bluuebunny/crossref_metadata_2025_split huggingface dataset:
0640 Initial Sleep Center Evaluation and Follow Up Improves Positive Airway Pressure (PAP) Therapy Adherence When Compared to Direct Referrals Without Sleep Physician Follow Up: A Retrospective Study
Authors: Aljarod T , Tran L , Al Ikhwan M , Prasad B 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) affects 26% of adults and positive airway pressure (PAP) is the gold-standard of therapy. Factors affecting PAP adherence—use &gt;4 hours in a 24-hour period—have been studied extensively. We compared of the three months (or other time frame) PAP adherence between patients seen by a sleep specialist prior to OSA diagnosis versus patients referred directly for OSA testing by non-sleep specialist providers. The goal of the study was to understand the impact of sleep consultation on PAP adherence.

Methods
Direct referral (DR) patients underwent polysomnography (PSG) and received PAP devices prior to the sleep clinic visit. In contrast, sleep center patients (SC) had a sleep clinic visit with a sleep physician or APRN prior to PSG.
Eighty-four patients were included in this study, 42 DR and 42 SC patients. Exclusion criteria were age &lt;18 years old, absence of baseline PSG, and lack of 90-day compliance data. Covariates included demographics, body mass index (BMI), AHI, nadir oxygen saturation, demographics, and Epworth Sleepiness Scale (ESS) score. Objective PAP adherence for first 90 days was the primary outcome.

Results
Age (p=0.1), ESS (p=0.3), BMI (p=0.6), and AHI (p=0.9) were not significantly different between the groups. SC patients had greater PAP adherence (4.77 hours, 95%CI: 4.1 to 5.4) compared to DR patients (3.61 hours, 95%CI: 2.88 to 4.33, p=0.02). SC patients were also 8 times more likely to follow up in clinic within 1 year of starting PAP treatment (Likelihood Ratio 8.25, p=0.004).

Conclusion
While possibly more time-efficient for patients, direct referrals may ultimately result in lower PAP adherence due to missed opportunities for receiving education about OSA and PAP therapy. This is consistent with findings from a previous meta-analysis demonstrating that educational interventions improve PAP adherence. Moving forward, we will continue encouraging directly referred patients to follow up in the sleep center after PSG.

Support
None
0650 Impact of Upper Airway Stimulation Therapy on 24 Hour Ambulatory Blood Pressure Monitoring
Authors: De A , Bena J , Wang L , Aylor J , Bhambra R , Kaw S , Lance C , Mehra R , Walia H 
Published: May 2020

Abstract

Introduction
Upper airway stimulation (UAS) is recommended treatment for moderate to severe obstructive sleep apnea (OSA) in select patients. Existing data have not focused on gold standard 24 hour ambulatory blood pressure monitor (ABPM) to elucidate the impact of UAS. We hypothesize that UAS reduces ABPM indices characterized using objective sleep-wake from actigraphy data over 12-month follow-up period.

Methods
A prospective sub-study of the Inspire ® post-approval study at the Cleveland Clinic was designed to examine the effect of UAS on 24-hour ABPM measures post-implantation by examining blood pressure (BP) at baseline, and-2, 6, and 12 months follow-up. Actigraphy data was contemporaneously collected. Paired T-tests were used to evaluate BP changes over time. Repeated measure correlations measured within-patient associations between BP and actigraphy measures.

Results
Average age and BMI were 62.4 +/-12.9) years and 30.1 +/-3.3 kg/m2, 73.3% males and all Caucasian. The mean baseline systolic, diastolic and mean arterial pressure (MAP) were 119.7+/-12.9 mmHg, 74.3+/-7.4 mmHg and 89.3+/- 8.1 mmHg. There were no changes to number, type or dosage of BP medications.
At 12 months, there were non-significant overall mean reduction in systolic [-0.55mmHg, p=0.75], diastolic [-0.73mmHg, p=0.63], and MAP [-0.55mmHg, p=0.71]. Mean sleeping systolic, diastolic and MAP changed by -4.36(p=0.34), -1.45 (p=0.57), -2.18 (p=0.50), respectively. Positive correlations above 0.25 (p&lt;0.10) were observed between all dipping percentage measures and total sleep time. Negative correlations were seen between overall systolic, diastolic and MAP with sleep latency (-0.22, p=0.19, -0.35, p=0.031 and -0.29, p=0.075 respectively). No significant changes in BMI was observed, but average hours of usage decreased over time.

Conclusion
Although consistent reduction of BP measures were observed post-UAS implantation, findings were not statistically significant. It is unclear whether this is due to insufficient sample size or true lack of effect. Larger-scale clinical and mechanistic studies are needed to enhance understanding of UAS-related vascular influences.

