bluuebunny/crossref_metadata_2025_split huggingface dataset:
0459 Restriction of Breathing in OSA Does Not Affect Sleep Spindle Density
Authors: Harding Christian , Holloway Breanna , Schmickl Christopher , DeYoung Pamela , Kwan Crystal , Ancoli-Israel Sonia , Banks Sarah , Malhotra Atul 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with major neurocognitive sequalae including impaired memory. OSA patients are deficient in NREM sleep spindles (11 Hz to 16 Hz electroencephalography (EEG) sigma oscillations) which have been shown to promote memory. This finding is a result of less time spent in deeper sleep states in which most spindles occur but also a reduction in spindle density, particularly during the later portion of the night. We tested the hypothesis that spindle density deficiencies are driven by restriction of breathing preventing spindle generation.

Methods
109 adults (ages 65-83, 53% female) with normal cognition underwent overnight polysomnography (PSG). Presence of sleep apnea was defined using AASM recommended criteria (apnea-hypopnea index &gt;15, n=81[OSA] vs 28[controls]). The right occipital channel EEG was bandpass filtered between 0.3-35Hz. Following rejection of movement artifacts, spindles were detected in NREM sleep stages 2 and 3 (N2/N3) using complex demodulation to extract high sigma activity signals from background sigma noise. Spindles were classified depending on whether the patient was in eupnea or apnea-hypopnea.

Results
Overall spindle density in OSA patients did not differ from overall spindle density in controls (2.86 vs 3.17 spindles/minute, t(57.4)=0.49, p=0.14). Apnea-hypopnea spindle density in OSA patients did not differ from eupnea spindle density in controls (3.10 vs 3.17 spindles/minute, t(70.8)=0.31, p-value=0.76). Eupnea spindle density in OSA patients was significantly lower than eupnea spindle density in controls (2.57 vs 3.17 spindles/minute, t(54.4)=2.94, p-value&lt; 0.01).

Conclusion
Contrary to our hypothesis, sleep spindle density was not reduced in OSA patients during apnea-hypopnea compared to healthy controls during eupnea, suggesting restriction of breathing does not affect spindle generation, but was reduced in OSA patients during eupnea. Whilst we did not observe an overall OSA-related spindle density deficit, our results suggest that previous findings of lower spindle density in OSA patients may in fact result from changes in spindle behaviour during eupnea. This observation raises the interesting possibility that using OSA interventions to prevent apnea-hypopnea occurring may not recover normal spindle density. Alternatively, our results could suggest that undetected N2/N3 sleep disruptions are occurring when OSA patients are breathing, skewing eupnea spindle density estimates.

Support (if any)
1R01AG063925-01A1
0460 Dose-response Relationship Between Thalamic Activity During Sustained Attention and Excessive Daytime Sleepiness
Authors: Azad Dishari , Valencia Daphne , Wickramaratne Sajila , Kam Korey , Fleysher Lazar , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by sleep fragmentation and intermittent hypoxia. Both are known causes of sleepiness and poor sustained attention, i.e., lapses in vigilance, which can be measured using the psychomotor vigilance test (PVT). Crucial to vigilance, the thalamus plays a key role by regulating sensory information essential for sustaining attention. However, to date, the relationship between thalamic activity underlying PVT and its relationship to sleepiness in OSA has not been investigated systematically.

Methods
A total of 5 newly diagnosed OSA subjects (mean AHI4% = 51±24, 5M, age 42±3 yrs., ESS [Epworth Sleepiness Scale] 11 ± 3.4), 3 healthy controls (1M/2F, age 35±2 yrs., ESS 3±3) and 9 PAP treated OSA subjects (diagnostic AHI4% = 15±12, 6M/3F, age 57±10 yrs., ESS 8±5) who demonstrated &gt;4 hours nightly PAP adherence were studied. Participants performed a PVT during fMRI after an in-lab nocturnal polysomnography. Each fMRI session consisted of 4 runs: two PVT runs interleaved with two control runs. Analyses in AFNI were restricted to the bilateral thalamus with percent signal change used as the primary metric of thalamic activity.

