bluuebunny/crossref_metadata_2025_split huggingface dataset:
0506 5-year, multi-center, observational study to assess safety, effectiveness and use of CAD/CAM patient-matched OAT for OSA treatment
Authors: Woidtke Robyn , Gagnadoux Frederic , Fortin Martine 
Published: May 2023

Abstract

Introduction
Oral appliance therapy (OAT) is used for the treatment of obstructive sleep apnea in mild to moderate patients. First-time fit is important for treatment burden and dental economics. This prospective, “real-world” collaborative (physician/dentist) study will assess the primary endpoint of at least a 50% reduction in baseline apnea-hypopnea index (AHI) at five years. Additionally, this study will assess fit during initial delivery. The Panthera D-SAD is a CAD/CAM, 3D-printed OAT. Updated design and comfort features have been integrated. Changeable rods (mechanical hinge) provide the mechanism for protrusion. This study fulfills French reimbursement requirements.

Methods
OAT naïve individuals with moderate OSA (AHI 15-30) or those with severe OSA (AHI 30 or greater) who decline CPAP will be included, meeting all other criteria. An estimated 337 participants will be enrolled at 11 centers in France. Consecutive sampling will be used. Participants will be medically assessed, a prescription for OAT obtained, dental assessment and then, the initial fitting will be at Visit 1 (V1). Standard of care for the study duration will be followed. Evaluation time points are three months (medical), six months (dental), two years (both), and five years (both). Secondary endpoints include OAT side effects, oxygen desaturation indices, quality of life, self-reported adherence, and subjective symptoms at the aforementioned time points

Results
To date, a total of 56 subjects have been enrolled. This report is focused on the 24 subjects who have had V1, OAT fit, and titration visits. The demographics are as follows:(F=8); Averages (and standard deviation) for the following are age 51.2 (1.5).; baseline AHI of 20.5 (6.07); ODI 14.71(8.9); SpO2 93.46 (1.06), BMI 25.73 (3.13), and rod length of 26.6mm (1.05). 91.6% of dentists reported at V1 that no rod changes were required. 82.6% of patients indicated the OAT was comfortable, three patients had dental or muscle pain, and one, the device was too tight.

Conclusion
V1 is a crucial step in the therapeutic journey. This early data demonstrate a high OAT acceptance rate for dentists and patients while reducing the time required for first-time fit, thus lowering practitioner and patient burden and costs.

Support (if any)
Panthera Dental Inc, Quebec City, Quebec Canada
0507 A wireless patch-based polysomnography system for conducting in-lab sleep studies
Authors: Schneider Hartmut , Mueller Syuyumbeki , Oloo Maryanne , Haisma Nicola , Knoops-Borm Martine , Stockhoff Mariele , Tijssen Marij , Ermers Pieter , DeFrancisco Ruben , Coughlin Steven 
Published: May 2023

Abstract

Introduction
Current attended in-lab polysomnographic sleep studies are time-consuming and costly, primarily due to the time required to “hook-up” a patient to multiple electrodes and sensors and meet the quality assurance and safety requirements of an in-lab study. We developed a wireless PSG system (Onera STS - Onera Health, NL) consisting of four disposable patches and reusable pods to record full polysomnography that may reduce hook-up time while preserving standards of an attended polysomnography in the lab.

Methods
We used the Onera STS system for monitoring EEG, EOG, EMG, forehead reflectance SaO2, ECG, bioimpedance derived respiratory airflow and effort, airflow via nasal cannula, snoring sounds, body position, actigraphy, and leg movements, and accessory online monitoring of finger SaO2, ECG, nasal cannula airflow and video via RemLogic 4.0 or REM logic MPR system for Q/A and safety monitoring. Seventeen subjects (8 male, 9 female, age 18-to-75 yrs, BMI 29.9±6.0 kg/m2) were monitored for the evaluation of sleep apnea. We measured hook-up times and observed oxygen saturation and cardiac rhythm throughout the night.

