bluuebunny/crossref_metadata_2025_split huggingface dataset:
0780 Continuous Positive Airway Pressure Adherence and the Risk of 30-day Hospital Readmission in Older Adults with Obstructive Sleep Apnea and Cardiovascular Disease
Authors: Bailey M Doyinsola , Wickwire Emerson , Albrecht Jennifer 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) negatively impacts outcomes among patients with pre-existing cardiovascular disease (CVD). Evidence suggests treating OSA can prevent additional cardiovascular events and health care utilization, but the benefits of continuous positive airway pressure (CPAP) are strongly related to adherence. We evaluated the effect of adherence to CPAP on 30-day hospital readmissions among Medicare beneficiaries with OSA and pre-existing CVD.

Methods
We conducted a retrospective study of a 5% sample of Medicare beneficiaries aged ≥ 65 years with pre-existing CVD who were newly diagnosed with OSA, initiated CPAP 2009-2013, maintained continuous Medicare coverage for 24 months post-CPAP initiation, and had at least one hospitalization. Monthly indicators of CPAP adherence (charges for machines, masks, or supplies) were summed over 25 months to create a CPAP adherence variable and then beneficiaries categorized as low, partial, or high adherers (i.e., &lt;4, 4-12 and &gt;12 CPAP charges, respectively).The primary outcome was the risk of 30-day readmission. Bivariate associations were assessed between CPAP adherence status, covariates, and potential confounders. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using logistic regression models, controlling for demographic factors, and pre-existing comorbidities. Statistical significance was assessed at p &lt; 0.05.

Results
We identified 1,301 beneficiaries meeting study criteria. The mean age was 73±6 years, 87% were White (n=1,137), and 53% were male (n=684). In the 2-year period following CPAP initiation, the overall 30-day readmission rate was 10.2%. Beneficiaries who were readmitted were more likely to be male and with a higher comorbidity burden. In adjusted models and compared to patients with low CPAP use (&lt;4 charges), those with partial use (4-12 charges) and high use (&gt;12 charges) had a lower odds of 30-day readmission (OR = 0.82, 95% CI 0.53-1.23 and OR = 0.41, 95% CI 0.24-0.70).

Conclusion
In this nationally representative sample of older adults with CVD and comorbid OSA, higher CPAP use was associated with decreased odds of 30-day readmission, highlighting the importance of adherence in mitigating negative outcomes.

Support (If Any)
This work is supported by an investigator-initiated grant and a diversity supplement from the American Association of Sleep Medicine Foundation (Albrecht, PI).
0786 Assessing the Adequacy of Auto Titrating Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea Diagnosed on Home Sleep Testing
Authors: Burcovschii Serghei , Beshay Sarah , Majid Ruckshanda , Mathew Reeba 
Published: May 2022

Abstract

Introduction
Auto titrating positive airway pressure (Auto-PAP) therapy has been increasingly prescribed to treat obstructive sleep apnea (OSA) without reliance on in-laboratory PAP titration studies. Given the current pandemic and the limited use of in laboratory titrations, Auto-PAPs have been prescribed increasingly. The ability to achieve optimal control of obstructive events with Auto-PAP for patients with severe OSA (respiratory disturbance index (RDI) &gt;30/hour of recording) on home sleep apnea testing (HSAT) has not been systematically investigated. Our study looks at the success of treatment on Auto-PAP in patients diagnosed with severe OSA on HSAT.

Methods
We retrospectively reviewed charts of patients who were diagnosed with severe OSA on HSAT and were prescribed an Auto-PAP at the Memorial Hermann – Texas Medical Center Sleep Disorders Center between September 2019 and May 2020. The usage data, residual AHI and adherence was assessed. Successful treatment was determined as a residual AHI (rAHI) &lt;15. We excluded patients those who were non-adherent to PAP therapy. This study was conducted as a quality improvement initiative at our institution.

Results
We identified 24 patients diagnosed with severe OSA on HSAT and prescribed Auto-PAP. Nine patients were excluded due to non-adherence to Auto-PAP (37%). Of the remaining 15 patients, 80% were male, the average age was 53.7 years (range 36-69) and the average RDI on HSAT was 51.4 events/hour (SD 17.1). The average usage &gt;4 hours was 76% in the adherent patients. The median pressure on Auto-PAP was 9 cm H2O (range 5.3-16.3). The average rAHI of 1.8 events/hour (range 0.3- 6.1). Usage data revealed only 1 patient with rAHI&gt;5 and central apnea index of 3.9, who was then referred for an in-lab PAP titration study.

