bluuebunny/crossref_metadata_2025_split huggingface dataset:
0528 Use of Inpatient Sleep Studies Decreases Time to Treatment in Patients with Obstructive Sleep Apnea (OSA)
Authors: Molin Nicole , Schonewald Brian , Lev Yair , Fast Zhanna 
Published: April 2024

Abstract

Introduction
OSA remains underdiagnosed in the general population and when left untreated, can have an effect on chronic illnesses including exacerbation of disease processes, potentially increasing hospitalization. The diagnosis of OSA in patients admitted to the hospital is important, however the time from hospital discharge to sleep study and then to OSA treatment can be prolonged. We aim to assess differences in outcomes between hospital admitted patients who undergo OSA workup during admission vs in the outpatient setting .

Methods
retrospective chart review with prospective component

Results
65 patients included all seen by sleep medicine service while admitted to the hospital and required workup for OSA; 57 received outpatient workup- 11/57 completed their sleep study (19%), all of which were prescribed PAP therapy for OSA. 2/57 (3.5%) had subsequent follow up by 6 months. Average time to diagnosis was 46 +/- 48 days and time to CPAP prescription was 56 +/- 53 days. 8 patients underwent inpatient OSA workup. All obtained a sleep study while in the hospital within 1 day of the consult; 6/8 were diagnosed with OSA all of which had the process started for CPAP set up within 2 days of sleep study. The time to diagnosis and start to treatment process was significantly less than the outpatient group (p&lt; 0.05). We are currently collecting data on long term health outcomes for these patients.

Conclusion
Inpatient sleep studies for OSA work up has the potential to decrease time to OSA diagnosis and time to treatment for patients. This new workflow may have the potential to improve long term health outcomes.

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0530 Rem-dependent Obstructive Sleep Apnea: Prevalence, Associated Comorbidities and Polysomnographic Characteristics
Authors: Rosa Cintia Felicio Adriano , Boldt Marcela Souza , Borgio João Guilherme , Zanatta Alessandra , Passos Pedro Henrique Vicari , Soares Victor Henrique Dominiak , Alves Matheus Roberto Schetz , Minniti Enrico Guido Oliveira , Rosa Ordival Augusto 
Published: April 2024

Abstract

Introduction
Obstructive Sleep Apnea (OSA) in the REM phase is a phenotype whose prevalence varies between 10% and 36% of patients with OSA, it is more common in women, especially those under 55 years of age. Characterized by muscle relaxation, sympathetic activation, hypoxemia and sleep deprivation, this type of OSA can increase metabolic and cardiovascular risks. This study seeks to understand, through a large population sample, how gender influences REM OSA and its relationships with other comorbidities and risk factors.

Methods
The study performed a retrospective epidemiological analysis on patients who underwent polysomnography type 1 between January and December 2020. Participants were grouped based on the presence of REM OSA or NREM OSA, considering female gender. REM-OSA was defined by an AHI ≥ 5, with the REM AHI being twice or more of the NREM AHI, with a NREM AHI &lt; 15. Comorbidities such as hypertension, diabetes, among others, were identified through medical history. The analyzes used statistical tests such as correlations, Chi-square and Student's T test for different variables, with a significance level of 5%.

Results
The study involved 1,313 patients, 444 women and 869 men, with an average age of 47.28 years. The prevalence of REM OSA was 21.7%, women represented 50.7% of the sample. The average age of women in the REM OSA group was 48.8 years. BMI analysis showed a predominance of overweight and obesity. In the NREM OSA group, there was greater severity of apnea, associated with conditions such as obesity, hypertension and stroke, and a prolonged time with low saturation. On the contrary, the OSA-REM group showed less severity of apnea, fewer associations with comorbidities and distinct characteristics in REM sleep. However, the presence of diabetes was significantly higher in women with REM-OSA, regardless of AHI and age (9,10% versus 3,65% p 0,018).

Conclusion
The increased prevalence of diabetes in women subgroup witnh REM-OSA suggests potential implications and highlights the importance of evaluating both the presence of REM OSA and glycemic metabolism, even in female cohorts with less pronounced OSA.