Support
Funded: Inspire Medical Systems
0663 The Longterm Effect of CPAP Compared to Mandibular Advancement Device on Metabolic Profile in Mild Obstructive Sleep Apnea
Authors: Togeiro S , Oliveira L S , Guimaraes T M , Luz G P , Coelho G , Badke L N , Tufik S , Bittencourt L 
Published: May 2020

Abstract

Introduction
Moderate and severe Obstructive Sleep Apnea (OSA) have been independently associated to dyslipidemia with controversial results of improvement with CPAP. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is Mandibular Advancement Device (MAD), however its effectiveness on metabolic profile needs to be compared to CPAP.Our aim was to compare MAD with CPAP and no treatment on metabolic profile during one year in mild OSA.

Methods
Cross sectional analyses included 79 mild OSA patients randomized in CPAP group (n: 31), MAD group (n. 25) and Control group (n: 23). Metabolic profile was investigated before and after 6 and months.

Results
Mean age: 47± 9 years, BMI: 28±3.7 kg/m AHI: 9.5±2.9/h. There were no differences in anthropometric data, total cholesterol (TCT) HDL-C, LDL-C, Triglycerides (TC) and glycated Hemoglobin (Hb1c) among groups. MAD and CPAP reduced AHI at 6 and 12 months (9.3 ± 5.2 to 4.2 ± 9.1 to 3.8 ± 12.6 / 10.0 ± 4.6 to 1.2 ± 9.9 to 1.7 ± 14.2, p: 0.01 respectively). BMI did not change in groups at 6 and 12 months. MAD adherence was higher than CPAP at 6 months (5.8 ± 2.8 hs/day vs 3.8 ± 3.0 hs/day; p: 0.01) and 12 months 5.7 ± 2.7 hs/day vs 3.8 ± 3.4 hs/day; p: 0.01). Despite of lower adherence than MAD, CPAP was effective in reduce TCT and LDL- CT at 6 and 12 months (Intention to treat analyses TCT: 189.3±51.4 mg/dl to 186.1±51.4 mg/dl to 174.6±51 mg/dl; p: 0.03 / 112.8±48.7 mg/dl to 110.5±48.7 mg/dl to 95.8±48.7mg/dl; p: 0.03 respectively), however HDL-C, TG and Hbc didn′t change.

Conclusion
Long term CPAP treatment was effective in reducing cholesterol in mild OSA.

Support
Associação Fundo Incentivo à Psicobiologia (AFIP)
CAPES
0673 Effects Of Solriamfetol On Driving Performance In Participants With Excessive Daytime Sleepiness Associated With Obstructive Sleep Apnea
Authors: Vinckenbosch F , Asin J , De Vries N , Vonk P , Donjacour C , Lammers G , Overeem S , Janssen H , Wang G , Chen D , Carter L , Zhou K , Vermeeren A , Ramaekers J 
Published: May 2020

Abstract

Introduction
Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) is associated with an increased risk of driving accidents. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved in the US (Sunosi®) for EDS associated with OSA (37.5-150 mg/day). This study evaluated solriamfetol’s effects on on-road driving performance in participants with EDS associated with OSA.

Methods
In each period of this randomized, double-blind, placebo-controlled, crossover study (NCT 02806895; EudraCT 2015-003930-28), driving performance during an on-road driving test was assessed at 2 hours and 6 hours postdose following 7 days of treatment with solriamfetol (150mg/day × 3, then 300mg/day × 4) or placebo. The primary endpoint—standard deviation of lateral position (SDLP), a measure of “weaving,” at 2 hours postdose—was compared between solriamfetol and placebo per time point using a repeated mixed-effects analysis of variance model.

Results
The study included 34 participants. Baseline characteristics reflected the broader OSA population (88% male; mean age=52 years; mean Epworth Sleepiness Scale score=14.4). SDLP at 2 hours postdose was statistically significantly lower following solriamfetol (least squares [LS] mean [standard error; SE], 18.83cm [0.63]) compared with placebo (19.92cm [0.63]): LS mean difference, -1.08cm; 95% confidence interval (CI), -1.85, -0.32; P=0.0062 (incomplete driving tests: solriamfetol, n=1; placebo, n=4), indicating better performance with solriamfetol. At 6 hours postdose, SDLP following solriamfetol (LS mean[SE], 19.24cm [0.63]) was statistically significantly lower compared with placebo (20.04cm [0.63]): LS mean difference, -0.80cm; 95% CI,
-1.58, -0.03; P=0.0432 (incomplete driving tests: solriamfetol, n=3; placebo, n=7). Common adverse events (≥5%) with solriamfetol were headache, nausea, insomnia, dizziness, and agitation.

