bluuebunny/crossref_metadata_2025_split huggingface dataset:
1071 Knowledge and Attitudes Regarding Obstructive Sleep Apnea Among Pulmonologists in South Korea: A Survey Study
Authors: Park Sunmin , Kim Seiwon 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) has known associations with cardiovascular and metabolic conditions and is increasingly recognized in chronic lung diseases like COPD and IPF. In South Korea, OSA patients receive care from various specialties, but pulmonologists' involvement is limited. This study aimed to assess the knowledge and attitudes of pulmonologists in South Korea regarding OSA.

Methods
An online survey was conducted in February 2023, targeting all registered respiratory specialists listed in the online directory of the Korean Academy of Tuberculosis and Respiratory Diseases. The survey utilized the "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA), a previously validated instrument. Three email invitations were sent to potential participants to encourage survey participation.

Results
A total of 127 pulmonologists (20.0%) completed and returned the questionnaires. The mean age of respondents was 45.4 ± 8.6 years, with 68.5% being male. Additionally, 71.7% of respondents were affiliated with university hospitals, and 79.5% were working in hospitals with more than 500 beds. The median total knowledge score was 15.0 [13.0;16.0], and the overall proportion of correct answers was 0.8 [0.7;0.9]. Notably, pulmonologists who had experience in managing OSA patients exhibited significantly higher knowledge and attitude scores than their counterparts without such experience. Furthermore, those with OSA treatment experience demonstrated more confidence in OSA screening, OSA diagnosis, and continuous positive airway pressure (CPAP) therapy management. Interestingly, attitude scores tended to be higher among older respondents and those who graduated from medical school and completed pulmonology specialist training earlier in their careers.

Conclusion
The knowledge levels of South Korean pulmonologists regarding OSA were found to be comparable to or better than those reported in previous studies. Nevertheless, there remains a need for targeted education and practical exposure to OSA management, especially for younger respiratory physicians, to enhance their proficiency in treating OSA patients effectively.

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1076 Feasibility of Sleep Staging EEG Acquired by a Dry-electrode Wearable Device Using a PSG-trained Algorithm
Authors: Cakir Ahmet , Josephs David , Kleinschmidt Dave , Guillot Antoine , Pathmanathan Jay , Donoghue Jacob , Chan Alexander 
Published: April 2024

Abstract

Introduction
Sleep monitoring hardware that allows for accurate sleep staging while also being unobtrusive and self-administered has the potential to make reliable EEG-based assessment of sleep quality at home widely accessible. However, for novel hardware utilizing dry EEG electrodes, a question remains regarding the similarity of these signals to traditional polysomnography (PSG), especially when used for therapy development. Here, we investigate how well EEG signals from a wearable dry electrode system can be sleep staged by an algorithm trained on traditional PSG.

Methods
The Dreem 3 headband, a low-profile sleep monitoring device with dry electrode EEG sensors, was used simultaneously with overnight PSG in 75 individuals. A machine learning model that was trained to stage sleep from the EEG signals of PSG, SleepStageML™, was run without modification on both the PSG and headband EEG signals. Each PSG recording was independently staged by 3 registered polysomnographic technologists to generate consensus ground-truth sleep stage labels. We compared the algorithmic performance of the sleep stages generated from the PSG signals to that of the sleep stages generated from the synchronously recorded headband data.

Results
Staging of PSG signals resulted in per-stage positive-percent-agreements (PPAs) of 92.4% for W, 58.4% for N1, 90.7% for N2, 76.0% for N3, and 92.9% for R. Negative-percent-agreements (NPAs) for these stages were 98.6%, 98.1%, 88.4%, 97.5%, and 98.4% respectively. When staging the headband recordings, performance remained high with PPAs for W, N1, N2, N3, and R of 94.4%, 34.7%, 88.2%, 78.6%, and 83.7% and NPAs of 96.2%, 98.9%, 86.5%, 96.3%, and 98.4% respectively. Cohen's Kappa on PSG signals was 0.82, and 0.77 on headband data.

