bluuebunny/crossref_metadata_2025_split huggingface dataset:
0550 Empiric ASV Settings for Central Sleep Apnea Following HSAT During SARS Covid-19 Pandemic- a Retrospective Analysis
Authors: Appalla Surya Deepika , Cutrufello Nicholas , Begay Melissa 
Published: April 2024

Abstract

Introduction
Adaptive servo-ventilation (ASV) uses noninvasive ventilator to treat hyper ventilatory central sleep apnea (CSA)by delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure. ASV devices appear to be effective for treatment of Central sleep apnea and Combined sleep apnea syndromes that are resistant to CPAP [1]. All the studies to date recommend ASV settings following in lab titration. However, during the SARS Covid-19 pandemic given the significant limitation of in lab studies, empiric ASV were prescribed for CSA following home sleep apnea studies. We retrospectively analyzed the empiric ASV settings and patient adherence in correlation to the BMI.

Methods
Retrospective chart review of 1582 pts (patients de-identified) who underwent HSAT at the NM VA clinic during 2021-2023 was done. Among the 1582 pts who underwent HSAT, 113 pts had predominant Central Sleep Apnea (CAI &gt;10) . 21 pts were placed on empiric ASV. We retrospectively analyzed the adherence to ASV therapy in 2 week and 3 years follow up period.13 of the 21 pts did not meet the 2 week and 3-year compliance. The EPAP data is derived from the 8 pts who continued on the empiric ASV settings and success is based on their 2 week and 3-year adherence.

Results
Median EPAP ranged between 5-7 cwp for pts with BMI less than 30, EPAP of 7-8 cwp with BMI between 30-40 and an EPAP 10 for BMI&gt;40. 8 pts had good compliance (&gt;70% use of &gt;4 hours every night) in 2 week download with median Apnea Index 0.1(SD 2.6), median pressure support used 4.6(SD1.1). Patients with cardiac concern had echocardiogram documented LVEF &gt;45% prior to starting empiric ASV. Serum Bicarbonate ranged between 17-26.

Conclusion
Though not the most efficient way compared to in lab titration study, empiric ASV settings based on the BMI may be utilized in resource limited settings or inability to perform in lab studies due to patient limiting factors. Providers should also be cognizant about hypo ventilatory concerns and respiratory depression given ASV therapy utilizes minute ventilation. Caution must be exercised in patients with heart failure due to the potential increased mortality on ASV.

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0552 Analysis of Autonomic Activity After Continuous Positive Airway Pressure Therapy Using Heart Rate Spectral Analysis
Authors: Costello Elizabeth , Crasta Maxim , Clum Alicia 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is estimated to affect 29.5 million people living in the United States. OSA patients experience repeated airway occlusions leading to numerous episodes of apnea nightly, increasing their risk for heart disease, stroke, and diabetes. Patients benefit from CPAP because it restores processes that promote recuperation of the autonomic nervous system (ANS). Several studies have investigated the health consequences using different measurements of ANS activity like heart rate variability (HRV). HRV can be analyzed using frequency domains such as the low-frequency (LF) to high-frequency (HF) ratio, or with time domains like the exhalation to inhalation (E:I) ratio. HF and exhalation are associated with parasympathetic activity, while LF and inhalation are associated with sympathetic activity. Here, we aimed to better understand the relationship between ANS activity in OSA CPAP-compliant versus CPAP non-compliant patients using HRV analysis. We hypothesized that compliant patients will have lower LF/HF ratios and greater E:I ratios compared to noncompliant patients during various ANS test maneuvers.

Methods
OSA patients were divided into CPAP-compliant (n= 20) and non-compliant groups (n= 18). Patients had to have been CPAP compliant for at least 8 weeks. HRV was determined using a wireless ECG device and IntelleWave HRV Analyzer software. Data was collected while patients were supine, sitting upright, performing a Valsalva maneuver with handgrip, and deep breathing.

