bluuebunny/crossref_metadata_2025_split huggingface dataset:
0540 Comparing Periodic Limb Movements of Sleep Before and After Hypoglossal Nerve Stimulation Therapy
Authors: Cho Unjung , Lee Chang-Hoon , Moon Hye-Jin , Im KyoungBin 
Published: April 2024

Abstract

Introduction
Patients with obstructive sleep apnea (OSA) exhibit high prevalence of periodic limb movements of sleep (PLMS). While many studies have explored the impact of positive air pressure (PAP) therapy on PLMS, there was no study of the impact of hypoglossal nerve stimulation (HNS) therapy on PLMS. We reported high prevalence of PLMS in patients receiving HNS therapy (separate abstract). We hypothesized the following: 1) OSA patients with PLMS become candidates for HNS therapy at a higher rate given PAP failure associated with PLMS; 2) HNS therapy itself increases PLMS. This study aims to test the above hypotheses by assessing pre- and post-HNS sleep study data and comparing PLMS in temporal fashion.

Methods
Among subjects receiving HNS therapy from December 2020 to August 2023, 38 subjects with periodic limb movement index (PLMI) data before and after HNS therapy were selected for the subgroup analysis. PLMS diagnosis was based on PLMI ≥ 15. We compared PLMI and PLMS diagnosis between before and after HNS therapy using Wilcoxon's signed rank test and McNemar test.

Results
In our study of 38 subjects, the average of PLMI before and after HNS therapy were median 7.1/hr (interquartile range, 0, 34.6) and 17.2/hr (interquartile range, 3.1, 37.5) respectively, resulting in no statistical significance (P=0.064 by Wilcoxon's signed rank test). Prevalence of PLMS before and after HNS therapy were 36.8% and 60.5% respectively showing significant increase with HNS therapy (P=0.039 by McNemar test).

Conclusion
Our study results indicate comparable baseline prevalence of PLMS as shown in other studies among OSA and significant increase in PLMS while using HNS therapy in this paired pre- and post-HNS analysis, suggesting HNS therapy being a possible cause of PLMS in OSA patients. Further work is warranted to re-confirm the above finding and potentially investigate long-term effect of HNS therapy on PLMS, and PLMS on the outcome of HNS therapy.

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0542 The Association Between the Effective Apnea Hypopnea Index and Blood Pressure Reduction Efficacy After Treatment
Authors: Ni Yuenan , Thomas Robert 
Published: April 2024

Abstract

Introduction
The effect of sleep apnea treatment on reducing cardiovascular disease risk remains inconclusive. This study aims to assess if the effective apnea hypopnea index (eAHI), a measure of residual sleep apnea burden post-treatment, is a factor in determining blood pressure (BP) response to continuous positive airway pressure therapy. The eAHI integrates time on therapy, residual apnea, and % of sleep time untreated.

Methods
A secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a randomized, controlled, parallel group assessment of continuous positive airway pressure (CPAP), oxygen and sleep hygiene. The Delta-AHI (▲AHI) was defined as the difference between baseline AHI and effective AHI at 12 weeks. Logistic and linear regression models estimated the predictors for nocturnal systolic BP change following sleep apnea therapy.

Results
One hundred and sixty-nine subjects with a mean age of 62.82 ± 6.99 years were included in the final analysis. Fifty subjects had ▲AHI ≤ 8 / hour of sleep and 119 subjects were higher. After adjustment, baseline mean nighttime systolic blood pressure (OR 1.036, 95% CI 1.015-1.058, p: 0.001) and ▲AHI ≥ 8 / hour (OR 2.406, 95% CI 1.116-5.185, p:0.025) were independent predictors for mean nighttime systolic blood pressure change &gt; 3 mm Hg. The effective AHI was negatively related with BNP (β: -2.564, SE: 0.167, p: 0.029) and positively related with troponin change (β: 0.703, SE: 0.256, p: 0.007).

Conclusion
The ▲AHI was an independent predictor of the blood pressure response to sleep apnea treatment.