Conclusion
Sensors in the airway circuit of PAP devices measure airflow, vibration, and flattening of the airflow profile. Auto-adjusting PAP devices use this feedback to make online adjustments in pressure to maintain upper airway patency. Our study suggests that Auto-PAP is an effective initial therapy even for severe OSA, permitting both timely and adequate control of OSA especially when in laboratory titrations are limited. Close monitoring is however recommended to ensure adherence, and also to assess the potential emergence of central events.

Support (If Any)
0787 Healthcare Utilization in Initiation of Oral Appliance vs Positive Airway Pressure Therapy for Sleep Apnea
Authors: Stothard Ellen , Hickey Mark , Wertz Adam 
Published: May 2022

Abstract

Introduction
The COVID-19 pandemic and related supply chain issues have created shortages in integral components of Positive Airway Pressure (PAP) devices, the gold standard treatment for sleep apnea. Concurrently, patients have delayed care and are returning in increasing numbers. With these overlapping pressures, alternative treatments are needed. Custom-fabricated Oral Appliances (OA) are uniquely poised as a solution. However, it is unknown if initiation and treatment cost and healthcare utilization are similar to PAP or will create further disruptions at scale.

Methods
Patients who initiated PAP or OA therapy 2018-2020 were included. Matched visits 2017-2021 were referenced. Patients with multiple treatment initiations were excluded. Healthcare utilization quantified number visits, stratified by provider type (Physician, Physician Assistant (PA), American Board of Dental Sleep Medicine (ABDSM) Accredited Dentist, or Registered Polysomnographic Technologist (RPSGT)). Contractual amounts for CPT codes were averaged to estimate cost.

Results
5172 patients, 374 received OA (7.2%). Prior to initiation, OA therapy utilized more visits on average than PAP (4.5±1.7(±SD) vs 3.5±1.9, p&lt;0.0001). Following initiation, OA therapy utilized fewer visits than PAP (4.1±3.9 vs 5.5±4.6, p&lt;0.0001). Specialized provider visits, i.e. dentist for OA, were lower compared to RPSGT for PAP therapy, both before and after initiation (1.4±0.8 vs 2.0±1.4 before, 1.9±1.2 vs 2.6±1.8 after, both p&lt;0.0001). Further, prior to initiation, Physician and PA utilization was similar between OA and PAP therapies (1.4±0.8 vs 1.5±1.0 Physician, 1.1±0.8 vs 1.2±0.8 PA, both p&gt;0.057). However, following initiation, OA therapy utilized fewer Physician visits than PAP (1.7±1.1 vs 2.1±1.7, p&lt;0.0001) but similar PA visits (1.9±1.5 vs 2.1±1.4, p&gt;0.5). Together, with OA dental visits estimated to be the least expensive associated visit, this analysis estimates that the provider cost of initiation of OA therapy is lower than that of PAP.

Conclusion
Overall, OA therapy requires less healthcare utilization, especially of providers with highest reimbursement rates. While OA requires more initial appointments, PAP therapy requires more follow up visits with specialized providers and physicians, thereby increasing cost for patients. Additional cost burden of these visits could impact patient willingness to initiate treatment. This analysis provides supportive evidence for OA as an alternative to PAP with lower treatment cost and healthcare utilization, which may provide an advantage for the already over-burdened healthcare system.

Support (If Any)
0789 Mask Magnets May Interact with Pacemakers and Implantable Cardioverter-Defibrillators
Authors: Ruoff Chad , Tashman Yasemin , Miller Bernie , Houser Ryan , Cheema Kamal , Haley Caitlin , Petersen Ann , Lizak Matthew , Goswami Umesh , Lizak Trevor , Krahn Lois , Srivathsan Komandoor 
Published: May 2022

Abstract

Introduction
Placing a magnet over a Permanent Pacemaker (PPM) or Implanted Cardioverter-Defibrillator (ICD) may cause the device to pace asynchronously or inhibit tachyarrhythmia detection, respectively, potentially preventing delivery of electrical shocks. Manufacturers for masks used with positive airway pressure devices have started using magnets in place of more traditional headgear clips to connect the headgear to mask. Mask manufactures do not list presence of a PPM/ICD as a contraindication to use of a mask with magnet but do recommend keeping the mask some distance away from PPM/ICD. A published case series describes two patients with magnet response events captured during PPM/ICD interrogation that correlated with nightly use of CPAP. The authors were able to replicate the response by placing the mask with magnet directly over the patient’s pulse generate site. Although we advise all patients with implanted device to avoid use of masks with magnets, select patients refuse to stop using mask with magnets regardless of our policy. We, therefore, started offering these patients referral for PPM/ICD interrogation to evaluate for an interaction between mask with magnet and PPM/ICD as next best alternative.

