bluuebunny/crossref_metadata_2025_split huggingface dataset:
0476 SPLIT-Polysomnography Parameters and Auto-CPAP Adherence Factors in Hispanic and Non-Hispanic-White Patients
Authors: Vazquez itzel Vazquez , Park Moon , Ferri Raffaele , DelRosso Lourdes 
Published: April 2024

Abstract

Introduction
Studies on Hispanic patients (HP) in the US have highlighted a higher prevalence of obstructive sleep apnea (OSA) compared to non-Hispanic White patients (WP). However, the role of obesity or body mass index (BMI) as a confounding factor remains unclear. Few studies have investigated the success of titration in split-night polysomnography (PSG) and factors affecting continuous positive airway pressure (CPAP) adherence. This study aims to assess OSA severity and PSG parameters in HP vs. WP, differences in treatment during split-night PSG studies, and CPAP adherence factors during follow-up.

Methods
We conducted a retrospective clinical chart review, split-night PSG studies, and CPAP adherence on adults at the University of California, San Francisco, in Fresno, from 3/1/2023 to 9/11/2023. Participants were categorized based on self-reported ethnicity as HP or WP.

Results
The study included 50 WP (15 women, 35 men, mean age 60.5±13.60 years, mean BMI 34.2±7.48) and 45 HP (24 women, 21 men, mean age 54.9±13.06 years, mean BMI 37.3±7.88). The mean apnea-hypopnea index (AHI) in HP was 51.1±33.67, saturation nadir 77.8±10.19, and time spent with saturation &lt; 88% was 16.9±23.50 minutes. In WP, the mean AHI was 39.2±24.49, saturation nadir 81.6±9.04, and time spent &lt; 88% was 7±11.36 minutes. All differences were statistically significant (p&lt; 0.05). Titration data did not vary between groups. Auto CPAP was prescribed to all patients, with adherence at 3-4 months in HP at 75%±30, usage of 5.5±2.2 hours, and residual AHI 3±3.5. In WP, adherence was 79%±30, usage 5.9±2.1 hours, and residual AHI 3.6±6.2. None of these differences were statistically significant. Among HP, 37% missed follow-up appointments compared to 12% of WP. More HP used full-face masks, while more WP used nasal masks.

Conclusion
HP exhibited significantly worse OSA parameters during the diagnostic portion of PSG than WP. However, both groups demonstrated similar treatment outcomes in the split study. HP had a significantly higher no-show percentage than WP. CPAP adherence and residual AHI were not statistically different among those with follow-up, but more HP missed follow-up appointments than WP. Mask preferences differed between groups, with HP favoring full-face masks and WP preferring nasal masks.

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0481 A Novel Phenotype Classification for Obstructive Sleep Apnea Based on Hypoxic Burden
Authors: Park Soo Ryun , Park Hea Ree , Yook Soonhyun , Kim Hosung , Joo Eun Yeon 
Published: April 2024

Abstract

Introduction
Currently, we rely on the apnea-hypopnea index (AHI) to diagnose and quantify the severity of obstructive sleep apnea (OSA). However, AHI does not reflect the severity of respiratory events and does not capture the heterogeneity of patients with OSA. This study aimed to establish a novel phenotype classification based on a refined hypoxic burden (HB) and investigated its associations with a wide range of OSA-related health outcomes.

Methods
We retrospectively recruited 250 participants in each of four groups: normal (AHI &lt; 5), mild (5 ≤ AHI &lt; 15), moderate (15 ≤ AHI &lt; 30), and severe (AHI ≥ 30) OSA. To calculate HB, we adopted the method developed by Ali et al.,1 and we further divided HB into apnea-specific HB and hypopnea-specific HB, defined as HB calculated only based on apnea and hypopnea events, respectively. Hierarchical cluster analysis was performed based on the log scale of apnea-specific HB and hypopnea-specific HB to explore OSA phenotypes. We compared demographics and clinical outcome variables, including the prevalence of cardiometabolic disorders, comorbidity scores, and brain age index (BAI) based on sleep-EEG among these subtypes.

Results
After excluding participants with poor data quality, 954 participants were analyzed. These participants were classified into five clusters (Figure): subgroup #1 (n=177, ‘normal sleepers’), subgroup #2 (n=211, ‘mild hypopnea-driven HB’), subgroup #3 (n=225, ‘moderate HB’), subgroup #4 (n=225, ‘severe HB’), and subgroup #5 (n=116, ‘extreme HB with apnea-dominance’). Compared to subgroup #1, all other groups (subgroup #2-5) had a higher risk of hypertension and total comorbidity scores. By contrast, BAI was increased only in subgroups #4 and #5, with a significant correlation between apnea-specific HB and BAI. Different health outcomes were observed among subgroups even within the same AHI severity category.

