bluuebunny/crossref_metadata_2025_split huggingface dataset:
0691 Comparison Of Odds Ratio Product And Other Polysomnographic Metrics Among Responders And Non-responders To Upper Airway Stimulation Treatment Of Obstructive Sleep Apnea
Authors: Yu J L , Keenan B T , Kuna S T , Younes M 
Published: May 2020

Abstract

Introduction
Upper airway stimulation (UAS) is a surgical method of treating obstructive sleep apnea (OSA). UAS involves an implantable neuro-stimulator that stimulates the hypoglossal nerve to protrude the tongue during sleep. OSA fails to improve in 22% of patients who receive UAS as defined by a &gt; 50% reduction in Apnea-Hypopnea Index (AHI) and an AHI &lt;20 events/hour. Light sleep may predict UAS failure in that it may limit the stimulus strength that can be applied. The odds ratio product (ORP) is a novel polysomnographic (PSG) metric of sleep depth. We hypothesized that ORP values prior to surgery will be higher (lighter sleep) in non-responders. Having markers that predict surgical success can help reduce unnecessary surgeries.

Methods
This is a retrospective cohort study of 126 patients (83 responders vs. 43 non-responders) who received UAS implantation for the treatment of OSA. PSG data was obtained from the Stimulation for Apnea Reduction (STAR) trial. Raw baseline PSG data were analyzed and ORP values calculated using Michele Sleep Scoring Software (Cerebra Medical, Winnipeg, CA). In addition, 13 PSG metrics that were considered possibly relevant to surgical outcome were calculated as an exploratory analysis. The measurements included: spindle density, spindle power, spindle frequency, alpha intrusion, Right/Left sleep depth correlation coefficient, respiratory duty cycle, respiratory flow limitation, and arousal intensity. Statistical Analysis: Comparisons between responders and non-responders used parametric t-tests for continuous data and chi-squared or Fisher’s exact tests for categorical data. Statistical significance was based on a Bonferroni-corrected p&lt;0.00357.

Results
Differences in ORP values and other PSG metrics between responders and non-responders were not statistically significant. Of all PSG metrics only differences in spindle density approached statistical significance (Responders = 2.33 spindles/minute vs Non-Responders = 1.39 spindles/minute, p=0.00360).

Conclusion
The findings suggest that differences in sleep depth and several other sleep characteristics do not play a significant role in determining response to UAS therapy.

Support
This project was supported by a Sleep Research Society Career Development Award #023-JP-19
0699 Effect Of Kidney Transplantation On Sleep Apnea Severity: A Prospective Controlled Polysomnographic Study
Authors: Forni Ogna V , Ogna A , Haba-Rubio J , Heinzer R 
Published: May 2020

Abstract

Introduction
Renal failure-associated fluid overload has been associated with a high prevalence of sleep apnea (SA) in patients with end-stage kidney disease (ESKD). Kidney transplantation has been shown to restore a normal renal function but its effect on SA remains unclear. In this prospective study, we hypothesized that improvement of kidney function and hydration status after kidney transplantation (Tx) may result in an improvement of SA severity.

Methods
A total of 196 patients on kidney transplant waiting list were screened for SA using home nocturnal polysomnography (PSG) to measure the Apnea-Hypopnea Index (AHI) and underwent bioimpedance to assess body composition. Polysomnography and bioimpedance were repeated 6 months after kidney transplant. Patients still on the waiting list after 6 months underwent same investigations as a control group.

Results
Of 88 participants (44.9%) with SA (AHI ≥15/h) at baseline, 42 patients were reassessed 6 months post-Tx and were compared to 27 control patients remaining on the waiting list after 6 months. There was a significant, although partial, post-Tx improvement in SA severity as measured by the AHI (from 44.2±24.3/h to 34.7±20.9/h, p=0.02), with a concomitant reduction in body water (from 54.9% to 51.6%, p=0.003), suggesting a causal implication of fluid overload. A post-Tx increase in body fat mass (from 26% to 30%, p=0.003) may have blunted the beneficial impact of kidney Tx on SA. These parameters remained unchanged in the control group.

