bluuebunny/crossref_metadata_2025_split huggingface dataset:
0598 Hypoglossal Nerve Stimulation: Does the Ratio of Apneas to Hypopneas Matter When It Comes to Successful Outcomes?
Authors: Baran Caroline , Hodge Evan , Santiago Louis , Lee Ryan , Kaur Parampreet , Ramzy Joseph , Guglielmello Giuseppe , Narla Gowtham , Zheng Matthew , Cohen David 
Published: April 2024

Abstract

Introduction
While hypoglossal nerve stimulation (HNS) is a safe and effective treatment for moderate to severe obstructive sleep apnea (OSA) HNS is not effective in some patients despite optimal titration. This study investigates whether apnea-predominant OSA versus hypopnea-predominant OSA during pre-operative sleep study can be used to predict successful outcomes after HNS implantation.

Methods
This is a single-center retrospective study of consecutive patients with moderate to severe OSA who underwent implantation of HNS at an academic medical center. Apnea-predominant and hypopnea-predominant were determined by comparing the proportion of obstructive apnea and hypopnea events in pre-operative polysomnography or home sleep apnea testing if polysomnography was not conducted. Post-implantation apnea/hypopnea index (AHI) was derived from polysomnography performed 3 months or later after device activation in all subjects. The Mann-Whitney nonparametric test was used to compare the distribution of AHI reduction between apnea-predominant and hypopnea-predominant cohorts.

Results
Eighty-two patients treated with HNS implanted between December 2021 and July 2023 were evaluated. Sixty-two (75.6%) patients were male, with a median age of 65.5 (55.3-71) years and a median pre-implantation Body Mass Index (BMI) of 29.4 (27.5-31.5) kg/m2. Median pre-implantation AHI was 28.8 (18.5-45.9) events/hour. Before HNS implantation, 45 patients had hypopnea-predominant AHI with a median apnea-to hypopnea ratio of 0.33 (0.14-0.60) and 37 patients had apnea predominant AHI with median apnea-to-hypopnea ratio of 2.23 (1.35-4.37). There was no significant difference between the two cohorts in age or BMI. The pre-implantation AHI was higher in the apnea-predominant cohort (36 (21.2-49.6) events/hour) compared to the hypopnea-predominant cohort (23.7 (18-37) events/hour). Median AHI reduction in the hypopnea-predominant cohort was 78.3% (51.2-90.2%). Median AHI reduction in the apnea-predominant cohort was 72.3% (35.5-85.4%). There was no significant difference in the distribution of AHI reduction between the two groups after HNS (p=0.40).

Conclusion
There was no statistically significant difference between pre-implantation OSA which was apnea-predominant versus hypopnea-predominant in the degree of AHI reduction with HNS therapy. However, this study may be limited on the basis of comparing pre-implantation AHI as obtained on a home sleep study, as compared to post implantation AHI obtained on a diagnostic polysomnogram.

Support (if any)
none
0606 Post Market Surveillance from Precision OAT Cases Indicates High Levels of Patient and Provider Satisfaction
Authors: Murphy Mark , Liptak Leonard , Ojeda Yoann 
Published: April 2024

Abstract

Introduction
Post Market Surveillance has emerged as an important tool for assessing the total quality of medical devices, including patient and provider experience and human factors. To prepare for forthcoming medical device directives that require more comprehensive post market surveillance, at least one manufacturer has implemented a program. This scientific abstract reports data from this program.

Methods
Post market surveillance cards from 10,880 patients and 646 individual providers were returned over a 60 month period to the manufacturer, immediately following delivery of each precision oral appliance therapy (OAT) device (ProSomnus Sleep Technologies, Pleasanton, CA, USA).

Results
98% of patients and provider reported a “First time fit” meaning the initial quality of the precision OAT was robust; 2% of precision OAT devices required adjustments or for the device to be remade by the manufacturer. 99% of patients reported being “satisfied” with their precision OAT device upon delivery. And 98% of providers reported being satisfied with the precision OAT device upon delivery to the patient. 100% of providers reported that they, “would recommend the treatment.”

