bluuebunny/crossref_metadata_2025 huggingface dataset:
0688 Insomnia Symptom Severity Predicts Greater Alcohol Use During the COVID-19 Pandemic: A Longitudinal Study
Authors: Bell Jessica , Egeler Mara , Snyder Hope , Walker Jamie , Hire Veronica , Vargas Ivan
Published: May 2022

Introduction

Individual stress levels undeniably increased following the start of the COVID-19 pandemic. Not surprisingly, sleep problems, including insomnia, have intensified during the pandemic due to the increase in overall stress levels. The impact that greater insomnia has had on other health outcomes, for example problematic drinking, has yet to be examined. Therefore, the aim of the present study was to assess whether greater insomnia symptom severity predicted future alcohol use patterns (i.e., frequency and severity).

Methods

The study used data from a nationwide sample of 2,979 who were surveyed at two different points during the COVID-19 pandemic (T1 = initial months after the start of the pandemic [April – June 2020]; T2 = 10-12 months later). Of those, 1,971 adults (mean age = 46.0 years; 80% women) reported having had an alcoholic beverage during the past 3 months and were included in the subsequent analyses. Insomnia symptom severity was assessed at both time points using the Insomnia Severity Index (ISI). Self-reported alcohol frequency (i.e., days per week) and severity (i.e., drinks per day) were assessed at T2.

Results

At T2, participants reported drinking alcoholic beverages (mean ± standard deviation) 2.7 ± 2.1 days during a typical week and drinking 1.8 ± 1.1 alcoholic beverages on days they did drink. According to results from separate multiple regression analyses, where T1 ISI scores were entered as the independent variable and alcohol frequency and severity were entered as the dependent variables, total ISI scores at T1 were associated with less frequent (β = -0.075, p = .001) but more severe drinking patterns (β = .088, p < .001). These associations remained significant while controlling for current insomnia symptom severity.

Conclusion

Baseline insomnia symptom severity was a predictor of future alcohol use patterns. Specifically, people with greater insomnia at T1 reported, on average, less frequent drinking (i.e., fewer days per week), yet greater consumption on days that they did drink alcohol. These data highlight the importance of assessing the impact that insomnia has had (and continues to have) on other behavioral health outcomes during the ongoing pandemic.

Support (If Any)

K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)
0695 Comparison of a Disposable Home Sleep Apnea Test to Polysomnography in Patients Referred for Obstructive Sleep Apnea Investigation
Authors: Tellez Daniela , Uhles Matthew , Alisic Sabina , Pinson Mary-Beth , Willes Leslee , Decker Meredith , Benjafield Adam
Published: May 2022

Introduction

In an effort to decrease cost and improve healthcare efficiency for the diagnosis of OSA, home sleep apnea tests (HSAT) continue to be developed and improved to enhance diagnostic accuracy. A disposable FDA cleared HSAT capable for multi-night evaluations, that uses peripheral arterial tonometry (PAT) to assess for sleep apnea. The form factor and care pathway have a strong appeal for a patient’s experience of the diagnostic journey. The data obtained from the study informs the strengths, weaknesses, and reliability of new HSAT technology in the clinical management of sleep apnea.

Methods

A prospective, open-label, single group study was conducted in a certified PSG sleep lab. Patients underwent a single overnight PSG study with concurrent disposable HSAT (NightOwl Mini, Ectosense) testing. The patient population were adults referred to a sleep lab for investigation of OSA. PSG recorded sleep time of ≥4hrs was required to be evaluable. The primary endpoint was clinical decision agreement for treatment, based on AHI threshold ≥15 events/hour. Pairwise comparisons were performed against PSG, and agreement was assessed using Cohen’s Kappa statistic.

Results

A total of 50 participants completed the study. There were 42 participants included in the analysis. The disposable HSAT had a Kappa value of 0.667 (95% CI 0.448, 0.886) for the clinical decision for treatment compared to PSG, which represents substantial agreement. The sensitivity and specificity were 0.769 and 0.938, respectively. For AHI, the disposable HSAT had a Spearman rank correlation of 0.903 with PSG. OSA severity categorization (based on AASM definitions), was also assessed, with disposable HSAT showing a weighted Kappa value of 0.646 (95% CI 0.501, 0.792). A limitation of this study was the single night use since the HSAT recommends multiple nights for a more accurate assessment.

Conclusion

A disposable HSAT was found to have substantial agreement with PSG’s clinical decision for treatment based on AHI values, despite the assessment being from a single night as opposed to multiple night usage. The performance and form factor make it an attractive HSAT to assess for sleep apnea and facilitate OSA diagnosis.

Support (If Any)

ResMed
0703 Development of the Obstructive Sleep Apnea Questionnaire for Use in Clinical Practice
Authors: Kirsch Douglas , Abbasi-Feinberg Fariha , Davies Charles , Gamaldo Charlene , Rosen Carol , Thomas Sherene , Koochaki Patricia , Lipman Kelly , Hall Nicolas
Published: May 2022

Introduction

An American Academy of Sleep Medicine (AASM) task force identified a need for a valid, reliable, patient-reported outcome measure (PROM) to monitor obstructive sleep apnea (OSA) in adults in clinical practice. Ideally, the PROM should be easy and quick to complete (<5 minutes), available electronically, and accepted by clinicians treating OSA. Development of the Obstructive Sleep Apnea Questionnaire (OSA-Q) was undertaken to meet this need and was guided by the 2009 Food and Drug Administration (FDA) Guidance for Industry on developing PROMs.

