bluuebunny/crossref_metadata_2025_split huggingface dataset:
419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study
Authors: Paul Ankita , Wong Karen , Das Anup , Lim Diane , Tan Miranda 
Published: May 2021

Abstract

Introduction
Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk.

Methods
Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios.

Results
In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN).

Conclusion
STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations
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430 Outcome of Sleep-Wake Pattern in Obstructive Sleep Apnea Patients after Positive Airway Pressure Therapy using Actigraphy
Authors: Luekitinun Narumol , Panjapornpon Kanlaya , Plurksathaporn Pattharaphong , Tangsrikertikul Rungaroon , Tongkien Wanlana , Pungtaway Sunsanee , na Mahasarakam Siwaporn Pawaphutanon , Singpeam Rungridee , Pinthong Pairaya 
Published: May 2021

Abstract

Introduction
The initial phase of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) may affect sleep parameters and PAP compliance. Actigraphy is a validated method using accelerometer to objectively measure sleep parameters in patients with a range of sleep disorders, including OSA, particularly to follow-up after treatment. We compare sleep parameters from actigraphy, sleep log, sleep diary, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients before and after CPAP therapy for 1 week.

Methods
This pilot study have been prospectively performed at Central Chest Institute of Thailand (CCIT) since June to November 2020. Adult OSA patients, diagnosed by ICSD-3 criteria and achieved optimal or good CPAP pressure titration from split-night polysomnography (PSG), were informed and consent to wear actigraphy before and after CPAP therapy each for 1 week. Clinical and sleep parameters were recorded and analyzed using Wilcoxon matched-pair signed-rank and Mann Whitney U test. P-value &lt; 0.05 was considered to have statistical significance.

Results
All 11 OSA patients participated in this study. Most patients were male (63.6%), hypertension (54.5%) and dyslipidemia (45.4%). Means of age, body mass index (BMI), ESS, PSQI, apnea hypopnea index (AHI), nadir SpO2, and CPAP usage were 45.5 ± 15.9 years, 29.1 ± 5.2 kg/m2, 10.8 ± 3.9, 7.7 ± 2.9, 65.2 ± 37.7 events/h, 82.3 ± 10.8 % and 9.5 ± 3.1 cmH2O, respectively. Comparing before and after 1-week CPAP therapy, an average number of wake bouts ((NWB), 48.4 vs 38 events, p=0.010), ESS (11 vs 9, p=0.035) and PSQI (8 vs 4, p=0.005) were significantly decrease. Additionally, when comparing between poor and good CPAP compliance group, NWB (55.1 vs 36.3 events, p=0.036) and the difference of wake after sleep onset (WASO, 10.5 vs -0.11 min, p=0.035) were significantly decrease.

Conclusion
OSA patients treated with CPAP for 1-week experienced marked improvement in sleepiness, sleep quality and nighttime awakening.
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432 Brain Structure and Baroreflex Sensitivity Associations in Obstructive Sleep Apnea with and without CPAP
Authors: Pal Amrita , Martinez Fernando , Aysola Ravi , Harper Ronald , Henderson Luke , Macey Paul 
Published: May 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) disrupts multiple aspects of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS.

Methods
We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR, and their variabilities: BPV and HRV (sympathetic-vagal).

Results
Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p &lt; 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p &lt; 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR, and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups.

Conclusion
BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage.

Support (if any)
NR-017435, HL135562
434 Precision Oral Appliance Therapy: The Prime-Time Treatment for OSA
Authors: Sall Edward 
Published: May 2021

Abstract

Introduction
CPAP was previously considered the “gold standard” due to its high efficacy in eliminating obstructive events. Despite improvements in technology, the “effectiveness” of CPAP has been compromised by poor real-world compliance. Technological improvements have improved the “effectiveness” of Oral Appliances. This study reports the efficacy of a novel, precision engineered Oral Appliance for the primary treatment of all severities of OSA.