Results
Mean hook-up time for the Onera STS was 5:22±1:17 minutes and for the additional on-line sensors (Finger SaO2, ECG and nasal cannula) was 3:15±1:10 minutes, resulting in an average hook-up time of less than 10 minutes. Onera PSG data revealed a mean oxygen desaturation event rate of &gt;3% (ODI3) of 8.8 (SD 18.6) and a mean fall of oxygen saturation (ΔSaO2/event) of 4.4 (SD 1.2). The accessory online SaO2, ECG and video monitoring showed that no subjects demonstrated sustained nocturnal hypoxia, severe cardiac arrhythmia or parasomnia events that would have required interventions.

Conclusion
The Onera STS system substantially lowers the burden to conduct attended polysomnographic sleep studies. In combination with standard monitoring of SaO2, ECG and video, it meets the safety requirements for attended sleep studies while reducing the overall operational and capital equipment costs. The ease of application together with the reduced hook-up time makes it now possible to implement polysomnographic sleep studies in the hospital setting, particularly in addition to conventional bedside monitoring units such as ICU-, step-down unit- or hospital beds.

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0508 Adherence with Transoral Neuromuscular Electrical Stimulation Therapy in Veterans with Mild OSA
Authors: Stepnowsky Carl , Zamora Tania , Cervantes-Gameros Cesar , Nokes Brandon 
Published: May 2023

Abstract

Introduction
Mild obstructive sleep apnea (OSA) is increasingly common in the VA. The first-line therapies are medical devices worn each night while asleep to control or manage OSA. These devices are burdensome for our patients with mild OSA. Stronger oral musculature can help reduce mild OSA. A new transoral Neuromuscular Electrical Stimulation (NMES) device was recently approved by the US FDA called eXciteOSA (Signifier Medical Technologies, Needham, MA). The eXciteOSA device provides gentle, low-frequency electrical stimulation intraorally to the tongue muscle and is efficacious for mild OSA.

Methods
A retrospective review of the data of the 71 patients prescribed the eXciteOSA device at the VA San Diego was analyzed. The device is prescribed for use over two phases: (1) one 20-minute session per day over 42 consecutive days and then (2) one 20-minute session on two days out of each week. Respiratory therapists performed 1-2 phone call visits to assess symptoms and address device concerns.

Results
68 of the 71 patients used the device for at least one 20-minute session over the first 42 days. Three patients (4.2%) did not use the device. Adherence was 60% for all 71 patients and 63% for the 68 patients who used it at least once. This means that, on average, our Veteran patients completed one 20-minute session on 25 of the first 42 days.

Conclusion
Recent non-Veteran data showed an adherence rate of ~80% (percentage of days with one completed 20-minute session over the first 42 days). Our analysis found an adherence rate of ~60%, suggesting significant room for improvement in eXciteOSA device use in Veterans. Future adherence studies should look at methods to improve device use over the first 42 days. In addition, more research may be needed to understand better what amount of use is efficacious on an individual basis. Some patients may obtain an adequate response with fewer sessions, while others may need more. It is unknown which endotypes of OSA most benefit from NMES, but further research is ongoing.

Support (if any)
VA RR&D D2651-R and the Sleep Medicine Section of the VA San Diego Healthcare System supported this project.
0516 Biopsychosocial intervention using virtual multidisciplinary group with improved PAP adherence after 1 year post intervention
Authors: Baker Nataliia , Saxby Dyani , Frigge Lauren , Khalil Wajahat , Irfan Muna 
Published: May 2023

Abstract

Introduction
Prevalence of untreated sleep apnea among veterans is 22.2 %. Untreated patients are at risk for multiple adverse outcomes including chronic sleep deprivation, excessive day time sleepiness, chronic fatigue, depression, and cardiovascular complications including hypertension, coronary artery disease, cerebrovascular accidents, pulmonary hypertension as result of increased sympathetic activity during apnea episodes. Nonadherence to PAP therapy within the first week of treatment are up to 50 % of patients who use PAP device during the first week between 12-25 % discontinue by PAP use by year 3. Barriers to PAP use include physical problems with PAP hardware, knowledge gaps, and psychological issues.

