bluuebunny/crossref_metadata_2025_split huggingface dataset:
451 Change of sleep disordered breathing severity in obese patients receiving Laparoscopic sleeve gastrectomy
Authors: Hsu Tzu-Chien , Lee Pei-Lin , Yang Po-Jen , Lee Po-Chu , Lee Pei-Jung , Lai Shang-Ru , Chang Yi-Cheng , Chen Chiung-Nien , Yang Wei-Shiung 
Published: May 2021

Abstract

Introduction
Bariatric surgery via laparoscopic sleeve gastrectomy (LSG) was proved to alleviate significantly in apnea hypopnea index (AHI) in obesity patients. We aimed to investigate LSG effects on AHI in different sleep stage (REM vs NREM) and in position (supine vs non-supine) and on CO2 reduction and to identify the factors associated of AHI reduction.

Methods
From April 2016 to December 2020, 22 obese patients who underwent PSG before and after bariatric surgery at National Taiwan university Hospital were retrospectively studied. The simultaneously nocturnal percutaneous transcutaneous CO2 (PtcCO2) monitoring was applied. Demographic, anthropometric characteristics, Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), PSG parameters were reviewed. Responsive to treatment was defined as AHI reduction ≥50% and residual AHI&lt; 10/hour.

Results
Postoperative PSG was performed in 22 patients [13 men and 9 women, median age 38 years (interquartile range, 32.8–46.5), median body mass index (BMI) 44.5 kg/m2 (39–52.5)] and median follow up days of 535 days (440–687) after LSG. The median post-op BMI was 32.4 kg/m2 (28.3–37.1). The AHI decreased from 51.9/h (27–85.9) to 10.7/h (2–16.3) (p&lt;0.01). The AHINREM decreased from 49.9/h (31.8–91.5) to 5.8/h (1.1–17.3) while the AHIREM decreased from 63.7/h (52.5–83.2) to 19.6/h (4.4–49.7) /h. The AHIsupine decreased from 64.1/h (40.1–88.8) to 11.9/h (2.3–18.7) while the AHInon-supine decreased from 27.5 /h (17.6–78.3) to 1 /h (0–2). The average PtcCO2 decreased from 51.6 mmHg (39.3–54.7) to 46 mmHg (36.6–49.3) while %PtcCO2-total sleep time&gt;50mmHg decreased from 84.5% (0.1–99.1) to 0% (0–44.6). Logistic regression showed baseline higher AHI was independently associated with less treatment responsive [odds ratio, 0.909 (0.84–0.985)].

Conclusion
The AHI and PtcCO2 marked decreased via LSG where the residual AHI was lower in NREM than REM sleep; and in non-supine than supine. Baseline AHI is inversely associated with the residual AHI

Support (if any)
Ministry of Science and Technology (MOST 109-2314-B-002-252)
459 The Effect of Upper Airway Stimulation Therapy on Blood Pressure
Authors: McKinlay Alex , Scalzitti Nick , Walters Ben 
Published: May 2021

Abstract

Introduction
Upper airway stimulation (UAS) therapy is a novel technique in the treatment of Obstructive Sleep Apnea (OSA). UAS therapy is indicated for patients with moderate to severe OSA who fail therapy with Continuous Positive Airway Pressure (CPAP) and/or the use of a dental appliance. Although research suggests that CPAP can modestly improve patients’ Blood Pressure (BP), little is known about the effect of UAS on BP.

Methods
Via a retrospective cross-sectional cohort study, we identified all patients undergoing UAS surgery at Brook Army Medical Center from July 2015 through July 2020. We captured pre-operative and post-operative data from a structured electronic medical record review, including Polysomnographic data and BP measurements at designated time points. We measured UAS therapy compliance in hours of usage per week. Statistical analysis includes paired T-tests to determine whether changes in BP and AHI were significant when comparing preoperative and postoperative values.

Results
We report data for 12 patients treated with Upper Airway Stimulation therapy in our cohort. The mean pre-operative Systolic Blood Pressure (SBP) is 128.3±7 mmHg, the mean post-operative SBP is 122.8±10 mmHg with a mean difference of -5.4mmHg (standard error for difference 2.9mmHg). The mean pre-operative Diastolic Blood Pressure (DBP) is 80.0±6 mmHg, the mean post-op DBP is 76.4±8 mmHg, with a mean difference of -3.6mmHg (standard error for difference 1.9 mmHg). Neither of these are statistically significant, with P values of 0.09 and 0.08 respectively. The mean pre-operative Mean Arterial Pressure (MAP) is 96.1±6 mmHg, the mean post-op MAP is 91.9± 8 mmHg, with a mean difference of -4.2 mmHg (standard error for difference 1.7 mmHg). This represents a statistically significant difference with a P value of 0.03. Seven patients carried a pre-operative diagnosis of Hypertension whereas five did not. There is not a statistical difference in BP changes between these subgroups.

