bluuebunny/crossref_metadata_2025_split huggingface dataset:
0688 Insomnia Symptom Severity Predicts Greater Alcohol Use During the COVID-19 Pandemic: A Longitudinal Study
Authors: Bell Jessica , Egeler Mara , Snyder Hope , Walker Jamie , Hire Veronica , Vargas Ivan 
Published: May 2022

Abstract

Introduction
Individual stress levels undeniably increased following the start of the COVID-19 pandemic. Not surprisingly, sleep problems, including insomnia, have intensified during the pandemic due to the increase in overall stress levels. The impact that greater insomnia has had on other health outcomes, for example problematic drinking, has yet to be examined. Therefore, the aim of the present study was to assess whether greater insomnia symptom severity predicted future alcohol use patterns (i.e., frequency and severity).

Methods
The study used data from a nationwide sample of 2,979 who were surveyed at two different points during the COVID-19 pandemic (T1 = initial months after the start of the pandemic [April – June 2020]; T2 = 10-12 months later). Of those, 1,971 adults (mean age = 46.0 years; 80% women) reported having had an alcoholic beverage during the past 3 months and were included in the subsequent analyses. Insomnia symptom severity was assessed at both time points using the Insomnia Severity Index (ISI). Self-reported alcohol frequency (i.e., days per week) and severity (i.e., drinks per day) were assessed at T2.

Results
At T2, participants reported drinking alcoholic beverages (mean ± standard deviation) 2.7 ± 2.1 days during a typical week and drinking 1.8 ± 1.1 alcoholic beverages on days they did drink. According to results from separate multiple regression analyses, where T1 ISI scores were entered as the independent variable and alcohol frequency and severity were entered as the dependent variables, total ISI scores at T1 were associated with less frequent (β = -0.075, p = .001) but more severe drinking patterns (β = .088, p &lt; .001). These associations remained significant while controlling for current insomnia symptom severity.

Conclusion
Baseline insomnia symptom severity was a predictor of future alcohol use patterns. Specifically, people with greater insomnia at T1 reported, on average, less frequent drinking (i.e., fewer days per week), yet greater consumption on days that they did drink alcohol. These data highlight the importance of assessing the impact that insomnia has had (and continues to have) on other behavioral health outcomes during the ongoing pandemic.

Support (If Any)
K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)
0695 Comparison of a Disposable Home Sleep Apnea Test to Polysomnography in Patients Referred for Obstructive Sleep Apnea Investigation
Authors: Tellez Daniela , Uhles Matthew , Alisic Sabina , Pinson Mary-Beth , Willes Leslee , Decker Meredith , Benjafield Adam 
Published: May 2022

Abstract

Introduction
In an effort to decrease cost and improve healthcare efficiency for the diagnosis of OSA, home sleep apnea tests (HSAT) continue to be developed and improved to enhance diagnostic accuracy. A disposable FDA cleared HSAT capable for multi-night evaluations, that uses peripheral arterial tonometry (PAT) to assess for sleep apnea. The form factor and care pathway have a strong appeal for a patient’s experience of the diagnostic journey. The data obtained from the study informs the strengths, weaknesses, and reliability of new HSAT technology in the clinical management of sleep apnea.

Methods
A prospective, open-label, single group study was conducted in a certified PSG sleep lab. Patients underwent a single overnight PSG study with concurrent disposable HSAT (NightOwl Mini, Ectosense) testing. The patient population were adults referred to a sleep lab for investigation of OSA. PSG recorded sleep time of ≥4hrs was required to be evaluable. The primary endpoint was clinical decision agreement for treatment, based on AHI threshold ≥15 events/hour. Pairwise comparisons were performed against PSG, and agreement was assessed using Cohen’s Kappa statistic.

Results
A total of 50 participants completed the study. There were 42 participants included in the analysis. The disposable HSAT had a Kappa value of 0.667 (95% CI 0.448, 0.886) for the clinical decision for treatment compared to PSG, which represents substantial agreement. The sensitivity and specificity were 0.769 and 0.938, respectively. For AHI, the disposable HSAT had a Spearman rank correlation of 0.903 with PSG. OSA severity categorization (based on AASM definitions), was also assessed, with disposable HSAT showing a weighted Kappa value of 0.646 (95% CI 0.501, 0.792). A limitation of this study was the single night use since the HSAT recommends multiple nights for a more accurate assessment.