Conclusion
This novel phenotype classification of OSA revealed significant associations with clinical outcomes, surpassing the limitations of the traditional categorization based on AHl. These insights could be used for risk stratification and the design of future OSA-related studies.

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0483 Real-world Study of Heart Rate Variability During Sleep Using Under-mattress Sensors in over 30,000 Individuals
Authors: Leng Yue , Cotton-Clay Andrew , Baron Susan , Fava Laura , Johnson Kyle , Easwar Venkat , Kinsolving Arthur , Kahn Philippe , Zitser Jennifer , Kushida Clete 
Published: April 2024

Abstract

Introduction
Heart rate variability (HRV), the beat-to-beat variation of the heartbeat signal, is a quantitative marker of Autonomic Nervous System (ANS) balance that may be influenced by obstructive sleep apnea (OSA) if measured during sleep. Notably, little is known about overnight HRV, and how this metric may differ by age, gender, or severity of OSA.

Methods
We used a commercially available home monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies Inc., California, USA) that measures HRV non-invasively and continuously during sleep using under-mattress piezo-electric sensors. We focus on two key HRV time domain metrics, the root mean square of successive RR interval differences (RMSSD, a measure used to estimate parasympathetic activity) and standard deviation of RR intervals between normal heartbeats (SDNN, a measure of overall variability influenced by both sympathetic and parasympathetic activity).

Results
We included data from 38,475 subjects [20712 males, 46.9±12.7 years; 17763 females, 46.7±12.6 years; 1575 with moderate to severe OSA (AHI≥15) and 30,816 without OSA (AHI&lt; 5)] with 2,720,720 recorded nights, collected from 08/16/2023 to 12/15/2023. Both HRV metrics decreased with age, whereas SDNN was lower in females. For both females and males, individuals with moderate to severe OSA had significantly lower RMSSD than those without OSA, though these differences decreased with age and were only significant among those aged 20-39 years [mean difference (MD)=-5.21, standard error (SE)=1.66 for females; -6.57, 0.97 for males] or 40-59 years [MD=-2.33, SE=0.60 for females; -2.43, 0.33 for males]. Meanwhile, individuals with moderate to severe OSA had significantly higher SDNN than those with no OSA, and these differences increased with age and were only significant among those aged 40-59 years [MD=2.39, SE=0.82 for females; 2.33, 0.42 for males] or 60-79 years [MD=2.14, SE=0.89 for females; 1.91, 0.56 for males]. For all age groups, men with moderate to severe OSA had significantly higher heart rate (HR) compared to those without OSA.

Conclusion
HRV during sleep varies with age, gender, and severity of OSA. OSA severity had different associations with HRV metrics relevant to sympathetic vs. parasympathetic activity. Emerging sleep technologies provide new opportunities for clarifying the association between HRV during sleep and OSA.

Support (if any)
Support from Fullpower Technologies.
0486 Performing Polysomnography in the Acute Post-stroke Setting
Authors: Masroor Kiran , Schwarz Joshua , Radulescu Radu , Tsang Sui , Sheth Kevin , Redeker Nancy , Yaggi Henry , Geer Jacqueline 
Published: April 2024

Abstract

Introduction
Despite being the leading cause of disability in adults, there are still limited treatments for ischemic stroke due to its narrow therapeutic window. Thereby, it is imperative to develop new strategies to prevent recurrent strokes and improve stroke recovery. Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is disproportionately prevalent among the stroke population, with prevalence estimates around 70%. Furthermore, many studies have established OSA as an independent risk factor for future stroke. We examined the potential benefit of bringing OSA diagnosis and therapy to the inpatient hospital setting by offering polysomnography (PSG) to stroke patients in the acute post-stroke environment.

Methods
Patients were recruited from the Yale New Haven Hospital, a large academic urban hospital, specifically within the following departments: Emergency Departments, Stroke units, and Neurology services. The electronic medical record was used to screen patients for various inclusion and exclusion criteria. Over the three years of active recruitment, 3,507 patients were screened. To assess the potential efficacy of this study design, the percentage of patients who were deemed eligible, who were enrolled, who received PSG, and who demonstrated a positive OSA diagnosis, were analyzed. For this study, OSA was defined as at least 15 apneas or hypopneas per hour.

