bluuebunny/crossref_metadata_2025_split huggingface dataset:
398 Agreement and reliability of a new respiratory event and arousal detection algorithm against multiple human scorers
Authors: Magalang Ulysses , Keenan Brendan , Staley Bethany , Ross Marco , Anderer Peter , Cerny Andreas , Vasko Raymond , Kuna Samuel , Bakker Jessie 
Published: May 2021

Abstract

Introduction
Scoring algorithms have the potential to increase polysomnography (PSG) scoring efficiency while also ensuring consistency and reproducibility. We sought to validate an updated event detection algorithm (Somnolyzer; Philips, Monroeville PA USA) against manual scoring, by analyzing a dataset we have previously used to report scoring variability across nine center-members of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC).

Methods
Fifteen PSGs collected at a single sleep clinic were scored independently by technologists at nine SAGIC centers located in six countries, and auto-scored with the algorithm. Arousals, apneas, and hypopneas were identified according to the American Academy of Sleep Medicine recommended criteria. We calculated the intraclass correlation coefficient (ICC) and performed a Bland-Altman analysis comparing the average manual- and auto-scored apnea-hypopnea index (AHI), arousal index (ArI), apneas, obstructive apneas, central apneas, mixed apneas, and hypopneas. We hypothesized that the values from auto-scoring would show good agreement and reliability when compared to the average across manual scorers.

Results
Participants contributing to the original dataset had a mean (SD) age of 47 (12) years, AHI of 24.7 (18.2) events/hour, and 80% were male. The ICCs (95% confidence interval) between average manual- and auto-scoring were almost perfect (ICC=0.80–1.00) for AHI [0.989 (0.968, 0.996)], ArI [0.897 (0.729, 0.964)], hypopneas [0.992 (0.978, 0.997)], total apneas [0.973 (0.924, 0.991)], and obstructive apneas [0.919 (0.781, 0.972)], and moderately reliable (ICC=0.40–0.60] for central [0.537 (0.069, 0.815)] and mixed [0.502 (0.021, 0.798)] apneas. Similarly, Bland-Altman analyses supported good agreement for event detection between techniques, with a mean difference (limits of agreement) of only 1.45 (-3.22, 6.12) events/hour for AHI, total apneas 5.2 (-23.9, 34.3), obstructive apneas 1.8 (-45.9, 49.5), central apneas 1.8 (-9.7, 13.4), mixed apneas 1.6 (-14.8, 17.9), and hypopneas 4.3 (-12.4, 20.9).

Conclusion
Results support almost perfect reliability between auto-scoring and manual scoring of AHI, ArI, hypopneas, total apneas, and obstructive apneas, as well as moderate reliability for central and mixed apneas. There was good agreement between methods, with small mean differences; wider limits of agreement for specific type of apneas did not affect accuracy of the overall AHI. Thus, the auto-scoring algorithm appears reliable for event detection.

Support (if any)
Philips
415 Risk of Obstructive Sleep Apnea after Treatment of Head and Neck Squamous Cell Carcinoma
Authors: Gavidia Ronald , Dunietz Galit Levi , O’Brien Louise , Schütz Sonja , Spector Matthew , Swiecicki Paul , Chervin Ronald 
Published: May 2021

Abstract

Introduction
Head and neck cancers (HNC) or their treatment may be associated with an increased risk of obstructive sleep apnea (OSA). Small studies that examined OSA risk factors in adults with HNC reported conflicting results. This study examined associations between tumor characteristics and risk of OSA among patients at least one year free of head and neck squamous cell carcinoma (HNSCC).

Methods
For this cross-sectional study of HNSCC patients at a large academic medical center, inclusion criteria were age ≥18 years, with absence of tracheostomy or mental impairment. The STOP-BANG questionnaire, with a threshold ≥3, was used to identify high risk for OSA. Descriptive statistics were used to compare demographic and health characteristics between OSA risk groups. Logistic and linear regression models adjusted for age and gender were used to examine associations between demographics, anthropometric measures, and OSA risk.

