bluuebunny/crossref_metadata_2025_split huggingface dataset:
0450 Backscattered Ultrasound Imaging of the Tongue Correlates with Severity of Obstructive Sleep Apnea in Adults
Authors: Bosschieter Pien Bosschieter , Kushida Clete , Liu Stanley 
Published: May 2023

Abstract

Introduction
Determination of intervention to manage obstructive sleep apnea (OSA) is dependent on clinical examination, polysomnography results, and imaging analysis. There remains the need of a non-invasive and cost-effective way to correlate relevant upper airway anatomy with severity of obstructive sleep apnea (OSA ) to direct treatment and optimize outcome. We aimed to determine whether ultrasonography with backscattered imaging (BUI) analysis of the tongue correlates with severity of OSA in adults.

Methods
A prospective, single-center, observational study of a consecutive series of patients (aged18 years and older) visiting our sleep clinic. All included patients had a polysomnography (PSG) within 3 years from the moment of BUI analysis. Patients were excluded if their BMI had changed more than 10%. We used and standardized the submental ultrasound scan with a laser alignment tool and applied BUI analysis to the tongue. Outcomes were correlated to the patients’ AHI, BUI results were compared to only echo intensity.

Results
Eighty-nine patients were included between July 2020 and March 2022. Mean age was 38.8±12.7 years, mean BMI was 26.7±5.0 kg/m2, and mean AHI was 17.5±16.8 events/h. Significant differences were found between the subgroups with AHI&lt; 15 and □15 events/h at specific regions of the tongue base using BUI analysis, echo intensity showed no significant differences. BUI values showed a positive correlation with AHI, with Pearson correlation coefficient of 0.42 and 0.37, and Spearman correlation coefficient of 0.43 and 0.43 for the A and B regions of the tongue, respectively. Higher BUI values are associated with more severe AHI, even after correction for covariates (BMI and age).

Conclusion
Standardized ultrasound scanning of the tongue with backscattered imaging analysis yields strong correlation with severity of OSA. With the intrinsic advantages in the use of ultrasonography in outpatient settings, this analysis is pivotal in reducing the gap between anatomy and physiology in clinical decision-making for treating OSA.

Support (if any)
None
0453 3-Year Outcomes of Proximal Hypoglossal Nerve Stimulation in the THN3 Controlled Trial
Authors: Schwartz Alan , Jacobowitz Ofer , Mickelson Samuel , Miller Mitchell , Oliven Arie , Certal Victor , Hopp Martin , Winslow David , Huntley Tod , Nachlas Nathan , Gillespie M , Weeks Brian , Lovett Eric , Malhotra Atul , Maurer Joachim 
Published: May 2023

Abstract

Introduction
The THN3 randomized, controlled trial of moderate to severe obstructive sleep apnea (OSA) showed that proximal (“targeted”) hypoglossal nerve stimulation (HGNS) safely improved sleep-disordered breathing (SDB) and quality of life (QOL) through 11 months of treatment. Outcomes of subjects receiving active proximal HGNS also surpassed those with inactive therapy 4 months post-implant. Herein 3-year outcomes of THN3 are reported and compared to distal HGNS (STAR trial).

Methods
THN3 OSA subjects (Apnea-Hypopnea Index, AHI, 20-65/hr; BMI ≤ 35 kg/m2, no drug-induced sleep endoscopy screening) were followed long-term. Complete data through 3-year follow-up were analyzed. Efficacy measures comprised AHI, Oxygen Desaturation Index (ODI), %sleep time O2 saturation &lt; 90% (T90), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ) EQ-5D Visual Analog Scale (VAS) and Snore Outcomes Survey (SOS). 36-Month medians were compared against those after 11 months of therapy (Month 12/15) and with STAR. Adverse events (AEs) during Months 12-36 for THN3 and STAR were also compared.

