bluuebunny/crossref_metadata_2025_split huggingface dataset:
0455 Association of high-risk obstructive sleep apnea with endothelial dysfunction in a large population-based sample in MiHeart Study
Authors: Khosla Atulya , Aneni Ehimen , Lahan Shubham , Saxena Anshul , Ali Shozab , Feldman Theodore , Fialkow Jonathan , Nasir Khurram , Walia Harneet 
Published: May 2023

Abstract

Introduction
Obstructive Sleep Apnea (OSA) is associated with endothelial dysfunction and cardiovascular disease (CVD). There are limited data evaluating the association with endothelial dysfunction measured by reactive hyperemia index (RHI) in an asymptomatic population free of CVD. We hypothesized that there would be a significant association between high risk of OSA and endothelial dysfunction in the Miami Heart (MiHeart) study, a population-based cohort of relatively young individuals free of known cardiovascular disease (CVD).

Methods
Cross-sectional data from 2097 participants (mean age: 53 years, 50% female) enrolled in the MiHeart study and underwent flow-mediated dilation using the EndoPat 2000 system was analyzed for this study. OSA was determined by Berlin questionnaire (high vs. low risk); logistic regression was utilized to examine the association between high OSA risk (reference low-risk OSA) and RHI (cut off &lt; 1.67 vs. ≥1.67) in unadjusted models, and after accounting for age, sex, race/ethnicity (model 2), and BMI, diabetes, hypertension, high cholesterol, and smoking (model 3).

Results
704 (34%) participants were categorized as high OSA risk, according to the Berlin questionnaire. These participants were more likely to be male, Hispanic and had a higher CVD risk factor burden when compared to low OSA risk. In addition, those with high OSA risk had higher prevalence of endothelial dysfunction (17.5% vs. 13.9%) than the low OSA risk (p &lt; 0.05) group. High risk of OSA was associated with a higher risk of endothelial dysfunction in the unadjusted model (OR=1.32, 95% CI 1.03, 1.68). When adjusted for age, sex, and race/ethnicity, this association was slightly attenuated (OR 1.26, 95% CI 0.97, 1.62). Upon adjusting for CVD risk factors (model 3), the association between high-risk OSA and endothelial dysfunction was further attenuated and was not statistically significant (OR=1.18, 95% CI 0.87, 1.59). There was a strong, independent association between presence of diabetes and endothelial dysfunction (OR= 2.01, 95% CI 1.35, 2.94).

Conclusion
Younger individuals with high risk for OSA have elevated odds of endothelial dysfunction, and this relationship is likely mediated by demographics and cardiometabolic risk factors such as diabetes.

Support (if any)
The Miami Heart Study is funded by Baptist Health South Florida.
0458 Cardiovascular and sociocultural factors are associated with sleep breathing differences in a diverse Hispanic/Latino cohort
Authors: Gonzalez Kevin , Tarraf Wassim , Kosik Eena , Guarian Kenton , Voytek Bradley , González Hector , Ramos Alberto 
Published: May 2023

Abstract

Introduction
Obesity and or obstructive sleep apnea (OSA) can impact awake breathing patterns, such as increments in the breathing rate. However, little is known about their associations with breathing dysregulations during sleep beyond the apnea-hypopnea events. Understanding this could help elucidate treatment mechanisms or different pathways for disease. Furthermore, there is a strong connection between breathing patterns and cardiovascular disease, thus it is also critical to understand the links between cardiovascular risk factors and disease (CVD) and sleep breathing patterns.

Methods
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective multicenter study of diverse Latinos. A total of N=16,415 participants from four major metropolitan areas and six different Hispanic/Latino backgrounds were sampled for appropriate generalization to the target population. Participants were given an ARES unirecorder device (Carlsbad, San Diego) for a single night of unsupervised at home recording (N=12,022). Raw data from cannula channel (sampled at 10Hz) was processed using the python Bycycle package. Bycycle is a cycle-by-cycle approach to analyzing time series data. Bycycle finds all peaks and throughs in cycles and allows users to extract time dependent information of cycles. We extracted breathing rate (breaths per minute), breathing variability (interquartile range of breathing rate) and time spent in inhalation phase (percent time).

Results
In multivariable models (N=10,175), age was linked to decreased breathing rate, breathing variability, and time spent in inhalation phase. Compared to females, males had higher breathing variability and spent more time in the inhalation phase. Compared to Mexicans and? Central Americans, Cubans, Dominicans, and Puerto Ricans had less time spent in inhalation phase. Dominicans and Puerto Ricans also had increased breathing rate compared to Mexicans. Smoking, body mass index, and moderate to severe OSA were associated with increased breathing rate and variability. Systolic, but not diastolic blood pressure, was associated with increased breathing rate. We found no significant associations with cardiovascular disease.