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0551 Telemedicine Motivational Enhancement in Heart Failure and Sleep Apnea Randomized Clinical Trial
Authors: Orbea Cinthya Pena , Bena James , Hsich Elieen , Drerup Michelle , Khayat Rami , Mehra Reena 
Published: April 2024

Abstract

Introduction
Despite evidence suggesting that Positive Airway Pressure (PAP) in patients with Acute Decompensated Heart Failure (ADHF) with Obstructive Sleep Apnea (OSA) confers improvement of cardiovascular outcomes, PAP adherence remains exceedingly low. We hypothesized that motivational enhancement (ME) via a telemedicine intensive approach improves PAP adherence post-discharge in hospitalized patients with ADHF and OSA

Methods
Telemedicine Intensive Motivational Enhancement (TIME) (NCT04752462) is an ongoing randomized clinical trial designed to investigate telemedicine ME effect on post-discharge PAP adherence, rehospitalizations, and patient-reported outcomes compared to standard of care at 3 and 6 months in patients admitted with ADHF and in-hospital OSA diagnosis (respiratory event index, REI&gt;5). We describe baseline characteristics of 56 patients currently enrolled. Unadjusted and adjusted linear models were used to describe associations of OSA measures (Respiratory Event Index, REI and percentage of recording time&lt; 90%SaO2,T90) with Kansas City Cardiomyopathy Score(KCCQ). Adjusted models included age, sex, race, and body mass index(BMI).

Results
Since April 2021, 5,742 patients were screened and of these, 3,822 had an admission diagnosis of ADHF, of which 343 underwent in-hospital portable sleep testing. Of these, patients were excluded for the following reasons: central predominant apneas (CA &gt;50% of total REI) 31.5%(n=108), sleep-related hypoxemia 18.7%(n=64), negative for OSA 20.1%(n=69), declined PAP therapy 10.5%(n=36) or declined to participate in the clinical trial 2.9(n=10). Characteristics of the 56 participants currently enrolled are:age:60±14 years, 38% women, 45%black race, BMI of 35±8, left ventricular ejection fraction:40±16%, REI:26±14 and T90:19±17% and Epworth Sleepiness Scale:6[IQR, 3-10]. Comorbidities were hypertension 77%, atrial fibrillation 34%, valvular disease 21%, myocardial infarction 20%, and diabetes 39%. Self-reported health status at baseline was poor with a KCCQ score of 38±26. In adjusted analyses, for each unit increase of REI and T90, the overall KCCQ scores were associated with non-significant reduction by -0.29 (95% CI:-0.89,0.31, p=0.34) and -0.19(95%CI: -0.73,0.35,p=0.49) points respectively.

Conclusion
The TIME trial is designed to elucidate the effect of ME through telemedicine on PAP adherence and patient outcomes post-discharge in patients with ADHF and OSA. Directionally increased OSA severity was related to lower KCCQ scores, as expected, in OSA and ADHF, however, these relationships were not significant.

Support (if any)
AASM Foundation
0554 Cardiac Impact of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
Authors: Gupta Suhani , Kanagarajan Karthik , Brandt Alexander , Stokes Jonathan , Hellman Joseph , Hensler Matthew , Chung Eugene 
Published: April 2024

Abstract

Introduction
Sleep disordered breathing is a common contributor to cardiovascular morbidities. Inspire™ hypoglossal nerve stimulation is an effective way to treat moderate to severe obstructive sleep apnea (OSA). Although the cardiovascular effect of this relatively new treatment is not established, resolution of OSA is associated with reduced cardiac afterload and sympathetic tone and should be of benefit to the heart. Accordingly, we report on a small case series (n=6) of OSA patients treated with this device, with available echocardiograms before and after device therapy.

Methods
In a single center retrospective analysis, we compared echocardiograms from mean of 479 days before and mean of 464 days after device implantation.

Results
Mean apnea hypopnea index decreased from baseline of 41 events/hour to 9.7 events/hour. Echocardiographic data suggest that with treatment, cardiac chambers decrease in size (left ventricle 5.5 to 5.1 cm, right ventricle 4.3 to 4.0 cm, left atrial volume index 42 to 33 ml / m2). Left ventricular ejection fraction increases (43 to 51 %). Central venous pressure decreases (4.4 to 3 mmHg) and mitral and tricuspid valve regurgitation appear to be somewhat less.