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0531 Identifying Airway Collapse Patterns in OSA Using Nasal Pressure Signal as a Surrogate for Airflow Shape
Authors: Shum Axel , Pinto João Viana , Woodson B 
Published: April 2024

Abstract

Introduction
Identification of the site(s) and characteristics of upper airway collapse is important for treatment selection and optimization in patients with obstructive sleep apnea (OSA) for whom an alternative to PAP therapy is indicated. The most widely accepted approach to reliably evaluate the location and severity of upper airway collapse is through drug-induced sleep endoscopy (DISE). Analysis of airflow shapes has emerged as a potential future alternative to DISE. Specifically, prior investigations have identified associations between the contours of objective airflow measurements and DISE findings from simultaneous endoscopy. Since objective airflow measurements are not obtained during standard polysomnography, this study sought to evaluate for associations between DISE findings and nasal pressure measurements as a surrogate for airflow.

Methods
Nasal pressure measurements were obtained using a type III home sleep testing device during DISE for patients at a single institution as part of their workups for non-PAP therapy. Nasal pressure data were synchronized to endoscopic video recordings, and segments of airflow waveforms corresponding to specific DISE findings were visually screened.

Results
Twenty four adult study subjects with OSA were ultimately included in this investigation. Only a subset of previously-described airflow shape correlations were found to retain associations to DISE findings. Four airflow shape surrogates were found to consistently correlate with specific DISE findings. Findings that relied on flow amplitude were not able to be detected using other nasal pressure signal characteristics.

Conclusion
Nasal pressure signal shape has potential as a limited surrogate for airflow shape, and in this investigation it was found to retain associations to upper airway collapse patterns obtained via DISE in patients with OSA .

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0536 Patient Profiles and Treatment Patterns for Obstructive Sleep Apnea (OSA) in Germany: A Real-world Data Analysis
Authors: Shinde Shraddha , Lin Xiaoyu , Yin Can , Pettine Meghan , Adam Atif , Khare Swarna 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) impacts approximately 30% of 30–69-year-olds in Germany, however comprehensive real-world data on patient demographics, diagnostic pathway, and treatment patterns, remains limited. This study aims to analyze real-world data to characterize OSA patient profiles and their treatment journey within Germany.

Methods
Retrospective longitudinal analysis of German Statutory Health Insurance claims data, including 146,227 adults (≥18 years) diagnosed with OSA between 2012-2022. Data included patient demographics, clinical diagnoses, sleep study history, and treatments. Patients had a minimum six-month enrollment prior to OSA diagnosis or treatment.

Results
An analysis of 146,227 OSA-diagnosed patients reported a mean age of 58.6 years at the time of diagnosis, with males constituting 70.3% of this population. Although a majority had missing BMI data, among those recorded, approximately one-third had obesity category II-IV. Most common OSA-related comorbidities were hypertension, dyslipidemia, cardiovascular diseases, and type 2 diabetes. Majority underwent OSA diagnostic procedures like polygraphy (89.2%) and polysomnography (29.4%). Delving into treatment sequences for 84,246 patients, PAP emerged as the predominant initial therapy in 88% of patients. Alternatives like upper airway surgery (4.1%) and lifestyle modifications (0.8%) played a secondary role in the treatment landscape. Adherence patterns, evaluated among 74,605 patients on PAP therapy, showed that 95.7% were non-adherent within 12 months post-initiation. Lastly, intervals between sleep studies, diagnosis, and treatment commencement were analyzed for 80,931 patients. On average, there was a 23.3-month gap from the initial sleep study to OSA diagnosis. However, the subsequent gap from diagnosis to treatment was shorter, averaging 8.2 months, hinting at improved efficiency in care post-diagnosis.

Conclusion
These results reveal a substantial burden of OSA , particularly in older males with metabolic comorbidities. While PAP therapy is the predominant initial treatment modality, its effectiveness is undermined by a high non-adherence rate within the first year of treatment. This high rate of non-adherence coupled with the lengthy diagnostic delays underscores critical unmet need in the current OSA treatment paradigm.

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0541 Impact of Sleep Apnea Treatment on Cardiometabolic Parameters in a Large National Multi-Center Alliance Registry
Authors: Cardenas Wendy , Davis Lisa , Patel Shachi , Kosiborod Mikhail , Magwire Melissa , Aistrope Daniel , Fialkow Jonathan , Iluyomade Adedapo , Walia Harneet 
Published: April 2024

Abstract

Introduction
There is paucity of real-world data regarding the association of Sleep Apnea (SA) treatment and cardiometabolic parameters. We examined the association of SA subgroup (CPAP vs. non-CPAP users) and cardiometabolic factors in the Cardiometabolic Center Alliance multi-center registry.

