bluuebunny/crossref_metadata_2025_split huggingface dataset:
0611 Screening for Obstructive Sleep Apnea in the Bariatric Surgery Population
Authors: Kreitinger K , Lui M M , Owens R , Schmickl C , Grunvald E , Horgan S , Malhotra A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is prevalent in the bariatric surgery population and has been associated with increased perioperative risk, especially if OSA is moderate-severe (apnea-hypopnea index ≥ 15/h). Consequently, screening for OSA is recommended as part of the preoperative evaluation. Several screening tools for OSA have been developed; however, some tools lack validation and their relative performance is unclear. The purpose of this study was to compare four existing screening tools (Epworth Sleepiness Scale (ESS), STOP-BANG, NO-OSAS, and No-Apnea) with regards to the ability to identify patients with moderate-severe OSA among bariatric surgery patients.

Methods
We retrospectively reviewed data from Jan 2015 to Mar 2019 for adult patients presenting consecutively to UC San Diego for first-time bariatric surgery who had undergone a home or in-lab sleep study (within one year of the initial encounter for bariatric surgery), which is our standard of care. We compared the accuracy of the four screening tools for detecting moderate-severe OSA based on the area under the receiver operating characteristic curves (AUC). Subgroup analyses were explored based on sex, BMI, and ethnicity (Hispanic/Latino vs non-Hispanic/Latino).

Results
Of the 214 patients (83.2% female, median age 39 years) included in the study, 45.4% had moderate-severe OSA. STOP-BANG (AUC 0.75 [95%CI: 0.68 to 0.81]) and NO-OSAS (AUC 0.76 [95%CI: 0.69 to 0.82]) had similar performance (p 0.62); both performed significantly better than the ESS (AUC 0.61 [95%CI: 0.54 to 0.68]; p 0.02 for both). STOP-BANG and NO-OSAS tended to perform better in the female vs male subgroup, but this finding did not reach statistical significance.

Conclusion
STOP-BANG and NO-OSAS are superior to the ESS when screening bariatric surgery patients for moderate-severe OSA. In future analyses we will further explore if adjustments of standard cut-offs improve test characteristics (i.e. sensitivity/specificity) when screening bariatric surgery patients (analyses ongoing).

Support
None.
0623 Respiratory Profiling of Community-dwelling Individuals Many Years After Polio Infection
Authors: Li X , Wang M , Wang J , Sun T , Sun Y , Dong X , Li J , Zhao L , Zhang X , Lv C , Strohl K , Han F 
Published: May 2020

Abstract

Introduction
To determine the presence of respiratory impairment in community-living subjects with a history of poliomyelitis.

Methods
In a study conducted from July 2013-January 2014, we used a national database to recruit individuals (212 males, 86 females) from north and south provinces in China with a known prior poliomyelitis infection &gt;25 years previously. 298 subjects (96.8%) completed overnight oximetry to collect the number/hr of drops in oxygen saturation &gt;4% (ODI4) and Epworth Sleepiness Scale (ESS); many completed a metabolic and lipid panel, arterial blood gas analysis, chest x-ray (CXR), spirometry and maximal voluntary ventilation (MVV). Some completed risk profiling for OSA.

Results
Age was 47.8 ± 6.7 years (M±SD) and, when known, the age of infection was 2.3 ± 1.8 yrs. As defined by ODI4 ≥ 5/hr, the frequency of sleep-disordered breathing (SDB) was 37.2%; 9% (n = 27) had an ODI4 ≥15/hr. Those with vs. those without SDB differed by male gender (81% vs 65%, p = 0.004) and BMI (25.9 vs 23.0kg/m2, p &lt; 0.001). ESS was within the normal range, but was higher in those with 6.8 ± 5.0 vs. without 5.2 ± 4.0 (p &lt; 0.01) SDB. Spirometry and MVV revealed no differences among groups. Scoliosis on the CXR was present 26.1% of those with and 14.4% of those without SDB. ODI4 correlated weakly with body mass index (r = 0.40). Glucose levels or hyperglycemia were not different. A triglyceride level &gt; 1.7 mmol/L was present in 47.2% of those with and 21.3% of those without SDB (p &lt; 0.001).

