bluuebunny/crossref_metadata_2025_split huggingface dataset:
0764 Evaluation of cloud-connected home sensors of apnea-hypopnea index versus polysomnography and home sleep test during upper airway stimulation home titration
Authors: Huyett Phillip , Yu Phoebe , Kent David , Stahl Stephanie , Manchanda Shalini , Mehra Reena , Rundo Jessica , Roy Asim 
Published: May 2022

Abstract

Introduction
A growing number of cloud-connected sensors can longitudinally record apnea hypopnea index (AHI) at home. The Ectosense NightOwl is an FDA-approved peripheral arterial tomography device; the Withings Sleep Analyzer mat is an under-mattress sensor with AHI data for retrospective research use (CE marked, not FDA approved). We used these sensors to monitor patients with upper airway stimulation (UAS) therapy during therapy acclimatization and post-titration follow-up and compared sensor AHI to polysomnography (PSG) and home sleep test (HST) AHIs.

Methods
Enrolled patients underwent UAS implantation as part of regular clinical care and were required to have a smartphone. The Ectosense and Withings sensors were distributed at UAS device activation. Patients were asked to use NightOwl weekly, and Withings provided nightly AHI. Sleep studies (PSG & HST) occurred at 3 and 6-mo post implant. Ectosense & Withings AHI were averaged and correlated against the nearest 3- and 6-month sleep study AHIs.

Results
Patients were 67% male, aged 57 ± 10 years. Smartphone platforms were 59% Apple iOS, 24% Google Android, and 17% Unknown. As of October 2021, 45 patients have had near-simultaneous Withings and PSG/HST AHI, 35 have had near-simultaneous NightOwl and PSG/HST AHI. The Withings AHI was fairly linear against PSG/HST AHI, adjusted R2 = 0.47, p &lt; 0.0001, (y=10 + 0.82x). Withings AHI &lt; 15 (n=18) had a 90% positive predictive value for a PSG/HST AHI less than 15 (n=20). Ectosense data was less linear and more scattered, adjusted R2 = 0.15, p=0.01, (y=14 + 0.47x). Ectosense AHI &lt; 15 (n=12) had an 80% positive predictive value of a PSG/HST AHI less than 15 (n=15).

Conclusion
Home-based sensors provide longitudinal SDB data in a home setting and may adequately classify patients with mild sleep apnea, and may have utility for home-based management of UAS patients in the post-implantation period.

Support (If Any)
Inspire Medical Systems
0812 Periodic Limb Movements in the Setting of Pediatric Traumatic Brain Injury
Authors: Willis Aaron , Petitto Lacie , Revana Amee 
Published: May 2022

Abstract

Introduction
Sleep disturbances following traumatic brain injury (TBI) are commonly diagnosed and can affect up to 70% of individuals, with many occurring after mild injuries such as concussions.1 Patients can experience a variety of sleep problems such as sleep-wake disturbances, infrequent parasomnias, and periodic limb movement disorders. While periodic limb movements (PLMs) can occur in pediatric patients, they are rare compared to their adult counterparts. Literature is limited regarding the presence of PLMs post-concussion in the pediatric population. We describe an unusual case of PLMs in the setting of mild TBI in a pediatric patient.
Report of Cases: A 6-year-old male with a past medical history significant for adeno-tonsillar hypertrophy and chronic cough was brought to the emergency department by ambulance after being found facedown secondary to a fall at school. Physical examination findings were significant for dried blood at the nares with an abrasion to the anterior nasal bridge. No other signs of trauma were noted, and his Glasgow Coma Scale (GCS) was 15. Computerized Tomography (CT) scan of the head was negative for any acute intracranial abnormality. He was diagnosed with a mild TBI and sent home with concussion precautions. Prior to his concussion, at the age of 4, he was diagnosed with obstructive sleep apnea (OSA) via polysomnography (PSG). Moderate OSA was noted with an apnea hypopnea index (AHI) of 8.1 per hour leading to adenotonsillectomy. Five weeks after his concussion, an evaluation by the pediatrician revealed complaints of restless sleep and worsened emotional lability prompting a referral to the sleep clinic. By comparison, the patient’s post-TBI PSG at age 6 showed no evidence of sleep-disordered breathing (AHI of 1.48 per hour) but with new periodic limb movements and an elevated PLM index of 6.56 per hour. An iron panel is pending.

