bluuebunny/crossref_metadata_2025_split huggingface dataset:
0482 Prevalence and Demographic Characteristics of Triple Overlap Syndrome Among Adults in the United States
Authors: Luyster Faith , Baniak Lynn , Edmiston Elizabeth , Imes Christopher , Jeon Bomin , Morris Jonna , Orbell Staci , Scott Paul 
Published: April 2024

Abstract

Introduction
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) often coexist, forming the “overlap syndrome”, which is associated with a worse prognosis than either disease alone. With the anticipated rise in the prevalence of severe obesity (body mass index ≥ 40), it can be projected that more patients will present with "triple overlap syndrome" (i.e., presence of severe obesity, COPD, and OSA), a distinct phenotype requiring complex disease management. This study determined the prevalence of triple overlap syndrome among U.S. adults and evaluated its prevalence over time and across demographic characteristics.

Methods
Cross-sectional analysis of 2005-2006, 2007-2008, 2015-2016, and 2017-2018 National Health Nutrition Examination Survey (NHANES) waves using self-report data. High risk of OSA was determined with an adapted multivariable apnea prediction (MAP) index score of &gt; 0.5. Survey-based Rao-Scott corrected χ2 test or t-test was used to compare prevalence rates between NHANES waves and to examine differences in age, sex, race/ethnicity, education, and health insurance status between those with triple overlap syndrome and overlap syndrome.

Results
A total of 8373 participants (mean age 57.2 ± 0.3; 69.8% women; 70.9% non-Hispanic White) were included in the overall sample. The prevalence of triple overlap syndrome was 1.9% and increased from 1.1% in 2005-2008 to 2.7% in 2015-2018 (a nearly250% increase, p&lt; 0.001), driven by increased rates of OSA, COPD, and severe obesity of 6.5%, 1.8%, and 2.3%, respectively. Overlap syndrome prevalence increased from 5.6% to 7.5%. Those with triple overlap syndrome were predominately middle-aged women of racial/ethnic minority, with at least a high school education and health insurance. As compared to those with overlap syndrome, those with triple overlap syndrome were younger (56.7 vs. 64.2 years, p&lt; 0.001), more likely to be women (62.4% vs. 29.2%, p&lt; 0.001), and less likely to be non-Hispanic White (43.4% vs. 61.9%, p&lt; 0.001). Education and health insurance status were similar between groups.

Conclusion
Women and ethnic/racial minorities may represent high-risk groups that should be targeted for assessment of the growing triple overlap phenotype. Further research is needed to explore social and environmental determinants of health disparities in the prevalence of triple overlap syndrome.

Support (if any)
No support
0485 Can Hypoxic Burden Predict Improvement in Sleepiness and Cognition in Response to CPAP Treatment in OSA Patients?
Authors: Gaynor-Sodeifi Kaveh , Greenberg Dylan , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) affects more than 10% of older Americans and is associated with future comorbid conditions. The current method for measuring OSA severity, the apnea-hypopnea index (AHI), is poorly correlated to symptom burden and clinical improvement. Hypoxic burden (HB), which quantifies and characterizes OSA-related hypoxemia, has been suggested as an alternative OSA measure. However, more research is needed to understand HB’s predictive ability. Thus, this study investigated whether HB could predict which OSA patients, prescribed CPAP, will have the greatest improvement in measures of sleepiness and cognition.

Methods
This is a secondary analysis from a trial that investigated the effects of CPAP versus sham treatment on sleepiness [Epworth Sleepiness Scale (ESS), psychomotor vigilance test (PVT)] and cognition [Buschke Selective Reminding Test (BSRT), Sustained Working Memory Test (SWMT), Cogscreen Pathfinder Number (PN)]. Using the SpO2 signal, HB was calculated as the area under the desaturation curve during all desaturation events (sustained &gt;3% dip in SpO2). For categorical analyses, we classified “sleepy” and “not sleepy” in two different ways: ESS≥10 or &lt; 10 and PVT lapses≥4 and &lt; 4, respectively.

Results
Of the 426 (66% male) participants included, ESS and PVT significantly decreased after two months of treatment; 10.2±4.2 vs 8.0±4.2 (p&lt; 0.001) and 2.5±1.6 vs 2.3±1.4 (p&lt; 0.01), respectively. After correcting for BMI, age, sex, and AHI, baseline HB was associated with a change in sleepiness after treatment (∆ESS R2=0.04, p&lt; 0.001; ∆PVT R2=0.01, p&lt; 0.05). Moreover, having higher baseline HB increased odds for transitioning from “sleepy” to “non-sleepy” based on ESS (1.006 [1.001, 1.012]) or PVT (1.07 [1.003, 1.011]). HB was not associated with change in cognitive variables at follow-up (p&gt;0.05), before correcting for any covariates.

