bluuebunny/crossref_metadata_2025_split huggingface dataset:
0539 Predictors of Driving Risk in CPAP-treated OSAS: A French Multicenter Prospective Cohort
Authors: Julien Coelho , Bailly Sébastien , Baillieul Sébastien , Micoulaud-Franchi Jean-Arthur , Taillard Jacques , Sagaspe Patricia , Tamisier Renaud , Pépin Jean-Louis , Philip Pierre 
Published: April 2024

Abstract

Introduction
Continuous Positive Airway Pressure (CPAP) therapy is effective in reducing Excessive Daytime Sleepiness (EDS) and driving risk in the vast majority of Obstructive Sleep Apnea Syndrome (OSAS) patients. There is a need to identify predictors of residual driving risk in CPAP-treated patients. We aimed to investigate the determinants of persistent driving risk related to sleepiness in CPAP-treated OSAS patients.

Methods
Longitudinal analysis of a prospective national database including 5,308 patients with OSAS and an indication of CPAP treatment. Near-misses, accidents, and sleepiness at the wheel were assessed before initiation and after ≥ 90 days of CPAP treatment. Multivariate associations with the cumulative incidence of near-misses and accidents on CPAP were calculated using Cox models adjusted for age, sex, obesity, sleep duration, sleepiness at the wheel, accidents/near-misses history, depressive symptoms, residual apnea-hypopnea index, and adherence to treatment.

Results
Residual sleepiness at the wheel on CPAP was associated with eight-fold higher incidence of near-misses (HR=8.63 [6.08-12.2]) and five-fold higher incidence of accidents related to sleepiness (HR=5.24 [2.81-9.78]). Adherence ≤4h/night was also a significant contributor of persistent driving risk (HR=1.74 [1.12-2.71] for near-misses and HR=3.20 [1.37-7.49] for accidents).

Conclusion
Residual sleepiness at the wheel and CPAP-adherence ≤4h/night are easy-to assess markers to detect persistent driving risk during the follow-up evaluations of patients on CPAP. Health professionals, but also policy makers, should be aware of the crucial importance to systematically evaluate these elements during the follow-up evaluations of the patients with OSAS treated by CPAP therapy to improve driving risk.

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0543 The Utility of the PAP NAP for Increasing Patient Utilization of Positive Airway Pressure Therapy
Authors: Creighton Erin , Markov Dimitri , Grewal Ritu 
Published: April 2024

Abstract

Introduction
While highly effective, compliance of positive airway pressure (PAP) therapy remains a barrier to treating obstructive sleep apnea (OSA) in many patients. PAP NAP is a brief, reimbursable sleep study, designed to help patients with insomnia and OSA acclimate to PAP therapy. Studies have shown increased utilization after the study.

Methods
This is a retrospective study at a single institution of patients who underwent a PAP NAP procedure at our sleep laboratory between 2019 and 2022. The electronic medical record and PAP provider interfaces were queried for demographics, medical and sleep history, sleep study data, and PAP usage. Initial follow-up and most recent available follow-up data was collected. Paired t-test was used to compare utilization before and after intervention.

Results
Twenty-four patients underwent PAP NAP. Average apnea hypopnea index was 34.1 (median 26.3, range 5.3 - 111.6). The average length of PAP NAP was 2 hours 10 minutes (range 50 min - 3 hours 55 minutes). The median initial follow-up time after PAP NAP was 33 days. The median long-term follow-up was 1.2 years. Prior to PAP NAP, 5 patients (20.8%) were compliant with PAP therapy as per Medicare criteria. After PAP NAP, 6 (25%) and 7 (29%) patients were considered compliant at initial and long-term follow-up, respectively. There were statistically significant increases in the percentage of nights with PAP usage at least 4 hours, with mean pre-PAP NAP nights over 4 hours averaging 27% and post-PAP NAP averaging 37% (p=0.02). There was no difference at long term follow-up nor were there significant differences in the percentage of total days used at initial or long-term follow-up.

Conclusion
While an initial increase in the percentage of nights PAP was used at least 4 hours, this does not represent a clinically meaningful difference as few patients increased usage enough to meet the standards of adequate PAP use, and there was no difference at long term follow up. There may be a role for PAP NAP in patients who are already compliant but have problems with tolerance, mask fit, or high residual disease. This area should be further explored as it was a small portion study.

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0544 The Impact of Telemedicine on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea Patients
Authors: Morales Sulimar , Baranowski Amanda , Garbioglu Pinar , Ali Mazen El , Patel Sanjay , Krishnamurthy Venkatesh B 
Published: April 2024

Abstract

Introduction
Telemedicine has grown in popularity among patients for initial sleep medicine consultation following the COVID-19 pandemic. We sought to evaluate whether initial telemedicine consultation adversely impacted CPAP adherence over the initial 90 days of use among patients diagnosed with obstructive sleep apnea (OSA).