Results
Of the 3,507 patients that were screened, 1,109 (31.6%) were deemed eligible for the study and 705 (63.6%) were approached for recruitment. Among those approached, 171 consented to participate and 107 underwent PSG testing with 97 (90.7%) demonstrating moderate or severe OSA.

Conclusion
The proportion of patients with sleep apnea in this study is higher than previously seen. One of the strengths of this study is the high ascertainment of PSG in the post-stroke acute setting. Additionally, the AHI cutoff of 15 events per hour likely led to an underestimation of OSA prevalence, further strengthening our findings. Limitations of this study include (1) selection bias, as patients with existing symptoms of OSA were more likely to enroll, and (2) the intentional timing of the PSG in the acute setting. This study demonstrates high rates of OSA in the acute post-stroke setting, paving the way for future interventions.

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0489 Age Modifies the Association Between Severe Sleep Apnea and Mortality
Authors: Ramezani Amin , Azarian Mehrnaz , Sharafkhaneh Amir , Maghsoudi Arash , Jones Melissa B , Penzel Thomas , Razjouyan Javad 
Published: April 2024

Abstract

Introduction
Prevalence of sleep apnea (SA) increases with age. However, data on severity of SA and aging and its impact on health outcomes is not known. We assessed the interaction between severity of SA and all-cause mortality in different age categories using large, longitudinal data.

Methods
We used Natural Language Processing program to extract apnea hypopnea index (AHI) from text of physician interpretation of sleep studies, i.e., polysomnograms and home sleep apnea testing, performed at the veteran health administration (VA) from 2000-2022. We grouped the participants to no-SA (n-SA, AHI&lt; 5) and severe SA (s-SA, AHI&gt;30) and excluded AHI range of 5-29. We further stratified the cohort based on age: Young, &lt; 40; Middle, &gt;40 and &lt; 65; and older, &gt;65. We calculated odds ratio (aOR) for mortality adjusted for age, sex, race, ethnicity, and Charlson-Comorbidity Index using n-SA as reference.

Results
We identified 209,374 participants (age, 54.7 ±14.4; BMI 32±5.25; male 90%, White 67%). Prevalence of s-SA increased with age categories as well as CCI. However, increases in BMI between n-SA and s-SA differed with the age categories (30.0 vs 34.1; 30.8 vs. 34.3; and 29.8 vs 32.2, for young, middle-age and elderly, respectively). All-cause mortality rates were higher in s-SA, compared to n-SA independent of age (young, 1.7% vs 1.2%; middle age, 10.41% vs 10.62%; and older adults, 23.04% vs 30.10%). However, the aOR of mortality among s-SA compared to no-SA reversed as the age categories increased (young, 1.14,95%CI:1.04,1.23; middle age, 0.90,95%CI:0.88,0.92; and older adults, 0.83,95%CI:0.59,0.84).

Conclusion
Although the prevalence of severe SA increases by age, the odds of all-cause mortality compared to no-SA diminished. The data suggests that older adults may be protected against harmful OSA outcomes. A causality analysis is warranted to assess the relationship between sleep apnea, aging, and mortality.

Support (if any)
Supported by NIH, NHLB Institute K25 funding (1K25HL152006-01 [J.R.]); Airborne Hazards and Burn Pits Center of Excellence (AHBPCE#FY2024-002 [J.R.]); and Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX.
0491 Exploring COMISA, Sleep-related Symptoms, and Healthcare Utilization in Military Personnel
Authors: Thomas Connie , Collen Jacob , Capaldi Vincent , Zhao Zhiwei , Williams Scott , Assefa Samson , Chen Shuo , Albrecht Jennifer , Wickwire Emerson 
Published: April 2024

Abstract

Introduction
Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders seen in clinical practice. Comorbid insomnia and OSA (COMISA) is a very common clinical presentation. The purpose of this study was to estimate the effect of COMISA on sleep, daytime symptoms, and healthcare resource utilization compared to OSA or insomnia alone among military personnel.

Methods
Military personnel with sleep problems were recruited from two military treatment facilities. Insomnia and OSA were defined using validated cutoffs on the Insomnia Severity Index and Berlin Questionnaire, respectively, and COMISA was defined as comorbid insomnia and OSA. Subjective and objective sleep were measured via standardized sleep diaries and a commercial wearable (Fitbit Inspire 2) over ten days. Daytime symptoms (e.g., sleepiness, depression, anxiety, pain) were assessed using standardized self-report questionnaires. Subjective cognition was assessed via three Likert items. Healthcare resource utilization (HCRU) was assessed using an established questionnaire tailored for this study. To compare differences between COMISA, OSA, and insomnia groups, one-way ANOVA was performed.