Conclusion
PLMs in the setting of pediatric TBI is a rarely diagnosed entity and, to our knowledge, has never been reported in the literature. Our case suggests that clinicians should have a high level of suspicion for sleep problems post-TBI and consider PSG to assess for PLMs which can affect recovery and the overall quality-of-life of the pediatric patient.

Support (If Any)
Viola-Saltzman M, Watson NF. Traumatic brain injury and sleep disorders. Neurol Clin. 2012;30(4):1299-1312. doi:10.1016/j.ncl.2012.08.008
0822 Caffeine as a treatment option for primary central sleep apnea of infancy in term infants
Authors: Shah Amit , Kasi Ajay , Shah Samar , Martinez Fran , Leu Roberta 
Published: May 2022

Abstract

Introduction
Primary central sleep apnea of infancy tends to improve over weeks with supportive care. No established treatments exist; however, infants with this condition remain at risk from sequelae of intermittent hypoxemia. We present a term infant with primary central sleep apnea of infancy treated with caffeine citrate resulting in clinical and polysomnographic improvement.
Report of Cases: A 7-day-old male infant born at 37 weeks gestation (gestational age confirmed by early first trimester prenatal ultrasound) was hospitalized following an episode of hypotonia and decreased responsiveness. Infectious studies, chest radiograph, and echocardiogram were
normal. During the hospitalization, oxygen desaturations during sleep were observed and
capillary blood gas during sleep showed a pH of 7.36 and a partial pressure of carbon dioxide of
54 mmHg. Polysomnography on room air showed central sleep apnea [central apnea hypopnea
index (AHI) of 58, obstructive AHI of 4, hypoxemia, hypoventilation with transcutaneous carbon
dioxide greater than 50 mmHg for 89% of sleep time, and periodic breathing for 21.7% of
sleep time]. Brain MRI and paired-like homeobox2B (PHOX2B) genetic testing were normal. A
trial of caffeine citrate was initiated with prompt resolution of oxygen desaturations during
sleep. Serial capillary blood gases showed improvement with partial pressure of carbon dioxide
between 39-44 mmHg. Polysomnography on room air three days after caffeine initiation
demonstrated resolved hypoxemia, hypoventilation, periodic breathing, obstructive sleep
apnea, and central sleep apnea (central AHI of 6.8). The patient was discharged home on
caffeine and continuous pulse oximetry during sleep. At follow-up six weeks later, the patient
had no oxygen desaturations and was successfully weaned off caffeine.

Conclusion
To our knowledge, there are no prior reports of term infants being treated with caffeine citrate for primary central sleep apnea of infancy. While caffeine is an established therapy for apnea of prematurity, it is typically discontinued at a postmenstrual age of 32 - 34 weeks. Our case demonstrates that in term infants with no underlying medical conditions and primary central sleep apnea of infancy, immature regulation of respiration should be suspected, and a trial of caffeine may be considered.

Support (If Any)
None.
0827 Obstructive Sleep Apnea in a Congenital Central Hypoventilation Syndrome Patient Post-Tracheostomy Ventilated with Diaphragmatic Pacing
Authors: Cocozza Victoria , Kim David , Hansen Shana , Frey William 
Published: May 2022

Abstract

Introduction
Congenital central hypoventilation syndrome (CCHS) is a rare, autosomal dominant disorder associated with a genetic mutation in the PHOX2B gene. While the treatment of CCHS requires lifelong ventilatory support, advancements in management have allowed for life expectancies comparable to healthy individuals. Prolonged lifespan of CCHS patients presents new challenges with regards to the chronic management of the disease, including the concurrence of obstructive sleep apnea (OSA) in patients ventilated with diaphragmatic pacing post decannulation.
Report of Cases: A 23-year-old female with a past medical history of adenotonsillectomy and CCHS with nocturnal ventilatory support via diaphragmatic pacer (DP) was referred to sleep clinic by her pulmonologist for an evaluation of increased obstructive events and worsening nocturnal hypoxia. The patient did not require daytime ventilatory support and did not complain of any sleep-related symptoms. The DP was implanted at age 17 and the patient previously had a
tracheostomy from age 3 months until decannulation at 18 years. She had a surgical closure a
year later. The DP settings were titrated by her pulmonologist and monitored with repeat home
sleep apnea testing (HSAT) to achieve optimal control of central hypoventilation. After an initial
period of response, however, subsequent HSATs showed a progressive increase in obstructive
breathing events associated with hypoxia. Further adjustments in the DP settings did not successfully correct the findings. An in laboratory polysomnography (PSG) confirmed moderate
OSA with significant hypercapnia. At clinic follow-up, the patient was offered positive airway
pressure therapy but chose to defer decision-making until pulmonary follow-up. The patient
was also referred to ENT for an anatomic evaluation to look for potential causes contributing to
upper airway obstruction.

