bluuebunny/crossref_metadata_2025_split huggingface dataset:
0621 Utilization of the Ares to Predict OSA Among Blacks Using Home-Based Watchpat Recording
Authors: Rogers A , Seixas A , Moore J , Zizi F , Williams S , Gyamfi L , Pichardo Y , Jean-Louis G 
Published: May 2020

Abstract

Introduction
In two waves of data we collected in Brooklyn New York, we observed blacks were at high risk for obstructive sleep apnea (OSA). In the NIH-funded study ‘Metabolic Syndrome Outcome Study (MetSO), blacks enrolled from primary-care settings had a 59% risk of OSA. Similarly, blacks surveyed in churches and barbershops had a 43% risk of OSA. While these studies showed higher than expected risk as noted in the general population (29%), it remains uncertain how many of those blacks would be diagnosed with OSA in that population. The purpose of this study was to explore the rate of OSA using the WatchPat device in a community-based setting.

Methods
Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks were screened for OSA using the Apnea Risk Evaluation System (ARES) Questionnaire; a score ≥6 denoted moderate-high OSA risk. Individuals were asked to wear the WatchPAT 200 for one night during a week-long sleep assessment. WatchPat 200 measures SaO2 to determine respiratory-related arousals, defined as an Apnea-Hypopnea Index (AHI) ≥5, which is used to identify and diagnose OSA. We used SPSS 25.0 to perform logical regression analysis to assess associations between ARES and WatchPat AHI.

Results
A sample of 111 blacks provided valid ARES and WatchPat data for the present analyses. Of the sample, the mean age was 62.26 (SD=13.52 years; female = 55%); 49% reported annual income &gt;20K and 79.5% reported a high school education. Moreover, 27% reported high blood pressure, 13%, diabetes, and 65% were overweight/obese. Multivariate-adjusted logical regression analyses indicated that blacks at risk for OSA were 66% more likely to receive an OSA diagnosis based on WatchPat AHI data (OR = 1.662, p &lt; 0.01). The model adjusted for age, sex, income, and education.

Conclusion
The present study demonstrated that blacks at risk for OSA at the community level have a significant likelihood of receiving an OSA diagnosis using home-based recordings.

Support
NIH Support (T32HL129953, RO1MD007716, K01HL135452 and K07AG052685).
0634 Volume-Assured Pressure Support is Effective Treatment for Obstructive Sleep Apnea Patients Who Failed CPAP Titration
Authors: Watanabe N , Levri J , Peng V , Scharf S M , Diaz M 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common disease, often treated using continuous positive airway pressure (CPAP). In many cases, patients fail an attended CPAP titration study, often due to inadequate control of AHI, and treatment-emergent central apneas as CPAP is increased. Here, we report our experience using volume-assured pressure support (VAPS) for these patients.

Methods
We retrospectively reviewed records of 45 adults who had OSA diagnosed on polysomnography (PSG) in whom CPAP titration had failed. In these patients, VAPS-AE (adjustable expiratory pressure) titrations were performed. Patients with central sleep apnea on baseline PSG were excluded.

Results
Reasons for CPAP titration failure included: treatment emergent central apneas (25), failure of maximum CPAP pressure to treat OSA (18), and persistent hypoxia (2). Average age was 57.9±13.1, BMI was 40.2±8.7, 26 males, Epworth sleepiness score was 10.7±7.9. The following significant changes from baseline PSG to VAPS titration were observed: AHI: 65.3±29.3 to 22.3 ±16.1 (p&lt;.001) events/hour. Time &lt; 88% saturation: 63.7 (median) to 6.9 (median) min (p&lt;.001). The number of patients with AHI&lt;15 was 0 on PSG and 16 (36%) on VAPS-AE, while the number of patients with AHI&lt;30 was 7 (16%) on PSG and 32 (71%) on VAPS-AE. Improvement in AHI was not related to gender, age, or narcotic use, but was correlated with BMI: ΔAHI = 12.2 - (1.4 * BMI); p=.05. VAPS resulted in improved sleep architecture: slow wave sleep increased (medians: 1.4% to 19.6% total sleep time (TST)) (p&lt;.001), REM sleep increased (medians 6.4% to 13.6% TST) (p&lt;.01).