Methods
Digital scans and digital bite registrations were recorded with a George Gauge utilizing a a 3mm bite fork. Initial protrusion was set at 40–60% and varied according to the degree of overbite and overjet, the severity of OSA, and the presence or absence of TMJ symptoms. All patients were fitted with a ProSomnus (IA) MAD and titrated according to their subjective symptoms. An efficacy study was obtained with a HST after titration and compared to the initial PSG or HST.

Results
Outcome data on 85 patients (37 female, 48 males, aged 56.7 +/1 10.2 years) was retrospectively reviewed. The patients were consecutively ordered for follow up data, many patients did not return for follow ups. The pre-treatment AHI was 24.5 +/- 19.1 with 36 patients Mild, 26 Moderate and 23 Severe patients. O2 Nadir was 84.1% +/- 5.5%. Post treatment AHI was 5.5 +/- 4.9 with an AHI reduction of 71.6% +/- 20.3%. 59% of the patients scored &lt;5, 31% 10 on the outcome AHI data. O2 Nadir improved to 88.2% overall. 31 patients had RERA’s (RDI-AHI) &gt;10 with an average of 16.7 +/- 7.5, of these patients 27 saw a reduction of RERA’s of 54.4% from 16.9 to 7.1.

Conclusion
The data shows that a precision oral appliance is capable of successfully treating patients with all levels of severity, with the majority of patients treated to an AHI&lt;5. 23 severe patients with an average AHI of 49.7 were treated to a final average of 8.6, 4 of the patients scored above 10. Additionally, patients successfully saw a reduction in upper airway resistance airflow as evidenced by a reduction of RERA’s of 54.5%, showing that a precision oral appliance can have a significant impact on the upper airway.

Support (if any)
None
436 Obstructive Sleep Apnea Treatment (e.g., CPAP) Differential Effects on Cognitive Performance
Authors: Hlaing Ei , Dollinger Stephanie Clancy , Brown Terry 
Published: May 2021

Abstract

Introduction
The efficacy of CPAP treatment for cognitive improvement among patients with OSA is inconsistent. Naegele et al. (1995) found that short term memory impairment persisted even after 4 to 6 months of CPAP; O’Donoghue et al. (2012) have reported they did not find improvement in vigilance or memory; Felver-Grant (2007) found that working memory improved but not other cognitive tests. Kanbay et al. (2015) found patients improved on the MMSE scores after 3 months of CPAP treatment. Kim et al. (2018) claimed just 3 weeks of CPAP treatment improved attention, sleep quality, and excessive daytime sleepiness (EDS). CPAP therapy has little effect on the improvement of cognitive deficits associated with OSA if the patients did not complain of daytime sleepiness (Zhou et al,, 2016).

Methods
Both untreated OSA patients (N=19) and ApneaLinkTM- screened controls (N=16) were administered a battery of cognitive tests before the patients started using CPAP and these two conditions were tested again after 3 months of CPAP treatment. A Fisher’s Exact Chi-Square test was used to determine if there was an association between conditions (OSA patients vs. Controls) and level of performance on cognitive tests (low vs. high scores) at the baseline and after 3 months of treatment.

Results
Depression scores, subjective sleep quality scores (global PSQI), EDS scores (Epworth Sleepiness Scale), and mood disturbance (Profile of Mood States) decreased after 3 months of CPAP treatment just for patients. Controls (individuals without moderate or severe OSA) performed better at the second time on phonemic fluency, immediate recall memory test, and 30 minute delayed memory recall test.

Conclusion
The fact that patients did not do better at time 2 on any of the cognitive tests may indicate a long term effect of hypoxia on the brain. The cognitive deficits may not reverse within the first 3 months of CPAP although self-reported depressive symptoms and perception of sleep quality and positive mood have improved when patients reported they are compliant with the treatment.