Conclusion
A disposable HSAT was found to have substantial agreement with PSG’s clinical decision for treatment based on AHI values, despite the assessment being from a single night as opposed to multiple night usage. The performance and form factor make it an attractive HSAT to assess for sleep apnea and facilitate OSA diagnosis.

Support (If Any)
ResMed
0703 Development of the Obstructive Sleep Apnea Questionnaire for Use in Clinical Practice
Authors: Kirsch Douglas , Abbasi-Feinberg Fariha , Davies Charles , Gamaldo Charlene , Rosen Carol , Thomas Sherene , Koochaki Patricia , Lipman Kelly , Hall Nicolas 
Published: May 2022

Abstract

Introduction
An American Academy of Sleep Medicine (AASM) task force identified a need for a valid, reliable, patient-reported outcome measure (PROM) to monitor obstructive sleep apnea (OSA) in adults in clinical practice. Ideally, the PROM should be easy and quick to complete (&lt;5 minutes), available electronically, and accepted by clinicians treating OSA. Development of the Obstructive Sleep Apnea Questionnaire (OSA-Q) was undertaken to meet this need and was guided by the 2009 Food and Drug Administration (FDA) Guidance for Industry on developing PROMs.

Methods
Development of the OSA-Q included interviews with patients with OSA (n=14) to identify important concepts to them, conceptual model and draft questionnaire formulation, and cognitive interviews (n=14) to assess content validity and guide revisions to wording, item comprehension and redundancies, recall period, and response options. Usability of the electronic version of the OSA-Q was then assessed in patients with OSA. Finally, acceptability and utility of the OSA-Q in clinical practice was evaluated by surveying clinicians in ten geographically-dispersed US sleep clinics.

Results
Patient interviews were used to construct a conceptual model for the draft OSA-Q which served as a basis for generating 44 items about daytime/night-time symptoms and OSA impacts. Cognitive interviews identified poorly worded, ambiguous, and redundant items to inform revisions, resulting in a revised draft OSA-Q (3 domains, 28 items). Subsequently, clinicians (n=13) administered the draft OSA-Q to five patients each, obtained patients’ feedback on the OSA-Q, and completed a survey regarding its comprehensiveness, format/content, utility, and acceptability in clinical practice. These clinicians endorsed the OSA-Q for ease of use, language simplicity, convenience of electronic platform, and speed of completion (3-5 min). They also indicated that the OSA-Q would be useful in clinical practice and enhance patient communications (69% and 77%, respectively). The OSA-Q was revised and finalized for psychometric testing, based on clinician comments.

Conclusion
A new AASM-supported PROM to monitor OSA in clinical practice has been developed, including the patients’ perspective according to FDA guidance. This OSA-Q shows content validity and is positively perceived by clinicians. Psychometric testing of the OSA-Q is underway to establish its measurement properties and demonstrate its validity, reliability, and sensitivity to change in patients with OSA.

Support (If Any)
This work was funded by the American Academy of Sleep Medicine.
0713 Longitudinal Sleep Position Patterns and Breathing Parameters in Pregnancy
Authors: Katz Juliana , Sanapo Laura , Dunsiger Shira , Guillen Melissa , Avalos Ashanti , Aldana Annaly , Wilson Danielle , Bourjeily Ghada 
Published: May 2022

Abstract

Introduction
Supine sleep position during pregnancy has been linked to increased risk of stillbirth in retrospective studies. However, existing literature is largely cross-sectional and limited by recall bias and self-reporting of sleep position. This study aims to use objectively-measured sleep position to quantify sleep position change between trimesters and its influence on maternal respiratory health.

Methods
This study is a secondary analysis of data from a study investigating maternal sleep, among women with singleton pregnancies and overweight or obesity. Each participant underwent level III sleep apnea monitoring using Noxturnal T3 devices (Nox Medical, Georgia, US), in the first (0-12 weeks) and third (29-40 weeks) trimester of pregnancy. Using accelerometry, the software differentiated 5 positions including supine, right lateral, left lateral, prone, and upright. The studies were scored using AASM 2012 recommended criteria. The first non-upright position was recorded as going-to-bed position. The number of sleep position changes was calculated using only positions that lasted ≥30 seconds.

