bluuebunny/crossref_metadata_2025_split huggingface dataset:
0760 Excessive daytime sleepiness, positive airway pressure, and patient satisfaction with multiple aspects of care in a real-world population with obstructive sleep apnea
Authors: Parthasarathy Sairam , Hyman Danielle , Doherty James , Saad Ragy , Zhang Jerrry , Morris Susan , Eldemir Lev , Fox Benjamin , Vang Mai Ka Ying , Schroeder Jessica , Marshall Nell , Parks Gregory 
Published: May 2022

Abstract

Introduction
Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and can persist despite use of positive airway pressure (PAP) therapy. These analyses assessed relationships between EDS, PAP use, and patient satisfaction across several aspects of OSA care in a real-world population with OSA.

Methods
US residents (aged ≥18 years, self-reported physician OSA diagnosis [1/1/2015–3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing Epworth Sleepiness Scale (ESS), PAP usage, and satisfaction with care. Self-reported PAP use was categorized as nonuse, nonadherent (&lt;4 h/night; &lt;5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk) (PAP-adherent=intermediate and highly adherent groups). Logistic regression models assessed impacts of PAP adherence and EDS on satisfaction with care across 7 domains. P-values are uncontrolled for multiplicity (nominal).

Results
Among all participants (N=2289; 50.3% female, 82.5% White, 44.8±11.1 years old [mean±SD], 35.4±8.7 kg/m2 body mass index [mean±SD]), 42.5% had EDS (ESS&gt;10). PAP use was: nonuse (n=700), nonadherent (n=153), or adherent (n=1436; intermediate n=225, high n=1211). Within these subgroups, the proportions (95% CI) with EDS were: nonuse (47% [43.7–51.1]), nonadherent (52% [44.4–60.2]), intermediate (53% [46.4–59.4]), and highly adherent (36% [33.7–39.1]). Logistic regression (using data from PAP users) showed a positive association of PAP adherence with satisfaction with PAP (OR [95% CI]: 5.43 [3.73–7.90]); OSA treatment effectiveness (3.56 [2.48–5.12]); OSA symptom management (3.15 [2.17–4.57]); coordination of OSA care (2.60 [1.82–3.72]); and education from their healthcare provider on the impact of OSA on cardiovascular health (1.62 [1.13–2.35]), importance of using PAP (1.7 [1.15–2.52]), or availability of prescription drugs to treat OSA symptoms (1.55 [1.06–2.26]). The presence of EDS was associated with lower patient satisfaction in nearly all domains examined (ORs ranged from 0.44–0.62 across 6 of 7 domains).

Conclusion
EDS was common in this real-world population with OSA, even among participants who were highly adherent PAP users. PAP adherence was associated with higher patient satisfaction across all care domains; the presence of EDS was associated with lower patient satisfaction across 6 of 7 domains.

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Jazz Pharmaceuticals
0766 Group Trajectories Demonstrate Robust Effects of Targeted Hypoglossal Nerve Stimulation in the THN3 Randomized, Controlled Trial
Authors: Schwartz Alan , Jacobowitz Ofer , Mickelson Samuel , Miller Mitchell , Oliven Arie , Certal Victor , Hopp Martin , Winslow David , Huntley Tod , Nachlas Nathan , Gillespie M Boyd , Weeks Brian , Lovett Eric , Shen John , Maurer Joachim 
Published: May 2022

Abstract

Introduction
THN3 was the first reported parallel-arm, randomized controlled trial (RCT) of hypoglossal nerve stimulation (HGNS), wherein targeted HGNS (THN) was shown to be safe and efficacious at ameliorating sleep disordered breathing in patients with moderate to severe OSA and BMI≤35kg/m2 without screening with drug-induced sleep endoscopy. Unique among reported HGNS trials, separate cohorts of patients receiving early and late THN were followed longitudinally.

Methods
Measurements of apnea-hypopnea index (AHI) were available Pre-enrollment, Baseline (2 nights), Month 4 and Month 12/15. Except for Pre-enrollment, AHI values were calculated by an independent core laboratory from polysomnographic recordings. All subjects with complete data were included for analysis. AHI trajectories were constructed for early and late THN activation (Treatment[T], N=83, Month 1 and Control[C], N=45, Month 4, respectively) by computing median values. Confidence intervals were calculated by bootstrapping each median (N=30,000). Patient-reported outcome measures (PROMs) were treated similarly.

