bluuebunny/crossref_metadata_2025_split huggingface dataset:
0432 Estimating the Prevalence of Obesity Hypoventilation Syndrome in a Rural Appalachian Inpatient Cohort
Authors: Del Prado-Rico Christine , Seol Calvin , Olgers Kassandra , Sharma Sunil , Stansbury Robert , Pham Christopher 
Published: May 2023

Abstract

Introduction
Patients with Obstructive Sleep Apnea (OSA) and concomitant Obesity Hypoventilation Syndrome (OHS) have been shown to have excess morbidity and mortality and higher healthcare expenditure when compared with patients with OSA only. Despite this, OHS is typically underdiagnosed and untreated. These effects may be more pronounced in rural Appalachian patients in whom rates of obesity, cardiovascular disease, metabolic disease, smoking, and COPD exceed the national average, yet poverty and challenging geography undermine access to healthcare.

Methods
Eligible patients from Sept 2019-Jan 2022 were evaluated for sleep disordered breathing under our hospital sleep medicine program. These patients were screened using high-resolution pulse oximetry, or a portable Type III sleep testing device, or both. Their data was recorded onto our program registry and retrospectively analyzed.

Results
Of 1676 hospitalized patients evaluated through our hospital sleep medicine program, we determined that 1345 (80.2%) of patients had a BMI &gt;/=30 kg/m2. Of these patients, 823 (49.1%) had an arterial or venous blood gas collected during screening. Excluding patients with other potential causes for hypercapnia, 178 (10.6%) met criteria for OHS. 119 (66.8% of this subgroup) met criteria for OSA/OHS, while 33% did not have OSA (AHI/ ODI&lt; 5). Patients with OSA/OHS overlap in our cohort typically had mild OSA.

Conclusion
When compared estimates in urban populations, our cohort is underrepresented. As such, many more patients with potential OHS and OSA/OHS overlap are discharged home without any treatment or plan for follow-up. One possible solution is suggested by the fact that only 49.1% of our initial cohort had an arterial or venous blood gas (ABG/VBG) collected during the admission. We recommend additional screening with serum bicarbonate and subsequent blood gases as part of an inpatient screening program for OSA/OHS. Early identification of these patients may facilitate early treatment while in-hospital and help reduce health disparity.

Support (if any)
0434 Long-Term Positive Airway Pressure Usage Disparities in Black or Hispanic of any Race Adults with OSA
Authors: Sawyer Amy , Mazzotti Diego , Keenan Brendan , Schutte-Rodin Sharon , Staley Beth , Schwab Richard , Maislin Greg , Kuna Samuel T , Watach Alexa , Bae Charles , Mowery Danielle , Saconi Bruno , Shi Jiaxiao M , Hwang Dennis , Pack Allan 
Published: May 2023

Abstract

Introduction
Black or African American and Hispanic of any race (B/H) adults are disproportionately affected by obstructive sleep apnea (OSA). Positive Airway Pressure (PAP) treatment may reduce disparities, but short-term PAP outcomes are worse among under-represented minority (URM) adults compared to other, mainly White, adults. No studies have examined if adherence disparities persist/worsen long-term. We evaluated disparities in PAP usage between B/H adults and other race/ethnicities.

Methods
We defined a clinical cohort of adults with moderate-severe OSA (apnea-hypopnea index [AHI]≥15 events/h) that underwent diagnostic sleep studies and initiated PAP between 01/2015-03/2018. Logistic regression was used to examine differences in the likelihood of still using PAP or meeting adherence threshold of ≥4 hours/night at 18-24 months. We performed mixed model for repeated measures to examine differences in h/night of PAP use over two years. Analyses were controlled for age, sex, BMI, AHI, and 3-month PAP usage to understand whether disparities emerged independent of short-term differences.

Results
Analyses included 1,518 individuals (694 [45.7%] B/H) with PAP usage at 3 months, who were middle-aged (53.4±14.1 years-old), majority men (64.4%), obese (38.2±9.8 kg/m2) and had severe OSA (46.6±30.2 events/h). B/H adults had 70% higher odds (OR [95% CI] = 1.70 [1.33-2.17]) of no longer using PAP 18-24 months after initiation. B/H adults using PAP had ~2 hours/night less usage than other race/ethnicities at 18-24 months (2.72 [2.49-2.97] vs. 4.52 [4.31-4.73] hours/night; p&lt; 0.0001). This difference was attenuated but remained significant after accounting for 3-month usage (mean [95% CI] difference = -0.64 [-0.92, -0.37] hours/night). B/H adults using PAP were also 3-times more likely to be non-adherent at 18-24 months (OR [95% CI] = 3.00 [2.28-2.95]), and remained 2-times more likely to be non-adherent controlling for 3-month usage (2.14 [1.56-2.92]).