Conclusion
SA is a frequent condition in ESKD patients. Kidney transplantation is associated with a reduction of fluid overload but an increase in fat mass, yielding only a partial improvement in SA severity. These results suggest that SA should be systematically assessed before and after kidney Tx

Support
Swiss Kidney Foundation, the Pulmonary League and the Organ Transplant Foundation of Lausanne
0700 Prediction Of Surgical Outcome Using Respiratory Pattern Clafification
Authors: Chiba S 
Published: May 2020

Abstract

Introduction: Introduction
A diagnosis of the surgical indication is important in Sleep surgery. In otolaryngology regions, it is usually considered that a site of occlusion diagnosis by DISE. However, for OSA patients with aging, heart failure and neurologic disease, the effect with the surgical treatment is still low. In these OSA patients, it is a reason that a functional factor is associated as well as an anatomical factor. Similarly, without clear complications including Aging etc, there are a lot of the OSA patients whom a functional factor is associated with. OSA is multi-factorial disease according to Wellman model, OSA is associated with the functional factor including loop gain and the ability of the upper airway to dilate associated with ventilatory drive, arousal threshold only other than the anatomical factor of the upper airway. By normal PSG, the respiratory event is classified as obstructive, mixed and central. However, there are a lot of events that a functional factor is associated with, even if it is a respiratory event to be diagnosed as an obstructive respiratory event. An effect of sleep surgery is expected only for an anatomical factor. Therefore, in the case of sleep surgery, we must diagnose a pure obstructive respiratory event precisely. Purpose of this study: To clarify a respiratory pattern to influence surgical success.

Methods: Methods
26 surgical patients with Pharyngeal surgeries diagnosed as OSA by PSG + Pes measurements were enrolled. We distinguish respiratory event as Pure obstructive event or not, using Pes signal pattern and EEG arousal timing.

Results: Results
Rate of pure obstructive event of all respiratory event varied by an individual patient. Mean rate of pure obstructive event is 57.3%. We find significant difference of AHI improvement rate between two groups which Rate of pure obstructive event shows more than 55% or less than 55%.

Conclusion: Conclusion
Breathing pattern is variety and pure obstructive event is few than ever considered. Respiratory pattern influence surgical success.

Support
Non
0709 Using The Sleep Adjusted Residual Apnea Hypopnea Index In The Real-World Monitoring Of Obstructive Sleep Apnea
Authors: Viteri E , McGhee V , Tackett J V , Freire A X 
Published: May 2020

Abstract

Introduction
Treatment efficacy of obstructive sleep apnea (OSA) depends on controlling respiratory events for the majority of sleep time. Apnea-hypopnea index (AHI) and adherence are frequently used to determine efficacy of continuous positive airway (CPAP) therapy, but fail to capture the effect of residual events during untreated sleep-time. The Sleep Adjusted Residual AHI (SARAHI) consolidates treated and untreated AHI and CPAP use into a single number: SARAHI = [(Untreated AHI × Hours Untreated) + (Treated AHI × Hours Treated)] / (Total Sleep Hours). We attempted to determine the clinical applicability of this index as a determinant of OSA control and its relation with sleepiness improvement.

Methods
As part of a quality assessment project, a convenience sample was haphazardly collected from a database of patients initiated on CPAP in a Veteran’s Affairs Hospital. Patients initiating treatment after OSA diagnosis by polysomnogram or portable sleep study were included. Information from a CPAP-download within a year of diagnosis and Epworth Sleepiness Scale (ESS) at diagnosis and follow-up were collected. SARAHI was calculated using two different measures of “total sleep hours”: 8 hours (SARAHI-8hrs) or recorded sleep time during sleep study (SARAHI-PSG).

Results
Thirteen patients (12 male) with a mean age of 53.3 years were included. At diagnosis, mean AHI was 26.0 events/hour and ESS was 14.6. At follow-up, CPAP mean adherence was 338 min and average use was 61.8% of days; mean residual AHI was 4.4 events/hour and mean ESS 13.7. SARAHI-8hrs was 16.0 events/hour and SARAHI-PSG was 13.8 events/hr. Simple linear regression did not show a significant correlation between ESS improvement and either of these indexes or with improvement in AHI.

Conclusion
SARAHI showed no correlation with ESS in this small sample. We recommend further research as SARAHI is simple to use and provides more information than currently used parameters.