Results
Significant differences in the LF/HF ratio were found between groups when patients were supine (p&lt; 0.001), standing (p&lt; 0.001), and during normal breathing (p&lt; 0.006). No significant difference was found between groups when performing the Valsalva maneuver. A significant difference in E:I ratios was observed only during deep breathing, 1.36±.15 in CPAP non-compliant patients versus 1.59±.24 in CPAP compliant patients; t (36) = -3.578, p &lt; .001.

Conclusion
A greater restoration of sympathovagal activity was observed during activities with a parasympathetic predominance (lying down, standing, and normal breathing) compared to maneuvers requiring significant physiological effort (Valsalva maneuver) following CPAP therapy. This suggests a greater duration of CPAP therapy may be required to restore autonomic balance during strenuous activities.

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0555 Treatment Responses in US Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea
Authors: Mysliwiec Vincent , Brock Matthew , Gomes Kimberly , Pruiksma Kristi , Li Xueying , Gerwell Kelsi , Powell Tyler , Mithani Sara , Straud Casey , Young-McCaughan Stacey , Peterson Alan 
Published: April 2024

Abstract

Introduction
Comorbid insomnia and obstructive sleep apnea (COMISA) is the most prevalent sleep disorder in military sleep clinics. While there is no established COMISA treatment regimen, patients frequently receive cognitive behavioral therapy for insomnia (CBTI) and positive airway pressure (PAP) therapy. The aims of this study were to examine treatment responses in military personnel with COMISA and determine if there were differential responses to therapy in male and females.

Methods
In an observational study, 130 participants (38.5% females) were diagnosed with COMSIA and received CBTI and PAP therapy in a routine clinical setting. Treatment responses were assessed by changes from baseline to 12 weeks with the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, parametric and non-parametric pairwise comparisons were used to assess differences between sexes at baseline. Linear mixed effects models for longitudinal data were used to examine differences between sexes in treatment responses overtime.

Results
There were significant decreases from baseline to 12 weeks in the ISI among males (-5.45 (95% CI, −6.94 to −3.96), p &lt;.0001), and females (-6.25 (95% CI, -8.18 to -4.31), p &lt;.0001), ESS among males (-2.52 (95% CI, -3.67 to -1.36), p &lt;.0001) and females (-2.21 (95% CI, -3.71 to -0.72), p = .0017), and PSQI among males (-3.94 (95% CI, -4.96 to -2.91), p &lt;.0001) and females (-3.64 (95% CI, -4.98 to -2.31), p &lt;.0001). PAP Adherence was 8.5% in women and 23.1% in men (p = .053). Treatment responses were not significantly differences between genders.

Conclusion
Although the majority of military personnel with COMISA were non-adherent to PAP, there were significant responses on the ISI, ESS, and the PSQI. This suggests the insomnia may have greater clinical significance than OSA. CBTI could be considered first line COMISA therapy in a military population that primarily has mild sleep disordered breathing.

Support (if any)
This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).
0556 Comorbid Insomnia & Sleep Apnea Is Linked to Worse Sleep & Function vs OSA Alone in Older Veterans with No PAP Use
Authors: Kelly Monica , Fung Constance H , Ryden Armand , Stepnowsky Carl , Erickson Alexander , Zeidler Michelle , Ganz David , Mitchell Michael , Barretto Bronson , Partch Lisa , Pearson Lori , Rodriguez Ariana , Josephson Karen , Martin Jennifer , Alessi Cathy 
Published: April 2024

Abstract

Introduction
Many patients with obstructive sleep apnea (OSA) discontinue positive airway pressure (PAP) over time. Insomnia symptoms frequently co-occur with OSA and are common in older adults. Comorbid insomnia and sleep apnea (COMISA) is associated with greater sleep disturbance, impaired daytime functioning, and worse quality of life vs OSA (or insomnia) alone. Whether COMISA vs OSA alone is associated with greater impairment in sleep quality and sleep-related function among older patients and no /limited PAP use is unknown.

Methods
Veterans with moderate or severe OSA (apnea-hypopnea index [AHI] &gt;15) and no/limited objective current PAP use (prescribed &gt;1 year ago) completed Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep (FOSQ-10) questionnaires. T-tests and age-adjusted regression analyses were used to compare participants who met DSM-5 diagnostic criteria for chronic insomnia disorder and sleep apnea (COMISA) vs OSA alone.

