bluuebunny/crossref_metadata_2025_split huggingface dataset:
0584 Influence of Comorbidities and Apnea-Hypopnea Index on CPAP Compliance in Patients with Obstructive Sleep Apnea
Authors: Raafat Amr , Ali Ibrahim Sultan 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent nocturnal breathing interruptions, often resulting in debilitating symptoms and a substantial cardiovascular burden. Continuous positive airway pressure (CPAP) remains the gold standard therapy for OSA, but its long-term effectiveness and the influence of comorbidities on treatment compliance require ongoing investigation.

Methods
In this retrospective study, we assessed the efficacy of CPAP therapy in a cohort of 201 OSA patients, using data collected from 2017 to 2023 in an outpatient sleep apnea clinic. The study population comprised 125 males and 76 females, with an average age of 66 years. The severity of OSA was categorized based on Apnea-Hypopnea Index (AHI) levels, and patients were prescribed CPAP therapy with tailored pressure levels. Compliance was evaluated by the percentage of nights with over 4 hours of CPAP usage, with results ≥70% considered compliant. The impact of comorbidities, including hypertension, diabetes mellitus, obesity, cardiac diseases and severe OSA, on treatment compliance was also assessed.

Results
Among the patients, 80.5% exhibited good compliance with CPAP therapy, while 19.5% demonstrated poor compliance. AHI values significantly improved, with the mean AHI at diagnosis 37.08 reducing to 3.41 at follow-up. Among patients with an AHI greater than 30, 90% exhibited good compliance, whereas those with an AHI less than 30 demonstrated good compliance in 69% of cases. Notably, the standard deviation of AHI values reduced from 29.01 to 4.35, underscoring a significant reduction in variability. Interestingly, patients with multiple comorbidities (61.6% of the patients) displayed a higher compliance rate compared to those with one or fewer comorbidities (17.9%).

Conclusion
This study reaffirms the enduring effectiveness of CPAP therapy as the gold standard for OSA treatment. High compliance rates with substantial reductions in AHI values support its continued use in managing patients with different comorbidities. Our findings indicate that increased compliance with CPAP is linked to the presence of multiple comorbidities and higher severity of AHI.

Support (if any)
In future research, there is a need for concentrated research endeavors to formulate strategies aimed at improving compliance, particularly among patients with a lower number of comorbidities.
0587 Adherence and Quality of Life of Patients with Sleep Disordered Breathing Treated with Automatic Servo-Ventilation
Authors: Bass Sarah , Jasko Jeff , Hardy William , Cain Chuck , Arzt Michael , Randerath Winifried 
Published: April 2024

Abstract

Introduction
Automatic servo-ventilation (Auto SV) treats Central sleep apnea (CSA) and obstructive sleep apnea (OSA) by monitoring airflow and intervening with changes or pauses in airflow patterns. Evidence on adherence to Auto SV therapy and its effects on symptoms, sleep quality and quality of life (QOL) in real world Auto SV users is sparse. The aim of this registry study was to describe the adherence to Auto SV (Philips DreamStation BiPAP auto SV) and to evaluate Auto SV therapy effects on sleepiness, sleep quality and QOL.

Methods
Data were collected at six sites across Germany from 2018 through 2023 at 6, 12, and/or 24 months. Auto SV adherence data were collected through Philips EncoreAnywhere™ (EA) software and examined according to intent-to-treat and subgroup analyses accounting for data gaps. Average adherence was calculated from the first to the final date of first device usage. Sleepiness, sleep quality and general QOL were assessed with the Epworth Sleep Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and the European Quality of Life-5 level questionnaire (EQ 5D-5L), respectively. Changes from baseline (CFB) were calculated for questionnaires collected at enrollment and at visits at 6, 12 and 24 months (Mixed-Models including Sidak adjustment).

Results
One hundred and twenty-five participants were enrolled. Average age was 65 ± 12 years; 106 (85%) were males. Average adherence over days used was 6.0 ± 1.9 hours/day (n = 103) and 5.0 ± 2.4 hours/day (n = 103) among all days (average follow-up 478 days). Percent days used averaged 78.5 ± 27.1%. ESS and global PSQI scores showed significant improvement from baseline at 24 months in completed-cases and last-observation-carried-forward analyses (ESS [Mean difference: CC -1.9 ± 3.9 (N=57), LOCF -1.8 ± 4.5 (N=103), p ≤0.001], PSQI [Mean difference: CC -1.7± 3.5, LOCF (N=55), -1.6 ± 3.5 (N=98), p &lt; 0.001]). The EQ-5D-5L did not significantly differ from baseline.

