bluuebunny/crossref_metadata_2025_split huggingface dataset:
0468 Effects of apnea-induced SWS disruption with and without supplemental oxygen on overnight spatial memory in CPAP-treated OSA
Authors: Mullins Anna , Valencia Daphne , Kam Korey , Parekh Ankit , Fakhoury Ahmad , Castillo Bresne , Ayappa Indu , Rapoport David , Varga Andrew 
Published: May 2023

Abstract

Introduction
Sleep disturbance from obstructive sleep apnea (OSA) impairs overnight memory processing. This may be mediated by changes to slow wave sleep (SWS) as less slow wave activity (SWA) is associated with worse overnight spatial and declarative memory. We developed a within-subjects model of SWS-specific CPAP-withdrawal to create 3 polysomnologically (PSG)-verified conditions of 1) stable-SWS on CPAP, 2) SWS-fragmentation with intermittent hypoxemia (OSAsws), and 3) SWS-fragmentation with reduced hypoxemia (OSAsws+O2). Using these conditions, we sought to dissociate of effects of SWS disruption and intermittent hypoxemia on overnight spatial navigational memory.

Methods
We included 33 patients (7 female, average age 54yrs) with moderate-to-severe OSA (AHI4%&gt;20/hr) who were CPAP-treatment adherent. During each PSG visit, they explored one of three 3D maze environments, performing 3 timed trials before and after each of 3 randomized and counterbalanced SWS disruption conditions [1)CPAP, 2)OSASWS & 3)OSASWS+O2]. %SWS, OSA severity during SWS, frontal SWA(0.5-4 Hz), and overnight change in maze completion times were compared according to PSG condition using Friedman Rank Sum and Conover’s tests. The relationship between SWA and maze performance was tested using Pearson correlation coefficient.

Results
%SWS was significantly greater during CPAP compared to CPAP-withdrawal conditions (CPAP=17.2%, OSAsws=13.3%, OSAsws+O2=13.8%, p&lt; 0.02). Apnea hypopnea index (AHI3A) in SWS during CPAP-withdrawal was significantly greater compared to CPAP (CPAP=0/hr, OSAsws=24.4/hr, OSAsws+O2=19.3/hr, p&lt; 0.00001). Hypoxic burden in SWS was significantly reduced in the OSAsws+O2 condition vs OSAsws (23 %min/hr vs 37 %min/hr, p &lt; 0.001). No significant differences were observed between the three conditions for SWA or overnight change in maze completion times. When including all PSG visits, greater SWA was significantly associated with better overnight maze improvements (R=0.28,p&lt; 0.01) which approached significance for the CPAP condition in isolation (R=0.33,p=0.068).

Conclusion
SWS-specific CPAP-withdrawal resulted in recurrence of mild OSA in SWS; supplemental oxygen reduced the hypoxic burden, but SWA did not differ between OSA with hypoxemia and without. There was, however, an overall positive relationship between SWA and maze performance. These observations suggest that the effect on spatial navigation of hypoxia in OSA is mediated by disruption of SWA.

Support (if any)
R01AG056682, AASM Focused Project Award.
0470 Factors Associated with Discordant Initial Home Sleep Apnea Testing and Polysomnography
Authors: Escobar Andres , Reyes Stephan , Majid Ruckshanda 
Published: May 2023

Abstract

Introduction
Nocturnal polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA). Home sleep apnea tests (HSAT) have been incorporated in the diagnostic algorithm in patients with a high pre-test suspicion of OSA. While many studies have compared HSATs with PSGs, it is not well understood what factors may be responsible for inconclusive HSAT results.

Methods
We performed a retrospective chart review of adult patients who underwent a non-diagnostic HSAT evaluation, who subsequently tested positive for OSA (on PSG) between 1/1/2022 and 11/1/2022. We collected demographic and sleep study data. Patients who did not have a follow up PSG were excluded.

Results
A total of 20 patients were reviewed. 80% had a negative HSAT with a positive subsequent PSG. The average age was 33.9 years (SD +/- 11.3 years). 43% were male and 50% were Caucasian. The average BMI was 29 kg/m2 (SD +/- 5.3 kg/m2). The average Epworth Sleepiness Scale score (ESS) was 8 (median 6.5) with only 31% reporting an ESS &gt;10. The average HSAT recording time was 449.1 minutes. The average respiratory disturbance index (RDI) on the follow up PSG was 17.7 events/hour of sleep (SD +/- 12). Only 1 patient was diagnosed with severe OSA. 38% were diagnosed with anxiety in this cohort. Other co-morbidities were insignificant. Of all the HSATs performed, 40% were denied for an initial PSG evaluation and converted to an HSAT evaluation.

