bluuebunny/crossref_metadata_2025_split huggingface dataset:
0590 Reliability of Simple Sleep Evaluation Device at Split-Night Polysomnography
Authors: Adachi T , Koba S , Hanyu A , Kato M , Morita M , Kawamoto T , Ida H , Watanabe Y , Shinke T 
Published: May 2020

Abstract

Introduction
Watch-PAT is a sleep evaluation device that measures the peripheral blood volume continuously with a probe attached to a fingertip and does not use an electroencephalogram or a nasal cannula. There has been no report on the usefulness of watch-PAT to determine the apnea diagnosis and continuous positive airway pressure (CPAP) use effects in split-night sleep study.

Methods
The consent of the study was obtained. Watch-PAT was simultaneously worn on a patient admitted for split-night polysomnography. The apnea-hypopnea index (AHI) obtained from PSG and the pAHI gained from the watch-PAT were measured when not using CPAP and when using CPAP respectively. And also we examined whether the reduction rates of AHI and pAHI could be correlated.

Results
38 subjects (32 men, age 55 ± 13 years old). BMI 28.3 ± 5.7 kg / m2. When CPAP was not used, AHI was 57.2 ± 23.3 / h and pAHI was 50.8 ± 20.3 / h (r = 0.93, p &lt; 0.0001), when CPAP was used, AHI was 5.2 ± 4.5 /h and pAHI was 6.2 ± 4.5 h (r = 0.82, p &lt; 0.0001), AHI reduction rate was 90.4 ± 8.0% and pAHI reduction rate was 85.4 ± 14.6% (r = 0.76, p &lt; 0.0001).

Conclusion
It was suggested that Watch-PAT had a good correlation with AHI at split night-sleep study.

Support
None
0603 Divided Attention Steering Simulator Compared to Other Daytime Sleepiness Tests in Sleep Apnea
Authors: Penzel T , Henning S , Glos M , Huang Y , Fietze I 
Published: May 2020

Abstract

Introduction
Sleep apnea is often associated with daytime sleepiness. A test which may be similar to driving situations is the divided attention steering Simulator (DASS) as a surrogate for testing sleepiness at the wheel. In this study we compared DASS parameters against Epworth sleepiness score (ESS) and psychomotor vigilance test (PVT) in subjects with sleep apnea.

Methods
In 16 healthy subjects without sleep disorders and in 38 patients with sleep apnea, we tested daytime sleepiness and Performance using different methodologies. We applied the DASS twice, the PVT twice, the testbattery for attentional Performance (TAP), and the MSLT during one day after polysomnography.

Results
Sleep apnea patients had a longer response time according to DASS (p&lt;0.05) and a larger average deviation from midline of the road (p&lt;0.05) and left the road more frequently (p&lt;0.05). Response time in DASS correlated well with PVT (p&lt;0.001). We found no significant association between ESS and DASS parameters. We no correlation between MSLT sleep latency and DASS parameters.

Conclusion
The DASS is very well to mirror reaction time as determined by PVT. However, the DASS does not reflect sleepiness as determined by MSLT or ESS. The study confirms the finding that reaction time testing, even using different tools, does not relate very well with perceived subjective sleepiness by ESS nor by objective sleepiness as assessed by multiple sleep latency test. Different measures do form a complex Picture which might lead to falling asleep when driving. All tests do show some limitations regarding this assessment.

Support
This study was supported by Charite University funds.
0614 Diurnal Patterning of Autonomic Measures in Sleep Apnea and Paroxysmal Atrial Fibrillation and Response to Continuous Positive Airway Pressure Therapy
Authors: Sandhu A , Wang L , Bena J , Kaffashi F , Loparo K , Aylor J , Nawabit R , Chung M , Van Wagoner D , Walia H , Mehra R 
Published: May 2020

Abstract

Introduction
Diurnal patterning of autonomic function in paroxysmal atrial fibrillation (PAF) and sleep disordered breathing (SDB) is unknown. We hypothesize heart rate variability (HRV) as surrogates of autonomic function, exhibit diurnal differences in PAF relative to SDB severity and treatment.