Support (if any)
A grant from the Center for Integrative Research on Cognitive Neural Science, Southern Illinois University Carbondale was received.
439 Continuous Positive Airway Pressure and Cardiovascular Risk in a Large Clinical Sample of Obstructive Sleep Apnea Patients
Authors: Mazzotti Diego , Chen Aiyu , An Jaejin , Arguelles Jessica , Keenan Brendan , Maislin Greg , Sawyer Amy , Glick Henry , Pack Allan , Hwang Dennis , Shi Jiaxiao 
Published: May 2021

Abstract

Introduction
While studies support the beneficial short-term role of continuous positive airway pressure (CPAP) therapy on cardiometabolic risk in adults with obstructive sleep apnea (OSA), its sustained effect on cardiovascular disease (CVD) risk is unknown. CPAP use data linked to electronic health records (EHR) offer opportunities to understand the role of OSA treatment for preventing CVD. We evaluated the association between CPAP use and CVD incidence in patients referred to a sleep study at a large health system.

Methods
We included adult patients with available apnea-hypopnea index (AHI) between 01/2018-02/2020 in Kaiser Permanente Southern California. At baseline, eligible participants had &gt;1 year of continuous insurance coverage allowing gaps &lt;90 days and were free of CVD 1 year prior to OSA diagnosis. Participants were distributed into three groups: no OSA (AHI&lt;5), OSA (AHI≥5) with any CPAP use (median[IQR] 2.5[0.7–5.0] h/day) and OSA without evidence of CPAP use. CVD incidence was defined as first occurrence of myocardial infarction, stroke, unstable angina, heart failure or CVD death, based on validated EHR algorithms. We used Cox proportional hazards models to assess the association between OSA with or without CPAP use and CVD incidence, adjusted for baseline age, sex, body mass index, race/ethnicity, Charlson comorbidity index, and use of anti-hypertensives and lipid-lowering medications. Stratified analyses were conducted based on OSA severity.

Results
We included 11,145 patients without OSA, 13,898 with OSA and CPAP use, and 20,884 patients without CPAP use. Median follow-up was 262 days (IQR=129–409). CVD incidence rates were, respectively, 0.26%, 0.45% and 0.56%. In adjusted models, moderate-severe OSA (AHI≥15) without CPAP use was associated with increased CVD incidence when compared to no OSA (HR=1.71; 95%CI=1.11–2.64; p=0.016). OSA with any CPAP use was associated with lower CVD incidence (HR=0.68; 95%CI=0.50–0.93; p=0.016) when compared to OSA patients with no CPAP use. Stronger effects were observed when restricting the sample to moderate-severe OSA (HR=0.56; 95%CI=0.39–0.81; p=0.002).

Conclusion
Our analysis in a large observational clinical sample suggests that moderate-severe OSA with no CPAP use is associated with increased CVD incidence. Moreover, OSA with CPAP use was associated with decreased CVD incidence relative to no CPAP use.

Support (if any)
AASM Foundation (194-SR-18;205-SR-19); AHA (20CDA35310360).
445 Predictors of the accuracy of positive pressure therapy machine-detected apnea-hypopnea events
Authors: Ni Yuenan , Thomas Robert 
Published: May 2021

Abstract

Introduction
During positive airway pressure (PAP) therapy for sleep apnea syndromes, the machine detected apnea hypopnea index (AHI) is an important method for clinicians to evaluate the beneficial effects of PAP. There are concerns about the accuracy of this detection, which also confounds a related question-how common and severe are residual events on PAP. Our study aimed for estimating the long term accuracy of machine detected AHI and the predictors.

Methods
Subjects with OSA who underwent a split night polysomnography were recruited prospectively. Those treated with PAP and tracked by the EncoreAnywhereTM system were analyzed. The ones who stopped PAP within one month were excluded for this analysis. Compliance, therapy data and waveform data were analyzed. Machine detected versus manually scored events were compared at the 1st, 3rd, 6th and 12th month from PAP initiation, and logistic regression was done to explore the factors associated with a high AHI difference.