Results
75% of THN3 participants (104/138) attended 3-year follow-up, with complete efficacy records in N≥93 except for SOS (N=67, not administered at all sites). Proximal HGNS produced clinically and statistically significant improvements in SDB and QOL at Month 12/15 that were closely maintained at 36 Months (median paired changes at Month 36 from Baseline/Month 12/15: □AHI:-18.2/-0.1, □ODI:-16.2/0.8, □T90:-1.8/0.2, □FOSQ:3.0/0.0, □ESS:-5.0/0.0, □VAS:5.0/0.0, □SOS:37.5/3.1) and were comparable to STAR at 36 Months (□AHI:-19.4, □ODI:-17.2, □T90:-1.5, □FOSQ: 2.6, □ESS:-4.0). Procedure- and device-related AEs respectively totaled (3 and 27)/(4 and 122) in THN3/STAR over Months 12-36. During this time, 3 severe related-AEs occurred in THN3; the most frequent related AEs involved tongue discomfort (N=8, device-related).

Conclusion
Improvements in sleep apnea and QOL on proximal HGNS at Month 12/15 persisted through at least Month 36. Proximal HGNS long-term efficacy was comparable to distal HGNS. AEs occurred uncommonly during long-term follow-up and were typically mild. Proximal HGNS is a safe, effective, stable, long-term therapy, yielding comparable improvements to distal HGNS in treating moderate to severe OSA. Results of the ongoing, confirmatory OSPREY randomized controlled trial will provide additional insights into therapeutic benefits of proximal HGNS.

Support (if any)
LivaNova
0454 A Specific STOP-BANG Score Cutoff is Not Predictive of Severe Obstructive Sleep Apnea in Bariatric Patients
Authors: Wittine Lara , Corsello Jenalee , Murr Michel 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is a common sleep disorder with obesity being a significant risk factor. Undiagnosed OSA increases the risk of complications at the time of surgery and those with severe OSA at increased risk of post-operative MI, stroke, arrhythmias, and death as well as readmission and acuity of post-operative care. Because of this, our Bariatric program screens all patients pre-operatively with a STOP-BANG questionnaire. Those with severe OSA (AHI or REI &gt; 29) require pre-treatment with PAP therapy until compliance is reached before the patient is eligible for surgery. This study examines those that screened at high risk for OSA with a STOP-BANG score &gt; 2 to see if there was a specific cutoff that predicts those having severe OSA in order to better expedite sleep testing as recent supply chain issues have greatly impacted the timeliness of care for these patients.

Methods
During the months of January to June 2022, demographic, clinical and sleep data was collected on all new patients being evaluated by the Bariatric Sleep clinic for use in quality assessment. Bariatric patients with BMI &lt; 50 and no significant cardiac or pulmonary disease were tested using HSAT, whereas those who met one or more of the above comorbidities underwent PSG.

Results
There were 143 bariatrics patients who screened as “high risk” for OSA with a STOP-BANG score &gt; 2 during these 6 months and 112 (78%) of them completed sleep testing. There were 25 patients (22%) with severe OSA. The average STOP-BANG score for those with severe OSA was 4.3. Women averaged 4.0 (range 3-6), while men averaged higher at 4.8 (range 4-6) likely reflecting that male gender garners an extra point with the STOP-BANG. STOP-BANG scores increased with age: 20s x=3, 30s x=4.1, 40s x=4.4, 50s x=4.6, 60s x=6.

Conclusion
There was no specific cutoff for the STOP-BANG score that predicted severe OSA in our bariatric patients to help our program triage those most at surgical risk in order to place them in an expedited sleep testing and PAP therapy pathway. Overall, STOP-BANG scores were impacted by gender and age.

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0472 INSOMNIAS IN OSA PATIENTS WITH DIFERENT DEGREES OF SEVERITY: A STEP TOWARDS PHENOTYPING COMISA
Authors: Fonseca Ana , Laranjinha Ana , Cruz Miguel Meira e 
Published: May 2023

Abstract

Introduction
With this pilot study, authors aimed to find how OSA and insomnias (sleep onset and maintenance insomnia) interact.