Results
A total of 126 women were included. Mean BMI was 34.00±5.14 and mean age was 30.46±5.40 years. Mean number of position changes was similar in early (14.19±7.82) vs. late (14.58±8.25) pregnancy. There was a significant correlation between sleep onset position and predominant sleep position in both early (p=0.001) and late (p&lt;0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. There was a significant change in sleep position between early and late pregnancy (p=0.04) with a reduction in supine sleep (51.6% to 30.2%) and an increase in left lateral sleep (24.6% to 37.3%). Only in the third trimester, there was a significant positive correlation between time spent supine and oxygen desaturation index (r=0.22, p=0.01), and a trend toward positive correlation with respiratory event index (r=0.15, p=0.08).

Conclusion
Going-to-bed position predicts predominant sleep position in less than half of women with overweight and obesity. Time spent supine in late pregnancy correlates with measures of sleep-disordered breathing. More prospective studies are needed to evaluate the potential for sleep position changes over time as a potentially modifiable risk factor for maternal and neonatal health outcomes.

Support (If Any)
R01HL130702, R01HD078515, SRA grant
0724 Age-related AHI cut-offs associated with cardiovascular and cerebrovascular disorders: clinical implications
Authors: Vgontzas Alexandros , Fernandez-Mendoza Julio , Karagkouni Efthalia , He Fan , Lenker Kristina , Basta Maria , Liao Duanping , Bixler Edward 
Published: May 2022

Abstract

Introduction
Several studies have shown that the association of obstructive sleep apnea (OSA) with clinical outcomes, such as hypertension, weakens in older adults. An apnea hypopnea index (AHI) ≥5 is recommended as the cut-off for initiating treatment without any consideration of possible age differences. We aimed to examine at which cut-off point of AHI, OSA is associated with cardiovascular and/or cerebrovascular diseases (CBVD) in middle-aged adults and in older adults.

Methods
We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority), who underwent a 1-night sleep laboratory evaluation, clinical history and physical examination. Hypertension was defined as a diastolic blood pressure ≥90 mmHg or a systolic blood pressure ≥140 mmHg or the use of anti-hypertensive medication. CBVD was defined based on a self-report of a physician diagnosis of heart disease and/or stroke. Logistic regression models examined the odds of having hypertension or CBVD in a step-wise manner starting from an AHI ≥5 up to AHI ≥30 by increments of 5 events, while simultaneously adjusting for sex, race and BMI and stratifying by age.

Results
The odds of hypertension were significantly increased in adults aged &lt;60y (43.2±9.1y) with an AHI≥5 (OR=1.56, 95% CI 1.01-2.41, p=0.045), while the odds of hypertension were not significantly increased in adults aged ≥60y (68.4±6.3y) for any given AHI cut-off. The odds of CBVD were significantly increased in adults aged ≥60y with an AHI≥15 (OR=2.50, 95% 1.24-5.04, p=0.011), while the odds of CBVD were not significantly increased in adults aged &lt;60y for any given AHI cut-off.

Conclusion
These data suggest that AHI cut-offs warranting treatment of OSA should be adjusted based on age and prevalent clinical disorders, consistent with the concept of personalized medicine. These findings are also consistent with the notion that OSA in older adults is a distinctly different phenotype than in young and middle-aged adults.

Support (If Any)
0741 Nasal airflow shape on home sleep studies predicts epiglottic collapse
Authors: Sharma Abhay , Woodson B , Noel Jacob 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by collapse of various portions of the pharynx. Epiglottic collapse can be difficult to diagnose and can affect a patient’s tolerance to continuous positive airway pressure (CPAP) or oral appliances (OA). Previous research shows a distinct nasal airflow pattern during periods of epiglottic obstruction. We sought to determine if primary epiglottic collapse noted on drug induced sleep endoscopy (DISE) would correlate with nasal airflow signals seen on home sleep studies.