Methods
Veterans from sleep medicine and sleep apnea clinics as well as multiple primary care clinics participated in the PAP adherence group following 6 weeks biopsychosocial model. The intervention included weekly synchronized video encounters of behavior sleep specialist, respiratory therapist and sleep clinic nurse with the targeted group of veterans with sleep apnea and poor PAP adherence. This approach has multiple benefits, including being patient centered, cost effective and efficient with ability to help veterans at various motivational levels, assist 6-10 veterans virtually in 6 one-hour group sessions and easy care coordination.

Results
A total of 21 veterans with sleep apnea participated in virtual multidisciplinary group to improve PAP adherence between September 2020 and January 2021. Patients PAP adherence before intervention, post intervention and 1year after intervention was evaluated. Percent of patients using PAP &gt;2 hours before intervention was 5 %, immediately after intervention it increased to 20 %, and there was further increase up to 33% after 1 year post.

Conclusion
A structured multidisciplinary biopsychosocial intervention demonstrated statistically significant improvement in PAP adherence which persisted up till 1 year post intervention. In fact additional improvement of &gt;2 hours of PAP usage was noted in this patient group suggesting possible long term benefit of psychosocial multidisciplinary intervention on PAP adherence. This study also demonstrated efficiency of utilization of virtual/telemedicine platform for psychosocial intervention and brief behavioral therapy.

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0518 Characteristics of obstructive sleep apnea among pregnant Japanese woman and their birth outcomes
Authors: Suzuki Takumi , Hosomichi Jun , Miyasaka Naoyuki , Miyazaki Yasunari , Taki Atsuko , Zaitsu Takashi , Morioka Chikako , Sato Noriko , Moro Manaka , Ono Takashi 
Published: May 2023

Abstract

Introduction
Pregnant women are at an increased risk for obstructive sleep apnea (OSA) due to pregnancy-related weight gain. However, a detailed clinical study on OSA and birth outcomes among pregnant women in eastern Asia has not been conducted. This study, therefore, aimed to investigate characteristics of OSA among pregnant Japanese women and their birth outcomes.

Methods
Subjects were selected from pregnant women who underwent a polysomnography (PSG) during 28–36 weeks gestation at Tokyo Medical and Dental University Hospital. Diagnosis of OSA was based on sleep history and PSG with an apnea-hypopnea index (AHI) ≥ 5 (OSA+ group). Those with AHI &lt; 5 were regarded as the OSA- group. The body height, weight, head circumference, and chest circumference of all offspring were measured at birth and 1 month of age. Data were analyzed statistically using unpaired t test and Pearson correlation and logistic regression analyses.

Results
Of 102 pregnant Japanese women, 13.7 % were diagnosed with OSA during the third trimester. PSG data showed significant differences in AHI between the OSA- (1.2 ± 1.0) and OSA+ (14.8 ± 16.7) groups. Moreover, there were significant differences in the oxygen desaturation index, mean and minimum SpO2, and mean and maximum heart rate between the OSA+ and OSA- groups. The logistic regression analysis revealed that AHI was associated with body mass index (OR, 1.274; p = 0.001), but not with age, gestational age, and body height, suggesting that high BMI is a risk factor for OSA in Japanese pregnant women. The Epworth sleepiness scale score was comparable between the two groups. A comparison of body weight between the pregnant mothers and their offspring showed that the maternal weight during the third trimester was negatively associated with offspring’s weight at birth and at 1 month of age in the OSA+ group.

Conclusion
Findings suggest that a high BMI is a major risk factor for OSA among pregnant Japanese women.

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0521 Correlation Between Socio-Demographic Risk Factors and Self-Reported Apnea
Authors: Alla Rupini , Thakur Bhaskar , Khan Safia 
Published: May 2023

Abstract

Introduction
Apnea, pauses in breathing, is a chronic and rising condition in the US and is itself a risk factor for various conditions such as hypertension, cardiovascular disease, and stroke. This study aims to analyze the National Health and Nutrition Examination Survey (NHANES) dataset to see if certain socio-demographic risk factors contribute to the prevalence of apnea.