Conclusion
These results contrast with provider satisfaction reported previously for other OSA treatments. A study by Fletcher Spaight of 100 physicians board certified in sleep medicine reported 60% satisfaction for legacy, non-precision OAT devices, and 68% satisfaction for CPAP.Precision OAT devices made from precision, digital manufacturing processes are associated with high levels of satisfaction amongst patients and providers in this large sample size post-market surveillance dataset.

Support (if any)
No support provided for this study The authors disclose their association with ProSomnus sleep technologies, who provided this dataset.
0607 Update on Observational Restrospective Study of the Efficacy of Oral Appliance Therapy for Obstructive Sleep Apnea
Authors: Meskill Sarah , Flores Jacob , Boren Payton , Richardson Sue Ellen , Meskill Gerard 
Published: April 2024

Abstract

Introduction
Obstructive sleep apnea (OSA) affects approximately 15-30% of males and 10-15% of females in North America. While positive airway pressure (PAP) therapy remains the standard in the treatment of OSA, oral appliance therapy (OAT) has emerged as a viable non-invasive alternative. However, there are limited data on OAT efficacy published, and therefore many sleep clinicians question its efficacy. As an update to last year’s presentation, we extended our single-center consecutive chart review to 26 months to evaluate OAT efficacy.

Methods
A manual chart review was performed for records from 11/1/2020 to 12/20/2023. Potential charts were identified in the electronic health record by searching for prescriptions for OAT and orders for home sleep apnea tests (HSAT). If there was a test performed after the prescription was written, the chart was reviewed manually for previous test results and verified that post-OAT testing was conducted. Extracted information included age, BMI, gender, pre-OAT HSAT apnea-hypopnea index (AHI), and post-OAT HSAT AHI. The 4% desaturation criteria for AHI was used in accordance with current Medicare guidelines. A paired t-test was performed after ensuring there were no outliers and a normal distribution.

Results
There were 34 patients included in the analysis: 17 women, 17 men. The average age was 60.2 years (95% CI XXX), and average BMI was 29.5 (95% CI XXX). Prior to intervention, 12 patients had moderate OSA with the rest mild (average pre-OAT AHI 10). After OAT device, 2 patients had more than mild obstructive sleep apnea,18 patients had mild OSA, and the rest (14) did not have residual OSA (average post-OAT AHI 6). The results of the paired t-test showed that the mean AHI was statistically significantly different between the two groups.

Conclusion
The results demonstrate efficacy of OAT in treating OSA. Clinicians should consider OAT as both primary and secondary therapy for mild-to-moderate OSA.

Support (if any)
0608 No Adverse Effects from Expiratory Positive Expiratory Pressure (EPAP) Enhanced Mandibular Advancement Device (MAD)
Authors: Metwali Rami Al , Conflitti Antonella , Reiter Hilary , Sharma Sat 
Published: April 2024

Abstract

Introduction
The ExVent is an optional accessory to the O2Vent Optima mandibular advancement device (MAD) and provides oral Expiratory Positive Airway Pressure (EPAP). Oral EPAP with the ExVent is designed to provide upper airway support via similar mechanisms of action of nasal EPAP devices in commercial distribution, e.g., passive dilatation of the airway, which reduces flow limitation. Nasal EPAP devices are in commercial distribution as stand-alone therapies for the treatment of OSA. The oral EPAP provided by the ExVent accessory augments the OSA therapy provided by the O2Vent Optima. Long-term complications and adverse effects associated with this combination therapy are not known, but require further study.

Methods
We conducted a retrospective survey of all patients who received O2Vent Optima mandibular advancement device and oral expiratory positive pressure accessory (ExVent) in Canada and Australia from 2019 to November 2022. A study investigator contacted the participants via telephone, obtained consent and collected data on: demographics, duration of use, frequency of use, complications and adverse events.

Results
Out of the patient database of 480 subject, 168 (35%) participated. 31 (18%) stopped using the appliance. Out of 137 (81%) subjects, 118 (86%) were still using the ExVent Accessory, 92% medium strength (Yellow). Mean age 52±7 yrs, 76% Male. Mean duration of use 2.7±0.9 years, 91% for most nights, 86% for &gt;6 hours/night. 56% used morning aligner and 74% performed regular jaw exercises. After 4 weeks of use, excessive salivation was occasional (12%), tooth and jaw pain occasional (8%), tooth movement none (0%). Gum /tongue bruises reported in none (0%). TMJ pain/stiffness reported (5%). Change in bite or occlusion leading to discontinuation none (0%), temporary chewing difficulties (24%), dry mouth none (0%). Difficulty with insertion/removal of ExVent valve none (0%), difficulty breathing in none (0%), Malfunctioning/dislodgement of ExVent valve reported in none (0%). Participants reportedly loved their device (94%) and benefited from ExVent (100%).