Results
The final sample included 201 participants (n=113, 43.8[%] men, mean age=44.5 [SD=12.7]) who self-reported being of White (111, 55.2%), Black (50, 24.9%), Hispanic (21, 10.5%) or Other (19, 9.5%) race. Of these, 22 (10.9%) were categorized as insomnia alone, 98 (48.8%) as OSA alone, and 81(40.3%) as COMISA. Relative to individuals with OSA, individuals with COMISA demonstrated worse subjective (but not objective) sleep; worse subjective daytime symptoms; worse subjective memory, attention, and executive function; and increased healthcare utilization including total HCRU and outpatient visits to internal medicine, neurology, emergency department, and urgent care. Some but few significant differences were observed between participants with insomnia relative to those with COMISA.

Conclusion
Among military personnel with sleep problems and relative to OSA alone, COMISA was associated with worse subjective sleep, worse daytime symptoms, worse subjective cognition, and greater HCRU. Future research should seek to seek to improve health and economic outcomes among individuals with COMISA.

Support (if any)
DoD (W81XWH1990006 via the Medical Technology Enterprise Consortium)
0493 Characteristics of Middle-Aged and Older Adults with Comorbid Insomnia and Sleep Apnea vs. Sleep Apnea Alone
Authors: Tseng Chien-Yu , Wickwire Emerson , Albrecht Jennifer , Malhotra Atul , Spira Adam , Roth David , Gross Alden , Amjad Halima , Blinka Marcela D , Sekhon Vishaldeep , Kaufmann Christopher 
Published: April 2024

Abstract

Introduction
Sleep apnea and insomnia often co-occur in older adults, complicating treatment and worsening outcomes. More research is needed to characterize sleep apnea patients with and without co-morbid insomnia. We characterized differences in demographic and clinical characteristics between individuals with co-morbid insomnia and sleep apnea (COMISA) and those with sleep apnea alone in a national sample of U.S. middle-aged and older adults.

Methods
Data came from the 2018 interview of the Health and Retirement Study, a nationally representative cohort of approximately 20,000 U.S. older adults. Participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder, including sleep apnea. Participants reported frequency of insomnia symptoms (difficulty falling asleep, waking during the night, waking too early, and feeling rested in the morning), and were categorized as having each symptom if they reported experiencing the symptom “most of the time” for the first three symptoms and “rarely or never” for the latter. Employing bi-variate logistic regression, we compared demographic and clinical characteristics of participants with sleep apnea who reported ≥1 insomnia symptom (COMISA) to those reporting 0 symptoms (sleep apnea alone).

Results
Among N=1,816 respondents reporting sleep apnea, 47.2% also had insomnia symptoms (COMISA). Compared to those with sleep apnea alone, participants with COMISA were younger (65.3±9.61 years vs. 66.4±9.25, p=0.015), and more likely to be female (51.5% vs. 40.3%, p&lt; 0.001), but did not differ by race and ethnicity. They also were more likely to report several health conditions, including a markedly higher prevalence of mental health problems (43.1% vs. 24.8%, p&lt; 0.001), dementia/cognitive impairment (4.9% vs. 2.7%, p&lt; 0.001), and also have greater depressive symptomatology as measured by CES-D (2.8±2.44 vs. 1.1±1.67, p&lt; 0.001).

Conclusion
Notable differences were identified between participants with COMISA and those with OSA alone. Of note, COMISA patients were more likely to have several health conditions, especially mental health, which suggests COMISA patients may benefit from psychosocial interventions aimed at improving treatment adherence and preventing poor health outcomes.

Support (if any)
This study was supported by the National Institute on Aging (R01AG079391, K01AG061239, P30AG028740) and the Sleep Research Society Foundation (23-FRA-001).
0494 Sleep Related Respiratory Events on Buprenorphine Compared to Naltrexone
Authors: Glidewell Geoffrey , Walker Nathan , Roth Heidi , Vaughn Brad , Fan Zheng , Bricker Katelyn 
Published: April 2024

Abstract

Introduction
Opioid medications are associated with an increased risk of sleep related respiratory events, especially central apneas. However, the potential impact of partial agonists (buprenorphine) and full antagonists (naltrexone) is less well known. In this study we hypothesize that patients using buprenorphine will have a greater prevalence of central apneas and require more frequent use of bilevel PAP therapy than those using naltrexone.

