bluuebunny/crossref_metadata_2025_split huggingface dataset:
0457 Cardiopulmonary Coupling as an alternative to classic Home Sleep Apnea Testing: Head to Head Assessment
Authors: Simmons Jerald , Thomas Robert , Gregory Keri , Feuquay Cole , Mann Chris 
Published: May 2023

Abstract

Introduction
Standard HSATs directly measure airflow and chest-movements to diagnose OSA. Indirect measures such as Cardiopulmonary-Coupling (CPC) now FDA approved as “Software-as-a-medical-device” are gaining utilization. The FDA assessment of CPC was from NPSG oximetry recordings to which it was compared. SleepImage (SI) recently made CPC commercially available using ring-based oximetry. Out of lab “real-life” validation or head-to-head comparisons of SI-CPC-ring based HSATs to traditional nasal cannula / strain gauge sensor HSTs has ever been published. We performed a Head-to-head study of SI-CPC Ring system to two different HSTs, ApneaLink (AL) by ResMed and Z-Machine (ZM) by General Sleep Corporation. The ZM also provides an EEG derived assessment of sleep stage.

Methods
Patients undergoing AL or ZM HSAT studies were simultaneously placed on SI-CPC-ring devices. Statistical assessments consisted of Bland-Altman-plots and correlation-coefficients to assess for similarity of these devices. Here we report 3%AHI (analogous to the 1A AHI) and 4% AHI analogous to the 1B AHI). Additionally Total-Sleep-Time(TST) and Sleep Efficency(Slp-Eff) are reported with the ZM, which utilized EEG to provide these parameters.

Results
AL-vs-SI-CPC N=44. ZM-vs-SI-CPC N=50. The Bland-Altman-plot and correlation-coefficients demonstrates SI-CPC provided statistically similar results. AL-3%AHI ( Ⴟ 20.3, +/-21.8) vs SI-sAHI3% ( Ⴟ 24.2, +/-25.2) MD: -6.641 (CI -10.127 to -3.154) Range 3.800 to 110.000, R= 0.923 AL-4%AHI (Ⴟ 15.8 +/-21.4 ) vs SI-sAHI4% (Ⴟ 15.8 +/-25.5) MD: 0.132 (CI -2.489 to 2.753) Range 0.000 to 105.600, R= 0.952 ZM-3%AHI (Ⴟ 15.2 +/-30.0) vs SI-sAHI3% (Ⴟ 13.8 +/-19.4) MD: 1.334 (CI -2.709 to 5.377) Range -27.121 to 29.789 R=0.92 ZM-4%AHI (Ⴟ 1.5 +/-27.7) vs SI-sAHI4% (Ⴟ 8.9 +/-17.4) MD: 1.598 (CI -1.917 to 5.113) Range -23.135 to 26.331 R=0.95 ZM-TST (Ⴟ 355 +/-92) vs SI-TST (Ⴟ 355 +/-86.0) MD: 0.076 (CI -24 to 24) Range -171 to 171 R=0.59 ZM-Slp-Eff (Ⴟ 0.818 +/-0.115) vs SI-Slp-Eff (Ⴟ 0.826 +/-0.120) MD: -0.008 (CI -0.044 to 0.027) Range -0.258 to 0.241 R=0.44

Conclusion
HSATs with SI-CPC-ring is an easier method to administer than HSATs using air-flow and chest-sensors. This head-to-head study may enhance adoption of this type of testing, using indirect measures since the SI-CPC-ring system is not inferior, as demonstrated in our study.

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0459 Cardiovascular Endpoints for Obstructive Sleep Apnea with Twelfth Nerve Stimulation: Measures of Sleep-Related Function
Authors: Tangutur Akshay , Cai Yi , Keenan Brendan , Basner Mathias , Dedhia Raj 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is an increasingly prevalent sleep-related breathing disorder linked to cognitive dysfunction and daytime sleepiness. Positive airway pressure (PAP) therapy, the first-line treatment for OSA, may improve cognitive function and sleepiness, but responses vary. Hypoglossal nerve stimulation (HGNS) is a novel and effective PAP alternative, but its effect on mitigating cognitive decline secondary to OSA is unknown. In the first sham-controlled HGNS trial, we evaluated the effect of HGNS therapy on cognitive measures and patient-reported outcomes (PROs) in patients with moderate-severe OSA.

