bluuebunny/crossref_metadata_2025_split huggingface dataset:
0569 Soft Palate Fat Between Lean Adults with Obstructive Sleep Apnea and Healthy Control
Authors: Xu L , Keenan B T , Wiemken A S , Pack A I , Schwab R J 
Published: May 2020

Abstract

Introduction
Previous studies have shown that obese patients with obstructive sleep apnea (OSA) have a significantly greater percentage of fat tissue in soft palate than normal subjects. However, the influence of soft palate fat is not clear in non-obese adults with OSA. This study compared the volume of fat in the soft palate between lean adults with OSA and lean controls.

Methods
We examined soft palate fat in 21 lean OSA cases and 16 lean controls with body mass index (BMI) &lt;25 kg/m2. All subjects underwent a magnetic resonance imaging (MRI) with three-point Dixon scan. We used volumetric reconstruction algorithms to quantify the amount of soft palate fat, which was compared between apnecis and controls. Analysis reproducibility was quantified using intraclass correlation coefficients (ICC) from repeated analyses of 20 randomly-chosen MRIs.

Results
Analysis of soft palate fat was highly reproducible, with an ICC (95% confidence interval) of 0.968 (0.923, 0.987). Lean apneics were younger than lean controls (45.3±13.0 vs. 62.1±10.4 years; p&lt;0.0001). No significant differences between apneics and controls were observed in the average BMI (23.4±2.2 vs. 23.5 ± 2.6 kg/m2; p=0.824), the fat pads volume (4198±1728 vs. 3880±1544 mm3; p=0.646), and the proportion of males (61.9% vs. 68.8%; p=0.666). In unadjusted analyses, the lean OSA group showed significantly higher soft palate fat volume than lean controls (7605±2109 vs. 5327±1783 mm3; p=0.003). When adjusting for age, gender and BMI, no differences was observed between groups in soft palate fat volume (p=0.122) and fat pads volume (p=0.702).

Conclusion
Analysis of soft palate fat volume from Dixon MRI is highly reproducible. Our results indicate no significant difference in deposition of fat at soft palate between lean patients with OSA and lean controls when accounting for age, gender and BMI.

Support
This study is supported by National Institutes of Health Grant: 2P01HL094307-06A1. LX is supported by Young Elite Scientists Sponsorship Program of China Association for Science and Technology.
0574 Prevalence and Characteristics of Rapid Eye Movement Obstructive Sleep Apnoea (REM OSA) in a Multi-Ethnic OSA Cohort
Authors: Wong H , Poh Y , Mok Y 
Published: May 2020

Abstract

Introduction
Recent studies have shown that REM OSA is associated with increased incidence of hypertension and insulin resistance. However, there is a lack of Asian data on REM OSA. Our study aimed to examine the prevalence and characteristics of REM OSA in a multi-ethnic OSA cohort.

Methods
This was a retrospective observational study of all patients who underwent an overnight diagnostic polysomnography at a Singapore tertiary hospital from 1st August 2017 to 31st August 2018. All patients with a diagnosis of OSA (Apnoea Hypopnea Index (AHI) ≥5) were included in the study. REM OSA is defined as an overall AHI≥5, REM AHI/Non REM (NREM) AHI&gt;2, NREM AHI&lt;15 and at least 15 minutes of REM sleep.

Results
457 OSA subjects were included in the analysis. 19% (87/457) had REM OSA. Univariate analysis showed that REM OSA was more prevalent among female OSA than male OSA [34/115 (29.6%) versus 53/342 (15.5%) respectively, p&lt;0.001]. Compared to non REM OSA, REM OSA had milder OSA severity [mean AHI 12.74±4.71 versus 45.34±28.38, p&lt;0.001] and lower prevalence of hypertension [21/87 (24.1%) versus 138/370(37.3%), p=0.02]. No differences were found between both groups for age (p=0.273), ethnicity (p=0.615), Body Mass Index (p=0.336), diabetes mellitus (p=0.245) and Epworth Sleepiness Scale (0.06). Gender and OSA severity differences between both groups remained statistically significant in multivariate analysis (higher prevalence of REM OSA in female, p=0.043 and milder disease severity in REM OSA, p=0.006).

