bluuebunny/crossref_metadata_2025_split huggingface dataset:
0499 Identifications of symptoms clusters by the Quebec Sleep Questionnaire in sleep apnea patients
Authors: Series Frederic , Lajoie Annie , Lacasse Yves 
Published: May 2023

Abstract

Introduction
Sleep apnea (SA) patients may present different symptom clusters. The clinical importance of such clustering is supported by the differences in the incidence of cardiovascular diseases between hypersomnolent and non hypersomnolent patients. The Quebec Sleep Questionnaire (QSQ) has been elaborated 20 years ago that documents quality of life in SA patients by measuring the impact of the disease on five different domains (nocturnal and diurnal symptoms, hypersomnolence, emotions and social interactions). Previous cluster analyses took into account the frequency of typical SA symptoms. Many, but not all symptoms selected in these studies are addressed in the QSQ. The objective of this study is to determine if quality of life clusters can be identified using responses collected from the QSQ in SA patients.

Methods
A cluster analysis was completed in symptom scores collected from the QSQ+ Epworth scores in147 patients who filled in the questionnaire during its validation (75.5 % males, age: 53 ± 11 y, BMI: 30.4 ± 4.7 Kg.m2, AHI 31.3 ± 14.8 /h). For each item, patients were considered as symptomatic for scores ≤ 4 (the lowest the score the higher the impact) and for ESS &gt; 10.

Results
Three clusters were identified: patients in cluster 1 (20.4 % of patients) can be identified as minimally symptomatic in each domain. In the cluster 2 (32.6 %), quality of life was mainly impacted by hypersomnolence with disturbed sleep. Patients in cluster 3 (46.9 %) reported important impacts on their quality of life in each domain of the QSQ. Gender, BMI and AHI did not differ between the three clusters. However, patients in cluster 1 were significantly younger than those of cluster 2 (50.5 ± 9.9 and 57.6 ± 11.9 years, respectively, p = 0.01).

Conclusion
Different clusters of quality of life can be identified by the QSQ in SA patients. These clusters seem to have close similarities with previously reported symptom frequency driven clusters. The relationship between quality of life symptom clusters and long-term clinical outcomes should be explored in a large prospective cohort of sleep apnea patients.

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0502 Number of Nights to Achieve High Sensitivity/Specificity for Detecting OSA Using a Large US Sample by Home Under-Mattress Devices
Authors: Kushida Clete , Cotton-Clay Andrew , Fava Laura , Easwar Venkat , Kinsolving Arthur , Kahn Philippe 
Published: May 2023

Abstract

Introduction
Clinical sleep studies typically rely on one night for OSA detection and diagnosis. However, uncertainty exists regarding the degree of AHI stability across different nights. Population studies collecting continuous nightly data on a large scale enable detection of night-to-night variability in OSA severity; this study is the largest to date for evaluation of the number of nights to achieve high sensitivity/specificity for OSA detection.

Methods
Sleep-disordered breathing was analyzed by a commercially available home monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies Inc., California, USA) that passively monitors sleep using piezo-electric sensors. Validated sleep/respiratory parameters were derived from device data. De-identified data were analyzed, following review and exemption of the study (#57681) from Stanford University IRB. Data from 10/01/2021 to 09/30/2022 were reviewed in 96,228 individuals with 19,148,323 recorded nights. Individuals with at least 300 nights with a computed AHI (TST≥4hrs) were included in the analytic dataset.

Results
A total of 23,105 individuals (10,711 men, 49.6±12.93 years; 9,430 women, 49.4±12.85 years; 2,964 no gender provided, 50.4±14.37 years) with 7,947,840 recorded nights met the inclusion criteria. Maximum (but not mean) AHIs for each individual for 3 randomly-selected (vs. consecutive) nights revealed sensitivities (≥95%)/specificities [and CIs] of 94.9%[94.8,95.1]/82.5%[82.2,82.7], 95.2%[95.0,95.5]/94.3%[94.1,94.5], and 96.2%[95.8,96.6]/97.9%[97.8,98.0] for detecting any, moderate-to-severe, and severe OSA, respectively, as categorized by mean AHI over 1 year. Sensitivities for a single night were in the low 70s, and, for maximum AHI over two randomly-selected nights, near 90%, with a tradeoff for decreased specificities for 3+ nights. For moderate-to-severe and severe OSA subjects over 1 year, means of 5.1±7.7% and 5.4±7.3% nights, respectively, showed OSA severity decreases by 2+ categories (i.e., moderate to normal, severe to mild/normal).

