bluuebunny/crossref_metadata_2025_split huggingface dataset:
0605 Temporomandibular and Oral Parafunction as Risk Factors for Jaw Pain Related to Oral Appliance Therapy
Authors: Hamza Amina , Giri Subha , Morgenthaler Timothy 
Published: April 2024

Abstract

Introduction
Oral Appliance Therapy (OAT) is a management option for patients with Obstructive Sleep Apnea (OSA). A reported drawback to OAT is symptoms relating to Temporomandibular Joint Disorder (TMD), including post-procedure jaw pain. Some studies reported TMD in over 50% of patients prior to OAT. The aim of this study was to evaluate the prevalence of TMD and oral Parafunction Habits (PFH) in patients with OSA referred for OAT, and determine any relationship between patient characteristics, demographics, medical history, and degree of OAT advancement with post-procedure jaw pain.

Methods
A retrospective analysis was conducted, reviewing the electronic health records of 125 patients with OSA referred to the division of dental sleep medicine in Mayo Clinic Rochester, for OAT. Records reviewed included patient demographics, TMD-PFH symptoms and signs before and after initiation of OAT, self-reported history of, and signs of PFH, AHI pre-initiation of OAT, presence of fibromyalgia, SSRI use, and percent advancement of appliance at time of re-evaluation.

Results
The median age of patients reviewed was 58 (Interquartile Range (IQR) 20), median BMI 30.5 (IQR 7), median AHI 11.3 (IQR 9.5). 57% were male, 43% female. 20.8% patients had TMD history, 37.6% had TMD signs, 47.2% had PFH history (jaw clenching, lip biting, and/or thumb sucking). 96% had signs of PFH. 15.2% reported post-procedure jaw pain. There was a statistically significant relationship between both TMD history and TMD signs, with post-procedure jaw pain (p value 0.002 and 0.013 respectively), although after multi-variate analysis, only TMD history remained associated with post-procedure jaw pain (Odd’s Ratio 3.385, 95% Confidence Interval 1.081 – 10.601, p value = 0.036). Age, BMI, gender, PFH signs and history, SSRI use, fibromyalgia history, % advancement of OA had no statistical association with post-procedure jaw pain.

Conclusion
Having a history of TMD symptoms prior to OAT is a risk factor for post-OAT jaw pain. A thorough oral and maxillofacial history in patients being considered for OAT is important to identify patients with TMD history, to establish a clear path to initiate OAT and to closely monitor, reduce or potentially eliminate the reported side effect.

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0609 Improved Sleep Quality with Expiratory Positive Airway Pressure Enhanced Mandibular Advancement Device in OSA
Authors: Sharma Sat , Metwali Rami Al , Conflitti Antonella , Reiter Hilary 
Published: April 2024

Abstract

Introduction
The ExVent is an optional accessory to the O2Vent Optima mandibular advancement device (MAD) and provides oral Expiratory Positive Airway Pressure (EPAP). Oral EPAP with the ExVent is designed to provide upper airway support via similar mechanisms of action of nasal EPAP devices in commercial distribution, e.g., passive dilatation of the airway, which reduces flow limitation. The oral EPAP provided by the ExVent accessory augments the OSA therapy provided by the O2Vent Optima. Long-term benefits on sleep quality and daytime functioning with combination therapy have not been studied.

Methods
We conducted a retrospective survey of all patients who were prescribed O2Vent Optima mandibular device and oral expiratory positive pressure accessory in Canada and Australia from 2019 to November, 2022. A study investigator contacted the participants via telephone and obtained consent to participate. Data collected included: demographics, duration of use, frequency of use, daytime sleepiness, bed partner reported snoring, sleep satisfaction, morning and daytime functioning, daytime tiredness/fatigue and bed partner’s sleep.

Results
Out of the patient data base of 480 subject, 168 (35%) participated. 31 (18%) stopped using the appliance. Out of 137 (81%) subjects, 118 (86%) were still using the ExVent Accessory, 92% medium strength (Yellow). Age 53±7 yrs, 76% Male. Data showed mean duration of use 2.7±0.9 years, mean frequency of use - most nights (91%), use &gt;6 hours/night (86%). Sleep quality was compared from before to after therapy. Daytime sleepiness improved to none/mild from moderate/severe (96%). Bed partner reported snoring improved to none/mild from moderate/severe (94%). Participants slept very well/reasonably well compared to not well/not well at all (82%), woke up more refreshed most mornings compared to some/rare mornings (86%), functioned very well/reasonably well to not well/not well at all (88%), felt fatigue and tiredness none of the time compared to some/all the time (83%), bed partner’s sleep interruption was none/some of the time from all the time (95%).

