is independently associated with worsened health outcomes and increased economic burden. This study aimed to determine the effect of occult OSA on incident depression among a national sample of Medicare beneficiaries. We hypothesized that relative to non-sleep disordered controls, older adults with occult OSA would demonstrate greater risk for incident depression during the year prior to OSA diagnosis.

Methods

Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Obstructive sleep apnea, depression, and medical comorbidities were defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes during the twelve months prior to OSA diagnosis. Beneficiaries with history of depression prior to the beginning of follow-up (12 months before OSA diagnosis) were excluded. Non-sleep disordered controls were required to possess no evidence of sleep-related diagnosis, testing, or treatment during the study period. Log binomial regression was used to model risk for incident depression as a function of occult OSA. Inverse probability of treatment weights were used to balance covariates between exposure groups.

Results

The final sample included a total of 21,116 beneficiaries with occult OSA and 237,375 individuals without sleep disorders. In fully adjusted models, beneficiaries with OSA demonstrated significantly higher risk of depression during the year prior to OSA diagnosis (risk ratio 3.19; 95% confidence interval 3.00, 3.39).

Conclusion

In this national study of older adult Medicare beneficiaries, occult OSA was associated with three-fold risk of incident depression. Future research should 1) examine the disease burden including health and economic consequences, of comorbidity OSA and depression and 2) also seek to determine the effect of screening, assessing, and treating OSA on risk for depression.

Support (if any)

This research was supported by an investigator-initiated grant from the ResMed Foundation to the University of Maryland, Baltimore (PI: EMW).
0550 Positive Airway Pressure for Obstructive Sleep Apnea in Diastolic Heart Failure Patients Reduces Healthcare Resource Utilization
Authors: Kuniyoshi Fatima Sert , Cistulli Peter , Cole Kate , Malik Anita , Pépin Jean-Louis , Benjafield Adam , Somers Virend
Published: May 2023

Introduction

Although diastolic heart failure (HFpEF) patients frequently have comorbid obstructive sleep apnea (OSA), which has been associated with poor prognosis, the impact of positive airway pressure (PAP) therapy remains unclear. This retrospective study sought to investigate the association between 1 year adherence to PAP therapy and healthcare resource utilization (HCRU) in patients with newly diagnosed OSA and comorbid HFpEF.

Methods

A national sample of administrative claims data linked to objective PAP therapy usage was used for this analysis. Eligible patients either had two healthcare encounters or one hospitalization with a diastolic heart failure ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. HCRU was measured as a composite outcome of hospitalizations and emergency room (ER) visits. Propensity score matching was used to create well-balanced groups with differing PAP adherence levels to assess the association with 1 year HCRU outcomes. Risk-adjusted models were used to generate the number needed to treat (NNT) that referred to the number of patients that need to become adherent to PAP from non-adherent to avoid 1 visit.

Results

4,237 patients with OSA and comorbid HFpEF were included. With propensity score matching, 963 PAP adherent and 963 non-adherent patients remained. After 1 year of PAP therapy, adherent patients had fewer visits than non-adherent patients (1.16 visits per subject vs. 1.75, p < 0.001), driven by a 57% reduction in hospitalizations and a 36% reduction in ER visits for adherent patients. Total HCRU costs were lower in adherent patients than in non-adherent patients ($12,732 vs. $15,610, p< 0.01). Converting 1 patient from non-adherent to adherent would avoid 1.25 visits (either ER visit or hospitalization), with an NNT of 0.8.

Conclusion

HFpEF patients with OSA that are adherent to PAP therapy for 1 year have fewer hospitalizations and ER visits than patients that are not adherent. More importantly, HCRU costs were lower in adherent patients, highlighting the clinical and economic benefits of treating OSA with PAP therapy in HFpEF patients.

Support (if any)

Funding Source: ResMed
0554 Racial Disparities in Healthcare Resource Utilization among Older Adult Medicare Beneficiaries With Comorbid OSA and Depression
Authors: Wickwire Emerson , Albrecht Jennifer
Published: May 2023

Introduction

Depression and obstructive sleep apnea (OSA) are highly comorbid and independently associated with increased economic burden. Evidence suggests important racial disparities in diagnosis and treatment of each condition. This study sought to evaluate the economic burden of occult OSA among Black and White older adults with depression. We hypothesized that the impact of occult OSA on healthcare resource utilization would differ by race.

Methods

Data were derived from a 5% sample of Medicare administrative claims data. Inclusion criteria were age >64 years, 12 months continuous enrollment prior to OSA diagnosis, depression, and Black or White race. Undiagnosed OSA and pre-existing depression were defined using ICD-10 codes during the 12 months prior OSA diagnosis. HCRU was defined as monthly counts of inpatient, outpatient, and emergency department (ED) visits in each of the 12 months before OSA diagnosis. The relationship between undiagnosed OSA and HCRU was modeled using negative binomial regression. Inverse probability of treatment (IPT) weighting was used to balance covariates between groups. Effect modification by race was evaluated using an interaction term; estimates were stratified by race.

Results

Of 39,192 beneficiaries with pre-existing depression, 4,353 suffered undiagnosed OSA (n=325 Black adults, 7.5%). Relative to White beneficiaries with undiagnosed OSA, Black beneficiaries with undiagnosed OSA were more likely to be female (76.6% vs. 68.6%, p=.002) and to suffer multimorbidity (>7 comorbid conditions [71.7% vs 52.7%, p<.001]). In IPT weighted models and relative to Black non-sleep disordered controls, Black beneficiaries with undiagnosed OSA had higher inpatient (RtR 1.89; 95% CI 1.33, 2.71), outpatient (RtR 1.38; 95% CI 1.04, 1.83) and ED (RtR 1.83; 95% CI 1.22, 2.75) utilization. Relative to White non-sleep disordered controls, White beneficiaries with undiagnosed OSA demonstrated higher inpatient (rate ratio (RtR) 1.51; 95% CI 1.38, 1.65)), outpatient (RtR 1.18; 95% CI 1.10, 1.26) and ED (RtR 1.45; 95% CI 1.34, 1.57) utilization. The interaction between race and undiagnosed OSA was significant in all models (p<.001).

Conclusion

Among Medicare beneficiaries with pre-existing depression, comorbid undiagnosed OSA is associated with increased HCRU across multiple points of service. The strength of this association is greater among Black (vs White) beneficiaries.

Support (if any)

ResMed Foundation