Conclusion
Factors commonly linked to OSA were associated with increased breathing rate, a compensatory mechanism for optimal oxygenation, and breathing variability. Given cessation or reduced breathing during an apnea-hypopnea event, breathing variability may add more precision to account for varying oxygen demands.

Support (if any)
0464 Deep Learning to Predict PAP Adherence in Obstructive Sleep Apnea
Authors: Rusk Samuel , Nygate Yoav , Fernandez Chris , Shi Jiaxiao M , Arguelles Jessica , Klimper Matthew T , Watson Nathaniel F , Stretch Robert , Zeidler Michelle , Sekhon Anupamjeet , Becker Kendra , Kim Joseph , Hwang Dennis 
Published: May 2023

Abstract

Introduction
Machine Learning (ML) algorithms to predict Positive Airway Pressure (PAP) adherence may support personalized clinical management. Models were developed to predict adherence at various time-points after PAP initiation and in moving time windows.

Methods
Deep neural network (DNN) models were trained utilizing daily PAP data (Kaiser Permanente, Southern California). The DNN was evaluated with 10-fold cross-validation on N=21,397 patients. Algorithms developed included (a) Models 1 and 2 which utilized early usage to predict adherence at 90-days and 1-year respectively, and (b) Model 3 which utilized 14 and 30-day moving windows to predict subsequent usage. Regression analyses compared ML and Naïve (i.e., future use equals previous use) predictions versus Actual adherence.

Results
Model 1 predicted “% days without usage” for first 90-days based on first 7, 14, 21, 30-days of input and at 1-year (90-day window) based on first 30, 60, 90, 180-days of input. ML was superior to Naïve in predicting adherence [R 2 for ML versus Naïve compared to Actuals for different input days— 0.495-vs-0.193; 0.660-vs-0.465; 0.748-vs-0.607; 0.828-vs-0.735 at 90-days and 0.362-vs-0.104; 0.463-vs- 0.247; 0.513-vs-0.339; 0.680-vs-0.547 at 1-year; all p&lt; 0.05]. Model 2 predicted “hours/night” of use—ML did not outperform the Naïve prediction with similar R 2 ; however, when ML predicted &lt; 3 hours/night, nearly all patients had “no significant usage” at 1-year (comparatively, the naïve model had no differentiating threshold to predict this outcome.) Model 3 utilized different windows of PAP usage to predict subsequent usage. ML predictive accuracy was similar using 14 or 30-days of input [R 2 for ML vs. Actuals in predicting 7, 14, and 30-day “% days used ≥4 hours” were 0.687, 0.701, 0.699 using 14- days input and 0.582, 0.702, 0.77 using 30-days input; all p&lt; 0.05.]

Conclusion
ML algorithms based on PAP usage can predict future adherence, potentially supporting personalized treatment decisions and pre-emptive interventions when upcoming non-adherence is predicted.

Support (if any)
AASM Foundation SRA205-SR-19
0469 Efficacy of In-Person vs Telehealth Positive Airway Set-Up in Veterans
Authors: Gomez Alexander , Sarmiento Kathleen , Ryden Armand , Mitchell Michael , Lee Diane , Smith Connor , Seo Jiyeon , Bhattacharyya Sarathi , Harris Brian , Mempin Roberto , Moghtaderi Isabel , Jawed Yameena , Martin Jennifer , Zeidler Michelle 
Published: May 2023

Abstract

Introduction
The SARS-CoV-2 pandemic necessitated a transition to sleep telehealth, including for positive airway pressure (PAP) set up. Prior to this change, the standard of care for initiation of PAP therapy included a face-to-face visit with education. This study sought to evaluate whether telehealth set-up was non-inferior to in-person set-up for veterans initiating PAP therapy.

Methods
VA patients were identified through prosthetic inventory package orders at two large VA systems. The telehealth PAP set-ups occurred between March, 2020 and December 2021. The in-person PAP set ups occurred between January and December, 2019. PAP data was extracted for days 1-30 (month 1) and 60-90 (month 3). PAP use was compared between in-person and tele-medicine utilizing hours used per night, days used (out of 30 days), and residual AHI (among compliant users). Non-inferiority analyses were performed, using the following non-inferiority margins: 45 minutes for hours used, 4 days for days of usage, and 5 events per hour for residual AHI.