Conclusion
DP remains a treatment option for select patients with CCHS. Limited studies have shown that OSA can occur in patients with CCHS using DP as their primary management modality. Our case demonstrates the importance of keeping a broad differential in evaluating the development of concurrent OSA in these patients. Potential contributors to developing OSA include weight gain, tracheomalacia or tracheal stenosis resulting from longstanding tracheostomy status, and effects of increased DP amplitude settings.

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0828 Positional Central Sleep Apnea
Authors: Mempin Roberto , Sarrami Kayvon , Thomas Aaron , Zeidler Michelle 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is well known to often improve with non-supine positioning as opposed to supine positioning. The prevalence of OSA that may improve on proper positioning is 50-60% and the prevalence of OSA that appears when supine and disappears when non-supine is 25-30%. Sleeping in a lateral positioning is thought to reduce pressure on the airway, shift the directional effect of gravity on airway structures, and counteract physiologic genioglossus collapse that occurs when supine. On the other hand, the effect of positional changes on the severity of central sleep apnea (CSA) is not well documented aside from Cheyne-stokes breathing in congestive heart failure.
Report of Cases: We present two cases of positional CSA. One patient is a 52-year-old male with a history of traumatic brain injury, hypogonadism, hypothyroidism and Parkinson’s Disease. He underwent split-polysomnography (PSG) for dream enactment behavior, was found to have severe CSA, which occurred almost exclusively supine (Supine Apnea-Hypopnea Index (AHI) 66/hr, Non-Supine 0.8/hr). A positional belt was recommended to the patient. The second patient is an 89-year-old male with history of chronic obstructive pulmonary disease and chronic kidney disease who underwent PSG for symptoms of sleep apnea. He was found to have severe obstructive and central sleep apnea with periods of Cheyne-stokes breathing. This also occurred almost exclusively supine (Supine AHI 69/hr, Non-Supine 0/hr) and improved on continuous positive airway pressure (CPAP) independent of position (AHI 6/hr). CPAP or positional belt was recommended to the patient.

Conclusion
Positional CSA unrelated to congestive heart failure is an uncommon phenomenon with poorly understood pathophysiology. Treatment of CSA is often challenging and based on elucidating and addressing the underlying cause such as optimizing treatment of heart failure. Positional therapy is characteristically thought of as a potential treatment option for OSA. However, our findings further support the presence of a phenotype of central sleep apnea that may respond to positional therapy.

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0839 Complex Sleep Apnea Improved with Decompression of a Chiari I Malformation in a Pediatric Patient
Authors: McKee Matthew , Petitto Lacie , Kaplan Kevin 
Published: May 2022

Abstract

Introduction
Chiari malformation (CM) occurs when a portion of the cerebellum herniates through the foramen magnum. CM is categorized as two types. Type 1 involves the cerebellar tonsils and type 2 involves the cerebellum and brain stem. Those with CM can be asymptomatic to having debilitating neurologic symptoms such as dysphagia, tinnitus, emesis, balance difficulty, muscle weakness, and/or headache. Central sleep apnea (CSA) and obstructive sleep apnea (OSA) have been associated with CM. It is postulated that the sleep disordered breathing (SDB) is due to compression of the medulla which houses the breathing center and cranial nerves that play a role in nocturnal breathing. OSA has been thought to be related to muscle weakness of the lower airway in those with CM. After resolving CM with surgical decompression, residual OSA is common requiring treatment with positive airway pressure therapy.
Report of Cases: A 3-year-old male with a history of OSA and tonsillar hypertrophy. Polysomnography (PSG) was performed after tonsillectomy and adenoidectomy indicating severe OSA (oAHI 17.7/hr) and CSA (CSAI 29.9/hr). A titration study was conducted and bilevel positive airway pressure spontaneous/timed (BPAP ST) 10/6 cmH2O with a backup rate of 12 breaths per minute was utilized further resolving his SDB and daytime sleepiness. After months of BPAP ST therapy, he presented to an urgent care with symptoms of somnolence, emesis, and nystagmus of the left eye. Magnetic resonance imaging of the brain revealed a 2 cm herniation of the cerebellar tonsils indicating CM type 1. Neurosurgery performed surgical decompression without complication. Post-operative PSG indicated significant improvement of OSA (oAHI of 3.45/hr) and resolution of CSA (0.9/hr). BPAP ST therapy was discontinued with the resolution of his daytime sleepiness and SDB.