Methods
We retrospectively analyzed the home sleep studies and DISE of 13 patients being considered for surgical therapies due to intolerance to CPAP. Characterization of nasal airflow signals as epiglottic collapse and non-epiglottic collapse was based on previously published data.[1] Airflow signals were individually scored as either epiglottic type collapse (type 1) and non-epiglottic type collapse (type 2). Total number of breaths and number of flow limited breaths were calculated by the algorithm in the home study device.

Results
Patients included had either complete (n=6) or no epiglottic collapse (n=7). The mean AHI 18 and 19.6, respectively. There was no difference in the fraction of type 1 breaths over total flow limited breaths between the two groups (1.1% for each group). When comparing type 1 breaths to the total number of type 1 and type 2 breaths counted, patients with complete epiglottic collapse on DISE showed a higher percentage of type 1 breaths (33%) compared to those without epiglottic collapse (23%)

Conclusion
Nasal airflow signal shape on home sleep studies can suggest the presence of epiglottic collapse. This type of analysis can provide a noninvasive assessment of physiology and improve treatment decisions.

Support (If Any)
Azarbarzin, A., et al., Predicting epiglottic collapse in patients with obstructive sleep apnoea. Eur Respir J, 2017. 50(3).
0748 Proteomic Biomarkers of Obstructive Sleep Apnea
Authors: Cederberg Katie , Hanif Umaer , Leary Eileen , Schneider Logan , Morse Anne Marie , Blackman Adam , Schweitzer Paula , Kotagal Suresh , Bogan Richard , Kushida Clete , Mignot Emmanuel 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is characterized by recurrent, partial or complete obstructive respiratory events accompanied by interruptions in sleep with frequent arousals, deoxygenation, and/or sleep disturbance. The present study profiled the largest array of plasma proteins, to date, to contribute to the identification of proteomic biomarkers associated with the presence and severity of OSA.

Methods
The SomaScan highly multiplexed aptamer assay was used to profile 5,000 proteins in 24–48-hour old EDTA plasma samples from the Stanford Technology Analytics and Genomics in Sleep (STAGES) study. The apnea-hypopnea index (AHI) was derived from overnight polysomnography and all participants provided a blood sample. OSA severity was classified as moderate-to-severe (AHI&gt;15) and controls/mild OSA (AHI&lt;15). Univariate linear regression analyses included log2-normalized relative protein expression as the dependent variable, AHI/OSA as the independent variable, and important covariates such as age, gender, BMI, BMI2, age x gender x BMI, sample storage time, and blood draw period. False discovery rate (FDR) to control for multiple testing was applied with an a-priori p-value of 0.05 for identifying significance.

Results
Univariate analyses identified 101 (65 upregulated, 36 downregulated) differentially expressed proteins (DEPs) between moderate-to-severe OSA and controls/mild OSA and 120 proteins (69 positive, 51 negative) associated with AHI as a continuous outcome with 70 proteins consistent in both models. Upregulated proteins involved pathways related to complement and coagulation cascades and metabolic processes and downregulated proteins involved pathways related to regulation of insulin-like growth factor, fibrin clot formation, and MAPK signaling. An OSA machine learning classifier (AHI&gt;15 vs AHI&lt;15) trained on relative protein expression performed robustly, achieving 72% accuracy in a validation dataset. Significant contributing features of the classifier included age, BMI, and 134 proteins, including 22 DEPs identified in univariate analyses for OSA categories.

Conclusion
The present study identified differential protein expression patters associated with OSA and AHI, thereby supporting the potential of proteomic biomarkers in OSA and providing new insight into the mechanisms underlying OSA.

Support (If Any)
This work was supported, in part, by the National Heart, lung, and Blood institute [T32HL110952] and the Klarman Family Foundation.
0749 Does Prior Nasal Surgery Impact Outcomes of Upper Airway Stimulation Therapy for OSA?
Authors: Ramprasad Vaibhav , Menzl Anna , Makey Lauren , Chio Eugene , Steffen Armin , Maurer Joachim , Heiser Clemens , Lee Kent , Soose Ryan 
Published: May 2022

Abstract

Introduction
Nasal airway obstruction can play an important role in pathogenesis and treatment of obstructive sleep apnea (OSA). Surgery for nasal obstruction can improve patient-reported OSA outcomes, including snoring and daytime sleepiness, as well as adherence and pressure requirements with continuous positive airway pressure (CPAP) therapy. The aim of this study was to examine whether previous nasal surgery was associated with UAS treatment efficacy.