Support
None
0710 Hypoglossal Neurostimulation In Rem- Vs. Nrem-predominant Obstructive Sleep Apnea
Authors: Cabrera C I , Szelestey B , Strohl K , Schell A 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) is a chronic condition that requires appropriate treatment strategies to optimize outcomes while minimizing risk. In addition to anatomy, physiologic factors such as arousal threshold and loop gain (i.e. “endotypes”) play a known role in the disease process. Because loop gain tends to be higher and arousal threshold lower in NREM sleep, we hypothesize that patients with NREM-predominance may achieve less success with anatomical therapy such as upper airway stimulation (UAS). Our study aims to evaluate baseline characteristics and objective results related to NREM-predominance in patients treated with UAS.

Methods
Using data from the STAR trial, we identified patients (n=103) with at least 20 minutes of REM on baseline testing and complete demographic and disease data at baseline and month 18. Baseline NREM-predominant disease (percent NREM events &gt; 50) was defined as a binary variable. We created two cohorts: 1) patients with REM-predominant disease and 2) those with NREM-predominant disease. ODI and AHI were evaluated at month 18.

Results
Overall 62% (n=64) of patients had NREM-predominant disease at baseline. Other baseline characteristics were similar between both groups. In univariate analysis, age was significantly associated with lower AHI in the NREM-predominant population (p&lt;0.05) but not in the REM-predominant group (p&gt;0.05). Results were similar for ODI. For both groups, increasing age was correlated negatively with increasing AHI; this correlation was stronger in the NREM-predominant group

Conclusion
A majority of patients in the STAR trial had NREM-predominant OSA at baseline. There appears to be an interaction between NREM-predominance and age as predictors of UAS outcomes.

Support
0725 PRESHYON: The Prevalence On The Risk Of Obstructive Sleep Apnea Among Patients With Uncontrolled Hypertension Seen At The Out-Patient Department Of The University Of The Philippines- Philippine General Hospital
Authors: Tojino A G , Jorge M C , De Leon L F , Chua J R , Dela Cruz A V 
Published: May 2020

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is a breathing disorder linked to increased morbidity and mortality, 1 and associated with decreased quality of life and functional impairment of daily living.2 OSA has been established to be associated with hypertension wherein the prevalence of OSA is 30%, 24,25 however, local prevalence has been lacking. The gold standard for OSA is polysomnography but this is expensive and has limited availability. Questionnaires provide risk stratification to determine if the patient needs further sleep evaluation. Recognition and treatment of OSA could lead to improving long term outcomes of patients with uncontrolled hypertension. 31-33

Methods
This is a cross-sectional study that enrolled 325 adult Filipino HTN patients seen at the outpatient department (OPD) of UP-PGH from January 2019 to July 2019. Participants also answered Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS) and the St. Lukes Medical Center-Obstructive Sleep Apnea Clinical Score (SLMC-OSACS) for their OSA risk. Descriptive statistics were used to summarize the clinical characteristics of the patients. Chi-square test was used to analyze categorical data univariately. Logistics regression analysis was used to determine the association of the different independent variable with the outcome (dependent) variable.

Results
The risk of OSA was significantly high among uncontrolled HTN patients: 106 (60.7%) based on BQ (p&lt;0.0001) and 68 (69.4%) based on SLMC-OSACS (p&lt;0.0001). OSA risk among uncontrolled HTN was 6x higher (OR=5.69; 95% CI=3.49-9.28;p&lt;0.0001) using the BQ and 4x higher (OR=3.70; 95% CI=2.19 - 6.26;p=&lt;0.0001) using the SLMC-OSACS than those with controlled HTN. Other variables significantly associated with high risk OSA were BMI and other comorbidities.

Conclusion
The risk of OSA was significantly high among uncontrolled HTN patients. In utilizing these sleep questionnaires and determining the risk for OSA among patients with uncontrolled hypertension will lead for early evaluation of OSA and complications. Locally this will aid in improving detection and provide a more strategic management of uncontrolled hypertension to decrease associated cardiovascular events. This will guide our clinicians to prioritize patients who would benefit referral to sleep specialists

Support
0766 Safety And Tolerability Of Pitolisant In The Treatment Of Adult Patients With Narcolepsy: Final Analysis Of An Open-label, Expanded Access Program In The United States
Authors: Bauer E D , Davis C W , Patroneva A , Dayno J M , Thorpy M J 
Published: May 2020

Abstract

Introduction
Pitolisant Expanded Access Clinical Evaluation (PEACE) provided adult patients with narcolepsy access to treatment with pitolisant while it was an investigational medication in the United States.