Results
There was a dose response relationship of ESS to thalamic activity during PVT such that subjects with lowest levels of sleepiness (ESS) exhibited the greatest thalamic activity: untreated OSA (3±2%), CPAP treated OSA subjects (7.2±1.9%), healthy controls (21.8±1.1%); χ2(3) = 7.13, p&lt; 0.05. CPAP treated OSA subjects with persistent sleepiness (ESS≥10) exhibited lower thalamic activity than those without persistent sleepiness (ESS&lt; 10), however it did not reach statistical significance (5.3±3.4% vs. 6.9±2.9%).

Conclusion
Based on the collected data, the thalamic activity underlying PVT shows a dose response relationship with level of sleepiness. The lower degree of thalamic activity in CPAP treated patients with persistent sleepiness as compared to those without suggesting a level of irreversible injury to the thalamus due to OSA. Our findings should be further validated with a larger sample size with varying degrees of sleep apnea severity.

Support (if any)
NIH K25HL151912, NIH R01HL171813, NIH R21HL165320
0464 The Impact of Fatigue and Sleepiness on Patients with OSA: A Closer Look with Patient Reported Outcome Measures
Authors: Emsellem Helene , Colwell Hilary , Cronin John , Farkas Ron , Mathias Susan 
Published: April 2024

Abstract

Introduction
Qualitative interviews were conducted to understand experiences of individual with OSA by evaluating the content validity and relevance of 5 patient reported outcome (PRO) measures (PROMIS-Fatigue-8a, the PROMIS-Sleep Impairment-8a, the Epworth Sleepiness Scale (ESS), Patient-Global Impression of Severity (PGI-S)-Fatigue, and Patient-Global Impression of Change (PGI-C)-Fatigue).

Methods
3 US sites identified individuals with OSA. Once consented, participants completed an interview containing concept elicitation and cognitive debriefing questions. Interviews were recorded, transcribed, and analyzed using qualitative software. Symptoms and impacts were mapped to the PROs, and a gap analysis was conducted. The study was approved by WCG IRB.

Results
30 individuals with OSA (20 current non-PAP users [mean age=55; 50% male] and 10 current PAP users [mean age=52, 80% male]) were interviewed. Non-PAP and PAP users viewed fatigue and feeling sleepy as separate, distinct symptoms. Among non-PAP users the most common symptoms were fatigue (100%), difficulty concentrating (85%), feeling sleepy (75%), dry mouth (60%), interrupted sleep (50%), and headaches (50%). Fatigue (63%) was most bothersome, while 5% rated feeling sleepy as most bothersome. Among PAP users the most common symptoms were fatigue (100%), feeling sleepy (90%), difficulty concentrating (60%), dry mouth/throat (60%), headaches (50%), and interrupted sleep (50%). Fatigue (63%) was most bothersome, while 25% rated feeling sleepy as most bothersome. Non-PAP and PAP users reported negative impacts on daily activities (50% both), physical (60% and 50%, respectively), social (50% both), and emotional functioning (80% and 60%), and relationships (75% and 70%). Impacts on ability to work for pay and work productivity (45% and 70%) were also common. PAP users reported improvements on their ability to do daily activities (80%) and all areas of functioning after initiating PAP (range: 80-100%). In general, participants found these PROs to be clear and appropriate. Fatigue and sleepiness were two of the most common symptoms cited; these concepts are comprehensively covered by these PROs.

Conclusion
Fatigue and sleepiness should both be assessed in OSA trials and clinical practice. This study provides evidence to support the content validity, clarity, and relevance of the PROMIS-Fatigue-8a, PROMIS-Sleep Impairment-8a, ESS, PGI-S-Fatigue, and PGI-C-Fatigue PROs in an adult OSA population.

Support (if any)
Funded by Apnimed.
0466 Benzodiazepines and Opiates Shorten Exacerbation-Free Time in COPD Patients on Long-Term Non-Invasive Ventilation
Authors: Chai Andrew , Csoma Balazs , Bentley Andrew , Bikov Andras 
Published: April 2024

Abstract

Introduction
Benzodiazepines and opiates are taken by patients with very severe COPD to relieve breathlessness. There is a growing concern that these medications can depress the respiratory drive and could contribute to worsening respiratory failure. However, the relationship between exacerbation rate and medication taken is poorly understood in patients with chronic respiratory failure.