Conclusion
Use of a noninvasive in-home monitoring device enabling collection and analysis of a large sample of sleep/respiratory data on a continuous nightly basis showed that a single night yields low sensitivity for detection of OSA and on average OSA severity decreased by 2 categories on 5% or more nights. Maximum (but not mean) AHI across 3 non-consecutive nights yields good sensitivities/specificities for moderate-to-severe and severe OSA detection. Ongoing work explores statistics for nights beyond 3 to further improve sensitivity/specificity.

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0510 Altered functional connectivity of the ascending reticular activating system in obstructive sleep apnea
Authors: Shin Won Chul , Byun Jung-Ick , Jahng Geon-Ho , Jung Ki-Young 
Published: May 2023

Abstract

Introduction
Recurrent arousals in obstructive sleep apnea (OSA) may lead to alteration in functional connection involving in the ascending reticular activating system (ARAS). We aimed to evaluate resting-state functional connectivity (FC) between eight ARAS nuclei and 105 cortical/subcortical regions in OSA patients and matched controls.

Methods
Total of 50 patients with moderate to severe OSA and 20 controls without OSA underwent overnight polysomnography (PSG) and resting-state functional magnetic resonance imaging in the following morning. Seed to voxel analysis of ARAS-cortical FC was compared between the patients and controls. The ARAS nuclei included dorsal and median raphe nucleus, locus coeruleus (LC), laterodorsal tegmental nucleus (LDTg), pedunculopontine tegmental nucleus, pontine nucleus oralis, parabrachial complex, and ventral tegmental area (VTA). Correlations between average FC values of significant clusters and PSG parameters were calculated in the patients.

Results
FC values in the three of the ARAS nuclei (LC, LDTg, and VTA) were significantly different between the group. The FC value between the LC and the precuneus cortex, posterior cingulate gyrus, and right lateral occipital cortex (LOC) was increased in OSA patients compared to the controls. The FC value between the LDTg and right LOC was enhanced, but the FC one between the VTA and right LOC was reduced in the patients. The average LC-cortical FC values positively correlated with the arousal index(r=0.282, p=0.047), apnea index(r=0.325, p=0.021), or apnea-hypopnea index (r=0.302, p=0.033) in OSA patients.

Conclusion
The results of this study support alteration in ARAS-cortical FC in OSA patients. Degree of the noradrenergic LC-cortical FC may be related to arousal or OSA severity in the patients.

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0514 Association of muscle distribution and insomnia severity in COMISA
Authors: Kim Jae Rim , Kim Dong Yeop , Song Pamela , Joo Eun Yeon 
Published: May 2023

Abstract

Introduction
Insomnia and obstructive sleep apnea(OSA) may co-exit, and it is now named comorbid insomnia and OSA(COMISA). Such combined condition is associated with increased morbidity, and impairment, which requires treatment for both insomnia and OSA. Bioelectrical impedance analysis(BIA) is a widely used convenient method of body composition. In OSA patients, muscle and fat distribution are different among different sex, and severity of OSA. We hypothesized that the muscle distributions in COMISA were different from OSA, which can help early identification COMISA to optimize treatment.

Methods
All the patients aged 18 or older with symptoms of sleep disturbances who visited single tertiary sleep clinic in Korea were enrolled from December 2017 to September 2022. All patients underwent structured sleep evaluation, insomnia severity index (ISI), overnight polysomnography and BIA. All patients with apnea-hypopnea index (AHI) 15 or greater were enrolled. The COMISA were classified by insomnia symptoms based on the ISI score greater than 15.