Conclusion
In this first report of hypoglossal nerve stimulation therapy for OSA, treatment appears to have a salutary impact on cardiac structure and function. While the small number of patients makes it impossible to draw definitive conclusions, the consistent direction of trends for all the relevant parameters is notable. Larger, prospective studies are warranted to confirm these preliminary observations.

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0557 The Impact of Gender on the Obstructive Sleep Apnea—Depression Relationship
Authors: Patel Sanjay , Dexter R , Woodford Caleb , Cameron Ann , Alpert Naomi , McConnell Will , Sterling Kimberly , Cistulli Peter , Malhotra Atul , Pépin Jean-Louis , Cole Kate 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) and depression commonly co-exist and have complex relationships. Depressive symptoms may be a particularly common manifestation of OSA among women, with women going undiagnosed with OSA for many years. Conversely, effective OSA treatment may improve depression control. We sought to evaluate the relationship between OSA and depression including the impact of treatment, and how this varies by gender.

Methods
We linked administrative claims data with objective positive airway pressure (PAP) therapy device usage data to identify a cohort of adult patients diagnosed with OSA, newly initiated on a PAP device, with medical and pharmaceutical claims data available from 1 year prior to 2 years post PAP initiation date (index). Depression was defined by at least 2 healthcare encounters with a depression diagnosis code in the year prior to index, with no depression pre-index defined by no depression diagnosis codes. PAP adherence was categorized as consistently adherent, intermediately adherent, or non-adherent based on objective usage over 2 years.

Results
A total of 345,707 patients with OSA initiating PAP were included in this analysis, of whom 57,397 (16.6%) had depression, including 25.5% of women and 10.6% of men (p&lt; 0.001). In both women and men, individuals with depression had a greater burden of most comorbidities, including severe obesity, hypertension, type 2 diabetes, coronary artery disease, cerebrovascular disease, and heart failure. Over 2 years, PAP adherence was lower among patients with depression. Women with depression had the lowest proportion of adherent patients (23.3% vs 28.8% men with depression, 31.3% women without depression, 37.8% men without depression, p&lt; 0.001). Hours per day and days per week of PAP use followed this same pattern. Lower PAP adherence was associated with lower rates of antidepressant medication use at 1- and 2-years post-PAP initiation in both women and men.

Conclusion
We found in a real-world cohort that depression commonly co-exists with OSA, particularly in women. PAP adherence is lower in those with depression, especially among women. This study highlights the need to further understand the impact of depression in women with OSA.

Support (if any)
ResMed
0559 Predictive Parameters of Veterans with False Negative Home Sleep Apnea Test in Diagnosis of Obstructive Sleep Apnea
Authors: Duggal Aarti , Bond Sarah , Thammasitboon Supat 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is prevalent among United States Veterans. The STOP-BANG questionnaire and Home Sleep Apnea Testing (HSAT) provide a cost-effective alternative to polysomnography (PSG). However, HSAT's diagnostic accuracy is not always precise. Our hypothesis posits a higher false negative (FN) rate in veterans with specific demographics or comorbidities, even with a STOP-BANG score of 3 or more. Our study explores variations in HSAT diagnostic accuracy across demographics and predictive parameters for FN HSAT in identifying OSA patients.

Methods
This retrospective chart review includes Veterans referred to SLVHCS Sleep Center for OSA evaluation (01/01/2023 to 12/01/2023) with a STOP-BANG score of 3 or more. HSAT with WatchPAT® was performed, followed by confirmatory PSG post-negative WatchPAT® analysis. FN rates and predictive parameters were compared between FN and true negative (TN) using paired t-testing and chi-square testing.

Results
A total of 107 negative HSAT patients (68.22% male, 31.78% female) with an average age of 43.36 ± 11.9 were included in the study. Among patients with negative HSATs, males had a higher FN rate than females (73% vs. 44%, p=0.0028). Further analyses showed no significant differences in age, BMI, PSG sleep time, STOP-BANG score, or psychiatric comorbidity between false and true negatives. Interestingly, a trend was noticed in African Americans, who had more FN tests than Caucasians (69.8% vs. 59.2%, p=0.090).

Conclusion
Our findings suggest a higher likelihood of FN results in negative HSATs among male compared to female Veterans. Additionally, there may be an association of higher FN tests in the African American race. Further analyses with a larger sample size and inclusion of true positive tests are needed for a conclusive assessment of HSAT's diagnostic capability in the specified categories.