Conclusion
REM OSA was common in our OSA cohort and had higher prevalence in female and milder disease severity compared to non REM OSA. However, we did not find an increased prevalence of hypertension or diabetes mellitus in REM OSA. Further population-based study on REM OSA is needed to understand this phenotype better.

Support
NIL
0578 Incident Hypertension Rates in OSA Identified Using American Academy Of Sleep Medicine (AASM) Hypopnea Criteria, but Misclassified by Medicare (CMS) Hypopnea Definition
Authors: Budhiraja R , Javaheri S , Berry R B , Parthasarathy S , Quan S F 
Published: May 2020

Abstract

Introduction
The impact of not treating OSA identified using AASM standards (hypopneas scored using a minimum 3% O2 desaturation or arousal), but misclassified by CMS standards (hypopneas scored only if minimum 4% O2 desaturation) remains unclear. This analysis determined the ~5 year incident hypertension rates using the new 2018 ACC/AHA blood pressure (BP) guidelines in these individuals.

Methods
Data were analyzed from all Sleep Heart Health Study exam 2 study participants (N=1219) who were normotensive (BP≤120/80) at exam 1. The apnea hypopnea index (AHI) at exam 1 was classified into 4 categories of OSA severity: &lt;5, 5 ≤15, 15 ≤30 and ≥30/hour using both the AASM or CMS definitions. Three definitions of hypertension were used: Elevated BP (&gt;120/80), Stage 1 (&gt;130/80) and Stage 2 (&gt;140/90) to determine incidence rates at exam 2.

Results
Five year follow-up data were available for 476 participants classified as having OSA (AHI ≥5) by AASM criteria, but not by CMS standards at exam 1. Incident hypertension rates in these misclassified participants for ACC/AHA defined BP categories were 15% (Elevated BP), 15% (Stage 1) and 6% (Stage 2). 4% of normotensive participants used hypertensive medications. Overall incidence rate of at least an elevated BP was 40% (191/476) in those with OSA defined using AASM, but not by CMS criteria and 17% (191/1219) of the overall population at risk. In comparison to those with incident hypertension and OSA identified by CMS standards, BMI (27.7 vs 30.1 kg/m2, p&lt;.001) and % men were lower (45 vs 58%, p=.012), but age and race were not different.

Conclusion
Use of the CMS hypopnea definition as a component of the AHI resulted in the failure to identify a significant number of individuals with OSA who eventually developed hypertension and could have benefited from earlier diagnosis and treatment.

Support
HL53938
0586 Advanced Tree Models to Predict Moderate-to-Severe Obstructive Sleep Apnea
Authors: Kim S , Yang K 
Published: May 2020

Abstract

Introduction
The aim of this study was to develop a predicting model for the moderate-to-severe obstructive sleep apnea (OSA) by using advanced tree models.

Methods
We retrospectively investigated the medical records of patients who undertaken overnight polysomnography (PSG) at our sleep disorders center. We divided the data to a training set (70%) and a test set (30%), randomly. We made a random forest and a XGBoost model to predict the moderate-to-severe OSA (apnea hyponea index [AHI] ≥ 15/h) by using the training set, and then applied each models to the test set. To compare the fitness of the models, we used an accuracy, and an area under curve (AUC).

Results
Finally, 1,426 patients (AHI &lt; 5:AHI ≥ 15= 464:962) were enrolled. The random forest model showed an accuracy of 0.79, and AUC of 0.82. In the random forest model, the sleep apnea scale of the sleep disorders questionnaire (SA-SDQ), age, neck circumference, male sex, body mass index (BMI), hypertension, and hyperlipidemia appeared in order of a variance importance. The XGBoost model showed an accuracy of 0.75 and AUC of 0.79.

Conclusion
The random forest model to predict moderate-to-severe OSA showed better performance compared to the XGBoost model. The further study for validation is required.

Support
None
0591 The Significance of Body Mass Index in Varying Sleep Apnea Levels for Men and Women
Authors: Jones A M , Rogers A E , Hertzberg V S , Bliwise D L , Lewis T T 
Published: May 2020

Abstract

Introduction
A BMI increase, in men and women, is associated with an increased severity and progression of OSA. This study will examine the impact of BMI on varying levels of OSA severity and progression.