Conclusion
At 18-24 months, Black or Hispanic of any race adults with moderate-severe OSA were less likely to use PAP, had less usage when still using PAP, and were less likely to achieve adherence thresholds. Long-term PAP disparities exist, even after accounting for short-term differences. Promoting longer-term PAP adherence for URM is a priority to reduce these disparities and address healthcare inequities.

Support (if any)
AHA (20CDA35310360), NIH P01 HL094307, AHRQ K12HS026372
0438 Obstructive sleep apnoea in patients with stroke verses those with refractory hypertension search for common pathogenic mechanism
Authors: Gupta Anupama , Shukla Garima , Sharma Gautam , Roy Ambuj , Goyal Vinay , S Vivekanandhan , Bhargava Balram , Behari Madhuri 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea [OSA] is a risk factor for stroke and refractory hypertension [RH]. OSA causes disrupted sleep, intermittent hypoxia, and hypoxia-induced systemic inflammation and sympathetic activation are potential pathogenic mechanisms for the first ever stroke and refractory hypertension. The aim of the present study was to evaluate sleep quality among OSA among patients with first ever stroke, as compared to RH and to assess markers of sympathetic activation and systemic inflammation in patients with either stroke or RH.

Methods
All patients with stroke and RH were recruited from the Departments of Neurology and Cardiology, respectively at the All India Institute of Medical Sciences, New Delhi. All patients were interviewed for demographic details, clinical history and were scheduled for polysomnography. Fasting blood samples were collected during morning hours, to estimate biochemical markers [Norepinephrine, CRP, TNF-∞, VGEF and IL6] . CRP, TNF-alpha, and IL-6], measured by the chemiluminescence method. Nor-adrenaline and VEGF were measured using ELISA techniques.

Results
A total of 114 stroke patients and 56 refractory hypertension patients were included. The prevalence of OSA among stroke and RH patients was found to be 86.85 and 81% respectively. The mean number of wake after sleep onset periods (WASOs) [45±19.22 vs 29.8±11.14, p&lt; 0.01]was significantly higher in patients with stroke. REM AHI [240.04±24.65 vs 33.20±22.35, p&lt; 0.01] was significantly higher in patients with RH.CRP and VEGF values were higher than normal, in both groups. The median value of early morning serum nor-adrenaline was higher in the RH group[407 (66.6-1000) vs 515 (240-1250), p = 0.05].

Conclusion
OSA is highly prevalent among the patients in both groups. Systemic inflammation is a common pathogenic mechanism linking OSA with RH and stroke, whereas early morning sympathetic activation appears significantly important in the pathogenesis of refractory hypertension.

Support (if any)
This study was funded by Indian council of Medical Research, New Delhi, India.
0441 Positive airway pressure therapy associated changes in ventricular repolarization in patients with heart failure
Authors: Patel Salma , Zareba Wojciech , Woosley Raymond , Perez Karolina , Xia Xiaojuan , Wendel Chris , Patel Imran , Miller Jerod , Quan Stuart , Parthasarathy Sairam 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with prolonged ventricular repolarization at baseline that further increases during sleep when an apnea/hypopnea event occurs. Aggressive treatment of OSA with positive airway pressure therapy (PAP) may further prolong ventricular repolarization during apnea/hypopnea events particularly in patients with heart failure (HF). The goal of this study was to evaluate how ventricular repolarization changes during apnea/hypopnea events in patients with heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction and in those patients without HF.

Methods
Thirty patients with OSA in each of the following groups were randomly selected from a dataset of 2,817 patients: HFrEF, HFpEF and no HF failure. Overnight polysomographies (PSG) for these patients were reviewed and beat-to beat measurements during apnea/hypopnea events were obtained at baseline (without PAP) and on the highest PAP setting attempted. Fridericia’s heart rate corrections were used to calculate QTc. QT variability was measured as the standard deviation of QT intervals (SDQT).