Methods
We leveraged the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT,NCT02576587) study focused on participants with PAF and SDB (apnea hypopnea index,AHI≥15,3% oxygen desaturation hypopnea). Attended 16-channel polysomnography (PSG) and continuous ECG monitoring (Heartrak Telemetry®) for 7-21 days was performed at baseline and after 3-months of continuous positive airway pressure (CPAP). Linear mixed-effects models (least square means,95%CI) were used to assess relationships between daily average HRV measures (frequency domain:LF,HF,LF/HF;time domain:MNN,RMSSD,SD1,SD ratio and novel non-linear:DFA-alpha measures) with SDB (AHI),%sleep time with SaO2&lt;90%(TRT&lt;90): per 5-unit increase),effect of 3-month CPAP relative to sleep-wake and statistical interaction of sleep-wake. Analyses were conducted using SAS version v.9.4, Cary, NC.

Results
The analytic sample was comprised of 33 cases with PAF and SDB:61.1±11.7 years,62.5% male, BMI:33.9±7.2kg/m2,75% Caucasian,AHI 15.1 (IQR: 4.4,29.4) and 68.8% on atrioventricular nodal blocking medications. AHI was associated with frequency (HF:0.08[0.01,0.16] and LF/HF:-0.11[-0.20, -0.01]), time (SD1:0.08[0.02,0.14] and SD ratio: 0.09[0.04,0.14]) and non-linear (DFA-alpha1: -0.02[-0.036,-0.003]) domain measures during wake, but not sleep. Significant sleep-wake and AHI as well as TRT&lt;90 interactions relative to HRV measures were observed (p≤0.001). Only SD ratio was associated with TRT&lt;90 (0.12[0.03,0.24]). Baseline to follow-up CPAP time domain measures were altered mainly during wake versus sleep with MNN increased 0.13: [0.08,0.19],p&lt;0.001; RMSSD increased 0.13 [0.08,0.19], p&lt;0.001; SD1 increased 30% [0.09,0.55], p=0.004; SD ratio increased 20% [0.01,0.43], p=0.033,and also frequency domain: HF increased 33%[0.03,0.72], p=0.028.

Conclusion
SDB defined by AHI--more so than nocturnal hypoxia--was associated with surrogate autonomic measures impacted by CPAP intervention during wake and not sleep in PAF. SDB-related autonomic influences in PAF appear to be more pronounced during wakefulness suggesting long-term potentiation-like influences.

Support
This study was supported by the National Heart, Lung and Blood Institute (NHLBI) [Grant R01 HL108493] and National Institutes of Health (NIH) National Center for Research Resources [Grant UL1 RR024989]
0617 Optimization of OSA Screening in a Black Population
Authors: Fossum M , Najimi N , Whitesell P 
Published: May 2020

Abstract

Introduction
Racial disparities in the prevalence and severity of Obstructive Sleep Apnea (OSA) in Black Americans may play an important contributory role in the increased burden of cardiometabolic disease experienced by this population. Effective screening for OSA could permit early recognition and treatment, thereby preventing future the adverse cardiovascular outcomes which contribute to a decreased life expectancy. The STOP-BANG questionnaire is a validated screening tool for OSA as demonstrated in many populations and settings. Unfortunately, Blacks have typically been underrepresented in studies evaluating the sensitivity and specificity of the tool. Potentially unique biologic and psychosocial factors may affect the phenotypic expression of OSA and influence the performance of the STOP-BANG. Data are needed regarding the reliability of the tool for this population and potentially modifications to optimize its usefulness.

Methods
Data were from 204 patients evaluated at the Howard University Hospital Sleep Disorder Center between April 2018 and June 2019. Records were reviewed for demographic information, body mass index (BMI), neck circumference, and medical history, including the presence of snoring, tiredness/sleepiness, observed apneas, and hypertension and results of sleep study testing. Data were analyzed using SPSS software. Subcomponents of the STOP-BANG scoring criteria were adjusted to improve performance.

Results
Mean age was 48.5. 62% of subjects were female and mean BMI was 40.2 The mean ESS was 9.9. The mean AHI was 27.7 with a prevalence of mild or greater OSA (AHI &gt;5) of 80%. Scoring of the STOP-BANG using a criterion of 3 or greater as indicating increased risk demonstrated a sensitivity of 90%, specificity of 8%, PPV of 80%, and NPV of 17%. Performance was worse for women then men. Multiple adjustments to scoring were evaluated to improve accuracy.

