bluuebunny/crossref_metadata_2025_split huggingface dataset:
0697 Improving Detection of Obstructive Sleep Apnea in Pregnant Women Using a Six-Point Screening Tool
Authors: Jaziri Miriam , Smith Nicolina , Bazan Luisa , Pitts D'Angela , Kalmbach David 
Published: May 2022

Abstract

Introduction
Pregnant patients with obstructive sleep apnea (OSA) are at higher risk for adverse outcomes. There are currently no established screening tools for pregnant women. OSA in pregnancy continues to be underdiagnosed resulting in missed opportunities to prevent possible adverse outcomes.

Methods
A screening pilot program was implemented at our general obstetrics and maternal fetal medicine (MFM) clinic to improve diagnosis of OSA among pregnant women. Patients were screened by a nurse for snoring/apneas, BMI &gt; 35, essential hypertension, glucose disorders, neck size &gt; 36 cm, and symptoms of excessive daytime sleepiness. If a patient scored 3/6 or greater, a home sleep apnea test (HSAT), and in some cases an in-lab sleep study (PSG), was recommended to test for OSA after discussion of risks and benefits with an obstetrician.

Results
Since the initiation of the screening program, 302 women screened positive for OSA based on our 6-point screening tool. Average gestational age at the time of screening was 14.34 +/- 7.97 weeks. Of the women who scored ≥3 on the 6-point screening tool, 92 (30.46%) were referred directly to a sleep study and 31 (10.3%) received a referral to see a sleep medicine provider. A total of 78 underwent sleep testing and 58 (74.4%) were diagnosed with OSA with an apnea-hypopnea index (AHI) ≥ 5. Most patient were African American (67.9%) with an average age of 31.49 +/-5.74. The diagnosis of OSA correlated moderately well with the total score of the 6-point screening tool (p&lt;.001), BMI (p=.005), essential hypertension (p=.01), glucose disorders (p=.07), and neck size (p=.039). Only a BMI of &gt;35 was independently associated with a 3.7 increase in odds for OSA (95%CI=1.17, 11.76, p=.026).

Conclusion
A significant increase in screening for obstructive sleep apnea was achieved with implementation of the new screening protocol. Ease of use makes the six-point screening protocol a useful tool in clinic. More research is needed to test the accuracy of the six-point screening as a testing tool in this population. Additional barriers to screening and testing for OSA in pregnancy, including social and lifestyle factors should be explored in more depth.

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0720 Accuracy of WatchPat Portable Sleep Monitoring and Sleep Assessment in Patients with Atrial Fibrillation
Authors: Roth Robert , Stafford Patrick , Mehta Nishaki , Bilchick Kenneth , Davis Eric , Bonner Heather , Sobremonte-King Michelle , Cho Yelim , Kwon Younghoon 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea(OSA) is an established risk factor for atrial fibrillation(AF), necessitating early diagnosis and management. Home-based sleep-monitoring technology has become a mainstream diagnostic modality. Peripheral arterial tonometry (PAT) device is increasingly being used to screen for OSA in patients with AF. Our study aimed to examine the accuracy of Watch-PAT (WP) in OSA evaluation, and night-to-night variability of sleep characteristics as measured by WP when used during consecutive night sleep studies.

Methods
Patients with history of AF undergoing clinically indicated PSG were prospectively enrolled and had concurrent WP while undergoing PSG. Patients then were studied again using WP over two consecutive days at home. We compared agreement of OSA severity(defined as no OSA[AHI (apnea hypopnea index)&lt;5], mild OSA[15&gt;AHI³5], moderate OSA[30&gt;AHI³15], severe OSA[AHI&gt;30]) and total sleep time(TST) using Cohen’s Kappa(K) for categorical and Bland-Altman plots for continuous variables. To further characterize PSG versus WP, the cohort was stratified into paroxysmal versus persistent AF types. 1A/1B hypopnea scoring criteria was defined as per AASM.

Results
Our cohort included 24 patients with AF(80% male, mean age 68y). Most patients had clinically defined OSA(AHI³5). Patients with persistent AF had more severe OSA than those with paroxysmal AF (severe OSA present in 60% vs. 29%). Comparison of PSG to concurrently conducted WP in the lab showed substantial agreement in OSA severity by both 1A(K=0.623) and 1B(0.706) criteria. Percent difference in TST between PSG versus WP in the paroxysmal AF versus persistent groups was not statistically significant(p=0.387). Comparing two consecutive at-home WP tests showed substantial agreement in OSA severity measures(1A=0.872,1B=0.889). Bland-Altman plots for TST and sleep architecture showed ³95% of residuals within 2 standard-deviations, suggesting intertester agreement. Confidence intervals were broad in these plots reflecting our small sample size.