Results
One hundred and seventy-two patients with mean age of 58.79 ± 13.80 and 63.4% male were included. The differences between the machine detected AHI and manual scored AHI was 10.72 ±8.43 in the first month and were stable for up to 12 months. Male sex, large leak ≥ 1.5% of the whole night, titration arousal index ≥ 15 times/hour, and higher ratio of unstable breathing were associated with AHI difference ≥ 5 times/hour.

Conclusion
The limited agreement between machine detected AHI in the tracking system and manually scored AHI persists for up to 12 months. Gender, large leak, the amount of unstable breathing on PAP, and arousal index during the titration were factors associated with this inaccuracy.

Support (if any)
positive airway pressure, apnea hypopnea index; detection accuracy
448 Association between Positive Airway Pressure Adherence and Healthcare Costs
Authors: An Jaejin , Glick Henry , Shi Jiaxiao , Chen Aiyu , Arguelles Jessica , Keenan Brendan , Maislin Greg , Mazzotti Diego , Sawyer Amy , Pack Allan , Hwang Dennis 
Published: May 2021

Abstract

Introduction
The impact of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on healthcare costs is uncertain. We explored the relationship between 3-year PAP adherence and direct healthcare cost utilizing the Tele-OSA study cohort.

Methods
The Tele-OSA randomized clinical trial demonstrated improved PAP adherence in patients receiving automated feedback messaging regarding their PAP use versus usual care. The study enrolled patients at Kaiser Permanente Southern California, a large integrated healthcare system, from 2014–2015. Patients with moderate-severe OSA (Apnea Hypopnea Index [AHI] ≥15) from all study arms were consolidated, then stratified into PAP adherence groups based on mean PAP hours and PAP use patterns over 3-year follow-up period: (a) high adherence (consistent ≥4 hours/night); (b) moderate adherence (2–3.9 hours/night or inconsistent ≥4 hours/night); (c) low adherence (&lt;2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from Federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs during follow-up were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI.

Results
Of 374 patients (mean age 50 years, 63% male), 22% were categorized into high adherence, 18% moderate adherence, and 60% low adherence to PAP therapy. Mean (SD) hours of PAP use were 6.5 (1.1) hours, 3.7 (1.3) hours, and 0.3 (0.5) hours for high, moderate, and low adherence groups, respectively. The high adherence group had the lowest average (SE) adjusted 6-month healthcare costs compared with other groups (High: $2,991 [$234]; Moderate: $3,604 [$412]; Low: $3,854 [$300]). Cost savings of high vs low adherence were $862 (95% CI $1540, $185). Cost savings of moderate vs low adherence were $250 (95% CI -$694, $1,193).

Conclusion
Better PAP adherence was associated with significantly lower healthcare costs over 3 years in patients with moderate-severe OSA. Findings support the importance of care strategies to enhance long-term PAP adherence for OSA therapy.

Support (if any)
The Tele-OSA Study was supported by AASM Foundation SRA Grant #: 104-SR-13
449 The Effects of Positional and Sleep Stage Dependency on Mandibular Advancement Device Treatment Outcome in Obstructive Sleep Apnea
Authors: Lee Chien-Feng , Chen Yunn-Jy , Chen Yu-Ching , Lin Ming-Tzer , Lee Pei-Lin , Yu Chong-Jen 
Published: May 2021

Abstract

Introduction
Mandibular advancement device (MAD) responder phenotype are not well understood in patients with obstructive sleep apnea (OSA). Recent studies have reported the association between MAD treatment response and polysomnographic phenotypes using positional and sleep stage dependency, but with inconsistent findings. Thus, the study aims to investigate the relationship between the two phenotypes and MAD response.

Methods
This retrospective study recruited patients with OSA (apnea-hypopnea index [AHI] &gt;10/h), who were 20 to 80 years old, treatment naïve, and received MAD treatment for more than three months from 2009 to 2017. AHIsupine/AHInon-supine ≥2 and &lt;2 meant supine predominant (supine-p) and non-positional OSA, respectively. REM-AHI/NREM-AHI ≥2, ≤0.5, and between 0.5 to 2 indicated REM-predominant (REM-p), NREM-predominant (NREM-p), and stage-independent (SI) OSA, respectively. Three criteria defined successful MAD treatment (i.e., criterion 1: residual AHI &lt;5/h with &gt;50% reduction; criterion 2: residual AHI 50% reduction; criterion 3: reduction &gt;50%). The association between the two phenotypes and the three treatment criteria was identified using multivariable logistic regression.