Conclusion
We demonstrate that the EEG signals from a dry-electrode sleep monitoring system are similar enough to the EEG signals of a traditional PSG that an algorithm trained to stage PSG can also stage these dry-electrode signals. These results suggest that dry electrodes configured in a comfortable headband montage can capture clinical grade EEG useful for sleep staging with existing paradigms. These findings are promising for the broader investigation of cerebral functioning in sleep pathology, and could simplify the development of sleep biomarkers of neuropsychiatric disease.

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1078 Performance of USleep Algorithm to a Better Than “Gold-Standard” Polysomnogram Validation Data Set
Authors: Hanif Umaer , Jubien Guillaume , Cairns Alyssa , Radke Tammie , Mysliwiec Vincent 
Published: April 2024

Abstract

Introduction
Algorithm based PSG scoring is increasingly used in clinical practice and research. Currently, there is no accepted PSG validation data set to ensure algorithms are developed from an accepted standard; thus algorithm-based scoring has inherent inaccuracies. The purpose of this study was to evaluate the inter-rater agreement between three experienced sleep technicians to develop a PSG validation data set with a high interscorer reliability and compare performance of the USleep algorithm to the PSG validation data set.

Methods
One-hundred de-identified PSGs from a clinical database with 55 males and 45 females were independently scored by three different technicians and each record was quality controlled by a lead technician. The data set encompassed all sleep-related events: sleep stages, apneas, hypopneas, desaturations, arousals, and PLMs. Consensus annotations were computed when at least two technicians agreed upon a given event. The performance of each technician was compared against the consensus annotations. USleep was evaluated on the validation data set and the performance with respect to sleep stages was compared against the consensus annotations.

Results
The inter-rater agreement was 96.0% for sleep stages across all epochs, which did not greatly differ between N1 (88.3%), N2 (97.3%), N3 (94.2%) and REM sleep (98.1%). The inter-rater agreement across all records was 88.9% for arousals, 84.0% for obstructive apneas, 80.2% for central apneas, 76.4% for mixed apneas, 89.4% for hypopneas, 94.9% for desaturations, and 81.3% for PLMs. Comparing USleep to the consensus yielded an accuracy of 78.3%, with differences between N1 (46.2%) and N2 (76.8%), but not N3 (99.3%) and REM sleep (92.1%).

Conclusion
This data set has high accuracy for sleep stages. The USleep algorithm showed poor performance for N1 and moderate for N2, but high for N3 and REM. Frequently scored PSG measures to include arousals, hypopneas and obstructive apneas had high degrees of accuracy; however, this decreased for central and mixed apneas. This dataset can serve as a benchmark for developing and validating algorithms in PSG scoring for sleep stages and certain PSG measures. Further development is required to provide basis for a comprehensive PSG validation data set.

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1080 The Sleep Physiological Change with Light Interventions in Adolescents - A Magnetic Resonance Spectroscopy Study
Authors: Lu Tsung-Hua , Yang Ya-Ting , Yang Yen-Kuang , Wang Jeen-Shing , Lin Shih-Hsien 
Published: April 2024

Abstract

Introduction
The good sleep quality contributes to the better emotion and cognitive functions. A significant portion of adolescents in Asia shows insufficient sleep quality, which impacts the emotion such as depression and anxiety. The bright light exposure could regulate sleep and mood. The aim of this study was to figure out the sleep and emotion change after artificial bright light intervention in female senior high students, by the measurements of salivary melatonin, polysomnography and magnetic resonance spectroscopy.

Methods
There were two classes of the same senior-high school enrolled in and assigned to the control group and experimental group. During the middle to the end of semester, the students in the control group received basic sleep education. The students in the experimental group received artificial bright light exposure (500 LUX, 5000K) in the classroom from 8:00 AM to 12:00AM every morning for total 58 days. The students in the two classes had the same persistent academic stresses during this period. We randomly selected eight students from the control group and seven students from the experimental group without any diagnosis of mental disorders. Before and after the interventions, Pittsburgh Sleep Quality Index(PSQI), Hospital Anxiety and Depression Scale(HADS) were measured for sleep quality and emotion, salivary melatonin for the dim-light melatonin onset, polysomnography for sleep parameters, and brain magnetic resonance spectroscopy for excitatory/inhibitory ratio(E/I ratio). Correlation analysis was conducted to probe the association between these variables. ANOVA tests were used to examine group differences before and after the intervention.