Conclusion
HB had a significant yet weak effect on subjective (ESS) and objective (PVT) measures of sleepiness after correcting for covariates. HB did not significantly explain changes in any cognitive measure after two months of CPAP treatment. Whether this lack of an association is due to the absence of an overall improvement in cognition or the inability of HB to explain variability remains to be tested.

Support (if any)
NIH K25HL151912 NIH R01HL171813 NIH R21HL165320
0488 Exploring Study Recruitment Trends in the Acute Post-Stroke Setting
Authors: Schwarz Joshua , Masroor Kiran , Radulescu Radu , Tsang Sui , Sheth Kevin , Redeker Nancy , Yaggi Henry , Geer Jacqueline 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing due to intermittent upper airway closure causing hypoxia, sympathetic activation, and hemodynamic changes that impact cerebral blood flow during sleep and predispose to ischemia. OSA is a well-established independent risk factor for acute ischemic stroke (AIS) with a prevalence estimate ranging from 60-80%. The Recovery in Stroke Using Positive Airway Pressure (RISE-UP) clinical trial is an ongoing study designed to investigate the influence of OSA treatment with continuous positive airway pressure (CPAP) on post-stroke functional recovery in both the subacute and acute post-AIS setting.

Methods
The RISE-UP trial recruits patients admitted to Yale-New Haven Hospital, a large academic medical center in an urban location. Over a period of three years, 3507 patients have been screened for the study. Preliminary data was analyzed for trends in recruitment. Exclusion criteria included being unable to consent for themselves, past use of CPAP, and an estimated life expectancy of less than six months. Passive refusal can be defined as when patients choose not to enroll or participate without actively expressing a refusal.

Results
Of the 1109 (31.6%) patients deemed eligible for the study, 705 (63.6%) were approached, 171 (24.2%) consented to participate, and 489 (69.3%) refused. Among those who refused, the most common reasons were lack of interest (58.8%), passive refusal (21.7%), feeling overwhelmed (12.3%), and family discouragement (4.1%).

Conclusion
The recruitment data presented provides useful insight into the potential challenges of recruitment in the immediate post-stroke setting. In particular, the most common reasons for refusal included lack of interest, passive refusal, and feeling overwhelmed. Based on these findings, more robust education regarding the pertinence of OSA screening in those at risk for cardiovascular disease, such as stroke, and the relationship between OSA and AIS may increase enrollment among this patient population in the future. By understanding patient’s concerns and collaborating with the healthcare system, this analysis serves as a valuable opportunity to aid in recruitment efforts within this domain.

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0498 Driving Performance of OSA Referrals Is Not Correlated with ODI or ESS: Preliminary Results from the ODESA Study
Authors: Lee Kieran , Bekinschtein Tristan , Smith Ian 
Published: April 2024

Abstract

Introduction
Untreated obstructive sleep apnoea (OSA) is associated with 3-fold increased risk of a motor vehicle collision. To date research in this area has focused on driving simulators, crash records and emergency room reports each of which has limitations. Predictors of poor on road driving performance with OSA are not well developed.

Methods
We are recruiting to a study (ODESA), to assess on-road driving performance, collected through a smartphone app developed by our industry partner (Sentiance). Participants are recruited from referrals for investigation of possible OSA. Here, we present preliminary data from the first participants to assess if our measures of driving distinguish varying levels of performance between drivers, and if any measure is correlated with levels of oxygen desaturation (ODI), and Epworth Sleepiness Scale (ESS). Driving scores of Hard Events, Hard Acceleration and Hard Turning were compared across participants using one-way ANOVA’s, and tests of correlation with ODI and ESS were computed using Spearman's Rho.