Conclusion
This retrospective study demonstrated that majority of patients prescribed EPAP enhanced MAD with O2Vent Optima and ExVent accessory were compliant. There were no significant complications and only minor adverse effects were observed with the combination therapy.

Support (if any)
Centre for Sleep and Chronobiology, Toronto, ON, Canada
0612 Adenotonsillectomy During Childhood Does Not Elevate the Likelihood of Adulthood Overweight
Authors: Goldbart Aviv D , Abuhasira Ran , Even-Tsur Jacov , Shiloh Adi , Tarasiuk Ariel 
Published: April 2024

Abstract

Introduction
Adenotonsillectomy for pediatric obstructive sleep apnea (OSA) might not promote healthy body weight in the short term, as overweight children could still experience accelerated weight gain and increased risk of obesity. Limited data exists regarding the long-term effect of adenotonsillectomy on body mass index (BMI) as individuals enter their third decade of life. Our study investigated BMI twenty years following adenotonsillectomy or watchful waiting (WW).

Methods
Between 1998 and 2000, we enrolled 260 children with OSA, as defined in our previous study (PMID: 14754948). Among them, 132 had undergone adenotonsillectomy, 127 WW, and one participant died from cardiac arrest. All patients have been members of Clalit Health Services (CHS), Israel's largest healthcare organization, for over 25 years. CHS offers compulsory healthcare coverage via the National Health Insurance Law and employs a unified medical record system. Polysomnography records were obtained from the sole pediatric Sleep-Wake Laboratory in southern Israel. In June 2023, we received adulthood anthropometric data from the original study participants' electronic medical records.

Results
Both groups had moderate OSA and showed no differences in their initial BMI z-scores, which were -0.2 ± 1.6 and 0.1 ± 1.4 (p = 0.5) for the WW and adenotonsillectomy groups. The twenty-year follow-up indicated similar BMIs of 26.0 ± 5.8 (kg/m2) for the WW group and 25.5 ± 6.4 (kg/m2) for the adenotonsillectomy group (p = 0.5). However, children with baseline BMI z-scores ≥ median, especially females (p &lt; 0.05), exhibited higher BMIs after 20 years. Following accounting for sex, apnea-hypopnea index, and socioeconomic status, it was found that adenotonsillectomy did not elevate the risk of being overweight (BMI ≥ 26) in the third decade of life. Females had a higher likelihood of being overweight (OR = 2.22, 95% CI: 1.10-4.58), as did individuals with childhood BMI z-scores ≥ median (OR = 4.67, 95% CI: 2.39-9.82).

Conclusion
Childhood adenotonsillectomy does not increase the risk of being overweight. High BMI z-scores correlate with an increased risk of adult overweight, unaffected by adenotonsillectomy. Adenotonsillectomy does not impact future BMI, highlighting the importance of promoting a healthy childhood lifestyle to prevent adult obesity.

Support (if any)
Israel Science Foundation grant No 164/2018
0614 Comparison and Outcomes of Adenotonsillectomy for Obstructive Sleep Apnea in Children with Achondroplasia
Authors: Ascencio Claudio Gomez , Wani Anna , Mitchell Ron 
Published: April 2024

Abstract

Introduction
Achondroplasia, a genetic disorder arising from a FGFR3 mutation, is typically detected perinatally, and affects 1 in 40,000 children. The diagnosis of achondroplasia has many associated medical complications, one of which is obstructive sleep apnea (OSA). The objective was to compare demographics between children with achondroplasia and OSA with the general pediatric population with OSA, as well as present treatment outcomes for children with achondroplasia.

Methods
Retrospective chart review of 22 children with achondroplasia and OSA. A sample of 141 children with OSA without achondroplasia was used as a control. Parameters from polysomnography (PSG) were recorded and analyzed. Values before and after adenotonsillectomy (T&A) were compared for the achondroplasia group, while baseline values were compared between the control group and achondroplasia group.