Methods
Out of 1575 patients, baseline characteristics of 683 patients with SA stratified by CPAP use were compared using Student’s t-tests/Wilcoxon rank-sum test for continuous variables and chi-square/Fisher’s exact tests for categorical variables. Logistic regression model was used to assess the association of CPAP-use and cardiometabolic factors (Hb A1c, systolic blood pressure and diastolic blood pressure (SBP and SDB mmHg)), Triglycerides (TG) and BMI in unadjusted (Model 1) and after adjusting for age, sex, ethnicity, race, BMI (Model 2) and cardiac co-morbidities, medications, and medication adherence (Model 3).

Results
Overall, median (IQR) age was 65 years (58.0-71.0). 683 (43 %) had sleep apnea, and of those 447 (65%) were CPAP-users. Median age of CPAP-users compared to non-users was 66 years (60-71) vs, 63 years (55.5-71), and they were more likely to be male (275 (61.5%) vs. 112 (52.8%)), and white (398 (89%) vs. 163 (76.9%) (all p &lt; 0.05). Among CPAP users HbA1c, SBP, and DBP were 7.2% ± 1.5%, 128.2 ± 18.2, 72.9 ± 11.5; in non-CPAP users the corresponding values were 7.6% ± 1.9% (p=0.002), 131.1 ± 19.4 (p = 0.064), 76.0 ± 12.1 (p =0.002) respectively. Logistic regression showed that CPAP-use was associated with lower HbA1c (-0.31% (95% CI -0.59%, -0.04%), p =0.025) in Model 2 but not in Model 3 (-0.19% (95% CI -0.46%,0.08%), p=0.165). CPAP use was associated with lower SBP (-3.99 (95% CI -7.18, -0.8), p =0.014) and DBP (-2.52 (95% CI -4.45, -0.6), p=0.010) even after adjusting for multiple confounders in Model 3. Higher TG were observed (23.02 mg/dL (95% CI 1.03,45.01), p=0.04) in CPAP-users compared to non-CPAP users (Model 2). CPAP-users compared to non-users had higher BMI (1.14 (95% Cl 0.17, 2.65) p=0.026) Model 3.

Conclusion
In this multi-center registry of patients with cardiometabolic disease, sleep apnea was common, and CPAP use was associated with better control of several key risk factors.

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0545 Hypoglossal Nerve Stimulation: Does Higher Pre-Implantation PAP Pressure Result in Less Successful Outcomes?
Authors: Hodge Evan , Baran Caroline , Santiago Louis , Lee Ryan , Kaur Parampreet , Guglielmello Giuseppe , Narla Gowtham , Cohen David , Zheng Matthew , Ramzy Joseph 
Published: April 2024

Abstract

Introduction
Despite hypoglossal nerve stimulation (HNS) being an approved therapy for moderate to severe OSA, some patient’s do not have a favorable outcome despite meeting the inclusion criteria for the procedure. This study investigates whether higher pre-implantation optimal PAP pressure results in less successful HNS outcomes.

Methods
This is a single-center retrospective study of consecutive patients with moderate to severe OSA who underwent implantation of HNS at an academic medical center. The optimal pre-implantation pressure setting was derived from either PAP titration studies (optimal CPAP or EPAP pressure) or PAP therapy compliance reports (90th or 95th percentile CPAP pressure or 95th percentile EPAP pressure). Pre-implantation AHI was obtained from either a home sleep study or diagnostic sleep study. Post-implantation apnea/hypopnea index (AHI) was derived from polysomnography performed 3 months or later after device activation in all subjects. Success of HNS therapy was defined as either a reduction of the pre-implantation AHI by equal to or greater than 50% or a residual AHI &lt; 15. A Mann-Whitney nonparametric test was used to compare the distribution of pre-implantation PAP pressure between successful and unsuccessful HNS therapy.

Results
Fifty-one patients with HNS implanted between December 2021 and July 2023 were evaluated. 74.7% were male with a median age of 65 years (25th percentile 57 and 75th percentile 72) and median body mass index (BMI) of 29.4 (25th percentile 27.2 and 75th percentile 31.6). Median BMI of the HNS success group was 29.4 (n = 45, 25th percentile 27.4 and 75th percentile 31.6) and median BMI of the HNS not success group was 30.0 (n = 6, 25th percentile 26.8 and 75th percentile 33.2). Median pre-implantation optimal PAP pressure of the HNS success group was 11.2 cm H2O (25th percentile 8.7 and 75th percentile 14.25). Median pre- implantation optimal PAP pressure of HNS not success group was 9.2 cm H2O (25th percentile 5.6 and 75th percentile 15.5). There was no significant difference between optimal pre- implantation PAP pressure and HNS outcome (p = 0.3).

