bluuebunny/crossref_metadata_2025_split huggingface dataset:
0610 Prevalence of Positional Obstructive Sleep Apnea Based on 3% Vs 4% Oxygen Desaturation Using Home Sleep Apnea Testing
Authors: Mandal M , Rengan R , Rani S , Ramzy J , Vega Sanchez M , Jaffe F , D’Alonzo G , Shariff T , Chatila W , Weaver S , Krachman S 
Published: May 2020

Abstract

Introduction
Approximately 30% of patient with obstructive sleep apnea (OSA) have positional OSA [non-supine apnea-hypopnea index (AHI) &lt; 5 events/hr]. However, the prevalence is based on variable definitions for hypopneas related to the degree of oxygen desaturation. In addition, use of a home sleep apnea test (HSAT) to identify positional OSA is limited. We hypothesized that in patients evaluated with an HSAT, using a definition for hypopneas based on 4% compared to 3% oxygen desaturation will significantly decrease the percentage diagnosed with positional OSA.

Methods
Fourteen patients with positional OSA based on a non-supine respiratory event index (REI) &lt; 5 events/hr were included. The initial diagnosis was determined based on a hypopnea definition of ≥ 3% oxygen desaturation. The studies were reanalyzed using a hypopnea definition of ≥ 4% oxygen desaturation.

Results
Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 &lt; 90% 4±6%] were identified with positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) using a hypopneas definition of ≥ 3% oxygen desaturation. When reanalyzed using a hypopnea ≥ 4% oxygen desaturation there was a significant decrease in the REI to 7±2 events/hr (p&lt;0.001). Three patients (21%) no longer were considered to have OSA. These patients were younger (32±14 vs. 50±11yrs, p=0.03) and had less severe OSA (REI 6±1 vs. 9±3 events/hr (p=0.04), but there was no difference in BMI (32±11 vs. 31±5 kg/m2, p=0.9) or mean and lowest SaO2 (96±0.4 vs. 94±2%, p=0.13, and 82±8 vs. 81±6%, p=0.9, respectively).

Conclusion
In patients with mild positional OSA, using a hypopnea definition of at least 4% vs. 3% oxygen desaturation on a HSAT will have a significant effect on the overall REI and often exclude patients who would otherwise be treated for OSA.

Support
None.
0624 Voice of the Patient: A Patient-Centered Exploration of Factors Influencing Obstructive Sleep Apnea Care
Authors: Puravath F M , Ash T , Rottapel R , Spadola C , Bandana S , Schonberg M , Redline S , Bertisch S 
Published: May 2020

Abstract

Introduction
Despite widely available efficacious treatments for obstructive sleep apnea (OSA), patients commonly report frustration in accessing and adhering to treatments. Sparse research has explored factors influencing OSA care from the patient perspective, which may limit provision of patient-centered care: care responsive to patient preferences, needs, and values. To this end, we conducted qualitative research to identify factors, voiced by patients, that influence OSA treatment initiation and adherence.

Methods
We performed semi-structured interviews with 15 patients previously diagnosed with OSA from Boston, MA and a national patient portal (MyApnea.Org). Patients were asked about barriers and facilitators to their diagnosis and treatment as well as about their preferences and values that informed their treatment decisions. Interviews were audio-recorded and transcribed. A qualitative content analysis was performed to identify themes. After developing a codebook, interviews were coded. Codes were then audited and finalized by study team consensus.

Results
Our sample was aged 25-74 years; 71% identified as female. Among participants, 57.1% identified as White, 14.3% Black, 14.3% Asian, and 14.3% Other. Major themes were broadly classified as (1) facilitators (provision of useful information on treatment options, participation in shared decision-making, continued clinician support); (2) barriers (inconvenience of treatment, difficulty of habit formation, treatment side effects, competing comorbid conditions); (3) motivators (value of improving chronic health, family support, positive treatment effects); (4) contextual factors (insufficient knowledge/awareness of OSA, navigating healthcare systems, access to informational resources). Awareness of OSA symptoms and treatments, and ongoing support were cited as the most common factors influencing the patient experience.

Conclusion
This formative research highlights that diverse factors impact the OSA evaluation and treatment patient experience. Further research should test interventions that promote effective patient-centered care for OSA, such as shared decision-making tools.