Methods
As part of a retrospective service evaluation project, we analysed 383 patients with COPD (pre-setup 64±9 years, 143 men, FEV1 38.1±15.9 %pred, mMRC 3.7±0.6, 3 /2-5 interquartile range/ exacerbations/year, capillary blood pH 7.39±0.08, pO2 7.9±1.6 kPa, pCO2 8.2±2.1 kPa) who were established on long-term non-invasive ventilation at our tertiary centre. We analysed associations with medication usage, pre-setup overnight and daytime gas exchange as well as symptoms and pre- and post-setup annualised exacerbation rate.

Results
Seventy-seven patients took benzodiazepines (0.65±0.58 mg/day clonazepam equivalent), 185 patients took opiates (34.1±42.6 mg/day morphine equivalent). Neither benzodiazepine nor opiate usage was associated with overnight hypoxaemia (as measured by oxygen desaturation index or time spent with saturation below 90%), daytime hypercapnia, hypoxia or the number of annual exacerbations before NIV setup. The mMRC scores were higher in patients taking both benzodiazepines (3.9±0.2 vs. 3.7±0.7, p=0.02) and opiates (3.9±0.4 vs. 3.6±0.7, p&lt; 0.01) compared to those who did not. Long-term NIV significantly reduced the number of yearly exacerbations in this cohort (from 3 /2-5/ to 2 /1-5/, p&lt; 0.05). However, the time to the next exacerbation post-NIV setup was shorter in patients who took benzodiazepines (5.7±8.9 vs. 6.5±7.4 months, p=0.04) and opiates (4.4±6.2 vs. 6.2±8.7 months, p=0.03).

Conclusion
Benzodiazepines and opiates are commonly taken in this cohort, especially in those with a high symptom burden. Whilst they do not seem to contribute to impaired gas exchange or exacerbation rate pre-setup, they may limit the benefit of long-term NIV in reducing exacerbation rate.

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0470 Real-time Data Showing Immediate Improvement of Obstructive Sleep Apnea Following Renal Transplant
Authors: Sedar Cole , Andre Aguillon 
Published: April 2024

Abstract

Introduction
There is a well-documented correlation between end stage renal disease (ESRD) and obstructive sleep apnea (OSA). Prevalence of OSA in the ESRD population has been show to be as high as 51%. There is a complicated interrelation between the two pathologies. Hypertension, is a major contributing factor to the progression chronic kidney disease and subsequently ESRD. It is a consequence of the cascade of increased sympathetic tone, vasoconstriction, and oxidative stress caused by the hypoxic episodes of OSA. Volume overload and fluid shifts during recumbence leads to an increase in tissue fluid around the upper airway in patients with ESRD and has been shown to worsen OSA4. Data on improvement in OSA after renal transplantation has been mixed, with some case reports of OSA resolution after transplantation, but a greater number of studies showed no significant improvement of OSA following transplantation. Most studies review long term SDB in relation to transplant, few studies measure sleep disordered breathing in the immediate post-op period

Methods
Our patient is a 54-year-old African-American male with ESRD secondary to systemic lupus erythematosus on HD since 2017. He had been treated with methotrexate, hydroxychloroquine, mycophenolate mofetil, and corticosteroids prior to transplant. Medical history other than the above includes rheumatoid arthritis, pericarditis, hypertension, osteoporosis, and OSA treated with CPAP. The patient had been compliant with CPAP prior to transplant. OSA was diagnosed in 2014 with AHI of 26.1 events/ hour, with a nadir Sao2 of 60%.

Results
He underwent deceased donor renal transplant on 11/11/2018. During this hospitalization he was using his home CPAP, which recorded his compliance and treatment data. Evaluation of his downloaded CPAP compliance report revealed a dramatic improvement in respiratory events starting the day of transplant. AHI improved from 0.6 events/hour to 0.2 events/hour immediately following transplant.

Conclusion
Although recent studies have not shown resolution of obstructive sleep apnea in ESRD patients following transplantation, this case does show a dramatic improvement in the degree of sleep-disordered breathing immediately following surgery. This case also provides real time data regarding the effects of renal transplantation on sleep disordered breathing.

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0477 Impact of Socioeconomic Disparities on CPAP Compliance
Authors: Shing Samuel , Molin Nicole , Perlov Natalie , DeKloe Jefferson , Grewal Ritu 
Published: April 2024

Abstract

Introduction
Social disparities is known to have a significant impact on health outcomes including those related to obstructive sleep apnea (OSA). More recently a metric known as area deprivation index (ADI) which combines 17 social determinants of health has been used to better quantify this impact. We aim to examine the relationship between socioeconomic disparities and CPAP adherence among adults with OSA using ADI.