Methods
In a double-blind, sham-controlled, randomized crossover therapy trial, patients already stabilized on HGNS therapy underwent four weeks of active and four weeks of sham HGNS, each with a 1-week washout period. Sham therapy was defined as the lowest voltage at which HGNS was sensed by the patient or visualized by the clinician. Cognitive measures (Psychomotor Vigilance Test [PVT], Digit Symbol Substitution Task [DSST]) and sleep-related PROs (Epworth Sleepiness Scale [ESS], Snoring Visual Analog Scale [VAS], Insomnia Severity Index [ISI], Functional Outcomes of Sleep Questionnaire [FOSQ]) were assessed after each 4-week period and compared between active and sham therapy.

Results
Sixty randomized patients were included. On average, participants were elderly (67.3±9.9 years), overweight (BMI 28.7±4.6 kg/m2) and had severe OSA prior to HGNS therapy (AHI 33.1±14.9 events/hour). Patients’ AHI decreased to 23.0±15.6 events/hour with sham therapy (p=0.0001) and 18.1±14.8 events/hour with active therapy (p&lt; 0.0001), with a 4.9 event/hour decrease between active and sham therapy (p=0.014). There were no significant differences in performance measures on PVT or DSST between active and sham HGNS. All sleep-related PROs were statistically significant with moderately large (effect sizes ~0.41-0.56) improvements following active HGNS.

Conclusion
The HGNS system permits a unique investigation of the therapy “on/off” effect on measures of cognitive function. In the first sham-controlled, randomized crossover trial of patients using HGNS, all sleep-related PROs, but not objective measures of cognition, were significantly different between sham and active (therapeutic) levels. These findings warrant additional investigation examining the relationship between subjective and objective measures of function in OSA.

Support (if any)
American Heart Association (17SDG33670349) American Sleep Medicine Foundation (176-JF-17) National Institutes of Health (P01-HL094307)
0460 Challenges with Administrative Claims Data to Assess Health Disparities in Patients with Obstructive Sleep Apnea
Authors: Cole Kate , Dexter R Benjamin , Alpert Naomi , More Suyog , Cameron Ann , Kaye Leanne , Lyson Helena , Barrett Meredith , McConnell Will , Sterling Kimberly 
Published: May 2023

Abstract

Introduction
Health disparities adversely affect people based on characteristics that are historically linked to discrimination or exclusion. There is limited research on understanding consequences of health disparities in the diagnosis and treatment of obstructive sleep apnea (OSA). This retrospective study sought to investigate health disparities affecting OSA patients using real-world data.

Methods
A national sample of administrative claims data from OSA patients who had a claim for a sleep test (home sleep test or polysomnography) was used. Gender, insurance payer, race/ethnicity, and 3-digit zip code were characterized from the claims data at the time of the first sleep test to describe differences across patients.

Results
The sample included about 2 million patients with 44.9% female, an average age 51.0 years, and an insurance payer breakdown of 74% commercial, 18% Medicaid, and 8% Medicare Advantage. There were a number of challenges that made it difficult to draw conclusions about the impact of health disparities in this data. The source of gender data was unknown; therefore, we do not know if it represents identified gender or biological sex. Race/ethnicity data was listed as “unknown” for 89% of commercial patients, 18% of Medicaid patients, and 36% of Medicare Advantage patients. Data reporting did not allow for details on multiple races or separation of race and ethnicity. Using 3-digit zip codes proved to be unreliable for drawing conclusions about a patient’s residence and access to care as 3-digit zip code areas are heterogenous and could cover a small section of a major city, a large rural portion of a state, or both. Lastly, ICD-10 Z codes, which describe social determinants of health (SDOH), appear to be underutilized.

Conclusion
Currently, using administrative claims as a real-world data source to assess health disparities is difficult due to data incompleteness, lack of adequate data definitions, and data aggregations made to protect patient privacy. Strategies to increase usability of claims data for investigating health disparities may include improvements in payer data reporting, increased utilization of SDOH Z codes, and linking to other more patient-centric data sources. Analyzing large samples of real-world data may help identify disparities and improve care for all patients.