Conclusion
Solriamfetol (300mg/day) improved SDLP, an important measure of driving performance, at 2 and 6 hours in participants with EDS associated with OSA.

Support
Jazz Pharmaceuticals
0697 Early Sleep Apnea Termination By Bone-conducted Sound Stimulation Reduces Oxygen Desaturation Magnitude And Duration
Authors: Waeber A , Arnal P , Mignot E , Heinzer R 
Published: May 2020

Abstract

Introduction
Obstructive sleep apneas (OSA) usually end with an oxygen desaturation and/or an arousal. In most epidemiological studies, OSA-associated oxygen desaturations are stronger predictors of cardiovascular morbidity than OSA-associated arousals. The aim of this study was to determine if induction of a premature arousal by a bone-conducted sound stimulation shortly after the onset of an event can reduce the magnitude of OSA-associated oxygen desaturation.

Methods
Eight severe OSA patients (2 women, 45 [20-68]y.o.) underwent polysomnography at the Lausanne University Sleep Center (CIRS). Short acoustic stimulations were administered every second sleep apnea by remote control using a Dreem® headband worn by the patients. Acoustic stimulations were administered by bone conduction. The magnitude(%) and the duration(s) of the oxygen desaturations following these prematurely-terminated apneas were compared with previous and following non-acoustic stimulated sleep apnea events.

Results
Analysis of 549 paired (stimulated-unstimulated) respiratory events in N1(14.2%), N2(69.9%), N3(4.2%), and REM sleep (9.6%) showed a 30.3% reduction in oxygen desaturation amplitude (mean difference±SD: -1.9±2.8%, p&lt;0.0001), a 39.6% decrease in desaturation duration (-5.7±9.2 seconds, p&lt;0.0001), and a 21.4% decrease in apnea duration (-3.4±7.2 seconds, p&lt;0.0001) in stimulated apneas compared to the previous and subsequent non-stimulated apnea events. When analyzed individually, each patient showed a significant improvement following acoustic stimulation of events. Sound-associated discomfort was rated 1.14±1.53 on an 8 points scale (8=worst). Of the 68.6±38 administered sound stimuli per patient, only 6.8% of were perceived by the patients. A reduction in the desaturation amplitude occurred in each sleep stage but was milder in N3.

Conclusion
Bone-conducted sound stimuli applied trough a headband during the apneas decreased duration and magnitude of OSA-associated oxygen desaturation. These were well tolerated and often not perceived by the patient. This new treatment approach should be further investigated, with monitoring of its effect on cardiovascular parameters and daytime sleepiness.

Support
Customized Dreem headbands were provided by Dreem company
0703 Transvenous Phrenic Nerve Stimulation Provides Safe And Effective Therapy For Cheyne Stokes Respiration
Authors: Schwartz A R , Sundar K , McKane S , Germany R , Khayat R 
Published: May 2020

Abstract

Introduction
Cheyne-Stokes respiration (CSR), a specific type of central sleep apnea (CSA) is characterized by a waxing and waning pattern of breathing with absent air flow at the ventilatory nadir followed by oxyhemoglobin desaturation. CSR is most common in patients with heart failure (HF) and predicts morbidity/mortality. Therapeutic options remain limited, especially for patients with reduced left ventricular ejection fraction (LVEF).

Methods
Patients (n=151) with predominantly CSA were implanted with a transvenous phrenic nerve stimulation device (TPNS, remedē system, Respicardia Inc.) and randomized to 6-months of active vs. deferred (control) therapy. Patients were divided into subgroups based on percentage of sleep in CSR (&lt;20%, 20-50%, &gt;50%) on their baseline polysomnogram. Response to TPNS, defined by ≥50% reduction in apnea-hypopnea index, and Epworth Sleepiness Scale were assessed. TPNS efficacy and safety was analyzed in each subgroup.

Results
As percentage of CSR during sleep increased, more patients had a history of HF and lower LVEF. The proportion of TPNS responders was similar among CSR subgroups at 6 months (63% [17/27] CSR&lt;20%, 52% [11/21] CSR 20-50%, 54% [7/13] CSR&gt;50%); the corresponding control response rates were ≤16% in each subgroup. Central apnea index decreased from median 33, 17 and 30 events/hour in these subgroups to ≤2 in TPNS-treated subgroups; control subgroups had median ≥17 events/hour at 6 months. Daytime sleepiness improved more in TPNS patients with &lt;20% CSR (4/24 points vs. 2 in &gt;20% CSR subgroups). In the CSR&gt;50% subgroup, cardiovascular death (pump failure) was observed in 2/25 control and 0/14 treatment subjects through 6 months. One cardiovascular death (sudden death) occurred in the TPNS 20-50% CSR subgroup.