Conclusion
Our findings demonstrate that WP is a reasonable alternative to PSG, particularly if using the 1B criteria to diagnose OSA. Additionally, our results show that persistent versus paroxysmal AF does not seem to affect the results of WP tests. Night to night variability of OSA measures and TST was small. Future studies should verify the results of our study in a larger cohort.

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0726 Visceral adiposity and daytime sleepiness are associated with hypertension in mild-to-moderate sleep apnea: age-related differences
Authors: Karagkouni Efthalia , Vgontzas Alexandros , Fernandez-Mendoza Julio , Lenker Kristina , Basta Maria , Krishnamurthy Venkatesh , Bixler Edward 
Published: May 2022

Abstract

Introduction
Mild-to-moderate obstructive sleep apnea (OSA) affects 15-40% of the adult general population and is associated with incident hypertension, particularly in young and middle-aged adults. We examined whether visceral adiposity, a key predictor of OSA, and excessive daytime sleepiness (EDS), a cardinal symptom of OSA, are associated with hypertension in middle-aged and older adult patients with mild-to-moderate OSA.

Methods
A clinical sample of 148 adults (53.79±12.45y, 36.5% female) with mild-to-moderate OSA (5≤AHI&lt;30) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure. EDS was defined as an Epworth Sleepiness Scale (ESS) score ≥11. Hypertension was defined as blood pressure ≥140/90mmHg or the use of anti-hypertensive medication. Visceral Adiposity Index (VAI) was calculated within each sex using Amato et al (2010) standardized formulas based on waist, BMI, triglycerides and HDL cholesterol. Logistic regression models examined the association between VAI, AHI and EDS with hypertension, adjusting for sex and stratifying by age. Under the receiver-operating characteristics (ROC) curves (AUC) with sex, BMI, AHI, VAI and EDS as independent variables examined predictive risk of hypertension.

Results
VAI (OR=1.64, 95%CI=1.23-2.20, p=0.001) and EDS (OR=2.73, 95%CI=1.04-7.17, p=0.042), but not AHI (OR=1.05, 95%CI=0.98-1.13, p=0.165), were associated with significantly increased odds of hypertension in adults aged &lt;60y (46.81±8.83y), while none of these associations were significant in adults aged ≥60y (67.06±5.65y). Adding VAI and EDS to standard clinical factors (age, sex, and BMI) yielded a strong risk model for hypertension in adults aged &lt;60y (AUC= 0.80), and weaker in adults aged ≥60y (AUC=0.62).

Conclusion
These data indicate that the combination of visceral adiposity and subjective sleepiness improves markedly the ability for clinicians to detect cases of mild-to-moderate OSA with increased cardiovascular risk, an association that is strongest in young and middle-aged adults. These findings also further support that OSA in older subjects is a distinctly different phenotype than in young and middle-aged adults.

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0733 Elucidating Sleep-Related Health Disparities across The Socioeconomic Spectrum Leveraging a Large-Scale Sleep Registry
Authors: Mehra Reena , Bruckman David , Schold Jesse , Foldvary-Schaefer Nancy , Kazaglis Louis , Alberts Jay , Orbea Cinthya Pena 
Published: May 2022

Abstract

Introduction
Sleep disparities have been implicated as a contributor to overall health disparities in socially disadvantaged groups. Despite epidemiological studies reporting sleep deprivation and poorer sleep quality among those with low socioeconomic status and group minorities, little is known about the extent to which sleep disorders such as sleep-disordered breathing (SDB), varies across the socioeconomic spectrum.

Methods
A retrospective cohort study was conducted utilizing data from the Cleveland Clinic Sleep Laboratory Registry. All adults who underwent diagnostic or split (baseline diagnostic) polysomnogram (PSG) or home sleep apnea test (HSAT) were included in the study. Area Deprivation Index (ADI), a biomarker of neighborhood socioeconomic disadvantage, was calculated by national rank, i.e. 25th, 50th and 75th percentiles; higher quartiles reflect greater deprivation. Generalized linear models adjusted for age, race, sex, body mass index(kg/m2) and primary payer were used to investigate association of ADI with SDB breathing measures (apnea hypopnea index, (AHI) and sleep-related hypoxemia (percentage of total sleep time &lt;90%SaO2, [TST&lt;90]).