Methods
Data from PSG-level 1 consecutive Obstructive Sleep Apnea (OSA) patients were retrospectively collected. Insomnia and OSA severity were assessed. Arousals (A), arousal index (AI), wakefulness after sleep onset (WASO), total sleep time (TST) and sleep eficiency (SE) were used to better characterize insomnias. Epworth Sleepiness Sclae (ESS) was used to assess excessive daytime sleepiness (EDS).

Results
From 87 OSA patients, 43 (51.8 %): 53.5 % being females (F), where insomniacs (COMISA). Patients with COMISA where distributed as follows: Mild OSA (5 F: 22%; BMI=26.9±4.0 Kg/m2; Age=50.3±15.8 years old - yo; AHI=15.9±13.3 ev/h; ODI3%=4.0±3.9 ev/h; SaO2mean=96.4±0.98 %; SaO2min=89.5±4.2 %) with a TST of 414.5±70.9 min, SE=79.6±13.6 %, WASO=83.7±57.0 min and 182.7±84.8 arousals (AI=26.6±11.1 ev/h); Moderate OSA (8 F: 35%; BMI=28.7±4.7 Kg/m2; Age=53.5±13.4 yo; AHI=24.4±3.1 ev/h; ODI3%=8.8±5.7 ev/h; SAO2mean=95.3±1.2 %; SaO2min=87.7±3.9 %) with a TTS=385.8±69.2 min, SE=80.7±12.6 %, WASO=81.4±62.3 min and 178.8±69.5 arousals (AI=27.5±8.9 ev/h); Severe OSA (10 F: 43 %; BMI=30±5.2 Kg/m2; Age=58.6±7.8 yo; AHI=48.1± 19.9 ev/h; ODI3%=25.4±25.1 ev/h; SaO2mean=94.5±2.4%; SaO2min=82.6±10%) had a TTS=386.5±64.5 min, SE=77.4±11.4%, WASO=93.3±49.8 min and 274.2±95.3 arousals (AI=42.6±12.9 ev/h). The others 40:48.2 % presented with Isolated OSA: Mild OSA (7 F: 39 %; BMI=27.8±3.9 Kg/m2; Age=48.3±12.1 years old - yo; AHI=8.9±3.2 ev/h; ODI3%=2.5±2.7 ev/h; SaO2mean=96.4±0.8%; SaO2min=90.8±2.6%) had a TST of 423.9±36.7 min, SE=86.4±7.3%, WASO=58.1±27.2 min and 151.6±42.1 arousals (AI=21.6±6.5 ev/h); Moderate OSA (7 F: 39%; BMI=27.1±5.4 Kg/m2; Age=53±13.1 yo; AHI=21.2±3.8 ev/h; ODI3%=6.9±3.8 ev/h; SAO2mean=95.9±0.6%; SaO2min=86.7±4.1%) had a TTS=406.3±86.5 min, SE=79.4±15.2%, WASO=77.2.3±68 min and 196.3.8±60.4 arousals (AI= 29.1±6.6 ev/h); Severe OSA (4 F: 22%; BMI=28.3±4.2 Kg/m2; Age=62±12.5 yo; AHI=51.8± 18.7 ev/h; ODI3%=28.5±21.2 ev/h; SaO2mean=93.9±3.5%; SaO2min=81.4±10.2%) had a TTS=385.9±105.7 min, SE=76.2±20.1%, WASO=92.9±80.1 min and 272.7±115.6 arousals (AI=42.5±14.9 ev/h). ESS was 10.1±7.9, 9±5.4 and 8±5.7 for the Mild, Moderate and Severe OSA in COMISA group, and 14.6±7.3, 10.9±5.2 and 5.9±5.2, for the mild, moderate and severe forms of the isolated OSA group.

Conclusion
Insomnia complaints in OSA patients and PSG correlates seems to indicate clinically relevant COMISA phenotypes that would help to better characterize and manage this condition at different degrees of OSA severity.

