bluuebunny/crossref_metadata_2025_split huggingface dataset:
468 Optimizing treatment of the intra-oral negative air pressure for obstructive sleep apnea
Authors: Chen Chia-Chi , Lin Chia-Mo 
Published: May 2021

Abstract

Introduction
The intra-oral negative air pressure device (iNAP) is designed to develop a negative pressure gradient in the oral cavity of the user. The pressure gradient provides a force to move the tongue and soft palate forward. Previous works show the treatment response rate of intra-oral pressure therapy varying between 25–79%. However, for those OSA patients with very high BMI or AHI, they may need higher pressure to achieve optimizing treatment outcome.

Methods
To provide an optimizing treatment of intra-oral pressure, 30 patients treated with iNAP successfully completed one baseline PSG and one treatment PSG with in-laboratory pressure adjustment. When conducting the iNAP titration PSG, the initial treatment pressure is 40mmHg. iNAP pressure should be increased by at least 10mmHg an interval no shorter than 15 min. In order to eliminate obstructive respiratory events, iNAP pressure should be increased when observe obstructive apnea or hypopnea or unambiguous snoring.

Results
A total of 30 patients presented their consent to participate in this study. The mean age of the patients was 51.2 ± 13.97 years, and their mean body mass index (BMI) was 25.87 ± 3.41 kg/m2. The mean baseline AHI was 39.59 ± 20.05 events/h, which decreased significantly to 8.17 ± 8.11 events/h. No significant change in sleep efficacy, and percentage of N1 stage was found in the treatment PSG. However, significant improvements in the percentage of N3 stage, Min SpO2, and arousal index were observed in the treatment PSG.

Conclusion
In this study, the clinical response rate, as defined by the Sher criteria, was 86% (26/30 patients), when the Tx PSG response was compared with the baseline values. Besides, the mean AHI under final titration pressure is 2.58. The results show that increasing intraoral pressure would help to further improve the sleep apnea.

Support (if any)
This study was sponsored by Somnics, Inc.
475 Automatic detection of self-similarity and prediction of CPAP failure
Authors: Oppersma Eline , Ganglberger Wolfgang , Sun Haoqi , Thomas Robert , Westover Michael 
Published: May 2021

Abstract

Introduction
Sleep disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. Tolerance and efficacy of continuous positive airway pressure (CPAP), the primary form of therapy for sleep apnea, is often poor. High loop gain (HLG) is a driving mechanism of central sleep apnea or periodic breathing. The current study aimed to develop a computational approach to detect HLG based on self-similarity in respiratory oscillations during sleep solely using breathing patterns, measured via Respiratory Inductance Plethysmography (RIP). To quantify the potential utility of the developed similarity metric, the presented algorithm was used to predict acute CPAP failure.

Methods
We developed an algorithm for detecting apneas as periods with reduced breathing effort, manifested in the RIP signal as low signal amplitude. Our algorithm calculates self-similarity in breathing patterns between consecutive periods of apnea or hypopnea. Working under the assumption that high loop gain induces self-similar respiratory oscillations and increases the risk of failure during CPAP, the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict failure of CPAP, which we defined as titration central apnea index (CAI)&gt;10. Central apnea labels are obtained both from manual scoring by sleep technologists, and from an automated algorithm developed for this study. The Massachusetts General Hospital (MGH) sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings.

Results
Diagnostic CAI based on technologist labels predicted failure of CPAP with an AUC of 0.82 ±0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ±0.02. A subanalysis was performed on a population with technologist labeled diagnostic CAI&gt;5. Full night similarity predicted failure with an AUC of 0.57 ±0.07 for manual and 0.65 ±0.06 for automated labels.