Results
In the achondroplasia group, 12 children who were treated with T&A were included. In the control group, 141 children were included. In the T&A achondroplasia group, 0 children had mild OSA, 1 had moderate OSA, and 10 had severe OSA. In the comparative group 16 had mild OSA, 11 had moderate OSA, and 114 had severe OSA. The achondroplasia population had a much younger age at T&A compared to the control population (p-value &lt; 0.001.) Obstructive Apnea-Hypopnea index, a marker of OSA severity, trended toward being higher in the achondroplasia group (p-value = 0.06). The lowest SpO2 saturation was not significantly different in the achondroplasia group. When comparing baseline data in the achondroplasia population with respective T&A outcomes, both oAHI (p-value &lt; 0.05) and SpO2 (p-value &lt; 0.05) were significantly improved.

Conclusion
Patients with achondroplasia and OSA have an earlier age of onset compared to children without achondroplasia. For these patients, treatment with adenotonsillectomy shows a significant improvement in OSA severity. Future research needs would be to increase sample sizes, establish a standard treatment for OSA in children with achondroplasia, and also establish improvement and treatment frequency by OSA severity. There is also a need to compare the improvement of OSA in children undergoing other interventions and compare these to the general pediatric population.

Support (if any)
0615 DISE-Cryotherapy a Novel Treatment for Patients with Obstructive Sleep Apnea
Authors: saleh Abdelbaset , Mohamed Fatmah , Hussein Mona , Awadalla Nabil , Mohammadien HamdyA 
Published: April 2024

Abstract

Introduction
Drug induced sleep endoscopy (DISE) can provide valuable information about the level (VOTE), pattern and degree of upper airway obstruction in patients with obstructive sleep apnea (OSA). Integrating DISE with cryotherapy can provide a novel and successful treatment for OSA patients. The objective of this study was to examine safety and efficacy of a novel DISE-Cryotherapy technique in treating OSA.

Methods
A prospective single-arm interventional trial was done after institution review board approval and formal patient consent. Thirty adult subjects with confirmed OSA underwent DISE and cryotherapy in two sessions with two weeks interval using a flexible cryocanalization probe (78 cm in length/2.4 mm in diameter, ERBE, Medizintechnik GmbH, Tübingen, Germany) with cryomachine (ERBECRYO CA, ERBE, Tübingen, Germany). Polysomnogram (PSG) was done pre-intervention and repeated 12-weeks post-intervention. Primary outcomes were reduction in baseline DISE score and apnea hypopnea index (AHI), and improvements in excessive daily sleepiness (EDS) and other OSA related symptoms. Patients follow up was done at two-weeks and, and 12-weeks post-intervention.

Results
Twenty men and 10 women with OSA were included in the study. There mean (SD) age and BMI were 42.57(9.52) years and 32.28 (3.19), respectively. Preoperative Mallampati, tonsillar size and VOTE mean scores were 2.4 (0.49), 1.33 (0.47) and 2.7 (1.02) respectively. Preoperative mean AHI and desaturation index were 31.10 (19.15) and 29.01(20.40), respectively. A two-week post cryotherapy evaluation showed reduction in the mean of VOTE score to 1.6 (0.93) and significant improvements in all sleep related clinical symptoms. Twelve-week post cryotherapy assessment revealed a significant reduction in the mean AHI, and desaturation index to 10.07 (7.65), and 10.3(8.33) respectively. The median (range) of percentage reduction in baseline AHI was 71.36% (42.05-86.38). Above 50% reduction in baseline AHI was achieved in 90% of patients with a mean of 70.63%, while only 10% showed 20-50% reduction with a mean of 45.78%. Significant independent predictors for percentage reduction were age and preoperative total VOTE score. No immediate or remote side effects were reported.

Conclusion
Cryotherapy is a safe and promising intervention for treatment of OSA patients.

Support (if any)
No
0616 Effects of Oropharyngeal Rehabilitation After Transoral Robotic Surgery in Patients with Obstructive Sleep Apnea
Authors: Lai Yi-Ju , Li Chung-Yi , Tsai Kun-Ling , Lin Cheng-Yu , Hung Ching-Hsia 
Published: April 2024

Abstract

Introduction
To demonstrate the effects of postoperative oropharyngeal rehabilitation on inflammatory mediators and antioxidant capacity in adult obstructive sleep apnea patients.