Results
AHI (Median (95% CI)) trajectories demonstrated a consistent pattern of pre-implant alignment (Pre-enrollment T:39.1 (36.0-45.0), C:38.0 (32.0-41.0); Baseline 1 T:36.1 (33.0-39.9), C:31.3 (27.2-38.6); Baseline 2 T:37.0 (34.3-41.0), C:35.2 (32.3-38.2)), divergence at the conclusion of the randomization period (Month 4 T:15.6 (11.9-25.3), C:30.6 (23.7-38.6)) and reconvergence following 11 months of treatment (Month 12/15 T:20.7 (16.0-26.4), C:18.1 (16.3-23.3)). Non-standardized Pre-enrollment AHI was slightly higher than Baseline values. Trajectories were similar for oxygen desaturation index (Baseline 1 T:35.3 (31.9-38.0),C:34.3 (27.5-40.3); Baseline 2 T:37.1 (33.4-39.3),C:36.8 (33.9-38.3); Month 4 T:19.5 (16.2-28.5), C:33.8 (25.4-41.1); Month 12/15 T:19.5 (16.0-25.6), C:19.7 (16.3-26.0)), the Epworth Sleepiness Scale (Baseline T:11.0 (10.0-13.0),C:11.5 (8.5-14.0); Month 4 T:6.0 (5.0-7.0), C:11.5 (8.0-12.5); Month 12/15 T:6.0 (4.0-7.0), C:5.5 (4.5-6.0)), the Functional Outcomes of Sleep Questionnaire (Baseline T:15.3 (14.0-16.5),C:14.7 (13.3-16.6); Month 4 T:18.3 (17.7-18.8), C:16.7 (14.9-17.7); Month 12/15 T:18.8 (18.3-19.3), C:18.5 (17.5-19.5)) and the Snore Outcomes Survey (Baseline T:26.6 (21.9-31.3),C:21.9 (18.8-31.3); Month 4 T:60.9 (56.3-67.9), C:29.7 (23.4-42.9); Month 12/15 T:62.5 (59.4-68.8), C:68.8 (62.5-71.9)).

Conclusion
Group trajectories of sleep-disordered breathing and PROMs further demonstrate the robust effects of THN in patients with moderate to severe OSA and the value of parallel-arm RCTs. Similar results may be expected in the ongoing OSPREY confirmatory trial of THN.

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LivaNova
0772 Clusters of Upper Airway Stimulation Adherence Patterns in the First 90 Days
Authors: Soose Ryan , Araujo Mattheus , Faber Kevin , Roy Asim , Lee Kent , Ni Quan , Srivastava Jaideep , Strollo Patrick 
Published: May 2022

Abstract

Introduction
Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with CPAP intolerance. While overall adherence is high, some patients have suboptimal adherence to UAS, which limits effectiveness. Our goal was to identify UAS therapy usage patterns during the first three months of therapy that affect adherence.

Methods
We retrieved anonymized UAS therapy usage data from 2,091 individuals stored in a cloud-based monitoring system during the first three months after device activation. We aggregated adherence data including mean and standard deviation (SD) of nightly hours of use, therapy pauses, hours from midnight when the therapy was turned ON and OFF, and percentage of missing days. We computed the difference of the stimulation amplitude between the first and last day. We performed cluster analysis with Gaussian mixture models and computed the centroids of each cluster highlighting their main differences.

Results
We identified six distinct clusters of UAS usage patterns. Clusters 1A (34% of the total cohort) and 1B (23%) had excellent therapy usage with 7.23h and 7.14h on days of use, respectively; with 1B distinguished by increased night-to-night variability. Clusters 2A (16%) and 2B (12%) had good mean therapy use of 6.63h and 6.21h, respectively, but their usage patterns were distinguished by a higher percentage of missing days (8% missing days in 2A and 23% in 2B) and less favorable therapy timing with an average therapy ON time after midnight. Clusters 3A (8%) and 3B (7%) were characterized by the lowest nightly use at 6.16h and 5.50h, respectively, and the highest night-to-night variability. 3A was further distinguished by the highest percentage of missing days (34%) while 3B was characterized by the frequent therapy pauses (mean 4.1 pauses per night) and the least increase in stimulation amplitude across the first 90 days.

Conclusion
Cluster analysis of UAS usage patterns identified six distinct groups that may enable custom interventions for improved long-term management. Differentiation of these groups may have clinical implications on conditions (e.g. therapy discomfort, comorbid insomnia, poor sleep hygiene) that impact adherence.