Conclusion
Similar to its performance in other populations, the STOP-BANG demonstrated high sensitivity but very poor specificity and overall poor accuracy in a Black population referred for Sleep Medicine Consultation to an urban university hospital. Performance was worse for women than men. Modifications are presented to try to improve performance and the clinical utility for this population.

Support
Howard University RCMI
0622 In-Depth Surveillance of Central Sleep Apnea in Patients with Stable Heart Failure
Authors: Ibrahim S , Wharton R , Harmon E , Bonner H , Davis E , Cho Y , Mazimba S , Kwon Y 
Published: May 2020

Abstract

Introduction
Central sleep apnea (CSA) is unique sleep breathing phenotype in patients with advanced chronic heart failure (HF) and portend poor prognosis. The prevalence of CSA in HF patients under contemporary therapy is uncertain.

Methods
We reviewed consecutive HF patients on optimal medical therapy who underwent clinically indicated diagnostic in-lab polysomnography at a single academic center. Age, sex and BMI matched patients without HF were selected from sleep clinic as a control. Patients with atrial fibrillation were excluded from this study. Apnea subtypes were determined after careful scoring and confirmation by sleep physicians. ‘Any CSA’ was defined by central apnea index (CAI) &gt;5 and &gt;1/hr. ‘True CSA’ was defined if met both CAI≥5/hr and &gt; obstructive apnea index (OAI). Obstructive sleep apnea (OSA) was defined if apnea hypopnea index &gt;15 and OAI&gt;CAI. Multivariate analysis was performed using logistic regression adjusting for age, sex, HF and systolic dysfunction as appropriate.

Results
In patients with HF (N=95, mean age 59, female: 50%), CSA was low and was comparable to control group (N=94) (HF vs. Non-HF; CSA: 5.3 vs. 4.3%, P=NS; Any CSA 14.7 vs. 17%, P=NS). Only 3 patients with HF had true CSA. In contrast, OSA was common in both groups regardless of obesity status (52.3 vs. 55.3%). In patients with HF, Cheyne Stokes respiration was more frequent in patients with Any CSA vs. without Any CSA (13.3 vs. 3.8%, p=0.04). In multivariate analysis, presence of OSA, but not HF, was associated with Any CSA in entire cohort (Any CSA OR: 3.1 [1.3, 8.1], p=0.02). In patients with HF, male sex was associated with Any CSA (OR: 5.3 [1.1, 40.8], p=0.05). Exclusion of patients with high BMI did not change the results.

Conclusion
CSA was rare in patients with stable HF on contemporary optimal medical therapy.

Support
None
0637 Comparison of AHI and ESS Outcomes Between Patients with Obstructive Sleep Apnea Undergoing Sleep Surgery versus Upper Airway Stimulation
Authors: Huntley C , Doghramji K , Tschopp K , Tschopp S , Jardin P B , Heiser C , Schwab R , Thaler E , Jenks C , Walia H , Kominsky A , Kezirian E , Waxman J , Lin H , Boon M 
Published: May 2020

Abstract

Introduction
Single or multi-level soft tissue surgical interventions are common options for CPAP-intolerant patients with OSA. Upper Airway Stimulation (UAS) is an alternative option using an implantable hypoglossal nerve stimulator. We compared patient outcomes between traditional sleep surgery (TSS) and UAS.

Methods
We selected patients who underwent TSS (including palate, oropharynx, tongue, and/or epiglottis-based procedures) for OSA and also met general UAS criteria (BMI≤35, AHI between 15-65, absence of palate concentric collapse during DISE, if available) for chart review. UAS outcomes were collected from the ADHERE international registry. For both groups, post-op AHI was collected, including full-night UAS efficacy studies. Data are presented as mean and standard deviation.

Results
The TSS group (n=284) and UAS group (n=541) were predominantly male and overweight. The TSS group was younger than UAS (47±12 vs 60±11 years, p&lt;0.001). At baseline, both groups had severe OSA with AHI of 34±14 and 36±15 (p=0.23) and excessive daytime sleepiness with ESS of 12±5 and 12±6, (p=0.38), respectively. TSS follow-up was 169±151 days vs 392±181 days for UAS, which was significantly different. UAS had significantly larger decrease in AHI than TSS (-21/h±18 vs -16/h±16, p&lt;0.0001). Both groups had a large decrease in ESS, however, the UAS group had a slightly smaller decrease, (-6±5 vs -5±5, p=0.01). Using the Sher response criteria of 50% AHI reduction and ≤ 20 events/hour, UAS had a 70% response rate vs 51% for TSS.