Conclusion
Upper Airway Stimulation surgery appears to decrease SBP, DBP, and MAP measurements with a similar magnitude as Positive Airway Pressure Therapy. In our cohort, only MAP changes appear to reach statistically significance. Further studies are warranted to elucidate the clinical significance of UAS on physiologic parameters such as blood pressure.
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463 The Effect of Intervention of Medical Staff on the Adherence of CPAP and Heart Rate in Patients with Obstructive Sleep Apnea
Authors: Shirahama Ryutaro , Ishimaru Rie , Takagiwa Jun , Mitsukura Yasue 
Published: May 2021

Abstract

Introduction
Recent studies have indicated that obstructive sleep apnea syndrome (OSAS) is associated with hypertension. OSA is a common cause of sympathetic nervous activity. Increase of sympathetic nervous activity causes hypertension. Continuous positive airway pressure (CPAP) is the most useful treatment for OSAS. Good CPAP adherence treatment improve the risk of hypertension. This study examined the effect of intervention of medical staff on the adherence of CPAP, heart rate and sleep stages in patients with OSA.

Methods
All patients diagnosed with OSA and undergoing subsequent CPAP were clinically followed for 12 months to examine CPAP adherence, as well as longitudinal changes in blood pressure, average heartrate of 24 hours and sleep stages. They were divided into 2 groups, Group A: patients who had individual consulted in person by sleep physician and technicians before start using CPAP and Group B: patents who did not have individual consulted. Patients in both groups were consulted by sleep physician and technicians after start CPAP with utilizing tele-monitoring. If the adherence were poor, the patients were recommended to stop CPAP. We provided 3D accelerometer and an optical pulse photoplethysmography to all the patients and analyzed the data of heart rate and sleep stages.

Results
A total of 30 OSA patients underwent CPAP, were enrolled in the study and assessed for changes in mean heart rate and body weight during the study period. We found a significant reduction in mean heart rate in both group A and B compared with baseline (p&lt;-0.05). The patients aged under 50 years old and whose AHI&lt;20 times/hour have higher ratio of dropout CPAP therapy. There was no significant difference between Group A and Group B on the persistency rate of CPAP therapy. Also, no significant association was found between group A and B on the adherence of CPAP.

Conclusion
We showed the importance of the effect of intervention of medical staff on the adherence of CPAP and heart rate in patients with OSA the consultation after starting CPAP for a while with utilizing tele-monitoring data would be more effective compared with that in person before start using CPAP.
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474 Phenotyping of patients with Moderate to Severe OSA on Polysomnography after Negative Home Sleep Apnea Testing
Authors: Sarfraz Sarah , McCullough Lindsay , Arantes Henry , Lastra Alejandra 
Published: May 2021

Abstract

Introduction
Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients.

Methods
We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index &lt;5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis.

Results
The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h.

Conclusion
A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient.
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481 Solriamfetol Titration & AdministRaTion (START): Characteristics of patients with narcolepsy and solriamfetol prescriber rationale
Authors: Thorpy Michael , Hyman Danielle , Parks Gregory , Chen Abby , Foley Catherine , Ito Diane , Singh Haramandeep 
Published: May 2021

Abstract

Introduction
Pharmacotherapy for excessive daytime sleepiness (EDS) associated with narcolepsy is diverse, with factors such as efficacy, side effects, and tolerance influencing treatment decisions. Solriamfetol (Sunosi®), a dopamine/norepinephrine reuptake inhibitor, is approved (US and EU) to treat EDS in adults with narcolepsy (75–150 mg/day) or obstructive sleep apnea (OSA) (37.5–150 mg/day). This study characterized real-world patients with narcolepsy starting solriamfetol and prescribers’ rationales for initiating treatment.

Methods
This virtual, descriptive study included a quantitative retrospective patient chart review among US-based physicians prescribing solriamfetol. Target enrollment was 25 physicians treating patients with EDS associated with OSA or narcolepsy. Treatment initiation was classified as de novo (no EDS medication prior to solriamfetol), transition (switched/switching from existing EDS medications onto solriamfetol), or add-on (adding solriamfetol to current EDS medication).