Conclusion
Mild (28%) and to a smaller extent moderate-severe (9%) SDB is present many years after surviving poliomyelitis in infancy. In most, sleepiness is low but scoliosis is often present, and associations to hyperlipidemia and obesity are not reflected in fasting glucose levels.

Support
no
0627 Cognitive Perceptions Impact Short-Term CPAP Adherence in Asian Patients with Obstructive Sleep Apnea
Authors: Png C A , Liang J , Mok Y , Chang J 
Published: May 2020

Abstract

Introduction
Adherence for the gold standard Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea (OSA) is poor worldwide. Studies have explored factors impacting CPAP adherence but data is limited for Asian patients where cultural and social norms differ. This study aimed to examine the role of disease and treatment-related perceptions in short-term CPAP adherence among patients from a multi-ethnic Southeast Asian country.

Methods
34 patients with newly diagnosed OSA were recruited from Changi General Hospital, a 1000-bed tertiary hospital in Singapore between September 2018 and February 2019. Psychological factors of self-efficacy, risk-perception and outcome expectancies were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. The SEMSA questionnaire has been previously validated for the evaluation of adherence-related cognitions. Patients were administered the SEMSA questionnaire before commencement of CPAP treatment and 1 month after.

Results
73.5% (25/34) of the patients were male (82.4% Chinese, 11.8% Malays, 2.9% Indians, 2.9% others). Mean age was 43.3 ± 11.8 years, mean apnea hypopnea index (AHI) was 45.2 ± 29.6 events/hr and mean CPAP usage at one month was 3.6±2.0 hours. 47% were adherent to CPAP, defined as average device use &gt; 4 hrs/day. Pre-treatment self-efficacy was significantly correlated with CPAP adherence (r = 0.498, P&lt;0.01). Outcome expectancies and self-efficacy measured after one-month CPAP use were significantly correlated with CPAP adherence (r = 0.702, P&lt;0.01; r = 0.467, P&lt;0.01, respectively). However, no association between risk perception and CPAP adherence was noted at either time points.

Conclusion
Consistent with previous literature in Western population, our study demonstrated that patients’ cognitive perceptions of outcome expectancies and sense of self-efficacy have an impact on CPAP adherence in a Southeast Asian population. Strategies targeting these aspects would be important in designing patient education programs.

Support
0629 Feasibility of Observed but Physically Unaided Continuous Positive Airway Pressure Set Ups
Authors: Hevener W , Barnes F , Munafo D A 
Published: May 2020

Abstract

Introduction
We sought to determine if an observed but physically unaided CPAP set up, utilizing only a detailed set of CPAP instructions without direct involvement of a Respiratory Therapist, could yield similar Medicare compliance rates when compared to the conventional method of hands-on instruction.

Methods
This was a single center, prospective trial. All patients were CPAP naïve. A total of 393 patients completed the physically unaided set ups utilizing a starter kit designed by Resmed (Airsense 10 Autoset, instructions and 3 mask options, P10,N20,F20). Patients were asked to set themselves up under observation with only verbal assistance provided if requested. No patient required conversion to conventional set up. 5287 completed the conventional set ups. We compared the success of observed but unaided CPAP set ups to the success rate for conventional CPAP set ups performed with physical assistance. The primary success endpoint was Medicare compliance within 90 days.

Results
The two groups were not significantly different with regard to gender, age, baseline AHI, and initial mask selection. The Medicare compliance of the unaided set ups was not significantly different from the conventional set ups (75% vs. 77% respectively, p=NS). Similarly, adherence at ten days (65% vs. 69%, p=NS) and thirty days (65% vs. 68%, p=NS) was no different between the two groups and the percentage of mask re-fits required at ten and thirty days was similarly no different.

Conclusion
We conclude that for the CPAP equipment used, observed but physically unaided CPAP set ups can yield similar Medicare compliance rates when compared to physically aided CPAP set ups. Further, we speculate that because these techniques yielded similar success rates the principal factor determining ultimate success is patient follow up and support once therapy is initiated.

Support
None.
0651 Longitudinal Effects of CPAP Adherence on Changes in PTSD Symptoms and Subscales: The Importance of Hyperarousal on Adherence and Outcomes
Authors: Colvonen P J , Lizbeth G , Sarmiento K 
Published: May 2020

Abstract

Introduction
Comorbidity of posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) is staggeringly high, with rates of 75.7% when using criteria of apnea/hyponea index (AHI) &gt; 5. Continuous positive airway pressure (CPAP) therapy can decrease PTSD symptoms, however, no study has used advanced mixed-modeling to examine which cluster of PTSD CPAP therapy effects.