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0461 CPAP adherence in commercial bus drivers in a public transportation company
Authors: Hamada Eriko , Yamauchi Motoo , Fujita Yukio , Muro Shigeo 
Published: May 2023

Abstract

Introduction
We have been serving a sleep health promotion in a local public transportation company. One of the projects is OSA screening for all commercial bus drivers. In addition, since April 2018, we have made provision for the CPAP adherence, that is, all of the bus drivers have been monitored adherence, and if CPAP adherence was poor for two consecutive times, an interview with us is mandated. In case of the drivers whose adherence is not improved after the interview, they must be away from driving until CPAP adherence is improved. Thus, we hypothesized such a provision makes CPAP adherence better as compared with real-world data of CPAP adherence in Japan (45.6%) which was our presentation at the SLEEP 2022.

Methods
Pulse oximetry-based OSA screening is performed for all of the commercial bus drivers in the public transportation company. In case of 3% oxygen desaturation index ≥15, In-lab diagnostic PSG is performed. The drivers who are prescribed CPAP must submit CPAP adherence data sheet basically every month. Using the data of current employed bus drivers, we calculated the prevalence of OSA and recent CPAP adherence for a total of more than 90 days. CPAP adherence was defined as CMS criteria.

Results
The total number of commercial bus drivers in the company was 1237, of which 131 were diagnosed with OSA, 123 were CPAP users. The prevalence of OSA was 10.6%. Among 123 of CPAP users, 7 drivers lost the CPAP adherence data sheet, 1 driver was absent for a long time due to a malignant disease, and 2 drivers have recently started CPAP therapy, so CPAP adherence for 90 days could not be obtained, Eventually, CPAP adherence was assessed with 113 CPAP users. Eighty-seven drivers achieved CMS criteria, thus CPAP adherence was 77.0% which is comparable to the recent cloud-based CPAP adherence data in the US (72.6%).

Conclusion
CPAP adherence in this study was higher than in the real-world data in Japan. Our sleep health promotion of CPAP therapy in this company successfully increased CPAP adherence.

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0462 CPAP-Experienced Patient Perceptions of CPAP & Novel Nasopharyngeal Airway Device as CPAP Alternative for Obstructive Sleep Apnea
Authors: Marten Thomas , Joshi Sonal , Raven Sarah , Chen Alyssa , Plott Jeffrey , Nourmohammadi Zahra , O'Brien Louise , Zopf David 
Published: May 2023

Abstract

Introduction
Untreated obstructive sleep apnea (OSA) can impact numerous critical organ systems with drastic health ramifications while decreasing daily quality of life of individuals and their family. While Continuous Positive Airway Pressure (CPAP) can be highly effective, adherence is remarkably low. This is a preliminary initiative to gauge patient perceptions of a new non-surgical nasopharyngeal airway (NPA) device in development for OSA.

Methods
An IRB-approved single-site study surveyed 10 patients with polysomnography-confirmed OSA and at least 3 months’ experience using CPAP therapy. An independent expert in patient-reported outcomes helped develop the instrument to understand perceptions and attitudes towards CPAP and gauge initial reactions to the NPA-OSA device. This was reviewed by three Sleep Medicine experts for content validity. An NPA-OSA device description and insertion training video were provided to elicit feedback. Sixty-minute telephone interviews were conducted with OSA patients and transcribed by the independent expert.

Results
Ten patients (4 male), participated with an age range from 31 to 82 years. Nine used CPAP nightly, although described situations when they would not. All participants described significant dissatisfaction with some aspect of their CPAP treatment (e.g., restrictions on sleep position, difficulty cleaning and traveling, reliance on electricity), though most cope and appreciate therapeutic benefit. Respondents were motivated to find new treatment options for OSA, but were not actively seeking new options. Surgical treatment was considered by most, but with fear of unsuccessful outcomes/complications. A few of the respondents had previously used oral appliances with limited success. When introduced to the NPA device, most participants were interested in trying it. Positive attributes were non-invasive, portable and not requiring electricity. Ultimately, participants believed that the device had the potential to improve sleep. Primary concerns were the potential of pain during insertion, discomfort during use, and treatment effectiveness. All those interviewed were interested in participating in a clinical trial using the device.

Conclusion
Patients successfully using CPAP may still be dissatisfied and motivated to explore new options. The NPA-OSA device was considered a compelling option.