Conclusion
This case demonstrates a patient with severe OSA and CSA due to an undiagnosed CM type 1. OSA and CSA are associated with CM; however, residual OSA typically exists status post decompression and can require positive airway pressure therapy for treatment. Our case demonstrates the need for consideration of CM in patients with complex sleep apnea and that surgical decompression can improve both OSA and CSA in these patients.

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0856 Correcting Sleep/Wake Cycle and Reducing Combativeness in an 84-year-old Patient
Authors: Bell Alexa , Capaldi Vincent 
Published: May 2022

Abstract

Introduction
Sleep disruption is a common occurrence in hospitalized geriatric patients. Such patients frequently arrive at the emergency department for behavioral changes due to delirium, which can often be mistaken for, or compounded by, underlying dementia. Behavioral symptoms may vary, including disinhibition, aggression, distress during care, mood disturbance, and paranoia, affecting approximately 90% of patients. Effectively treating these patients is challenging; antipsychotic use is a commonly implemented treatment in hospitalized settings, but is complicated by adverse side effects and an increased risk of CVA. In this case report, we discuss the use of an antipsychotic, olanzapine, to treat an 84 year old hospitalized patient presenting with sleep disruption and changes in mental status.
Report of Cases: An 84 year old gentleman with a history of Alzheimer’s dementia with worsening behavioral changes was admitted for urinary tract infection, humeral fracture secondary to mechanical fall, and increasing aggression toward his caretaker. At home the patient was sleeping during the day and more was active and combative at night. While hospitalized, he had become aggressive with hospital staff due to his distress and was minimally oriented at baseline. We trialed the patient on olanzapine 5mg at night to facilitate sleep and reduce his aggression, in addition to environmental changes to reorient day and night. After a few days of this treatment, this patient was much more pleasant and oriented, able to hold conversation, and no longer aggressive. His initial disposition was to be transferred to a memory care facility, given increasing safety concerns expressed by the caretaker. However, following these changes, he was able to return home in the comfort of his family and caretaker.

Conclusion
Antipsychotic use in the elderly for sleep disruption and behavioral disturbances is heavily debated, though there may be some benefit to their use. The CATIE-AD trial and a Cochrane Review suggest Olanzapine may reduce aggression, particularly in Alzheimer’s disease, and has the added benefit of sedation which aids in establishing sleep cycles. However, many patients discontinue antipsychotic treatment due to side effects and routine use is discouraged. When in use, regular monitoring should take place to evaluate for side effects associated with pharmacotherapy and continued therapeutic benefit should be reassessed.

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HMGN3 represses transcription of epithelial regulators to promote migration of cholangiocarcinoma in a SNAI2‐dependent manner
Authors: Sorin Supannika , Kubota Sho , Hamidi Sofiane , Yokomizo‐Nakano Takako , Vaeteewoottacharn Kulthida , Wongkham Sopit , Waraasawapati Sakda , Pairojkul Chawalit , Bai Jie , Morii Mariko , Sheng Guojun , Sawanyawisuth Kanlayanee , Sashida Goro 
Published: May 2022