Conclusion
This study represents largest and first international, multicenter comparison of UAS to traditional surgical interventions for OSA, albeit with limitations of potential differential patient selection. While both TSS and UAS show similar improvement in symptoms, upper airway stimulation has a larger reduction of AHI with higher rates of therapy response than traditional sleep surgery

Support
ADHERE data assistance from Inspire Medical (Minneapolis, MN)
0639 Long Term Oral Appliance Therapy Decreases Stress Symptoms In Upper Airway Resistance Syndrome Patients
Authors: Godoy L B , Sousa K M , Palombini L O , Guimarães T M , Poyares D , Tufik S , Togeiro S 
Published: May 2020

Abstract

Introduction
Upper Airway Resistance Syndrome (UARS) is suspected in individuals with excessive daytime sleepiness, fatigue and sleep fragmentation due to increased respiratory effort. UARS can negatively impact daytime function and decrease quality of life. Cognitive impairment in UARS patients has not been well stablished yet. The objective of the study was to evaluate the long-term effects of a mandibular advancement device (MAD) on cognitive function in patients with UARS compared with placebo.

Methods
This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and MAD groups. UARS criteria were the presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) &gt; 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Rey Auditory-Verbal Learning Test (RAVLT), the Logical Memory Test, the Stroop Color Test, the Trail Making Test, the Digit Symbol Substitution Test and Inventory of Stress Symptoms (Lipp test). Cognition protocol was defined based on most used neuropsychological tests in the literature. Evaluations were performed before and after 1.5 years of treatment.

Results
There was no statistically significant difference in RAVLT, Logical Memory Test, Stroop Color Test, Trail Making Test, Digit Symbol Substitution Test before and after 1.5 year of treatment in both groups. The Lipp test score decreased at alarm phase (p = 0.05) and at resistance phase (p = 0.01) after 1.5 year of MAD treatment compared to placebo.

Conclusion
Mandibular advancement device was effective in decreasing stress symptoms in alarm and resistance phases of Lipp test in UARS patients after 1.5-years of MAD treatment.

Support
The authors would like to thank for the support by grants from Associação Fundo de Incentivo a Pesquisa (AFIP), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
0644 An Educational and Behavioral Intervention Failed to Improve PAP Use Among Veterans With Spinal Cord Injuries and Diseases: Results of a Randomized Controlled Trial
Authors: Martin J L , Sankari A , Salloum A , Zeineddine S , Arvai K , Henzel M K , Shamim-Uzzaman Q , May A , Fung C H , Mitchell M N , Strohl K P , Badr M S 
Published: May 2020

Abstract

Introduction
Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adherence among Veterans with SCI/D over the first 3 months of use.

Methods
63 Veterans (mean age=60.7(10.2) years; 92% male) with SCI/D (33 SCI, 30 SCD; 25 cervical involvement; 38 thoracic and below) and SDB (23 with AHI 5-15; 40 with AHI&#8805;15) who received PAP treatment (CPAP or BPAP) were randomly assigned to receive a comprehensive 3-month intervention (INT) or an equal attention control (EAC). INT and EAC both included 1 face-to-face session (week 1) and 5 additional telephone sessions (weeks 2, 3, 4, 8 and 12). Main outcome measures were PAP use over the first 3 months: nights of use, nights of use &#8805;4 hours, and mean hours of use per night. Repeated measures ANCOVA models were used to test the differences between INT and EAC over the first 3 months of treatment.

Results
Number of nights with &#8805;4 hours of use in months 1-3 was 9, 7, and 6 nights in the INT and 8, 5 and 4 nights in the EAC (p’s&#8805;.37), respectively. There were no significant differences between INT and EAC for number of nights with any use (p’s&#8805;.24), or mean hours of use per night (p’s&#8805;.30). All 3 PAP use variables declined over time in both groups.

Conclusion
Sustained use of PAP therapy was difficult to achieve among those with SCI/D, and a 6-session behavioral intervention did not lead to significant improvements in use. Even when relatively high levels of initial use are achieved, this is difficult to sustain over time. Future studies should explore whether SCI/D patients experience significant symptom relief with PAP, and if so, whether home-based interventions or more intensive face-to-face PAP adherence programs will be effective.