Support (if any)
This work was funded by the University of Michigan Coulter program.
0463 Deep Learning Classification of Future PAP Adherence based on CMS and other Adherence Criteria
Authors: Rusk Samuel , Nygate Yoav , Fernandez Chris , Shi Jiaxiao M , Arguelles Jessica , Klimper Matthew T , Watson Nathaniel F , Stretch Robert , Zeidler Michelle , Sekhon Anupamjeet , Becker Kendra , Kim Joseph , Hwang Dennis 
Published: May 2023

Abstract

Introduction
Improving positive airway pressure (PAP) adherence is crucial to sleep apnea therapy success. Although behavioral interventions may be deployed to increase PAP adherence, operationalization remains an ongoing clinical challenge. Treatment outcomes may be optimized by forecasting PAP use to identify patients at risk for non-adherence enabling early intervention. We build upon our previous work by leveraging a larger dataset, additional metadata, and new Deep Learning approaches to forecast future PAP adherence.

Methods
We collected a cohort of N=21,397 subjects with daily PAP usage recorded during 2015-2021. We defined the input to models as the number of minutes the PAP machine was used during each day for the first 30-days. The ground truth was defined as the PAP adherence of the patients at the 3-month, 6- month, and 1-year endpoints. Adherence was calculated based on a 30-day window as ≥4-hours of usage for ≥70% of nights. We evaluated a Deep Neural Network (DNN) model with 10-fold cross- validation to forecast future adherence by leveraging previous daily usage information. Results were compared to a naive method which assumes adherence at each time point equals adherence during the first 30-days.

Results
The DNN models predicted adherence with a sensitivity of 90%, 81%, 77% and a specificity of 90%, 81%, 77%, for 3-month, 6-month, and 1-year endpoints, with ROC-AUC values of 0.97, 0.89, and 0.84 respectively. The models converged to ROC-AUC performance &gt;0.90 for the first 90-days within the first 7 to 14-days of PAP use.

Conclusion
DNN models demonstrated strong predictive performance for PAP adherence, as defined by the CMS adherence criteria, measured by sensitivity, specificity, and overall ROC-AUC results at clinically relevant 90-day, 6-month, and 1-year timepoints. AI approaches show promise as early predictors of the likelihood to meet key therapy utilization thresholds within the first 1-2 weeks of therapy, enabling early PAP intervention or transition to alternative therapies.

Support (if any)
AASM Foundation SRA205-SR-19
0465 Difficulty initiating and maintaining sleep is associated with increased blood pressure in people with obstructive sleep apnea
Authors: Lechat Bastien , Scott Hannah , Sweetman Alexander , Escourrou Pierre , Eckert Danny 
Published: May 2023

Abstract

Introduction
Approximately 30-50% of people with obstructive sleep apnea (OSA) have difficulty initiating and/or maintaining sleep (DIMS). The co-occurrence of OSA and DIMS is associated with worse mental health and quality of life compared to OSA alone. This study investigated potential associations between OSA and regular sleep disturbances (defined over multiple months) with blood pressure and hypertension.

Methods
A validated under-mattress sleep analyzer (WITHINGS) monitored sleep in 12,287 participants over ~6-months at home. The mean apnea-hypopnea index (AHI), sleep onset latency (SOL) and wake after sleep onset (WASO) were calculated over the recording period. OSA was defined as an average AHI ≥ 15 events/hour. DIMS was defined as an average SOL ≥30 min and/or WASO ≥ 45min. Participants were categorized into those with neither condition (control), OSA-alone, DIMS-alone, and OSA+DIMS. Blood pressure measurements were recorded using a home monitor to define hypertension based on mean systolic blood pressure ≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between OSA+DIMS and hypertension were investigated using regression analyses controlled for age, sex, and BMI.

Results
Participants were middle-aged (Mean±SD; 50±12 y), mostly men (88%) and overweight (BMI; 28±6 kg∙m-2). The prevalence of DIMS-alone, OSA-alone and OSA+DIMS was 10%, 21% and 8%, respectively. OSA-alone was associated with (mean [95%CI]) 4.5 [4.1, 5.0] and 2.6 [2.3, 2.93] mmHg higher systolic and diastolic blood pressure values compared to control. OSA+DIMS was associated with a 5.9 [5.3, 6.6] and 3.7 [3.3, 4.2] mmHg difference compared to control, and the increased difference was greater than OSA-alone (systolic: +1.4 [0.8, 2.0]; diastolic: +1.12 [0.7, 1.6] mmHg; p-values &lt; 0.001).Furthermore , OSA-alone and OSA+DIMS were associated with a 37 [22 to 54] and a 60 [36 to 88] % increase in hypertension prevalence compared to control, respectively. OSA+DIMS had a greater increase in hypertension prevalence (17% [-1 to 38%]) compared to OSA-alone.