Conclusion
For OSA patients for whom CPAP titration failed, titration with VAPS-AE was an effective treatment for many patients.

Support
N/A
0638 Evaluation of an Oral Drug Pyridostigmine Bromide in Patients with Mild to Moderate Obstructive Sleep Apnea
Authors: Fan J , Wu H , Chen G , Lv Q , Shi C , Ma X , Gao H , Palling D 
Published: May 2020

Abstract

Introduction
A randomized, double-blind, cross-over, placebo-controlled clinical study with pyridostigmine bromide (PYD) in obstructive sleep apnea (OSA) patients ranging from mild to moderate disease was conducted to evaluate its clinical efficacy and safety.

Methods
Six diagnosed male patients with averages of age 48 yr (38 - 57 yr), BMI 28 (26 - 33), AHI 19.2 (15 - 26.2), minimum oxygen saturation (Min SaO2) 81% (75 - 87%) were enrolled to the study. The study consisted one-night acclimatization period followed immediately by a 2-night double-blind treatment period when subjects received either a single dose of PYD (a cholinesterase inhibitor, 90 mg) or placebo before sleep. Subjects were required to maintain in a supine position, and monitored by a standard polysomnography all the time. Sleep questionnaires (The SMH Sleep Questionnaire and ESS) were taken daily immediately after sleep and at the evening to evaluate the sleep satisfaction and the day-time quality, respectively. Safety of the drug was monitored and evaluated.

Results
Reductions of AHI (28.1%, p &lt; 0.01), apnea index (37.2%, p &lt; 0.05), % of total apnea/hypopnea time (36.4%, p &lt; 0.05) were observed in the treatment group compared with the placebo between 2-7 hours of sleep. Min SaO2 was increased, no change, or decreased by PYD in 3, 2, or 1 subject(s), respectively. PYD was generally well tolerated with minimum minor incidents. Subjects reported to have more satisfied sleep and more clear-headed in the treatment night, and more energy, more concentrated and less sleepy during the daytime following the treatment night.

Conclusion
This study demonstrated the initial effectiveness of the PYD treatment for OSA, indicating that it may provide a new treatment option if the efficacy can be maintained in a large-scale clinical trial.

Support
N/A
0649 Ultrasound Assessment of Tongue Movement as a Predictor of Response to Hypoglossal Nerve Stimulation (HGNS)
Authors: Korotun M , Hahn S , Quintero L , Rajan P , Iakovou A , Mayo P , Greenberg H 
Published: May 2020

Abstract

Introduction
HGNS is an approved therapy for obstructive sleep apnea (OSA). Initial setting of HGNS voltage is based on observation of anterior tongue movement, which may not reflect opening of the retroglossal airway. We developed an ultrasonographic (US) technique to assess tongue movement with HGNS. We correlated US measures of tongue movement at the initial HGNS voltage setting with the AHI determined by PSG/HSAT on HGNS therapy.

Methods
Eleven subjects implanted with INSPIRE™ (HGNS) were enrolled at least one month post-implantation. Initial HGNS voltage was determined while awake and semi-recumbent and set to achieve visualized anterior tongue protrusion at a tolerable stimulation voltage. A curvilinear probe (5-2MHz) was placed longitudinally in the submental region at the midline with the indicator pointed anteriorly. Hyoid bone excursion (HBE) with stimulation was used as a marker of base of tongue movement. PSG or HSAT was performed to determine AHI with HGNS. Responders were defined as those with a reduction in AHI ≥50% and an AHI &lt;20 events/hr.