Methods
Retrospective chart review of patients with diagnosis of OSA and prescribed CPAP from Oct-Dec 2022. Patients were divided into more or less socioeconomically disadvantaged groups using a validated measure, the area deprivation index (ADI). 30 day CPAP compliance was collected. CPAP compliance was defined using Medicare criteria (&gt;4hrs/night 70% of the nights). Long term CPAP data is currently being collected.

Results
452 patients included. Patients from the most deprived areas as determined by ADI had significantly lower CPAP compliance than those from the most advantaged areas (34% compared to 56%) (p&lt; 0.05). Patients from areas with lower rates of high school graduates had lower CPAP compliance (p&lt; 0.05). In multivariate regression non-English speaking appeared to be a significantly negative predictor of CPAP compliance.

Conclusion
Socioeconomic disparities appear to have a significant impact on CPAP compliance. In particular, those from areas that are considered more deprived, areas with lower rates of high school graduates and non English speakers seem to be impacted the most. Patients within these groups may benefit from additional resources and/or closer follow up to improve compliance with treatment.

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0478 The Association of Obstructive Sleep Apnea with Metabolic Syndrome Is Modified by Age
Authors: Vgontzas Alexandros , Pejovic Slobodanka , He Fan , Fernandez-Mendoza Julio , Bixler Edward 
Published: April 2024

Abstract

Introduction
It has been proposed that there is a bi-directional, feed forward, pernicious association between obstructive sleep apnea (OSA) and metabolic syndrome, all promoting atherosclerosis and cardiovascular disease. However, the cardiometabolic comorbidities associated with OSA tend to diminish with age. The goal of this study is to examine whether the association of OSA with MetS is modified by age.

Methods
We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority) who underwent a 1-night polysomnographic evaluation, clinical history, and physical examination. The presence of OSA was defined as an apnea/hypopnea index ≥15 events/hour. Outcome variables include the five MetS components as defined by the National Heart, Lung, and Blood Institute/American Heart Association modified criteria, i.e., obesity (BMI≥30 kg/m2), hypercholesterolemia (≥200 mg/dL), hypertriglyceridemia (≥150 mg/dL), diabetes (fasting glucose ≥100 mg/dL and/or treatment), and hypertension (blood pressure ≥130/85 mm Hg and/or treatment). Logistic regression models examined the association of OSA with MetS components in the entire cohort and divided by age (&lt; 60 and ≥ 60 years) adjusting for race, sex, smoking, alcohol and sampling weight.

Results
There was a significant interaction between MetS components and age. In individuals younger than 60 years old, OSA was significantly associated with increased risk of diabetes (OR=5.619, 95%CI=2.74-11.53, p=&lt;.001), hypertension (OR=3.85, 95%CI= 1.95-7.63, p=&lt;.001), hypercholesterolemia (OR=5.99, 95%CI=2.36-15.21) and hypertriglyceridemia (OR=4.75,95%CI=2.30-9.90, p=&lt;.001). There was no association of OSA and these four components of MetS syndrome (i.e., hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia) in individuals 60 years or older. The association of OSA with BMI was stronger in those younger than 60 vs. those older than 60 (OR=6.03, 95%CI=3.08-11.78, p&lt;.001 vs, 2.47, 95%CI= 1.23-4.94, p=.011, respectively).

Conclusion
The association of MetS components with OSA is strong in young and middle-aged adults, but not in older adults. These findings suggest that MetS is key to the pathogenesis of OSA in young and middle-aged adults whereas other mechanisms such as airway anatomy and collapsibility play a greater role in older adults. This suggest different treatment strategies may be needed for this highly prevalent sleep-related breathing disorder among different populations.

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0479 The Association of Positional Obstructive Sleep Apnea with Blood Pressure
Authors: Chow Christine , Kang Hyojung , Logan Jeongok , Liu Xiaoyue , Kwon Younghoon 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with hypertension and adverse cardiovascular (CV) outcomes. Sleep position plays a critical role in the pathophysiology of OSA. Generally, positional OSA (POSA) refers to OSA that mostly occurs in the supine position, the most vulnerable position for upper airway obstruction. It is unclear whether POSA has CV risk implications. The purpose of this study was to compare blood pressure (BP) and BP variability (BPV), two well-established CV risks between the patients with POSA and non-POSA.