Results
10 participants (51 +/- 12 years [mean +/- SD], 4 female), have recorded 683 journeys (68 +/- 36 [mean +/- SD]). Significant effects of driving scores between participants, were found for Hard Events (F[9,533]=16.3, p&lt; 0.00001), and Hard Acceleration (F[9,592]=5.64, p&lt; 0.00001), but not Hard Turning (F[9,590]=1.48, p= 0.15). There was no reliable relationship between either ODI (10.2 +/- 15.6 [mean +/- SD]) and Hard Events (rs=.18, p=.63), Hard Acceleration (rs=.25, p=.49) and Hard Turning (rs=-.14, p=.7), or EES (10.9 +/- 4.8 [mean +/- SD]) and Hard Events (rs= .08, p=.83), Hard Acceleration (rs=.31, p=.39) and Hard Turning (rs= -.02, p=.96).

Conclusion
This preliminary analysis shows that despite finding variation in driving performance measures of Hard Events and Acceleration between participants, neither OSA severity or subjective sleepiness (EES), was correlated with the current data configuration. The ODESA study plans to test if neurophysiological measures (EEG), and temporal experience traces (TET), are more informative measures of driving behaviour in patients with suspected OSA.

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0500 Sleep Disordered Breathing in Children with Sanjad-Sakati Syndrome
Authors: Saleh Dana , Katwa Umakanth 
Published: April 2024

Abstract

Introduction
Sanjad-Sakati syndrome (SSS) is a rare, autosomal-recessive disorder with an estimated incidence of 1: 600,000 live births. 1 It has been primarily described in patients of Arab descent and manifests with extreme growth and developmental delays, hypoparathyroidism, scoliosis, risk for hypoglycemia, restrictive lung disease (RLD), and craniofacial abnormalities (infantile facies, depressed nasal bridge, micrognathia).1,2 RLD and low pulmonary reserve place affected children at high risk for sleep disordered breathing (SDB). To date, there are no reports of the pattern of SDB in these children.

Methods
We describe 2 female siblings with SSS who underwent polysomnogram (PSG) to evaluate for SDB.

Results
Patient one was 14 years old at time of PSG; she had severe short stature and RLD and presented with daytime fatigue and oxygen desaturation. She had baseline tachypnea and small oral and chest cavities. PSG demonstrated central sleep apnea (CSA) cAHI of 3.4/hr and REM dominant hypoventilation (CO2 52 - 67 torr), with 55% of total sleep time (TST) spent with CO2 &gt; 50 torr. She was treated with BiPAP of 20/6 cw, with back up rate (BUR) 20/min to stabilize hypoventilation. Patient two had a similar clinical presentation; PSG at 19 years of age demonstrated severe REM-dominant CSA (cAHI 10.9/hr, REM cAHI 63.4/hr) with recurrent oxygen desaturations to a nadir of 67% and sleep hypoventilation (CO2 52-60 torr), 63% of TST was spent with CO2 &gt; 50 torr. She was treated with BIPAP 19/5 with BUR 20/min.

Conclusion
Children with SSS are at high risk of SDB which is typically characterized by sleep hypoventilation that is worse in REM sleep, with severe REM hypoxemia and frequent CSA. They also tend to have poor sleep patterns, predominantly due to RLD and respiratory control dysfunction. Hence children with SSS should be screened for SDB and early treatment with bi-level positive pressure ventilation is recommended. In addition, these children are at high risk to study in sleep labs as they are at risk for seizures, rapid desaturations and/or hypoglycemia (due to low physiological reserve) and hence should be studied in the in-patient setting.

Support (if any)
Included 2 references 1. doi:10.7759/cureus.8770 2. doi:10.3390/children9040448
0505 Empowering OSA Care: Patient Profiles and Treatment Patterns in Japan
Authors: Khare Swarna , Lin Xiaoyu , Yin Can , Pettine Meghan , Adam Atif , Shinde Shraddha 
Published: April 2024

Abstract

Introduction
In Japan, the estimated prevalence of OSA is around 15%, and about 20% of adult males and 10% of postmenopausal women are estimated to have moderate-to-severe OSA. Despite the high prevalence, few studies have assessed the patient journey from sleep test to diagnosis and treatment initiation. This study aims to assess the patient journey and the associated real world treatment pathways.

Methods
This study utilized the retrospective longitudinal real-world Japan Claims database, standardized to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) from January 1, 2017, to May 31, 2022. The data encompassed patient demographics, OSA diagnoses, sleep study records, and treatment details. Adults over 18 with a minimum of 6 months of enrollment pre-diagnosis or treatment initiation were included.