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0477 Positive Airway Pressure Therapy and Antidepressant Medication Adherence in Patients with Obstructive Sleep Apnea and Depression
Authors: Sterling Kimberly , Dexter R Benjamin , Pépin Jean-Louis , Cole Kate , Wickwire Emerson 
Published: May 2023

Abstract

Introduction
Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with OSA and comorbid depression may improve response to antidepressant medication therapy. At the same time, scant evidence has examined the impact of medication and PAP adherence in patients with OSA and comorbid depression. Patients that adhere to one therapy may be more likely to adhere to other therapies or healthy behaviors in a so-called “healthy user effect.” This retrospective study investigated the association between antidepressant medication adherence and PAP therapy adherence in patients with newly diagnosed OSA and comorbid depression.

Methods
Our data source was a national sample of administrative claims data linked to objective PAP therapy usage. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. Adherence to antidepressant medication was defined as ≥80% of proportion of days covered (PDC), and non-adherence was defined as &lt; 80% PDC within a 180-day exposure window during the year prior to starting PAP therapy. Adherence to PAP therapy was categorized as consistently adherent, intermediately adherent, or not adherent based on objective usage over 2 years.

Results
36,668 patients with OSA and comorbid depression were included. 27% were classified as consistently adherent, 45% intermediately adherent, and 28% non-adherent to PAP therapy. 68.6% of patients used antidepressant medication in the year prior to PAP initiation. 67.7% used a selective serotonin reuptake inhibitor, 43.8% atypical antidepressants, 32.1% serotonin and norepinephrine reuptake inhibitor, 10.7% tricyclic antidepressant, and 0.1% monoamine oxidase inhibitor. Relative to patients not adherent to antidepressant medication (22.2% consistently adherent, 43.8% intermediately adherent, 33.9% not adherent), those adherent to antidepressant medication in the year prior were also more adherent to PAP therapy over 2 years (29.2% consistently adherent, 45.2% intermediately adherent, 25.6% not adherent).

Conclusion
Patients that were adherent to antidepressant medication in the year prior to starting PAP therapy have slightly better adherence to PAP therapy over 2 years. In real-world studies, medication adherence may be an important confounder to adjust for when comparing patient outcomes.

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0478 Pre-test probability of OSA based on subjective questionnaires can indicate who will benefit the most from a Type II study
Authors: Guadagni Veronica , Bender Amy 
Published: May 2023

Abstract

Introduction
Type III home sleep apnea tests have become increasingly popular due to reduced cost and convenience. However, previous research has reported limitations in their diagnostic accuracy. In this study, we assessed which individuals would benefit the most from a Type II home-PSG study when the only information available to clinicians were answers to subjective questionnaires.

Methods
We analyzed responses to a custom sleep survey from 510 participants (age 46.2±12.4; 229 females). We entered 13 outcomes to a principal component analysis (PCA). These included age, body mass index (BMI), Epworth sleepiness scale (ESS) scores, sex, questions about snoring, subjective hours of sleep, satisfaction with own sleep, movement symptoms, problems falling asleep, staying asleep and waking up early. Based on the correlations between the original outcomes, the PCA extracted 3 factors that were interpreted as 3 different phenotypes: I) insomnia (e.g., sleep initiation and maintenance complaints, satisfaction with sleep, lower subjective sleep duration); ii) OSA (e.g., bed partner snoring complaints, snoring self-awareness, sleepiness, respiratory complaints); iii) movement disorder (e.g., movements, female, lower age, higher BMI). We then computed the pre-test probability of OSA (factor 2 scores &gt;80%) and conducted a series of ROC analyses to assess specificity of the AHI in the same patient from both Type II and a simulated Type III (with EEG channels removed), RDI, and ORP metrics.

Results
The AUC values assessing the ability to predict 80% pre-test probability of OSA were: AHI Type II (0.734), AHI Type III (0.672), RDI (0.729), ORPNREM (0.622) and ORPTRT (0.543). The clinically used cut-off of 15 for the AHI Type II correctly classified 83% of patients with 47% probability of false positives, while the same cut-off for Type III correctly classified 43% of patients with 33% probability of false positives.