Results
Before the intervention, these two groups showed no significant difference in the above variables. The scales for anxiety showed significantly negative correlation with sleep phase angle from all these participants. After the bright light intervention, the change of HADS showed no significant difference between groups. However, only in the control group, the sleep phase angle became longer and the E/I ratio became higher significantly, but no change in experimental group.

Conclusion
During persistent academic stress, the daytime artificial bright light exposure might have buffering effects for the adolescent students, preventing them from delaying sleep onset and over-activating the arousal system in brain.

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1082 Accreditation of Home Sleep Apnea Testing in British Columbia, Canada: The Types of Nonconformance
Authors: Markin Aleksei , Rakhra Nav , Homewood Laura , Manship Sharan 
Published: April 2024

Abstract

Introduction
Accreditation of Home Sleep Apnea Testing (HSAT) has been conducted in British Columbia (BC) since 2021. BC is one of only two provinces in Canada that require accreditation for HSAT facilities. In this study, we analyzed the types of nonconformance cited, based on the first facilities completing on-site assessments.

Methods
The accreditation process was divided into three phases: an initial attestation, a desktop audit, and an on-site assessment. In 2022-2023, we analyzed data from 46 HSAT facilities who have completed an onsite assessment based on 329 standards. The assessment approach included reviewing evidence, interviewing staff, and observing patient practices. All assessment questions were categorized and included a complete set of HSAT Accreditation Standards (1). The outcomes of these assessment activities highlighted nonconformance for the facilities to meet to obtain full accreditation.

Results
By December 2023, 46 out of 172 facilities in BC (26.7%) had completed on-site assessments, and 480 nonconformance were cited. The nonconformance identified in the on-site assessments was analyzed. Among the nonconformance, we found 105 (21.9%) in procedural and documentation areas, 78 citations (16.3%) in human resources standards, 54 (11.3%) in the medical director’s duties, 38 (7.9%) in HSAT equipment evaluation and maintenance aspects, 32 (6.7%) in reporting, 29 (6.0%) nonconformance were identified in ethical standards, 28 (5.8%) in complaint and feedback processes, 22 (4.6%) were related to technical HSAT issues, 18 (3.7%) in safety and privacy and the same number 18 (3.7%) were associated with patients communication problems, 13 (5.0%) nonconformance were in scoring and interpretation area, and 34 (7.1%) in referral process, infection prevention and control, and information management groups of standards.

Conclusion
Standalone HSAT facilities will continue to play a significant role in providing diagnostic sleep services. HSAT facilities have welcomed the accreditation process to facilitate continuous patient care and safety improvement. Our study, showing the first experience of the HSAT accreditation process, strives to create a path for further research on the positive influences of accreditation programs on public health indicators.

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1084 Association of Social Determinants of Health and Sleep Study Completion Rates in a Large Cohort
Authors: Okoli Chimuanya , Bena James , Sulaj Holta , Dalton Jarrod , Mehra Reena , Pena-Orbea Cinthya 
Published: April 2024

Abstract

Introduction
The effects of social determinants of health (SDH) on health outcomes are well documented. However, the extent to which SDH influences sleep study completion is unknown.

Methods
A retrospective cohort study was conducted utilizing sleep study referrals at the Cleveland Clinic Sleep Center from 1/3/2017 to 8/5/2023. Adult patients who underwent sleep testing and completed at least one SDH screening questionnaire including food insecurity, financial strain, housing stability were included. A comparison between sleep study and SDH completion was conducted using Pearson chi-squared tests and Wilcoxon rank sum tests for unordered and ordered variables respectively. Continuous measures were summarized and compared with two-sample t-tests or ANOVA. Univariate logistic regression was used to measure associations between sleep testing completion rates, with SDH measures and demographic variables.