Results
A total of 218 patients with a median age of 52.5 years, body mass index (BMI) of 25.4 kg/m2, and AHI of 28.2/h were recruited. Supine-p OSA had lower waist circumferences than non-positional OSA. The REM-p group had lower AHI and more female than the NREM-p and SI group. Supine-p OSA had better response than non-positional OSA (criterion 1: 43.2% vs 34.1%; criterion 2: 63.6% vs 34.1%; criterion 3: 77.3% vs 51.2%). NREM-p OSA had lower response across all three criteria (REM-p vs NREM-p vs SI: criterion 1: 57.6% vs 0% vs 42.0%; criterion 2: 75.8% vs 16.7% vs 56.5%; criterion 3: 75.8% vs 33.3% vs 77.1%). The odds of MAD response for supine-p OSA was 3.78 (95% CI = 1.44–9.93) to 3.98 (95% CI = 1.58–9.99)-fold than non-positional OSA while the odds for NREM-p OSA were 0.06 (95% CI = 0.01–0.58) to 0.15 (95% CI = 0.03–0.67)-fold than SI OSA after adjusting demographics and clinical features affecting MAD response.

Conclusion
Positional and sleep stage dependency were associated with MAD response and could be indicators for personal-tailored OSA treatment.

Support (if any)
The Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252)
460 Alianza Barbed Pharyngoplasty in Moderate to Severe OSAS Patients
Authors: Sabatino Lorenzo , Moffa Antonio , Rinaldi Vittorio , Casale Manuele 
Published: May 2021

Abstract

Introduction
Alianza barbed pharyngoplasty is a recent non-resective surgical tecnique, indicated for patients with obstructive sleep apnea syndrome (OSAS) with circular retropalatal obstruction pattern. It has the aim of stabilizing and reducing the collapsibility of the palato-pharyingeal area during sleep. It uses barbed absorbable sutures that allow to suspend palato-pharyngeal structures to anatomical non-collapsable landmarks (posterior nasal spine, pterigoideal hamulus, pterigomandibular raphe). The aim of this study is to evaluate efficacy and safety of Alianza barbed pharyngoplasty in moderate to severe OSAS.

Methods
Thirty-six consecutive patients with moderate to severe OSAS underwent Alianza barbed pharyngoplasty. Preoperatively all patients presented with palatal hypertrophy, concentric collapse and retropalatal flatter during drug induced sleep endoscopy (DISE) and did not tolerate CPAP and/or MAD therapies. All patients underwent clinical examination, polysomnography, and subjective evaluation of snoring with visual analogue scale (VAS) and Epworth Sleepiness Scale (ESS) both pre-operatively (T0) and at 6 months postoperatively (T1).

Results
There was a significant reduction of AHI at T1, from 32.49 ± 14.55 to 12.1 ± 12.16 (p&lt; 0.05) of AHI. Mean AHI gain was of 20.39 ± 11.58, in particular 13.34 ± 5.48 in moderate OSAS patients and 30.18 ± 9.34 in severe OSAS patients. There was also a significant ODI reduction, from 27.57 ± 15.68 to 12.97 ± 13.25 (p&lt; 0.05). There was a significant reduction of ESS, from 8.75 ± 4.51 to 4.05 ± 2.39 (p&lt; 0.05) and a significant reduction of snoring VAS from 7.85 ± 1.23 to 3.2 ± 1.7 (p&lt; 0.05).

Conclusion
Alianza barbed pharyngoplasty led to significant improvement both in objective parameters measured with polysomnography (AHI and ODI), and in subjective parameters (ESS and snoring VAS) in moderate to severe OSAS patients.
Support (if any):