Results
N=11, 6M, 5F, Age=66.5 ±18.4 years, BMI=27.9±2.7 kg/m2. Pre-treatment AHI=38.8±13.4/hr, T-90%=10.5±16.7%. Mean HBE in responders=1.02±0.17cm vs 0.76±0.20cm in non-responders (p=0.006). Best subsets regression analysis performed using post-treatment AHI as the dependent variable and age, BMI, baseline AHI, HBE and HGNS voltage as independent variables showed that HBE (coef. -29.1, p=0.038) and BMI (coef. 2.6, p=0.018) were independent predictors of response.

Conclusion
We demonstrated that ultrasound assessment of HBE during HGNS may be a useful tool to predict response to therapy and guide HGNS settings. HBE, rather than voltage, predicted post-treatment AHI.

Support
None.
0661 Comparison Between Ventilator Detected Apnea Hypopnea Index and Manual Scored Results
Authors: Ni Y , Dunhsm K , Cunningham L , Thomas R 
Published: May 2020

Abstract

Introduction
The apnea hypopnea index and percentage of periodic breathing detected by the ventilator machine are often used by sleep doctors to evaluate whether sleep apnea has been adequately treated or need further interventions. There are concerns about the accuracy of this autodetection.

Methods
Patients with sleep apnea who were treated with positive airway pressure at the Beth Israel Deaconess Medical Center (Boston) and tracked by the EncoreAnywhere system were included. The machine detected AHI(AHIm) and PB(PBm) were extracted from the first week data in every month from the start of use. The manual scored AHI(AHIs) and PB(PBs) were calculated from the last waveform graph during every month. The apnea hypopnea index as well as periodic breathing in 1st, 2nd, 3rd,6th month AHIm, AHIs, PBm and PBs were compared respectively.

Results
A total of 128 patients were included. The mean age was 56.5 and 66% of them were male. In the first month, the mean AHIs was significantly higher than AHIm, 16.27 vs. 5.36, p&lt;0.001. There was also a large difference between percentage of PBs and PBm, 15.55% vs. 1.96, p&lt;0.001. 78% patients whose AHIm &lt;5 were actually has AHIs &gt;5. The Kappa value for the AHIm and AHIs were 0.074, p=0.069; the value of PBm and PBs was 0.216, p=0.015. In the 2nd, 3rd and 6th months, the mean difference between AHIs and AHIm was 10.58, 10.68, 10.12, respectively. The mean difference between PBs and PBm was 12.32%,11.53%,and 9.18%.

Conclusion
Autodetection of respiratory events consistently under-estimates the severity of residual events. Mean differences remained stable over 6 months. Caution is recommended when attributing non-apnea reasons for residual symptoms in patients with apparently low machine estimated AHI and PB.

Support
This study is supported by American Academy of Sleep Medicine Foundation, category-I award to RJT
0662 Hybrid Therapies to Improve Sleep Apnea Management
Authors: Pogach M , Cohn V , Thomas R J 
Published: May 2020

Abstract

Introduction
A one-size fits all approach to sleep apnea management, as is promoted by insurance requirements, pervades the field of sleep medicine but does not address individual differences in disease phenotype or treatment tolerance or attempt to achieve meaningful targets for adherence or disease optimization. Continuous positive airway pressure (CPAP) is considered to be the gold standard treatment for sleep apnea, yet CPAP nonadherence rates remain high (estimates at &gt; 30%) while usage goals (at least 4 hours/night) and therapeutic success targets (machine detected AHI &lt; 5) allow for substantial residual disease to persist. Hybrid therapy, combining mandibular advancement device (MAD) and positive airway pressure (PAP), has demonstrated additive effects on lowering the AHI, ODI, and therapeutic PAP pressure in severe OSA patients with pressure intolerance. This analysis explores the impact of hybrid therapy on treatment adherence and optimization, and identifies patient and data characteristics suggestive of benefit from combined therapies.