Results
432 VA patients (93.5% male) who underwent PAP set up were included (224 in person; 208 telehealth). Average age and BMI (SD) were 55.9±15.8 years and 31.9±5.6. Race and ethnicity identification was 60.7% White; 15.7% Black; 6.9% Asian and 15.5% Hispanic/Latino. 76.2% of participants resided in urban locations. Non-inferiority was established for PAP usage at month 1 (90% CI=-0.31,0.53) and month 3 (90% CI=-0.18, 0.71), days used at month 1 (90% CI=-2.28, 1.33) and month 3 (90% CI=-1.75, 2.20), and residual AHI at month 1 (90% CI=-0.40, 1.62) and month 3 (90% CI=-0.69, 2.30).

Conclusion
Initiation of PAP therapy via telehealth was non-inferior to in-person set up visits in terms of PAP adherence among Veterans who use VA care. Findings suggest that veteran preference and structural factors should be considered in determining which approach is most appropriate for a given patient.

Support (if any)
VA Office of Connected Care QI; VA HSR&D RCS-20-191 and NIH/NHLBI K24HL143055 (Martin).
0476 Peripheral Arterial Tonometry-Based Home Sleep Apnea Test vs. Polysomnography in Detection of Central Disordered Breathing Events
Authors: Jenad Hussam , Junna Mithri , Selim Bernardo , Park John 
Published: May 2023

Abstract

Introduction
In-laboratory polysomnography (PSG) is the gold standard diagnostic test for sleep-disordered breathing (SDB). WatchPAT® is a type of home sleep apnea testing (HSAT) that utilizes peripheral arterial tone (PAT) signals and other sensors to evaluate for SDB. There is an abundance of data to support the use of a PAT-based HSAT for obstructive sleep apnea (OSA), though data to support its use in central sleep apnea (CSA) in the general population undergoing PSG is lacking. We therefore aimed to compare the agreement of a PAT-based HSAT and PSG in detecting central disordered breathing events in the general population undergoing PSG.

Methods
A prospective cross-sectional study was conducted in eligible adult participants with suspected sleep apnea who were scheduled to undergo diagnostic or split-night PSG at the Center for Sleep Medicine at Mayo Clinic in Rochester, MN, between May 2021 and October 2022. The PAT-based HSAT was applied during the night of PSG to obtain simultaneous recording. Subjects were excluded if they had chronic atrial fibrillation, permanent pacemaker, or finger deformity precluding finger probe use or if they were on alpha- antagonists or short-acting nitrates. The PAT-based HSAT data were automatically scored with the use of proprietary software, and the PSG data were manually scored by registered polysomnography technologists. All studies were reviewed by board-certified sleep medicine providers.

Results
A total of 147 subjects (53% female) were included in the final analysis after excluding 18 subjects due to malfunction of the PAT-based HSAT. The subjects had a mean age of 58±15 yrs and BMI of 34±9 kg/m². 95 (65%) subjects underwent split-night studies. OSA was diagnosed in 81% with a mean PSG AHI of 28±27 events per hour. CSA was diagnosed in 3% of subjects with a mean PSG AHI of 33±27 events per hour. Of the total 2120 central disordered breathing events reported by the PAT-based HSAT (mean pAHIc 3±5 events per hour), 365 (17%) correlated with central apneas and 78 (3.7%) correlated with central hypopneas found on PSG.

Conclusion
In our prospective study, the PAT-based HSAT demonstrated low positive predictive value in detecting central disordered breathing events when compared to PSG.

Support (if any)
0482 Sleep Apnea Diagnosis Disparities from Serious Mental Illness in a Veteran Cohort
Authors: May Anna , Carter Isabelle 
Published: May 2023

Abstract

Introduction
Sleep apnea (SA) diagnosis requires multiple steps including an office visit and testing. People with serious mental illness (SMI) may require a longer time from referral to diagnosis and be less likely to complete the full diagnostic pathway because of functional limitations.

Methods
A retrospective cohort of VA Northeast Ohio Healthcare System Veterans referred for sleep medicine consultation (1/1/2010-12/31/2020). Dates of consultation, sleep clinic visits, and testing was collected in addition to demographics, past medical history, and medications at the time of initial consultation. SMI was defined as a composite of schizophrenia, schizoaffective disorder, and bipolar diagnosed disorder before the initial consultation. The outcome was defined as the time until fulfilling minimal SA diagnostic pathway defined as completing both a sleep clinic appointment and at last one sleep test. Relationships between SMI and pathway completion were tested using survival analyses. Analyses were adjusted for age, sex, race, insurance status, service connection percent, Medicare eligibility, marital status, alcohol use, and drug use to account for other potential sources of health disparities. Sensitivity analyses evaluated differences in time to pathway completion via the Wilcoxon-Mann-Whitney test.