Results
Total of 3328 subjects were finally enrolled(79.7% males and 20.3% females), and among them 29.5%(n=981) was COMISA. Compare to OSA without insomnia symptoms COMISA were older(COMISA,56.6 ± 12.9, OSA,54.3 ± 13.3; p&lt; 0.001), and were more likely to be female(COMISA,27.5%, OSA,17.3%; p&lt; 0.001). Although AHI had no significance, apnea was lower, and hypopnea was higher in COMISA than OSA. The muscle distribution in COMISA was different compared to OSA in non-obese groups(BMI&lt; 25). In both male and female, total muscle mass(MM), skeletal muscle mass(SMM), Rt and Lt arm(RAMM, LAMM), Rt and Lt leg(RLMM, LLMM), and trunk(TMM) muscle mass, and fat free mass(FFM) were significantly different between non-obese COMISA and OSA. The correlation analysis in non-obese COMISA group revealed that ISI is negative correlated with muscle masses in both sex (M:F); MM(M,F:rho:-0.09*,-0.16*), SMM(rho:-0.01*,-0.17*), RAMM(rho:-0.07*,-0.15*) LAMM(rho:-0.07*,-0.16*), RLMM(rho:-0.09*,-0,15*), LLMM(rho:-0.09*,-0.16*), TMM(rho:-0.08*,-0.17*), FFM (rho: -0.1*,-0.16*)[*p&lt; 0.05].

Conclusion
This study revealed that the muscle distribution is different in non-obese, male and female, moderate to severe COMISA population. And insomnia symptom severity has negative relation with trunk and limb muscle masses. Our study suggests possible insomnia symptoms among OSA patients have different pathomechanisms in relation to body muscle distribution.

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0515 Awake endoscopy optimizes tolerance and effectiveness of hypoglossal nerve stimulation
Authors: Oster Joel , Grover Aarti 
Published: May 2023

Abstract

Introduction
Hypoglossal nerve stimulation(HGNS) which has been available and FDA approved since 2014 in the US may allow for effective treatment of obstructive sleep apnea(OSA) in patients without concentric collapse on Drug induced Sleep Endoscopy and other clinical parameters who have failed CPAP. Tolerance of the stimulation parameters may be problematic in a subset of patients not allowing them to adhere to the therapy. Although there are not currently clinically authoritative studies regarding the role of awake endoscopy in management of such patients, visualizing what comfortable settings that allow for effective tongue protrusion while awake potentially allowing for effective treatment of upper airway obstruction in the office setting might serve as a surrogate for ensuring optimization of such treatment during patients' sleep and this is a retrospective review of such patients at Tufts Medical Center in Boston MA.

Methods
A retrospective chart review of patients who were implanted with a HGNS device (Inspire TM) who did not tolerate therapy and proceeded to awake endoscopy to optimize therapy settings that allowed tolerance or comfort of stimulation were analyzed. Patients who had HGNS and awake endoscopy as part of clinical assessment at any time during the course of their clinical evaluations were included in the review.

Results
Out of 129 patients implanted at Tufts Medical Center in Boston, MA, 13 such patients (Approximately 10 % of the total number of HGNS implanted patients) proceeded to awake endoscopy to optimize therapy as noted above. A subset of these patients had improved adherence to therapy and treatment of OSA with HGNS therapy subsequently to such management.

Conclusion
A subset of patients may remain adherent to HGNS therapy after strategically performing awake endoscopy for ensuring comfort and adequacy of tongue protrusion during awake endoscopy in the outpatient setting. This retrospective review indicates that awake endoscopy may optimize tolerance and adherence of HGNS therapy for treatment of OSA in selected patients.

Support (if any)
None
0517 Changes in AutoCPAP Settings as a Function of Weight Loss Over Time in Bariatric Surgery Patients with Obstructive Sleep Apnea
Authors: Potarazu Deepika , Panahi Armon , Hung Chen-min , Koizumi Naoru , Lee Juliet , Vaziri Khashayar , Jackson Hope , Ahari Jalil 
Published: May 2023

Abstract

Introduction
Positive pressure remains the main treatment for obstructive sleep apnea (OSA). Compared to traditional continuous positive airway pressure (CPAP) machines with fixed pressure settings, AutoCPAP machines can titrate settings based on user requirements and transmit data to the pulmonologist. While bariatric surgery has been associated with improvement in OSA, there is little data examining associations between postoperative weight loss and positive pressure requirements longitudinally. The purpose of this study was to evaluate changes in AutoCPAP pressure settings as a function of weight loss over time.

