bluuebunny/crossref_metadata_2025_split huggingface dataset:
0799 Impact of Highly Effective Modulator Therapy on Obstructive Sleep Apnea in People with Cystic Fibrosis
Authors: Shakkottai Aarti , Kim Stephany , Mitchell Ron 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is frequently seen in people with cystic fibrosis (PwCF). The presence of upper airway pathology including adenotonsillar hypertrophy and chronic sinusitis is a known risk factor for OSA in PwCF. The widespread use of highly effective modulator therapy (HEMT) such as elexacaftor/tezacaftor/ivacaftor has led to improvements in nutritional status, lung function, and sinus disease among PwCF. However, the impact of HEMT on OSA is still unknown.

Methods
We conducted a single center retrospective review of polysomnographic data in PwCF between 1/1/2009-10/31/2022.

Results
Fifty-three children with CF had undergone diagnostic polysomnography during the study period. Twenty-eight (53%) patients had OSA. Frequency of OSA did not differ by race or mutation type (p&gt;0.5). Eighteen (34%) patients were on HEMT at the time of polysomnography. Mean ages of PwCF in the post-HEMT vs pre-HEMT were 11.6±5.4(sd) vs 6.4±3.5 years respectively, p=0.001. Mean body mass index percentile was 70.8±27.4 vs 55.8±31.2 respectively, p=0.09. Mean forced expiratory volume in 1 second as a percent predicted was 97.1±22.5 vs 87.0±20.9 respectively, p=0.2. Frequency of OSA was 67% in the post-HEMT group and 46% in the pre-HEMT group (p=0.1). Snoring was present in 91% of PwCF in the pre-HEMT group and 78% of those in the post-HEMT group (p=0.2). Frequency of mouth breathing was 77% and 56% in the pre-HEMT and post-HEMT groups respectively (p=0.1). Large adenoids were present in 37% of PwCF in the pre-HEMT group as compared to 11% of those in the post-HEMT group (p=0.046). Frequency of large tonsils in the pre-HEMT and post-HEMT groups was 43% vs. 28% (p=0.3). There were no differences in frequency of chronic sinusitis between the groups (p=0.7).

Conclusion
Frequency of OSA among PwCF continues to be high even in the post-HEMT era. PwCF on HEMT showed a trend towards more frequent OSA despite having less upper airway pathology. The better nutritional status afforded by HEMT could be contributing to the high frequency of OSA in this population. Larger studies are needed to formally test this hypothesis.

Support (if any)
0804 Sleep-disordered Breathing in Myelomeningocele and Chiari II Malformation: Our Experience at a Tertiary Care Center
Authors: Imran Sehyr , Ingram David , Tam-Williams Jade 
Published: May 2023

Abstract

Introduction
Children with myelomeningocele (MMC) and Chiari Malformation type II (CMII) have some degree of sleep-disordered breathing (SDB), which may include central apnea, obstructive apnea, and hypoventilation. Untreated SDB may lead to growth failure, neurocognitive and behavioral abnormalities, cor pulmonale, and death. There is no standardized diagnostic and management protocol to be followed if SDB is suspected in a patient with CMII and MMC.

Methods
Variability in physician practice patterns was assessed for patients with CMII and MMC suspected of having SDB at a tertiary care center from January 2008 to December 2018.

Results
180 patients with CM2 and MMC were identified. Pulmonology/Sleep providers were consulted on 63 of them. A sleep study was ordered for 73% of these patients, with snoring being the most common indication. Most patients had obstructive sleep apnea, with mean obstructive AHI of 6 events/h. Recommendations after sleep study included supplemental oxygen (20%), non-invasive positive airway pressure initiation (9%), subspecialty referral in 35% (otolaryngology and neurosurgery), and tracheostomy with mechanical ventilation in 10% of the patients.

Conclusion
In a large tertiary care center, there was significant variability in clinical practice patterns for children with CM2 and MMC who have SDB. Clinicians caring for these patients should consider PSG to enhance early diagnosis and management of SDB. A standardized diagnostic and management protocol could complement physician judgment to care for this complex patient population.