Methods
We included patients who had at least three separate BP measurements taken during office visits within one year prior to clinically indicated polysomnography at a single center. Systolic BP (SBP), diastolic BP (DBP), SBP coefficient of variation (SBP-CV) and DBP coefficient of variation (DBP-CV) were measured. POSA was defined by patients with an apnea-hypopnea index (AHI) ≥5 events/hour as well as supine AHI at least twice as high as non-supine AHI. ePOSA consisted of the previously mentioned criteria with the additional requirement that non-supine AHI normalize to &lt; 5 events/hour. Independent two sample t-tests were performed for comparison.

Results
We included 1,750 patients with OSA (age 54 years and 59.5% female). Patients with POSA or ePOSA had a lower BMI than those with non-POSA or non-ePOSA. Those with POSA or ePOSA were more likely to have mild OSA (AHI 5-15 events/hour) compared to patients with non-POSA or non-ePOSA (52.7% vs. 48.2%; 71.8% vs 44%). Patients with POSA or ePOSA had a significantly lower SBP-CV compared to non-POSA and non-ePOSA (9.7 [ 4] vs 10.2 [4.2], p=0.014; 9.5 [SD 4.2] vs. 10.1 [SD 4.1], p=0.005). There were no significant differences in mean SBP, mean DBP, or mean DBP-CV in the comparison of POSA vs non-POSA. However, patients with ePOSA had a lower mean SBP (128.8 vs 131.2 mmHg, p=0.003) and mean DBP (73.6 vs 75 mmHg, p=0.004) than those with non-ePOSA.

Conclusion
POSA is associated with lower BP risk profile. This may have implications for this subgroup of OSA patients and their risk for hypertension and cardiovascular outcomes. Future studies should consider the positional component in studying CV risks of OSA.

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0480 Less Is More? A Study Comparing Outcomes Between 4% vs 3% Hypopnea Scoring Rules
Authors: Tu Xinhang , Morgenthaler Timothy , Baughn Julie , Herold Daniel , Reckward Dennis , Fenske Chris , Brown Jennifer , Becker Stephanie , Erickson Melanie , Lipford Melissa 
Published: April 2024

Abstract

Introduction
The definition of respiratory events has evolved over decades. The current American Academy of Sleep Medicine scoring manual recommends hypopneas be defined by a ≥ 30% airflow reduction with either ≥ 3% desaturation or an arousal, while the prior “recommended” criteria of a ≥ 30% airflow reduction and associated ≥ 4% oxygen desaturation (with no requirement of arousal) was changed to “optional”. Consequently, events previously characterized as a respiratory effort related arousal (RERA) may now be defined as a 3% hypopnea. We hypothesized that while the 3% apnea-hypopnea index (3%AHI) will be higher than the 4%AHI, the 3%AHI will be similar to the 4% respiratory disturbance index (4%RDI), and that the measurement of RERAs under 3% scoring criteria will be clinically insignificant.

Methods
We prospectively collected 70 consecutive in-lab polysomnography results in 4 adult age groups. We re-scored the respiratory events utilizing the 3% hypopnea rule, and compared the differences between 3% and 4% scoring criteria.

Results
Among the 70 studies (mean age 50, males 46%), the 3%AHI was significantly higher than the 4%AHI (+9.247 ± 1.161, p&lt; 0.001). This was mainly due to increased hypopnea events (+10.313 ± 1.617, p&lt; 0.001). The 3%AHI was significantly different from the 4%RDI (+7.096 ± 1.133, p&lt; 0.001). There were no significant differences between the 3% and 4% RERA indices, with both values being minimal. Results were similar in both diagnostic and titration phases of testing.

Conclusion
As previously shown, utilizing the 3% hypopnea rule results in an increased AHI. Most of this difference is related to hypopneas with negligible influence of RERAs. This may lead to increased diagnosis and severity of sleep-disordered breathing in the adult population, and potentially be associated with payer ramifications. Our findings demonstrated negligible RERA indices on average with either rule, thus calling into question the clinical significance of this index in most patients.

Support (if any)
NA