Conclusion
This study showed that central apnea labels can be derived in an automated way. The proposed self-similarity feature, as a surrogate estimate of expressed respiratory high loop gain and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow-limitation, and can aid prediction of CPAP failure or success.
Support (if any):
478 The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality
Authors: Patel Salma , Zareba Wojciech , LaFleur Bonnie , Couderc Jean-Philippe , Xia Xiaojuan , Woosley Raymond , Combs Daniel , Patel Imran , Mashaqi Saif , Perez Karolina , Parthasarathy Sairam 
Published: May 2021

Abstract

Introduction
Sleep disordered breathing (SDB) is associated with increased mortality. Obstructive apneas/hypopneas have been associated with an increase in both QTc duration and QT variability. These markers of ventricular repolarization are associated with arrhythmias and death. It is unknown whether SDB-related QTc changes are responsible for the relationship between QTc/QT variability and cardiovascular death (CVD).

Methods
From the Sleep Heart Health Study, we randomly selected 200 subjects in each of four groups based on overall apnea/hypopnea index: those with no SDB and those in either, mild, moderate or severe SDB at baseline, matched for gender, age and BMI. Respiratory-related channels and electrocardiograms (ECG) from each polysomnography were analyzed. QTc was calculated using Bazett’s heart rate correction. The following measures of QT variability were obtained: i) standard deviation of QT intervals (SDQT) at 1- and 5-minute intervals and ii) short-term interval QT variability (STVQT) at 5-minute intervals. Cox proportional hazards regression models were used to evaluate potential predictors of CVD.

Results
Twenty-nine subjects were excluded either due to missing data or low quality ECG. The 771 subjects included were 68±10 years of age, half were female. During follow-up, 220 subjects (28.5%) died of CVD among whom, 67 (30.5%) had comorbid severe SDB, 45 (20.5%) had no SDB, and the remaining CVD deaths had mild (47, 21.4%) and moderate 61 (27.7%) SDB. The CVD patients were more likely to be older(p&lt;0.001), hypertensive (p&lt;0.001), diabetic(p&lt;0.001), and had increased SDQT(p&lt;0.001), STVQT(p&lt;0.001) and QTc (0.017). After adjusting for covariates, the presence of mild (p=0.562), moderate(p=0.439) and severe SDB (p=0.912) did not moderate the association between QTc prolongation and CVD. Additionally, mild (p=0.486), moderate(p=0.478) and severe SDB (p=0.849) did not moderate the association between SDQT and CVD. Similarly, mild (p=0.144), moderate(p=0.594) and severe SDB (p=0.508) did not moderate the association between STVQT and CVD. However, QTc, SDQT, STVQT, mild and severe SDB were individually associated with CVD (p=0.004, 0.000, 0.000, 0.014, 0.022, respectively).

Conclusion
SDB was not a factor in the relationship between QTc prolongation/QT variability and CVD.

Support (if any)
American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career and Development Award (5299903)
499 Utilization of Diagnostic Sleep Testing Prior to Idiopathic Hypersomnia Diagnosis Among US Adults: A Real-World Claims Analysis
Authors: Saad Ragy , Ben-Joseph Rami , Prince Patricia , Stack Catharine , Bujanover Shay , Taylor Ben 
Published: May 2021

Abstract

Introduction
A retrospective analysis was conducted to characterize diagnostic sleep testing during the 12 months before diagnosis of idiopathic hypersomnia (IH), a hypersomnolence disorder with no approved treatments.

Methods
IBM® MarketScan® claims data were analyzed (1/1/14–9/30/19) to identify adults with newly diagnosed IH, defined as ≥2 claims with an IH diagnosis code ≥1 day and ≤180 days apart, and without an IH diagnosis ≤12 months before cohort entry. Demographics, diagnosing physician specialty, and diagnostic sleep disorder testing (identified via claims with procedure codes for multiple sleep latency test/maintenance of wakefulness test [MSLT/MWT], home sleep test, and polysomnography) were summarized. Analyses were performed on patients with IH diagnosis codes recorded in any position on the claims (“overall IH”) and in the primary position (“primary IH”) to understand the effects of applying a more specific definition of IH.