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0807 The Odds Ratio Product as a Metric of Obstructive Sleep Apnea Severity in Adolescents
Authors: Fernandez-Mendoza Julio , Isely Alexis , Ricci Anna , He Fan , Calhoun Susan , Fang Jidong , Vgontzas Alexandros , Liao Duanping , Bixler Edward 
Published: May 2023

Abstract

Introduction
Although the apnea-hypopnea index (AHI) remains the gold-standard metric of the severity of obstructive sleep apnea (OSA), it is often criticized for its limitations. The odds ratio product (ORP), a continuous standardized measure of sleep depth that ranges from 0 (deep sleep) to 2.5 (full wakefulness), has been proposed as a potential EEG-based alternative to assess the severity of OSA, including its association with cardiovascular outcomes such as elevated blood pressure (eBP).

Methods
We extracted ORP during rapid eye movement (REM) and non-REM sleep stages from the sleep EEG of 421 adolescents (median 16y) from the Penn State Child Cohort. Higher ORP indicates lower sleep depth. Systolic and diastolic BP levels were measured in the seated position and eBP was identified using American Heart Association guideline-recommended pediatric criteria. OSA was defined as an AHI of 2 or greater events per hour of sleep. Logistic regression models examined the joint of effect of AHI and ORP on eBP, while adjusting for sex, age, race/ethnicity and body mass index, and stratified by the presence of OSA.

Results
We found a significant interaction between AHI and ORP on eBP (p-interaction=0.016). Among adolescents with OSA, each additional 0.5-point increase in ORP was associated with 6.3-fold odds (95%CI=1.9-20.6, p=0.003) of eBP. Specifically, each additional 0.5-point increase in ORP was associated with 6.4 mmHg (SE=3.0, p=0.036) higher systolic BP among adolescents with OSA. These associations were not significant among adolescents without OSA (eBP: OR=0.8, 95%CI=0.4-1.8, p=0.602 for each additional 0.5 increase in ORP).

Conclusion
Our data support ORP as a prognostic sleep-EEG metric of OSA in youth. Future clinical trials should examine the added value of ORP in OSA endophenotyping, its response to treatment and role in improving cardiovascular outcomes.

Support (if any)
National Institutes of Health (R01HL136587, R01MH118308, UL1TR000127)
0809 Development and validation of a questionnaire to assess toddler sleep
Authors: Gupta Gita , O'Brien Louise , Dang Louis , Ibadat Shewar , Neff Katherine , Sturza Julie , Shellhaas Renée 
Published: May 2023

Abstract

Introduction
Few sleep questionnaires focus on toddlers, whose sleep is unique from both infants and older children. Fewer include both medical and behavioral items, or have been externally validated against polysomnograms (PSGs).

Methods
Caregivers of children 12 to 36 months old were recruited through social media, flyers in common hospital spaces, general pediatrics clinics, a pediatric neurology clinic, and at the sleep lab. A questionnaire using a 5-point Likert scale was developed. Questionnaire items pertained to behavioral issues, restless legs syndrome, sleep-disordered breathing, dysautonomia, feeding, attitudes toward sleep, and comorbidities. Factor analysis was used to determine which items represent distinct dimensions of toddler sleep. A diagnosis of sleep apnea was not included in the generation of the factors. Cronbach’s alpha was calculated to evaluate internal consistency within the derived factors. Sleep apnea was defined as the presence of either obstructive or central sleep apnea diagnosed by PSG. We used receiver operating characteristic (ROC) curves to determine which factors most closely estimate sleep apnea. Concordance of factors with the presence of sleep apnea was determined by measuring the area under the ROC curve (AUC).

Results
Responses from 720 caregivers of toddlers were used to generate the factors. External validation was performed using the PSG data of 35 children. One distinct factor emerged which had good concordance with a diagnosis of sleep apnea (AUC≥0.70). The factor was comprised of the following items: “My child has noisy breathing during sleep”, “My child snorts and gasps during sleep”, “My child snores”, “My child's breathing is heavy during sleep”, “My child breathes through their mouth while sleeping”, “My child breathes through their mouth during the day”, “My child "belly breathes" during sleep”; Cronbach’s alpha=0.83; AUC=0.70). Factors associated with daytime behavior, behavioral insomnia of childhood, and excessive daytime sleepiness were not associated with sleep apnea.

Conclusion
Obstructive features are most associated with sleep apnea, whereas daytime and bedtime behavioral characteristics, and excessive daytime sleepiness are not, unlike in studies of older children. This may reflect the natural history of sleep apnea in children. Further study with a larger sample size is required to confirm this finding.