Conclusion
HSATs are validated in patients with a high pretest probability of OSA. Anxiety was found in one third of patients included (possibly contributing to a negative initial HSAT). Patient demographics however were also not remarkable for a high risk of OSA in this group (e.g. non-obese, &lt; 55 years, female). The subsequent diagnosis for OSA was also only mild or moderate (93.8%) in this lower risk cohort. Hence, another explanation for the initial negative HSAT evaluation may have been the insurance denial of the initial PSG request (40%). Denials of low risk patients for PSG may contribute to a misuse of resources. We also need to educate referring physicians to follow appropriate HSAT ordering criteria (based on high OSA risk factors).

Support (if any)
0471 Having a Surgical Aortic Valve Replacement? You Very Likely Have Obstructive Sleep Apnea
Authors: Oldham Mark , Pigeon Wilfred , Yurcheshen Michael , Lee Hochang 
Published: May 2023

Abstract

Introduction
Patients with advanced aortic stenosis (AS) have a high risk of sleep-related breathing disorders (SRBD), yet prior research is limited to type III sleep apnea tests. Whereas the American Academy of Sleep Medicine recommends polysomnography for SRBD diagnosis in patients with significant cardiorespiratory disease, unattended studies are often more acceptable, especially to surgical candidates. We conducted this study to address the need for comprehensive sleep testing in patients with advanced AS.

Methods
We conducted unattended type II sleep tests in 23 adults aged 50 and older scheduled for surgical aortic valve replacement (SAVR) and not using positive airway pressure. We obtained demographics and medical history and administered Clinical Dementia Rating, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 9-item Patient Health Questionnaire. We characterize this pre-surgical sample and report SRBD prevalence.

Results
Average age of the sample was 68.3 ± 7.2 (mean ± SD), and 74% were male. Charlson comorbidity index was 2.0 ± 2.0. Three (13%) had a global CDR of 0.5, consistent with mild cognitive impairment. Mean PSQI scores were 7.0 ± 3.6, ESS 6.7 ± 4.0, and PHQ-9 4.6 ± 5.3. No subject had an AHI &lt; 5: 7 had a score of 5–14, 8 of 15–29, and 8 of 30 or greater. Mean obstructive AHI was 25.3 ± 20.7, central AHI 1.9 ± 3.4, and respiratory arousal index 8.7 ± 6.2. Total sleep time 362.7 ± 82.6 min with sleep efficiency of 82.1% ± 8.6%. Sleep stage data to be presented.

Conclusion
All subjects in this sample not using positive airway pressure had an AHI ≥ 5. Sixteen subjects (70%) had an AHI ≥ 15, indicating moderate to severe sleep apnea due to predominantly obstructive events. These results strongly suggest that patients with severe AS, especially those undergoing SAVR, would benefit from evaluation for SRBD.

Support (if any)
This research was supported in part by the National Institute on Aging, K23AG072383. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support provided by University of Rochester Medical Center funds through the Departments of Psychiatry and Cardiology/Cardiac Surgery.
0473 Multi-outcome of mandibular advancement device in Obstructive Sleep Apnea with different polysomnographic phenotype
Authors: Lee Chien-Feng , Chen Yunn-Jy , Chen Yu-Ching , Lee Pei-Lin , Yu Chong-Jen 
Published: May 2023

Abstract

Introduction
The association of mandibular advancement device (MAD) treatment response and polysomnographic phenotype in patients with obstructive sleep apnea (OSA) has not been fully elucidated. We hypothesized MAD response would be associated with two polysomnographic phenotypes, including sleep stage and positional dependency in treatment-naïve patients with moderate-severe obstructive OSA.

Methods
This retrospective study recruited OSA patients with AHI ≥15/h, aged 20 to 80, treatment naïve, and received MAD treatment for more than three months. Positional phenotype included supine predominant (supine-p) and non-positional OSA. Sleep stage phenotype included REM-predominant (REM-p), NREM-predominant (NREM-p), and stage-independent (SI) OSA. MAD response was defined as criterion 1: residual AHI&lt; 5/h with &gt;50% reduction, and criterion 2: residual AHI&lt; 10/h with &gt;50% reduction. Outcomes included the change in PSG parameters, habitual latency of sleep onset and sleep hour, Epworth sleepiness scale, excessive daytime sleepiness, depression, physical, vitality and mental health domain of SF-36, and in-lab bedtime and wake blood pressure (BP).