Methods
A retrospective review of bariatric surgery patients at a single institution from 2018-2022 was performed. Participants included patients with OSA who used an AutoCPAP machine and had at least one appointment within the first 18 months postoperatively. Preoperative BMI, postoperative BMI and percent excess weight loss were analyzed. AutoCPAP parameters used as markers of OSA severity included 95th or 90th percentile pressure depending on the machine and apnea-hypopnea index (AHI). Paired t-tests were performed to evaluate changes in BMI and 90th/95th percentile pressures. Linear regressions with fixed effects were performed to investigate changes in pressures and BMI over time.

Results
345 patients with OSA who underwent bariatric surgery and were prescribed AutoCPAP were evaluated. Of those, twenty-eight (8%) were compliant with their AutoCPAP and were included in this study. Overall, 90th/95th percentile pressures improved postoperatively by 1.32 cmH2O± 0.33 (P= 0.003). Patients with a preoperative BMI ≥40 demonstrated improved 90th/95th percentile pressures over time by 1.22 cmH2O± 0.34 (P=0.002) while those with a preoperative BMI &lt; 40 did not (-1.7 cmH2O ± 0.86; P= 0.106). Reduction in BMI was associated with reduction in 90th/95th percentile pressures at 2-6 weeks and 2-6 months postoperatively.

Conclusion
Patients with a higher preoperative BMI demonstrated improved positive pressure requirements postoperatively compared to patients with a lower preoperative BMI. This suggests that there may be a critical BMI after which further weight loss is not associated with significant improvements in OSA. Further, positive pressure requirements may decrease most significantly within the first several months postoperatively.

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0519 Comparing the delta power during titration of INSPIRE therapy and PAP therapy
Authors: Kranthi Bhavana , Naha Sowjanya , Sahota Pradeep , Thakkar Mahesh 
Published: May 2023

Abstract

Introduction
Delta power is a known indicator of sleep drive and sleep pressure. Non-REM sleep delta power is increased in patients with sleep-disordered breathing. Treatment of sleep-related breathing disorder reduces delta power. The purpose of this study is to investigate and compare delta power between individuals on INSPIRE therapy and individuals on PAP therapy.

Methods
A retrospective review was performed by selecting nine patients who underwent INSPIRE titration study at the MU HealthCare Sleep Disorders Center, between 8/1/2021 and 8/1/2022. Nine patients with similar age and gender who underwent PAP titration study were selected from the database (PolySmith®). Spectral analysis was performed using F4-M1 leads, and delta power was calculated for Stage N3 portion during the last sleep cycle.

Results
There were 3 patients on INSPIRE who did not have any N3 sleep and those were excluded. Thus, average delta power in 6 patients during INSPIRE titration was 541.88. In contrast, the average delta power for 9 patients during PAP titration was 554.93.

Conclusion
Results showed that there was minimal difference in patients’ delta sleep during titration of INSPIRE therapy as compared to patients during titration of PAP therapy. However, there were limitations including the amount and timing of N3 sleep, success of titration study, patient’s medications - which may have altered the sleep architecture, and comorbidities such as PLMS (which untreated can affect sleep).

Support (if any)
The authors have no sources of support to declare.
0520 Comparison of Upper Airway Stimulation Outcomes in STAR and ADHERE sub-populations: Narrow AHI Range vs Broad AHI Range
Authors: Bosschieter Pien , DeVries Nico , Vanderveken Olivier 
Published: May 2023

Abstract

Introduction
Upper Airway Stimulation is an approved technology for the treatment of moderate to severe obstructive sleep apnea. Differences exist among specific indications for use and/or coverage limits, with certain geographies supporting a broader AHI range (15-65 events/hr) compared to others that are limited to a narrower range (AHI 20-50 events/hr). This study provides a comparison of the outcomes related to these two groups.

Methods
This is a retrospective analysis of two data sets: (1) STAR pivotal data set, including only patients with a baseline AHI (average of pre-implant and post-implant/pre-activation AHIs) between 20 - 50 event/hr; compared to (2) ADHERE Registry data set, including only patients with a baseline AHI (pre-implant) between 15 -65 events/hr. Baseline demographics, as well as AHI and Epworth Sleepiness Scale (ESS) at 12 months post-implant, were compared between the two groups.