Methods
We reviewed the medical records of all patients initiated on CPAP therapy between January and May of 2023 at three academic sleep clinics at the University of Pittsburgh Medical Center. We compared CPAP adherence at 90 days between patients whose initial evaluation was done via telemedicine versus an in-person visit. Logistic regression was used to compare the odds of achieving Centers for Medicare & Medicaid Services (CMS) adherence criteria for long-term coverage accounting for age, sex, and race.

Results
A total of 289 patients were initiated on CPAP during the period studied with 141 (48.8%) having a telemedicine consult and 148 (51.2%) having an in-person visit. The cohort had a mean age 52 +/- 15 yrs, 38% were women, 76% were White and 18% were Black with no significant differences between the two groups. There was no difference in the percentage of patients achieving CMS criteria for long-term coverage (72.4% with telemedicine vs. 69.3% with in-person, p=0.95). Similarly, mean nightly usage over 90 days (261 ± 12 min with telemedicine vs. 243 ± 13 min with in-person, p=0.31) and percent of nights with more than 4 hours of CPAP use (60.0 ± 2.8% with telemedicine vs. 55.4 ± 2.9% with in-person, p=0.26) did not differ between groups. Results were similar when stratified by sex and did not change when adjusted for age, sex, and race.

Conclusion
Clinical outcomes in the treatment of OSA are not inferior in patients evaluated via telemedicine. Given the convenience of telemedicine for many patients, particularly those living in rural areas and those with limited ability to take time off from work or access transportation, greater use of telemedicine can expand access to OSA care without reducing the quality of care.

Support (if any)
none
0546 Aroxybutynin and Atomoxetine for the Treatment of OSA: Rationale and Design of the SYNAIRGY Phase 3 RCT
Authors: Strollo Patrick , Taranto-Montemurro Luigi 
Published: April 2024

Abstract

Introduction
There are no FDA-approved drugs available for the treatment of obstructive sleep apnea (OSA). The relaxation of upper airway muscles at sleep onset and insufficient muscle reactivation during obstructive events are the key pathophysiological determinants of OSA. Pharmacotherapy targeting the activation of upper airway muscles is a promising strategy for the alleviation of OSA.

Methods
AD109 is a combination of the antimuscarinic aroxybutynin 2.5 mg, the R-enantiomer of oxybutynin, and the norepinephrine reuptake inhibitor atomoxetine 75 mg. In the phase 2b Mariposa trial, AD109 demonstrated a clinically significant reduction of -47.1% (95% CI: -61.2 to -27.9) in the apnea-hypopnea index (AHI) compared to a placebo, along with an important decrease in subjective fatigue, measured using the Patient Reported Outcome Measurement Information System (PROMIS) scale, at one month of treatment. The ongoing SYNAIRGY study, a placebo-controlled 26-week phase 3 clinical trial, is designed to investigate both the efficacy and safety of AD109 2.5/75 for the treatment of mild to severe OSA. Eligible participants include adults with AHI4 (4% desaturation definition for hypopneas) ≥5, and a BMI &lt; 42kg/m2 for women and &lt; 40 kg/m2 for men who either decline or are unable to tolerate continuous positive airway pressure treatment. Approximately 640 participants will be randomized in a 1:1 ratio to receive either placebo or AD109. We hypothesize that AD109 treatment will provide a clinically meaningful AHI decrease compared to placebo-treated participants with OSA.

Results
The primary endpoint is the response rate in the AD109 arm vs. placebo arm, where response is defined as &gt;50% reduction in AHI4 from baseline to 26-week polysomnogram (PSG). Participants will have a PSG on treatment at week 4. Secondary endpoints include changes from baseline in PROMIS-Fatigue, PROMIS-Sleep Impairment, hypoxic burden, Patient Global Impression of Severity (PGI-S) for fatigue, and the Epworth Sleepiness Scale. Safety assessments will include multiple in-office measurements of heart rate and blood pressure throughout the treatment period.

Conclusion
The SynAIRgy phase 3 randomized, controlled clinical trial aims to assess the efficacy and safety of AD109 in in the treatment of OSA by targeting key pathophysiologic mechanisms of upper airway muscle relaxation during sleep.