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0577 Women's Perspectives of Received Support When Initiating Continuous Positive Airway Pressure (CPAP) Treatment
Authors: Morris Jonna , Speakman Campell , Patel Sanjay , Luyster Faith 
Published: April 2024

Abstract

Introduction
Women are less adherent to CPAP than men, but the reasons are unclear. Our goal was to qualitatively explore women’s perceptions of support from their healthcare provider, durable medical equipment (DME) company, and family or friends during the initiation and continuation of CPAP treatment.

Methods
We conducted 28 semi-structured interviews with women diagnosed with OSA who via self-report were using CPAP every night (n=11), using CPAP intermittently (n=8), or had discontinued use (n=9). The women had mean age ± SD = 51 ± 15, were 29% Black, 71% White, and OSA severity was 40% mild, 21% moderate, 25% severe, 14% unknown. Interview questions were structured to elicit the women’s detailed experiences and perceptions of support while beginning CPAP treatment. Two independent reviewers analyzed responses using a thematic approach that identified the major conceptual categories.

Results
All the women described overcoming challenges when initiating CPAP treatment, in particular those related to mask fit and discomfort, machine set up, and receiving adequate support when problems arose. In their descriptions of how they solved their challenges, three themes emerged: 1) Self-advocacy was essential, yet many women hesitated to ask for continued support, 2) Tenacity and ‘trial and error’ were crucial to overcoming challenges, 3) Desire for live support including video calls for demonstration of CPAP set up and also general coaching or reinforcement. Women who consistently used CPAP every night, were more likely to discuss overcoming challenges during treatment initiation compared to those who had discontinued its use or were using it intermittently. The consistent CPAP users also discussed receiving support from various sources, particularly their DME company, but also healthcare providers, friends, family, and even Facebook groups; in contrast the women who discontinued its use were less likely to discuss receiving support outside an initial call to their DME.

Conclusion
Women had to actively pursue support and information that wasn't readily available during initiation and continuation of CPAP treatment, potentially creating a deterrent to its use. Tailored support may be necessary to assist women in overcoming challenges during the initial stages of treatment.

Support (if any)
University of Pittsburgh, School of Nursing, Center for Research and Evaluation
0582 Exploring a Supplemental Measure of CPAP Adherence
Authors: Velazquez Yzabel , Zamora Tania , Sarmiento Kathleen , Stepnowsky Carl 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is highly prevalent in the Veteran population. The prevailing treatment for OSA is positive airway pressure (CPAP), but benefits depend on regular use. CPAP adherence is operationally defined as the number of hours of CPAP use per 24-hour period at the prescribed pressure. There are a variety of alternate metrics help to describe CPAP use, with most focused on duration and some type of categorization. Given the limited utility of these kinds of CPAP metrics, we wondered if a different type of CPAP adherence metric might be warranted. Putting on the CPAP mask is a behavioral action, so we explored the value of a metric focused on putting the mask on at least once per day.

Methods
Participants in an CPAP trial were provided standard education about their diagnosis and treatment at baseline. Follow-up visits were held two and four months from start of treatment. Treatment adherence metrics were derived from CPAP usage data. The “anyuse” metric was defined as the percentage of nights the mask was put on at least once in a 24-hour period.

Results
Twenty participants had a mean age of 50.2±13.9, mean AHI of 23.3±16.0, and mean BMI of 31.3.8±4.9 (kg/m2). Nightly CPAP adherence measured over the two-month period was 2.6±1.6 hours per night (mean±SD). The average anyuse at two-month was 78% ± 0.24 (12%-100%). Anyuse was moderately correlated with CPAP adherence (r=0.682, r-squared=0.465, p&lt; 0.001), which means that while 46% of the variance in adherence was accounted for by anyuse, 54% of the variance was not.

Conclusion
The anyuse metric is a relatively simple metric that might have value as a supplemental metric to CPAP adherence. Importantly, it does not overlap substantially with CPAP adherence and provides a measure of initial behavioral action. A possible related metric is a count of the number of mask on events per day. Further exploration of these metrics appears to be warranted.