Support
Brigham and Women’s Hospital Research Institute Patient-Centered Comparative Effectiveness Research Center Grant
0628 An Observational Report of Clinical Outcomes Among Veterans with Obstructive Sleep Apnea Treated with Hypoglossal Nerve Stimulation
Authors: Raman S , Fernandez A D , Mathew E V , Hudgins L E , Cornman E 
Published: May 2020

Abstract

Introduction
The efficacy of positive airway pressure (PAP) therapy in the management of obstructive sleep apnea (OSA) is limited by inadequate patient adherence. Hypoglossal nerve stimulation (HNS) is an FDA approved PAP-alternate surgical treatment option that is available for patients with poor PAP tolerance. The purpose of this pilot study was to review outcome measures and adherence data for patients treated with HNS therapy in a military veteran population.

Methods
Methodology involved a retrospective chart review of 30 PAP intolerant cases referred for HNS treatment over the course of 2 years. The inclusion criteria were Body Mass Index (BMI) &lt; 35 kg/m2, Apnea Hypopnea Index (AHI) of 15-65/hour and drug induced sleep endoscopy (DISE) showing antero-posterior pharyngeal collapse. Qualified veterans proceeded to HNS implantation. Variables for analysis included BMI, Epworth sleep scale (ESS), DISE results, pre- and post-treatment AHI and adherence data.

Results
Of the 30 veterans, 17 proceeded to DISE. 15 had partial or complete AP collapse and 2 had concentric collapse. 12 veterans proceeded to HNS implantation. 6 veterans who completed HNS titration studies showed an average improvement of 77% from baseline AHI. There was significant decrease in mean AHI from 43.95/hour to 10.52/hour. The mean ESS decreased from 13 to 11. The mean compliance was 6.66 hours/night.

Conclusion
This limited veteran observational study supports that HNS is an effective treatment option for the management of PAP-intolerant patients with OSA. Our preliminary data suggests improved treatment adherence. Future prospective large-scale cohort studies should be considered.

Support
The authors declare no conflicts of interest nor any financial support
0633 Volume Assured Pressure Support is an Effective Treatment in Patients with Central Sleep Apnea Syndrome
Authors: Levri J M , Watanabe N , Peng V , Scharf S M , Diaz M 
Published: May 2020

Abstract

Introduction
Central sleep apnea syndrome (CSA) is commonly found in patients with congestive heart failure, brainstem disorders, and narcotic use. Various treatment modalities have been used with varied effectiveness in reducing the apnea-hypopnea index (AHI) and improving ventilation in patients with CSA. This study assessed whether Volume Assured Pressure Support (VAPS), a BiLevel mode of ventilation, is effective in treating CSA.

Methods
We performed a retrospective review of polysomnography (PSG) and VAPS titration studies on 11 patients at our institution: 7 patients had CSA with Cheyne-Stokes Respiration, 2 patients had CSA attributed to narcotic use, and 2 patients had primary CSA. CSA was diagnosed if more than 50% of the disordered breathing events were central. Five patients had failed a Continuous Positive Airway Pressure (CPAP) titration and then proceeded to VAPS while in 6 patients, VAPS was the initial treatment modality tried. We examined the effectiveness of VAPS in reducing AHI, improving oxygenation, and improving sleep architecture.

Results
Among the 11 patients, age was 63.0±12.1 yo, BMI was 33.7 ±4.5, 7 were males, Epworth sleepiness score was 9.3±4.9. The following significant changes from baseline PSG to VAPS titration were observed: AHI: 59.1± 8.0 to 27.2 ± 9.9 (p&lt;.01); Time ≤ 88% O2 saturation (min): 48.1±14.5 to 15.4±6.1 (p&lt;.05). Improvement in AHI was not related to gender, body mass index, narcotic use, or age. No significant changes in sleep architecture between the two studies were found. Ten (91%) patients had AHI &gt; 30 on initial PSG. In 6 (55%) patients AHI was reduced to &lt;15 with VAPS use. An additional patient had AHI reduced to 22.2, while 4 (36%) patients did not achieve an AHI &lt; 30 with VAPS.

Conclusion
VAPS is an effective mode of treating CSA in the majority of patients.

Support
NA
0647 The Effect of CPAP on the Blood Flow to the Brain: A Preliminary Report
Authors: Alperin N , Hernandez-Cardenache R , Lee S , Junco B , Ramos A R 
Published: May 2020

Abstract

Introduction
We aim to determine the effect of positive airway pressure (PAP) on total cerebral blood flow in a sample of middle-aged to older male patients with obstructive sleep apnea (OSA).