Methods
We performed a retrospective chart review of patients in a sleep laboratory database identifying patients who were prescribed naltrexone or buprenorphine at the time of a diagnostic PSG or PAP titration between 2019 and 2023. We only included initial diagnostic studies and initial titrations. The patients were split into four groups (buprenorphine/diagnostic, buprenorphine/titration, naltrexone/diagnostic, naltrexone/titration). Polysomnograms (PSG) were performed and scored in accordance with AASM guidelines. The Epworth Sleepiness Scale (ESS) and standard PSG variables were collected, and group differences were analyzed. Statistical significance was determined using a two-tailed T test.

Results
A total of 87 patients and 114 studies were included (n= 43 buprenorphine/diagnostic, n=25 buprenorphine/titrations, n=22 naltrexone/diagnostic, n=24 naltrexone/titration). Overall average age was 48 years, with 60.5% female. No significant difference of age or gender was found between the groups. All groups had high rates of underlying hypertension, depression, anxiety, and substance use disorders. Patients on buprenorphine were subjectively sleepier and demonstrated more frequent sleep-related respiratory events. Patients on buprenorphine presenting for initial diagnostics had higher ESS scores (11.1 vs. 7.14, p=0.017), and higher sleep efficiency (87.3% vs. 78.6%, p=0.045). The buprenorphine group had higher mean AHI (18.0 vs. 8.62, p=0.008) and more central apneas per hour, but this did not meet statistical significance (5.21 vs. 1.81, p=0.12). In the PAP titrations, patients on buprenorphine had more difficult titrations and a greater proportion of the buprenorphine group failed CPAP and required bilevel PAP.

Conclusion
Our cohort demonstrates a higher degree of subjective sleepiness, a tendency toward more central apneas, and increased likelihood to fail CPAP and require bilevel PAP in patients prescribed buprenorphine. We believe clinicians should have a higher degree of suspicion for central apnea in patients who are prescribed partial opioid agonists.

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0495 Association of Cannabis Use and Symptoms Among Patients with Obstructive Sleep Apnea
Authors: Inaya Andira , Baldassarri Stephen , Sands Scott , Yaggi Henry , Wellman Andrew , Redeker Nancy , Zinchuk Andrey 
Published: April 2024

Abstract

Introduction
The use of recreational substances such cannabis is linked to sleep quality. Long-term cannabis use has been linked to increased sleep latency, less slow wave sleep, and worse sleep efficiency. However, little is known about the relationship between cannabis use and subjective OSA symptoms. We examined the association of cannabis use and symptoms among patients newly diagnosed with and yet to be treated for OSA.

Methods
This was an interim analysis of participants enrolled in the NICEPAP Study (n=182/267, NCT05067088) a prospective observational study assessing physiological predictors of CPAP effectiveness. Participants self-reported cannabis use over a six-month period prior to OSA diagnosis. Outcomes included symptoms of pain affecting sleep, parasomnias, nightmares, sleep latency, sleep duration, insomnia symptoms (Insomnia Severity Index), sleepiness (Epworth Sleepiness Scale), sleep quality PROMIS (Patient-Reported Outcomes Measurement Information System) and OSA-related quality of life FOSQ (Functional Outcomes of Sleep Questionnaire). Groups were compared using Chi-squared, and the Mann-Whitney U tests as appropriate.

Results
We studied 182 enrolled participants, 47% were male with a mean age of 51.3 years; of this total sample, 32 patients (17%) reported cannabis use. Users of cannabis reported more regular alcohol use and tobacco use (72% vs 46% and 44% vs. 29% respectively, p&lt; 0.01). No differences were observed in other demographics, sleep latency, self-report sleep duration or OSA severity. Cannabis users reported higher but not statistically significant proportion of pain during sleep (38% vs 25%, p=0.17). No differences from non-users were noted for other presenting symptoms including nightmares, parasomnias, insomnia, sleepiness, sleep quality or OSA-related quality of life.

Conclusion
One in six individuals in this cohort of individuals recently diagnosed with OSA, reported use of cannabis. Cannabis users also noted higher consumption of alcohol and tobacco. There was a trend for higher prevalence of pain affecting sleep. Notably, no other statistical differences were noted upon analysis of daytime and nighttime symptoms. Further research is needed to better understand the long-term effects of cannabis on subjective symptoms of sleep in OSA patients.

Support (if any)
This study was supported by the Parker B. Francis Foundation, National Heart, Lung, and Blood Institute NIH/NHLBI