Conclusion
This retrospective study demonstrated that majority of subjects prescribed EPAP enhanced MAD with O2Vent Optima and ExVent were compliant, experienced improved sleep quality, daytime functioning and their partner’s sleep was significantly less interrupted.

Support (if any)
Centre for Sleep and Chronobiology, Toronto, Canada
0610 Mouth Taping, Nighttime Exercises, Acupuncture and More: Who Seeks out Solutions to Stop Snoring?
Authors: Gorovoy Suzanne , Grandner Michael 
Published: April 2024

Abstract

Introduction
Snoring affects roughly 90 million Americans. Although snoring may indicate a serious health condition such as obstructive sleep apnea, most people attempt to manage snoring using alternative over-the-counter strategies. The present study examined the use patterns of alternative strategies across sociodemographic factors.

Methods
Data were obtained from households in the USA, UK, and Australia that had attempted to stop snoring using alternative strategies (N=4,346). Variables of interest included age, sex, race/ethnicity, country, employment, urban environment, and prior diagnosis of sleep apnea, chronic pain, depression, or anxiety.

Results
Older age was generally associated with using extra pillows, humidifier, cutting alcohol, nasal strips/stents, nasal sprays, saline rinses, and sewing a tennis ball into a shirt. Males were more likely to use honey/lemon, change sleeping position, Vaseline on the nose, snoring exercises, tennis ball, and nighttime exercise, and less likely to use extra pillows. Hispanics/Latinos were more likely to use honey/lemon, anti-snore pillows, snoring exercises, mouth taping, saline rinses, nighttime exercise and cutting alcohol; Blacks/African-Americans were less likely to use nasal strips/stents or sprays and more likely to use nighttime exercise; Asians were more likely to use mouth taping; Native/Indigenous groups were more likely to change sleeping position, use snoring exercises, and increase water intake at night. Australians were more likely to use extra pillows, hot showers, and nighttime showers and exercise. People from the UK were less likely to use humidifiers, nasal strips/stents, nighttime showers, or hot showers. Urban individuals were more likely to use acupuncture, Vaseline, snoring exercises, mouthguards, and mouth taping. Rural individuals were less likely to employ nearly all of the approaches. Employed individuals and those with a history of sleep apnea, chronic pain, depression, and/or anxiety were more likely to employ nearly all of the strategies.

Conclusion
Alternative strategies for managing snoring varied across demographic groups. Males, older adults, and those with a history of chronic pain, obstructive sleep apnea, depression, and/or anxiety were more likely to utilize a wider array of strategies. Future work should explore whether people who use specific alternative strategies are more likely to have an undiagnosed condition such as obstructive sleep apnea.

Support (if any)
Rhinomed Ltd; #R01DA051321
0611 Gamification of Digital Oropharyngeal Exercises Improves Therapy Adherence in OSA Patients
Authors: Goswami Umesh , Krohn Brian 
Published: April 2024

Abstract

Introduction
OSA is caused by the interaction of impaired upper airway anatomy and dysfunctional upper airway muscle response to airway narrowing during sleep. Oropharyngeal exercises focused on training upper airway muscles are effective in reducing OSA severity and symptoms. However, similar to other physical therapy programs, oropharyngeal exercises require patients to complete multiple therapy sessions which affects patient compliance. To address this, we developed a smartphone application to provide oropharyngeal exercise and tested the effect of adding gamification and habit formation techniques on therapy adherence.

Methods
The experimental app which included oropharyngeal exercise therapy administered using voice-controlled games, a reward system, a reminder system, and supportive video content was compared to the control app that included text-based exercise therapy instructions and limited video content. Participants with mild to moderate OSA were randomly assigned (1:1) to either group. Demographics, sleep apnea variables, therapy progress, self-reported snoring severity questionnaires were collected for both groups. Appropriate descriptive statistics were used to summarize baseline and outcome data.