Conclusion
Auto SV use averaged 5 hours per night and Auto SV significantly improved sleepiness and sleep quality, but not general QOL, in a real-world sleep clinic population. ESS approached clinical significance (MCID 2.0) while the PSQI did not (MCID 3).

Support (if any)
0589 Evaluating the Impact of Sleep Position on Efficacy of Hypoglossal Nerve Stimulation
Authors: Castillo Horacio Romero , Jain Nikhita , Ren Jennifer , Oby Brandon , Lin Fred , Chou Courtney , During Emmanuel 
Published: April 2024

Abstract

Introduction
Current literature supports hypoglossal nerve stimulation (HNS) as a treatment option for select patients with moderate-to-severe obstructive sleep apnea (OSA). However, in about a third of implanted patients, HNS is ineffective. To date, few publications have investigated how sleep position impacts HNS efficacy. In 2019, the Stanford group found that HNS had a greater impact on non-supine AHI vs supine AHI; the data was limited to eleven patients monitored in the sleep lab and did not incorporate full-night data. We explored the effect of sleep position on HNS efficacy in a larger sample by comparing pre- and post-operative overnight sleep studies.

Methods
We performed a retrospective chart review of 136 patients implanted at Mount Sinai Hospital from 2016-2023. Patients were included if they tolerated therapeutic voltage and completed pre- and post-operative sleep studies with at least 30 minutes of supine and non-supine sleep. Mean differences in pre- and post-operative overall AHI4% (DeltaAHI), supine AHI4% (DeltaSupine) and non-supine AHI4% (DeltaNon-supine) were calculated. Paired T-Test was then performed to compare AHI4% percent reduction when supine versus non-supine. Secondary outcomes included mean difference in pre- and post-operative ODI4 (DeltaODI) and ESS (DeltaESS). We also calculated our cohort’s surgical success rate, as defined by Sher’s criteria.

Results
Seventeen patients met inclusion criteria. Mean age was 60.2+/-11.2 years, and 15 patients were male (88.2%). Mean BMI was 29.1+/-3.0 kg/m2. Mean preoperative AHI4% was 29.4+/-14.8 events/hour; mean preoperative supine AHI4% and non-supine AHI4% were 44.6 events/hour and 13.3 events/hour respectively. Overall DeltaAHI was 15.2 events/hour (p=0.0004), DeltaSupine was 21.4 events/hour (p=0.0071), and DeltaNon-supine was 6.2 events/hour (p=0.0486). Despite the difference in absolute reduction, there was no statistically significant difference (p=0.3242) between the percent reduction of supine AHI4% (41.7%) versus non-supine AHI4% (10.0%). Mean differences for DeltaODI and DeltaESS were 11.5 (p=0.0051) and 2.9 (p=0.2) respectively. Overall success rate was 58.8% (10 of 17 patients), which is similar to other studies in the literature.

Conclusion
In our sample, we found no difference in AHI percent reduction between supine and non-supine position, suggesting that HNS is effective in improving OSA regardless of positionality.

Support (if any)
NCATS: TL1TR004420;
0591 Improving Efficiency & Patient Outcomes Using Longitudinal Monitoring via a HSAT with Hypoglossal Nerve Stimulation
Authors: Patel Ruchir , Gunn Stacey , Messner Stephanie , Rodriguez Haley , Casselman Erica , Reuveny Amir , Rohrscheib Chelsie 
Published: April 2024

Abstract

Introduction
Hypoglossal Nerve Stimulation (HGNS) is an increasingly prevalent treatment for moderate-severe obstructive sleep apnea (OSA). HGNS therapy requires titration to identify the optimal stimulation parameters for patient comfort and OSA improvement. The recommended post-activation care protocol is long, typically taking 90-120 days to complete. The purpose of this study was to evaluate an optimized protocol utilizing a home sleep apnea test (HSAT) capable of long-term longitudinal monitoring to frequently assess treatment efficacy as stimulation amplitude adjustments were being made.