Results
Of the 17,631 adults with OSA, 70.5% were aged 40-59, and 83.6% were male. Overnight polysomnography was used to diagnose 91% of the cases. All patients had at least one BMI reported within 1 year of OSA diagnosis with 9,185 adults (52.1%) having BMI &gt;=25.0 kg/m². Dyslipidemia and hypertension were present in 19.2% and 18.5% of patients, respectively. The mean time from the first sleep study to OSA diagnosis was 7 months (SD: 16.8). 9,522 patients received OSA treatment, with 75% aged between 40-59 years and a male predominance of 92.8%. Mean time from OSA diagnosis to treatment was 3.5 months (SD: 5.1). Majority (98.6%) received Positive Airway Pressure (PAP) therapy as the primary treatment. Bariatric and upper airway surgeries were less common. PAP adherence within the first year after treatment initiation was higher amongst patients with obesity (93.1%) compared to those without (82.7%), with mean time on therapy being approximately 11.8 months (SD:0.2).

Conclusion
Our study highlights a significant prevalence of OSA, especially among middle-aged males and individuals with higher BMI. PAP therapy emerges as the primary OSA treatment with consistent adherence within the first year of treatment. Further research is needed to better understand the treatment outcomes and the unmet needs with the current standard of care for people living with OSA and Obesity.

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0516 Alice NightONE™ vs WatchPAT ™: How Do These Two Home Sleep Apnea Tests Compare to One Another?
Authors: Abbas Sayeda , Naik Sreelatha 
Published: April 2024

Abstract

Introduction
Home sleep apnea testing allows patients to test and receive prompt treatment for obstructive sleep apnea (OSA). We wanted to compare a traditional device such as the Alice NightOne™ to a newer device called WatchPAT™.

Methods
We looked at 119 studies using Alice NightOne™, as well as 120 studies using WatchPAT™. We compared the results of the two devices with the goal of calculating the total positive and negative results, the severity of sleep apnea, and the number of patients who were started on treatment. Sleep apnea severity was classified as mild, moderate, and severe.

Results
Of the 119 patient who underwent Alice NightOne™, 78.15% (93/119) had OSA. There were 66 females and 53 males, with an average age of 49.08 years, BMI of 35.20 kg/m2 and ESS of 8.2. Of the patients diagnosed with sleep apnea, 48.39% (45/93) were diagnosed with mild OSA, 22.58% (21/93) with moderate OSA and 29.03% (27/93) with severe OSA. 54.84% (51/93) patients were treated with CPAP therapy, while 21.51% (20/93) patients were recommended to have a titration study and 23.66% (22/93) patients were lost to follow up. Of the 120 patients who underwent WatchPAT™ study, 70.83% (85/120) had OSA. There were 56 females and 64 males, with an average age of 46.04 years, BMI of 35.99 kg/m2 and ESS of 9.1. 42.35% (36/85) were diagnosed with mild OSA, 21.18% (18/85) with moderate OSA and 36.47% (31/85) with severe OSA. Of the 85 patients who were diagnosed with sleep apnea, 87.06% (74/85) patients were treated with CPAP therapy, while 3.53% (3/85) patients refused therapy and 9.41% (8/85) patients were lost to follow up.

Conclusion
Based on the results of testing, we found that the diagnostic utility between the two modalities was comparable. WatchPAT™ was able to identify 70.83% of patients with OSA, while NightOne™ was able to identify 78.15%. Of the patients identified with sleep apnea, 54.84% of patients undergoing NightOne™ were started on CPAP therapy and 87.06% of patients undergoing WatchPAT™ were started on PAP therapy.

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0535 The Relationship Between Position-dependent Snoring and Sleep Apnea in Heavy Snorers
Authors: Song Xin , Tracy Emma , Ediger Tatiana , Kumar Ajay Karthick Senthil , Maidens John , He David , Moyen Nicole 
Published: April 2024

Abstract

Introduction
Snoring can often be one of the first signs of sleep apnea. Earlier research suggested that apneic snorers tend to be position-dependent (snore more when sleeping on their back); however, existing literature is inconsistent. Moreover, the prevalence of positional dependency among heavy snorers is not well-established. This study aims to assess the prevalence of positional dependency and how positional snoring is associated with sleep apnea in heavy snorers.