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0775 Impact of insomnia, depression and anxiety on adherence to upper airway stimulation for obstructive sleep apnea: ADHERE registry update
Authors: Patil Reena Dhanda , Ishman Stacey , Chang Jolie , Thaler Erica , Suurna Maria 
Published: May 2022

Abstract

Introduction
Insomnia, depression and anxiety are common comorbid conditions in patients with obstructive sleep apnea (OSA) and can negatively impact positive airway pressure (PAP) therapy adherence. Subsequent intolerance to PAP may lead to surgical treatment such as upper airway stimulation (UAS). We sought to determine the impact of baseline insomnia, anxiety or depression on UAS therapy adherence using data from a large multi-center registry.

Methods
The ADHERE registry collects information on patients undergoing UAS (Inspire Medical, Golden Valley, MN) including baseline history of insomnia, depression, anxiety and the Insomnia Severity Index (ISI) questionnaire. We determined overall prevalence of insomnia, depression and/or anxiety, as well as UAS adherence after 6 months of therapy in groups with insomnia, depression, anxiety or none of these conditions. Using ISI to quantify insomnia, adherence in patients with no/mild insomnia (ISI &lt; 15) was compared to those with moderate/severe insomnia (ISI ≥ 15).

Results
1639 patients were included; 10% reported a history of insomnia, 23% depression and 16% anxiety. There was no difference in UAS adherence between groups with or without a history of insomnia, depression, or anxiety. A baseline ISI score was available in 470 patients with no history of insomnia, and in 81 patients with a history of insomnia. In patients with no history of insomnia, 59% had ISI scores ≥15, while in those with a history of insomnia, 85% had ISI scores ≥15 (p &lt; 0.001). There was no difference in therapy usage between patients with ISI scores &lt;15 and ≥15 (6.7 ± 2.2 hours/night versus 6.4 ± 2.5 hours/night, p = 0.5).

Conclusion
This study examined the impact of insomnia, depression or anxiety on adherence to UAS therapy for OSA. Patients with and without these conditions had similar UAS adherence. We found that insomnia as objectively based on the ISI score may be underdiagnosed in UAS patients who have no subjective history of insomnia at baseline. Despite this, ISI severity did not impact UAS adherence. Longer term follow-up with serial ISI scores and adherence data is needed to further understand how insomnia severity impacts UAS therapy outcomes and usage.

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0777 The OHS Pathway: An EMR-Integrated Clinical Pathway to facilitate BiPAP on Discharge for Hospitalized Patients with Obesity Hypoventilation Syndrome
Authors: Camacho Jessica , Green Katherine 
Published: May 2022

Abstract

Introduction
With the rise of severe obesity, obesity hypoventilation syndrome (OHS) is increasingly recognized as a cause of sleep disordered breathing and hypercapnic respiratory failure. OHS is often diagnosed in the inpatient setting when patients present with acute respiratory failure, at which point 18-month mortality approaches 23%. Positive airway pressure (PAP) is a highly effective treatment for OHS. Clinical responses to PAP therapy include improvement in symptoms, gas exchange, hospitalization rates, and mortality. The American Thoracic Society published guidelines in 2019 recommending patients hospitalized with acute respiratory failure suspected of having OHS be discharged on nocturnal NIV therapy. Insurance criteria significantly limit access to home NIV/PAP without a sleep study, and inpatient providers seldom have success prescribing this treatment on discharge.

Methods
We first surveyed providers from a large academic hospitalist group to assess for knowledge gaps and challenges in OHS management. We then recruited inpatient respiratory therapists, providers, and care coordinators to design an EMR-integrated clinical pathway. The pathway begins with diagnostic criteria for OHS, then directs providers through the insurance criteria for BiPAP for hypoventilation, which do not require a sleep study. The criteria include wake PaCO2 ≥ 45mmHg, ≥ 7mmg increase in PaCO2 during sleep, and FEV1/FVC ≥ 70%. If these criteria are met, the pathway assists providers in writing BiPAP orders for discharge.

Results
We collected 40 survey responses. 67.5% of respondents reported being slightly familiar with the diagnostic criteria for OHS, and 75% of providers reported never having been successful prescribing BiPAP on discharge. Educational sessions were held to familiarize providers with OHS and the OHS Pathway. After launching in March 2021, the OHS team convened monthly to optimize the pathway. To date, 20 patients have utilized the pathway.

Conclusion
Pre-intervention results confirm gaps in knowledge and treatment challenges regarding BiPAP therapy for OHS patients. Our preliminary data demonstrate that this is a feasible and reproducible pathway to improve the likelihood of successful initiation of BiPAP therapy on discharge for this high-risk population. A close examination of these cases is required to identify barriers to successful qualification for BiPAP.