Conclusion
OSA when combined with difficulties initiating and maintaining sleep, consistent with insomnia symptomology, was associated with higher blood pressure and increased hypertension prevalence compared to OSA-alone.

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0466 Effect of Obstructive Sleep Apnea and CPAP on Telomere Length and its Associated Mechanisms
Authors: Tempaku Priscila , D'Almeida Vânia , Silva Sylvia , Bittencourt Lia , Tufik Sergio 
Published: May 2023

Abstract

Introduction
Growing evidence suggests the contribution of obstructive sleep apnea (OSA) in the molecular pathways of aging related to the maintenance of telomere length. The present study aimed to investigate the effect of OSA and its treatment with continuous positive airway pressure (CPAP) on the variation of telomere length and its associated mechanisms.

Methods
For this, a 6-month randomized, double-blind and sham-controlled clinical trial was conducted. Participants were randomized to CPAP or sham-CPAP and attended 7 visits, in which they underwent clinical assessment and had their blood collected to determine mean leukocyte telomere length (LTL) and the dosage of metabolic and inflammatory markers.

Results
Among 127 individuals that we contacted, 46 met the inclusion criteria. At baseline, individuals in both groups were homogeneous, including LTL (p=0.106). Adherence during the intervention was 5.29 ± 1.09 in the sham-CPAP group and 5.71 ± 0.19 in the CPAP group. After 6 months of intervention, we observed a statistically significant effect of the treatment (p=0.001) on LTL, in which the sham-CPAP group (1.0117 ± 0.1552, 0.9457 ± 0.0747, 0.8482 ± 0.2163) showed a more significant reduction than the CPAP group (1.0960 ± 0.1122, 1.0521 ± 0.1094, 1.0675 ± 0.1225). Furthermore, we found a negative correlation between delta LTL and dela TNF-α at Visit 7 and Visit 1 (rho=-0.216, p=0.003) due to the sham-CPAP intervention (rho=-0.383, p=0.009) in relation to the use of CPAP (rho=0.021, p=0.800).

Conclusion
We can conclude that CPAP, when compared to sham-CPAP placebo, caused an effect on LTL stability, potentially by the modulation of TNF-α.

Support (if any)
Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Fundação de Amparo à Pesquisa de São Paulo (FAPESP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Conselho Nacional de Desenvolvimento Científico Tecnológico (V.A. and S.T. received CNPq fellowships).
0467 Effect of Transoral awake state neuromuscular stimulation therapy on sleep efficiency in patients with mild OSA
Authors: Kumar Kelash , Kallamadi Rekha , Khalil Wajahat , Irfan Muna 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnea can cause fragmented sleep which decreases total sleep time thus decreasing sleep efficiency. Studies have shown improvement in sleep efficiency with the treatment and adherence to therapy for sleep apnea. Due to the CPAP shortage, alternative treatment options for sleep apnea have opted including Transoral awake state neuromuscular stimulation is a novel FDA-approved therapy for mild sleep apnea.

Methods
Transoral awake state neuromuscular stimulation device procured through the regulatory process at VA Minneapolis is offered to veterans with Mild OSA (AHI 5-15) on a home sleep study. A retrospective data analysis was done on the sleep efficiency of veterans who completed the initial 6 weeks of at least 20 minutes of daily followed by maintenance of 2 weeks of twice weekly use. Sleep efficiency was calculated by total sleep time divided by total recording time multiplied by 100.

Results
A total of 112 patients with mild OSA were offered devices as an alternative option for treatment during the period of December 2021 to August 2022. Of these, 22 veterans completed a post-therapy home sleep study. The average age of patients is 53.22 years (ranging from 27-75). The average mean sleep efficiency Pre-therapy was 78.86% (ranging from 62.55% - 95.29%) post-therapy was 82.97% (ranging from 63.52% - 92.23%) A paired t-test was obtained for sleep efficiency which showed a mean difference of 4.11% with a p-value of 0.150 which is statistically non-significant.

Conclusion
Sleep efficiency can be affected by multiple co-morbid conditions among veterans though our study did show a mean difference of 4.11% pre- and post-therapy it was not statistically significant with a p-value of 0.150 that could be related to the small sample size. We proposed that to evaluate sleep efficiency a large sample size is needed with no other co-morbid conditions which can affect sleep efficiency.

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