Methods
The study included 30 adults undergoing titration of an HGNS implant at a Sleep Clinic in Arizona, USA from January-October 2023. The revised protocol: The device was activated 3-weeks post-op and the stimulation amplitude was increased by 0.1V every 4 days following device activation. Patients were advised to test their sleep with a HSAT for 1 night on the 2nd night after every amplitude increase to minimize the risk of “1st night effect” after the initial amplitude increase. Follow-up visits were scheduled every 2 weeks post-activation, where the HSAT data was reviewed. Apnea/Hypopnea Index (AHI) and SPO2 were used to evaluate OSA severity. An in-lab titrations study was conducted 10-12 weeks post-activation if the patient was asymptomatic and adherent, and the HSAT showed significant improvement in OSA parameters.

Results
The updated care protocol took an average of 63.76 (SD 41.14) days from activation to completion 86.6% (n=26) of patients completed the program in &lt; 90 days and 60% (n=18) completed the program in ≤60 days. The mean percent reduction in AHI was 68.09% (SD 21.89; mean -15.21 AHI). The mean increase in minimum SPO2 was 4.31% (SD 5.11).

Conclusion
A new HGNS titration protocol that included frequent testing with a HSAT allowed for objective, longitudinal assessment of the effectiveness of each amplitude/output adjustment. Monitoring OSA parameters minimized over-titration of the device amplitude, improving patient comfort, and allowed for earlier identification of the need to try a different electrode configuration if the AHI was not improving. This study demonstrated that a shorter program length was possible while still maintaining good treatment efficacy.

Support (if any)
Employees of Wesper contributed to the data analysis.
0594 Novel Device to Simulate Hypoglossal Nerve Stimulation Response to Predict Surgical Success
Authors: Glick Aaron , Singh Supriya 
Published: April 2024

Abstract

Introduction
Hypoglossal Nerve Stimulation (HGNS) is a surgical procedure to treat obstructive sleep apnea (OSA). The procedure involves placing an electrical cuff around the hypoglossal nerve to electrically stimulate the nerve during inspiration to anteriorly position the tongue thus treating the obstructive event. Currently, a drug induced sleep endoscopy is completed prior to the HGNS surgery to investigate if implantation would be predictably successful. Yet, treatment failures continue to exist despite current VOTE classifications, concentric collapse identification, and other methods used to improve patient selection for HGNS implantation.

Methods
A pilot study was conducted to investigate the potential of a non-invasive hypoglossal nerve stimulator to evaluate the potential of predicting surgical success during DISE. The non-invasive stimulator activates the hypoglossal nerve without direct contact with the nerve and therefore does not require surgery. Ten adult patients (≥ 18 years of age) presenting at Michael E. DeBakey Department of Veterans Affairs Medical Center with moderate to severe OSA (15-60 AHI) and BMI less than 40 that were undergoing DISE procedure participated. The stimulator device was used during the DISE procedure to identify reduction of collapse during hypoglossal stimulation prior to implantation. Endoscopy videos were collected during standard procedure and during use of the stimulation device and shown to three blinded board-certified sleep physicians to score likelihood of success with HGNS implant based on absence of concentric collapse identification, presence of anterior-posterior collapse using the VOTE classification, and stimulation device method.

Results
Patients will be followed to identify percentage AHI reduction, patient reported tolerance of implanted HGNS, and provider reported overall success of implanted HGNS.

Conclusion
The novel non-invasive HGNS device has the potential to improve prediction of implantation AHI reduction success and understand likelihood of tolerance.

Support (if any)
Ember Sleep provided the stimulation device at no cost.
0600 Baseline Decisional Conflict and 3-Month Decision Regret Among Patients Considering Sleep Surgery
Authors: Ikeda Allison , Weaver Edward 
Published: April 2024

Abstract

Introduction
Sleep surgery has a role as secondary or adjunctive treatment of obstructive sleep apnea (OSA) after unsuccessful trial of CPAP therapy. In the shared decision-making process, patients are informed of the potential benefits, expected course, and potential risks of surgery. We believe that the careful consideration of these competing issues can increase decisional conflict initially but reduce decision regret subsequently. We hypothesized that patients considering sleep surgery who have higher baseline decisional conflict will have lower 3-month decision regret after making a choice, whether or not they proceed with surgery.