Methods
Obstructive sleep apnea patients were recruited and divided into conservative treatment group (n = 17), surgery group (n = 23), or surgery combined with oropharyngeal rehabilitation group (n = 19) by their willingness. Polysomnography data and the concentration of inflammatory mediators and antioxidant capacity were determined at baseline, after 6 weeks and 18 weeks of treatment.

Results
The data of fifty-nine patients was analyzed. Post-treatment percent change of apnea–hypopnea index in rapid eye movement sleep was positively correlated with that of interleukin-6 (0.641, 95%CI 0.598 to 0.685; P&lt;.001). Compared with the patients in control group, those in surgery combined with oropharyngeal rehabilitation group had significantly reduced post-treatment percent change of interleukin-6 (-77.273, 95%CI -144.580 to -9.966; P=.216). In addition, the concentration of interleukin-6 (-3.423, 95%CI -6.638 to -0.207; P=.037) and matrix metallopeptidase-9 (-20.517, 95%CI -40.584 to -0.450; P=.045) exhibited significantly decreased in the surgery combined with oropharyngeal rehabilitation group. The level of total antioxidant capacity exhibited significantly improved in the surgery combined with oropharyngeal rehabilitation group as compared to the surgery–only group (0.034, 95%CI 0.005 to 0.063; P=.020).

Conclusion
The presented results demonstrate postoperative oropharyngeal rehabilitation could decreased the serum level of inflammatory mediators and increased antioxidant capacity. Results from this study could potentially be targeted by combination of different treatments.

Support (if any)
This work was supported by National Cheng Kung University Hospital (grant numbers NCKUH 10802018, NCKUH-10902002, and NCKUH-11002046).
0621 Glucagon-Like Peptide 1 Receptor Agonist and Positive Airway Pressure Use in Patients with OSA and Obesity
Authors: Malik Anita , Cameron Ann , Woodford Caleb , 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 obesity are strongly associated and highly prevalent in the United States (US). Routine treatment for OSA often includes positive airway pressure (PAP) therapy combined with weight management strategies, more recently including use of glucagon-like peptide 1 (GLP-1) receptor agonists. This real-world analysis assessed the impact of recent GLP-1 use on PAP therapy use over 1 year in non-diabetic patients with PAP-treated OSA and obesity.

Methods
Administrative claims data from January 2014-May 2023 linked to objective PAP usage data were analyzed. Commercially- or Medicaid insured non-diabetic adults (18-64 years) with OSA and obesity, ≥1 year of claims data before and after PAP setup (index date), and ≥1 year of PAP therapy data post index were included. Patients who filled a GLP-1 prescription within 90 days prior to index were considered recent GLP-1 users. Other GLP-1 users were excluded. PAP therapy adherence was categorized as adherent, intermediately adherent, or non-adherent based on objective usage over 1 year. PAP discontinuation was defined as &gt;30 consecutive days with no use. Inverse probability of treatment weighting was used to balance groups on baseline covariates to compare PAP use over 1 year for OSA patients with and without a recent GLP-1 fill prior to index.

Results
A total of 267,794 patients with OSA were included (mean age 47.7 years; 44.1% female), of which 1,137 (0.43%) were recent GLP-1 users at index. Recent GLP-1 users were more commonly female (66.6% vs 44.0%), commercially insured (82.2% vs 77.7%), and with class III obesity (67.5% vs 46.8%) than those without a recent GLP-1 prescription fill. Average hours/day of PAP use at 1 year did not differ significantly between groups (3.80 vs 3.96). There was no significant difference in PAP adherence rates (adherent: 42.1% vs 45.1%; intermediately adherent: 29.5 vs 28.4%; non-adherent: 28.5 vs 26.5%) or PAP discontinuation (43.9% vs 41.7%) for those with and without recent GLP-1 use prior to index.

Conclusion
PAP use was similar among non-diabetic patients with OSA and obesity who did and did not have recent GLP-1 use prior to PAP.

Support (if any)
ResMed