Methods
Thirty snorers (43.0 ± 12.1 y) qualified for the study by snoring &gt;10% on one out of two screening nights measured by SnoreClock (an audio-based snore measurement app). For an average of three nights, participants used SnoreClock and wore a Home Sleep Test (HST) device (Zmachine Synergy), which recorded sleep positions using a tri-axial accelerometer and calculated the Apnea-Hypopnea Index (AHI). Snorers were categorized based on their average nightly snoring duration: mild (&lt; 10%), moderate (10–40%), or heavy (&gt;40%). Their nightly AHI was classified as non-apneic or apneic (mild, moderate, or severe). A night was position-dependent if snoring was reduced &gt;50% in the lateral vs. supine position. Final classifications for positional dependency and AHI were based on the subject’s mode across nights. The relationship between positional dependency and AHI was examined.

Results
Of the 30 subjects tested over a total of 81 nights, 24 were classified as heavy snorers, 5 were moderate, and 1 was light. Among the 24 heavy snorers, 83.3% (n=20) were non-positional snorers, 87.5% (n=21) were apneic snorers, and 70.1% (n=17) were both. A Chi-Square Test of Independence revealed no significant association between the apnea severity and positional dependency among heavy snorers (χ²(3, N=24) = 2.4, p = 0.49), suggesting that the severity of sleep apnea, as measured by AHI, shows no strong association with positional dependency in heavy snorers.

Conclusion
This study shows that heavy snorers are more likely to be non-positional, and positional dependency is not associated with apnea severity. Contradicting previous research, our results indicate that the majority of heavy snorers with sleep apnea are not position-dependent, offering more insights into sleep-related breathing patterns.

Support (if any)
This study is funded by Eight Sleep Inc.
0537 Enhancing PAP Adherence in Black and Hispanic Patients Utilizing an Automated Telemonitoring Intervention
Authors: Hwang Dennis , Yan Rui , Arguelles Jessica , Jemmott John , Klimper Matthew , Rosen Ilene , Keenan Brendan , Kuna Samuel T , Maislin Greg , Mazzotti Diego , Pack Allan , Saconi Bruno , Watach Alexa , Shi jiaxiao , Becker Kendra , Kim Joseph , Sawyer Amy 
Published: April 2024

Abstract

Introduction
The Tele-OSA randomized trial demonstrated improved PAP adherence in obstructive sleep apnea (OSA) patients receiving a telemonitoring intervention (automated messages triggered by low usage [U-Sleep, ResMed]). We conducted a sub-group analysis to explore the effect of the intervention in Black and Hispanic adults (B/H) compared to adults of all other races/ethnicities.

Methods
Tele-OSA (Kaiser Permanente; Fontana, CA) enrolled 556 patients with OSA [AHI≥5] newly initiated on PAP (AirSense 10, AutoCPAP) and randomized to Telemonitoring (TM) or Usual Care (UC). TM showed improved adherence compared to UC at 3 months (primary endpoint). TM was further split into two groups: those in which the intervention was discontinued per-protocol at 3 months (TM3) and those inadvertently continued indefinitely (TMC). Post-hoc analysis revealed that the TMC group maintained higher PAP adherence than the UC group over two years, while the TM3 group showed no difference from UC. In the current study, we conducted a sub-group analysis comparing adherence (mean “minutes/night” and “% days used”) between B/H and all other races/ethnicities in the TMC and UC groups across four time intervals: 3-6; 6-12; 12-18; 18-24 months. Kruskal-Wallis tests were used to compare the groups at each time interval.

Results
Of the 556 trial participants (50.5±12.1 years; 58.6% male, AHI 31.9±25.8), 269 were B/H (221 Hispanic; 48 Black) and 287 were non-B/H (233 White; 39 Asian). At baseline (i.e., Usual Care) B/H adults consistently showed lower adherence compared to non-B/H over two years (min/night for each time interval: 170.9±164.7 vs 195.5±172.5; 144.2±168.4 vs 167.1±172.7; 128.0±169.3 vs 158.9±181.2; 119.5±170.2 vs 148.1±184.3). B/H TMC participants had equivalent or higher PAP use compared to non-B/H TMC participants at each interval (251.8±142.1 vs 235.2±175.77; 211.2±152.1 vs 204.9±175.3; 190.4±168.3 vs 180.3±182.5; 163.3±180.2 vs 158.9±184.9). Similar findings were seen when analyzing “% nights used”.

Conclusion
Our study findings show that B/H adults had lower PAP adherence compared to non-B/H adults over a two-year period. Notably, a TM intervention effectively closed the disparity gap, resulting in similar PAP adherence levels for B/H and non-B/H adults. These findings underscore the importance of rigorously testing distance-accessible strategies to enhance PAP adherence and promote health equity.

Support (if any)
AASM Foundation104-SR-13