Methods
From the ADHERE Registry, propensity score matching generated a cohort of UAS patients with prior nasal surgery including septoplasty, turbinate reduction, polyp removal (NS) and a comparable cohort of UAS patients without prior nasal surgery (WNS). Patients were matched based on demographic variables including pre-operative oral appliance use, prior CPAP use, gender, age, baseline apnea hypopnea index (AHI) and baseline Epworth Sleepiness Score (ESS). Data included demographic variables, therapy outcome measures including AHI, ESS, therapy use, and responder rate. Student’s t-test was used to compare normally distributed numeric data and Fisher’s exact test to compare categorical data. One sided t-tests with non-inferiority margin of 7.5 events/hr for AHI, 2 points for ESS, and 0.5 hr/night for Therapy Use were performed to determine non-inferiority.

Results
The ADHERE dataset from October 2021 included 169 patients from each cohort were matched for comparison. Reduction in AHI was 21.01 ±17.94 in WNS cohort and 18.39 ± 16.4 after UAS (p=0.162) in NS cohort. Reduction in ESS in WNS cohort was 4.85 ± 4.98 and 4.48 ±5.83 (p=0.528) in NS cohort. Therapy use was similar, 5.67 ± 1.95 in WNS and 5.97 ± 2.06 in NS (p=0.181). Responder rate was also similar in WNS (64.5%) and NS (62.1%) (p=0.735).

Conclusion
Retrospective analysis of UAS patients with vs without prior nasal surgery did not identify differences in UAS therapy outcomes or adherence. Furthermore, outcomes for patients with nasal surgery were non-inferior to those without. Future prospective studies of UAS candidates with nasal airway obstruction may better determine the role of adjunctive nasal surgery in this population.

Support (If Any)
Inspire Medical Systems
0752 Preliminary Efficacy of a Novel Iterative Device and Material
Authors: Murphy Mark , Carollo John , Smith Kent , Desai Aditi 
Published: May 2022

Abstract

Introduction
Launching a new device design or use of a new material with optimistic expectations should always be undertaken with caution and an ounce of skepticism. When this novel device and material was first described in an IRB Abstract derivative report at the AASM, it was under the umbrella of a patient and provider preference survey. In April 2020, the broader availability post FDA clearance is providing strong early indications of excellent efficacy.

Methods
An analysis of data from four treatment centers using this novel device and material was undertaken. Patients were to be included if they had a diagnosis of mild, moderate, or severe OSA confirmed by a physician, and an AHI score &gt;5 and a follow up study resulting in treatment success or failure. Results would be grouped as Complete Success = AHI &lt;5, Clinical Success = 50% reduction and &lt;10. All patients were to be treated with the Novel ProSomnus EVO Iterative advancement device.

Results
55 total consecutive patients were treated at four centers for dental sleep medicine. 37 male and 18 female patients with an average age of 53.3 ranging from 30 to 78 with pre and post data were included and treated with a ProSomnus EVO. The initial AHIs ranged from 6.0 to 116.0 with an average of AHI pretreatment of 26.4 (15 mild, 23 moderate and 17 severe). Follow up testing for this group revealed an average overall reduction in AHI of 75%, from 26.4 to 6.6. Overall, 62% resolved to below an AHI of 5 (100% of mild, 65% of moderate and 24% of severe patients). Similarly, 85% resolved to below an AHI of 10 and a 50% reduction (100% of mild, 96% of moderate and 59% of severe patients)

Conclusion
This novel interactive device and material combination appear, after early analysis, appear to yield significantly better results that previous data has demonstrated. The literature suggests that legacy oral appliance efficacies range from 50%-62% and other AADSM poster/abstracts have reported similar precision milled, control cure PMMA appliances in the 74% - 76% range. These results suggest a need for further investigation of exceptional efficacy for this device design and material.

Support (If Any)
No support was provided for this abstract