Results
A total of 94 STAR subjects (AHI 20-50) were compared to 1604 ADHERE subjects (AHI 15-65; with AHI 15-20 in 192 subjects and AHI 50-65 in 208 subjects). The STAR group had a significantly lower age (54.6±10.2 vs 60.2±10.9, p&lt; 0.001), lower baseline AHI (31.8±7.6 vs 34.7±12.6, p&lt; 0.001) and more males (85.1% vs 75.5%, p=0.03) compared to the ADHERE group. At 12-months post-implant, there were no significant differences in AHI (15.2±15.5 vs 15.7±14.7, p=0.33), change in AHI from baseline (16.5±14.7 vs 18.5±20.3, p=0.23), Sher Responder Rate (67.7% vs 63.4%, p=0.47) or ESS (7.0±4.2 vs 6.9±4.6, p=0.53) between the STAR and ADHERE groups.

Conclusion
While subjects implanted under the narrower AHI range (20-50 events/hr) were younger and had a significantly lower AHI at baseline, results in these patients were comparable to patients implanted under the broader range of AHI 15-65.

Support (if any)
The STAR study and ADHERE Registry were sponsored by Inspire Medical Systems, Inc.
0527 Effectiveness of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea at a Major Tertiary Academic Sleep Center
Authors: Patel Rutwik , Wang Hannah , Landsness Eric 
Published: May 2023

Abstract

Introduction
The use of hypoglossal nerve stimulation (HGNS) for treatment of obstructive sleep apnea (OSA) has been reported to be efficacious in up to 75% of patients with a 68% improvement in the 3% apnea hypopnea index (AHI). Based on these results, HGNS is an increasingly widespread alternative treatment for OSA patients who are intolerant of Positive Airway Pressure (PAP) treatment. It is unknown if HGNS is equally efficacious outside of the highly controlled setting of a clinical trial. Here, we performed a retrospective cohort study from patients who underwent implantation of a hypoglossal nerve stimulator at our academic institution and report the efficacy based on improvement in AHI.

Methods
Adult subjects with a diagnosis of OSA, who were intolerant of PAP therapy and underwent implantation of HGNS at Barnes Jewish Hospital in St. Louis, Missouri from 6/4/2019 to 6/28/2022 were included in this retrospective cohort study. Only those who were referred for implantation from Washington University Sleep Medicine Center were included. The efficacy of HGNS was evaluated by comparing the 3% AHI on subjects’ polysomnography before and after the HGNS was implanted and activated. Analysis of the data was done using paired t-tests to determine efficacy of HGNS via a reduction of at least 50% of the 3% AHI and a reduction in 3% AHI to less than 20 events per hour.

Results
45 subjects were implanted of which 1 subject did not tolerate HGNS, and 8 subjects were lost to follow-up. Of the remaining 36 subjects, the median 3% AHI decreased 79% from 29.5 to 6.5 events per hour (p&lt; 0.0001). There was a reduction of at least 50% of the 3% AHI in 83% of subjects and a reduction of 3% AHI to less than 20 events per hour in 86% of subjects.

Conclusion
HGNS achieved significant therapeutic results in the majority of patients with OSA who are intolerant of PAP therapy. These results add to the growing body of evidence reproducing the original clinical trial in a “real-world” setting free of any conflict of interest. Future studies examining predictive factors influencing the effectiveness of HGNS are needed.

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0528 Effects of continuous positive airway pressure on white matter microstructure in patients with obstructive sleep apnea
Authors: Park Hea Ree , Joo Eun Yeon 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests.

Methods
Twenty-two male patients with moderate to severe OSA were recruited and underwent DTI scanning before and 6-44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up MRI in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method.

Results
The TSSA analysis showed that FA values in the middle part of the right CST were increased after treatment in the CPAP group. No significant change in FA value was observed between baseline and post-scan in the untreated group. In the CPAP group, the post-treatment FA value in the anterior part of the right ATR was significantly correlated with durations of CPAP therapy after controlling for age, body mass index, and baseline FA value.

Conclusion
Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA.

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