Results
Of 113,843 patients referred for sleep testing, 55% (n=62,569) patients completed at least one SDH screening questionnaire. Of these, 40% (n=25,003) completed a sleep study and 60% (n=37,556) did not. Patients who completed at least one SDH screening questionnaire were older (55.0±15.6 vs 53.5±15.8), of White race (77.7%vs76.3%, p&lt; 0.001), non-Hispanic (95.9%vs94.9%, p&lt; 0.001) and more likely to complete their sleep study (40.0%vs29.6%, p&lt; 0.001) compared to those who did not complete any SDH screening questionnaire. On the other hand, the subset of patients who completed at least one SDH measure and sleep testing were older (56.0±15.65 vs 54.4±15.5, p=&lt; 0.001), had a higher BMI 34.4±8.8vs33.8±8.3, p&lt; 0.001) and were of Hispanic origin (4.4%vs3.8%, p&lt; 0.001) compared to patients who did not complete sleep testing. Likewise, completers reported medium to high financial strain (15.8%vs13.7%, p&lt; 0.001), high risk for housing stability (11.5%vs10.3%, p&lt; 0.001) and food insecurity (9.9%vs8.9%, p=0.027) versus the subset of patients who did not complete sleep testing.

Conclusion
SDH screening questionnaires are not routinely completed by patients referred for sleep testing. However, patients who completed SDH screening questionnaires and sleep testing reported higher risk for food insecurity, housing stability and financial strain. Systematic efforts are needed to investigate the feasibility and acceptability of implementing SDH screening in sleep clinics to understand the relationship between social needs, access and utilization for sleep testing.

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1085 Evaluating Different Message Strategies from the AASM “Count on Sleep” Campaign to Promote Awareness About OSA
Authors: Robbins Rebecca , Honaker Sarah , Morkous Sameh , DelRosso Lourdes 
Published: April 2024

Abstract

Introduction
The American Academy of Sleep Medicine (AASM) initiated “Count on Sleep” in 2023, a public health campaign that was awarded to the AASM by the Centers for Disease Control (CDC) ) and Prevention of the U.S. Department of Health and Human Services (HHS) in 2021, with the goal of raising the awareness of Obstructive sleep apnea (OSA) among general practitioners and the public. Three campaign messages were developed and disseminated via social media. We examine the impact of these campaign messages using back-end analytics from the social media platform Meta.

Methods
We downloaded impressions (number of times the message was displayed on a screen), clicks, and shares for each of three public health messages from Meta, including demographic information for users (age, gender). Three message strategies were tested: positive outcome expectations (e.g., “improve your health”); negative outcome expectations (e.g., “increase your risk of health problems”); and partner-focus (e.g., “have you heard your partner snore?”).

Results
The campaign received a total of 142,607 impressions, divided into positive outcome expectation (n=120,062), negative outcome expectation (n=12,286) and partner-focus (n=10,259) messages. The campaign yielded a total of 3038 link clicks, with the highest number for positive outcome expectation (n=3,006), followed by negative outcome expectation (n=21) and partner-focus (n=11) messages. The total shares were 276, with most shares (165) for the negative outcome post. Female users were more likely to engage with the positive outcome (39% v.28%) and negative outcome (34% v.25%) messages; engagement did not vary by sex for the partner-focus message (36% v.36%). Those 65 years and older had the highest engagement of all age groups (negative outcome: 54%; positive outcome expectation: 47%; and partner-focus: 40%).

Conclusion
Although the positive outcome message strategy received the most engagement and clicks to the website for more information, the message using a negative outcome approach was the most frequently shared message. Females and older adults were more likely to engage with OSA messaging. These results provide information about the reach and uptake of OSA messages with different frames (e.g., negative/positive outcomes, partner-focus).