AbstractHigh mobility group nucleosome‐binding protein 3 (HMGN3), a member of the HMGN family, modulates the structure of chromatin and regulates transcription through transcription factors. HMGN3 has been implicated in the development of various cancers; however, the underlying mechanisms remain unclear. We herein demonstrated that the high expression of HMGN3 correlated with the metastasis of liver fluke infection‐induced cholangiocarcinoma (CCA) in patients in northeastern Thailand. The knockdown of HMGN3 in CCA cells significantly impaired the oncogenic properties of colony formation, migration, and invasion. HMGN3 inhibited the expression of and blocked the intracellular polarities of epithelial regulator genes, such as the CDH1/E‐cadherin and TJAP1 genes in CCA cells. A chromatin immunoprecipitation sequencing analysis revealed that HMGN3 required the transcription factor SNAI2 to bind to and repress the expression of epithelial regulator genes, at least in part, due to histone deacetylases (HDACs), the pharmacological inhibition of which reactivated these epithelial regulators in CCA, leading to impairing the cell migration capacity. Therefore, the overexpression of HMGN3 represses the transcription of and blocks the polarities of epithelial regulators in CCA cells in a manner that is dependent on the SNAI2 gene and HDACs.
BMI and miscarriage after IVF
Authors: Bellver José 
Published: May 2022

Purpose of review
To summarize recent findings related to the risk of miscarriage in women with elevated BMI undergoing IVF, and the mechanisms involved in said risk.

Recent findings
Miscarriage rates are increased in overweight and obese women in both natural and assisted reproduction. Oocyte and embryo quality assessed according to classic morphological static parameters does not seem to be affected by excessive female body weight. Despite the initial lack of consensus between studies regarding embryo morphokinetics in obese women, blastocyst formation and quality have recently been shown to be similar across BMI groups, even in the case of euploid embryos. However, some metabolomic differences have been described in oocytes and embryos from obese women, thus pointing to a functional alteration. In women with elevated BMI, the percentage of aneuploid embryos is similar to that of normal weight women, and rates of miscarriage are higher, despite the transfer of euploid embryos. Therefore, the origin of the increased pregnancy loss rate after IVF in these women may be related to metabolomic, epigenetic or mitochondrial oocyte and embryo disturbances, or to the abnormal endocrine, metabolic and inflammatory uterine environment induced by obesity, which seems to be also responsible for other numerous complications during pregnancy and the in-utero fetal programming of postnatal diseases. A displacement of the window of implantation in obese women undergoing artificial endometrial preparation has recently been described and may be related to the poorer embryo implantation rates and increased risk of miscarriage observed following fresh and frozen embryo transfers with autologous oocytes, and with donated ova in recipients with extremely high BMI.

Summary
Female obesity is related to poorer outcome in natural and assisted conception, including an increased risk of miscarriage. Embryo morphology, assessed by conventional methods or by morphokinetics, does not seem to be affected by excess weight, with similar blastocyst formation and quality than normal weight women reported in IVF cycles. Embryo aneuploidy is not increased, and higher miscarriages rates are seen after euploid embryo transfer in obese women. Disturbances of the uterus or its environment induced by female obesity seem to be the most likely cause of the increased risk of miscarriage, although metabolomic, epigenetic or mitochondrial oocyte and embryo dysfunction cannot be ruled out as cannot congenital anomalies. In the context of all the above, weight reduction before pregnancy should be advised in obese women trying to become pregnant.
Racial disparities in access to reproductive health and fertility care in the United States
Authors: Beroukhim Gabriela , Mahabamunuge Jasmin , Pal Lubna 
Published: May 2022

Purpose of review
To examine the status of racial and ethnic inequalities in fertility care in the United States (U.S.) at inception of 2022. This review highlights addressable underpinnings for the prevalent differentials in access to and utilization of infertility treatments and underscores gaps in preventive care as key contributors to racial and ethnic disparities in risk burden for subfertility and infertility.

Recent findings
Significant gaps in access to and utilization of fertility care are consistently reported among racial and ethnic minorities, particularly Black and Hispanic women. Access to and utilization of contraceptives, human papilloma virus vaccination rates, preexposure prophylaxis use, and differentials in treatment of common gynecologic disorders are relevant to the prevalent racial and ethnic disparities in reproductive health. The spectrum of differential in reproductive wellness and the magnitude of reproductive health burden afflicting racial minorities in the U.S. raise concerns regarding systemic and structural racism as plausible contributors to the prevalent state of affairs.

Summary
Despite efforts to reform unequal reproductive health practices and policies, racial and ethnic disparities in fertility care are pervasive and persistent. In addition to measures aimed at reducing barriers to care, societal efforts must prioritize health disparity research to systematically examine underpinnings, and addressing structural racism and interpersonal biases, to correct the prevalent racial inequities and mitigate disparities.