Results
Among 67 participants, 57 (85%) were male, mean age was 62.0±8.0 (s.d.) years, mean body mass index (BMI) was 28.7±4.6 Kg/m2, and mean neck circumference (NC) was 16.3±1.2 inches. A total of 50 (75%) participants received chemoradiation only. High OSA risk was observed in 40 (60%) of the participants. Tumor location, tumor stage, and type of cancer treatment were not different between OSA risk groups. Body mass index and NC were greater in the high OSA risk group (BMI 29.6±4.5 Kg/m2 vs. 27.3±4.1 Kg/m2, p=0.03; NC 16.5±1.3 inches vs. 15.8±0.5 inches, p=0.01). In age and gender-adjusted logistic regression models, BMI (OR=1.2, 95% CI 1.0, 1.4) and NC (OR=2.9, 95% CI 1.1, 7.3) were associated with high OSA risk. Adjusted linear regression models showed that BMI (β=0.10, 95%CI 0.04, 0.17) and NC (β=0.64, 95%CI 0.32, 0.96) were associated with STOP-BANG scores.

Conclusion
High OSA risk was quite common after HNSCC treatment. However, measured HNSCC characteristics were not different between high and low OSA risk groups. Instead, OSA risk factors included BMI and NC, as often reported in non-HNSCC patients as well. Prospective studies before and after cancer treatment will be needed to further elucidate potential roles of HNSCC and its treatment in subsequent OSA incidence.

Support (if any)
Dr. Gavidia’s work was supported by an NIH/NINDS T32-NS007222 grant.
418 The Berlin Questionnaire in Pregnancy Predominantly Identifies Obesity
Authors: O’Brien Louise , Levine Rivkah , Dunietz Galit Levi 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, it performs poorly in this population, likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity-related. Therefore, this study examined associations between each of the three BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP).

Methods
Pregnant third-trimester women aged at least 18 years with a single fetus were recruited from a tertiary medical center. All women completed the BQ, which includes three domains: snoring; sleepiness; and obesity/high blood pressure (BMI/BP). The latter domain was further examined as two separate sub-domains: obesity or chronic hypertension. A positive response in 2-of-3 domains identifies high OSA risk. Medical records were accessed for diagnoses of GDM and HDP.

Results
Of 1,588 women, 44% had a positive BQ. Women with positive domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk of GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the BMI/BP domain had increased odds of GDM (OR 2.0, 95%CI 1.3–3.3) and HDP (OR 2.9, 95%CI 1.6–5.5). Any positive score in domain combinations that included BMI/BP had increased odds of GDM and HDP compared with negative scores in all domains. A positive score in BMI/BP-alone, BMI/BP-and-sleepiness, BMI/BP-and-snoring, and an intersection of all three domains, had increased HDP odds compared with controls: OR 2.9 (95%CI 1.6–5.5), OR 2.2 (95%CI 1.1–4.4), OR 2.9 (95%CI 1.5–5.7), and OR 4.6 (95%CI 2.6–8.6), respectively. Women absent of positive BMI/BP domain but with a positive score in the other two domains (or their combination) had similar odds of GDM and HDP as controls.

Conclusion
The poor performance of the BQ in screening for OSA risk in pregnant women may be attributed to its predominant reliance on identification of obesity.

Support (if any)
NIH NHLBIHL089918
420 Evaluating the Rate of Referral for Obstructive Sleep Apnea in a Pre-Doctoral Dental Clinic Using the STOP-Bang Questionnaire
Authors: Guess Nathan , Fischbach Henry , Ni Andy , Firestone Allen 
Published: May 2021

Abstract

Introduction
The STOP-Bang Questionnaire is a validated instrument to assess an individual’s risk for obstructive sleep apnea (OSA). The prevalence of OSA is estimated at 20% in the US with only 20% of those individuals properly diagnosed. Dentists are being asked to screen and refer patients at high risk for OSA for definitive diagnosis and treatment. The aim of this study was to determine whether patients in a dental school student clinic who were identified as high-risk for OSA, were referred for evaluation of OSA.