Methods
In a retrospective analysis, we reviewed the demographic data, medical histories, home sleep test, diagnostic and therapeutic attended polysomnography results, and PAP device settings and data (including usage, leak, residual event index, and waveforms) pre-and post-hybrid approach, in patients treated with hybrid therapy in our multidisciplinary academic sleep disorders clinic from 2014-2019.

Results
Hybrid therapies utilized include simultaneous (MAD worn together with PAP), alternating (MAD and PAP separately over parts of or on alternating nights), and anchoring (MAD to maintain mouth closure and jaw stability to minimize leak). Preliminary analysis (N=30) shows that hybrid therapy compared to PAP alone improves PAP adherence, lowers residual AHI, minimizes periodic breathing, reduces aerophagia, and lowers therapeutic PAP pressure in these patients. Patient and data characteristics suggestive of benefit include high loop gain sleep apnea, complex apnea, mouth breathing, and position dominance.

Conclusion
Individualizing treatment by combining therapies can result in improved PAP tolerance, usage, and disease control.

Support
0664 A Low Arousal Threshold Causes Bad Shift of Positive Airway Pressure Compliance Over Time in Obstructive Sleep Apnea Patients
Authors: Wu H , Wei Y , Fang F 
Published: May 2020

Abstract

Introduction
To determine the predictive factors of initial and long-term adherence to positive airway pressure (PAP) therapy and which factors leading a shift of good initial compliance to noncompliance.

Methods
In this follow-up study, A cohort of 166 adult patients who underwent polysomnography (PSG) between January 2017 and April 2019, newly diagnosed with obstructive sleep apnea (OSA) and were amenable to PAP therapy were selected. Information on basic demographics, comorbidities and sleep-related symptoms was collected. PAP adherence data were collected at the end of the first week and the third month. After 3 months of follow-up, 142 participants were included for final data analysis.

Results
Pressure levels were stable during 3 months of PAP treatment. Overall average daily usage time and percentage of PAP used days ≥4 hrs were lower for 3 months than that in the first week. After adjustment for age and gender, multinomial logistic regression analysis showed that less number of sleep-related symptoms (OR, 0.69; 95% CI, 0.52-0.91) and low arousal threshold (ArTH) (OR, 4.44; 95% CI, 1.52-12.98) were associated with a higher odds of consistent noncompliance of PAP; Low ArTH (OR, 2.87; 95% CI, 1.09-7.57) and less BIM (OR, 0.88; 95% CI, 0.78-0.99) increased the risk of compliance-to-noncompliance shift.

Conclusion
Different from the predictors of consistent PAP noncompliance of OSA patients, only less BMI and low ArTH would cause a good PAP compliance shift to noncompliance over time.

Support
Science and technology Beijing 100 leading talents (Z171100001117168)
0671 Combination Of Transoral Robotic Surgery And Oropharyngeal Myofunctional Therapeutic Training For Patients With Obstructive Sleep Apnea
Authors: Lai Y J , Hung C H , Lin C Y 
Published: May 2020

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is a type of sleep disorder characterized by intermittent, partial or complete upper airway collapse. Mostly, moderate to severe OSA cases were recommended to treat with continuous positive airway pressure, however, some of them were withdrawn. Transoral robotic surgery (TORS) was considered for OSA patient with tongue base hypertrophy, but the success rate was only 66.9% and the symptoms might relapse because of aging and gaining weights. Myofunctional therapeutic training (MFTT) was also an alternative treatment for patients with mild to moderate OSA. In our study, we investigated the effect of TORS surgery and oropharyngeal MFTT for OSA patients.

