bluuebunny/crossref_metadata_2025_split huggingface dataset:
0484 The association between obstructive sleep apnea, energy balance and body composition: a clinical cohort
Authors: Lee Pei-Lin , Lai Shang-Ru , Gooley Joshua , Feng Hsin-Chun , Chen Shih-Kuo , Chien Meng-Yueh , Lin Ming-Tzer , Chen Yung-Hsuan , Chiu Hung-Chih , Liu Po-Kang , Ku Bo-Wen , Chang Chin-Hao , Yang Wei-Shiung , Yu Chong-Jen 
Published: May 2023

Abstract

Introduction
A couple of studies investigated the energy balance in patients with obstructive sleep apnea (OSA) but the results were inconclusive. Moreover, OSA have been associated with visceral adiposity but the mechanism has not been fully elucidated. We hypothesized that OSA was associated with lower basal metabolic rate (BMR) and increased nutrition intake which further attributed to body adiposity. The aim of the present study is to determine the association between OSA, and BMR, nutrition intake, and body composition (BC).

Methods
Patients were recruited from referrals to sleep lab for suspect OSA. Measurement of the BMR with indirect calorimetry and BC with bioelectrical impedance analysis, and blood sampling were conducted in the morning next to the overnight polysomnography. Afterward, participants were evaluated with short -form IPAQ, 3-day intake dietary, 7-day sleep log, and wore Actiwatch for 7 days. The outcomes are resting energy expenditure (REE) and respiratory quotien (RQ), total fat mass (TFM), fat free mass (FFM), nutrition intake, daily total activity count, nightly sleep hour, and hormone. The association between OSA □apnea hypopnea index (AHI) &gt;=15/h□ and REE, RQ, TFM, and FFM was analyzed with multivariable linear regression.

Results
85 patients were enrolled with median age 41.7 y/o, 78.6% male, body mass index (BMI) 25.4 kg/m2, and AHI 28.8/h. Compared to no OSA, patients with OSA had higher BMI, RQ, TFM, activity count, and similar age, gender, REE, FFM, nutrition intake, sleep hour, cortisol, leptin, and Ghrelin. OSA was independently associated with RQ (coefficient 0.031; 95% CI 0.004-0.057, p=0.022) with adjustment of age, gender, BMI, and activity count but not associated with REE, TFM, and FFM.

Conclusion
Though OSA may be associated with metabolic dysregulation, it was not associated with energy balance and BC. Further validation of the findings in a large scale and multi-ethnicity cohort to validate the findings of the present study is warranted.

Support (if any)
National Science and Technology Council, Taiwan (NST 111-2314-B-002-293; MOST 109-2314-B-002-252); Ministry of Education (NTU-107L900502, 108L900502, 109L900502)”, National Taiwan University Hospital (NTHU 108-S4331, 109-42, 111-S0298, 111-X0033); MediaTek Inc. (201802034 RIPD), and LARGAN Health AI-Tec CO., Ltd (202003021 RIPB)
0489 Two Years Of Experience Managing OSA Patients Using Remote Patient Monitoring
Authors: Simmons Jerald , Sadeghian Hesam , Lavender Maggie , Hua Olivia , Hernandez Patricia , Cordero Clifford 
Published: May 2023

Abstract

Introduction
Remote-Patient-Monitoring(RPM) is gaining implementation but to date, nightly-monitoring of OSA other than PAP devices, has not become a standard of care. We have taken the lead on OSA-RPM and developed a platform that imports data from a FDA-approved technology based on Cardiopulmonary-Coupling software linked to a ring oximeter (SleepImage) worn at night. Last year we presented on the practicality and patient adherence of our approach. Here we are presenting our experience over the past two years of using our platform to assist in the management of a wide range of OSA treatment approaches.

Methods
We developed software to manage the work-flow involved with nightly RPM of sleep. Patients wear a ring oximeter at night designed to provide data to a cloud-based platform for retrieval by our staff using our tracking software platform. Inclusion criteria: OSA with an abnormal baseline AHI. Also included are narcolepsy patients on oxybate, known to enhance OSA. Patient self-reported inputs regarding therapy are captured. Treatment approaches range from PAP (CPAP/BiLevel), Inspire-HGNS, Oral-Appliance-Therapy, Surgical-Interventions (i.e. MMA), orthodontics and combinations of the above.