Results
The cohort (n=11,030) was primarily male (91.1%), with mean age of 55.8 ±14.4 yrs, with mean body mass index of 32.9 ± 6.4 kg/m2, and a mean pathway completion in 71 days, interquartile range (IQR): [33, 135]. Those with SMI had similar pathway completion rates (89.9% in SMI vs. 90.2% without), but a longer time to completion (83 days, IQR = [35.5, 185.5] in SMI vs. 70 days IQR: [32, 132]). Pathway completion time was significantly higher in those with SMI (Wilcoxon rank sum test difference = 9.0 days, 95%CI: [4.0, 14.0]. ]SMI was associated with a lower hazard of time to pathway completion (HR = 0.87, 95% confidence interval (CI): [0.91, 0.94] in unadjusted and HR = 0.87, 95%CI:[0.81, 0.94].

Conclusion
Although pathway completion rates were similar, Veterans with SMI were more likely to take longer before pathway completion. Additional investigation of factors that delay pathway completion may offer tailored avenues to improve the time to diagnosis.

Support (if any)
VA CSR&D IK2CX001882
0486 The Effect of Acoustic Resonance Therapy on CPAP Adherence
Authors: Munafo Dominic , Gopi Paramesh , Mohan Vivek , Hwang Peter , Lin Bryant , Hekier Elan , Lane Bretton , Guerrero Christy , Dauphin Betsy , Kushida Clete 
Published: May 2023

Abstract

Introduction
CPAP is the gold standard therapy for OSA. Unfortunately, a significant percentage of patients do not tolerate CPAP therapy. Of those who struggle, a significant portion state that nasal congestion is a limiting factor. Acoustic Resonance Therapy (ART) is a new non-medication based treatment for nasal congestion. We sought to determine if patients struggling with Medicare CPAP adherence and reporting nasal symptoms would benefit by the addition of ART.

Methods
This was an IRB approved, prospective, non-randomized, controlled pre-/post-treatment study. Twenty-five adult participants with an OSA diagnosis (AHI&gt;5) were enrolled by BetterNight (OSA management, San Diego, CA). Participants were new to CPAP within the previous 90 days and were not Medicare adherent. Participants self-reported nasal congestion as a significant contributor to non-adherence. After struggling with CPAP for varying durations, participants began the Sonu vibrational headband system (SoundHealth Systems, Los Altos, CA) for 15 minutes each evening, immediately prior to wearing CPAP, on 28 sequential nights. The Sonu headband is worn circumferentially just above the eyebrows. It utilizes a smartphone application and the self-facing camera to capture a facial scan and estimate sinonasal volume which determines the appropriate resonant frequencies and harmonics. Two vibrational transducers produce a signal in the audible acoustic range, from 80 Hz to 16 KHz. Total nasal symptom scores (TNSS) were obtained at baseline and self-reported daily during Sonu use.

Results
Participants were 64% male, age 48.2±12.9, AHI 31.6±22.7, BMI 32.5±6.6 (mean±SD). On days the 25 participants used CPAP, mean hours (h) of use increased during the intervention from 2.7h±1.9 to 4.0h±2.2 (48%,p=0.004). On a subset of 12 participants for whom 28 days of pre/post data was available, mean total hours of CPAP use increased from 64.8h±51.6 to 94.0h±59.4 (45%,p=0.0107). CPAP Medicare adherence increased from 30.0%±27.4 to 45.8%±35.0 (53%,p=0.0175). TNSS decreased from 4.8±2.2 to 2.1±1.9 (-56%,p=0.0016).

Conclusion
The use of the Sonu headband was associated with increased hours of CPAP use, improved CPAP adherence and reduced nasal symptoms.

Support (if any)
0488 The Relationship between Myocardial Blood Flow and Diastolic Function in a Clinical Population with Obstructive Sleep Apnea
Authors: Aneni Ehimen , Saeed Gul jana , Thorn Stephanie , Miller Edward , Sinusas Albert , Yaggi H 
Published: May 2023

Abstract

Introduction
Emerging evidence links abnormal myocardial blood flow reserve (MBFR), a marker of coronary microvascular dysfunction (CMD), and heart failure with preserved ejection fraction (HFpEF). However, the relationship between CMD and diastolic dysfunction (DD) in patients with OSA remains unclear. We analyzed the relationship between OSA, abnormal MBFR and markers of DD in a patient cohort.