Methods
Seven adult patients were recruited, who were newly diagnosed with moderate to severe OSA (Apnea-hypopnea Index, AHI, 49.8±27.7/h). Polysomnography, questionnaire (Pittsburgh sleep quality index, PSQI; Snore Outcomes Survey, SOS), and the muscle strengths over tongue and jaw-opening were assessed before TORS surgery, 6-week and 18-week after surgery. The components of MFTT program involved jaw opening, tongue protrusion, tongue left, tongue right, tongue up and tongue down. It began at 6th week after surgery and these patients underwent 12 weeks of the home-based oropharyngeal MFTT. During the training intervention period, subjects were interviewed every week for adjusting the treatment intensity.

Results
Mean age was 45.9 years old (SD 9.8) and body mass index (BMI) was 26.6 (SD 3.6). After combination treatment of TORS surgery and MFTT, AHI-supine was significantly decreased from 66.3/h to 26.8/h (p&lt;0.05). PSQI and SOS scores were significantly improved (-2.1, 28.8, respectively). Compared with different components of MFTT program, muscle strength of tongue protrusion was the only significant predictor of AHI-supine reduction.

Conclusion
Our study presented that combination of TORS surgery and oropharyngeal MFTT could improve OSA severity and symptoms.

Support
This work was supported by National Cheng-Kung University Hospital (grant number NCKUH-10802018).
0672 The Effect Of Armodafinil On Sleep Spindles In Obstructive Sleep Apnea: Secondary Analysis Of A Randomized Placebo-controlled Trial
Authors: Emami L , Marshall N S , Chapman J L , Cho G , Grunstein R R , Yee B J , D’Rozario A L 
Published: May 2020

Abstract

Introduction
Armodafinil has been trialed in OSA patients to promote wakefulness and simulated driving performance. We have previously completed a 6-month trial of 150mg of armodafinil vs placebo in moderate-severe OSA patients not using CPAP (ACTRN# 12611000847910) observing that participants on armodafinil learned to perform better across a 90-minute driving simulator task faster than those on placebo. It is possible that this reduction in time-on-task decrement may have been due to increased learning on armodafinil.
Sleep spindles have previously been implicated in procedural learning and neurobehavioral performance. We hypothesized that armodafinil increases sleep spindle events during NREM sleep to enhance learning.

Methods
Sixty-three overweight severe OSA patients (mean BMI: 32.3kg/m2 (26.1-42.5); age 53.1 years (28-71), 52 males) underwent overnight in-lab polysomnography at baseline (0 months) and at a 6-month follow-up. All-night EEG signals were analyzed using a previously validated automated spindle detection algorithm. EEG recordings were visually inspected by an experienced sleep physician (LE), who was blinded to drug allocation. To minimize the likelihood of type 1 error we selected three key spindle variables detected at Cz for analysis of change between 0 and 6 months: 1) total number of spindle events (11-16 Hz) in NREM sleep 2) density of slow spindles (≥11 to ≤ 13Hz) per minute of NREM sleep, and 3) fast spindle density in NREM (&gt;13 to ≤ 16Hz).

Results
The change in total spindle count in NREM sleep (armodafinil=11.6 vs Placebo =-17.1, p=0.57), fast spindle density (armodafinil=0.06 vs Placebo =-0.02, p=0.63) and slow spindle density (armodafinil=-0.00 vs. Placebo =-0.03, p=0.74) were not increased by armodafinil.

Conclusion
If armodafinil enhances simulated driving performance in a way that suppresses time-on-task effects it does not appear to be through a sleep spindle enhancing mechanism. Armodafinil is probably not a pharmacological method of enhancing sleep spindles.

Support
World Sleep Society (International Sleep Research Training Program)CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney
0676 Long-term Effects Of Upper Airway Stimulation For Treatment Of Obstructive Sleep Apnea On Measurements Of Central And Mixed Apneas
Authors: Myers S A , Sundar K M , Strollo P J 
Published: May 2020

Abstract

Introduction
Upper airway stimulation (UAS) of the hypoglossal nerve for obstructive sleep apnea (OSA) is well-tolerated and results in sustained reduction in the apnea-hypopnea index (AHI). Treatment-emergent CSA is reported to occur in 3.5-19.8% of OSA patients treated with CPAP. We aimed to examine the occurrence or emergence of central and mixed apneas in a cohort of participants that received UAS and were followed for 5 years post implantation.