Results
Since 1-1-2021, 140pts enrolled, 85 since 1/1/2022, and 87 currently monitored (12/1/2022). Ave 59yrs +/- 13, 64% Males. Discontinuation resulted for reasons ranging from clinical improvement, financial limitations, lack of compliance and other. Numerous treatment modifications have been guided without repeat NPSG/HSAT testing. OSA-RPM has influenced management of PAP, Inspire-HGNS, Oral-Appliance, orthodontics, and surgical therapies, as well as combination of the above. Detailed outcomes to be furnished. In brief, OSA-RPM with our system has provided extensive insight into efficacy of treatment approaches. Additionally, night to night variability can be better appreciated with this RPM technique, implying the limitation of single-night sleep studies.

Conclusion
Using this approach has allowed direct ongoing assessment of the impact of therapy modifications directed by both the clinician and the patient. There are currently no established protocols or guidelines for the use of this type of OSA-monitoring. It is important that guidelines be implemented to provide an improved level of care and not abused to just increase reimbursements with little added value, as abuse could hinder the growth of this type of care.

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0491 Use of Neuromuscular Stimulation device of Tongue to treat Mild obstructive sleep apnea in Veteran population
Authors: Kallamadi Rekha , Kumar Kelash , Gravely Amy , Henry Amber , Khalil Wajahat , Irfan Muna , Zebrosky Teri 
Published: May 2023

Abstract

Introduction
Approximately 30 million adults in United States suffer from obstructive sleep apnea (OSA), with much higher prevalence in veterans. However, the treatment options of sleep apnea are currently limited due to CPAP device shortage, hence, unravelling a significant gap for alternative user-friendly therapeutic options. Neuromuscular stimulation device of the tongue is a novel FDA approved therapy becoming more relevant with the ongoing CPAP device shortage.

Methods
Neuromuscular stimulation device of tongue procured through regulatory process at VA Minneapolis, is offered to veterans with Mild OSA( AHI 5-15) on home sleep apnea testing.Baseline and post therapy data including patient's snoring, Epworth sleepiness score(ESS),Apnea - Hypopnea Index(AHI) was collected. Post therapy data was collected after initial 6 weeks of at least 20-minute daily followed by maintenance of 2 weeks of twice weekly use.

Results
A total of 112 patients with Mild OSA were offered the device as an alternative option of treatment during the period of December 2021 to August 2022. Of these, 39 patients completed therapy with mean age of 54.5 years (age ranging from 28y-80y), 36 were males and 3 were females. Among a total of 31 patients who completed their ESS pre and post questionnaire, and 22 patients who had pre and post AHI available, a paired t-test was obtained. In the 31 patients with pre and post ESS, the results of paired t- test showed a mean difference in ESS score of 1.90 with 95% CI (0.55 -3.25) with statistically significant P value of 0.0073. In the 22 patients with pre and post AHI, results of paired t -test showed Mean difference in AHI score of 2.54 with 95% CI (0.24-4.84) with statistically significant P value of 0.0316.

Conclusion
Findings suggest that the alternative treatment to CPAP provided to patients did result in improvement of Mild OSA both in subjective sleepiness symptoms and objective degree of residual apnea, and hence can be used as a feasible alternative therapy. However, the study is limited by small size (112) with a relatively low response rate from the participants (39), and availability of matched data (ESS -31, AHI -22). Therefore, larger studies are warranted.

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0492 Variability in High Altitude Sleep Disordered Breathing and Impact of Acclimatization
Authors: Jiwa Farzin , DeYoung Pamela , Pham Kathy , Frost Shyleen , Nasr Ledia , Malhotra Atul , Heinrich Erica , Orr Jeremy 
Published: May 2023

Abstract

Introduction
Individuals who travel to high altitude experience variable levels of poor sleep quality and sleep disordered breathing, which can have neurocognitive and other systemic impacts. Past studies by our group and others have shown that the apnea hypopnea index (AHI) increases, and nocturnal oxygen saturation decreases at higher altitude. This may change over time with acclimatization to environmental hypoxemia. The aim of this study was to examine the trajectory and variability in high altitude sleep disordered breathing effects in healthy young adult volunteers.

Methods
Twenty healthy volunteers were recruited from a local university (35% women), mean age 23.5(20.0, 32.2) years and BMI of 30.0(28.0, 35.9) kg/m2. Peripheral Arterial tonometry based home sleep apnea tests (HSAT; WatchPat One) was performed on all subjects at sea level up to three days prior to transportation via car to high altitude (3800m White Mountain Research Center - Barcroft Station, CA). Participants continued HSAT testing for three consecutive nights at high altitude sleeping in any position, without oxygen, acetazolamide, or use of any other medications impacting sleep or breathing. Mixed effects modeling was used to compare sleep parameters across nights.