Results
379 patients with median age of 52.2 years, BMI of 26 kg/m2, 78.1% of men, and AHI of 28.2/h were recruited. Supine-p and REM-p OSA had lower baseline AHI and desaturation. The overall response rate were 34.7% (criterion 1 ) and 56% (Criterion 2). Supine-p OSA had higher response rate than non-positional OSA (criterion 1: 42.2% vs. 20.3%; criterion 2: 64.3% vs. 32.5%), while NREM-p OSA had lower response rate than REM-p and SI (REM-p vs. NREM-p vs. SI: criterion 1: 43.9% vs. 9.7% vs. 34.2%; criterion 2: 54.5% vs. 41.9% vs. 53.3%). Despite the more reduction in AHI, desaturaiotn, and arousal in responders, there was no differences in change of ESS, EDS, sleep pattern, depression, SF 36 domain, and BP between responders and non-responders which remained unchanged after stratified with sleep stage and position phenotypes.

Conclusion
Non-positional and NREM-predominant OSA had lower responses rate to MAD treatment. There were no differences in non-breathing outcomes between responders and nonresponders regardless of sleep stage and positional phenotype.

Support (if any)
The work was supported by grants from the National Science and Technology Council, Taiwan (NSTC 111-2314-B-002-293); Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252); National Taiwan University Hospital (NTUH 107-19, 111-X0033, 111-S0298)
0474 Observing the Changes of Tongue and Airway Configurations in Responders of Mandibular Advancement Device Using Ultrasound Imaging
Authors: Chen Yunn-Jy , Chang Ke-Vin , Chao Pei-Yu , Chen Argon 
Published: May 2023

Abstract

Introduction
Mandibular advancement device (MAD) is designed to pull the mandible and the tongue forward anteriorly to increase the cross-sectional airway dimension and thus possibly reduce airway obstructions during sleep. The effectiveness of a MAD may be affected by the pre-treatment OSA severity, BMI, and degree of changes in pharyngeal dimensions resulting from the device in situ. In this study, 3D submental ultrasound imaging is applied to evaluate the difference in the tongue and airway configurations between the responders and non-responders of the MAD treatment.

Methods
In this retrospective study, 31 subjects (25 males, median age/BMI/baseline AHI of 56/24.5/25.3) diagnosed with sleep apnea and underwent tongue-backing-MAD (t-MAD) treatment were consented from the Department of dentistry of National Taiwan University Hospital between April and December 2022 (IRB 202108078RIPD). Changes in the severity of OSA were assessed with polysomnographic studies. Success of t-MAD treatment was defined by an AHI of less than 10 events/hour and at least 50% decrease in AHI from baseline. There were no significant differences in age, BMI, gender and baseline AHI between responders (17) and non-responders (14). While awake and lying in supine position, the tongue and airway configurations at retropalatal and retroglossal regions without and with t-MAD in situ were assessed with standardized 3D submental ultrasound imaging (AmCAD BioMed Corp., Taiwan). Statistical comparisons were performed using t-tests, chi-square tests and nonparametric Mann-Whitney tests.

Results
The anteroposterior location of the tongue-airway interface at retroglossal region, relative to the superior-inferior location of the soft-palate-airway interface, was found significantly reduced in responders when t-MAD is in situ (p = 0.0078). 13 responders (76.5%) and 9 non-responders (64.3%) were observed with airway width increase in the retroglossal region with t-MAD in situ. However, the difference in airway width changes between responders and non-responders was not statistically significant possibly due to the limited sample size.

Conclusion
With the real-time visualization and quantitative characterization of the tongue and airway configurations, the 3D submental ultrasound with standardized imaging protocol is able to differentiate the responders from non-responders of the t-MAD treatment and could be a potential tool for treatment response evaluation.