Methods
Participants were 59 veterans with PTSD and undiagnosed OSA. Apnea/Hypopnea index (AHI) was scored according to AASM criteria. Auto-titration CPAP devices were prescribed with pressures empirically selected by the sleep physician based on BMI, overall AHI, and dominant event type; maximum pressures was set at 20cm H2O. Analyses used hierarchical linear modeling to examine changes in PTSD symptoms clusters as a function of CPAP use over 6-months. Measures include PTSD checklist (PCL) and clusters (reexperiencing, avoidance, and hyperarousal), percentage of nights CPAP used, weight, and BMI.

Results
Baseline scores were high: PCL (M=60.02; SD=15.03) and AHI (M=28.18 per hour; SD=20.35). Average number of nights CPAP use in the last 6-months was 59.3%, with 3.5 hours each night with clear adherent and non-adherent groups emerging. The adherent group showed a 15-point drop in PCL scores and the non-adherent group had a 3-point drop. More days of CPAP use in the last 6-months predicted larger decreases in hyperarousal (d=0.56) and re-experiencing (d=0.47)
clusters, but not avoidance. The intercept was significant in the hyperarousal analyses suggesting individuals with higher hyperarousal at baseline had less CPAP adherence.

Conclusion
The need for PTSD clinicians to screen and refer for OSA is necessary, but may not be sufficient, in treating PTSD. Change in hyperarousal symptoms accounted for most of the effects from CPAP use. Higher hyperarousal symptoms at baseline predict lower CPAP adherence, suggesting a higher clinical need to address these individuals as they will get the most positive effects from CPAP.

Support
This work is supported by a VA RR&D CDA (1lK2Rx002120-01) to Peter Colvonen.
0653 Positive Effects of Long Term Continuous Positive Airway Pressure Therapy on Blood Pressure in Obstructive Sleep Apnea Patients
Authors: Shirahama R , Tanigawa T , Tomooka K , Fan Yun L , Ikeda A , Wada H , Kales S N 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is one of the common causes of hypertension. Therefore, we examine the longitudinal effect of continuous positive airway pressure (CPAP) therapy and its adherence on blood pressure among OSA patients.

Methods
One thousand two hundred ninety-three (male 1,130, female 163) patients, who were diagnosed with OSA and underwent CPAP therapy were investigated for longitudinal changes (24 months observation period) in the levels of blood pressure and body weight. The longitudinal analyses were performed by mixed effect model. Multiple Imputation with Chained Equations was also used to impute missing data. Good CPAP adherence is defined as more than 70% of the time using CPAP more than 4hours at all the measuring. Poor CPAP adherence is defined as less than 70% of the time using CPAP more than 4hours at all the measuring time points.

Results
The patient group with good CPAP adherences), compared to poor CPAP adherence, showed significant diastolic blood pressure reduction in 24 months follow-up period (β=-0.13, p=0.03) despite a lack of significant weight loss (β=-0.02, p=0.59). However, no significant associations were found between systolic blood pressure and CPAP adherence (β=-0.14, p=0.11).

Conclusion
CPAP therapy was found to have a longitudinal effect on diastolic blood pressure despite a lack of significant weight loss.

Support
0656 Mortality and Hospitalization in Patients With Heart Failure and Sleep Apnea: A Retrospective Study of Positive Airway Pressure Therapy in Medicare Beneficiaries
Authors: Huang F , Patel S L , Combs D , Parthasarathy S 
Published: May 2020

Abstract

Introduction
Sleep apnea is common in patients with heart failure (HF) and can be treated with positive airway pressure (PAP) therapy. In patients with both HF and sleep apnea, whether treatment of PAP therapy is associated with reduction in hospitalization or mortality is unclear.

Methods
We used 5% Medicare limited-dataset (LDS) from 2013-2015 to perform a retrospective study of hospitalizations and mortality in HF patients with sleep apnea who received or did not receive PAP therapy over an 18-month time period. All-cause mortality during post-treatment period, any and HF-related hospitalizations in baseline, pre-treatment and post-treatment periods were measured and compared. Propensity score matching, generalized estimating equations (GEE) model for repeated measures analysis and COX-survival analysis adjusted by multiple covariates were used for longitudinal comparisons and mortality.