Results
Twenty-six physicians participated. Seventy patients with narcolepsy were analyzed (type 1, n=24; type 2, n=46; mean±SD age, 40±11 years; 57% female; 6 also had OSA); EDS was primarily moderate (59%) or severe (36%). Twenty-two patients (31%) were obese (BMI≥30); other common physician-reported comorbidities were migraine headaches (n=12, 17%), depression (n=10, 14%), and cardiovascular disorders (n=10, 14%). Solriamfetol initiation was de novo for 19 (27%) patients, transition for 31 (44%), and add-on for 20 (29%). Patients transitioning to solriamfetol were taking 1 (29/31, 94%) or 2 (2/31, 7%) prior EDS medications; patients adding solriamfetol were taking 1 (16/20, 80%), 2 (3/20, 15%) or 3 (1/20, 5%). Most patients transitioning to solriamfetol were taking wake-promoting agents (22/31, 71%); patients adding solriamfetol were most frequently taking sodium oxybate (11/20, 55%). Solriamfetol’s efficacy profile was the primary reason prompting the discussion to prescribe solriamfetol de novo (12/19, 63%); need for better efficacy/augmenting effects of other medications was the primary reason for transitioning (18/31, 58%) and add-on therapy (19/20, 95%). At data collection, 63 (90%) patients were still on a stable solriamfetol dose. The most common reasons for discontinuing solriamfetol were lack of efficacy (n=3) and side effects (n=3).

Conclusion
Efficacy and the need for improved efficacy over existing medication(s) were key considerations for physicians prescribing solriamfetol treatment to patients with narcolepsy in clinical practice.

Support (if any)
Jazz Pharmaceuticals
502 Idiopathic hypersomnia and co-occurring psychopathology among veterans
Authors: Bishop Todd , Ashrafioun Lisham , Pigeon Wilfred 
Published: May 2021

Abstract

Introduction
Idiopathic hypersomnia (IH) is relatively rare and characterized by excessive daytime sleepiness despite prolonged and undisturbed sleep as well as the absence of cataplexy and other causes of hypersomnolence. The etiology of IH is largely unknown. The present study capitalized on electronic medical record (EMR) data from the Veterans Health Administration (VHA) to create a cohort of veterans diagnosed with IH in order to: 1) estimate the prevalence of IH diagnosis in the VHA, and 2) identify co-occurring physical and behavioral health conditions to characterize IH in the sample.

Methods
Using 2009–19 VHA EMR data, we created two cohorts: those with an IH diagnosis (N = 3,674) or a hypersomnia diagnosis (e.g., primary hypersomnia) other than IH (N = 110,530). Diagnostic data (i.e., ICD 9 and 10 codes) were extracted for the 6-months prior to index diagnosis to examine group differences in the prevalence of physical and behavioral health conditions.

Results
Veterans diagnosed with IH, as compared to veterans with another hypersomnia disorder, were more likely to be female (30.1% vs 12.3%) and less likely to be obese (16% vs 28.3%; chi-squared = 79.27, p &lt;.001), or carry diagnoses of diabetes (type 1 or 2; 9.7% vs 24.4%; chi-squared = 123.02, p &lt;.001), or anxiety disorders (5.8% vs 9.5%; chi-squared = 16.83, p &lt;.001). Individuals with IH were more likely to carry diagnoses of chronic fatigue syndrome (4.2% vs 1.6%; chi-squared = 45.91, p &lt;.001), depression (31.3% vs 23.4%; chi-squared = 36.04, p &lt;.001), and posttraumatic stress disorder (29.5% vs 26.5%; chi-squared = 5.79, p = .02).

Conclusion
Data suggest that veterans diagnosed with idiopathic hypersomnia may present with different diagnostic profiles than veterans with other hypersomnia disorders. Far more basic and clinical research is needed in IH.

Support (if any)
This work was supported by the Hypersomnia Foundation and in part by the VA Center of Excellence for Suicide Prevention in the Finger Lakes Healthcare System.
511 Pathological sleep prolongation and sleep onset REM period
Authors: Honda Makoto , Kimura Shinya , Sasaki Kaori , Wada Masataka , Ito Wakako 
Published: May 2021

Abstract

Introduction
ICSD-3 employs two definitions of pathological sleepiness: sleep prolongation with 24-hour total sleep time (24hrPSG TST) ≥660 and high sleep propensity with mean sleep latency(mSL) ≤8 min on MSLT. Multiple SOREMPs on MSLT reflects the pathophysiology (sleep instability) of narcolepsy, but it is not clear whether the lack of SOREMPs is associated with the pathophysiology of idiopathic hypersomnia. We performed 24hr PSG and PSG-MSLT sequentially to understand the meaning of SOREMP in those with pathological sleep prolongation.

Methods
Fifty-six consecutive patients visiting Seiwa Hospital or Koishikawa Tokyo Hospital affiliated to Institute of Neuropsychiatry with suspected idiopathic hypersomnia with habitually long sleep time were evaluated by 3-day sleep studies: unattended 24hr PSG followed by PSG and MSLT from January 2017 to November 2020. After excluding inadequate recordings or other sleep pathologies, we analyzed 52 data and found that 39 patients (23 females, 21.8 ± 7.9 years old, BMI 20.4 ± 2.5 kg/m2) exhibited pathological sleep prolongation.