Results
Of 32,948,986 eligible people, 4,980 (0.015%) newly diagnosed IH patients were identified. Mean age was 43 years and 67% were female; those with primary IH (n=2,205; 44% of overall IH) were younger (mean age, 39 years) and more likely to be female (73%). Long sleep time was documented for 69% of the overall IH group and 67% of the primary IH group. The top 3 diagnosing physicians’ specialties were similar for overall IH/primary IH: pulmonology (23%/26%), neurology (14%/16%), and internal medicine (11%/10%). Few patients (9% overall IH; 7% with primary IH) were diagnosed in family practice. Any sleep testing was performed in 44% of overall IH and 53% of primary IH patients. Polysomnography and MSLT/MWT, the most frequently used sleep tests, were less common in overall IH (39% and 22%) than in primary IH (48% and 32%).

Conclusion
IH patients were typically diagnosed by specialists, outside of general medical practice. The most common diagnosing physicians were pulmonologists and neurologists for both the overall and primary IH groups. Objective sleep testing was more frequently documented in diagnosis of primary IH but utilization was low regardless of the definition of IH diagnosis. Further research is needed to investigate the utilization of sleep testing by clinicians for diagnosing IH.

Support (if any)
Jazz Pharmaceuticals
508 Narcolepsy Associated With a History of Head Injury: A Retrospective Review
Authors: Stultz Debbie , Osburn Savanna , Burns Tyler , Gills Thomas , Welch Darrell , Shaffer Christina , Walton Robin , Cope Amy , Pawlowska-Wajswol Sylvia 
Published: May 2021

Abstract

Introduction
Head injuries are becoming much more prevalent and may be secondary to sports injuries, motor vehicle accidents, falls, domestic violence, assault, and military blast explosions. Sleepiness may occur acutely and/or chronically after a head injury. Chronic hypersomnia may be overlooked or under-reported in those with a history of head injury, and the association may not be made. Hypersomnia can occur in those with mild, moderate, and severe head injuries, with or without loss of consciousness. The pathophysiology/neuropathology of sleep-wake disturbances after Traumatic Brain Injury was discussed by Lim and Baumann 2020 in their Up To Date review entitled “Sleep-wake disorders in patients with traumatic brain injury”. They reported possible abnormalities in orexin/hypocretin, decreased histaminergic neurons, melatonin abnormalities, decreased serotonergic neurons, decreased noradrenergic neurons, and structural brain changes that can play a role. It is also possible that a head injury occurs in someone predisposed to the development of narcolepsy or that the sleepiness of undiagnosed narcolepsy leads to increased injuries.

Methods
A retrospective review of charts from 2013 to 2020 revealed 176 patients diagnosed with narcolepsy in our psychiatric/sleep outpatient practice. Information on head injuries was obtained by questionnaires completed by the patient and/or interview with staff. Narcolepsy was diagnosed by PSG/MSLT and/or DSM-V criteria of narcolepsy.

Results
Of the 176 patients diagnosed with narcolepsy, 125 were female (71%) and 51 were male (29%). The age range was 11 to 75 years, with an average age of 39 years old. Cataplexy was present in 117 patients (66.8%). A history of a head injury was reported at intake by 50 patients (28.4%). Of the patients with a history of a head injury, 34 (68%) were female, 16 (32%) were male, and 36 (72 %) had a history of cataplexy.

Conclusion
This study revealed 28.4% of patients diagnosed with narcolepsy reported a history of a head injury of varying degrees of severity. While direct causation cannot be declared, the association of a head injury and continued hypersomnia suggests further evaluation of narcolepsy may be beneficial.

Support (if any)
**No support for this study was given.
534 Food Insecurity and Sleep Health by Race/Ethnicity and Age Group in the United States
Authors: Riley Nyree , Alhasan Dana , Jackson W Braxton , Jackson Chandra 
Published: May 2021

Abstract

Introduction
Food insecurity may influence sleep through poor mental health (e.g., depression) and immune system suppression. Although prior studies have found food insecurity to be associated with poor sleep, few studies have investigated the food security-sleep association among racially/ethnically diverse participants and with multiple sleep dimensions.