Methods
We evaluated consecutive treatment-naïve male OSA patients with Apnea hypopnea Index (AHI)≥15, from January to November of 2019. We obtained demographic variables, vascular risk factors, the Epworth sleepiness scale (ESS) and the Pittsburgh sleep quality index (PSQI). Brain magnetic resonance imaging (MRI) consisted of high resolution anatomical imaging and velocity encoded phase contrast MRI to measure volumetric blood flow rate to the brain, or the total cerebral blood flow (tCBF), by summation of the flow rate through the two internal carotid and vertebral arteries. Positive airway pressure at various pressures was provided during the MRI, while subjects were awake, starting at 0 cm H20, then 5 cmH20, 10, 15, and 20 cmH20. Each setting was applied for six minutes. Two subjects did not tolerate pressure setting of 20 cmH2O.

Results
We had a total of 11 participants’ age 40-73 years, 70% Hispanic/Latino background. The average ESS was 8.2±6.0, PSQI=5.7±4.9, and AHI=48.9±25.5. Five of the subjects had hypertension and a quarter had diabetes. In all subjects total CBF monotonically decreased with increasing PAP. The initial decreases in total CBF (PAP from 0 to 5 and 5 to 10) where significantly larger than the decrease in the higher pressure range. In two subjects the total decrease in tCBF was nearly 50%. The average tCBF was 682.3 mL/min at 0 cmH20 and 506.3 ml/min at 20 cmH20.

Conclusion
Incremental increases in PAP lead to substantial decrease in tCBF during wake. Substantial decrease in tCBF is possibly explained by decreasing end tidal CO2 pressure. The specific physiologic cause and the neurologic impact of prolonged decreased tCBF during CPAP therapy needs to be further investigated.

Support
Scientific Advisory Committee, Pilot grant, Miller School of Medicine; R21AG056952; R21HL140437; Jazz-Pharmaceutical.
0648 Impact of Positive Airway Pressure (PAP) Troubleshooting Clinic Visits on Patient Satisfaction, PAP Use, Mask Leak, and Prolonged Use
Authors: Bennett K L 
Published: May 2020

Abstract

Introduction
Patients with sleep apnea are often prescribed positive airway pressure (PAP) treatment. Some patients have difficulty consistently using a PAP machine due to problems such as air leak, mask discomfort, and dry mouth. The purpose of this project is to evaluate the satisfaction and efficacy of a PAP Troubleshooting Clinic lead by a RN and a respiratory technician (RT). This clinic seeks to improve PAP compliance, increase PAP tolerability and increase PAP treatment efficacy

Methods
The PAP Troubleshooting Clinic consists of a RN and RT with specialized knowledge about sleep apnea and PAP treatment. During a 30 or 60-minute clinic visit, these providers review the patient’s experience with PAP, assess mask fit, review PAP data and PAP settings, and recommend treatment adjustments for the primary Sleep Clinic provider’s consideration. Outcomes assessment includes satisfaction (a telephone survey one week after the visit) and efficacy (30-day data on overall use, mask leak, and days with ≥ 4 hours of use downloaded from PAP machines).

Results
To date, 58 patients have received care in the clinic and 56 (96.5%) patients reported they were satisfied/highly satisfied with the PAP Troubleshooting Clinic. From the sample, forty-three (74.1%) patients were compliant with mask use over 30 days. Twenty-four (55.81%) showed a greater than 10% reduction in mask leak after intervention. Ten patients (23.3%) achieved an improvement with a 10% increase in number of days with &gt; than 4 hours of PAP use.

Conclusion
Patients and Sleep Clinic providers are very satisfied with the PAP Troubleshooting Clinic. Patients are referred to this clinic because they have significant issues with PAP usage and are at high risk of discontinuing use. Patients find the clinic helpful and encouraging, while sleep medicine physicians and APPs appreciate the assistance in helping patients succeed with PAP, especially during the 30-day time period where PAP compliance receives scrutiny from clinics and payers.