Results
The analytic sample included 81,212 sleep studies; 60,013(74%) were PSG and 21,199(26%) HSAT with age: 52.0[41.0, 62.3], 49% females, 19% black race, with BMI=34.5±8.5 kg/m2, 44% with Medicaid and Medicare. Median ADI National Rank 59.0[39.0, 81.0] with higher 4th quartiles in PSG versus HSAT:29.1% vs 16.3%,p&lt;0.001. In the PSG group, ADI was associated with hypoxia measures: TST&lt;90(coefficient p&lt;0.0001), model R2=0.171; mean SaO2(p&lt;0.0001), R2=0.189; minimum SaO2(p&lt;0.0001), R2=0.169; all measures were higher with higher ADI quartiles. In the HSAT group, ADI was associated with mean SaO2(p&lt;0.0001), R2=0.188 and minimum SaO2(p&lt;0.0001), R2=0.181 with all measures being higher with higher ADI quartiles. AHI was associated with ADI(p=0.0032), R2=0.239; but least squares mean AHI did not differ among ADI quartiles in PSG and HSAT groups. Interactions were observed between ADI and age, BMI and male sex (p&lt;0.05), but not race.

Conclusion
Sleep-related hypoxia was greater among patients living in areas of higher deprivation when considering rankings of neighborhoods by socioeconomic disadvantage. Further understanding of the reason for this sleep disorder-related disparity is needed, i.e. further characterizing theoretical domains and social and geographic determinants of income, education, employment, and housing quality with the overarching goal to improve disparities in health.

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0739 Cerebrovascular Response to Intermittent Hypoxia During Sleep in OSA Patients
Authors: Liu Junjie 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with increased risks of cerebrovascular accidents, but it remains unclear how OSA impacts the cerebral vasculature. Intermittent hypoxia is a hallmark feature of OSA and recurs throughout sleep. In awake humans, the cerebrovascular response to intermittent hypoxia has been well characterized, as an increase of blood perfusion that begins at least a few seconds after the start of hypoxia. Functional magnetic resonance imaging (fMRI) that measures the blood oxygen level dependent (BOLD) signal has revealed significant differences between the cerebrovascular responses in awake humans with and without OSA. However, intermittent hypoxia occurs primarily during sleep in OSA, yet the cerebrovascular response to intermittent hypoxia has not been studied during sleep.

Methods
Eight adult patients with severe OSA were recruited to this study. Each subject first underwent an acclimatization session in which they tried to sleep in the MRI scanner while listening to sound recordings of the fMRI. Each acclimatized subject then underwent an overnight study in which T2*-weighed BOLD fMRI of the whole brain was conducted for 1.5-3 hours in total (TE: 35 ms, TR: 2.0 s, 35 sagittal slices, 3.5 mm isotropic). Oxygen saturation (SaO2), chest movement, end-tidal carbon dioxide and scalp encephalography (EEG) were simultaneously recorded with the fMRI. After rigid-body motion correction and removal of artifacts, the temporal correlation between BOLD signal and the SaO2 signal was analyzed on a voxel-by-voxel basis.

Results
Four subjects (50%) were acclimatized to sleep in the MRI scanner and completed this study. In all subjects, the BOLD fMRI signal showed an initial decrease corresponding to the decrease of SaO2, followed by a delayed increase corresponding to the hyperperfusion, throughout the gray matter of cerebral cortex. The time course of BOLD fMRI signal was significantly advanced in time, by 2-4 seconds, in the visual cortex compared to the rest of cerebral cortex in all subjects. This phenomenon was also observed in some other brain regions, but not consistently across subjects.

Conclusion
This study is, to our knowledge, the first study of the cerebrovascular response to intermittent hypoxia during sleep in humans. In patients with OSA, we observed spatiotemporal heterogeneity of the cerebrovascular response, such that the response in the visual cortex was significantly advanced in time than other brain regions. This phenomenon has not been reported before, and future studies are needed to understand how this heterogeneity is associated with OSA.

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AASM Foundation
0740 Correlation of Pharyngeal Critical Pressure with Upper Airway Anatomy in Obstructive Sleep Apnea: A Systematic Review
Authors: Hartfield Phillip , Janczy Jaroslaw , Sharma Abhay , Newsome Hillary , Woodson B , Garcia Guilherme 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is a disease characterized by multiple episodes of upper airway collapse during sleep that causes oxygen desaturation and waking, leading to multiple comorbidities. The gold standard objective measure of upper airway collapsibility is the pharyngeal critical pressure (Pcrit), the nasal pressure at which inspiratory airflow is abolished. The objective of this systematic literature review is to summarize the current understanding of the anatomical factors that determine upper airway collapsibility.