Methods

Development of the OSA-Q included interviews with patients with OSA (n=14) to identify important concepts to them, conceptual model and draft questionnaire formulation, and cognitive interviews (n=14) to assess content validity and guide revisions to wording, item comprehension and redundancies, recall period, and response options. Usability of the electronic version of the OSA-Q was then assessed in patients with OSA. Finally, acceptability and utility of the OSA-Q in clinical practice was evaluated by surveying clinicians in ten geographically-dispersed US sleep clinics.

Results

Patient interviews were used to construct a conceptual model for the draft OSA-Q which served as a basis for generating 44 items about daytime/night-time symptoms and OSA impacts. Cognitive interviews identified poorly worded, ambiguous, and redundant items to inform revisions, resulting in a revised draft OSA-Q (3 domains, 28 items). Subsequently, clinicians (n=13) administered the draft OSA-Q to five patients each, obtained patients’ feedback on the OSA-Q, and completed a survey regarding its comprehensiveness, format/content, utility, and acceptability in clinical practice. These clinicians endorsed the OSA-Q for ease of use, language simplicity, convenience of electronic platform, and speed of completion (3-5 min). They also indicated that the OSA-Q would be useful in clinical practice and enhance patient communications (69% and 77%, respectively). The OSA-Q was revised and finalized for psychometric testing, based on clinician comments.

Conclusion

A new AASM-supported PROM to monitor OSA in clinical practice has been developed, including the patients’ perspective according to FDA guidance. This OSA-Q shows content validity and is positively perceived by clinicians. Psychometric testing of the OSA-Q is underway to establish its measurement properties and demonstrate its validity, reliability, and sensitivity to change in patients with OSA.

Support (If Any)

This work was funded by the American Academy of Sleep Medicine.
0713 Longitudinal Sleep Position Patterns and Breathing Parameters in Pregnancy
Authors: Katz Juliana , Sanapo Laura , Dunsiger Shira , Guillen Melissa , Avalos Ashanti , Aldana Annaly , Wilson Danielle , Bourjeily Ghada
Published: May 2022

Introduction

Supine sleep position during pregnancy has been linked to increased risk of stillbirth in retrospective studies. However, existing literature is largely cross-sectional and limited by recall bias and self-reporting of sleep position. This study aims to use objectively-measured sleep position to quantify sleep position change between trimesters and its influence on maternal respiratory health.

Methods

This study is a secondary analysis of data from a study investigating maternal sleep, among women with singleton pregnancies and overweight or obesity. Each participant underwent level III sleep apnea monitoring using Noxturnal T3 devices (Nox Medical, Georgia, US), in the first (0-12 weeks) and third (29-40 weeks) trimester of pregnancy. Using accelerometry, the software differentiated 5 positions including supine, right lateral, left lateral, prone, and upright. The studies were scored using AASM 2012 recommended criteria. The first non-upright position was recorded as going-to-bed position. The number of sleep position changes was calculated using only positions that lasted ≥30 seconds.

Results

A total of 126 women were included. Mean BMI was 34.00±5.14 and mean age was 30.46±5.40 years. Mean number of position changes was similar in early (14.19±7.82) vs. late (14.58±8.25) pregnancy. There was a significant correlation between sleep onset position and predominant sleep position in both early (p=0.001) and late (p<0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. There was a significant change in sleep position between early and late pregnancy (p=0.04) with a reduction in supine sleep (51.6% to 30.2%) and an increase in left lateral sleep (24.6% to 37.3%). Only in the third trimester, there was a significant positive correlation between time spent supine and oxygen desaturation index (r=0.22, p=0.01), and a trend toward positive correlation with respiratory event index (r=0.15, p=0.08).

Conclusion

Going-to-bed position predicts predominant sleep position in less than half of women with overweight and obesity. Time spent supine in late pregnancy correlates with measures of sleep-disordered breathing. More prospective studies are needed to evaluate the potential for sleep position changes over time as a potentially modifiable risk factor for maternal and neonatal health outcomes.

Support (If Any)

R01HL130702, R01HD078515, SRA grant
0724 Age-related AHI cut-offs associated with cardiovascular and cerebrovascular disorders: clinical implications
Authors: Vgontzas Alexandros , Fernandez-Mendoza Julio , Karagkouni Efthalia , He Fan , Lenker Kristina , Basta Maria , Liao Duanping , Bixler Edward
Published: May 2022

Introduction

Several studies have shown that the association of obstructive sleep apnea (OSA) with clinical outcomes, such as hypertension, weakens in older adults. An apnea hypopnea index (AHI) ≥5 is recommended as the cut-off for initiating treatment without any consideration of possible age differences. We aimed to examine at which cut-off point of AHI, OSA is associated with cardiovascular and/or cerebrovascular diseases (CBVD) in middle-aged adults and in older adults.

Methods

We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority), who underwent a 1-night sleep laboratory evaluation, clinical history and physical examination. Hypertension was defined as a diastolic blood pressure ≥90 mmHg or a systolic blood pressure ≥140 mmHg or the use of anti-hypertensive medication. CBVD was defined based on a self-report of a physician diagnosis of heart disease and/or stroke. Logistic regression models examined the odds of having hypertension or CBVD in a step-wise manner starting from an AHI ≥5 up to AHI ≥30 by increments of 5 events, while simultaneously adjusting for sex, race and BMI and stratifying by age.

Results

The odds of hypertension were significantly increased in adults aged <60y (43.2±9.1y) with an AHI≥5 (OR=1.56, 95% CI 1.01-2.41, p=0.045), while the odds of hypertension were not significantly increased in adults aged ≥60y (68.4±6.3y) for any given AHI cut-off. The odds of CBVD were significantly increased in adults aged ≥60y with an AHI≥15 (OR=2.50, 95% 1.24-5.04, p=0.011), while the odds of CBVD were not significantly increased in adults aged <60y for any given AHI cut-off.