Results
We divided 39 patients with pathological sleep prolongation into those with at least one SOREMP(n=9) and those without SOREMP(n=30) and explored differences in clinical symptoms and PSG variables. There were no differences in conventional sleep variables except for PSG sleep latency, shorter in those with SOREMP (20.8min vs 43.8min, p=0.032). Also 24hr PSG sleep variables showed no differences except for the number of NREM-REM cycles, more in those with SOREMP (10.4 vs 8.1, p=0.037). Frequency of clinical symptoms such as REM related phenomena and various symptoms characteristic for idiopathic hypersomnia did not differ between groups except for less frequency of general malaise p=0.003 and orthostatic hypotension p=0.049 in those with SOREMP. We had similar results when we compared 5 patients with multiple SOREMPs and 30 patients without SOREMP.

Conclusion
Our results indicated that sleep variables and clinical characteristics of idiopathic hypersomnia in those with pathological sleep prolongation were mostly the same regardless of the status of SOREMP on MSLT, suggesting that the absence of SOREMPs on MSLT were not fundamentally related to the pathophysiology of those with pathological sleep prolongation (idiopathic hypersomnia with long sleep time).
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516 Impacts of Chronic Nausea and Vomiting on Daytime Sleepiness and Fatigue
Authors: Ohayon Maurice , Chen Y J , Cote Marie-Lise 
Published: May 2021

Abstract

Introduction
Chronic nausea and vomiting (CNV), common symptoms in patients with GI disorders like gastroparesis, can be a debilitating health problem with considerable impact on patients’ health-related quality of life during daytime. Yet, little is known about how CNV may impact on sleepiness and fatigue during the daytime. Our aim was to examine the impact of CNV on daytime sleepiness and fatigue based on the data from a longitudinal study.

Methods
Prospective longitudinal study with two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the US general population. Analyses included subjects participating to both waves (N=10,931). CNV was defined as episodes of nausea and vomiting occurring at least twice a month for at least 1 month (outside pregnancy). Logistic regression models were employed to determine whether CNV is a predictive variable for excessive sleepiness or fatigue.

Results
Out of all W1 participants, 9.8% (95% CI: 9.2%-10.4%) reported nausea only while 3% (95% CI: 2.7%-3.3%) reported CNV. In W2, 7.7% (95% CI: 7.2%-8.2%) reported nausea only and 2.5% (95% CI: 2.2%-2.8%) reported having CNV. Of the subjects who participated in both W1 and W2, 25.7% of them reported CNV in W1. CNV subjects reported more frequently excessive daytime sleepiness (53.5% vs. 25.9%) and being moderately or severely fatigued (38.6% vs, 5.4%) compared with the participants without nausea or vomiting. After controlling for age, sex, BMI, health status, alcohol intake, sleep disorders and psychiatric disorders that might impact on daytime sleepiness or fatigue, it was found that subjects with CNV at both W1 and W2 had a significantly higher relative risk of reporting daytime sleepiness (RR: 2.7 (95% CI:1.9–3.9) p&lt;0.0001) and fatigue (RR: 4.9 (95% CI:3.2–7.5) p&lt;0.0001) at W2, compared with the participants without nausea or vomiting.

Conclusion
Many factors are likely to influence daytime sleepiness. CNV appears to be an important contributor even after controlling for several factors that can explain the sleepiness. This underlines the extent to which alertness could be disturbed and impacted by chronicity of nausea/vomiting symptoms.

Support (if any)
This analysis study was funded by Takeda Pharmaceutical Company
531 Efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: A pilot RCT
Authors: Cederberg Katie , Motl Robert 
Published: May 2021

Abstract

Introduction
Restless legs syndrome (RLS) occurs in approximately 26% of persons with multiple sclerosis (MS) and can worsen other symptoms of MS, including sleep quality. Physical activity represents a promising approach for managing RLS and its secondary effects in MS. This pilot randomized controlled trial examined the feasibility and efficacy of a physical activity intervention for improving RLS severity and secondary sleep outcomes among a sample of adults with MS.

Methods
Participants with MS (N=15) were randomly assigned into intervention (n=8) or waitlist control (n=7) conditions. The physical activity behavioral intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions.

Results
There was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), RLS severity during the night (p=.03,ηρ2=.35), RLS severity during the day while resting (p=.01,ηρ2=.44), and RLS severity during the day while active (p&lt;.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction (p&lt;.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality (p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed (p=.03,ηρ2=.37) and total sleep time (p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency (p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04; p=.35,ηρ2=.08; p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality.

Conclusion
This study provides initial evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and possibly self-reported sleep quality outcomes in persons with MS. These preliminary results should inform a future, fully-powered randomized controlled trial that further establishes the efficacy of physical activity for reducing symptoms of RLS and secondary outcomes in a larger sample of adults with MS and RLS.

Support (if any)
This work was supported, in part, by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health [F31HD097903]. ClinicalTrials.gov Identification Number: NCT0406168.