Methods
We retrospectively reviewed all patients (n=10) referred for routine PPM/ICD interrogation to test whether the mask with magnet interacted with PPM/ICD when mask on face as during normal use (i.e., simulated normal use) or magnetic area of mask placed directly over the PPM/ICD (i.e., direct contact).

Results
Although no interaction was detected in any patient (n=10) with simulated normal use (0 %), one interaction was documented with direct contact (10 %).

Conclusion
Although simulated normal use of masks with magnets did not demonstrate any interactions, it is concerning that one patient (10 % of patients) demonstrated an interaction with direct contact of magnetic area of mask over the PPM/ICD. It is not uncommon for patients to remove a mask during the night while sleeping. This preliminary data along with the published case series calls for further research and increased awareness of this potential interaction for both sleep and cardiac health care providers.

Support (If Any)
None
0790 Racial Differences in Self-Efficacy for Positive Airway Pressure Therapy Among Individuals Newly Diagnosed with Obstructive Sleep Apnea
Authors: Byrne Sean , Sharma Akanksha , Deng Annan , Chu Jen-Hwa , Sands Scott , Wellman Andrew , Redeker Nancy , Yaggi Henry , Zinchuk Andrey 
Published: May 2022

Abstract

Introduction
Continuous positive airway pressure (CPAP) therapy is the first-line treatment for OSA, yet its effectiveness is limited by poor adherence. Self-efficacy is an individual’s belief that they can successfully execute a behavior to achieve a desired outcome. Evidence shows that self-efficacy predicts adherence to and outcomes of CPAP therapy, as do race and ethnicity. Little, however, is known about how self-efficacy may differ between racial and ethnic groups. Accordingly, we aimed to determine whether self-efficacy for CPAP differs by race and ethnicity among individuals newly diagnosed with OSA.

Methods
Adults newly diagnosed with OSA and prescribed CPAP who were enrolled in the NICEPAP Study (n=267, NCT05067088), a prospective, observational cohort study investigating predictors of CPAP adherence were assessed. Those with need for non-CPAP therapy or with unstable medical conditions (e.g., cancer receiving chemotherapy, severe lung, heart or mental health disorders) were excluded. Exposures were race and ethnicity. Outcomes were subscale scores of the Self-Efficacy Measure for Sleep Apnea (SEMSA) completed prior to CPAP initiation: perceived risk, outcome expectancy, and self-efficacy. SEMSA sub-scale scores for race/ethnicity were compared using Kruskal-Wallis test. Medians (Q1, Q3) are reported.

Results
We analyzed data for 52 participants (33 women) enrolled to date who identified as White (n=29), Black (n=14), More than one race (n=5) and Other (N=5). Participants were 51.0 (36.8, 58.8) years old with an apnea-hypopnea index of 17.0/hour (11.1, 26.0) and body-mass-index of 35.0 (31.6, 43.5) kg/m2. Baseline characteristics did not differ by race, except higher poverty (p=0.005) and less completed years of education (p=0.010) for Black participants. The SEMSA scores were not statistically different between each race. However, self-efficacy was significantly lower for Black participants vs. rest of the cohort combined (2.4 (1.9, 3.1) vs. 3.3 (2.7, 3.8) p=0.020). Poverty, but not education, may be a potential mediator of this relationship (mediation analysis p=0.052). There were no differences in SEMSA scores between Hispanic and Non-Hispanic participants.

Conclusion
In our cohort, self-efficacy for OSA therapy was lower for Black participants compared to those of other races. Targeting early interventions to improve CPAP self-efficacy in Black patients may improve OSA therapy outcomes.