Conclusion

These data suggest that AHI cut-offs warranting treatment of OSA should be adjusted based on age and prevalent clinical disorders, consistent with the concept of personalized medicine. These findings are also consistent with the notion that OSA in older adults is a distinctly different phenotype than in young and middle-aged adults.

Support (If Any)
0741 Nasal airflow shape on home sleep studies predicts epiglottic collapse
Authors: Sharma Abhay , Woodson B , Noel Jacob
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is characterized by collapse of various portions of the pharynx. Epiglottic collapse can be difficult to diagnose and can affect a patient’s tolerance to continuous positive airway pressure (CPAP) or oral appliances (OA). Previous research shows a distinct nasal airflow pattern during periods of epiglottic obstruction. We sought to determine if primary epiglottic collapse noted on drug induced sleep endoscopy (DISE) would correlate with nasal airflow signals seen on home sleep studies.

Methods

We retrospectively analyzed the home sleep studies and DISE of 13 patients being considered for surgical therapies due to intolerance to CPAP. Characterization of nasal airflow signals as epiglottic collapse and non-epiglottic collapse was based on previously published data.[1] Airflow signals were individually scored as either epiglottic type collapse (type 1) and non-epiglottic type collapse (type 2). Total number of breaths and number of flow limited breaths were calculated by the algorithm in the home study device.

Results

Patients included had either complete (n=6) or no epiglottic collapse (n=7). The mean AHI 18 and 19.6, respectively. There was no difference in the fraction of type 1 breaths over total flow limited breaths between the two groups (1.1% for each group). When comparing type 1 breaths to the total number of type 1 and type 2 breaths counted, patients with complete epiglottic collapse on DISE showed a higher percentage of type 1 breaths (33%) compared to those without epiglottic collapse (23%)

Conclusion

Nasal airflow signal shape on home sleep studies can suggest the presence of epiglottic collapse. This type of analysis can provide a noninvasive assessment of physiology and improve treatment decisions.

Support (If Any)

Azarbarzin, A., et al., Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J, 2017. 50(3).
0748 Proteomic Biomarkers of Obstructive Sleep Apnea
Authors: Cederberg Katie , Hanif Umaer , Leary Eileen , Schneider Logan , Morse Anne Marie , Blackman Adam , Schweitzer Paula , Kotagal Suresh , Bogan Richard , Kushida Clete , Mignot Emmanuel
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) is characterized by recurrent, partial or complete obstructive respiratory events accompanied by interruptions in sleep with frequent arousals, deoxygenation, and/or sleep disturbance. The present study profiled the largest array of plasma proteins, to date, to contribute to the identification of proteomic biomarkers associated with the presence and severity of OSA.

Methods

The SomaScan highly multiplexed aptamer assay was used to profile 5,000 proteins in 24–48-hour old EDTA plasma samples from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. The apnea-hypopnea index (AHI) was derived from overnight polysomnography and all participants provided a blood sample. OSA severity was classified as moderate-to-severe (AHI>15) and controls/mild OSA (AHI<15). Univariate linear regression analyses included log2-normalized relative protein expression as the dependent variable, AHI/OSA as the independent variable, and important covariates such as age, gender, BMI, BMI2, age x gender x BMI, sample storage time, and blood draw period. False discovery rate (FDR) to control for multiple testing was applied with an a-priori p-value of 0.05 for identifying significance.

Results

Univariate analyses identified 101 (65 upregulated, 36 downregulated) differentially expressed proteins (DEPs) between moderate-to-severe OSA and controls/mild OSA and 120 proteins (69 positive, 51 negative) associated with AHI as a continuous outcome with 70 proteins consistent in both models. Upregulated proteins involved pathways related to complement and coagulation cascades and metabolic processes and downregulated proteins involved pathways related to regulation of insulin-like growth factor, fibrin clot formation, and MAPK signaling. An OSA machine learning classifier (AHI>15 vs AHI<15) trained on relative protein expression performed robustly, achieving 72% accuracy in a validation dataset. Significant contributing features of the classifier included age, BMI, and 134 proteins, including 22 DEPs identified in univariate analyses for OSA categories.

Conclusion

The present study identified differential protein expression patters associated with OSA and AHI, thereby supporting the potential of proteomic biomarkers in OSA and providing new insight into the mechanisms underlying OSA.

Support (If Any)

This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952] and the Klarman Family Foundation.
0749 Does Prior Nasal Surgery Impact Outcomes of Upper Airway Stimulation Therapy for OSA?
Authors: Ramprasad Vaibhav , Menzl Anna , Makey Lauren , Chio Eugene , Steffen Armin , Maurer Joachim , Heiser Clemens , Lee Kent , Soose Ryan
Published: May 2022

Introduction

Nasal airway obstruction can play an important role in pathogenesis and treatment of obstructive sleep apnea (OSA). Surgery for nasal obstruction can improve patient-reported OSA outcomes, including snoring and daytime sleepiness, as well as adherence and pressure requirements with continuous positive airway pressure (CPAP) therapy. The aim of this study was to examine whether previous nasal surgery was associated with UAS treatment efficacy.