Conclusion
TPNS effectively treats CSA regardless of CSR. Risk of cardiovascular death did not differ by CSR severity with TPNS, but may increase in CSR without treatment. TPNS therapy appears safe and efficacious for CSA with and without CSR.

Support
Respicardia and NIH R01 HL 144859
0713 Association Between Obesity Indices And Obstructive Sleep Apnea Is Modified By Age In A Sex-specific Manner
Authors: Liu Y , Meng L , Guan J , Yi H , Yin S 
Published: May 2020

Abstract

Introduction
The beneficial effects of weight loss on obstructive sleep apnea (OSA) are highly variable. Whether the variability is associated with the effects of age and sex remains unclear. This study examined this issue with large cross-sectional data.

Methods
A total of 4600 adult males and 1156 females with suspected OSA were included in the study. Anthropometric measurements, polysomnographic variables, biochemical indicators, and medical history were collected for each subject. Multivariable linear regression with interaction terms was used to estimate the modification effect of age on the associations between OSA severity (assessed by apnea-hypopnea index, AHI) with obesity indices (body mass index, BMI; neck circumference, NC; waist circumference, WC) in a sex-specific manner, and vice versa.

Results
BMI, NC, and WC were all positively correlated with AHI after adjusting for potential confounders in all populations. In males, these associations were much stronger and more significant in younger than older individuals (P for interaction &lt; 0.001). For example, a 10% increase in BMI was independently associated with a 31.6% increase in AHI for males &lt; 40 years old, whereas the corresponding increases were 20.8% and 16.7% for males 40-60 and &gt;60 years old, respectively. By contrast, no modification effect of age was observed in females (P for interaction &gt; 0.05). A 10% increase in BMI was associated with 25.6%, 26.8%, and 23.8% increases in AHI for females &lt; 40, 40-60, and &gt;60 years old, respectively.

Conclusion
Age modifies the associations between obesity indices and OSA severity in a sex-specific manner, and vice versa. These findings may broaden the understanding of age- and sex-related heterogeneities in the pathogenic role of obesity in OSA, and may be beneficial for individualized risk evaluation and treatment management for patients with OSA.

Support
This study was funded by Shanghai Municipal Commission of Science and Technology (grant number.18DZ2260200); the National Key R&D Program of China (grant number: 2017YFC0112500); Multi-Center Clinical Research Project from the School of Medicine, Shanghai Jiao Tong University (grant number: DLY201502); and the Shanghai Shen-Kang Hospital Management Center Project (grant number: SHDC12015101 and 16CR3103B).
0715 Long-term CPAP Adherence In A Public Sleep Clinic
Authors: Rezayat T , Vassar S , Hakopian S , Wallace J 
Published: May 2020

Abstract

Introduction
CPAP adherence may drop substantially over a long time frame. Since minorities including Hispanics and low socioeconomic groups have lower short-term acceptance and adherence, long-term adherence may also be reduced. We adapted a brief motivational enhancement education program (BMEEP) (Lai, CHEST 2014) in a Los Angeles County safety-net sleep clinic and found improved CPAP adherence at 3 months. We now report longitudinal long-term adherence over &gt;=2 years. Our hypothesis: Many patients would meet CMS adherence criteria over &gt;= 2 years.

Methods
During 3/1/2016 - 4/1/17, 118 patients completed BMEEP during CPAP initiation and were scheduled for a reinforcement session and routine clinic visits at 1 and 3 months and every 6 months thereafter. Electronic adherence and efficacy data were accessed each visit. Multivariate regression analyses explored association of adherence variables with demographic, clinical and workflow features.

Results
Baseline characteristics (mean (SD) or percent): Age 57.2 (17.8); Women 44.9%; Hispanic 69.5%, Non-Hispanic-White 22.9%, Other 5%, Black 3%; BMI 37; Epworth score 10.4 (6.05). Home sleep testing (69 patients) respiratory event indices were &gt;=15/hr in 67% and &gt;=30/hr in 57%. Polysomnography (81 patients) apnea hypopnea indices were (AHI) &gt;= 15 in 78% and &gt;=30/hr in 43%. By 7/1/2019, 23 (19%) patients were lost with unknown CPAP use status, while 76 (70.5%) of remaining patients continued to use CPAP. At 2 years, CPAP adherence parameters included: Average nightly use, 75% (27.7); Average hours/night, 4.74 (2.5); Average nightly use &gt;=4 hours, 65.2% (31.6); &gt;=70% nightly use &gt;= 4 hours, 35 (51.5%). Average residual AHI was 2.05 (1.69). Adherence parameters in individual patients remained similar throughout 2 years. Long-term adherence was not associated with the demographic, clinical or workflow variables tested.