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Apnimed
0553 Changes in QTc and QT Variability in Patients with OSA with and Without Heart Failure with PAP Based on Sleep Stage
Authors: Perez Karolina , Zareba Wojciech , Woosley Raymond , Quan Stuart , Xia Jean , Shah Misty , Rothers Janet , Patel Imran , Patel Salma 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete collapse of the upper airway. OSA has been associated with increases in QTc interval and QT variability—risk factors for ventricular arrhythmias and death. This study explores how QTc and QT Variability change with positive airway pressure therapy (PAP) in patients without heart failure (HF), HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF) based on sleep stage.

Methods
Consecutive patients with OSA undergoing diagnostic and PAP titration polysomnography (PSG) were included for analysis. Electrocardiogram (ECG) analysis during PSG was performed using Comprehensive Analysis of Repolarization Signal (COMPAS) software for the longest apnea/hypopnea events in NREM and REM for the diagnostic period as well as on the highest CPAP or BPAP pressure delivered for the titration PSG. Both Bazett’s (QTbc=QT/RR1/2) and Fridericia’s (QTfc=QT/RR1/3) corrections were used to calculate corrected QT. QT variability measures included the standard deviation of QT intervals (SDQT), normalized QT interval variance (QTVN), short-term interval beat-to-beat QT variability (STVQT) and QT Variability Index (QTVi). Sleep stages were characterized as Non-Rapid eye movement (NREM) vs. REM.

Results
Ninety two patient diagnostic and 92 titration PSG were reviewed (54% male, age 54 ± 15 years, BMI 38.5 ± 8.9, AHI 51.8/hr ± 39.0, minimum spO2 74.9% ± 14.4). Only eight percent of the patients had HF. There were no significant differences in QTfc and QTbc in NREM and REM. In the no HF cohort, QTVi decreased significantly in REM (n=31) during titration (0.78 ±1.79) when compared to baseline (1.64 ± 1.65), p=0.0026. In the no HF cohort, no significant changes were noted in QT variability during NREM (n=66) in the titration PSG when compared to the diagnostic PSG. No other findings in QT variability were statistically significant including the HFrEF and HfpEF cohorts however those sample sizes were very small.

Conclusion
PAP in patients with no HF may result in decreased QT variability and the effects may be varied based on sleep stage. Our findings need to be verified in larger cohorts.

Support (if any)
American Academy of Sleep Medicine Foundation, National Institutes of Health , The University of Arizona
0562 Evaluation of Habitual Sleep Duration and PAP Adherence to Quantify Effective AHI Reduction at Home in Older Adults
Authors: Licona Diego Quintana , Kam Korey , Valencia Daphne , Roberts Zachary , Parekh Ankit , Schoenholz Reagan , Adawi Ayham , Martillo Katarina , Tolbert Thomas , Wang Jing , Guevarra Jay , Ayappa Indu , Rapoport David , Varga Andrew 
Published: April 2024

Abstract

Introduction
Any consequence of OSA treatment with PAP is likely to depend on baseline OSA severity and adherence to PAP in relation to habitual sleep duration. These variables can be combined to evaluate 1) the degree of effective residual AHI and 2) the degree of effective reduction in the AHI. We sought to characterize both of these outcomes in older adults newly diagnosed with OSA.

Methods
We recruited 19 patients (ages 55-85) from the Mount Sinai Integrative Sleep Center with a diagnostic PSG or WatchPAT showing AHI4% &gt; 15/hour and willing to initiate PAP therapy. PAP adherence was obtained via remote monitoring after 3 months of use, and habitual sleep duration was obtained with 3-19 days of wrist actigraphy (ActiGraph). To account for differences between the AHI4% and the PAP-generated residual AHI, the AHI4% on PAP was considered 0/hour when the PAP-generated AHI was ≤5/hour or 5 units below the PAP-generated AHI when &gt;5/hour. The effective residual AHI was defined as: ([AHI4% on PAP x usage hours] + [diagnostic AHI4% x (habitual sleep duration – usage hours)]) / (habitual sleep duration). Effective AHI4% reduction = diagnostic AHI4% - effective residual AHI4%. Wilcoxon signed rank tests were used to compare diagnostic AHI4% to the effective residual AHI4%.

Results
Mean age was 63±1.4 years, 37% were female, with mean BMI 33±1.7 and mean Epworth Sleepiness Score 6.5±0.7. Average habitual sleep duration was 5.8±0.3 hrs and average PAP use duration was 3.4±0.6 hrs. The median effective residual AHI4% was 9±20/hour, which was significantly lower than the diagnostic AHI4% (27±20/hour, p=0.002). The median effective AHI4% reduction was 15±23/hour, reflecting a mean 54±9% reduction from the baseline diagnostic AHI4%. Patients using PAP ≥ 6hrs (n=4) had an effective residual AHI4% of 1±2/hour (median diagnostic AHI4%: 29±24/hour), whereas patients using PAP &lt; 2hrs (n=7) had an effective residual AHI4% of 24±17/hour (median diagnostic AHI4%: 24±37/hour).