Methods
Using National Health Interview Survey data, we examined overall, age-, sex/gender-, and racial/ethnic-specific associations between food insecurity and sleep health. Food security was categorized as very low, low, marginal, and high. Sleep duration was categorized as very short (&lt;6 hours), short (&lt;7 hours), recommended (7–9 hours), and long (≥9 hours). Sleep disturbances included trouble falling and staying asleep, insomnia symptoms, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CI) for sleep dimensions by very low, low, and marginal vs. high food security.

Results
The 177,435 participants’ mean age was 47.2±0.1 years, 52.0% were women, 68.4% were Non-Hispanic (NH)-White. Among individuals reporting very low food security, 75.4% had an annual income of &lt;$35,000 and 60.3% were ≥50 years old. After adjustment, very low vs. high food security was associated with a higher prevalence of very short (PR=2.61 [95%CI: 2.44–2.80]) and short (PR=1.66 [95% CI: 1.60–1.72]) sleep duration. Very low vs. high food security was associated with both trouble falling asleep (PR=2.21 [95% CI: 2.12–2.30]) and trouble staying asleep (PR=1.98 [95% CI: 1.91–2.06]). Very low vs. high food security was associated with higher prevalence of very short sleep duration among Asians (PR=3.64 [95% CI: 2.67–4.97]), Whites (PR=2.73 [95% CI: 2.50–2.99]), Blacks (PR=2.03 [95% CI: 1.80–2.31]), and Hispanic/Latinxs (PR=2.65 [95% CI: 2.30–3.07]).

Conclusion
Food insecurity was associated with poor sleep in a diverse sample of the US population.
Support (if any):
546 Association of personality traits with napping behaviors in older adults
Authors: Shen Yuqi , Rojo-Wissar Darlynn , Duggan Katherine , Hasler Brant , Spira Adam 
Published: May 2021

Abstract

Introduction
Greater neuroticism and lower conscientiousness are linked to poorer nighttime sleep among older adults, but little is known about the association between personality and daytime sleep. Napping increases in older adulthood, and napping has been linked to health outcomes, including cognitive impairment. Thus, it is important to extend personality and sleep research to investigate napping behavior. We examined the association between personality and napping in a nationally representative cohort of older adults.

Methods
We studied 742 adults aged ≥65 years from the National Health and Aging Trends Study (NHATS) who completed the sleep and personality modules in NHATS rounds 3 or 4 (2013–2014). Personality dimensions (neuroticism, extraversion, openness, agreeableness, conscientiousness) were assessed by the Midlife Development Inventory Personality Scales. Participants reported nap frequency over the past month (most days or everyday [nappers-frequent]; some days [nappers-infrequent]; rarely/never [non-nappers]); napping intention (intentional/unintentional); and average nap duration (coded as ≤40 minutes [short]; and &gt;40 minutes [long], consistent with previous studies). Personality dimensions were included together in all models. Model 1 adjusted for age, sex, education, and BMI, and Model 2 further adjusted for anxiety and depression, comorbidities, sleep medications, and nighttime sleep duration. Only nappers were included in models with nap frequency, intention, or duration as outcomes (n=387).

Results
There were no personality differences between nappers and non-nappers. Among nappers, however, higher neuroticism was associated with lower odds of frequent naps (OR=0.73, 95% CI: 0.55,0.97), and higher agreeableness was associated with greater odds of unintentional napping (OR=1.95, 95% CI:1.12, 3.41) and lower odds of long nap duration (OR=0.54, 95% CI:0.33, 0.90) in Model 1. Associations remained in Model 2. Higher neuroticism was also associated with greater odds of long nap duration in Model 1 (OR=1.40, 95% CI:1.03, 1.91), but not after further adjustment in Model 2.

Conclusion
This is, to our knowledge, the first study examining the association between personality and daytime napping behaviors among a large sample of older adults, extending the literature on personality and nighttime sleep in this population. Because napping behaviors are associated with health outcomes, personality may be an important factor to consider in interventions addressing napping.