Conclusion
Programs that educate, motivate and provide regular follow-up for predominantly Hispanic low income populations can achieve acceptable long-term CPAP adherence rates.

Support
None
0716 The Clinical Characteristics And Therapeutic Efficacy Of Catathrenia
Authors: Wen Y , Xu L , Han F 
Published: May 2020

Abstract

Introduction
Catathrenia/nocturnal groaning, is a rare sleep disorder characterized by repeated groaning in a protracted expiration preceded by a deep inspiration. The classification was moved from ICSD-2 as parasomnia to sleep-disordered breathing(SDB) in ICSD-3. The pathogenesis of catathrenia is unknown.

Methods
To investigate catathrenia’s response to continuous positive airway pressure (CPAP) treatment, and its relationship with SDB. We analyzed patients diagnosed at the Sleep Center of Peking University People’s Hospital from 2009 to 2016. All patients were confirmed with nocturnal groaning by polysomnography(PSG), and recording of the sounds. The patients were recommended for treatment of CPAP.

Results
A total of 49 patients were recruited into this study, including 31 female and 18 male, age ranging from 16 to 64 years. The average onset age was 19.81 ± 8.65 years old, the average BMI was 21.76 ± 2.62 kg/m², the average groaning index (GI) was 11.58 ± 13.32 times per hour, and the average apnea hypopnea index (AHI) was 3.59 ± 8.83 times per hour. The GI in REM and NREM sleep were 39.31 ± 44.39 and 6.74 ± 8.5 times per hour respectively (p &lt;0.01). The GI of 26 patients who received CPAP treatment decreased from 10.57 ± 12.01 to 5.65 ± 7.10 times per hour (p &lt;0.001).

Conclusion
Catathrenia occurs mainly in REM sleep, and treatment with CPAP is effective, although cannot be completely eliminated. Suggest that catathrenia might be a sleep breathing disorder

Support
There is no support of this study
0722 The Association Between Obstructive Sleep Apnea and Neurobehavioural Function in Men: A Large, Population-Based Cohort Study
Authors: Parker J L , Adams R J , Appleton S L , Melaku Y A , Vakulin A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is linked with impaired vigilance, attention, memory and executive function. However, this evidence largely comes from small experimental studies or larger studies in clinical samples and therefore the scope and magnitude of OSA driven neurobehavioural dysfunction in the general population remains unclear. This study aimed to examine the cross-sectional association between OSA and neurobehavioural function in a large community sample of men.

Methods
A total of 837 participants from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, a longitudinal cohort of men 40+ years, underwent full overnight polysomnography. Participants completed the inspection time (IT) test, mini-mental state examination (MMSE), Fuld object memory evaluation (FOME), and trail-making test (TMT) part A (TMT-A) and part B (TMT-B). Using regression models adjusted for multiple important covariates, we examined the association between neurobehavioural function scores, clinical metrics of OSA severity (Apnea-Hypopnea Index (AHI); percentage total sleep time with oxygen saturation &lt;90% (TST90), and measures of sleep disruption (duration of rapid eye movement (REM) and non-REM (NREM) sleep; and total sleep time (TST).

Results
In multivariable linear regressions, greater TST was associated with worse IT scores (B=13.688, 95% CI [0.134, 27.241], P=0.048) and TMT-B scores (B=19.255, 95% CI [0.931, 37.578], P=0.040). In logistic regressions, greater TST was associated with better MMSE scores (Odds ratio [OR]=0.440, 95% CI [0.194, 0.997], P=0.049); and higher AHI was strongly associated with worse FOME scores in fully adjusted models (OR=1.358, 95% CI [1.252, 1.472], P&lt;0.001).

Conclusion
The AHI and TST were positively, significantly associated with neurobehavioural function across different domains. This cross-sectional data shows that neurobehavioural function deficits in OSA are directly related to sleep and breathing disruptions. Future large prospective studies are needed to determine if OSA and sleep disruption predict future onset of neurobehavioural dysfunction and cognitive decline.

Support
National Health and Medical Research Council and the Adelaide Institute for Sleep Health.