Conclusion
This pilot study presents a characterization of the effective residual AHI and degree of effective AHI reduction in older sleep clinic patients prescribed PAP therapy. These values may be useful when considering health-related consequences of OSA treatment.

Support (if any)
R01AG066870, RF1AG083975, R01AG080609, R01AG082278, R01AG056682
0565 Utilization of Pap Titration as Indicator for Prediction of Pap Adherence
Authors: Tran Jenny , Park Justin , Modi Jhalak , Faryad Shujaa , Prasad Bharati 
Published: April 2024

Abstract

Introduction
Patient characteristics like self-efficacy, daytime sleepiness, and obstructive sleep apnea (OSA) severity are associated with positive airway pressure (PAP) treatment adherence. We examined the association of changes in sleep architecture with PAP titration on split-night polysomnography (PSG) with PAP adherence in an urban, racially diverse population.

Methods
PSG conducted between January and December 2019 were reviewed for sleep architecture data. The main variables were change in sleep efficiency (SE), arousal index (AI), N1, N3, and REM sleep. Changes were assessed as ratios and differences (therapeutic/diagnostic and therapeutic-diagnostic). Demographic data, body mass index (BMI), social vulnerability index (SVI), apnea hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and the initial 90-day adherence data from PAP download were collected. PAP adherence was defined as ≥4 hours/day use for ≥70% days. Stata v17 was used for analysis.

Results
PSG was conducted in 381 patients, and 239 patients had complete data for PAP use. The baseline characteristics of analyzed patients (N=239) were not significantly different from the missing sample (N=143). The PAP adherent group (N=109) were similar to the non-adherent group (N=130), except for a higher baseline ESS was noted in the adherent group (p=0.01). The logistic regression model showed that increasing age and lower ESS were associated with greater likelihood of PAP adherence (Odds Ratio, OR 1.02,95% confidence interval, CI 1.00-1.05 and OR 0.94, CI 0.89-0.99). Regarding the changes in sleep architecture with PAP titration, increases in SE and N3 sleep during the titration portion of the PSG were associated with higher likelihood of PAP adherence (OR 1.01, CI 1.00-1.03 for each). Changes in AI, N1, and REM sleep were not associated with PAP adherence.

Conclusion
Improvements in SE and an increase in N3 sleep during PAP titration on split-night PSG are associated with a higher likelihood of PAP adherence.

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0571 Impact of CPAP Adherence on Objective and Subjective Sleepiness Measures
Authors: Schwab Allison , Keenan Brendan , Staley Beth , Basner Mathias , Bae Charles 
Published: April 2024

Abstract

Introduction
Sleepiness, a common symptom of various sleep disorders, has been subjectively measured using the Epworth Sleepiness Scale (ESS) and objectively quantified using the Psychomotor Vigilance Test (PVT). The relative merit of these two measures of sleepiness has been debated, and both have shown inconsistent relationships with severity of obstructive sleep apnea (OSA) and responses to treatment. We report the relative associations of ESS and PVT with hours of CPAP use within a clinical sample.

Methods
Patients being evaluated for sleep disorders at the University of Pennsylvania’s Sleep Center competed both the ESS and PVT measurements in a single clinical visit. Thirty-nine patients had a diagnosis of OSA and were currently using CPAP. Pearson’s correlations were utilized to examine the association between CPAP adherence and both the ESS and PVT measures (transformed lapses [sum of square root of number of lapses and square root of lapses+1]) and mean reciprocal response time (RRT).

Results
total of 39 patients (64.1% males; 52.6% White, 39.5% Black) were studied, with a mean (SD) age of 61.1 (16.4) years and BMI of 35.2 (9.5) kg/m2; residual apnea-hypopnea index (AHI) was 6.5 (10.8) events/hour (23 [63.9%] had residual AHI &lt; 5 events/hour). Participants used CPAP an average of 5.87 (2.27) hours/night in the past 30 days, 5.87 (2.47) hours/night over the past 7 days, and 5.91 (2.86) hours/night the day prior to ESS/PVT measurement. Overall, we observed a strong correlation between less subjective sleepiness based on ESS and more CPAP usage at 30-days (rho = -0.48, p=0.002), 7-days (rho = -0.43, p=0.006) and the prior day (rho = -0.38, p=0.017). However, there was no correlation between hours/night of CPAP adherence and objective function as measured on PVT.