Methods
All new patients over the age of 18 admitted to The Ohio State University - College of Dentistry complete an “Adult Medical History Form”. Included in this study were 21,312 patients admitted between July 2017 and March 2020. Data were extracted from the history form to determine the STOP-Bang Score for all patients: age, sex, BMI, self-reported snoring-, stopped breathing/choking/gasping while sleeping-, high blood pressure-, neck size over 17” (males) or 16” (females)-, and tiredness. Each positive response is a point, for a maximum of 8 points possible. Additionally, any previous diagnosis of sleep apnea, and the patient’s history of referrals were extracted from the health record. According to clinic policy, if the patient did not have a previous diagnosis for OSA noted in the health history, and scored 5 or more on the STOP-Bang Questionnaire, they should receive a referral for an evaluation for OSA. Notes and referral forms were reviewed to determine if the appropriate referrals occurred for patients at high risk without a previous diagnosis.

Results
Of the 21,312 patients screened; 1098 (5.2%) screened high-risk for OSA, of which 398 had no previous diagnosis of OSA. Of these 398 patients, none (0%) had referrals for further evaluation for OSA.

Conclusion
The rate of appropriate referrals from a student dental clinic with an electronic health record was unacceptably low. Continued education and changes to the electronic health record are needed to ensure those at high-risk for OSA are appropriately referred and managed.
Support (if any):
424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy
Authors: Bazalakova Mihaela , Wiedmer Abigail , Rice Lauren , Bajaj Sakshi , Jacobson Natalie , Antony Kathleen 
Published: May 2021

Abstract

Introduction
Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals.

Methods
We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing.

Results
The vast majority of referrals (&gt;95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing.

Conclusion
We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with &gt;50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy.

Support (if any)
None
427 Comparison of PAP Interface Pressure on the Nasal Bridge: Soft Cloth vs. Traditional Masks
Authors: Anastasi Matthew , Pasquale Maria , Tubbs Andrew 
Published: May 2021

Abstract

Introduction
Pressure between a CPAP mask and the skin is a significant contributor to irritation and pressure ulcers, an area of localized soft tissue ischemic necrosis caused by prolonged pressure over bony prominences that exceeds supra capillary pressure (70 mmHg). We hypothesized that cloth masks (CM) would exert a lower nasal bridge pressure than traditional mask (TM) products constructed of silicone and plastic.

Methods
We evaluated the pressure exerted by seven types of nasal masks in three trials onto the nasal bridge of two healthy adult volunteers, one female, one male, while they received 10 cm H₂O of CPAP. Five commercially available CMs (SleepWeaver® 3D, SleepWeaver® Advance Pediatric, SleepWeaver® Élan, and SleepWeaver® Prevent, Circadiance®, LLC) were tested as were three TMs constructed primarily of silicone and plastic (DreamWisp™, Philips Respironics, Inc.; Mirage™, ResMed; Zest™, Fisher & Paykel Healthcare). Pressure was detected using a texsens®-g low pressure sensor force measuring device. Pressure data from each 30 second trial were summarized as the median value after confirming that pressure did not vary by time (one-way ANOVA, p = 0.7393). Median values were then compared across trials, subjects, and masks using one-way ANOVAs and student’s t-tests.

Results
After confirming that pressure did not vary by trial (one-way ANOVA, p=0.4585) or subject (t-test, p=0.0938), pressure data were summarized by mask. On average, CMs exerted 37.0 (17.7) mmHg of nasal bridge pressure, although there was significant variation across masks (one-way ANOVA, p &lt; 0.0001). Conversely, TMs averaged 112 (38.5) mmHg of nasal bridge pressure without significant variation across masks (one-way ANOVA, p=0.1291). CMs averaged 75.26 mmHg less pressure than TMs (p &lt; 0.0001), a difference of 67 percent.