Support (if any)
0475 Optimal Thresholds for Split-Night Polysomnography with Transitions in Laboratory Hypopnea Scoring Criteria
Authors: Plante David , Hamm Brian , Rumble Meredith 
Published: May 2023

Abstract

Introduction
Performance of split-night polysomnography, the application and titration of positive airway pressure (PAP) therapy after an initial diagnostic interval, is a common practice in clinical sleep medicine. There is no currently recommended apnea-hypopnea index (AHI) threshold at which PAP should be applied during polysomnography. Differences in American Academy of Sleep Medicine (AASM) and Centers for Medicare and Medicaid Services (CMS) hypopnea scoring criteria and limitations on real-time hypopnea classification complicates identification of an optimal split-night threshold. Of particular concern is that patients may be “split” under AASM hypopnea rules but have insufficiently severe sleep disordered breathing under CMS rules to be diagnosed or treated appropriately. This study aimed to clarify optimal AHI thresholds for split night polysomnography in the context of a laboratory-wide transition from CMS to AASM hypopnea scoring criteria.

Methods
Effective October 1, 2021, our laboratory transitioned solely to scoring AASM-defined hypopneas, with additional post hoc identification of CMS hypopneas for reporting purposes. With this change, the split-night threshold was changed from 15 to 30/hr. All diagnostic polysomnograms (without PAP therapy) performed on adult patients through October 31, 2022, were retrospectively analyzed to clarify the effect of changing hypopnea scoring criteria in this context.

Results
634 diagnostic polysomnograms were analyzed. An AHI threshold of 15/hr (using AASM hypopnea criteria) in the first two hours of sleep with at least 3 hours of time remaining for PAP titration would have resulted in 96 additional patients receiving treatment with PAP therapy. Among these, only one (1.04%) had CMS AHI below 5/hr. Sixty-eight of these patients had CMS AHI 5-15/hr during the first two hours of sleep. Among these, only eight patients did not have an additional comorbidity or symptom profile under CMS guidelines making them eligible for PAP therapy, however, none had CMS AHI &gt;15/hr when the full night of sleep was analyzed.

Conclusion
Our study suggests there is little need to raise the split-night threshold when transitioning from CMS to AASM hypopnea criteria, and doing so substantially reduces the number of patients treated with PAP therapy in the sleep laboratory.

Support (if any)
None
0479 Prevalence, Clinical Features, and Impact of Low Respiratory Arousal Threshold on Patients with Hypoglossal Nerve Stimulation
Authors: Shah Sachin , Manchanda Shalini , Stahl Stephanie , Hasnain Fahad , Patel Jaimin , Dabboussi Tarek , Parker Noah 
Published: May 2023

Abstract

Introduction
This study aims to explore the prevalence and clinical features associated with low respiratory arousal threshold (ArTH) amongst patients with hypoglossal nerve stimulation (HNS) for the treatment of obstructive sleep apnea (OSA) and the possible effects it has on HNS adherence and device usage between time of activation and 1-year post-activation.

Methods
Following institutional review board approval, consecutive patients who underwent HNS system implantation were retrospectively studied, including clinical characteristics, diagnostic polysomnography (PSG) or homes sleep apnea test (HSAT) and HNS post-implant data. Inclusion criteria were patients with ≥1 year of HNS usage who had also completed a post-implant HNS PSG titration study.

Results
Forty-five patients met inclusion criteria. Low ArTH was present in 44.4% of patients and compared to those with high ArTH, low ArTH had a higher prevalence of restless leg syndrome (RLS) (45% vs 12%, p&lt; 0.05) and depression (60% vs 28%, p&lt; 0.05). Low ArTH exhibited a trend toward shorter diagnostic total sleep time (TST) (295.0 vs 373.3 minutes, 0.05 &lt; p &lt; 0.1). Bivalent logistic regression indicated the odds of having low ArTH is 8.6 times greater in patients with RLS (OR 8.6, CI 1.1 – 68.6, p&lt; 0.05). Across all time points, low ArTH resulted in lower mean percentage of HNS nights used (92% vs 86%, p&lt; 0.001) and a lower HNS amplitude (2.41 V vs 1.96 V, p&lt; 0.001) and demonstrated a trend towards lower percentage of nights used ≥4 hours (72.9% vs 66.1%, 0.05 &lt; p &lt; 0.1). 1-year post activation, low ArTH patients continued to show lower percentage of HNS nights used (89.8% vs 75.6%, p&lt; 0.01) and a lower HNS amplitude (2.3 V vs 1.9 V, p&lt; 0.01).

Conclusion
Low ArTH was highly prevalent amongst patients with OSA treated with HNS and was more frequently associated in patients with RLS. Patients with a low ArTH demonstrated significantly lower percentage of nights used and lower amplitudes, indicating the importance this particular phenotype may play in patient compliance with HNS. These findings could help better select candidates who will tolerate HNS therapy and develop targeted therapies to improve long-term adherence.