Conclusion
AHI Type II tests had the highest sensitivity in detecting OSA despite someone having &gt;80% pretest probability. This may be due to the characterization of hypopneas, respiratory effort related arousals, and total sleep time versus total recording time. These analyses indicate the superiority of Type II studies and indices that involve EEG signals to accurately detect OSA in patients with high pretest probability.

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0481 Sex Differences in Moderate-Severe Obstructive Sleep Apnea Diagnosis using Different Sleep Study Modalities
Authors: Junejo Shoaib , Gratton Matt , Shippy Daniel , Stewart Nancy , Stevens Damien , Morris Jonna , Mazzotti Diego 
Published: May 2023

Abstract

Introduction
Male sex is a risk factor for obstructive sleep apnea (OSA). However, because men have been historically described as more vulnerable towards developing OSA, definitions of severity have been based mostly on male-specific pathophysiology. This study aimed to describe sex differences in referral patterns of diagnostic sleep study modalities (in-lab polysomnography [PSG], home sleep apnea tests [HST]) and their results as they related to OSA severity.

Methods
We defined a clinical cohort of individuals that underwent diagnostic sleep testing at the University of Kansas Health System Sleep Disorders Center between 2012-2021. We determined the association between sex and moderate-severe OSA (as compared to no or mild OSA) separately for individuals that underwent HST and PSG, in logistic regression models adjusted for age, body mass index (BMI) and Epworth sleepiness scale (ESS) scores. A complementary analysis stratified by age groups (&lt; 35, 35-50, 50-65, ≥65 years) was also conducted.

Results
A total of 10,357 participants were included in this analysis (5,428 women [52.4%]; 53.0 [14.4] years; BMI=34.0 [16.1] kg/m2). Individuals that underwent HST were younger, more likely to be men, had higher BMI, lower ESS scores, and more severe OSA. Men were more likely to be diagnosed with moderate-severe OSA in both modalities, however higher odds were observed in those diagnosed using HST (ORHST [95%CI] = 2.86 [2.52-3.25]) than in those diagnosed using PSG (ORPSG [95%CI] = 2.48 [2.09-2.95]). Further disparities were observed among those with &lt; 35 years, where men had a 4-fold increase in the odds of a moderate-severe OSA diagnosis than women in a HST (ORHST [95%CI] = 4.10 [2.59-6.50]) and only a 2.5-fold increase in the odds in a PSG (ORPSG [95%CI] = 2.48 [1.13-5.45]).

Conclusion
As expected, men are more likely than women to receive a diagnosis of moderate-severe OSA, however the effects were stronger in those diagnosed with HSTs as compared to PSGs, particularly at younger ages. These results suggest that potential sex inequalities in diagnosis and determination of OSA severity may be influenced by the choice of diagnostic sleep study modality, particular in younger women.

Support (if any)
NCATS (UL1TR002366), AHA (20CDA35310360).
0485 The clinical utility of echocardiography in identifying patients with heart failure at a single academic sleep center
Authors: Patel Salma , Zareba Wojciech , Woosley Raymond , Perez Karolina , Patel Imran , Xia Xiaojuan , Wendel Chris , Miller Jerod , Quan Stuart , Parthasarathy Sairam 
Published: May 2023

Abstract

Introduction
Heart failure and sleep disordered breathing are prevalent in the United States and often co-exist; diagnostic strategy and management for sleep disordered breathing may change based on the presence, absence and type of heart failure. The goal of this study was to evaluate how many additional patients would be identified with either heart failure with reduced (HFrEF) or preserved (HFpEF) ejection fraction through existing echocardiogram results when this diagnosis is not explicitly stated in the medical records for patients evaluated at a single academic sleep center.