Methods
Participants, divided by sex, included 2728 (47%) men and 3076 (53%) women over the age of 40 that were in the Sleep Heart Health Study (SHHS). Participants were separated into 1 of 10 groups based on initial OSA levels at SHHS time point 1 (SHHS1) and ending OSA levels at SHHS time point 2 (SHHS2) as measured by RDI. A Kruskall-Wallis test examined the BMI median differences in the groups. Post-hoc tests, including pairwise comparisons and Wilcoxon rank sum test with Holm adjustment, were conducted to further examine results.

Results
Significant differences existed between certain groups (Men: Chi-Square=146.87, p&lt;.001, df=9; Women: Chi-Square=128.59, p&lt;.001, df=9). For men and women, those in the group with normal OSA levels at SHHS1 and SHHS2 had significant BMI differences compared to those in all 9 other groups where mild, moderate, or severe OSA levels exist at SHHS1 or SHHS2. Additionally, in men, BMI is significantly different for those with normal or mild OSA levels at SHHS2 compared to those with moderate or severe OSA levels at SHHS2. Also, a significant BMI difference exists in men maintaining mild OSA levels throughout SHHS compared to those maintaining severe OSA levels.

Conclusion
Although BMI is a known influential factor in OSA progression, this study demonstrated that those maintaining normal OSA levels over time have a significant BMI difference compared to those reaching even mild OSA levels over time. Additional implications were also found for men. These findings may coincide with recent research suggesting that one needs to progress only to moderate OSA levels to reach a tipping point of significantly increasing and impacting many health risks.

Support
Robert Wood Johnson Foundation Future of Nursing Scholars Program
0592 Prevalence of Sleep Apnea in Patients with Tracheobronchomalacia
Authors: Chopra S , Luthra S , Dalal L , Blattner M , August J , Thomas R , Heckaman E 
Published: May 2020

Abstract

Introduction
Tracheobronchomalacia (TBM) is a pathologic weakness in the trachea and bronchi leading to excessive dynamic narrowing of the airway. A relationship between sleep disordered breathing (SDB) and TBM has been observed before. SBD may be an important contributor to development or progression of TBM. The objective was to determine the Prevalence and characteristics of sleep disordered breathing in patients with tracheobronchomalacia.

Methods
We performed a retrospective chart review of patients who have been diagnosed with tracheobronchomalacia and who also underwent a polysomnogram (PSG) at the AASM - accredited Sleep Center of Beth Israel Deaconess Medical Center.

Results
In our 24 patient cohort of TBM, 71% were females, mean age 55 years (SD ± 12.3 years) and mean BMI 31.7 kg/m2 (SD ± 9.4 kg/m2). In patients with TBM we found a sleep apnea prevalence of 62.5% (n= 15), defined as an apnea-hypopnea index&gt;5/hour (hour) with a desaturation greater than 4%. Of the 15 patients, 73.3% (n = 11) had mild sleep apnea, 20% (n = 3) had moderate sleep apnea, 6.6% (n = 1) had severe sleep apnea, defined per the AASM criteria with oxygen desaturation greater than 4%. The TBM cohort had a mean sleep efficiency of 72.7% (SD ± 22.2%) with a mean REM of 16.3% (SD ± 9.8 %). Other characteristics included a median AHI 3% of 19.9/hour (95% CI 3.9 - 25.0), median AHI 4% of 5.5/hour (95% CI 3.9 - 9.3), Respiratory disturbance index of 22/hour (95% CI 15.1 to 28.4). No unique challenges for treatment with positive airway pressure were noted.

Conclusion
Sleep apnea may be more common in patients with tracheobronchomalacia and could be regularly screened.

Support
none
0599 The Association Between Obstructive Sleep Apnea and Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis
Authors: Sutherland R , Platt J 
Published: May 2020

Abstract

Introduction
Sleep related breathing disorders (SRBD) are common (20% prevalence) in the general population and can have multiple health consequences. There is growing evidence that chronic hypoxia - a key consequence of sleep apnea - is a common feature in solid tumour tissue, therapeutic resistance, tumour progression, and metastasis. However, there is conflicting evidence regarding the association between sleep apnea, cancer incidence, or mortality. A review of all available literature and subsequent meta-analysis was done to clarify these relationships.