Support (If Any)
0795 Association of Nasal and Sleep Apnea Clinical Measures
Authors: Ikeda Allison , Weaver Edward 
Published: May 2022

Abstract

Introduction
The association between nasal measures and polygsomnography measures is modest. However, nasal treatment can improve sleep quality in people without sleep apnea. The association of nasal and sleep apnea clinical measures in patients with sleep apnea is unknown. Our primary hypothesis is that the subjective nasal obstruction is associated with reduced sleep apnea-specific quality of life at baseline and with sleep apnea treatment after 6 months.

Methods
This prospective cohort study included patients with newly diagnosed sleep apnea who were prescribed CPAP. Data were collected before CPAP and 6 months later, including the validated Nasal Obstruction Symptom Evaluation (NOSE, range 0-100, higher worse) scale and validated Symptoms of Nocturnal Obstruction & Related Events (SNORE-25, range 0-5, higher worse) quality of life instrument. Additional nasal measures, sleep apnea clinical measures, and covariates were collected. We tested the association between nasal and sleep apnea clinical measures with multivariate linear regression, adjusting for important confounding variables.

Results
The cohort (N=242) was middle-aged (47+/-12 years), included both sexes (65% men), and had severe sleep apnea (apnea-hypopnea index 33+/-24 events/hour). The baseline NOSE was strongly associated with SNORE-25, independent of demographics, comorbidity, and sleep apnea severity: beta 18, 95% CI 15-22, p&lt;0.001, meaning for every unit of SNORE-25 increase there was an adjusted increase in NOSE score of 18. The 6-month changes in NOSE and SNORE-25 were strongly associated, independent of demographics, comorbidity, sleep apnea severity, and CPAP use: beta 17, 95%CI 13-22, p&lt;0.001. Secondary nasal and sleep apnea clinical measures were associated, but nasal and polysomnography measures were not associated.

Conclusion
Nasal clinical measures are associated with sleep apnea clinical measures at baseline and with sleep apnea treatment, while the nasal measures are not associated with polysomnography measure. These data support the importance of the nasal airway on sleep apnea clinical outcomes.

Support (If Any)
R01 HL084139 (Weaver), T32 DC000018 (Stone), Seattle Veterans Affairs Medical Center
0802 Central Sleep Apnea as a Result of Cerebral Cavernous Malformation Hemorrhage in the Pediatric Population
Authors: Bowling Joshua , Hassan Fauziya 
Published: May 2022

Abstract

Introduction
Cerebral Cavernous malformations (CCMs) consist of a collection of capillaries in the central nervous system (CNS) that are enlarged and irregular in structure. Patients with CCMs are at increased risk of hemorrhage into the brain or spinal cord, resulting in seizures, focal neurologic deficits, hydrocephalus, and death. Given the importance of the brainstem and central chemoreceptors in regulating respiratory function, rupture of CCMs can also lead to dysregulation of breathing. We present a series of 3 pediatric patients who have a diagnosis of central sleep apnea (CSA) due to rupture of CCMs managed with home ventilators with significant differences in clinical presentation from mild CSA to night time respiratory support for severe CSA and chronic respiratory failure requiring continuous mechanical ventilation.
Report of Cases: Subject 1 is a 13 yo M with a history of ruptured posterior fossa
arteriovenous malformation (AVM) complicated by post-hemorrhagic hydrocephalus, right hemiparesis and severe central apnea requiring nighttime mechanical ventilation via
tracheostomy. Subject 2 is a 19 yo M with a history of mid-pontine cavernoma with multiple episodes of hemorrhage failing surgical resection resulting in right hemiparesis, severe central apnea and hypoventilation requiring continuous mechanical ventilator support via tracheostomy. Subject 3 is a 6 yo F with a history of thoracic cavernous hemangioma resulting in spinal cord injury and mild central sleep apnea requiring mask ventilation via home ventilator during sleep. All of these patients experienced loss of respiratory drive as a result of complications from brainstem or spinal cord lesions with varying degrees of ventilator support requirement and clinical presentation.

Conclusion
Due to the propensity for CNS bleeds among patients with CCM they are at increased risk of respiratory compromise. Home ventilator support can be used effectively to treat central apneas and chronic respiratory failure but this is a moving paradigm as subsequent bleeds worsen respiratory compromise.