Methods
A retrospective chart review was performed for all patients undergoing for a sleep study and/or a PAP device from February 2012 through September 2019 at the University of Arizona. Sleep disordered breathing was identified through either polysomnography (PSG) or home sleep apnea testing (HSAT). Patients were identified with heart failure with reduced ejection fraction if an echocardiogram (TTE) listed ejection fraction

Results
2,817 patients were evaluated (age 57 (±16 years), 53% male and 77% Caucasian). Ninety-nine patients (3.51%) were noted to have HFrEF based on past medical history and an additional 38 patients were identified through TTE. One hundred and fifteen patients (4.08%) were noted to have HFpEF based on past medical history and an additional 265 patients were identified through TTE. Among these, a majority had OSA (77% HFrEF and 83% HFpEF), followed by combined OSA and CSA (7% HFrEF and 5% HFpEF), and primary CSA (5% HFrEF and 3% HFpEF). Of the patients identified after having reviewed TTE results, 6 (16%) with HFrEF and 42 (16%) with HFpEF developed treatment emergent central sleep apnea.

Conclusion
Existing echocardiography data in the electronic medical record can identify additional patients with HFrEF and HFpEF which may impact clinical diagnosis and management of sleep disordered breathing.

Support (if any)
AASM Foundation (203-JF-18), NIH (HL126140, 2L30HL154400-023), University of Arizona (5299903; 5833261; 4258021)
0490 Under-Recognition and Undertreatment of Obesity Hypoventilation Syndrome (OHS) After Hospital Discharge: A Persistent Challenge
Authors: Nowalk Nathan , Neborak Julie , Leonhard Aristotle , Rojas J C , Mokhlesi Babak 
Published: May 2023

Abstract

Introduction
Hospitalization for acute-on-chronic hypercapnic respiratory failure (ACHRF) in OHS is associated with increased short-term mortality. The 2019 American Thoracic Society’s guidelines recommend that hospitalized OHS patients be discharged on nocturnal noninvasive ventilation (NIV). However, this was graded as a weak recommendation given that the data was retrospective and derived from European/Australian studies limiting generalizability to other healthcare systems. We aimed to assess post-discharge therapeutic plans for hospitalized patients with ACHRF and suspected OHS in an urban, tertiary care center in Chicago serving a large minority population.

Methods
We retrospectively queried the electronic health record of University of Chicago from 2008 to 2020 for hospitalized adults with BMI ≥35 kg/m2 admitted from the emergency department, requiring NIV/mechanical ventilation with evidence of respiratory acidosis on first blood gas (pH &lt; 7.35 with PaCO2 ≥ 45 mmHg or PvCO2 ≥ 50mmHg). Subjects were excluded for obstruction on spirometry, greater than 20-pack year smoking history, CT evidence of parenchymal lung disease, acute neurologic process, significant left-sided heart failure and neuromuscular disease.

Results
Of the 797 obese patients requiring NIV/mechanical ventilation, we excluded 672 for lack of acute hypercapnia or low suspicion for OHS. The remaining 125 patients were predominantly Black (n = 116, 93%) and female (n = 94, 75%), mean age of 53±13.9 years, mean BMI of 50.8±12.8 kg/m2, mean first pH of 7.22±0.097, PaCO2 79.9±24.5 mmHg (n = 31) and PvCO2 74.7± 20.2mmHg (n = 94). On admission, 84 patients (67%) did not carry a diagnosis of OHS and 66 patients (53%) were PAP-naïve. 54% were discharged on PAP (43% CPAP, 43% Bilevel, and 14% other). Patients discharged on PAP were more obese (p = 0.001) and more hypercapnic (p = 0.002). Post-discharge polysomnography/sleep clinic referral was planned for 40% of patients. The 1-year mortality rate was 8% with no association recognized between 1-year mortality and PAP on discharge.

Conclusion
In our cohort, the proportion of patients discharged on nocturnal NIV was low. In contrast to the guideline recommendation, we did not find an association between being discharged on PAP therapy and mortality. Larger studies in more diverse populations are needed.

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