Methods

From the ADHERE Registry, propensity score matching generated a cohort of UAS patients with prior nasal surgery including septoplasty, turbinate reduction, polyp removal (NS) and a comparable cohort of UAS patients without prior nasal surgery (WNS). Patients were matched based on demographic variables including pre-operative oral appliance use, prior CPAP use, gender, age, baseline apnea hypopnea index (AHI) and baseline Epworth Sleepiness Score (ESS). Data included demographic variables, therapy outcome measures including AHI, ESS, therapy use, and responder rate. Student’s t-test was used to compare normally distributed numeric data and Fisher’s exact test to compare categorical data. One sided t-tests with non-inferiority margin of 7.5 events/hr for AHI, 2 points for ESS, and 0.5 hr/night for Therapy Use were performed to determine non-inferiority.

Results

The ADHERE dataset from October 2021 included 169 patients from each cohort were matched for comparison. Reduction in AHI was 21.01 ±17.94 in WNS cohort and 18.39 ± 16.4 after UAS (p=0.162) in NS cohort. Reduction in ESS in WNS cohort was 4.85 ± 4.98 and 4.48 ±5.83 (p=0.528) in NS cohort. Therapy use was similar, 5.67 ± 1.95 in WNS and 5.97 ± 2.06 in NS (p=0.181). Responder rate was also similar in WNS (64.5%) and NS (62.1%) (p=0.735).

Conclusion

Retrospective analysis of UAS patients with vs without prior nasal surgery did not identify differences in UAS therapy outcomes or adherence. Furthermore, outcomes for patients with nasal surgery were non-inferior to those without. Future prospective studies of UAS candidates with nasal airway obstruction may better determine the role of adjunctive nasal surgery in this population.

Support (If Any)

Inspire Medical Systems
0752 Preliminary Efficacy of a Novel Iterative Device and Material
Authors: Murphy Mark , Carollo John , Smith Kent , Desai Aditi
Published: May 2022

Introduction

Launching a new device design or use of a new material with optimistic expectations should always be undertaken with caution and an ounce of skepticism. When this novel device and material was first described in an IRB Abstract derivative report at the AASM, it was under the umbrella of a patient and provider preference survey. In April 2020, the broader availability post FDA clearance is providing strong early indications of excellent efficacy.

Methods

An analysis of data from four treatment centers using this novel device and material was undertaken. Patients were to be included if they had a diagnosis of mild, moderate, or severe OSA confirmed by a physician, and an AHI score >5 and a follow up study resulting in treatment success or failure. Results would be grouped as Complete Success = AHI <5, Clinical Success = 50% reduction and <10. All patients were to be treated with the Novel ProSomnus EVO Iterative advancement device.

Results

55 total consecutive patients were treated at four centers for dental sleep medicine. 37 male and 18 female patients with an average age of 53.3 ranging from 30 to 78 with pre and post data were included and treated with a ProSomnus EVO. The initial AHIs ranged from 6.0 to 116.0 with an average of AHI pretreatment of 26.4 (15 mild, 23 moderate and 17 severe). Follow up testing for this group revealed an average overall reduction in AHI of 75%, from 26.4 to 6.6. Overall, 62% resolved to below an AHI of 5 (100% of mild, 65% of moderate and 24% of severe patients). Similarly, 85% resolved to below an AHI of 10 and a 50% reduction (100% of mild, 96% of moderate and 59% of severe patients)

Conclusion

This novel interactive device and material combination appear, after early analysis, appear to yield significantly better results that previous data has demonstrated. The literature suggests that legacy oral appliance efficacies range from 50%-62% and other AADSM poster/abstracts have reported similar precision milled, control cure PMMA appliances in the 74% - 76% range. These results suggest a need for further investigation of exceptional efficacy for this device design and material.

Support (If Any)

No support was provided for this abstract
0760 Excessive daytime sleepiness, positive airway pressure, and patient satisfaction with multiple aspects of care in a real-world population with obstructive sleep apnea
Authors: Parthasarathy Sairam , Hyman Danielle , Doherty James , Saad Ragy , Zhang Jerrry , Morris Susan , Eldemir Lev , Fox Benjamin , Vang Mai Ka Ying , Schroeder Jessica , Marshall Nell , Parks Gregory
Published: May 2022

Introduction

Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and can persist despite use of positive airway pressure (PAP) therapy. These analyses assessed relationships between EDS, PAP use, and patient satisfaction across several aspects of OSA care in a real-world population with OSA.

Methods

US residents (aged ≥18 years, self-reported physician OSA diagnosis [1/1/2015–3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing Epworth Sleepiness Scale (ESS), PAP usage, and satisfaction with care. Self-reported PAP use was categorized as nonuse, nonadherent (<4 h/night; <5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk) (PAP-adherent=intermediate and highly adherent groups). Logistic regression models assessed impacts of PAP adherence and EDS on satisfaction with care across 7 domains. P-values are uncontrolled for multiplicity (nominal).

Results

Among all participants (N=2289; 50.3% female, 82.5% White, 44.8±11.1 years old [mean±SD], 35.4±8.7 kg/m2 body mass index [mean±SD]), 42.5% had EDS (ESS>10). PAP use was: nonuse (n=700), nonadherent (n=153), or adherent (n=1436; intermediate n=225, high n=1211). Within these subgroups, the proportions (95% CI) with EDS were: nonuse (47% [43.7–51.1]), nonadherent (52% [44.4–60.2]), intermediate (53% [46.4–59.4]), and highly adherent (36% [33.7–39.1]). Logistic regression (using data from PAP users) showed a positive association of PAP adherence with satisfaction with PAP (OR [95% CI]: 5.43 [3.73–7.90]); OSA treatment effectiveness (3.56 [2.48–5.12]); OSA symptom management (3.15 [2.17–4.57]); coordination of OSA care (2.60 [1.82–3.72]); and education from their healthcare provider on the impact of OSA on cardiovascular health (1.62 [1.13–2.35]), importance of using PAP (1.7 [1.15–2.52]), or availability of prescription drugs to treat OSA symptoms (1.55 [1.06–2.26]). The presence of EDS was associated with lower patient satisfaction in nearly all domains examined (ORs ranged from 0.44–0.62 across 6 of 7 domains).