Conclusion
There was no statistically significant difference between optimal pre-implantation PAP pressure and HNS outcome.

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none
0547 Vil-tra
Authors: Aishah Atqiya , Kim Molly , Norman Daniel , Ojile Joseph , Gell Laura , Pho Huy , Taranto-Montemurro Luigi , Vena Dan , Azarbarzin Ali , Esmaeili Neda , Wellman Andrew , Sands Scott , Messineo Ludovico 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) poses deleterious health consequences. Pharmacotherapy is a promising alternative to the current standard of care; recently, a combination of the noradrenergic atomoxetine, with the antimuscarinic aroxybutynin reduced OSA severity. Atomoxetine has also proven to be efficacious in combination with the anti-depressant trazodone. However, atomoxetine is wake-promoting especially in the subgroup of poor CYP2D6 metabolizers, which may contribute to apnea cycling and reduced drug tolerability. Therefore, we investigated the effect of a potentially more manageable noradrenergic, viloxazine, with and without trazodone, on OSA severity.

Methods
Twenty-five patients with OSA (apnea-hypopnea index [AHI4] 10-45) aged 18-75 years were randomized to viloxazine 500mg, viloxazine/trazodone 500/75mg or placebo according to a double-blind, placebo-controlled, crossover study. Drugs were taken before bed, for two weeks each period, with a first week of run-in (viloxazine 200mg and/or trazodone 50mg) and a 1-week washout between periods. In-laboratory polysomnography was performed at the end of each crossover period. Mixed model analyses compared the effect of the combination vs. placebo on AHI4 (primary outcome), hypoxic burden, total sleep time (TST) and wake-after-sleep-onset (WASO; secondary outcomes). Tertiary analyses explored differences between the parameters above across all treatment arms, in addition to sleep architecture and subjective outcomes. Safety endpoints were also assessed.

Results
Viloxazine-trazodone reduced AHI4 (13 [6, 19] events/h] vs. placebo (53 %min/h, 28 events/h) and hypoxic burden (mean reduction (95% CI): 26 [14, 34] %min/h). The combination reduced TST [37 [13, 61] min) and increased WASO (26 [2, 49] min) vs. placebo. Viloxazine alone had a similar effect on OSA severity vs. placebo. However, its impact on sleep quality (TST -61 [-85, -37] min; WASO 41 [18, 64]) was accentuated vs. placebo. Both viloxazine and the combination worsened patient-reported outcomes vs. placebo; these changes seemed more pronounced on viloxazine alone vs. placebo. 6 patients terminated the study early, 5 due to adverse events. Commonly reported adverse events were insomnia, constipation, headache, and xerostomia. Both treatments slightly increased heart rate.

Conclusion
Viloxazine-trazodone combination may reduce OSA severity. Potential deleterious effects of viloxazine on sleep quality appear partly attenuated by concurrent trazodone.

Support (if any)
This study was funded by Apnimed.
0548 A 5-year Multi-center Real-world Study Evaluating the Effectiveness and Use of CAD/CAM 3D-printed OAT to Treat OSA
Authors: Woidtke Robyn , Gagnadoux Frederic , Kün-Darbois Jean-Daniel , Forcioli Jérôme , Ferret Claude , Clavel Robert , Griffet Benoît , Le Balc’h Morgan , Dupuy-Bonafé Isabelle , Recart Didier , Toubal-Biret Mirentchu , Micoulaud-Franchi Jean-Arthur , Fortin Martine , Sedki Mohammed , Trevillot Vincent 
Published: April 2024

Abstract

Introduction
Oral appliance therapy (OAT) treats a wide range of obstructive sleep apnea (OSA). This prospective, collaborative (physician/dentist) study will assess the primary endpoint of at least a 50% reduction in baseline apnea-hypopnea index (AHI) at five years with initial objective efficacy evaluation at three to six months. The Panthera D-SAD is a CAD/CAM, 3D-printed OAT. Patient- matched for fit and comfort. Changeable rods provide the mechanism for protrusion. This study fulfills French reimbursement requirements.