Methods
A search using the PRISMA methodology was performed on PubMed for English language scientific papers that correlated Pcrit to anatomic measurements (such as airway length, airspace cross-sectional area, airway compliance, lung volumes, BMI, neck circumference, and waist circumference). In addition, papers reporting a correlation between Pcrit and the apnea-hypopnea index (AHI) were reviewed.

Results
751 papers were retrieved, and a total of 29 papers that matched eligibility criteria were included in the quantitative synthesis. The literature review confirmed that Pcrit has a significant correlation with the AHI. Pcrit also correlated with multiple anatomic measurements, including airway length, tongue dimensions, lung volume, and measures of obesity including BMI, neck circumference, and waist circumference.

Conclusion
The pharyngeal critical pressure is a measure of disease severity in OSA, as demonstrated by its correlation with AHI. The primary variables determining Pcrit were found to be airway length and measures of obesity. Surprisingly few studies to date have investigated the correlation between Pcrit and pharyngeal compliance and between Pcrit and airway cross-sectional area. In the future, a better understanding of the biomechanical factors that determine upper airway collapsibility is expected to help identify the optimal intervention of each phenotype of airway collapse for personalized medicine.

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Medical College of Wisconsin Department of Otolaryngology
0746 Mediation of Biomarkers of Inflammation in Sleep-Related Hypoxia and COVID-19 Clinical Outcomes
Authors: Orbea Cinthya Pena , Wang Lu , Shah Vaishal , Jehi Lara , Milinovich Alex , Foldvary-Schaefer Nancy , Chung Mina , Aboussouan Loutfi , Mehra Reena 
Published: May 2022

Abstract

Introduction
Central to the pathophysiology of SARS-CoV-2 is immune dysregulation and systemic inflammation, however, it is yet unknown whether sleep-related hypoxemia--which we have recently noted to be associated with worse COVID-19 clinical outcomes--is mediated by these biomarkers and pathways.

Methods
Data from patients who tested positive for SARS-CoV-2 and part of the integrated Cleveland Clinic COVID-19 and sleep laboratory registries from March-November 2020 were included. To assess the mediation effect of biomarkers, the relationship between sleep-related hypoxia measures (% sleep time&lt;90%SaO2,T90) and moderate/severe WHO-7 COVID-19 score (use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ECMO or death) was first tested. The mediation effect, or natural indirect effect, of biomarkers of inflammation (C-Reactive Protein (CRP), white blood cell (WBC) count (with a focus on lymphocyte count) and lactate) was then estimated by logistic regression models adjusted for demographics, comorbidities, smoking pack year and site location using PROC CAUSALMED statement in SAS software (version 9.4, Cary, NC).

Results
The analytic sample included 446 patients hospitalized due to COVID-19: age:63.3.±13.8 years,51.3% female,39% African American with body mass index(BMI)=36.1±9.3kg/m2. Thirty-six percent used supplemental oxygen, 4% used high-flow or non-invasive ventilation,5% required ECMO or mechanical ventilation and 2% died. Hypoxic measures were associated with moderate/severe WHO-7 COVID-19 outcome: T90 median (&gt;1.8%vs.≤1.8%) (OR=2.04, 95%CI:1.28-3.23,p=0.003), 5% increases in both mean SaO2 (OR=0.43, 95%CI: 0.26-0.70,p=&lt;0.001) and minimum SaO2 (OR=0.84, 95%CI: 0.72-0.99,p=0.03). CRP was associated with mean SaO2 (p=0.040) and minimum SaO2 (p=0.029), likewise mediation analysis showed that there was a significant natural indirect effect of CRP in both hypoxia measures (OR=0.86,95%CI 0.73-0.99,p=0.036;OR=0.95,95%CI 0.90-1.00,p=0.034 respectively). WBC count, but not lymphocyte count subset, was associated with mean SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23. Lactate was associated with minimum SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23). T90 median was not associated with CRP(p=0.13), WBC count(p=0.87) or lactate(p=0.28).

Conclusion
CRP appears to represent a relevant mediator of sleep-related hypoxia and WHO-7 clinical outcomes. Further investigation is needed to elucidate if treatment of sleep-related hypoxia downregulates biomarkers of systemic inflammation to modify disease course.