Results
In 128 veterans (Mage=64.6 years, 89% male, 19.5% Hispanic, 35.9% Black, 9.4% American Indian/Alaska Native, mean comorbidity index=5.5, BMI=32.2) with no/limited PAP use, COMISA (n=77, mean ISI=13.3) was associated with worse PSQI [7.8 vs 10.9], ESS [7.6 vs 9.6] and sleep-related function (FOSQ-10 15.6 vs 14.1) vs OSA alone (n=51, mean ISI=8.9) (all P&lt;.05) despite no differences in AHI.

Conclusion
Among veterans with moderate-to-severe OSA and no/limited current PAP use, those with comorbid insomnia disorder (COMISA) have worse sleep quality, more daytime sleepiness and worse sleep-related function. These findings suggest that efforts to address insomnia disorder in addition to PAP use may be particularly important among older veterans with COMISA who do not use their prescribed PAP.

Support (if any)
VA, NIH/NHBLI
0558 Could Treatment of Sleep Apnea Worsen Somnolence?
Authors: Balasubramanian Prasanth , Khalil Melissa , Arunthari Vichaya , Colaco Brendon 
Published: April 2024

Abstract

Introduction
Patients presenting with daytime somnolence need to be evaluated for common etiologies including sleep-related breathing disorders, shift work disorder, insufficient sleep, insomnia and disorders of hypersomnolence. Sleep disordered breathing (SDB) is one of the most common causes of daytime sleepiness. We postulate that treatment of SDB may actually worsen symptoms, if associated with poor sleep due to positive airway pressure (PAP) therapy.

Methods
N/A

Results
A 49-year-old female presented to our clinic with increased daytime somnolence. She was diagnosed with obstructive sleep apnea (OSA) at an outside center 3 years ago and was started on auto PAP therapy with pressure settings at 6-10 cmH2O. She had 100% usage, 95th percentile pressure of 9 cm H2O, and a residual Apnea Hypopnea Index (AHI) of 1.1. The patient reported excessive daytime sleepiness, with an Epworth Sleepiness Scale of 16, requiring a daily 3-hour nap. Further sleep history revealed that she had multiple nocturnal awakenings due to discomfort with PAP therapy, including mask related issues causing sleep disruption. Several mask adjustments did not result in any sleep improvement. We decided to re-evaluate her with an in-lab polysomnography. Diagnostic data revealed an overall AHI of 1.6, supine AHI of 12.0, and lateral AHI of 1.5. Mean oxygen saturation was 94.6% with a nadir of 89.0%. The patient was advised to discontinue PAP therapy, and to sleep on her sides, which led to improvement in her sleep quality and daytime sleepiness.

Conclusion
Positional OSA, defined by greater than 50% increase in AHI in supine position compared to non-supine position, with or without AHI less than 5 in non-supine position, is seen in up to 50-60% of patients with OSA. In addition, intolerance to CPAP has been noted in 29-83% of patients. We need to be clinically aware of the potential effect of PAP devices, or oral appliances, on sleep disruption among intolerant patients. Among this group, conservative therapies like positional therapy or weight loss may be more effective for symptom management, especially for mild SDB.

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0560 CPAP Effect on Energy Expenditure, Intake, Body Composition, and Sleep Patterns: A Randomized Controlled Trial
Authors: Lee Pei-Lin , Chien Meng-Yueh , Lai Shang-Ru , Gooley Joshua J , Feng Hsin-Chun , Chen Shih-Kuo , Lin Ming-Tzer , Chen Yung-Hsuan , Chiu Hung-Chih , Liu Po-Kang , Ku Bo-Wen , Chang Chin-Hao , Yang Wei-Shiung , Yu Chong-Jen 
Published: April 2024

Abstract

Introduction
The mechanism of weight gain after continuous positive airway pressure (CPAP) treatment for treating obstructive sleep apnea (OSA) has not been fully elucidated. We hypothesized that CPAP treatment could result in positive energy expenditure through lowering basal metabolic rate (BMR) and increasing nutrition intake which the later associated with delayed bedtime and shorter sleep duration. That led to increase in body weight and fat mass.