Conclusion
Among patients with OSA using CPAP evaluated at University of Pennsylvania’s Sleep Center, greater amounts of CPAP use were significantly associated with lower ESS scores (e.g., less sleepiness). Conversely, no significant correlations were observed between CPAP use and objective data on PVT. Larger studies examining the causal effects of CPAP on subjective and objective sleepiness, including with repeat assessments of ESS and PVT during therapy, are warranted.

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0573 Morning Questionnaire Post-PAP Titration as a Prediction Tool of Early PAP Adherence
Authors: Abdallah Tarek , Bertschy Calli , Sargsyan Lilit , Majid Ruckshanda , Mathew Reeba 
Published: April 2024

Abstract

Introduction
Positive airway pressure (PAP) therapy is first line treatment for obstructive sleep apnea (OSA). Challenges however exist in regard to optimal PAP adherence. Patterns of PAP adherence in the first month of device use can predict long-term adherence. We investigated the corelation between immediate PAP acceptance, measured by the morning PAP titration questionnaire (MPQ), administered immediately after the titration, and the initial 90-day PAP adherence.

Methods
We performed a retrospective review of patients who completed a PAP titration between January and June 2023 at Memorial Hermann Sleep Disorders Center - Texas Medical Center. Initial 90-day adherence (defined as usage ≥4 hours/night for ≥70% of nights) was obtained on each patient. The patients were grouped based on optimal adherence (Group 1) versus non-adherence (Group 2). The MPQ score was obtained for each patient (completed on the morning after the titration). The MPQ included 4 questions (sleep quality, morning alertness, PAP tolerance, likelihood of device usage) with each affirmative response receiving 1 point. An MPQ score of ≥3 was established as significant for PAP acceptance.

Results
A total of 20 subjects were analyzed with the following characteristics: Group 1 - N 10 (7 men, 3 women), mean age 66 years, mean AHI 43/hour of sleep. Group 2 - N 10 (8 men, 2 women), mean age 63 years, mean AHI 35/hour of sleep. In Group 1, 80% (8 patients) had a score ≥3 compared to 50% patients (5 patients) in Group 2. MPQ scores of 3 and 4 conferred the highest 90-day adherence (62% and 81% respectively). A significant MPQ score also translated into an 82% positive predictive value for PAP adherence in the initial 90 days.

Conclusion
Our results show that patients with a significant MPQ score of ≥3 post-PAP titration are more likely to adhere to PAP therapy than those with non-significant scores and this can hence be used to predict immediate (and potentially long-term) adherence patterns. This simple questionnaire can be implemented to guide strategically timed early follow up and interventions (amongst those who score &lt; 3) to best utilize limited sleep resources and reduce the prevalence of PAP non-adherence.

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0580 Predictors of PAP Compliance One Month After Bariatric Surgery
Authors: Badhwar Ankita , Shakaroun Dania , Bugazia Seif , Carlin Arthur , Roehrs Timothy , Skiba Virginia 
Published: April 2024

Abstract

Introduction
Obesity is a major risk factor for Obstructive sleep apnea (OSA). Bariatric surgery is a popular treatment modality for sustainable weight loss in obese patients with OSA. Meta-analysis of several randomized controlled trials and observational studies showed that bariatric surgery led to improvement in OSA severity but not cure. These patients will likely need continued treatment for OSA to minimize its complications. It is unclear what factors influence positive airway pressure (PAP) therapy adherence and compliance postoperatively. Our study aims to identify predictors of PAP compliance 1 month after bariatric surgery.

Methods
Patients who underwent bariatric surgery at our institution between April and October 2023 and had diagnosed obstructive sleep apnea were identified. The 140 patients were followed prospectively through surgery and 30-day post-surgery. Medical health records, polysomnography or home sleep study results, and on-line databases of PAP use were reviewed for each patient. We used Pearson correlation coefficient testing and t-test to examine potential predictors of PAP use in the 30-day post-operative period.

Results
There are statistically significant correlations (p &lt; 0.05) between post-surgical PAP use and use during 7 days of initial set up (r = 0.642), time spent below 90% SpO2 during sleep testing (r = 0.425), time spent below 88% SpO2 (r = 0.246), pre-operative STOP-BANG (r = 0.200), and time from sleep testing to surgery (r = 0.242). Pre-surgical AHI and having been evaluated by a sleep physician pre-operatively did not show statistically significant association with post-operative PAP use.

Conclusion
PAP use during 7 days of initial set up is highly predictive of 1-month post-operative PAP use and may serve as a valuable marker to intervene on those patients with low use to improve long-term PAP use. Patients who were diagnosed with OSA close to their surgery had lower PAP use, suggesting patients may benefit from more time to get used to the treatment before having surgery.

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