Support (if any)
NIH 2T32HL110952-06
0810 Effect of supraglottoplasty on respiratory parameters in infants and children with laryngomalacia and oxygen dependence
Authors: Wickemeyer Johanna , Nakamura Aisaku , Hossain Md Monir , Simakajornboon Narong 
Published: May 2023

Abstract

Introduction
Supraglottoplasty (SGP) is the surgical treatment of choice for laryngomalacia and obstructive sleep apnea (OSA). Several recent studies have shown that oxygen can act to stabilize ventilatory control in infants with OSA and high loop gain. However, there is very limited information on the effect of SGP on OSA in infants with laryngomalacia and evidence of high loop gain.

Methods
A retrospective chart review was performed in infants with laryngomalacia and OSA at Cincinnati Children’s Hospital Medical Center from January 2008 to June 2022. Only patients treated with oxygen prior to SGP were included in the analysis. The pre-surgical polysomnograms (PSGs) were classified by responsiveness to oxygen into 2 groups; oxygen responders ([R]; &gt;50% decrease in apnea-hypopnea index (AHI) with oxygen, indirect evidence of high loop gain) and non-responders ([NR]; &lt; 50% decrease in AHI). Data were reported as mean±SD. The comparison of AHI and obstructive AHI (OAHI) between pre-surgical and post-surgical PSGs were performed in each group using paired t-test or Wilcoxon signed rank test. The differences of percentage decreases in AHI and OAHI after surgery between R and NR were calculated using Wilcoxon Rank Sum test.

Results
Forty-nine infants (with 52 SGPs) met the study enrollment criteria, with 33 (67.3%) male and 16 (32.7%) female patients. There were no statistically significant differences in age or sex between oxygen responders and non-responders. AHI after SGP in both oxygen responders (50.1±59.2/hr [pre] vs 17.6±21.1/hr [post]; P&lt; 0.0001) and oxygen non-responders (25.2±13.3/hr [pre] vs 12.4±9.4/hr [post] vs; P=0.0006] decreased significantly. Similarly, there were significant decreases in OAHI after SGP in both groups. Additionally, there were no significant differences in the percentage decreases of AHI (57.3±26.1% [R] vs 41.4±48.8%[NR]; P=0.6410) and OAHI (64.0±21.9% [R] vs 50.3±41.4% [NR]; P=0.5260) between the 2 groups.

Conclusion
Both oxygen responders and non-responders had significant decreases in AHI and OAHI after surgery with similar magnitude of improvement. Supraglottoplasty is an effective treatment in infants with larygnomalacia and OSA, even in those with evidence of high loop gain. We speculate that non-anatomic traits such as high loop gain would only manifest in the context of significant respiratory disturbances from anatomic traits.

Support (if any)
0822 Sleep and Nighttime Urine Production
Authors: Tyagi Shachi , Clarkson Becky , Newell Kandy , Perera Subashan , Resnick Neil , Buysse Daniel 
Published: May 2023

Abstract

Introduction
Nocturia (waking from sleep to urinate) is the most common cause of sleep interruption among older adults and nocturnal polyuria (NP; increased sleep time urine production) is its most common cause. Conversely, poor sleep with repeated awakenings contributes to both nocturia and NP. However, whether a behavioral intervention to reduce repeated awakenings can improve nocturia and NP has not been examined in a clinical trial. The current study assesses the effect of Brief Behavioral Treatment for Insomnia (BBTI) on nocturia and NP in older adults.

Methods
Fifty-six community-dwelling older adults (mean age, 72±6 years; 64% women) with nocturia frequency ≥2 per night were randomized to receive BBTI vs information-only control (IC). All participants completed a 3-day voiding and sleep diary to assess nocturia, and sleep. Participants with a nocturnal polyuria index (NPi; percent of 24-hour urine volume excreted at night) ≥35% were considered to have NP.

Results
At baseline, nocturia frequency correlated with total sleep time (r=.54, p&lt; 0.001) and duration of the first uninterrupted sleep period (FUSP, r=-.40, p=0.004) after adjusting for age and body mass index. BBTI significantly improved nocturia frequency compared to the IC group (-1.0±0.7 vs -0.3±0.9; p=.02). FUSP increased by 54±77 minutes in the BBTI group and NPi decreased by 7.1±13.2%, but these changes were not significantly different from the IC group. Change in NPi correlated with change in FUSP (r=-.36, p=.01; longer FUSP associated with lower NPi), but not with change in total sleep time (r=-.04, p=.7).