Results
The electrocardiogram was analyzable for n=11 with HFrEF (age 71± 17 years , 91% male) , n=28 with HFpEF (age 71± 12 years , 43% male) and n=30 without HF (age 57± 12 years , 50% male). In those with HFrEF, the mean (SD) QTc increased from 442(12)ms to 452(13)ms and SDQT increased from 9(2) to 13 (2) from baseline to the highest level of PAP attempted. In those with HFpEF, the mean (SD) QTc decreased from 448 (8) to 436 (8) ms and SDQT increased from 10 (1) to 11 (1) from baseline to the highest level of PAP attempted. In those without HF, the mean (SD) QTc increased from 429(37) to 439(56) and SDQT was stable from 8(6) to 8(8) from baseline (no PAP) to the highest level of PAP attempted. There were significant differences noted between the groups in changes in QTc (p=0.002) and SDQT (p=0.048) on PAP when compared to baseline.

Conclusion
Patients with HFrEF had increases in both QTc and SDQT with PAP at high pressures placing them at greater risk for ventricular arrhythmias.

Support (if any)
AASM Foundation (203-JF-18), NIH (HL126140, 2L30HL154400-023), University of Arizona (5299903; 5833261; 4258021)
0442 Progress in the SUPRA Trial for the Treatment of CPAP-intolerant OSA patients: AHI and Safety
Authors: Strohl Kingman , Mehra Reena , Patel Sanjay , Pena-Orbea Ciythya , Bogan Richard , Magalang Ulysses 
Published: May 2023

Abstract

Introduction
An external collar with ~30cmH2O vacuum applied to the anterior neck can expand the oro- and naso-pharynx and improve Pcrit (Kato et al 2015- PMID: 25614595. The hypothesis of SUPRA (Study Using Negative Pressure to Reduce Apnea - NCT04861038) is that the self-contained vacuum device (aerSleep® II) can treat obstructive sleep apnea (OSA) in those unable to use CPAP.

Methods
Conducted at 15 sleep centers in the United States, CPAP–intolerant subjects meeting eligibility (age &gt;18 yrs, BMI &lt; 42, and an untreated AHI4% by Nox T3 HSAT of 15-50/hr) were fitted to one of three collar sizes. After a 7-day acclimatization trial, those that showed a &gt;50% reduction in AHI4% to less than 20/hr (“Responders”) and accepted therapy agreed to 6 months of supervised treatment, with final assessments at 6 months. 7-day and 6-month end-points reported here are AHI and safety.

Results
Of screened subjects, 50.2% were excluded, most frequently due to baseline AHI being too high or, mostly, too low (72%). 110 subjects (59±SD11 years, 43% Female, 84% Caucasian) met study criteria. Following device acclimation, 28 (50%) did not meet 7-day pre-selected on-treatment AHI criteria. In 23 subjects (41%), AHI reduced from 26.6±8.5 to 8.1±5.6 (p=0.001), and these Responders differed from non-responders (AHI from 32.7±13.1 to 26.7±9.4, p=0.06) in regard to reductions in apneas and hypopneas and ODI; non-responders had converted to hypopneas. During the 6-month phase, 7 withdrew consent. In all, local irritation occurred in 29 instances in 28 participants, resolving with 1-3 days of discontinuation, and therapy resumed. Eight have completed 6 months without safety issues, and 7 continued to exceed AHI efficacy endpoints.

Conclusion
We conclude that the aerSleep II device, with current collar sizes and pressure, can reduce the AHI burden at 7 days and continues for 3-6 months without major safety concerns.

Support (if any)
Presented for the SUPRA Study Group, supported by Sommetrics Inc, San Diego CA
0443 Proposing a ‘projected apnea-hypopnea index (AHI)’ to mitigate intrinsic pitfalls of conventional AHI and testing its validity
Authors: Im SangHyuk , Lee Chang-Hoon , Im KyoungBin 
Published: May 2023

Abstract

Introduction
The night-to-night variability of apnea-hypopnea index (AHI) can be explained by the fact that a person with OSA tends to spend less time in supine position and potentially less REM sleep, during which obstructive events could be a lot worse than in the other form. The primary aim of this study is to propose and test a “projected AHI” (pAHI) with which AHI can be mathematically adjusted for sleep position and sleep stage spent in a night of recording.

Methods
Using mathematical modeling explained in a separate abstract, a final pAHI formula was generated from polysomnography data of 337 subjects who exhibited all four sleep-types [combination of REM vs NREM and supine (SUP) vs non-supine (nSUP)] in one overnight study. A confusion matrix was generated using cutoffs of (p)AHI of 5 and hypothesizing pAHI being the gold standard and AHI being the test. Among subjects with borderline results (AHI of 5±3), sleep-type time and sleep-type AHI were compared between 4 groups of the confusion matrix to test the validity of the pAHI model.