Results
Subjects' characteristics: median (IQR)[range] age 23(20,32)[19,39] years, BMI 30(28, 36)[23,48] kg/m2, 35% women. AHI at altitude night 1 (67±4 events/hour) was significantly higher than sea level (7±4 events/hour; P&lt; 0.001). Mean sleep SpO2 at altitude night 1 (79±1%) was significantly lower than sea level (95±1%; P&lt; 0.0001). There was no statistically significant change in AHI or mean sleep SpO2 on nights 1-3; however substantial variability was noted between individual trajectories.

Conclusion
Healthy young adults exhibit severe Sleep Disordered Breathing when traveling to high altitude. Despite acclimatization, the severity of Sleep Disordered Breathing remained relatively unchanged overall. However substantial differences in individual trajectories were apparent. Larger studies are needed to understand how differences in genetics, sex, and other factors might impact Sleep Disordered Breathing at altitude. In addition, the impacts of (or tolerances to) altitude are likely to be broadly informative towards Sleep Disordered Breathing, hypoxemia, and other areas.

Support (if any)
N/A
0494 Early Feasibility Study on Use of Noninvasive Temporal Interference Stimulation of the Hypoglossal Nerve in the Treatment of OSA
Authors: Shangold Lee , Hanes William , Solomon Wyle , Williamson Adam , Missey Florian , Ejneby Malin Silvera , Trajilinek Jan 
Published: May 2023

Abstract

Introduction
Hypoglossal nerve stimulation has proven effective as an alternative to Positive Airway Pressure (PAP) machines in treating obstructive sleep apnea (OSA). The only currently FDA-approved hypoglossal nerve stimulator requires surgical implantation. Somnial Inc. is developing a noninvasive nerve stimulator based on temporal interference (TI), such that multiple supra-kHz-modulating electrical fields overlap to create a hyper-localized field modulating at a lower, nerve-stimulating frequency equal to the offset between the original fields. Bilateral stimulation reduces lateral movement of the tongue and requires less energy applied to the individual nerves. In early studies, transcutaneous, bilateral TI stimulation showed strong forward and central tongue movement with long-term tolerability.

Methods
To determine the clinical impact of TI on the treatment of OSA, 11 patients recently diagnosed with moderate to severe OSA (AHI 15-50/hour) based on in-lab polysomnography (PSG) and BMI &lt; 35 were subjected to bilateral TI stimulation of the hypoglossal nerves during another PSG. Two pairs of electrodes were placed on either side, medial to the inferior aspect of the mandible overlying the genioglossus muscle. The frequencies were modulated in a 4-second-on, 2-second-off pattern. Initial power settings were determined as sufficient to move the tongue without discomfort and were increased throughout the night in an approach similar to a CPAP titration study.

Results
5 of the 11 patients analyzed in the study, including 4 out of 4 women, responded to the therapy (AHI reduction from baseline by &gt;50% and an AHI of &lt; 20/hour). Patient questionnaires indicate the treatment was well tolerated throughout the night.

Conclusion
These promising proof of concept results after a single night indicate the potential for the use of TI in the treatment of OSA. Transcutaneous application of stimulation energy via TI energy could be used to determine the efficacious does required to reduce AHI events in the at-home healthcare setting. This justifies future research in long-term, chronic-treatment studies with TI stimulation and the advancement of a home-based device.

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0498 Home automated OSA quantification of night-to-night short term variability: analysis of the associated conditions
Authors: Pépin Jean-Louis , Martinot Jean-Benoit , Bailly Sebastien , Tamisier Renaud , Le-Dong Nhat-Nam 
Published: May 2023

Abstract

Introduction
Single night in-lab polysomnography (PSG) is still the conventional procedure for making obstructive sleep apnea (OSA) diagnosis, or alternatively a home sleep apnea test (HSAT) in patients free from comorbidity. Recent publications drew attention to considerable internight within-subject variability in OSA clinical status, notably but not only with HSAT. Taking benefit of multiple nights recording in home-based setting using measurements of mandibular jaw movement (MJM) combined with automated machine learning analysis, this study aimed to investigate the effect of change in sleep parameters on the internight variability of the apnea hypopnea index (VAHI).

Methods
160 adults suspected of having OSA successfully completed 3 sleep tests at home with the Sunrise device (Sunrise, Namur, Belgium). Data analysis implied generalized estimating equation (GEE) regression.