Conclusion
In older adults with nocturia, behavioral treatment directed solely at sleep also improves nocturia. Improving sleep continuity in the first half of the night and increasing FUSP, but not total sleep time, may also improve NP.

Support (if any)
NIA AG060292
0823 Social Determinants of Sleep Disorders Among Multiethnic Americans in the NIH All of Us Research Program
Authors: Blanc Judite , Barr Peter , Seixas Azizi , Chery Maurice , Bernard Maritza , Rogers April , Jean-Louis Girardin , Bigdeli Tim 
Published: May 2023

Abstract

Introduction
Studies show that social characteristics associated with good health, such as a high level of education, being married, and being employed, are associated with healthier sleep health. Accordingly, we leveraged All of Us (AOU), an NIH research, to analyze sleep disorders prevalence and sociodemographic covariates.

Methods
Phecodes for diagnoses were derived from the ICD-9/10 billing codes in participants’ electronic health records (EHRs). We used 0 phecodes of the parent category of sleep disorders (insomnia and sleep apnea) (phecode 327) in a person’s EHR to classify individuals as not having a diagnosis and 2+ phecodes as having a diagnosis (those with only one instance in their EHR were dropped). Logistic regression analysis was conducted to assess associations between sleep disorders and race/ethnicity, sex, age, and education level using the R statistical framework.

Results
A total of 214, 206 participants were available for analysis; of whom 61.3% were female (mean [SD] age, 51.7 [16.6] years). Women were 1.27xmore likely to have a diagnosed sleeping problem (95% CI: 1.31,1.23; p=1.31×10-61). We observed higher rates of sleep disorders in older individuals; compared to persons between 18-30 years old, those aged 65 years or older were 4.74 times more likely to have a diagnosable sleep disorder (95% CI: 3.83, 4.33; p&lt; 10-300). We also observed a trend of greater education attainment corresponding to an increased likelihood of sleep problems; this was most extreme when comparing individuals with some college versus those who did not complete high school (OR=1.38; 95% CI: 1.30, 1.46; p=3.65×10-29). Individuals with reported income &lt; 25K/year were 1.44x more likely to be diagnosed than those earning &gt;100K (95% CI:1.51, 1.37; p=1.05×10-51). Individuals identified as Black were least likely to have a diagnosis (OR=0.52; 95% CI: 0.50, 0.54; p=2.2that 2×10-208).

Conclusion
Among All Of Us populations, self-identified Blacks, men, younger adults, higher-income, and non-college-educated patients are less likely to have recorded insomnia or sleep apnea diagnoses. Some of these unexpected within-group differences could be due to self-reported versus clinically recorded diagnoses and access to healthcare. Planned analyses aim to explore further social determinants of health by incorporating geospatial and available self-report data on exposures

Support (if any)
1HL152453, R01MD007716, R01HL142066
0833 Acceptability of the Transdiagnostic Behavioral Sleep and Circadian Intervention to Individuals in Cardiac Rehabilitation
Authors: Tighe Caitlan , Phares Angela , Weiner Debra , Buysse Daniel , Forman Daniel 
Published: May 2023

Abstract

Introduction
Sleep health is often compromised among individuals undergoing cardiac rehabilitation and does not consistently improve over the course of treatment. Behavioral sleep and circadian interventions may improve the sleep health of cardiac rehabilitation patients but have not been widely tested in this context. We conducted a preliminary test of an adapted version of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) with Veterans in cardiac rehabilitation to evaluate its acceptability with these unique patients.

Methods
Eight Veterans with sleep disturbance and/or sleep-related impairment who were participating in outpatient cardiac rehabilitation completed the adapted TranS-C intervention and post-intervention acceptability measures. Intervention acceptability was assessed quantitatively with subscales from the Multidimensional Treatment Satisfaction Measure (subscale scores range from 0-4; higher scores indicate greater satisfaction) and qualitatively via semi-structured interviews. We calculated descriptive statistics for quantitative measures and analyzed semi-structured interviews using a rapid qualitative analysis approach.