Methods
The consecutive patients with untreated moderate-severe OSA assessed with 7-day Actiwatch, 3-day intake dietary, repeated polysomnography, BMR, body composition, and blood check. Participants were randomized to CPAP or usual care and reassessed 12 weeks later. The primary outcome was resting energy expenditure (REE) and respiratory quotien (RQ) while second outcomes were nutrition intake, eating behavior, and fat/fat free mass. Third outcomes were objectively measured mid-sleep time and sleep hour. The APAP effect was assessed with between-group differences in outcome changes.

Results
From 66 patients recruited, 26 patients each were randomized to CPAP and usual care, which 21 patients and 24 patients completed the study, respectively. Compared to usual care, CPAP treatment was not associated with changes in REE and RQ, total caloric intake, fat mass, mid-sleep time and sleep hour, while it was associated with increase in body mass index (mean difference 0.6 kg/m2, 95% confidence interval, 0.07 to 1.19), fat free mass, and fat intake, and less Cognitive Restraint eating.

Conclusion
The short-term CPAP treatment had no effect on energy expenditure and sleep pattern though it increased weight, fat free mass, fat intake, and improve eating behavior.

Support (if any)
NSTC (111-2314-B-002-293), NTU (107L900502, 108L900502, 109L900502), NTHU (109-42, 111-S0298, 111-X0033); MediaTek Inc. (201802034 RIPD)
0561 CPAP Tolerance Scores Are Effective in Predicting CPAP Usage in the Short-Term
Authors: Creighton Erin , DeKloe Jefferson , Tekumalla Sruti , Plawecki Andrea , Kaffenberger Thomas , Alapati Rahul , Doghramji Karl , Boon Maurits , Huntley Colin 
Published: April 2024

Abstract

Introduction
Our group previously presented work demonstrating the value of a 10-question CPAP tolerance survey in predicting therapy compliance at 30-90 days after CPAP prescription. We conducted a follow-up survey in the same cohort 6 months after CPAP prescription to examine the utility of the survey in predicting CPAP compliance.

Methods
This was a prospective study at a single tertiary care hospital. Patients diagnosed with clinically significant OSA (moderate disease, mild disease with symptoms, or mild disease with a comorbidity) between January-March 2023 that had initiated PAP therapy and attended a follow-up visit were provided a 10-question survey regarding symptoms and attitudes related to CPAP at their first follow up visit and again 6-9 months later. Data collected used for statistical analysis included: tolerance survey scores, CPAP usage, attendance of 6-month follow-up visit, demographics, OSA severity, and Epworth Sleepiness Scale (ESS) scores. Univariate and multivariate regression were used to analyze relationships between survey responses and CPAP usage data. Adherence was defined as using PAP therapy for ≥ 4hrs for ≥ 70% of nights in a 30-day period.

Results
Of the 105 respondents to the initial survey, 56 (53.3%) responded to the 6-month survey. Tolerance scores at 6-months correlated with % adherence at 6-months (p = 0.02) and minutes of CPAP usage at 6-months (p = 0.04). Each point of increase in 6-month survey scores was associated with an additional 2.7 minutes of use, on average. Initial tolerance survey scores did not significantly correlate with compliance 6-months later (p = 0.17). Initial tolerance survey scores did, however, correlate with tolerance survey scores 6 -months later (ß = 0.77, p &lt; 0.001) and there was no significant difference between initial tolerance survey scores and scores at 6-months (mean difference -2.81, p = 0.11). Stepwise regression models showed minimized error when age, ESS at first follow-up, OSA severity and 6-month tolerance scores were used as covariates for an outcome of minutes of CPAP usage at 6-months.

Conclusion
CPAP tolerance surveys have utility in estimating CPAP compliance in the short-term but may not capture important changes in patient attitudes that allow for the prediction of long-term CPAP compliance.