Support
A PAP Troubleshooting Clinic is an effective way to improve patient PAP Use, Mask Leak, Prolonged Use and Patient Satisfaction. Importantly, this new clinical model offers a valuable alternative to provide patients with the appropriate level of care.
0667 Positive Airway Pressure Non-Adherence Interacts With Post-Traumatic Stress Disorder to Increase Risk of Back Pain
Authors: Taylor K A , Schwartz S W , Sebastião Y V , Anderson W M , Foulis P R 
Published: May 2020

Abstract

Introduction
Altered sleep, as is associated with obstructive sleep apnea (OSA), may increase the risk of back pain (BP). However, little to no evidence regarding the effect of OSA on musculoskeletal pain is currently available, let alone the effect of positive airway pressure (PAP) treatment non-adherence. The purpose of this analysis is to investigate the effect of PAP non-adherence on future BP diagnosis.

Methods
A sample of 1,662 veterans who had a sleep study between January 2003 and October 2006 and receiving PAP treatment for OSA were used for analysis. Measures at baseline included demographic and OSA symptom severity data. Up to 3 weeks of PAP adherence data were collected and patient chart data was collected through May 2010 to determine outcomes. Time was calculated from PAP treatment start to BP diagnosis or censoring, which occurred at date of death or last recorded encounter. Survival analysis was conducted to obtain the hazard ratios (HR) for the effect of PAP non-adherence on BP diagnosis and to investigate whether post-traumatic stress disorder (PTSD) is an effect modifier of this relationship.

Results
PAP treatment non-adherence significantly increased the risk of BP diagnosis (HR 1.88 [95% CI: 1.08, 3.27]) among veterans with PTSD, while non-adherence among veterans without PTSD was not a statistically significant risk factor. Relative excess risk due to interaction (RERI) was 0.97 (95% CI: -0.07, 2.02; p-value=0.068). These estimates are independent of age, sex, race, body mass index, apnea severity (based on Apnea-Hypopnea Index), PTSD diagnosis, income level, and marital status.

Conclusion
PAP treatment non-adherence among veterans with PTSD appears to result in a significant increase in risk of future BP diagnosis. The interaction between PAP non-adherence and PTSD appears to be borderline synergistic. Therefore, improving PAP adherence among veterans with PTSD may decrease risk of future BP diagnosis.

Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
0669 The Effects Of Continuous Positive Airway Pressure Therapy In Moderate To Severe Obstructive Sleep Apnea: A High-density EEG Study
Authors: D’Rozario A L , Kao C , Mullins A E , Memarian N , Yee B , Duffy S , Banerjee D , Cho G , Wong K K , Kremerskothen K , Chapman J , Haroutonian C , Bartlett D J , Naismith S L , Grunstein R R 
Published: May 2020

Abstract

Introduction
A previous high-density electroencephalography (EEG) investigation in asymptomatic OSA showed regional deficits in sleep EEG power particularly slow wave activity (SWA) during NREM sleep in the parietal region. It is unclear whether treatment with CPAP can reverse local sleep EEG abnormalities in OSA, and whether any recovery is related to improvement in sleep-dependent memory consolidation.

Methods
Fifteen male participants (age 50.4±6.5yrs, AHI 51.7±23.5/h) with moderate-severe OSA (AHI&gt;15/h) underwent overnight polysomnography with 256-channel high-density EEG at baseline and following 3 months of CPAP therapy. A word paired associates declarative memory task was administered before and after sleep. After artefact removal, spectral analysis was performed for all channels. Topographical power maps were calculated for standard frequency ranges for NREM sleep (164 channels within a 0.57 radius from the vertex). Maps were compared using both absolute and normalized power (z-scores computed for each subject) and differences between baseline and treatment were determined by statistical nonparametric mapping.

Results
In 11 CPAP compliant patients (intolerant of CPAP [n=3]/high-density EEG [n=1]), analysis of polysomnographic variables showed that total sleep time did not differ but N1 (baseline vs. treatment: 66.9 vs. 39.5 mins,p=0.008) and N2 (195.0 vs. 150.6 mins,p=0.002) sleep was lower and N3 (89.8 vs. 128.7 mins,p=0.003) was higher after CPAP. Topographic analysis of high-density EEG data revealed a regional increase in SWA (1-4.5Hz) EEG power during N3 sleep in a cluster of electrodes overlying the centro-parietal cortex (cluster mean t-value=2.87,p=0.02). The change in overnight declarative memory consolidation (% recognition) after CPAP was significantly correlated with the change in slow spindle frequency activity in frontal regions (cluster mean r=0.875,p=0.003).

Conclusion
CPAP treatment may enhance localised deficits in sleep EEG activity in OSA, and specific regional recovery may translate to memory improvements in the short-term. These data also highlight the potential for long-term therapeutic effects on cognitive outcomes in OSA.