Methods
Using healthcare records, we generated a cross-sectional database of 231 individuals who had sleep testing, echocardiogram(s), and cardiac PET stress test. Abnormal MBFR was defined as the stress-to-rest ratio of myocardial blood flow &lt; 2.0. We created DD score with a point each given to a) left atrial volume index (LAVI) ≥34, b)average E/e’ ratio&gt;14/lateral e’&gt;10/medial e’&gt;7, and in a subgroup of 122 individuals with available data we added c)tricuspid regurgitation jet (TR) velocity &gt; 2.7m/s. Higher scores suggest greater likelihood of DD. Models were adjusted for demographics and cardiometabolic risk factors.

Results
The mean (SD) age and BMI was 60(11) years and 39.5(8.7) kg/m2; 61% were female. Eighty-four participants had severe OSA (apnea-hypopnea index ≥ 30/hr). Compared to non-severe OSA, severe OSA was associated with 2-fold odds of abnormal MBFR (adjusted OR [aOR) 2.1, 95%CI:1.1–4.0). However, there was no association with abnormal LAVI, abnormal E/e’ (average E/e’&gt;14 vs. &lt; 9), or elevated TR velocity. In the adjusted model, abnormal MBFR was associated with abnormal E/e’ (aOR 4.4 [95% CI: 1.6-11.8]) and elevated TR velocity (aOR: 3.7 [95%CI: 1.3-10.9]). Abnormal MBFR was associated with increase in DD score (range 0–2; aOR per-unit increase = 1.7 [95% CI: 1.0-3.0]. In the subset with data on TR velocity, abnormal MBFR was associated with a three-fold increase in the odds of a unit increase in DD score (range 0–3; aOR 3.3 [95% CI: 1.5,7.4]). The association between abnormal MBFR and DD was present regardless of OSA severity. Severe OSA was not associated with DD.

Conclusion
Abnormal MBFR/CMD may be implicated in the development of DD and HFpEF in patients with OSA. MBFR assessment may be useful in HFpEF risk stratification in non-severe OSA. Larger studies are required to determine the role of CMD in the development of DD/HFpEF in OSA.

Support (if any)
0496 Factors Associated with the Report of Trouble Sleeping to Healthcare Providers in Adults at High Risk for Obstructive Sleep Apnea
Authors: Orbell Staci , Scott Paul , Baniak Lynn , Chasens Eileen , Godzik Cassandra , Jeon Bomin , Morris Jonna , Luyster Faith 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is often underdiagnosed and untreated partially because only one-third of adults with symptoms of OSA talk to a healthcare provider (HCP) about their sleep. It is unclear how sociodemographic and clinical factors may influence communication with HCPs regarding sleep difficulties in adults at risk for OSA. This analysis examined associations between sociodemographics, comorbidities, and OSA-related symptoms and reporting trouble sleeping to an HCP in adults at high risk for OSA.

Methods
The sample comprised adults at high risk for OSA (STOP-Bang of &gt;=5 or STOP &gt;=2 + body mass index (BMI) &gt;35 kg/m2 or male sex) from the 2015-2018 National Health and Nutrition Examination Survey (n=2009). Participants were asked, “Have you ever told a doctor or other health professional that you have trouble sleeping?” OSA-related symptoms included daytime sleepiness, fatigue, insomnia, nocturia, snoring, and snorting/gasping/breathing cessation during sleep. Weighted binomial logistic regression models were employed.

Results
Participants were middle aged (mean age = 53.21 years + 0.5), obese (mean BMI = 34.76 + 0.25 kg/m2), and primarily male (71.9%) and white (65.2%). Half of the sample (50.8%) never reported trouble sleeping to an HCP. Female sex, former smoking, and diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and/or snorting/gasping/breathing cessation during sleep were associated with higher odds of reporting trouble sleeping to an HCP. Snoring was not a significant predictor. Mexican American and non-Hispanic Asian race, having less than a high school education, and male sex were associated with lower odds of reporting trouble sleeping to an HCP.

Conclusion
Not reporting trouble sleeping to an HCP among adults at high risk for OSA is common. Differences in sex, race, education, smoking status, comorbidities, and OSA-related symptoms exist between whose who have and have not reported trouble sleeping to an HCP. Insomnia and snorting/gasping/breathing cessation during sleep were the strongest symptom-related factors associated with reporting trouble sleeping to an HCP. It is important for HCPs to ask all adults about sleep problems, recognizing that men, racial minorities, and persons with lower educational attainment may be less likely to initiate a conversation about trouble sleeping.

Support (if any)
None