Conclusion

EDS was common in this real-world population with OSA, even among participants who were highly adherent PAP users. PAP adherence was associated with higher patient satisfaction across all care domains; the presence of EDS was associated with lower patient satisfaction across 6 of 7 domains.

Support (If Any)

Jazz Pharmaceuticals
0766 Group Trajectories Demonstrate Robust Effects of Targeted Hypoglossal Nerve Stimulation in the THN3 Randomized, Controlled Trial
Authors: Schwartz Alan , Jacobowitz Ofer , Mickelson Samuel , Miller Mitchell , Oliven Arie , Certal Victor , Hopp Martin , Winslow David , Huntley Tod , Nachlas Nathan , Gillespie M Boyd , Weeks Brian , Lovett Eric , Shen John , Maurer Joachim
Published: May 2022

Introduction

THN3 was the first reported parallel-arm, randomized controlled trial (RCT) of hypoglossal nerve stimulation (HGNS), wherein targeted HGNS (THN) was shown to be safe and efficacious at ameliorating sleep disordered breathing in patients with moderate to severe OSA and BMI≤35kg/m2 without screening with drug-induced sleep endoscopy. Unique among reported HGNS trials, separate cohorts of patients receiving early and late THN were followed longitudinally.

Methods

Measurements of apnea-hypopnea index (AHI) were available Pre-enrollment, Baseline (2 nights), Month 4 and Month 12/15. Except for Pre-enrollment, AHI values were calculated by an independent core laboratory from polysomnographic recordings. All subjects with complete data were included for analysis. AHI trajectories were constructed for early and late THN activation (Treatment[T], N=83, Month 1 and Control[C], N=45, Month 4, respectively) by computing median values. Confidence intervals were calculated by bootstrapping each median (N=30,000). Patient-reported outcome measures (PROMs) were treated similarly.

Results

AHI (Median (95% CI)) trajectories demonstrated a consistent pattern of pre-implant alignment (Pre-enrollment T:39.1 (36.0-45.0), C:38.0 (32.0-41.0); Baseline 1 T:36.1 (33.0-39.9), C:31.3 (27.2-38.6); Baseline 2 T:37.0 (34.3-41.0), C:35.2 (32.3-38.2)), divergence at the conclusion of the randomization period (Month 4 T:15.6 (11.9-25.3), C:30.6 (23.7-38.6)) and reconvergence following 11 months of treatment (Month 12/15 T:20.7 (16.0-26.4), C:18.1 (16.3-23.3)). Non-standardized Pre-enrollment AHI was slightly higher than Baseline values. Trajectories were similar for oxygen desaturation index (Baseline 1 T:35.3 (31.9-38.0),C:34.3 (27.5-40.3); Baseline 2 T:37.1 (33.4-39.3),C:36.8 (33.9-38.3); Month 4 T:19.5 (16.2-28.5), C:33.8 (25.4-41.1); Month 12/15 T:19.5 (16.0-25.6), C:19.7 (16.3-26.0)), the Epworth Sleepiness Scale (Baseline T:11.0 (10.0-13.0),C:11.5 (8.5-14.0); Month 4 T:6.0 (5.0-7.0), C:11.5 (8.0-12.5); Month 12/15 T:6.0 (4.0-7.0), C:5.5 (4.5-6.0)), the Functional Outcomes of Sleep Questionnaire (Baseline T:15.3 (14.0-16.5),C:14.7 (13.3-16.6); Month 4 T:18.3 (17.7-18.8), C:16.7 (14.9-17.7); Month 12/15 T:18.8 (18.3-19.3), C:18.5 (17.5-19.5)) and the Snore Outcomes Survey (Baseline T:26.6 (21.9-31.3),C:21.9 (18.8-31.3); Month 4 T:60.9 (56.3-67.9), C:29.7 (23.4-42.9); Month 12/15 T:62.5 (59.4-68.8), C:68.8 (62.5-71.9)).

Conclusion

Group trajectories of sleep-disordered breathing and PROMs further demonstrate the robust effects of THN in patients with moderate to severe OSA and the value of parallel-arm RCTs. Similar results may be expected in the ongoing OSPREY confirmatory trial of THN.

Support (If Any)

LivaNova
0772 Clusters of Upper Airway Stimulation Adherence Patterns in the First 90 Days
Authors: Soose Ryan , Araujo Mattheus , Faber Kevin , Roy Asim , Lee Kent , Ni Quan , Srivastava Jaideep , Strollo Patrick
Published: May 2022

Introduction

Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with CPAP intolerance. While overall adherence is high, some patients have suboptimal adherence to UAS, which limits effectiveness. Our goal was to identify UAS therapy usage patterns during the first three months of therapy that affect adherence.

Methods

We retrieved anonymized UAS therapy usage data from 2,091 individuals stored in a cloud-based monitoring system during the first three months after device activation. We aggregated adherence data including mean and standard deviation (SD) of nightly hours of use, therapy pauses, hours from midnight when the therapy was turned ON and OFF, and percentage of missing days. We computed the difference of the stimulation amplitude between the first and last day. We performed cluster analysis with Gaussian mixture models and computed the centroids of each cluster highlighting their main differences.