Support
VA Rehabilitation Research and Development Service, Merit Review (1RX002116; PI: Badr); NIH/NHLBI K24 HL143055 (Martin).
0646 Evaluation of Increased CPAP Compliance After Electronic Learning Video Aimed at Troubleshooting Common CPAP Related Problems
Authors: Slota K A , Wasey W , Dredla B K , Castillo P 
Published: May 2020

Abstract

Introduction
Obstructive sleep apnea(OSA) is a common diagnosis associated with immediate and long-term health consequences. Due to increasing awareness, the demand for treatment with CPAP is increasing. However, CPAP compliance remains a problem, and may be improved by initial patient education targeted at common CPAP problems

Methods
A 10 min video depicting common CPAP related problems was created in the Mayo Clinic Florida Simulation Center using standardized patients. Newly diagnosed patients with OSA requiring CPAP were randomized into two arms: (i) the intervention arm was shown the video and received standard of care; or (ii) in the “placebo” or standard of care alone. Our standard of care includes a review of the sleep study, discussion of diagnosis and recommendation for CPAP therapy along with Mayo OSA information packet, followed by compliance visit at 3 months. Compliance is defined as &gt;4 hours of CPAP use per night gathered from machine’s SD card. The two groups were compared for statistically significant difference in compliance at 3 months.

Results
47 patients diagnosed between 10/2018-5/2019 were included in the study(21:intervention, 26:placebo). 7 (33%) and 7 (26%) patients in the intervention and the placebo came back for follow up visit (p=0.63). Among them, median CPAP usage was 362.5 min (236.0, 480.0) in intervention arm vs 351.0 min (125.0, 466.0) in placebo group and the difference was not significant. Average nightly use of &gt;than 4 hours was 12(57.1%) in the intervention group and 17(65.4%) in placebo group.

Conclusion
In this group addition of an educational video to standard of care did not show benefit in CPAP compliance. There was a tendency toward greater median nightly usage. Patients receiving the video had a higher likelihood of making their follow up appointment which is pivotal, as it provides an opportunity for further intervention and enhancement of adherence.

Support
Mayo Clinic Jacksonville
0659 A Safe and Precise Tongue Base Surgery for Obstructive Sleep Apnea: Real-Time Intraoperative Ultrasound-Assisted Transoral Robotic Surgery
Authors: Lin C , Chang C , Hsiao J , Wu J , Tsai H 
Published: May 2020

Abstract

Introduction
Lingual artery (LA) injury is a devastating complication of tongue base surgery. Compared with the anatomic findings of computed tomography angiography (CTA), intraoperative blade of mouth gag might change the thickness of base of tongue (BOT) and anatomy of LA. We aimed to investigate the position of LA in the BOT with intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS), and evaluate the bleeding complications when assisted with / without IOU.

Methods
Adult obstructive sleep apnea (OSA) patients who received TORS in BOT resection were recruited since 2016. Assessment tools were pre-op over-night hospital polysomnography (PSG) and anatomy-based Friedman Staging System. Ultrasound imaging was utilized to identify anatomic parameters of LA in BOT, including distance to midline, arterial depth and diameter.

Results
Ninety-three OSA patients (82 male, 88.2%) were analyzed. The mean age was 42.2±10.0 years old and body mass index was 29.2±4.5 kg/m2. The average apnea hypopnea index (AHI) was 58.1±21.4 events/hour. There were 66 (71.0%), 24 (25.8%) and 3 (3.2%) patients in Friedman stages II, III and IV, respectively. Seventy patients underwent TORS with IOU had shorter operation time (191.7±3.8 minutes) than 23 patients without IOU (220.1±6.6 minutes), less total blood loss (11.3±10.8 versus 19.6±26.7 ml), and more BOT tissue reduction volume (7.1±2.5 versus 3.9±1.6 ml). Significant predictors of arterial depth were higher AHI level during rapid-eye-movement (REM) sleep stage (p=0.038), bigger tonsil size (p=0.034) and more elevated Friedman tongue position (p=0.012). Postoperative complication associated with LA injury was not found in the patients with use of IOU.

Conclusion
When tongue retracted with blade, the distance to midline and depth of LA were altered in BOT. With IOU assisted, surgeon could identify LA position confidently. It is expectable to maximize efficiency and minimize catastrophic bleeding complications when OSA patients received TORS in BOT resection.

Support
nil