Results
Out of 337 subjects with all four sleep-types, 119 subjects with AHI of 5±3 were identified and classified into a confusion matrix of no-OSA (43 TN, 10 FP), and OSA (13 FN, 53 TP). Actual sleep-type AHIs were in the order of increasing pAHI (TN, FP, FN, TP): 15.3, 29.2, 32.0, 34.8 for REMSUP; 4.00, 4.53, 4.73, 9.40 for REMnSUP; 2.83, 2.87, 9.38, 10.0 for NREMSUP; 0.44, 0.1, 1.06, 1.98 for NREMnSUP. Sleep time parameters were significantly different between no-OSA and OSA groups only when pAHI was used for diagnosis: %REMSUP (9.32 vs 5.39, p = 0.000009), %REMnSUP (8.08 vs 11.31, p = 0.002), %NREMSUP (48.13 vs 36.53, p = 0.001). %NREMnSUP (34.46 vs 46.77, p = 0.0002).

Conclusion
Without having to repeat a sleep study, projected AHI, by taking the effect of sleep position and sleep stages into account, can produce an AHI that mitigates night-to-night variability stemming from position and stage differences between nights. Projected AHI can be particularly useful in interpreting a sleep study with a borderline AHI result.

Support (if any)
0444 Racial Differences in Positive Airway Pressure Requirements Amongst Obstructive Sleep Apnea Patients (The RACE-PAP Study)
Authors: Cai Yi , Parekh Manan , Rodin Julianna , Tangutur Akshay , Yu Jason , Keenan Brendan , Schwartz Alan , Dedhia Raj 
Published: May 2023

Abstract

Introduction
Prior studies of patients with obstructive sleep apnea (OSA) show racial differences in clinical presentation. When compared with White patients, Black patients present with more severe OSA and greater sleepiness. Racial differences in upper airway collapsibility could explain these differences. Here, we investigated whether mean positive airway pressure (PAP) levels, a clinically accessible measure of upper airway collapsibility, differed by race in a cohort of patients adherent to PAP.

Methods
We conducted a retrospective analysis of White and Black adults with OSA who were prescribed auto-adjusting PAP (aPAP) therapy at a single academic center between January 2018 and January 2020. The analysis included adherent patients (usage on &gt;70% of nights for ≥4 hours per night) with well-controlled OSA (defined as ≥50% reduction in apnea-hypopnea index [AHI] on aPAP and residual AHI&lt; 10). Mean PAP level was compared between White and Black patients using linear regression controlled for age, gender, body mass index (BMI), AHI, O2 nadir, and mask type (full face, nasal, or unknown).

Results
Overall, 148 Black (56% women) and 230 White (36% women) patients were included. On average, Black patients were younger (50.7±14.6 vs. 53.8±12.7 years; p=0.037) with higher BMI (40.4±9.5 vs. 34.9±7.6 kg/m2; p&lt; 0.0001). Black patients had less severe OSA on average, but this difference was not statistically significant (AHI of 33.9±25.5 vs 38.6±24.9 events/hour; p=0.077). After adjusting for covariates, Black patients had a 0.62 cm H2O (95% CI: 0.21 to 1.03) higher mean PAP level than White patients (p=0.003). There was a larger racial difference in mean PAP level among men (0.76 [0.16, 1.35] cm H2O; p=0.013) compared to a non-significant difference among women (0.34 [-0.23, 0.91] cm H2O; p=0.242). While statistically significant, differences were &lt; 1 cm H2O and, thus, not clinically meaningful.

Conclusion
Black patients with OSA had a statistically significant but clinically insignificant difference in mean PAP level when compared with White patients. There was evidence of stronger differences in men than women. Further studies are needed to explore other potential mechanisms, including craniofacial anatomy, which may underlie racial differences in OSA presentation and outcomes.

Support (if any)
National Institutes of Health R01 1R01HL144859 (PIs: Schwartz, Dedhia)
0446 Sleep Disordered Breathing Treatment is Associated with Improved Mental Health Symptoms and Quality of Life in Women Veterans
Authors: Moghtaderi Isabel , Kelly Monica , Carlson Gwendolyn , Swistun Dominika , Erickson Alexander , Mitchell Michael , Josephson Karen , Lee Diane , Song Yeonsu , Fung Constance , Washington Donna , Yano Elizabeth , Zeidler Michelle , Alessi Cathy , Martin Jennifer 
Published: May 2023

Abstract

Introduction
Sleep disordered breathing (SDB) is associated with poor mental health and lower overall quality of life (QOL); however, research examining these outcomes after positive airway pressure (PAP) therapy for SDB in women is limited. We studied a 6-session PAP adherence program that included behavioral sleep improvement strategies plus concepts of Acceptance and Commitment Therapy (ACT) to promote sustained PAP use, and evaluated the impact of this ACT-based program on daytime and mental health symptoms and quality of life in a sample of women veterans with SDB who were prescribed PAP.