Support (If Any)
Support (if any):
0803 Extreme upper extremity movements in patient with narcolepsy type 1 and REM sleep behavior disorder affecting actigraphy results
Authors: Galagan Jack , York Carla , Soca Rodolfo 
Published: May 2022

Abstract

Introduction
Narcolepsy with Cataplexy is a central disorder of hypersomnia that is characterized by excessive daytime sleepiness and Rapid eye movement (REM) dissociation phenomena. A common manifestation of narcolepsy is REM behavioral disorder (RBD), a parasomnia characterized by loss of muscle atonia during REM sleep (RSWA). While RBD is relatively common in patients with narcolepsy, very extreme movements are considered rare.
Report of Cases: A 20-year-old male with no significant past medical history presented with 8 months of new onset daytime sleepiness, sleep paralysis, and auditory hallucinations at sleep onset. After initial evaluation at our sleep center, he was scheduled for actigraphy testing and sleep logs, followed by video polysomnogram and mean sleep latency testing (MSLT). Initial PSG results were notable for a total sleep time of 498 minutes, a normal apnea-hypopnea index of 0.7/hr., sleep onset latency of 0 minutes, and REM latency of 0 minutes. Based upon military medical standards, the MSLT scheduled for the following morning was cancelled due to limited sleep during the preceding 2 weeks as measured via actigraphy. However, the patient’s sleep logs
reported over 7.5 hours of sleep per night. The patient’s video PSG was reviewed, which
showed evidence of frank RSWA, as well as episodes of dream enactment behavior during REM
sleep, all including very violent movement in his upper extremities. Repeat trial of MSLT 2
weeks later showed mean sleep latency of 1.7 minutes, with 5 sleep onset REM periods
(SOREMPS), and evidence of dream enactment involving the upper extremities during 3 of
these SOREMPS.

Conclusion
We present the case of a patient with narcolepsy and RBD with significant upper extremity movements to the point of affecting the actigraphy sleep/wake detection algorithm. Actigraphy has been validated as a diagnostic tool in assessing sleep and wake patterns in individuals without significant REM sleep dissociation phenomena; however, our case highlights the necessity of further research of the validity of actigraphy in patients with Narcolepsy and/or REM behavioral disorder.

Support (If Any)
0806 REM sleep without atonia in the Setting of Duchenne muscular dystrophy: Can it Serve a Protective Role?
Authors: Sarrami Kayvon , Patel Jay , Sisan Mahtab Moshtagh , Avidan Alon 
Published: May 2022

Abstract

Introduction
Duchenne muscular dystrophy (DMD) has well-known associations with sleep-related breathing disorders such as sleep apnea and nocturnal hypoventilation. These disorders naturally follow from the progressive muscle weakness that is the hallmark of DMD. New data is emerging on the prevalence of other polysomnographic features affecting patients with DMD, particularly as they relate to the phenotype of the sleep disorders unique to DMD. We report on a patient with REM sleep without atonia (RWA) in DMD.
Report of Cases: A 13-year-old male with DMD was referred for a polysomnogram (PSG) due to new-onset snoring, but there was no history to suggest dream enactment behavior. He was not taking any CNS-acting medication such as serotonergic or sedative-hypnotic medications. Neurologic examination was notable for diffuse symmetric muscle weakness requiring the use of a wheelchair. PSG revealed obstructive sleep apnea syndrome with an apnea-hypopnea index of 3/hr overall and 5/hr during REM sleep, a respiratory disturbance index of 9/hr with minimum O saturation of 84%, and evidence of RWA in three 30-second epochs meeting AASM scoring criteria. Dream-enactment behavior was absent during the PSG and historically.

Conclusion
We report on a previously unrecognized finding of RWA the setting of DMD. While sleep studies are routinely performed in DMD due to the significant association with sleep-disordered breathing and REM-related hypoventilation, the presence of RWA was unusual. The finding of RWA in the setting of a dystrophinopathy prompts important questions. While it is unlikely that RWA is an emerging sign of an ⍺-synucleinopathy in the setting of DMD, its presence in a young teenager raises the possibility of hypocretin deficiency in the setting of DMD, as is the case with myotonic dystrophy type 1 reflecting impaired hypocretin neurotransmission. However, a more attractive explanation is that RWA may promote a protective effect against sleep apnea in patients with vulnerability to REM-related hypoventilation. Our data suggest a potential protective role conferred by the preservation of muscle tone in the setting of sleep apnea in neuromuscular conditions.

Support (If Any)
None