Results

We identified six distinct clusters of UAS usage patterns. Clusters 1A (34% of the total cohort) and 1B (23%) had excellent therapy usage with 7.23h and 7.14h on days of use, respectively; with 1B distinguished by increased night-to-night variability. Clusters 2A (16%) and 2B (12%) had good mean therapy use of 6.63h and 6.21h, respectively, but their usage patterns were distinguished by a higher percentage of missing days (8% missing days in 2A and 23% in 2B) and less favorable therapy timing with an average therapy ON time after midnight. Clusters 3A (8%) and 3B (7%) were characterized by the lowest nightly use at 6.16h and 5.50h, respectively, and the highest night-to-night variability. 3A was further distinguished by the highest percentage of missing days (34%) while 3B was characterized by the frequent therapy pauses (mean 4.1 pauses per night) and the least increase in stimulation amplitude across the first 90 days.

Conclusion

Cluster analysis of UAS usage patterns identified six distinct groups that may enable custom interventions for improved long-term management. Differentiation of these groups may have clinical implications on conditions (e.g. therapy discomfort, comorbid insomnia, poor sleep hygiene) that impact adherence.

Support (If Any)
0775 Impact of insomnia, depression and anxiety on adherence to upper airway stimulation for obstructive sleep apnea: ADHERE registry update
Authors: Patil Reena Dhanda , Ishman Stacey , Chang Jolie , Thaler Erica , Suurna Maria
Published: May 2022

Introduction

Insomnia, depression and anxiety are common comorbid conditions in patients with obstructive sleep apnea (OSA) and can negatively impact positive airway pressure (PAP) therapy adherence. Subsequent intolerance to PAP may lead to surgical treatment such as upper airway stimulation (UAS). We sought to determine the impact of baseline insomnia, anxiety or depression on UAS therapy adherence using data from a large multi-center registry.

Methods

The ADHERE registry collects information on patients undergoing UAS (Inspire Medical, Golden Valley, MN) including baseline history of insomnia, depression, anxiety and the Insomnia Severity Index (ISI) questionnaire. We determined overall prevalence of insomnia, depression and/or anxiety, as well as UAS adherence after 6 months of therapy in groups with insomnia, depression, anxiety or none of these conditions. Using ISI to quantify insomnia, adherence in patients with no/mild insomnia (ISI < 15) was compared to those with moderate/severe insomnia (ISI ≥ 15).

Results

1639 patients were included; 10% reported a history of insomnia, 23% depression and 16% anxiety. There was no difference in UAS adherence between groups with or without a history of insomnia, depression, or anxiety. A baseline ISI score was available in 470 patients with no history of insomnia, and in 81 patients with a history of insomnia. In patients with no history of insomnia, 59% had ISI scores ≥15, while in those with a history of insomnia, 85% had ISI scores ≥15 (p < 0.001). There was no difference in therapy usage between patients with ISI scores <15 and ≥15 (6.7 ± 2.2 hours/night versus 6.4 ± 2.5 hours/night, p = 0.5).

Conclusion

This study examined the impact of insomnia, depression or anxiety on adherence to UAS therapy for OSA. Patients with and without these conditions had similar UAS adherence. We found that insomnia as objectively based on the ISI score may be underdiagnosed in UAS patients who have no subjective history of insomnia at baseline. Despite this, ISI severity did not impact UAS adherence. Longer term follow-up with serial ISI scores and adherence data is needed to further understand how insomnia severity impacts UAS therapy outcomes and usage.

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0777 The OHS Pathway: An EMR-Integrated Clinical Pathway to facilitate BiPAP on Discharge for Hospitalized Patients with Obesity Hypoventilation Syndrome
Authors: Camacho Jessica , Green Katherine
Published: May 2022

Introduction

With the rise of severe obesity, obesity hypoventilation syndrome (OHS) is increasingly recognized as a cause of sleep disordered breathing and hypercapnic respiratory failure. OHS is often diagnosed in the inpatient setting when patients present with acute respiratory failure, at which point 18-month mortality approaches 23%. Positive airway pressure (PAP) is a highly effective treatment for OHS. Clinical responses to PAP therapy include improvement in symptoms, gas exchange, hospitalization rates, and mortality. The American Thoracic Society published guidelines in 2019 recommending patients hospitalized with acute respiratory failure suspected of having OHS be discharged on nocturnal NIV therapy. Insurance criteria significantly limit access to home NIV/PAP without a sleep study, and inpatient providers seldom have success prescribing this treatment on discharge.

Methods

We first surveyed providers from a large academic hospitalist group to assess for knowledge gaps and challenges in OHS management. We then recruited inpatient respiratory therapists, providers, and care coordinators to design an EMR-integrated clinical pathway. The pathway begins with diagnostic criteria for OHS, then directs providers through the insurance criteria for BiPAP for hypoventilation, which do not require a sleep study. The criteria include wake PaCO2 ≥ 45mmHg, ≥ 7mmg increase in PaCO2 during sleep, and FEV1/FVC ≥ 70%. If these criteria are met, the pathway assists providers in writing BiPAP orders for discharge.

Results

We collected 40 survey responses. 67.5% of respondents reported being slightly familiar with the diagnostic criteria for OHS, and 75% of providers reported never having been successful prescribing BiPAP on discharge. Educational sessions were held to familiarize providers with OHS and the OHS Pathway. After launching in March 2021, the OHS team convened monthly to optimize the pathway. To date, 20 patients have utilized the pathway.