Methods
A thorough literature search was completed using Medline, EMBASE and Web of Science databases. The search resulted in 7222 studies, 1551 duplicates were removed, 5552 studies were removed after abstract screening, and full text review was done on 119 studies, yielding 12 full retrospective cohort studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. Review and data extraction were done in duplicate.

Results
In the pooled analysis, 9 studies totalling 2,358405 subjects with OSA and 3.97% cancer incidence and 2,442794 subjects without OSA and 3.35% cancer incidence. A random effects model with inverse-variance weighting analysis yielded an unadjusted OR = 1.32 (95% CI: 0.76 - 2.30). After 2 studies with a moderate risk of bias were removed the pooling yielded an OR = 1.89 (95% CI: 0.99 - 3.50). Heterogeneity was high at 99.9% p-value less than 0.01. Meta-regression was then done to assess for the cause(s) of heterogeneity sex, age, or BMI were not significant contributors. A review of 3 studies, which included cancer mortality, was done. Hazard ratios in 2 studies suggested OSA increased the risk of cancer mortality. Hazard ratios also increased with increasing OSA severity.

Conclusion
Sleep apnea significantly increases cancer mortality and is positively associated with increasing severity. Meta-analysis demonstrated an 86% increase in the unadjusted odds of cancer in those with sleep apnea. However, this result was borderline non-significant with high heterogeneity. Further studies may be helpful in determining the true associations between sleep apnea and cancer.

Support
None.
0605 Comparison of Sleep Specialist vs Primary Care Driven Home Sleep Apnea Testing in Routine Practice
Authors: He K , Mendez M , Atwood C W 
Published: May 2020

Abstract

Introduction
Home sleep apnea testing (HSAT) has largely supplanted diagnostic polysomnography. Primary care (PC) driven HSAT utilization is common especially in rural settings that lack sleep specialist (SS) support. There have been no studies comparing appropriateness of HSAT utilization in veterans managed by SS vs. PC.

Methods
We use hub and spoke model to manage patients with OSA. SS selects testing for hub and PC utilizes HSAT for spoke patients. Testing is interpreted by SS. Patients referred for HSAT using WatchPAT over 4 months were compared on test failure rate, adherence to AASM guidelines for OSA diagnosis, adherence to HSAT use criteria, and diagnostic success rate (AHI ≥5) in high risk patients (STOPBANG ≥5) without significant comorbidities or HSAT contraindications compared to all comers.

Results
There were 125 hub and 170 spoke patients included in the analyses. Baseline characteristics were similar between sites (gender, age, BMI, Epworth sleepiness scale, neck size, STOPBANG, pacemaker dependence, and medication use affecting HSAT). Spoke patients had slightly higher prevalence of comorbidities (hypertension, cardiac arrhythmia, heart failure, COPD, stroke, and long acting opioid use). Complete HSAT failure (no data) was 2% and technical failure (monitoring time &lt;4 hours) was 13% at both sites. Unnecessary studies primarily to confirm OSA in those previously diagnosed on therapy seeking to establish care were 3% (hub) and 21% (spoke). HSAT done in patients without significant comorbidities was 77% (hub) and 68% (spoke). Adherence to HSAT use criteria was 74% at both sites. Diagnostic success rate of prespecified and all comers was 65% vs. 60% at hub and 86% vs. 64% at spoke sites.

Conclusion
Adherence to AASM guidelines and HSAT use criteria was overall fair with low failure rates. Further improving HSAT protocol for SS and PC with the aim to improve diagnostic success rate and minimize unnecessary studies should be pursued.

Support
0606 Comparative Effectiveness of Sleep Apnea Screening Tools During Inpatient Rehabilitation for Moderate to Severe TBI
Authors: Richardson R , Schwartz D , Drasher-Phillips L , Ketchum J , Calero K , Dahdah M , Monden K , Bell K , Hoffman J , Magalang U , Bogner J , Whyte J , Zeitzer J 
Published: May 2020

Abstract

Introduction
Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions.

Methods
This is a prospective diagnostic comparative effectiveness trial of sleep apnea screening tools (STOPBANG, Berlin, MAPI [Multi-Apnea Prediction Index]) relative Level 1 polysomnography at six TBI Model System Inpatient Rehabilitation Centers. Between 05/2017 and 02/2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The primary outcome was the Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).