Results
Even though the internight variability of AHI was not statistically significant at the population level with a mean VAHI of -1.1 ± 7.8 events/h, such variability could lead to misdiagnosis and wrong therapeutic decisions based on a single night. After adjusting for effects of gender, body mass index (BMI), age, total sleep time (TST) and time interval between sleep tests, regression models indicated that sleeping in supine position was positively and independently associated with VAHI, the AHI increased by 0.95 event/h for each 10% of increase in sleeping time in supine position. VAHI was negatively and significantly (p &lt; 0.01) associated with sleep efficiency and deep sleep; VAHI decreased of 0.16 event/h (0.04 to 0.28) and 0.29 event/h (0.17 to 0.42) for each % of increase in sleep efficiency and proportion of deep sleep, respectively.

Conclusion
At the individual level, position, sleep efficiency and deep sleep are associated with short-term internight variability in AHI. Clinical decision based on a single-night testing may lead to errors in OSA diagnosis with delayed or wrong therapeutic decisions.

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0501 Manganese and sleep health outcomes in U.S. adults: analysis of the NHANES 2017-2020
Authors: Yang Chia-Lun , Jansen Erica , Seo Young Ah 
Published: May 2023

Abstract

Introduction
Manganese (Mn) is an essential trace mineral required for normal growth and physiological processes. However, inadequate or excess Mn can have a detrimental impact on human health. Despite the essentiality, little is known about the relationship between Mn and sleep. The objective of this study is to examine the relationships between blood Mn levels and sleep patterns (duration, midpoint of sleep, obstructive sleep apnea [OSA] symptoms, and trouble sleeping) in U.S. adults.

Methods
Data from the 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) was used for the analysis. Adults aged 18 or older with both blood Mn levels and sleep parameters were included (n=8356). Self-reported fall asleep time and wake up time in the past week were used to calculate sleep duration and midpoint. Trouble sleeping and symptoms of OSA were also collected. Blood Mn levels were divided into quintiles for analysis. Multivariable logistic regressions that accounted for complex study design were used.

Results
The mean (SE) blood Mn concentration was 9.7 (0.1) µg/L, and was higher among participants who were younger, female, identified as non-Hispanic Asian, had lower income, were non-smokers, and had lower iron levels (P&lt; 0.05, for all). About 25% of adults had short sleep duration (&lt; 7 hours) on weekdays. OSA symptoms were noted in 49% of adults. In men, the odds of short sleep duration on weekdays were higher among those with the lowest Mn level (Q1: &lt; 7.0 µg/L) than the reference group (Q3: 8.5-10.0 µg/L) after adjusting for age, race, income, smoking, and iron (OR: 1.5, 95% CI: 1.1-2.1, P=0.03). Among women, Q2 (7.0-8.4 µg/L) was the related to the lowest odds of OSA symptoms compared to all other groups after adjusting for covariates (P=0.049).

Conclusion
Lower or higher Mn levels in blood were related to poor sleep health in U.S. adults, which suggests that inadequate or excessive Mn intake might be harmful to sleep. Future studies on the mechanisms of these relationships are needed.

Support (if any)
This work was supported by National Institutes of Health R01DK123022, R21NS112974 to YAS, and K01HL151673 to ECJ.
0503 Respiratory Effort During Sleep And Prevalent Diabetes In Obstructive Sleep Apnea
Authors: Martinot Jean-Benoit , Malhotra Atul , Le-Dong Nhat-Nam , Pépin Jean-Louis 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) and type 2 diabetes (T2Dia) is a frequent clinical association. Beyond OSA-related hypoxic burden, increased respiratory effort (RE) is one of the main features of OSA and contributes to sympathetic overactivity that in turn might participate to glucose homeostasis dysregulation. The independent contribution of RE to the OSA-T2Dia pathogenesis remains to be demonstrated. The study aims to determine the impact of metrics assessing sleep RE derived from the sleep mandibular jaw movements (MJM) signal on the prevalence of T2Dia in a large cohort of patients addressed for in-laboratory conventional polysomnography (PSG) with suspicion of OSA.

Methods
An interpretable machine learning model was built to predict T2Dia from clinical data, PSG indices, and MJM-derived parameters (including the time spent with increased RE, expressed in % of TST). The analysis included 1128 subjects, randomly assigned to training (n=853) and validation (n=275) subsets with equal T2Dia prevalence of 11%.