Conclusion
The data supports the hypothesis that pressure from CMs on the bridge of the nose are significantly lower than a sample of TMs with similar shape and style, and the null hypothesis was rejected. Furthermore, the average CM was below the threshold for capillary closing, in contrast to the average TM. Therefore, for CPAP users with predicted or existing skin sensitivity, comfort and/or compliance concerns, CM should be considered as a first choice in mask selection.
Support (if any):
431 Outcome of Positive Airway Pressure Therapy Combined with Telemonitoring in Patients with Obstructive Sleep Apnea Syndrome
Authors: Panjapornpon Kanlaya , Luekitinun Narumol , Luengwattanakit Puncharat , Denthet Manatsanan , Wonsa-Ardsakul Tanadol , Tongkien Wanlana , Pungtaway Sunsanee , na Mahasarakam Siwaporn Pawaphutanon , Singpeam Rungridee , Pinthong Pairaya 
Published: May 2021

Abstract

Introduction
The rate of positive airway pressure (PAP) adherences in obstructive sleep apnea (OSA) patients with PAP therapy has remains persistently low. Telemonitoring is a promising wireless technology to early detect of usage trouble and solve them simultaneously. We compare PAP compliance, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-10), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients with PAP therapy for 12 weeks between telemonitoring and protocol-based groups.

Methods
This is a prospective simple randomization (1:1) study, allocated into the telemonitoring and protocol-based groups, at Central Chest Institute of Thailand since June to November 2020. We recruited adult patients, who underwent split-night polysomnography (PSG), met diagnostic criteria of OSA by ICSD-3 and achieved optimal or good pressure. Demographics data, physiological sleep parameters and differences between groups were analyzed by using descriptive, paired t-test, and ANOVA.

Results
A total of ten OSA patients with PAP therapy were attended. Baseline characteristics between groups were compared, and it is apparent that among telemonitoring and protocol-based groups, most patients were male (60% in each group), the average age of patients were (45.60 ± 9.86 vs 41.60 ± 12.38, p = 0.588) years, body mass index (BMI) (24.66 ± 3.39 vs 30.21 ± 6.13, p = 0.114) km/m2, Epworth Sleepiness Scale (ESS) was (10.00 ± 2.92 vs 9.40 ± 3.57, p = 0.779), apnea-hypopnea index (AHI) of (60.06 ± 31.08 vs 77.98 ± 43.17, p = 0.473) events/hour, and PAP pressure usage (10.20 ± 3.71 vs 10.00 ± 3.67, p = 0.933) cmH2O. There was no significant difference between groups in clinical parameters, sleep questionnaires and PAP compliance of obstructive sleep apnea (OSA) patients with PAP therapy for 12 weeks. However, in telemonitoring group, PSQI compared among baseline, fourth and twelfth week were significantly improved (7.60 ± 2.71 vs 5.00 ± 2.00 vs 4.00 ± 1.00 respectively, p = 0.041).

Conclusion
Using telemonitoring-guided intervention causes significantly improved in Pittsburgh Sleep Quality Index in severe obstructive sleep apnea patients with PAP therapy for 12 weeks. There was no significant difference in PAP compliance between telemonitoring and protocol-based groups.
Support (if any):
442 Feasibility of a Sleep Technologist Driven Intervention Protocol to Address CPAP Adherence in Hospitalized Patients
Authors: Cheng Shan , Rivera Elizabeth , Beauchamp William , Cabral Laiheng , Calero Karel , Nallu Sagarika , Holderman Deborah , Schoonover Doris , Johnson Linda , Anderson William 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with development of high blood pressure, diabetes, pulmonary hypertension, heart attack, stroke, atrial fibrillation, motor vehicle accidents, and death. These comorbidities may result in hospital admissions. Much of the therapy has been directed towards outpatient treatment with CPAP. Unfortunately, patient adherence to CPAP therapy is not optimal. We conducted a feasibility study to determine if a sleep technologist driven intervention protocol could address CPAP adherence in hospitalized patients.