Results
Participants felt the intervention was suitable to their needs (M=3.00, SD=.94) and useful for increasing their knowledge and understanding of sleep problems and how to manage them (M=3.50, SD=.69). Participants endorsed positive attitudes toward the intervention (M=3.63, SD=.58) and high likelihood of recommending the intervention to others similarly experiencing sleep problems (M=3.63, SD =.58). Following the intervention, 62.5% of participants indicated that their sleep disturbance and sleep-impairment were ‘much better’ than at the first study visit and 37.5% indicated their sleep disturbance and sleep-related impairment were ‘somewhat better’. Qualitative findings converged with the noted quantitative findings.

Conclusion
Veteran cardiac rehabilitation patients expressed satisfaction and positive attitudes toward the adapted TranS-C intervention. All participants reported subjective post-intervention improvements in sleep disturbance and sleep-related impairment. These findings provide preliminary support for further large-scale testing of adapted TranS-C in cardiac rehabilitation.

Support (if any)
Dr. Tighe is supported by a Career Development/Capacity Building Award (IK2 RX003393) from the United States Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. This material is the result of work supported with resources and use of facilities at the VISN 4 Mental Illness Research, Education, and Clinical Center at VA Pittsburgh Healthcare System.
0834 Association of Sleep Disordered Breathing and Hemodynamics of World Symposium on Pulmonary Hypertension Groups in PVDOMICS Cohort
Authors: Musco Kaitlyn , Wang Lu , Hill Nicholas , Finet Emanuel , Mehra Reena 
Published: May 2023

Abstract

Introduction
As sleep disordered breathing(SDB)-related pathophysiology of intermittent hypoxia, autonomic dysfunction and intrathoracic pressure alterations, etc. likely exerts differential influences across World Symposium on Pulmonary Hypertension(WSPH) groups that have yet to be characterized , we postulate differing SDB-pulmonary hemodynamics relationships across these groups.

Methods
Pulmonary Vascular Disease Phenomics(PVDOMICS-NCT02980887), a multicenter cohort study, included patients with mean pulmonary artery pressure(mPAP) on right heart catheterization(RHC) ≥ 25mmHg and home sleep apnea testing(HSAT) within 6 weeks of RHC. SDB measures included apnea-hypopnea index(AHI, 3% desaturation hypopnea definition used) and % recording time&lt; 90% SpO2(TRT&lt; 90%). Pulmonary hemodynamic indices included:mPAP, mean pulmonary capillary wedge pressure(PCWP), right atrial mean pressure(RAP). Linear regression models(beta coefficients±standard error) were constructed to assess sleep indices and RHC measurements with adjustment for age, sex, race, body-mass index(BMI), PH medication and supplemental oxygen use; PH group interaction was analyzed.

Results
We included 424 participants with available data in the final analytic sample. Groups 2 and 3 were older(65.6±11.9, 64.2±10.8 years, respectively) and Group 5 had the highest % males(71.4%). Group 2 had highest BMI: 34.3±9.2kg/m2 and Group 5 lowest: 28.7±6.4k g/m2. SDB(AHI≥5), was most prevalent in Group 2(71.4%) and least in Group 4(42.9%). TRT&lt; 90% was highest in Group 1(37.0%, [P25=2.2, P75=87.3]) followed by Group 4(35.7% [5.3,82.9]) and lowest in Group 2(6.4% [0.61,41.8]). AHI and RAP association differed across groups, p=0.027 and was strongest in Group 2; per 5-unit increase in AHI, RAP increased by 0.75mmHg (estimate=0.75, standard error[0.15,1.36],p=0.015). TRT&lt; 90% and mPAP had significant cross-group differences, p=0.004. TRT&lt; 90% was associated with mPAP in Groups 1 and 4:per 5-unit increase in TRT&lt; 90%, mPAP increased by 2mmHg(2.10,[1.52,2.68],p&lt; 0.001) and 1.4mmHg(1.40,[0.07,2.73],p=0.039) respectively. Other associations were not significant.

Conclusion
SDB prevalence differs across WSPH groups and was highest in Group 2 PH. Findings suggest that AHI and TRT&lt; 90%SaO2 differentially contribute to the pathogenesis in PH groups; with AHI associating with RAP, especially in Group 2 PH, and TRT&lt; 90%SaO2 with mPAP in Groups 1 and 4 PH, perhaps via hypoxia-induced pulmonary vasoconstriction and remodeling.

Support (if any)
Funding: U01 HL125218, U01 HL125205, U01 HL125212, U01 HL125208, U01 HL125175, U01 HL125215, and U01 HL125177 and the Pulmonary Hypertension Association.