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0755 Comparison of clinical pathways for upper airway stimulation management: in-laboratory titration polysomnography versus home-based efficacy sleep testing
Authors: Kent David , Huyett Phillip , Yu Phoebe , Roy Asim , Mehra Reena , Rundo Jessica , Stahl Stephanie , Manchanda Shalini 
Published: May 2022

Abstract

Introduction
Upper airway stimulation (UAS) therapy is an alternative treatment option for select CPAP-intolerant patients with obstructive sleep apnea. Current standard-of-care management uses in-laboratory polysomnography for titration of UAS stimulation amplitude (tPSG) after 3 months of patient self-titration at home. This home monitoring study was designed to evaluate whether tPSG or efficacy home sleep test (eHST) with tPSG by exception for eHST non-responders would have non-inferior apnea-hypopnea index (AHI) outcomes.

Methods
Enrolled patients underwent UAS implantation as part of regular clinical care and were randomized at the activation visit 1:1 between tPSG or eHST for the 3-month post-activation visit. If eHST results were suboptimal (AHI &gt; 15 events/h or &lt; 50% reduction from baseline AHI) patients underwent tPSG titration at 5 months. Both groups had 2-night eHSTs at 6 months post-activation. The primary endpoint was 6-month AHI equivalence between arms (defined as ± 15 events/h). Secondary endpoints were equivalence of Epworth Sleepiness Score (ESS; ± 2), oxygen desaturation index (ODI; ± 15 events/h), and nightly UAS device usage (± 0.5 h).

Results
The study randomized 60 patients from August 2020 through September 2021, who were primarily middle aged (57 ± 10 years), male (67%), Caucasian (98%), and overweight (BMI 29 ± 3 kg/m2), with severe OSA (AHI 35 ± 16). Eleven patients withdrew from the study early. As of December 2021, 41 and 36 patients have completed 3- and 6-month follow-up visits, respectively. Six-month visit AHI, ESS, ODI, and device usage data between arms is currently blinded and is expected to be complete by Q2 2021 prior to SLEEP 2022.

Conclusion
If the study demonstrates equivalent 6-month AHI, ESS, ODI, and usage outcomes, the use of eHST to ascertain therapy efficacy prior to tPSG could be a non-inferior alternative management option to tPSG.

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Sponsored by Inspire Medical Systems, Inc.
0757 Cluster Analysis for Identifying Good CPAP Adherence Using the PSG Parameters and Patient Characteristics
Authors: Hamada Eriko , Yamauchi Motoo , Fujita Yukio , Ikegami Azusa , Shirahama Ryutaro , Takaoka Toshio , Nishijima Tsuguo , Yoshikawa Masanori , Muro Shigeo 
Published: May 2022

Abstract

Introduction
CPAP is the standard treatment for obstructive sleep apnea (OSA). One of the important clinical issues to be solved is poor CPAP adherence. A growing body of studies has identified predictive factors for CPAP adherence including AHI, BMI, age, gender, symptoms, etc. When our sleep physicians prescribe CPAP, we would consider these known factors in multiple ways. One may want to know factors' combinations rather than each factor. In this case, cluster analysis might be useful since it is a powerful data-mining tool to sort various factors into meaningful groups. Recently, cluster analysis has been adopted for research of sleep breathing disorders. However, no one has adopted to predict CPAP adherence. In this study, we aimed to explore the usefulness of cluster analysis to predict CPAP adherence using the diagnostic PSG parameters and patients’ characteristics.

Methods
The study design was a retrospective observational multi-center study including 5 certified sleep centers in Japan. For 2 years from 2017, 1133 patients who were diagnosed with OSA with in-lab PSG and newly initiated CPAP therapy were enrolled. We performed cluster analysis using the K-means clustering. Variables for clustering were determined by several sleep physicians among PSG parameters and patients’ characteristics. We assessed CPAP adherence for 90 days and 365 days after CPAP initiation in each created cluster. We adopted CMS criteria for good CPAP adherence, which is, more than four hours of use on 70% of nights.

Results
Cluster analysis classified 5 clusters. A significant difference in CPAP adherence for 90 days and 365 days was seen among 5 clusters with a test of independence (p=0.001, p=0.005, respectively). The cluster presenting moderate obese, very high AHI and ODI, and apnea predominant indicated good adherence, whereas the cluster presenting morbid obese, very high AHI and ODI, sustained severe hypoxia, younger age, and daytime sleepiness indicated poor adherence according to the post-hoc Chi-square test.

Conclusion
Cluster analysis successfully distinguished the different CPAP adherence and identified a combination of OSA patients’ profiles. Thus, cluster analysis would be a useful tool for predicting long-term CPAP adherence.

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