Methods
From 2015 to 2018 (using two consecutive cycles), a secondary dataset from NHANES was obtained. All 11,759 community dwelling individuals 16 years and older who responded to the sleep disorder questionnaire in the above survey were considered as study subjects. Questions were asked in the home by trained interviewers regarding sleep trouble including if they recalled episodes where they stopped breathing during sleep. In this study, we sorted the data to see the mean chance of “snort or stop breathing” amongst various categories such as gender, age, ethnicity, marital status, education, smoking history, alcohol consumption, income, physical activity, and obesity.

Results
The following socio-demographics were identified as having a higher association with apnea (p&lt; 0.0001); male gender, ages 41 – 50, smokers, and obesity. Unusually, those with higher physical activity self-reported more frequent episodes of stop breathing (p&lt; 0.00001). No significant association was noted for stop breathing events when looking at income, educational level, Hispanics vs. non-Hispanics, frequent alcohol consumption and health insurance.

Conclusion
These results confirm some of the established risk factors for apnea such as male sex, obesity and age. Oddly, those with higher self-reported physical activity had higher stop breathing events. Self-reported responses in the NHANES data could be associated with recall bias and treated as one of the current study limitations. Of note, there appears to not be an economic factor in terms of income or health insurance in the incidence of stop breathing events. Further awareness of these risk factors and knowing which sociodemographic groups have higher incidences of apnea can help with primary prevention of serious health outcomes.

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0522 CPAP Improves Cognition in Brain-Healthy Males: Secondary Analysis of a Randomized Trial
Authors: Sun Haoqi , Zinchuk Andrey , Locascio Joseph , Kushida Clete , Thomas Robert , Westover M Brandon 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with cognitive impairments. However, in many adequately powered randomized trials, there is weak or no evidence for the causal effect of treating OSA on cognition. A common characteristic of these randomized trials is heterogeneous participants. We hypothesize that there is a subset whose cognition could be improved by OSA treatment using CPAP.

Methods
This is a secondary analysis of the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized, double-blind, two-arm, sham-controlled, multicenter trial. The primary analysis had adult participants with baseline AHI ≥10/hour. We restricted to those with both baseline polysomnogram and outcome available: n=787. The outcome is 6-month Sustained Working Memory Overall index at mid-day, which was not significantly different in the primary analysis. The original exposure is randomized active- or sham-CPAP. However, the adherence rate (≥4 hours for &gt;70% nights in 1-month) is higher for active than sham (chi2 p&lt; 0.001). Therefore, we re-defined a non-randomized exposure as both under active-CPAP and being adherent (n=165) vs. all others (n=622). To account for confounding, covariates were clustered into 17 groups, plus age, sex, education, and baseline cognition. Individual treatment effect (ITE) was estimated using matching, which finds a matched group for each individual with similar covariates but opposite exposure. The ITE is the difference between two potential outcomes: the counterfactual outcome from the mean outcome of the matched group, and the factual outcome as observed.

Results
The overall ITE was non-significant compared to 0 (t-test p=0.4). A subset of 285 (Group 1) could have improved cognition if under active-CPAP and adherent (average ITE 0.68, p&lt; 0.001); another subset of 328 (Group 2) could have worsened cognition (average ITE -0.64, p&lt; 0.001). Group 1 is characterized by more males, higher baseline cognitive scores, lower EEG-derived brain age index, and slightly more depression; the opposite for Group 2.

Conclusion
Assuming the ITE is unbiased, relatively brain-healthy males with OSA can improve their cognition once OSA is treated by CPAP.

Support (if any)
MBW was supported by NIH (R01NS102190, R01NS102574, R01NS107291, RF1AG064312). RT received support from RF1AG064312. AVZ received the Parker B. Francis Fellowship award. JJL was supported by NIH UL1TR002541.
0523 Disparities in Discussion of Sleep-related Breathing Disorders with a Physician
Authors: Johnson Solomon , Nouraie S Mehdi 
Published: May 2023

Abstract

Introduction
Race, immigration status and healthcare access have known associations with sleep health in socially disadvantaged groups. The prevalence and severity of sleep disorders, such as obstructive sleep apnea (OSA) are higher among non-whites and underdiagnosed in socially disadvantaged groups. Associations between sleep health and country of birth have also been identified. Certain minority groups are known to be less likely to report symptoms of OSA or insomnia to a physician. It's therefore possible that propensity for sleep disorder self-report plays a role in disparities of sleep health in socially disadvantaged groups. To our knowledge the predictors of sleep disorder self-report have yet to be studied. We aim to assess the predictors of sleep disorder self-report and analyze for associations with race, immigration status and healthcare access.