Support (if any)
This project was funded by the CDC. Additional support from the NIH (K01HL150339).
1086 Literacy Profile of Digital Education on Positive Airway Pressure Interventions Generated by Machine Learning
Authors: Shreekumar Shreevarsha , Ramprasad Aarya , Singh Som 
Published: April 2024

Abstract

Introduction
Sleep apnea affects over 30 million individuals in the United States and contributes to a multitude of comorbidities among patients. Let alone, there has been a bibliometric increase in clinical research development on understanding and innovating the treatment of sleep apnea. One of the most common sleep interventions is using positive airway pressure (PAP) devices which play a key role in maintaining the oxygen saturation of a patient during sleep. As these devices continue to be used among individuals, it is imperative to ensure patients receive appropriate education on the management of these devices. However, few clinical studies have evaluated the quality of the most commonly used digital educational materials that are designated to specifically answer questions asked by patients regarding PAP devices. This study aimed to evaluate the comprehension and readability of digital patient education materials regarding PAP modalities.

Methods
To address the primary objective of this study, a cross-sectional methodology was employed. It extracted the most frequently asked questions from the Google RankBrain machine learning algorithm and each associated educational article regarding continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices. Following, two independent raters evaluated questions for JAMA Benchmark Criteria and Rothwell’s Classification of Questions. Additionally, these raters also utilized the Flesh Reading Ease scale and Brief DISCERN for each article to evaluate the quality, readability, and understanding of each educational material.

Results
This study extracted the first 200 frequently asked questions and educational articles on CPAP and BiPAP devices using the algorithm. Rothwell’s Classification revealed 93.0% of questions were classified as “Fact” (n= 186). Within this cohort, digital patient education materials that met grade-reading level recommendations (Flesh Reading Ease ≥ 60) were found in a tighter distribution for CPAP vs. BiPAP. Brief DISCERN scores were not found to be statistically significantly associated with Flesh Reading Ease when scores met grade-reading level recommendations (p = 0.13).

Conclusion
The findings of this study indicate that a majority of education materials on PAP devices do not meet US grade-reading level recommendations. These results encourage healthcare providers and educators to integrate techniques that improve healthcare literacy regarding PAP modalities.

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1090 Utilization of Advanced Practice Providers in a Pediatric Sleep Program: A Strategy for Expansion and Outcomes
Authors: Petitto Lacie , Spear Jinae , Revana Amee , Kancherla Binal 
Published: April 2024

Abstract

Introduction
With the increasing demand for sleep services and a declining number of board-certified sleep physicians, pediatric sleep centers are seeking ways to meet the demand of managing sleep disorders identified by polysomnography. Employment of advanced practice providers (APPs) is a strategy to bridge this gap in healthcare access. Currently, there is no literature describing expansion of a pediatric sleep program with APPs including orientation, utilization, and outcomes. Objectives: 1: Describe the curriculum/orientation and clinic scheduling; 2. Report patient satisfaction and access to care outcomes; 3. Explain how utilization of APPs has led to program expansion and community outreach.

Methods
Narrative review of the curriculum and program expansion. Retrospective review of Press Ganey scores and clinic volumes including third next available appointment (TNAA) data.

Results
The sleep laboratory expanded from 14 to 23 beds; therefore, 3 APPs were hired between December 2018 and August 2019 with one having sleep medicine experience. Orientation included reading assignments, didactic lectures, and ~450 clinical hours in sleep, otolaryngology, pulmonary, neurology, craniofacial surgery, and psychology clinics. Clinic schedules after orientation started at 25% of the expected patient volume and increased quarterly by 25%. 3,358 patients were seen by the APP team in the first fiscal year which was an ~92% clinic volume increase. TNAA decreased from 34 to 5 (-29 days). According to Press Ganey survey metrics, APPs’ top box scores were 1.28 points higher (86.6) than the collective physician and clinic scores increased by 5 percentile ranks (86.1). APPs have also been involved in multidisciplinary clinics including the Bariatric Surgery Program and Multidisciplinary Obstructive Sleep Apnea Clinic. Blog publications and community talks have been given regarding sleep training and sleep disorders in school age children. Performance evaluations have not indicated safety or quality concerns related to care delivery. Two APPs were onboarded in 2023 with another position pending approval.

Conclusion
We identify a detailed strategy using various metrics to help meet the demand of sleep services for pediatric sleep centers. Utilizing APPs can potentially increase patient satisfaction and access to care while maintaining high reliability and quality care of the institution’s sleep medicine practice.

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