Conclusion

Pre-intervention results confirm gaps in knowledge and treatment challenges regarding BiPAP therapy for OHS patients. Our preliminary data demonstrate that this is a feasible and reproducible pathway to improve the likelihood of successful initiation of BiPAP therapy on discharge for this high-risk population. A close examination of these cases is required to identify barriers to successful qualification for BiPAP.

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0778 Characterizing Women with Obstructive Sleep Apnea from Real World Data
Authors: Cole Kathleen , Dexter R Benjamin , Woodford Caleb , Sterling Kimberly
Published: May 2022

Introduction

Real-world evidence focused on women with obstructive sleep apnea (OSA) is lacking. This retrospective study aimed to characterize and evaluate the impact of age on female patients with OSA and their journey through OSA diagnosis and treatment.

Methods

De-identified US administrative claims data for patients with OSA who had a claim for a sleep test were used for this analysis. Age and insurance coverage were characterized at the time of the first sleep test. Comorbidity status was evaluated in the year prior to the sleep test by assessing ICD-9/10 codes associated with healthcare encounters. This protocol was submitted to an Institutional Review Board and was determined to be exempt from oversight.

Results

The study included 883,902 female OSA patients; mean age of 51.7 years; and 64.9% commercial, 24.7% Medicaid, and 10.3% Medicare Advantage insurance coverage. The most prevalent comorbidities were hypertension (54.9%), hyperlipidemia (46.5%), GERD (31.5%), type 2 diabetes (25.1%), depression (23.2%), and asthma (22.0%). When stratifying by age, the prevalence of all comorbidities increased with age except for affective disorders. Depression and anxiety decreased with age. In terms of the type of sleep test used to diagnose OSA, 58.8% had an in-lab polysomnography (PSG), 38.9% had a home sleep test (HST), and 2.3% had both a PSG and HST. About half (56.6%) of patients received a positive airway pressure (PAP) device in the year after being diagnosed. When stratifying the results by age, in-lab PSG testing was more prevalent in those over 65, while the percentage of those receiving a PAP device increased then slightly decreased with age (18-44y: 47.6%, 45-54y: 58.1%, 55-64y: 62.1%, 65-69y: 61.1%, >70y: 58.8%).

Conclusion

This retrospective study characterized the start of the women’s journey with OSA; describing the rates of sleep testing and PAP treatment from a sample of real-world data. These results begin to build an understanding of these patients and their journey to treatment, helping to raise awareness of undiagnosed OSA in women. Further research should be conducted to identify potential real-world impact of adherence to PAP on health outcomes.

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ResMed
0784 Couples-based treatment for obstructive sleep apnea: perspectives from patients with mild cognitive impairment and their partners
Authors: De Vettori Giulia , Troxel Wendy , Duff Kevin , Dixon Ava , Baron Kelly
Published: May 2022

Introduction

Patients with Mild Cognitive Impairment (MCI) have an increased risk of Obstructive Sleep Apnea (OSA) which may have implications for their cognitive function. Sleeping is often a shared behavior among couples, and for couples with MCI, partners often assume the role of caregiver. The goal of this study is to examine the role of bedpartners in adherence to treatment for OSA and to determine the feasibility for couples-based adherence interventions in individuals with MCI and their partners.

Methods

This study is ongoing and will include semi-structured interviews with 10 couples. Interviews will be conducted remotely over Zoom, then transcribed and coded using Dedoose software to identify common themes among transcripts. Interviews discussed the impact of OSA and MCI on the couple with regard to CPAP treatment, interdependence of sleep, and feasibility of a couples-based CPAP intervention.

Results

Currently, three out of 10 couples have been interviewed. The participants included three men and three women (mean age= 74 years). Themes from the interviews include significant involvement of partners in the treatment of OSA (e.g., reminders and ordering supplies). Couples felt that this program would have been helpful when they were beginning CPAP treatment. They provided suggestions for the format of a couples-based treatment in MCI including shorter sessions with more pictures and simplified content so that it could be better understood by the patient and partner.

Conclusion

Data from these interviews demonstrate the critical role of the partner in adherence to CPAP treatment among patients with MCI. While interviews are currently ongoing, both patients and partners view couples-based sleep apnea treatment as feasible and adaptations will be made for this population. Couples-based treatments may be a promising intervention for increasing CPAP adherence in OSA patients with MCI, and further slowing cognitive decline.

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NIA: #59317201
0791 Perceived racial discrimination predicts poor PAP adherence: a pilot study
Authors: Williams Natasha , Grant Andrea , Bubu Omonigho , Chung Alicia , Wallace Douglas
Published: May 2022

Introduction

Although racial and ethnic differences in continuous positive airway pressure (CPAP) adherence for people with obstructive sleep apnea (OSA) are well known, no studies have examined the influence of racial discrimination on CPAP use. The aim of this study was to determine if racial discrimination influenced CPAP use trajectories.

Methods

Participants with OSA initiating CPAP were enrolled from two sleep centers in New York City. Participants completed questionnaires including sociodemographics, perceived discrimination, daytime sleepiness, and depressive symptoms. Racial discrimination was measured via the validated Everyday Discrimination scale (EDS) , Participants endorsed at least one discriminatory experience “at least once a year” and race was the main reason for this treatment. Sociodemographic and questionnaire comparison were performed between participants reporting the presence and absence of racial discrimination. To examine differences in the trajectory of CPAP use based on racial discrimination status (between-subjects factor), we performed a two-factor repeated measures ANOVA with mean hours of daily use at 7, 30 and 90 days serving as the time dependent variable (within-subjects factor). Analyses were adjusted for depressive symptoms.