Support
0677 Patient Preferences On Initiating Treatment With Continuous Positive Airway Pressure
Authors: Borker P V , Wyland C , Patel S R 
Published: May 2020

Abstract

Introduction
Clinical guidelines recommend continuous positive airway pressure (CPAP) therapy be initiated in patients with obstructive sleep apnea (OSA) either at home using an auto-titrating device or following manual titration in the sleep laboratory. Patient preference between these two options is unknown.

Methods
Patients newly prescribed CPAP therapy for the treatment of OSA at an academic sleep medicine clinic were surveyed by telephone within one month of initiating treatment. Data on demographics, disease severity and CPAP adherence were obtained from the medical record.

Results
A total of 75 participants (56% male, mean age 52±15 yrs, 48% moderate to severe OSA) were surveyed. Physicians prescribed home initiation of CPAP in 51%, lab initiation in 23%, and allowed the patient to choose in 27% of cases. Overall, 67% of participants (95% CI [56%-77%]) reported preference for home initiation. Preference for home initiation did not vary by age, sex, AHI, degree of sleepiness, or type of diagnostic study (home vs. lab sleep study) performed (p&gt;0.10 for all). Convenience (44%) and starting treatment faster (44%) were the most common reasons provided for those favoring home initiation, while sleep technician availability (40%), optimization of pressure settings (32%), and ability to try multiple masks (28%) were cited by those favoring lab initiation. The prevalence of CPAP adherence at 90 days tended to be higher in those whose treatment was initiated aligned to preference (79% in those whose treatment initiation was concordant with preference vs. 64% in those whose treatment initiation was discordant, p=0.16).

Conclusion
Overall, two-thirds of patients with OSA prefer initiation of CPAP be done at home. This preference does not vary by demographics, OSA severity or diagnostic modality. Initiating treatment concordant with patient preference may lead to greater adherence.

Support
American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship, K24 HL127307
0680 The Effect of Continuous Positive Airway Pressure on the Levels of the Proinflammatory Markers in Patients with Obstructive Sleep Apnea
Authors: Wali S O , Al-Mughales J , Alhejaili F , Manzar M , Alsallum F , Almojaddidi H , Gozal D 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea (OSA) develops systemic inflammation, with increased levels of mediators. In general, significant elevations in serum levels of C-reactive proteins (CRP), and interleukin 6 (IL-6) are seen in patients with OSA. The literature is inconsistent regarding the effect of Continuous Positive Airway Pressure (CPAP) on the level of CRP and IL-6. The aim of this study is to evaluate the effect of CPAP on the levels of IL-6 and CRP in patients with OSA.

Methods
All patients newly diagnosed with moderate-severe OSA at the King Abdulaziz university sleep center were targeted. Patients with conditions that may affect the levels of inflammatory markers were excluded. All included patients had their fasting blood taken post the initial diagnostic polysomnography for pro-inflammatory markers. Patients were then classified into two groups. The first group included those that accepted treatment with CPAP (CPAPG). The second group included patients with OSA but refused treatment (No-CPAPG). Each group had been followed for one month, and then another blood samples were drawn for the levels of the pro-inflammatory biomarkers.

Results
Twenty patients in each group were recruited. At baseline IL-6 was significantly higher in the No-CPAPG compared to CPAPG (median 6.7 pg/ml [interquartile range 1.6-7.6] vs. 1.6 pg/ml [1.3-1.9], respectively; p = 0.006) despite similar OSA severity. At 1-month follow-up, IL-6 remained significantly higher in the No-CPAPG; p = 0.003 and there was no effect of CPAP on IL-6 in the CPAPG. There was no significant difference in CRP level at baseline or at 1-month follow-up among the two groups. However, there was neither an effect of time (F (1, 38) = 0.08, p = 0.78), nor an interaction effect between CPAP and time (F(1, 38) = 0.006, p = 0.94) on IL-6 level. Similarly, there was neither an effect of time (F(1, 38) = 1.68, p = 0.20), nor an interaction effect between CPAP and time (F(1, 38) = 0.17, p = 0.68) on CRP level.

Conclusion
IL-6 and CRP levels did not change significantly with CPAP over a one month period in OSA patients.

Support
By the DSR, KAU, Jeddah, KSA. No: KEP-2-140-39