Results
30 participants (13 male), mean age 60.7 ± 11.1 years were randomized equally to the experimental and control groups. 9 participants (6 in the experimental group and 3 in the control group) were unable to complete the study due to technical challenges with the apps and were excluded from analysis. No statistically significant differences were noted in either group’s baseline demographic and OSA measures. 7/9 (78%) participants in the experimental group vs 7/12 (58%) in the control group met the prespecified compliance thresholds for the 8 weeks therapy period. Self-reported snoring severity mean scores were significantly reduced in the experimental group (from 2.86 to 1.43, p-value 0.04) compared to the control group (from 2.14 to 1.77, p-value 0.21).

Conclusion
Addition of gamification and therapy monitoring techniques improve compliance to the prescribed oropharyngeal exercises in patients with OSA. Further studies are needed to establish the efficacy of gamified oropharyngeal therapy in the treatment of OSA.

Support (if any)
Research reported in this abstract was supported by NHLBI of the NIH under award number: R43HL152948-01.
0613 Referral Patterns for Sleep Surgery in Patients with Obstructive Sleep Apnea
Authors: Ramprasad Vaibhav , Tsai Sheila , Schell Amy , Green Katherine 
Published: April 2024

Abstract

Introduction
Surgical management of Obstructive Sleep Apnea (OSA) is utilized in patients unable to tolerate positive airway pressure (PAP). The American Academy of Sleep Medicine (AASM) recently published guidelines for referral for surgical consultation. The aim of this study was to characterize surgical referrals from an academic sleep medicine practice.

Methods
A retrospective chart review was conducted of 249 patients referred for sleep surgery from a sleep medicine practice from 01/01/2016 to 01/01/2023. All patients were initially evaluated by a sleep medicine provider at National Jewish Hospital. All patients considering sleep surgery were referred to the University of Colorado. A total of 142 patients (57.0%) completed at least one visit for surgical consultation. Demographics, polysomnographic parameters, details from evaluation in sleep surgery clinic and eventual surgical treatment were assessed. Pearson chi-square test, fisher exact test were utilized for ordinal variables. Analysis of variance and student t tests were utilized for continuous variables to determine statistically significant relationships with P&lt; 0.05.

Results
Those completing a surgical visit were older at time of referral with mean (SD) age 59.0 (14.0) compared to 54.4 (14.5). Of patients referred for surgery, 24 (8.4%) had BMI&gt;40, 43 (19.7%) had AHI&lt; 15 and 27 (10.8%) had AHI&gt;65. The majority, 107 of 142 (75.4%), of patients completing surgical evaluation did not undergo eventual surgery. Of the non-surgical cohort, 49 (45.8%) underwent a repeat trial of PAP, 22 (20.6%) had repeat sleep testing and 10 (9.3%) underwent trial of oral appliance therapy.

Conclusion
Sleep surgery is a viable alternative to management of OSA. In this study, a large proportion of patients originally referred for surgical evaluation did not complete follow up. Furthermore, the majority of patients seen in surgical clinic did not necessarily undergo surgery for OSA. Non-surgical modalities remained an option for patients with sleep surgery referral and likely enhanced decision-making by informing patients of risks and benefits of both surgical and non-surgical management. Further efforts should be made to understand reasons for incomplete follow-up or pursuit of non-surgical options to optimize surgical referrals for OSA.

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0618 Phrenic Nerve Stimulation for Central Sleep Apnea: A Single Institution Experience
Authors: Knapp Sarah , Van Dongen Kimberly , Khan Meena , Mease Julie , Augostini Ralph , McKane Scott 
Published: April 2024

Abstract

Introduction
Central sleep apnea (CSA) is a form of sleep disordered breathing where there is a lack of drive to breathe during sleep. CSA has been associated with symptoms of poor sleep and daytime sleepiness. Moderate to severe CSA (central apnea index (CAI) &gt;=15 central apneas/hour of sleep) has been associated with increased risk of heart failure, depressed heart rate variability, and higher incidence of nonsustained ventricular tachycardia [2-4]. Treatment of CSA has mainly centered around positive airway pressure (PAP) therapy. Phrenic nerve stimulation (PNS) was approved in 2017 for moderate to severe CSA. PNS is an implantable device that transvenously stimulates the phrenic nerve in order to stimulate the hemidiaphragm. PNS therapy was approved after the remedē System Pivotal trial that showed a ≥ 50% reduction in AHI and improvement in patient global assessment scale in patients with moderate to severe CSA [12].