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0778 Characterizing Women with Obstructive Sleep Apnea from Real World Data
Authors: Cole Kathleen , Dexter R Benjamin , Woodford Caleb , Sterling Kimberly 
Published: May 2022

Abstract

Introduction
Real-world evidence focused on women with obstructive sleep apnea (OSA) is lacking. This retrospective study aimed to characterize and evaluate the impact of age on female patients with OSA and their journey through OSA diagnosis and treatment.

Methods
De-identified US administrative claims data for patients with OSA who had a claim for a sleep test were used for this analysis. Age and insurance coverage were characterized at the time of the first sleep test. Comorbidity status was evaluated in the year prior to the sleep test by assessing ICD-9/10 codes associated with healthcare encounters. This protocol was submitted to an Institutional Review Board and was determined to be exempt from oversight.

Results
The study included 883,902 female OSA patients; mean age of 51.7 years; and 64.9% commercial, 24.7% Medicaid, and 10.3% Medicare Advantage insurance coverage. The most prevalent comorbidities were hypertension (54.9%), hyperlipidemia (46.5%), GERD (31.5%), type 2 diabetes (25.1%), depression (23.2%), and asthma (22.0%). When stratifying by age, the prevalence of all comorbidities increased with age except for affective disorders. Depression and anxiety decreased with age. In terms of the type of sleep test used to diagnose OSA, 58.8% had an in-lab polysomnography (PSG), 38.9% had a home sleep test (HST), and 2.3% had both a PSG and HST. About half (56.6%) of patients received a positive airway pressure (PAP) device in the year after being diagnosed. When stratifying the results by age, in-lab PSG testing was more prevalent in those over 65, while the percentage of those receiving a PAP device increased then slightly decreased with age (18-44y: 47.6%, 45-54y: 58.1%, 55-64y: 62.1%, 65-69y: 61.1%, &gt;70y: 58.8%).

Conclusion
This retrospective study characterized the start of the women’s journey with OSA; describing the rates of sleep testing and PAP treatment from a sample of real-world data. These results begin to build an understanding of these patients and their journey to treatment, helping to raise awareness of undiagnosed OSA in women. Further research should be conducted to identify potential real-world impact of adherence to PAP on health outcomes.

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ResMed
0784 Couples-based treatment for obstructive sleep apnea: perspectives from patients with mild cognitive impairment and their partners
Authors: De Vettori Giulia , Troxel Wendy , Duff Kevin , Dixon Ava , Baron Kelly 
Published: May 2022

Abstract

Introduction
Patients with Mild Cognitive Impairment (MCI) have an increased risk of Obstructive Sleep Apnea (OSA) which may have implications for their cognitive function. Sleeping is often a shared behavior among couples, and for couples with MCI, partners often assume the role of caregiver. The goal of this study is to examine the role of bedpartners in adherence to treatment for OSA and to determine the feasibility for couples-based adherence interventions in individuals with MCI and their partners.

Methods
This study is ongoing and will include semi-structured interviews with 10 couples. Interviews will be conducted remotely over Zoom, then transcribed and coded using Dedoose software to identify common themes among transcripts. Interviews discussed the impact of OSA and MCI on the couple with regard to CPAP treatment, interdependence of sleep, and feasibility of a couples-based CPAP intervention.

Results
Currently, three out of 10 couples have been interviewed. The participants included three men and three women (mean age= 74 years). Themes from the interviews include significant involvement of partners in the treatment of OSA (e.g., reminders and ordering supplies). Couples felt that this program would have been helpful when they were beginning CPAP treatment. They provided suggestions for the format of a couples-based treatment in MCI including shorter sessions with more pictures and simplified content so that it could be better understood by the patient and partner.

Conclusion
Data from these interviews demonstrate the critical role of the partner in adherence to CPAP treatment among patients with MCI. While interviews are currently ongoing, both patients and partners view couples-based sleep apnea treatment as feasible and adaptations will be made for this population. Couples-based treatments may be a promising intervention for increasing CPAP adherence in OSA patients with MCI, and further slowing cognitive decline.

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NIA: #59317201
0791 Perceived racial discrimination predicts poor PAP adherence: a pilot study
Authors: Williams Natasha , Grant Andrea , Bubu Omonigho , Chung Alicia , Wallace Douglas 
Published: May 2022

Abstract

Introduction
Although racial and ethnic differences in continuous positive airway pressure (CPAP) adherence for people with obstructive sleep apnea (OSA) are well known, no studies have examined the influence of racial discrimination on CPAP use. The aim of this study was to determine if racial discrimination influenced CPAP use trajectories.