Methods
Pitolisant was titrated to 35.6 mg/day (or the highest tolerable dose) over a 3-week period. Dose adjustments were permitted at the discretion of the treating physician based on patient response. Treating physicians followed their standard of care and were required to report adverse events (AEs). Demographic and baseline information for all enrolled patients, and safety results available through October 30, 2019, are reported here (presentation will include final data from the PEACE program).

Results
In all, 623 patients (67.9% female; 84.6% white; mean age, 40.0 years; narcolepsy type 1, 51.5%) were treated with pitolisant in the PEACE program. Nearly all patients (98.4%) had been previously treated with other narcolepsy medications (88.1% with ≥2 narcolepsy medications). Overall, 35.2% of patients discontinued from the program; 16.7% due to an AE and 12.2% for lack of effect. At Month 1, 97.3% of patients remained in the study, 88.2% at Month 3, 76.5% at Month 6, 66.9% at Month 9, and 55.0% at Month 12. In all, 256 (41.1%) patients experienced ≥1 AE; majority (52.5%) of these AEs occurred early in treatment (by Week 3). The most commonly reported AEs were headache (9.8% of AEs), nausea (6.6%), anxiety (5.6%), and insomnia (4.7%).

Conclusion
In the PEACE program, patient characteristics were generally reflective of the US narcolepsy patient population. The safety and tolerability profile of pitolisant was similar to that seen in the clinical development program, with no new safety signals identified. The program ceased enrollment in August 2019 after the US approval of pitolisant for the treatment of excessive daytime sleepiness in adult patients with narcolepsy.

Support
Harmony Biosciences, LLC.
0769 FDG-PET Imaging In Narcolepsy Type 1, Idiopathic Hypersomnia, And Non-Sleepy Controls
Authors: Trotti L , Meltzer C , Rye D , Nye J 
Published: May 2020

Abstract

Introduction
Functional imaging of narcolepsy type 1 (NT1) has shown disparate results, with evidence for both regional hyper- and hypo-metabolism. A FDG-PET study of idiopathic hypersomnia (IH) demonstrated regional hypermetabolism within the salience network.

Methods
Patients with NT1 (n=14) or IH (n=16) were recruited, with age-matched, non-sleepy controls (HC, n=8). Patients discontinued treatment for ≥5 half-lives. Participants underwent injection of 18F-fludeoxyglucose (FDG) in a dimly-lit room and were asked to remain awake, seated quietly. Simultaneous 6-channel EEG, EOG, and EMG were collected. Participants were alerted by a loud noise if sleep onset was observed. Thirty minutes after injection, patients underwent 36-minute PET scan. Images were spatially normalized to MPRAGE images and analyzed for group differences using SPM8.

Results
Groups were similar in age (NT1: 30.0 (+/-SD 8.3), IH: 36.3 (+/-12.4), HC: 33.2 (+/-16.2), p=0.29) and gender (%women, NT1: 71%, IH: 87.5%, HC: 62.5%, p=0.37). Patients were sleepier than controls by Epworth (NT1: 18.2 (+/-3.5), IH: 15.8 (+/-3.2), HC: 5.0 (+/-2.7), p&lt;0.0001) and MSLT mean latency (NT1: 2.0 (+/-1.4), IH: 5.1 (+/-1.7), HC: 14.6 (+/-2.6), p&lt;0.0001). Despite attempts to remain awake, NT1 patients had difficulty maintaining wakefulness during uptake, obtaining 6.2 (+/-5.9) minutes sleep versus &lt;1 minute for the other groups. Compared to controls, NT1 patients demonstrated increased activation in bilateral precentral gyri, left postcentral gyrus, left middle frontal gyrus, right insula, right inferior and superior temporal gyri, right fusiform gyrus, and bilateral inferior frontal gyri. Compared to controls, IH patients demonstrated increased activation in bilateral precuneus, bilateral inferior and middle frontal gyri, left middle and superior temporal gyri, left inferior parietal lobule, and left anterior cingulate.

Conclusion
Different patterns of metabolic activity are seen in two hypersomnia disorders, implying disease-specific activity rather than non-specific sleepiness. Inadvertent sleep during uptake is more common in NT1.