Methods
Women veterans with SDB (n=90, mean = 53.2 years [range 26-80]) receiving care in an urban VA healthcare system were randomly assigned to a “control” SDB/PAP education program or the “Acceptance and Behavioral Changes to treat Sleep Apnea” (ABC-SA) program. All received PAP therapy. Measures included: Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient-Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder Questionnaire 7-item (GAD), and The World Health Organization Quality of Life Scale, Brief (WHOQOL BREF). Mixed-effect models assessed the main effect of time across groups and between-group changes in these measures at post-treatment and 3 month-follow up compared to baseline.

Results
For the main effect of time, participants in both groups had significant improvements at post-treatment and 3-month follow-up in sleepiness, fatigue, depression, anxiety, and QOL (all p&lt; 0.05). Compared to controls, women who received ABC-SA reported greater improvements in daytime sleepiness (ESS) at post treatment (p=0.04) and in fatigue (FFS) at 3-month follow-up (p=0.008).

Conclusion
PAP treatment in women with SDB was associated with improvements in measures of mental health and QOL. There was some evidence of even greater benefits with ABC-SA. Further work is needed to understand the relationship between SDB treatment and improved mental health outcomes in women and other underrepresented populations.

Support (if any)
VA HSR&D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&D COIN; VAGLAHS GRECC and VA Office of Academic Affiliations
0456 Association of MOCA scores in individuals with Mild Cognitive Impairment-Alzheimer Disease and Obstructive Sleep Apnea
Authors: Khan Wahaaj , Pao Winnie , Mehra Reena 
Published: May 2023

Abstract

Introduction
Mild cognitive impairment (MCI) is considered a transitional stage between normal aging and dementia. Studies have demonstrated an association with rate of progression of MCI and dementia in individuals with OSA compared to those without OSA. The varying degree of hypoxia, sleep fragmentation and poor quality of sleep in OSA patients has been associated with increased risk of stroke, memory impairment, cardiac arrhythmias, dyslipidemia, hypertension, obesity and glucose intolerance. Identifying different variables in sleep study that can be linked with MCI and AD is helpful. We compared patients' MOCA score at the time of sleep study and compared it with multiple macro and micro variables tested on the sleep study.

Methods
Data was presented as mean ± (SD) or median [25th, 75th percentiles] for continuous variables and N (%) for categorical variables. Comparisons were performed between baseline MOCA groups (0-17 vs. 18-30) using two-sample T-test or Wilcoxon rank sum test for continuous variables based on distribution, and chi-square test or Fisher’s exact test for categorical variables. Linear regression was used to assess the relationship between baseline MOCA and sleep measures before and after adjustment for covariates. Covariates included age, gender, race, and BMI.

Results
Patients with smaller MOCA score were older (71.4 ± 8.7 vs. 68.1 ± 9.4, p=0.002), predominantly black (17.8% vs. 10.8%, p=0.013), weigh lower (median [IQR]: 80.5 [69.2, 94.0] vs. 86.2 [74.0, 99.0], p=0.023) and had less prevalence in ADHD, anxiety, depression, GERD and headache (p=0.034,0.024,0.013,0.016,0.040, respectively). After covariates adjustment (age, sex, race and BMI), when percent sleep time with SaO2&lt; 90% increase 10%, MOCA would decrease 0.24 (coefficient -0.21, 95%CI [-0.41,-0.01], p=0.043); when SaO2 nadir increased 10%, MOCA would increase 0.68 (coefficient 0.68, 95%CI [0.05,1.32], p=0.035); when sleep stage %N1 increased 1%, MOCA would decrease 0.04 (coefficient -0.04, 95%CI [-0.08,-0.01], p=0.011).

Conclusion
Changes in oxygen levels during sleep showed direct correlation between MOCA score in individuals with MCI and AD, at the time of sleep study. Decline in MOCA scores were directly associated with degree of hypoxia observed during the sleep studies. The study showed association of worsening MCI and AD with lower oxygen levels in patients with OSA.

Support (if any)