Support (if any)
NIH grant 5T32MH014592-39
559 Effect of Weekly Text Message Feedback on Continuous Positive Airway Pressure Adherence in Pediatric Obstructive Sleep Apnea
Authors: Finch Christina , Bercovitch Robert 
Published: May 2021

Abstract

Introduction
Continuous Positive Airway Pressure (CPAP) is an effective treatment for Obstructive Sleep Apnea (OSA) in children. However, adherence to CPAP therapy is often suboptimal. CPAP telemonitoring with automated feedback messaging has been shown to improved adherence in adults with OSA, but has not been widely studied as an intervention for children with OSA. This pilot study was conducted to investigate if feedback messaging could similarly improve CPAP adherence in children.

Methods
Pediatric OSA subjects (ages 11–17) with poor CPAP compliance or newly prescribed CPAP were selected from an outpatient Sleep Medicine clinic to receive weekly text messages with scripted feedback on CPAP adherence. Patients already meeting adherence goals were excluded from the study. Parental consent was obtained and participants were given the option to have text messages sent to parents or directly to the patient. Adherence was monitored over a four-month intervention period and compared to pre-intervention usage as a self-matched control. Total hours of use per month and numbers of days used per month were collected through daily remote CPAP monitoring. Average hours per use and average daily use per 30-day period were additional adherence measurements calculated. Data was analyzed using two-tailed paired T-tests with level of significance set at p&lt;0.05.

Results
There was no significant change in CPAP adherence (p&gt;.05) after initiation of weekly feedback messaging for the five patients included in the study. No participant, before or after intervention, met the Medicare definition of compliance (≥4hr nightly use for ≥ 70% of nights) and average adherence declined following intervention.

Conclusion
In a small pilot study, weekly feedback text messaging did not improve CPAP adherence in pediatric patients with OSA. This finding contrasts with larger studies in adult patients with OSA that have demonstrated improved CPAP adherence with automated feedback messaging. With the increasing use of telemedicine for CPAP follow-up, new strategies to successfully utilize this approach in the pediatric population may be needed.

Support (if any)
None.
564 Patient Charactarestics With Normal to Mild Apnea Hypopnea Index Undergoing Polysomnography to Diagnose Obstructive Sleep Apnea
Authors: AlTeneiji Majid , Schmalz Leah , Adeleye Adetayo 
Published: May 2021

Abstract

Introduction
Polysomnography (PSG) testing is expensive and not easily accessible. Waiting time for a routine PSG at the Alberta Children’s Hospital (ACH) can be up to a year. Majority of PSG studies performed are for diagnosis of obstructive sleep apnea (OSA). A previous quality improvement (QI) project conducted at the ACH showed that two-thirds of children who had undergone initial PSG testing had an apnea hypopnea index (AHI) in the normal or mild range. Given our limited resources, better characterization of patient referral characteristics and process factors as documented on the PSG requisition will inform our triage process, decrease wait time, improve resource allocation and information provided to referral sources.

Methods
Retrospective review of PSG’s performed for the initial diagnosis of OSA was completed between January 2018 and March 2020 at the ACH. Patient referral characteristics (age, sex, growth parameters, medical diagnosis, indication for PSG, previous airway surgery), process factors (source of referral, PSG referral and completion date, triage status) and AHI were recorded. Patients were divided into two groups (group A: normal and mild; group B: moderate and severe) based on AHI. Data obtained from the groupings were compared and analyzed descriptively. PSG triage to completion time was also calculated for each group.

Results
A total of 798 initial PSG studies were completed between January 2018 and March 2020. Of the PSG’s reviewed 64.8% were in group A and 35.2% were in group B. Common medical diagnoses in group A included ADHD, Asthma and Autism, whereas group B had T21 and Enuresis. History of previous airway surgery did not differ between groups.

Conclusion
Further clarification of the patient’s underlying medical diagnosis (referral characteristic) may help inform our triage process. The implication of previous airway surgery (process factor) on AHI severity is unclear at this point. More data is actively being collected to further interrogate these preliminary findings.
Support (if any):