Results

The sample consisted of 88 participants (40% female; 40% Non-Hispanic Black; mean age of 57 ± 14 yrs). Twenty-two individuals (25% of the cohort) reported racial discrimination. In unadjusted two-factor repeated measures ANOVA, the test statistic for equality of racial discrimination CPAP adherence means over time was highly significant [ F = 9.71 (1, 68); p = 0.003] while the test for interaction between racial discrimination and time was marginally significant [F = 3.19 (1.53, 103.8); p = 0.059). Main effects for time were significant for participants reporting discrimination (p=0.04) but not for those without racial discrimination experiences (p=0.25). Thus, people reporting racial discrimination experienced greater decrement in CPAP use over time while a more stable CPAP use pattern was observed in those not perceiving racial discrimination.

Conclusion

Racial discrimination status may determine future poor CPAP adherence. Larger studies examining mechanisms of how perceived racial discrimination mediates worse CPAP adherence may assist in mitigating CPAP adherence disparities.

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Natasha Williams was supported by grant from the National Institutes of Health: K23125939
0800 Dozing off is a problem, as is a toe falling off - Methylphenidate induced Raynaud’s phenomenon
Authors: Gaddam Maneesh , Zacharias Rajesh , He Wei , Oster Joel , Ostrow Peter , Schumaker Greg , Grover Aarti
Published: May 2022

Introduction

Narcolepsy is a clinical syndrome characterized by a constellation of symptoms including excessive daytime sleepiness, cataplexy, sleep paralysis and sleep hallucinations. Stimulants are commonly used to treat hypersomolence associated with narcolepsy. Common adverse reactions reviewed with patients prior to initiation of amphetamines include decreased appetite, nausea, xerostomia, headache, insomnia, tachycardia and hypertension. A relatively rare concern with stimulants is development of peripheral vasculopathy including Raynaud’s phenomenon.

Report of Cases: A 25-year-old female with past medical history of anxiety, depression and obstructive sleep apnea in childhood was treated with tonsillectomy and adenoidectomy. Over the years, she continued to have persistent hypersomnolence, auditory hypnogogic hallucinations with no symptoms of sleep paralysis or cataplexy. She had a polysomnography (PSG) along with multiple sleep latency test (MSLT). PSG did not show evidence of sleep apnea with an AHI of 0.96 per hour. MSLT confirmed the diagnosis of Narcolepsy, Type 2, with a mean sleep onset latency of 3.6 minutes and five sleep-onset REM periods (SOREMPs). She was started on 400mg daily of Modafinil and 20mg daily of Methylphenidate. After a month of using methylphenidate, she noticed purplish discoloration of her digits, sometimes with exposure to cold, other times with no obvious triggers, consistent with development of Raynaud’s phenomenon. The proposed mechanism is that use of methylphenidate causes excessive release of catecholamines due to inhibition of the reuptake of dopamine and norepinephrine, leading to peripheral vasoconstriction. As the patient’s hypersomnolence persisted, she was started on sodium oxybate and the dosage of methylphenidate was decreased to 10mg daily and eventually discontinued. With reduction in the dosage and discontinuation of methylphenidate, symptoms of Raynaud’s phenomenon improved.

Conclusion

Dose-related peripheral vasculopathy including Raynaud’s phenomenon has been reported in several case reports with the use of methylphenidate. Awareness of this relatively rare adverse effect is imperative among sleep physicians as it could cause significant delay in the diagnosis, management of Raynaud’s phenomenon and its complications including critical digital ischemia and gangrene. Dose adjustments and discontinuation of methylphenidate should be considered in the treatment course of the patients with such concern.

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0824 Can the interface utilized in continuous positive airway pressure therapy significantly alter the apnea-hypopnea index in certain patients with obstructive sleep apnea?
Authors: Dabaja Fauzieh , Skiba Virginia , Palmer William
Published: May 2022

Introduction

Multiple studies and analyses have demonstrated that use of an oronasal interface for delivery of continuous positive airway pressure (CPAP) therapy can lead not only to higher pressure requirements, but also a higher residual apnea hypopnea Index (AHI) in patients with obstructive sleep apnea (OSA).

Report of Cases: We record a 75-year-old man with severe OSA, AHI of 38, and treated with CPAP 16 cm water. On routine follow up, the residual AHI was 2.9, but he reported mouth-venting with nasal mask and stretched out the chinstrap. He was transitioned to an oronasal interface, and on subsequent follow-up his AHI was 19.6. The decision was made to change back to a nasal mask with a better-fitting chinstrap, which reduced his AHI to 4. To verify that the AHI recorded by the CPAP device was physiologic, the patient later used CPAP while wearing a home sleep apnea test (HSAT) utilizing peripheral arterial tonometry for 2 nights. On the night he used a nasal mask with a chinstrap, the AHI recorded on the CPAP was 1.4 and 3.9 on the HSAT. The following night, he wore the oronasal interface and the recorded AHI on CPAP was 31.6 and 18.5 on the HSAT.

Conclusion

Although oronasal masks are commonly used as an interface for CPAP, there is significant evidence that nasal delivery systems are more effective at controlling AHI in some individuals. Many studies show that oronasal masks not only correspond to an increase in AHI but also are associated with higher pressure requirements and a lower adherence compared to nasal interfaces. Imaging has shown greater retropalatal airway expansion when using a nasal interface compared to an oronasal device. Oronasal devices may also push the tongue posteriorly and cause increased occlusion of the airway. The consistent finding of worsening OSA control in the setting of oronasal masks has led many to consider CPAP with a nasal interface to be the gold standard for treating OSA. The clinician should therefore be mindful of these considerations when initiating or altering a CPAP interface.

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