Support
K23 NS083748
0775 Effects of Stress, Sleep and Depression on Resilience of Female Nurses Working in Shift and Fixed Work Schedules in General Hospital
Authors: Eun H , Shin H 
Published: May 2020

Abstract

Introduction
Healthy sleep is important and can have a positive effect on resilience. The aim of the present study was to compare the differences in resilience between two group nurses in rotating shift and daytime fixed work schedules and to investigate stress perception, coping factors, social and psychological health, and sleep factors that may affect resilience.

Methods
A total of 400 female nurses having rotating shift and daytime fixed work schedules at two hospital were surveyed from June 12, 2017 to June 12, 2018. Perceived stress scale(PSS), stress coping short form(Brief COPE), psycho-social wellbeing Index short form(PWI-SF) or general health questionnaire-18(GHQ-18), center for epidemiologic studies depression scale(CES-D), STAI-X-1 in state-trait anxiety inventory(STAI), Pittsburgh sleep quality index(PSQI), Epworth sleepiness scale(ESS), insomnia severity index(ISI), Conner Davidson resilience scale(CD-RISC) applied. Independent t-test, paired t-test, Pearson correlation analysis, and multiple regression analysis were applied to the results of the final 373 questionnaires of 400 nurses in two general hospitals.

Results
As a result of comparing the variable statistics between the two groups of rotating shift and daytime fixed work nurses, there were statistically significant differences in all variables except perceived stress, sleep quality, and daytime sleepiness. Factors that had a significant correlation with resilience were stress coping strategies, depression, and insomnia severity(p&lt;0.001). In multiple regression analysis, the larger positive reframing1(β=0.206, p&lt;0.001), the less depression (β= -3.45, p&lt;0.001), and the higher psychosocial health level(β=0.193, p &lt;0.001). As acceptance coping2 increases(β=0.129, p&lt;0.05), as daytime sleepiness decreases(β=-1.17, p&lt;0.05), and as active coping2 increases(β=0.118, p&lt;0.05), as the positive reframing2 increases(β=0.110, p&lt;0.05), the resilience increased.

Conclusion
In this study, it was found that resilience was higher in daytime fixed workers than in shift workers. In addition, specific stress coping strategies and sleep, depression, and anxiety factors were found to be associated with resilience.

Support
Key words: Shift work · Female nurse · Resilience · Sleep · Stress · Depression
0781 Impact Of Suvorexant On Total Daytime Sleep Hours In Shift Workers: A Randomized, Double-blind, Placebo-controlled Clinical Field Trial
Authors: Zeitzer J M , Joyce D S , Sterkel A L , Quevedo Y L , Hernandez B , Holty J 
Published: May 2020

Abstract

Introduction
Many shift workers have an inability to sleep during the daytime following a night shift not due to insomnia or lack of sleep pressure, but because a circadian signal promoting wakefulness is hampering their ability to maintain sleep. We have previously hypothesized that the neuropeptide hypocretin-1 is, in part, responsible for the physiologic expression of this circadian wake signal. As such, it was our intent to determine whether a pharmacologic blockade of hypocretin would enable shift workers to obtain more daytime sleep.

Methods
Nineteen shift workers took part in a placebo-controlled, double-blind field study of suvorexant. Following two weeks of baseline, participants received 10 mg suvorexant/placebo for one week and were titrated upward to 20 mg suvorexant/placebo for an additional two weeks. Subjective (diaries) and objective (actigraphy) sleep were monitored throughout. No restrictions were placed on participants’ schedules.

Results
Both subjective and objective measures of total sleep time significantly improved in the active vs. the placebo condition, increasing by 2.08 ± 0.47 hours (diary) or 1.04 ± 0.53 hours (actigraphy) by the end of the 10 mg condition, and increasing by 2.97 ± 0.56 hours (diary) or 2.16 ± 0.75 hours (actigraphy) by the end of the 20 mg condition. Physician ratings of change in the severity of symptoms similarly improved in the active group. There were no adverse events reported in the active condition.

Conclusion
Robust changes in total sleep time were observed after administration of suvorexant, a dual-hypocretin antagonist, prior to daytime sleep in a field study of shift workers. The very large changes in total sleep time, coupled with the permissive nature of the therapeutic mechanism (i.e., suppressing wake rather than inducing sleep) indicate that this could be a viable and important therapy for shift workers.

Support
Merck Sharpe and Dohme investigator-initiated study #53236