Support (if any)
0480 Psychoactive Substance Use and Sleep Characteristics Among Individuals with Untreated Obstructive Sleep Apnea
Authors: Walker Alexander , Baldassarri Stephen , Chu Jen-hwa , Deng Annan , Xu Zhichao , Blohowiak Reagan , Byrne Sean , Kushida Clete , Yaggi H , Zinchuk Andrey 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by recurrent airway obstruction causing intermittent hypoxia, arousal from sleep, and autonomic instability, and is associated with a variety of long-term health sequala. The fragmented sleep resulting from these respiratory events leads to disruption in normal sleep architecture and progression to deeper stages of sleep, a potential mediator for some of the functional and neurocognitive impairments seen in this population. Similarly, psychoactive substance use (i.e., nicotine, alcohol, and caffeine) impacts sleep architecture in healthy individuals, but their effects in those with OSA have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA.

Methods
We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol, and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and co-morbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety).

Results
Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Current smokers exhibited lower sleep duration (0.3 hours) and longer sleep latency (5 minutes) compared with non-smokers (all p-values&lt; 0.05). REM sleep increased in those with moderate and heavy alcohol use (2.5 and 5% of total sleep time respectively), and moderate caffeine use (2%, all p-values &lt; 0.05)). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 hours) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9). .

Conclusion
Both psychoactive substances and untreated OSA impact normal sleep architecture, their cumulative effect may have clinical implications in this subgroup. Stimulating or sedating substances may be used in OSA patients to mitigate daytime and nighttime symptoms respectively. Further investigation into the effects substances have on this population may present opportunities to better understand disease mechanisms and increase the effectiveness of treatment in OSA

Support (if any)
0483 Stakeholder Engagement Studios to Explore the Journey to Diagnosis of OSA Informed by Primary Care Providers and Patients
Authors: Watach Alexa , Sawyer Amy , Rosen Ilene , Simonsen Samantha , Pack Allan , Magalang Ulysses 
Published: May 2023

Abstract

Introduction
Barriers to obstructive sleep apnea (OSA) diagnosis include operational misalignments and miscommunications among patients, providers, industry, insurers, and the healthcare system. To explore this, we engaged stakeholders to examine determinants of OSA diagnosis in primary care to optimize trial planning.

Methods
We conducted two, separate, virtual, 1-hour stakeholder engagement studio sessions with Penn Medicine Primary Care Providers (n=6) and patients referred for OSA diagnostics within prior year (n=3). Facilitation guides were used to elicit barriers/facilitators to reaching diagnosis. Sessions were facilitated by a sleep physician and advanced practice sleep nurse with two note-takers in attendance. Rapid matrix analysis approach identified consistent themes within diagnosis barrier and facilitator categories. Themes were categorized by Safety Engineering Initiative for Patient Safety (SEIPS) work system domains: people (P), environment (E), tools (T), and tasks (T), PETT.

Results
Fourteen facilitators (2P, 3E, 3T, 6T) and 15 barriers (2P, 4E, 3T, 6T) were identified for “getting to OSA diagnosis.” Provider-level barriers include: hesitancy to provide anticipatory guidance to patients due to ambiguous workflows after referral, excessive referral order options, no access to templated patient instructions or quality education resources, confusing order panels and use of electronic health record (EHR) workarounds, and fragmented communication. Patient-level barriers include: timeliness of communication and care, sleep health unawareness, low technology literacy for EHR messaging, financial considerations, and insufficient follow-up from healthcare team. Provider facilitators include: classic OSA presentation, diagnosis decision aids, patient education resources, easy to find results in EHR, and low threshold to order referral due to knowledge about sleep. Patient facilitators include: trusted primary care relationship, choice of visit type (telehealth vs. in-person) and communication mode (phone call vs. text vs. EHR portal), active outreach/engagement by healthcare team, and access to educational materials.

Conclusion
Repeated studios, including stakeholders from varied sites, will further refine determinants with more saturation and validity. Engaging with stakeholders is supporting the design of a contextually relevant, end-user valued study to address undiagnosed OSA. Given the estimated high prevalence of undiagnosed OSA and the multiple stakeholders that contribute to the diagnostic process and experience, research-driven solutions will be impactful and better optimized with multi-level partnered research.

Support (if any)
K12HS026372