Results
The risk stratification model based on 19 input features including increased RE showed good performance for predicting prevalent T2Dia (sensitivity=0.81, specificity=0.89). Post-hoc interpretation using the Shapley additive explanation (SHAP) method revealed that increased RE was the most important risk factor of T2Dia after other clinical factors for T2Dia (i.e., sex, BMI and average SpO2), ahead of standard PSG metrics (including the apnea-hypopnea index and oxygen desaturation index).

Conclusion
These findings suggested that the proportion of sleep time spent with increased RE automatically derived from MJM is a potential new reliable metric to predict prevalent T2Dia in patients with OSA.

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0504 STOP BANG FAN, A Novel Screening Tool of OSA in Sleep Clinic
Authors: Gohar Ashraf , Cheng An-lin , Bhat Abid 
Published: May 2023

Abstract

Introduction
We noticed that patients with OSA when admitted to hospital requested a fan even in winter. We explored the literature and did not find any reports about fan use in OSA. STOP-Bang questionnaire has been widely used in preoperative clinics [4-6], sleep clinics [7-8] to detect patients at high-risk of OSA. STOP Bang score 5 or more has high risk of OSA. We did a pilot study to explore if adding the use of FAN, especially in winter, would increase the sensitivity of STOP Bang questionnaire in the sleep clinic.

Methods
We screened 350 consecutive patients referred to our sleep clinic for suspected OSA in the period of March 2021 to April 2022, with STOP Bang FAN questionnaire. The questionnaire added if they use FAN during sleep in addition to the air condition and if they still use it in winter.

Results
255 (73%) used FAN during sleep and 210 (60%) used the fan in winter. 247 patients had PSG, the others did not for variable reasons, including refusing COVID test before the study, insurance issues or no insurance. In the 247 patients who had the PSG the sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for OSA AHI 5 or more were 78%, 83% and 89%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for moderate and severe OSA AHI 15 or more were 65%, 74% and 79%. The sensitivity of STOP Bang score 5 or more, STOP Bang score 5 or more + Sleeping with FAN and STOP Bang score 5 or more + sleeping with Fan in winter for severe OSA AHI 30 or more were 55%, 64% and 71%.

Conclusion
Adding the use of the FAN and especially FAN in winter during sleep to STOP Bang would increase the sensitivity of the questionnaire for suspected OSA in sleep clinic.

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0505 3-Year follow-up of patients with OSA on telemonitoring
Authors: Guimarães Maria , Silva Elisabete , Costa Catarina , Silva Andreia 
Published: May 2023

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is a highly prevalent respiratory disease. In the subgroup of OSA patients on Positive Airway Pressure (PAP), telemonitoring for CPAP (Continuous Positive Airway Pressure) have emerged as follow-up option to monitor and detect poor compliance to treatment. We aimed to understand whether telemonitoring is an independent factor in the therapeutic adherence of OSAS patients.

Methods
A retrospective assessment was carried out in patients followed in the Sleep Medicine consultation between March 2019 and June 2022. A total of 312 patients with Resmed® model S10 CPAP devices with residual apnea detection algorithm, mean therapy pressure, and the number of hours of daily use ware included. After placement of the PAP patients were reassessed by consultation at 3, 6, 12, 24 and 36 months of therapy.

Results
A total of 312 patients were evaluated, 203 men and 109 women, with a mean daily use of 6 hours and 43 minutes, with a standard deviation of 1 hour and 52 minutes. The residual AHI of averaged 2.58/hour. In June 2022, 30 patients were included at 3 months, 30 at 6 months, 41 at 12 months, 84 at 24 months and 127 at 36 months, with a mean daily use of respectively: 4.29 (median 5.17), 4.33 (median 4.44), 3.52 (median 4.45), 5.05 ( median 5.59) and 4.40 hours (median (5.28), with no statistical significance and adherence being similar from the first trimester, as well as in the divisions of patients per group. This analysis shows that adherence did not decrease over the months of telemonitoring, which may mean that patients felt permanently monitored. The mean Residual AHI was respectively: 4.64, 2.08, 2.33, 2.33 and 2.37/hour, we found that the disease remained controlled and without much variation. We obtained an excellent adaptation to therapy in 262 patients (84%), and 16% (50 patients) abandoned therapy.

Conclusion
In patients with a confirmed diagnosis of OSA treated by PAP, telemonitoring has proven to be a helpful tool for a better follow-up and therapeutic adjustment, promoting ideal compliance to therapy, which is effective as early as the first three months.

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