Methods
The Stimulation Trial for Apnea Reduction (STAR) was a Phase III trial evaluating the safety and efficacy of UAS for CPAP-intolerant OSA. Major inclusion criteria were CPAP intolerance, AHI between 20-50, less than 25% central and mixed apneas and BMI &lt;= 32. Polysomnography was performed at baseline, 12, 18, 36 and 60-month follow-up. Data were scored by a core lab and was then retrospectively analyzed via the STAR PSG database to measure the evolution of central and mixed apneas on UAS therapy.

Results
Baseline age was 54.5 ± 10.2 years, BMI was 28.4 ± 2.6 kg/m2 and 83% male (n=126). AHI data were non-normally distributed. Median AHI was 29.3/hr at baseline, that was reduced to 9/hr at 12-months and 6/hr at 60-months. Median central apnea index (CAI) was 0.8/hr at baseline, 0.4/hr at 12-months, and 0.2/hr at 60-months. Median mixed apnea index (MAI) was 0.2/hr at baseline, 0.7/hr at 12-months and 0.4/hr at 60-months. The 12- and 60-month CAI was significantly lower than baseline (p&lt;0.05), but MAI was not. The percentage of central and mixed events remained stable throughout follow-up, approximately at 5% of the total AHI.

Conclusion
UAS reduced the overall AHI and results in a small but significant decrease in CAI. Given that OSA and CSA frequently co-exist, the role of UAS on reducing CSA in patients with combined OSA and CSA deserves further investigation.

Support
STAR study was sponsored by Inspire Medical Systems
0684 Overnight Fluid Shift In Apnea And Stroke: Does Being Physically Active Matter
Authors: Frange C , Coelho F M 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) and physical inactivity are frequent in patients with stroke. Overnight fluid shift may increase the propensity to pharyngeal obstruction and thus predispose to OSA. Also, physical inactivity can lead to consequent edema in the hemiparetic side.

Methods
In 7 patients at 3 months following post-first-ever ischemic stroke, we measured change in AHI (PSG), neck circumference, and arms and legs fluid volume (bioelectric impedance), before and after PSG in two conditions during the day before PSG: (1) inactive (sitting/lying), and (2) physically active (standing, walking, climbing stairs and mild exercise for 30 mins/hour).

Results
Being physically active for one day decreased mean AHI (inactive: 17.9/h; active: 12.6/h). Mean neck circumference increased overnight in both conditions (active and inactive) but increased more when the participants were physically active (inactive: 38 to 38.5cm; active: 38.43 to 39.5cm). Mean paretic arm fluid volume increased after inactive condition and did not change after physically active condition (inactive: 1.33L to 1.45L; active: 1.82L). Mean non-paretic arm fluid volume increased after active and inactive conditions (inactive: 1.34L to 1.45L; active: 1.74 to 1.78L). In both conditions and for paretic and non-paretic arms, being physically active for one day increased arm fluid volume between pre- and post-sleep comparisons. Mean paretic leg fluid volume increased after both conditions but increased more when the participants were inactive (inactive: 6.08L to 6.52L; active: 6.12 to 6.24L). Mean non-paretic leg fluid volume increased after inactive condition and decreased after being physically active (inactive: 6.01L to 6.45L; active: 6.15 to 6.06L).

Conclusion
Being physically active for one day decreased AHI, despite the increased fluid accumulation in the neck, and contributed to leaving no edema in the hemiparetic side. Breaking up inactivity and increasing physical activity in patients following stroke may be a promising intervention to reduce edema and OSA.

Support
São Paulo Research Foundation (FAPESP, grant #2018/18952-1 to CF).