Results
We have identified 281,161 patients with at least two distinct HF onsets and 62,800 of them had sleep apnea diagnosis (22%). Of these patients, 5,540 of them had initiated their PAP therapy while 12,129 of them only had their sleep apnea diagnosis during the selection time frame from Jan 1st, 2014 to June 30th, 2015 without PAP treatment (control group). After adjusting for various confounders and propensity score matching, bilevel PAP was strongly associated with lower hospitalization and HF-associated hospitalization (Bilevel-PAP vs. Control: Any hospitalization, OR=0.62, 95%CI=0.53-0.74, p&lt;0.0001; HF-associated hospitalization, OR=0.65, 95%CI=0.55-0.78, p&lt;0.0001). Cox proportional hazards survival analysis revealed that all of the PAP-treated groups had a better 6-month survival after treatment initiation when compared to controls (any PAP therapy vs. Control: HR=0.32, 95%CI=0.28-0.37, p&lt;0.0001).

Conclusion
In a retrospective analysis, PAP therapy was associated with lower 6-month all-cause mortality among Medicare beneficiaries with HF and sleep apnea. Bilevel-PAP therapy was consistently associated with significant reduction in hospitalization among these patients. Our observational findings warrant confirmation by future prospective intervention trials.

Support
NIH (HL126140; MD011600; HL138377; HL140144; IPA-014264-00001), PCORI (PPRND-1507-31666; PCS-1504-30430), American Academy of Sleep Medicine Foundation (169-SR-17), and Philips Healthcare/ Philips-Respironics Inc.
0670 The Outcome Of Cpap Titration Under Drug-induced Sleep Endoscopy: A Randomized Controlled Crossover Trial
Authors: Wang T , Lin T , Ni Y , Lo Y 
Published: May 2020

Abstract

Introduction
The titration pressure of continuous positive airway pressure (CPAP) is an important issue for patients with obstructive sleep apnea (OSA). The aim of this study was to understand the impact of drug-induced sleep endoscopy (DISE)-guided CPAP pressure and doctor-guided CPAP pressure on patients with OSA.

Methods
In this randomized controlled single-blinded crossover trial, we compared the effects of 1 month CPAP treatment on patients with OSA. Twenty-four patients with OSA were recruited and completed this study. They all underwent polysomnography, DISE-guided CPAP titration and accommodation. Doctor-guided CPAP pressure was determined before DISE. Patients were randomly assigned to receive DISE-guided or Doctor-guided CPAP pressure treatment for 1 month. Then, they switched to another CPAP pressure for another 1 month. Epworth sleepiness scale (ESS) will be recorded at baseline, 1 month and 2 months.

Results
The DISE-guided CPAP pressure and Doctor-guided CPAP pressure had no significant difference (13.9±0.7 cm H2O vs 13.5±0.5 cm H2O; P=0.92). In addition, residual AHI and compliance were also no significant difference between two groups. The ESS was significantly improved from baseline to 1 month CPAP treatment in both groups. Epiglottis (anterior-posterior collapse) was significant associated with AHI (P &lt; 0.001, by Spearman correlation). Both Epiglottis (anterior-posterior collapse) and tongue base collapse were significant associated with 95% CPAP pressure (P = 0.031 and 0.038). After multivariate regression analyses, epiglottis (anterior-posterior collapse) is the independent factor for 95% CPAP pressure.

Conclusion
The DISE-guided CPAP pressure and Doctor-guided CPAP pressure had no significant difference on the improvement of ESS. Epiglottis (anterior-posterior collapse) is the independent factor for AHI and 95% CPAP pressure.

Support
Chang Gung Memorial Hospital and Chang Gung University
0674 Association Between Lateral Wall Collapse On Drug-induced Sleep Endoscopy And MRI Findings In Hypoglossal Nerve Stimulator Patients
Authors: Liu Y , Wiemken A , Steffen A , Schwab R , Dedhia R 
Published: May 2020

Abstract

Introduction
Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients.

Methods
Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings.

Results
Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE.

Conclusion
In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study.