Methods
This is a retrospective analysis of patients ≥ 18 years of age who had PNS implanted for moderate to severe CSA at the OSUWMC. Patient data was gathered prior to implant and at a follow-up visit one year after implant to assess efficacy and safety. Data collection including sleep study results, Epworth Sleepiness Scale (ESS) scores, and Functional Outcomes of Sleep Questionnaire (FOSQ) scores were assessed at baseline and one-year post-implant.

Results
Twenty-two patients were implanted with PNS at OSU between February 1, 2018 and May, 31, 2022. The AHI improved from a median of 40 events/hour at baseline to 18 at follow-up (p-value =0.003). This improvement in AHI was primarily from a reduction in the CAI, which was reduced from 16 events/hour to 2 events/hour (p-value of 0.001). The obstructive apnea index, mixed apnea index, and hypopnea index did not significantly change. The ESS scores improved from a median score of 12 to 9 (p-value =0.028). The FOSQ, improved from 15.0 to 17.8 but was not significant (p-value of 0.086).

Conclusion
PNS therapy shows improvement in overall AHI, primarily from the reduction of central apnea events. There was also significant improvement in ESS and a trend to improvement in FOSQ at one-year follow-up. Minimal safety concerns were reported.

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0620 Effect of Tirzepatide on Weight Loss in Patients with Obstructive Sleep Apnea and Obesity from SURMOUNT-1
Authors: Grunstein Ronald R , Taylor Rebecca , Shinde Shraddha , Dunn Julia P , Bednarik Josef , Stefanski Adam , Falcon Beverly 
Published: April 2024

Abstract

Introduction
Obesity has been estimated to be prevalent in 70% of patients with obstructive sleep apnea (OSA). In SURMOUNT-1, phase 3, 72-week, randomized, double-blind clinical trial in participants with obesity or overweight, those treated with tirzepatide achieved significantly greater weight reduction than placebo. Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. The current post-hoc analysis assessed efficacy of tirzepatide versus placebo on weight reduction in participants with OSA and obesity or overweight.

Methods
MMRM analysis was conducted in SURMOUNT-1 participants reporting a baseline medical history of “apnoea”, “positive airway pressure therapy” or “sleep apnoea syndrome”. Weight loss measures were assessed in participants on treatment (efficacy estimand) using the modified intention-to-treat analysis set (participants who received at least one dose of study drug (tirzepatide 5mg, 10mg, 15mg, or placebo)).

Results
There were 197 participants with OSA included in this analysis (tirzepatide 5mg n=41, 10mg n=51, 15mg n=46, and placebo n=59), with baseline age of 48-53 years, body weight 110-122 kg, BMI 39-43kg/m2, presence of hypertension 48-73%, and proportion of females 42-53%. At week 72, estimated treatment difference between tirzepatide and placebo in mean percent weight change was -11.2% (5mg), -18.2% (10mg), and -20.7% (15mg), all P&lt; 0.001. Significantly more participants treated with tirzepatide achieved ≥5% body weight reduction (83-98% treated with tirzepatide, 25% with placebo) and ≥10% body weight reduction (46-93% treated with tirzepatide, 15% with placebo) than those treated with placebo (all P&lt; 0.001). 27-62% of participants treated with tirzepatide achieved ≥20% body weight reduction compared to 0% in the placebo group (tirzepatide 5mg P=0.006, 10mg and 15mg P&lt; 0.001). All doses of tirzepatide significantly reduced waist circumference from baseline to week 72 (-10.6cm, -18.2cm, -18.9cm, all P&lt; 0.001). Placebo did not significantly reduce waist circumference at week 72 compared to baseline (-3.5cm, P=0.053).

Conclusion
Participants with OSA and obesity or overweight treated with tirzepatide had significantly greater weight reduction than those treated with placebo in the SURMOUNT-1 trial. This degree of weight loss would be expected to have a clinically meaningful impact on OSA severity and is being investigated in the SURMOUNT-OSA trial.

Support (if any)
Eli Lilly and Company.
0623 Effects of Nasal and Upper Airway Surgery on Pharyngeal Collapsibility in People with Obstructive Sleep Apnea
Authors: Osman Amal , Eckert Danny , Carney Andrew , Ooi Eng , Joshi Himani , Nguyen Phuc , Catcheside Peter 
Published: April 2024

Abstract

Introduction
Upper airway surgery reduces obstructive sleep apnea (OSA) severity. However, therapeutic efficacy varies between patients and inter-individual effects on upper airway physiology post-surgery are not well characterized. Nasal surgery alone may help facilitate breathing and CPAP delivery but would not be expected to yield major reductions in upper airway collapsibility per se. Accordingly, this study aimed to assess changes in upper airway collapsibility following nasal and upper airway surgical procedures.