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0563 Exploring Trends of Oronasal versus Nasal Mask Use by Sleep Technologists
Authors: Farishta Mehdi , Neborak Julie , Mokhlesi Babak 
Published: April 2024

Abstract

Introduction
Continuous positive airway pressure (CPAP) therapy is the most prescribed therapy for obstructive sleep apnea (OSA). CPAP therapy has been shown to reduce daytime somnolence as well as reduce the risk of cardiovascular disease and mortality in patients with severe OSA and good adherence. Nasal and oronasal masks are the two main mask interfaces available for CPAP therapy. The oronasal mask is a larger interface and prior research shows that with an oronasal mask higher PAP pressures are needed compared to a nasal mask. These factors may reduce long-term adherence to CPAP when an oronasal mask is initially selected. There are no guidelines for sleep technologists when selecting a mask type during CPAP titration studies, however using an oronasal mask could affect the long-term adherence to CPAP therapy.

Methods
We retrospectively studied mask selection amongst our sleep technologists from 6/15/2023 to 9/30/2023. Our institution employs 12 sleep technologists; 6 work at lab 1 and 6 work at lab 2.

Results
Overall, 368 patients (199 at lab 1 and 169 at lab 2) underwent CPAP titration studies during the study period. There were no significant differences in patient demographics between the two sleep labs, including mean age (57.3±14.8 vs 57.2±14.9, p=0.95), sex (48% female vs 48% female, p=0.97) and mean BMI (39.6±19.4 vs 38.6±10.7, p=0.38). The prevalence of oronasal mask use was significantly higher at the lab 2 compared to the lab 1 (45% vs 30%, p=0.002).

Conclusion
Oronasal masks are still frequently used by our sleep technologists during CPAP titration studies. There was significant variation in the use of nasal versus oronasal masks by sleep technologists, even between two sleep lab sites that are part of the same institution. An educational program geared toward sleep technologists may reduce the use of oronasal masks during CPAP titration studies which may further improve the adherence to CPAP therapy.

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0564 Group Motivational Interviewing to Improve APAP Adherence: A Quality Improvement Project
Authors: Cocozza Victoria , Clay Collin , Ellis Jordan , Tchopev Zahari , Brock Matthew 
Published: April 2024

Abstract

Introduction
Automatic positive airway pressure (APAP) adherence to treat obstructive sleep apnea (OSA) is challenging to many patients. Motivational interviewing in one-on-one sessions has been shown to improve rates of APAP adherence. The goal of our improvement study was to improve APAP adherence and determine whether motivational interviewing is effective in a group setting.

Methods
Patients with a new diagnosis of OSA, regardless of severity, presented to our academic sleep disorders center for a group presentation on OSA and available treatments from November – December 2023. Groups of 5-10 patients received either a standard informative presentation or the same presentation with motivational interviewing techniques. Questionnaires with a Likert scale from 1 to 10 assessed pre- and post-presentation readiness to undergo treatment for their OSA and perceptions of importance to treat. Post-presentation questionnaires also included questions on likeliness to pursue treatment and confidence to pursue treatment.

Results
A total of 41 patients attended the group session with 53.6% (n=22) receiving the motivational interviewing component. For the motivational interviewing group, adherence data post-intervention revealed that the average total days of APAP use was 79%, average total hours used was 232.00 minutes, and average use greater than 4 hours was 51.6%. For the non-motivational interviewing group, adherence data post-intervention showed that the average total days of APAP use was 68.62%, average total hours used was 209.62 minutes, and average use greater than 4 hours was 46.54%. To date, 38% of non-motivational interviewing patients (n=13) were adherent by Medicare definition, compared to 40% of motivational interviewing patients (n=5). Questionnaires had equivocal scores in all categories pre- and post-presentation for the motivational interviewing and non-motivational interviewing groups and indicated a high level of motivation to pursue therapy.

Conclusion
Implementing motivational interviewing in a group setting was a feasible way to improve APAP adherence in our clinic. Patients are motivated to pursue APAP therapy in pre- and post-presentation questionnaires. This preliminary data is limited by ongoing intervention implementation yet promising for the use of motivational interviewing in the group setting. To the authors knowledge, no published improvement projects exist for evaluating the effectiveness of motivational interviewing in a group setting.

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