Support
Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)
0675 Nocturnal Oxygen Supplementation With Positive Airway Pressure Therapy For Obesity Hypoventilation Syndrome: Clinical Predictors And Liberation From Oxygen
Authors: Quintos A , Grewal R , Lee A 
Published: May 2020

Abstract

Introduction
Obesity hypoventilation syndrome (OHS) is associated with a high morbidity and mortality. Many patients require nocturnal supplemental oxygen on top of positive airway pressure (PAP) therapy for hypoxemia independent of apneic events. We need to clinically identify patients likely to require nocturnal oxygen supplementation. Follow up is essential as with adequate control of sleep apnea, hypoxia improves and liberation from nocturnal oxygen supplementation may be achievable.

Methods
Researchers obtained a list of patients with coding diagnosis of OHS, seen at the Jefferson Sleep Center between November 2016 and September 2019. Patients with BMI of ≥ 30 and evidence of hypoventilation were included. Hypoventilation was defined as an elevated CO2 level of ≥ 45 mmHg on blood gas analysis, elevated serum bicarbonate level of ≥ 27 mmol/L or by evidence of nocturnal hypoventilation by AASM criteria on polysomnography. Patients with pulmonary and neuromuscular disorders were excluded

Results
Out of 189 patients reviewed, 36 met the inclusion and exclusion criteria. Nineteen patients (53%) required nocturnal oxygen supplementation. A higher serum bicarbonate level of 33 mmol/L against 30 mmol/L (p=0.0078) and a lower resting awake SaO2 of 89% versus 95% (p &lt;0.01) were observed in the oxygen supplementation group. In polysomnographic data, the oxygen supplementation group had lower SaO2 nadir of 67% versus 73% (p=0.026) and had a longer time with SaO2 &lt;88% at 238.2 minutes versus 65.5 minutes (p &lt;0.01). Nine out of the 19 patients (47%) underwent nocturnal oximetry on PAP and room air. Of these, 4 patients (44%) were liberated from oxygen.

Conclusion
Fifty three percent of patients with OHS required nocturnal oxygen supplementation on top of PAP therapy. Higher serum bicarbonate level and lower resting awake SaO2 are potential clinical predictors of nocturnal oxygen supplementation. After nocturnal oximetry on PAP, 44% were successfully liberated from supplemental oxygen.

Support
0689 Use Of An Automated Scanning System To Select A Patient Interface
Authors: Hardy W , Jasko J , Bogan R 
Published: May 2020

Abstract

Introduction
There is no universal process for selecting mask style, size, and fit, and there is considerable variance in clinician and patient mask preference and patient anatomy. Poor mask fit may negatively affect adherence. A three-dimensional (3D) facial scanner and proprietary analytical software were developed to bring efficiencies to mask selection. This study explored the impact of that system on initial mask success compared to standard practice.

Methods
This was an open-label, randomized-controlled study. Participants provided written informed consent. 3D Scanner Arm (3DA): Participants answered questions about sleeping habits then had 3D facial images taken. Proprietary software recommended a hierarchy of up to four Philips Respironics masks and sizes. Traditional Fitting Arm (TFA): A designated clinician selected and fit masks using their standard methods. Mask selection was assessed by applying therapy and soliciting patient and clinician feedback. Mask refits and adherence were tracked through 90 days. Five sleep centers recruited 115 participants into the 3DA (61 males, 51.1±13.4 years, BMI 35.2±7.0, diagnostic AHI 26.2±21.9) and 123 into the TFA (79 males, 51.1±11.9 years, BMI 35±7.9, diagnostic AHI 26.9±22.6).

Results
A significantly higher percentage of 3DA patients required only one mask fitting (with no refits) compared to TFA during the initial setup (89.6% vs. 54.5%, p&lt;0.001) and through 90 days (62.6% vs 37.4%, p&lt;0.001). 3DA subjectively rated confidence in and satisfaction with the scanner-selected mask significantly higher than TFA. Mask leak was lower in the 3DA compared to TFA (29.4±10.6 vs 32.3±11.4 L/M, p= 0.043). The CMS adherence rate tended to favor 3DA vs. TFA (66.7% vs. 55.3, p=0.083). There were no significant differences in AHI or other adherence metrics.

Conclusion
The 3D scanner system was successful in mask selection with lower mask leak and greater patient satisfaction and confidence. This tool may bring about operational efficiencies to the mask selection process.

Support
This study was sponsored by Philips Respironics