Methods
This prospective cohort study enrolled consecutive adult patients considering sleep surgery for OSA after difficulty with CPAP therapy. After surgery consultation, patients completed the validated Decisional Conflict Scale (16 items, score range 0-100, higher worse, &gt;20 clinically important). At 3-months after surgery (surgery group) or 3-months after the consultation (control group), patients completed the validated Decision Regret Scale (5 items, score range 0-100, higher worse). Records were extracted for other variables. Linear regression analyses tested the associations between baseline Decisional Conflict and 3-month Decision Regret after adjusting for age, sex, race, Functional Comorbidity Index, type of sleep surgery, and history of sleep surgery.

Results
The cohort (N=157) characteristics include mean age 41+/-13 years, 60% males, and apnea-hypopnea index 26+/-22. For the whole cohort, baseline Decisional Conflict was 20+/-17 (borderline conflict), 3-month Decision Regret was 19+/-20 (mild regret), and there was no association between the two variables (adjusted R2=0.001, p=0.2). The surgery group had lower baseline Decisional Conflict and lower 3-month Decision Regret compared to the control group, but there was no association between baseline Decisional Conflict and 3-month Decision Regret in either group (R2=0.01 and 0.02).

Conclusion
Baseline decisional conflict was not associated with 3-month decision regret, whether or not surgery was chosen. The lack of association may be due to the low baseline decisional conflict, low 3-month decision regret, or other factors impacting decisional conflict (eg, choice predisposition, prior knowledge, risk aversiveness) or decision regret (eg, clinical outcome, adverse effects). Future work includes testing predictors of baseline decisional conflict and subsequent decision regret independently.

Support (if any)
American Academy of Otolaryngology Resident Research Award
0601 Hispanic Ethnicity Is Associated with Decreased Adherence to Hypoglossal Nerve Stimulation
Authors: Mayo Meagan , Abreu Alexandre , Suurna Maria , Wallace Douglas 
Published: April 2024

Abstract

Introduction
Hypoglossal nerve stimulation (HGNS) is an alternative therapy for patients with obstructive sleep apnea intolerant to positive airway pressure (PAP). Psychosocial variables proven to influence PAP adherence, such as race, ethnicity, and baseline insomnia, have not been well studied with HGNS. This study evaluates HGNS use based on ethnicity and baseline comorbid insomnia (COMISA).

Methods
We conducted a retrospective analysis of patients implanted with HGNS at the University of Miami and Miami VA sleep centers (2017-2023) who were seen for initial follow-up within one year post-implantation. Patient demographics, baseline sleep characteristics, comorbidities, and polysomnography variables were extracted from the electronic medical record. Comorbid insomnia was defined by sleep onset latency or wake after onset time &gt; 30 mins. Comparisons between Hispanic and non-Hispanic patient characteristics were performed with Chi-square or Student t-tests, as appropriate. Objective HGNS adherence data and stimulation parameters were extracted from the Inspire cloud or tablet monitoring system at the most recent visit. Adjusted linear regression models were constructed to determine if COMISA and Hispanic ethnicity were associated with mean nightly HGNS use. Analyses were adjusted for age, gender, sleepiness, AHI, and time to follow-up.

Results
The cohort included 68 patients (18% female, 97% White, 53% Hispanic, 38% US Veterans) with mean age of 62 +/- 11 years, mean body mass index of 29 +/- 3 kg/m2, and baseline apnea hypopnea index of 37 +/- 19 events/hour. Mean duration since implantation was 35 +/- 30 months and mean HGNS use was 274 +/- 147 min/night. In unadjusted comparisons there were no differences in demographics, sleep characteristics, treatment parameters, time since implantation, or follow-up between Hispanics and non-Hispanics. In adjusted analyses, Hispanic ethnicity was associated with 81.7 (p=0.035) fewer minutes of nightly HGNS use compared to non-Hispanic individuals. COMISA was not significantly associated with HGNS adherence.

Conclusion
Ethnicity influences HGNS adherence, while COMISA does not significantly affect usage. Hispanic patients used HGNS more than one hour less per night compared to non-Hispanic individuals. Further evaluation of potential contributing factors, such as socioeconomic status and referral biases, is warranted.

Support (if any)
0603 Transforming Obstructive Sleep Apnea Treatment: Telehealth and Mandibular Advancement Devices
Authors: Chilukuri Priyanka , Patel Imran , quan Stuart , Rothers Janet , Sans-Fuentes Maria , Patel Salma 
Published: April 2024

Abstract

Introduction
Effective obstructive sleep apnea (OSA) treatment can potentially reduce the risk and the public health burden of OSA. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treating OSA, long-term adherence is suboptimal. Although adherence to mandibular advancement devices (MADs) is higher, long-term data is lacking. This study explores the potential of MAD to i) improve patient symptoms and clinically relevant parameters and ii) evaluate telehealth as a platform to increase MAD accessibility and address the public health burden of OSA.