Support (if any)
This project was supported in part by the VA HSR&D IIR 16-277 and the VA San Diego Healthcare System Pulmonary Sleep Medicine Section and Research Service.
0585 PAP Therapy Impact on Bariatric Surgery Complications: A 30-Day Pre-Operative Evaluation
Authors: Bugazia Seif , Badhwar Ankita , Shakaroun Dania , Carlin Arthur , Roehrs Timothy , Skiba Virginia 
Published: April 2024

Abstract

Introduction
The coexistence of obstructive sleep apnea (OSA) and obesity creates an intricate clinical scenario, particularly for individuals pursuing bariatric surgery. OSA increases perioperative risks, including prolonged stay, re-intubation, and cardiovascular events. It is generally recommended that patients with OSA start using Positive Airway Pressure (PAP) therapy before surgery, however studies are mixed on whether use of PAP reduces postoperative or long-term complications, and many include only subjective compliance data. We examined objective pre-operative PAP use among OSA patients undergoing bariatric surgery and its impact in reducing post-operative complications.

Methods
Our study included data from 140 individuals who underwent bariatric surgery gathered over a 6-month period, with 79 having verified PAP use in the 30-days before surgery. A correlation analysis was conducted comparing 30-day pre-operative PAP use to total operative time, time in the Post-Anesthesia Care Unit (PACU), length of inpatient stay, collective PACU and inpatient time, ED visits within the 30 days post-op. There were no deaths, ICU transfers, respiratory or surgical complications in this sample. Furthermore, PAP use was categorized into tertiles, and an analysis of variances was completed for the following secondary variables: Apnea-Hypopnea Index (AHI), time with oxygen saturation &lt; 88% and &lt; 90%, age, and weight. Mean PAP use in minutes was 376±59 for the highest-use group, 183±61 for intermediate-use group, and 10±16 for lowest-use group.

Results
Our correlation analysis revealed no significant associations between 30-day pre-operative PAP use and above-mentioned outcomes. Upon PAP use stratification into tertiles, a statistically significant effect became apparent in relation to PACU time (p = 0.008), with oxygen saturation &lt; 88% as a significant covariate. The PACU time in minutes varied across tertiles, with the highest-use group having a PACU time of 169±106, the intermediate-use group with 217± 156s, and the lowest-use group with 202±129.

Conclusion
Overall, complications rates after bariatric surgery were low. Increased PAP use was significantly associated with shorter stays in the PACU, perhaps related to faster time to recovery from anesthesia due to lower number of desaturations, hence mitigating need for continued nursing monitoring which could potentially lower healthcare associated cost.

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0588 Combination Therapy: Hypoglossal Nerve Stimulation and Oral Appliance Therapy
Authors: Glick Aaron , Richardson Sue Ellen , Singh Supriya 
Published: April 2024

Abstract

Introduction
Hypoglossal nerve stimulation (HGNS) is an implantable body that protrudes the tongue anteriorly during sleep. This surgical procedure is effective with minimal side effects, however for some patients 80 complications arise and require additional treatment modalities. One such alternative is oral appliance therapy that uses a different mechanism of action to displace the mandible anteriorly which is worn on the upper and lower teeth.

Methods
Five patient charts were identified out of 80 that had undergone hypoglossal nerve stimulation surgery with subsequent placement of oral appliance. Patient characteristics were identified to understand clinical reasoning leading to combination therapy and success of treatment.

Results
The most common reasons for a referral to the dentist after surgical placement of hypoglossal nerve stimulator is due to abrasion of the tongue (60%) and residual snoring (60%) with some patients having multiple reasons for the referral. Oral appliances were made for 4 of the 5 patients. Of the 4 patients all have evidence of tooth wear with 50% of patients having minor chipping on a front tooth. Average pre-treatment AHI was 33±13 to average post-treatment for combination therapy (HGNS with oral appliance) AHI of 6±2. Combination treatment eliminated both residual snoring and abrasion of the tongue in all patients.

Conclusion
The limitations are that there was a small sample size since a referral after HGNS surgery to oral appliance is rare. While conclusions about the patient characteristics cannot be generalized to the general population due to the small sample size, it was found that all patients had evidence of tooth wear which is common in the obstructive sleep apnea population. Clinically, combination therapy of HGNS and oral appliance therapy can be a viable alternative for some patients.

Support (if any)
None.