Methods
Tampa General Hospital Sleep Center developed a quality improvement protocol that would address inadequate CPAP adherence. The components include: 1. Education on the cause and need for treatment of OSA based on comorbidities, 2. Choosing a patient preferred mask, 3. Mask desensitization while awake. These criteria were used to test the feasibility of implementing this protocol in hospitalized patients: 1. Completion of the protocol within 48 hours of receiving a consult, 2. Implementation of various components of the protocol, 3. Obtaining outcome measures to evaluate efficacy. Outcome measures include patient willingness to retry CPAP (on a scale from 0–10) and CPAP smartcard download. Additional outcome data included: patient reasoning for CPAP noncompliance and self-administered questionnaires (ESS, ISI, GAD-7, PHQ-9, SF-26).

Results
During November 2020, 31 inpatient consults were placed to the TGH Sleep Center. Within 48 hours of consult, the technologists implemented the protocol in 19 patients – 17 received mask fittings, 3 received education, and 3 had CPAP setting adjustments. 9 patients indicated their willingness to retry CPAP with an average rating of 9.1. 7 compliance downloads were obtained the following morning and usage ranged from 0:52 to 11:07 hours. 12 consults were not completed due to not meeting inclusion criteria (5), patient refusal (4), or other reasons (3).

Conclusion
This study demonstrates feasibility of a sleep technologist driven intervention protocol to address CPAP adherence in hospitalized patients. However, there were inconsistencies in protocol execution and obtaining outcome measures. We speculate that protocol improvement will require: 1. More consistent patient education, 2. Better correction of patient specific adherence issues, 3. Obtaining all smartcard downloads, 4. Compiling outcome measures using a convenient digital interface.
Support (if any):
443 Intervention Among PAP Users Newly Diagnosed with OSA Improves Long-term Adherence in Veterans with Sleep Apnea and PTSD
Authors: Gretler Julie , Noland Madeline , Jocson Valerie Alipio , Chen Marcel , Dominguez Christopher , Hernandez Beatriz , Noda Art , Holty Jon-Erik , Kuschner Ware , Yesavage Jerome , Kinoshita Lisa 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) and PTSD are commonly comorbid in veterans. While PAP is the first line treatment for sleep apnea, adherence is low among veterans (Collen et al, 2012). Studies have shown early adherence predicts later adherence (Budhiraja et al, 2007). The current study investigates the impact of intervention on PAP adherence over time.

Methods
Thirty-seven veterans with comorbid OSA and PTSD from VA Palo Alto clinics were randomly assigned to either cognitive behavioral therapy (CBT-OSA) or an education arm and also received usual treatment at VA or outside clinics. Twenty-six completed the study. Participants received weekly, individual visits during the first four weeks of PAP treatment, three subsequent quarterly booster sessions, and a final visit at 12 months. PAP data was downloaded at each time-point; prior PAP use was coded.

Results
Significant mean differences in mask-on time between treatment arms after weekly treatments (Kinoshita et al., 2020) were not maintained at 12 months. Linear mixed modeling showed weekly improvement in mean mask-on time (minutes) over the treatment period (Education: estimate = 13.7, SE = 3.2, 95% CI 7.3, 20.1; CBT-OSA: estimate = 11.4, SE = 3.6, 95% CI 4.3, 18.5); no significant difference between arms (estimate = -2.3, SE = 4.7, 95% CI -11.5, 6.9). Newly diagnosed participants had significantly higher mean mask-on time than prior-PAP users at the end of weekly treatments (F[1, 35] = 17.86, p &lt; 0.001) and at 12-months (F[1, 24] = 19.60, p &lt; 0.001). Average mask-on time following weekly treatments was significantly correlated with average mask-on time at 12-months (r = 0.75; p &lt; 0.001).

Conclusion
Consistent with prior research, findings suggest that newly diagnosed individuals benefit from weekly individual treatments, regardless of type, and maintain higher mask-on times at 12 months relative to prior PAP users. Early intervention when starting PAP treatment is important to support adherence, especially in patients with comorbid PTSD, a barrier to adherence in the veteran population.

Support (if any)
RR&D Merit Grant, Department of Veterans Affairs (Grant Number 1I01RX001799-01A2); Sierra Pacific MIRECC