Methods
The electronic medical records of patients administered a MAD for OSA at an academic medical facility from 2019 to 2023 were evaluated. Patient demographics and mode of healthcare delivery were extracted. For patients who received a MAD, variables from their diagnostic polysomnography, like the Epworth Sleepiness Scale (ESS) and the apnea-hypopnea index (AHI), were compared with those from follow-up polysomnography with the MAD. These variables were also compared between the in-person and telehealth cohorts.

Results
176 patients received a MAD for OSA treatment (56 ± 16 years of age, BMI 31 ± 7 kg/m2, 59% female, 82 White, 20% Hispanic/Latino). 37% and 59% of initial visits used telemedicine or teledentistry, respectively. Insurance coverage included AHCCS (26%), Medicare (20%), and commercial insurance (79%) as primary or secondary. The baseline ESS was 8 ± 4 (range 1-24). Initial diagnostic sleep study noted an AHI of 18 ± 15/hour (range 5-109.9/hour; supine 22±18/hour, lateral 14±25/hour), minimum oxygen saturation of 81 ± 7, sleep efficiency of 74 ± 16/hour, and an arousal index of 24 ± 19/hour. In the follow-up polysomnography with the MAD, significant differences were noted in AHI (p=0.0062) regardless of the frequency of in-person or telehealth encounters. While significant differences were not noted in ESS for the overall cohort (p=0.11), ESS improvement was significant in the telemedicine (p=0.03) and teledentistry (p=0.018) cohorts.

Conclusion
MAD use can improve clinically relevant parameters in OSA. Telehealth can deliver clinically effective treatment of OSA.

Support (if any)
American Academy of Dental Sleep Medicine, American Academy of Sleep Medicine Foundation, National Institutes of Health, The University of Arizona.
0604 Substantial Cost Savings with Novel Oral Appliance O2Vent Optima Compared to CPAP Therapy in Canada
Authors: Metwali Rami Al , Rana Shahzad , Sharma Vivek , Bloomfield Lisa 
Published: April 2024

Abstract

Introduction
There is a common perception that oral appliance therapy (OAT) is more expensive than the continuous positive airway pressure (CPAP) therapy. This may be a prohibitive factor for many clinicians and patients to choose a less intrusive therapy with better compliance. Private insurance payers in Canada offer preferential approvals for CPAP over OAT. While oral appliance costs vary and encompass high dentistry fees, CPAP costs are standard. The novel Oral appliance O2Vent Optima also has standard pricing in Canada. The purpose of this investigation is to examine the costs associated with O2Vent Optima versus the CPAP.

Methods
CPAP costs are partially offset by the governments in Canada, the consumables are paid by the users or private insurance. The replacement schedule for the consumables is manufacturer recommended, followed by the CPAP vendors and insurance payers. These include: mask, hose, filters, wipes, mask replacement cushions, water reservoir, tubing and distilled water. The O2Vent Optima also has additional costs for consumables: connector bands, antibacterial tablets for cleaning and ExVent valves.

Results
Initial CPAP price is $1,500; $1,085 with government subsidy. Yearly expenditure for the CPAP consumables is $1,330. Total cost for a 3- year and 5- year CPAP therapy is: $5,075 and $7,735 respectively. O2Vent Optima retails at $2,500 with the insurance payment, and $2,000 if paid out of pocket. The consumables cost $200/year. Total cost of O2Vent Optima at 3- year and 5- year is: $3,100 or $2,600 and $3,500 or $3,000 respectively. Over a 3- and 5- year period, O2Vent Optima resulted in a net saving of $1,975 and $4,235 over CPAP. Daily cost burden of CPAP at 3- and 5- year is $4.63 and $4.24 compared to $2.83 and $1.92 at 3- and 5- year with O2Vent Optima.

Conclusion
Therapy with CPAP compared to OAT with O2Vent Optima costs 165% more at 3 years and 220% more at 5 years. Based on this analysis, it is anticipated that private insurance payers in Canada will endorse a cost-effective and better tolerated therapy with novel oral appliance O2Vent Optima, in addition to the CPAP.

Support (if any)
This investigation was sponsored by Open Airway Dental Solutions Ltd. (OADS)