Results
Participants were primarily young to middle age (AGE IQR 28,40,59), male (81%), white (74%), and had primarily severe TBI (IQR GCS 3,6,14). A subset (26%) had a history of military service. Results revealed that the Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROCAUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI&gt;5. The pattern was similar across TBI severity subgroups except for delirium or post-traumatic amnesia status wherein the MAPI outperformed the Berlin and STOPBANG. Youden’s Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.

Conclusion
This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for moderate to severe TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.

Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
0631 Respiratory Infection Risk in PAP Users
Authors: Horvat M , Gavidia R , Dunietz G L , Braley T 
Published: May 2020

Abstract

Introduction
Although positive airway pressure (PAP) effectively treats obstructive sleep apnea (OSA), adherence remains suboptimal for many patients. One factor that may influence a patient’s decision to use PAP is a prevailing concern that use of unsanitized PAP equipment may serve as a reservoir for pathogens that cause respiratory tract infections (RTI). Conversely, untreated OSA could also have long-term consequences, including impaired immune function, raising the possibility that PAP therapy could reduce RTI risk. The objective of this study is to compare RTI patterns before and after initiation of PAP in persons with OSA, and examine clinical characteristics that may influence RTI risk.

Methods
Patients with at least 2 years of continuous primary care at Michigan Medicine preceding and following their OSA diagnosis (N=480) were considered eligible for analyses. Medical charts were reviewed to determine pre- and post-PAP RTI frequency and characteristics during this time frame. Change in RTI frequency was examined with paired T-tests.

Results
Male:female ratio was 1:1, mean age 56 years, mean apnea hypopnea index was 10, N=85/480 had documented good PAP compliance (defined as ≥ 4h/night, 70% of the nights). Among 480 patients, total RTI frequency pre and post PAP therapy were 170 and 144 respectively (p=0.11). Data collection is ongoing.

Conclusion
These preliminary data suggest that use of PAP is not associated with increased risk of respiratory infections. Further data regarding clinical characteristics that may influence RTI risk in OSA patients will be informed by ongoing data collection and planned multivariable analyses.

Support
Dr. Gavidia is supported by a Training in Clinical and Basic Neuroscience T32 (NIH/NINDS T32 NS 007222)
0632 The Correlation Between Severity of Obstructive Sleep Apnea and Patient Compliance
Authors: Roberts A C , Bastin G 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a prevalent disorder affecting 9-38% of the global population and is linked to multiple health complications. Continuous Positive Airway Pressure (CPAP) is regarded as the gold standard treatment for OSA, but its efficacy is limited by poor patient compliance. Studies have linked many clinical and lifestyle factors to CPAP adherence, but have produced conflicting outcomes. Based on the current literature, it is assumed patients diagnosed with severe OSA are more likely to be compliant with CPAP due to a greater improvement in quality of life. The goal of this study is to compare the compliance rate of CPAP for patients with mild, moderate, and severe OSA, as well as identify other potential predictors of CPAP compliance.

Methods
This study is a retrospective chart review of 100 patients who were newly diagnosed with OSA and started on CPAP between January 1, 2017 and January 1, 2018. Baseline demographic data, past medical history, OSA severity, Epworth sleepiness scale, and compliance to CPAP therapy were recorded. Compliance was defined as CPAP usage greater than four hours per night for at least 21 days per month.

Results
Mean follow-up time after CPAP initiation was 3.19 months. Overall 77% of patients were compliant to CPAP therapy, of which 48% were males and 52% were females (P=0.48). CPAP compliance rates for mild OSA (79.3%), moderate OSA (73.7%), and severe OSA (78.8%) showed no significant difference for independence (P=0.83) or correlation with compliance (P=0.99). Only seasonal allergic rhinitis showed a positive association with CPAP adherence (P=0.031) and depression showed a negative association (P=0.027).

Conclusion
The level of OSA severity is not a significant predictor of short-term CPAP compliance among newly diagnosed patients.

Support
Parkview Physicians Group, Indiana School of Medicine - Fort Wayne, and the Dr. Luis and Anne B Schneider Foundation.