Methods
Participants with OSA initiating CPAP were enrolled from two sleep centers in New York City. Participants completed questionnaires including sociodemographics, perceived discrimination, daytime sleepiness, and depressive symptoms. Racial discrimination was measured via the validated Everyday Discrimination scale (EDS) , Participants endorsed at least one discriminatory experience “at least once a year” and race was the main reason for this treatment. Sociodemographic and questionnaire comparison were performed between participants reporting the presence and absence of racial discrimination. To examine differences in the trajectory of CPAP use based on racial discrimination status (between-subjects factor), we performed a two-factor repeated measures ANOVA with mean hours of daily use at 7, 30 and 90 days serving as the time dependent variable (within-subjects factor). Analyses were adjusted for depressive symptoms.

Results
The sample consisted of 88 participants (40% female; 40% Non-Hispanic Black; mean age of 57 ± 14 yrs). Twenty-two individuals (25% of the cohort) reported racial discrimination. In unadjusted two-factor repeated measures ANOVA, the test statistic for equality of racial discrimination CPAP adherence means over time was highly significant [ F = 9.71 (1, 68); p = 0.003] while the test for interaction between racial discrimination and time was marginally significant [F = 3.19 (1.53, 103.8); p = 0.059). Main effects for time were significant for participants reporting discrimination (p=0.04) but not for those without racial discrimination experiences (p=0.25). Thus, people reporting racial discrimination experienced greater decrement in CPAP use over time while a more stable CPAP use pattern was observed in those not perceiving racial discrimination.

Conclusion
Racial discrimination status may determine future poor CPAP adherence. Larger studies examining mechanisms of how perceived racial discrimination mediates worse CPAP adherence may assist in mitigating CPAP adherence disparities.

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Natasha Williams was supported by grant from the National Institutes of Health: K23125939
0800 Dozing off is a problem, as is a toe falling off - Methylphenidate induced Raynaud’s phenomenon
Authors: Gaddam Maneesh , Zacharias Rajesh , He Wei , Oster Joel , Ostrow Peter , Schumaker Greg , Grover Aarti 
Published: May 2022

Abstract

Introduction
Narcolepsy is a clinical syndrome characterized by a constellation of symptoms including excessive daytime sleepiness, cataplexy, sleep paralysis and sleep hallucinations. Stimulants are commonly used to treat hypersomolence associated with narcolepsy. Common adverse reactions reviewed with patients prior to initiation of amphetamines include decreased appetite, nausea, xerostomia, headache, insomnia, tachycardia and hypertension. A relatively rare concern with stimulants is development of peripheral vasculopathy including Raynaud’s phenomenon.
Report of Cases: A 25-year-old female with past medical history of anxiety, depression and obstructive sleep apnea in childhood was treated with tonsillectomy and adenoidectomy. Over the years, she continued to have persistent hypersomnolence, auditory hypnogogic hallucinations with no symptoms of sleep paralysis or cataplexy. She had a polysomnography (PSG) along with multiple sleep latency test (MSLT). PSG did not show evidence of sleep apnea with an AHI of 0.96 per hour. MSLT confirmed the diagnosis of Narcolepsy, Type 2, with a mean sleep onset latency of 3.6 minutes and five sleep-onset REM periods (SOREMPs). She was started on 400mg daily of Modafinil and 20mg daily of Methylphenidate. After a month of using methylphenidate, she noticed purplish discoloration of her digits, sometimes with exposure to cold, other times with no obvious triggers, consistent with development of Raynaud’s phenomenon. The proposed mechanism is that use of methylphenidate causes excessive release of catecholamines due to inhibition of the reuptake of dopamine and norepinephrine, leading to peripheral vasoconstriction. As the patient’s hypersomnolence persisted, she was started on sodium oxybate and the dosage of methylphenidate was decreased to 10mg daily and eventually discontinued. With reduction in the dosage and discontinuation of methylphenidate, symptoms of Raynaud’s phenomenon improved.

Conclusion
Dose-related peripheral vasculopathy including Raynaud’s phenomenon has been reported in several case reports with the use of methylphenidate. Awareness of this relatively rare adverse effect is imperative among sleep physicians as it could cause significant delay in the diagnosis, management of Raynaud’s phenomenon and its complications including critical digital ischemia and gangrene. Dose adjustments and discontinuation of methylphenidate should be considered in the treatment course of the patients with such concern.

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