Methods
We conducted a cross-sectional analysis of 9,163 adult (age &gt;18) patients in the National Health and Nutrition Examination Survey 2017-2020 database who answered the sleep disorders questionnaire and had race, immigration status and healthcare access data. Any answer to “How often do you snort or stop breathing (during sleep)?” was used as a surrogate endpoint for symptoms of OSA. “Yes” to “Ever told a doctor that you had trouble sleeping?” was used as a surrogate endpoint for sleep disorder self-report. We analyzed this cohort for associations between demographic characteristics, symptoms of OSA and sleep disorder self-report with survey sampling weights in STATA 17.0.

Results
In patients with symptoms of OSA (24%), measures of limited healthcare access, such as lack of health insurance (OR=1.59, p=0.030), or lack of location routinely visited for healthcare needs (OR=1.77, p=0.024), predicted higher likelihood of sleep disorder symptom non-disclosure, after adjustment for sex, age, and BMI. Non-white race (OR=1.70, p&lt; 0.001) and being an immigrant (OR=2.40, p&lt; 0.001) predicted higher likelihood of sleep disorder symptom non-disclosure in patients without symptoms of OSA, but not in patients with symptoms of OSA, after adjustment for sex, age, and BMI.

Conclusion
Our findings indicate that patients with limited healthcare access should be considered more strongly for sleep health evaluation and that non-white and immigrant patients are less likely to discuss sleep health with a physician.

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0525 Effect of Body Position and Sleep State on Obstructive Respiratory Events Distribution in Children with Down syndrome
Authors: Boopathy Surya , El-Kersh Karim , Jawad Kahir , Senthilvel Egambaram 
Published: May 2023

Abstract

Introduction
The influence of body position and sleep state on obstructive respiratory events distribution in children with Down syndrome (DS) need further studies.

Methods
This was a single center, retrospective study that included children younger than 18 years old with DS who were evaluated for suspected sleep disordered breathing and underwent a full overnight polysomnography in an academic sleep disorders center over a period of 10 years. DS children with Obstructive apnea hypopnea index (OAHI) ≥ 1.5 were included in this study. Total OAHI, apnea hypopnea index (AHI) in different body positions and in different sleep stages including rapid eye movement (REM) and Non-REM (NREM) sleep were collected.

Results
A total of 158 children with DS met the inclusion criteria. The median age was 5 years (IQR 8.0---), 53.2% were male with a median BMI z-score of 1.2. Median times (%) spent in REM and NREM sleep were 17 % and 83% respectively. Median times (minutes) spent in different body positions were supine 194.1, left side 53.5, right side 39 and prone 32. The overall median OAHI was 7.6, respiratory obstructive events were more common in REM sleep and in supine position. The median REM obstructive AHI was 20 events per hour (IQR: 10.1-34.5), whereas the median NREM AHI was 5.2 events per hour (IQR: 2.4-15 p &lt; 0.0001). Similarly, supine obstructive AHI was 9.4 (IQR-4.15 – 24.1) and off supine AHI was 2.4 (IQR 0-8.9 p &lt; 0.0001). Only 24 out of 158 subjects had NREM predominant OSA. Age was a significant predictor of NREM predominant OSA (P= 0.012) compared to other factors such as gender, race, BMI, tonsillar grade, hypothyroidism and congenital heart disease. For every one year increase in age, the odds of having NREM predominant OSA was 14% higher than having REM predominant OSA.

Conclusion
Obstructive respiratory events in children with DS occur predominantly in REM sleep and in supine position. Non-REM predominant distribution of respiratory events was seen in older children with DS.

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