Methods
OAT naïve individuals with an AHI 15-30 or those with an AHI ≥ 30 who decline CPAP will be considered, meeting all other entry criteria. Fifteen centers in France will enroll an estimated 217 participants. Consecutive sampling will be used. Participants will be medically and dentally evaluated. The initial fitting will be at Visit 1 (V1). Standard of care for the study duration will be followed. Evaluation time points are three-six months (sleep testing/medical), six months (dental), and five years (both). Secondary endpoints include OAT side effects, oxygenation status, quality of life, self-reported adherence, and subjective symptoms at the aforementioned time points.

Results
Between April, 2022, and December, 2023, 171 subjects have had their sleep and orthosis evaluation for entry into the study (V0). The demographics for those who have completed V0 (n=171): averages (SD) age 49.7 (13.0); BMI 26.75 (4.81); baseline AHI of 22.2 (8.7), ODI 17.16 (11.92), SpO2 91.7 (2.18). This update summarizes data from the subset (n=76) with sleep testing (V2). At baseline, 92% of participants had moderate OSA. Sixty-three percent of all participants achieved at least a 50% AHI reduction. Sixty-two percent achieved an AHI &lt; 10. At V2, 84% severe and 87% moderate transitioned to a lower severity category. For moderate, 21% reached the normal category. Eighty-seven percent reported weekly use at V2 (n=62) for seven nights/week, and 97% indicated they used the device for ≥ 4 hours a night. Only 2.3% of participants stopped wearing the device.

Conclusion
This updated data demonstrates a high OAT acceptance and comfort rate for patients. Preliminary data are tracking well for reducing total AHI and migrating to a less severe AHI category.

Support (if any)
Panthera Dental Inc
0549 Non-Permanent Oral Appliance Treatment of Severe Obstructive Sleep Apnea
Authors: Kushida Clete , Cozean Colette , Alexander Jonathan 
Published: April 2024

Abstract

Introduction
The FDA recently cleared the first OSA treatment by oral appliances (mRNA, mmRNA, and DNA, Vivos Therapeutics, Littleton, CO). These appliances are designed to be worn 6-24 months and use slow maxillary expansion (DNA) combined with mandibular advancement (mRNA/mmRNA) to increase upper airway volume and improve OSA.

Methods
This retrospective analysis used a research database initiated in 2018 incorporating real world data from treating dentists for these devices to September 2023. Database contains pre-/posttreatment (without the oral appliance) AHI, transpalatal width (TPW), airway volume (AV) via cone beam computed tomography, and safety data. Study inclusion criteria were adults with severe OSA (AHI&gt;30), mRNA (includes mmRNA)/DNA treatment, and pre-/posttreatment AHI &gt; 6 months apart; exclusion criterion was no safety data. Co-primary endpoints were pre- to posttreatment AHI and TPW improvement; secondary endpoints were pre- to posttreatment AV improvement and safety measures.

Results
Seventy-three severe OSA patients (36 mRNA/37 DNA) were compared to 35 moderate OSA patients (12 mRNA/23 DNA). Severe OSA: 38 men/35 women, Age 56.3±10.8years, Treatment Duration 15.6±7.2months, Appliance Adherence 11.9±2.6hours. Moderate OSA: 15 men/20 women, Age 48.9±11.7years, Treatment Duration 13.0±6.0months, Appliance Adherence 12.4±2.5hours. For severe OSA patients, pre-treatment vs. posttreatment AHI, TPW, and AV were found to significantly decrease 46.1±15.1 to 21.7±14.8 (-50.8%, p&lt;.00001), increase 33.2±3.5 to 35.5±3.7mm (+7.2%, p&lt;.00001), and increase 20479±7991 to 23767±9191mm3 (+16.6%, p&lt;.00001), respectively. For moderate OSA patients, pre-treatment vs. posttreatment AHI, TPW, and AV were found to significantly decrease 21.6±4.5 to 12.0±10.5 (-44.4%, p&lt;.00001), increase 32.9±2.8 to 35.1±2.9mm (+6.6%, p&lt;.00001), and increase 21598±6260 to 24364±6033mm3 (+12.8%, p&lt;.005), respectively. Severe OSA patients who wore mRNA and DNA appliances decreased their AHI by 55.6% and 46.2% and reduced their AHI classification by 1 or improved their AHI by 50% were 81% and 78%, respectively. No significant safety issues were observed.

Conclusion
Historically, oral appliances were indicated for those with mild-moderate OSA; this study showed that severe OSA patients had more improvement in AHI, TPW, and AV vs. those with moderate OSA. Results were slightly better for patients with DNA vs. mRNA, demonstrating that the primary improvement mechanism is maxillary expansion with persistent treatment effects without the appliance in place.

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