Methods
People with OSA attended the sleep laboratory prior to and ≥3 months following nasal or upper airway surgery. At each visit, airway collapsibility via the upper airway collapsibility index (UACI) technique was assessed just prior to sleep and OSA severity was quantified during overnight polysomnography. To quantify the UACI, participants were instrumented with pressure sensors at the choanae and epiglottis, a sealed nasal mask and pneumotachograph. They were studied awake (verified via EEG) and supine. Brief (250ms) negative pressure pulses were delivered during early inspiration and early expiration (~-12cmH2O at the mask) every 2-10 breaths. The UACI, which correlates well with the critical closing pressure (Pcrit) during sleep, was quantified as the percent difference between nadir choanal and the corresponding epiglottic pressure to ~20 negative pressure pulses.

Results
7 participants (2 female), aged 47±12years, BMI 29±2kg/m2 with severe OSA had either upper airway surgery (uvulopalatopharyngoplasty combined with coblation channelling of the tongue, n=4) or nasal surgery alone (n= 3). Participants with upper airway surgery had a 58% reduction in upper airway collapsibility (40±18 vs. 17±22%, p=0.049) during early inspiration with similar improvements during expiration (63±9 vs. 38±30%, p=0.01). For nasal surgery only, upper airway collapsibility was not systematically different during early inspiration or expiration.

Conclusion
These preliminary findings indicate major improvements in upper airway collapsibility during wakefulness following upper airway surgery but no systematic changes with nasal surgery alone. Further application of these physiological measures may help explain between patient differences in therapeutic efficacy with upper airway surgery and assist with patient selection to improve treatment success rates.

Support (if any)
DJE reports funding from the National Health and Medical Research Council, Australia (1065571).
0625 Prevalence of Subjective Longer Sleep Times and Sleepiness in Patients Evaluated at a Tertiary Medical Center
Authors: Chen Xindi , Ruoff Chad , Buras Matthew , Carvalho Diego 
Published: April 2024

Abstract

Introduction
The ICSD-3-TR defines idiopathic hypersomnia in terms of objective sleep times as sleeping at least 11 hours using 24-hour polysomnography or wrist actigraphy averaged over at least 7 days. Published studies on sleep duration are generally limited by lower sleep duration cut-offs (e.g., ≥ 9 hours), so prevalence data on longer sleep durations are missing. This study used clinical questionnaire data from Mayo Clinic patients to characterize longer sleep times and excessive daytime sleepiness in this population.

Methods
We retrospectively identified patients who answered questions about subjective sleep times and excessive daytime sleepiness, using the Epworth Sleepiness Scale (ESS), as part of their evaluation in a sleep clinic across the Mayo Clinic Enterprise from 2017 to 2023. Demographic data and sleep disorder diagnoses were then analyzed.

Results
Patients (N=25,480) with subjective nocturnal sleep times of ≥ 9 (n=2721, 10.7%), ≥ 10 (n=1059, 4.2%), and ≥ 11 hours (n=349, 1.4%) had an ESS ≥ 10 in 33.5%, 41.0%, and 51.3% of the time, respectively. 3.6% (age 53.2±19.7; 58.9% female), 1.7% (age 53.1±20.4; 58.1% female), and 0.7% (age 49.8±19.9; 58.1% female) of the patients reported an ESS ≥ 10 and subjective nocturnal sleep times of ≥ 9, ≥ 10, and ≥ 11 hours per night, respectively. After adjusting for age and sex, patients with more than one diagnostic entry compared to those with one or fewer diagnostic entries for idiopathic hypersomnia with long sleep time (OR=12.75, 95% CI [6.09, 24.52], p&lt; 0.001) and narcolepsy with cataplexy (OR=5.53, 95% CI [1.31, 15.84], p=0.005) were significantly more likely to report ESS ≥ 10 and subjective nocturnal sleep times ≥ 11 hours per night.

Conclusion
Less than 1% of patients presenting to a Mayo Clinic sleep specialist have self-reported metrics (i.e., ESS ≥ 10 and subjective nocturnal sleep times ≥ 11 per night) consistent with basic clinical features of idiopathic hypersomnia with long sleep time. Additional data analyses (e.g., comorbid conditions, social history, and laboratory results) are underway.

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