bluuebunny/crossref_metadata_2025_split huggingface dataset:
0723 Elucidation of Obstructive Sleep Apnea-Related Heart Rate Response Using a Novel Continuous Beat to Beat Blood Pressure Monitoring Technology
Authors: Roth Robert , Stafford Patrick , Mazimba Sula , Bonner Heather , Baruch Martin , Cho Yoonsik , Cho Yelim , Kwon Younghoon 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) episode related sympathetic surge may mediate the association of OSA with cardiovascular disease. Heart rate (HR) response (HRR) to OSA events may reflect magnitude of sympathetic surge but is expected to be variable between individuals. We investigated the variability of HRR to OSA events and its relation to degree of oxygen desaturation.

Methods
We included patients undergoing clinically-indicated polysomnography (PSG). We calculated HRR by deriving inter-beat interval (IBI) from a novel continuous beat-to-beat (b-b) blood pressure (BP) monitoring technology (Caretaker™) that was concurrently recorded during PSG.HRR from respiratory (apnea, hypopnea and desaturation alone events) and non-respiratory events (spontaneous or leg movement-related arousals) were compared. We also examined the association of degree of oxygen desaturation with HRR in a given respiratory event combining all events accounting for the counts of the number of events. In the sub-cohort who underwent split night sleep study, we compared the hourly HR surge events (HRR&gt; 20 pm) between diagnostic and CPAP phases.

Results
A total of 17 patients(12 men, mean 52 years old, 9 diagnostic and 8 split night PSGs) were included after excluding one patient with poor signal quality due to excessive movement. The device was well tolerated by patients and IBI and BP data were successfully aligned with PSG data. Mean respiratory HRR ranged from 1.0 to 44.0 (Median [IQR]= 11.00[2.0, 20.0]) mmHg. Mean HRR was more pronounced during the non-respiratory events than respiratory events (12.5[7.2] vs. 11.9[6.6] mmHg, p=0.034).Accounting for the count distribution of desaturation/HRR data pair events, there was a moderately positive correlation between the degree of oxygen desaturation and HRR(R=0.63). Hourly HR surge events were significantly reduced during CPAP phase compared to diagnostic phase (11 events/hr vs 126 events/hr, p=0.032).

Conclusion
We demonstrated highly variable OSA-related HRR patterns between individuals with OSA. There was moderate correlation between degree of oxygen desaturation and HRR to respiratory events. HRR to non- respiratory events was more pronounced than to respiratory events. Future studies should evaluate the clinical implications of the OSA specific HRR.

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0731 What is HSAT Missing? A Comparison of Respiratory Events and OSA Diagnosis Across Type 2 and Type 3 Studies
Authors: Lambing Kari , Chalmers Eric , Gerardy Bethany , Younes Magdy , Bender Amy 
Published: May 2022

Abstract

Introduction
The need for having in-home sleep testing has grown due to the COVID-19 pandemic. While Type 3 Home Sleep Apnea Tests (HSAT) are frequently used, their accuracy remains questionable. This study aimed to compare respiratory events and diagnosis of obstructive sleep apnea between Type 2 and Type 3 studies.

Methods
550 participants completed overnight Type 2 sleep studies using the Cerebra Sleep System. Files were autoscored as a type 2 acquisition and were manually edited by a RPSGT. On a second auto-score, mapped file channels were reduced to nasal cannula, chest belt, SpO2, position, heart rate, and audio channels to simulate a Type 3 study. The respiratory disturbance index (RDI) in the Type 2 tests was compared to the apnea-hypopnea index (AHI) in the simulated Type 3 files using a 4% desaturation threshold. Diagnosis of severity of OSA was classified based on indices of &lt;5 as “None”, 5-14.99 as “Mild”, 15-29.99 as “Moderate”, and above 30 as “Severe”.

Results
5 records were removed for having a TST &lt;4 hours. Type 2 sleep tests detected significantly more respiratory events (21.0±21.2/hr.) compared to Type 3 tests (13.4 ±17.2; t(549) = 26.8, p&lt;.0001). The use of the Type 2 RDI resulted in 104 patients (18.9% of patients; 39.4% of treatable patients) with moderate OSA falling into the mild category under the Type 3 AHI. The number of treatable patients was thus 71% higher with a Type 2 study. Overall, the diagnoses of Type 2 RDI and Type 3 AHI were only in agreement for 263 out of the 550 records, or 47.8% of the time.

Conclusion
The use of a Type 2 study detected more respiratory events than the Type 3 device. Consequentially, 104 patients received a higher severity of obstructive sleep apnea when the EEG information was included. Our results provide support for the use of Type 2 devices for in-home detection of obstructive sleep apnea to provide more accurate diagnostic detection than the more frequently used Type 3 home sleep apnea tests.

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0734 Examining the diagnostic validity of the WatchPAT in a preliminary sample of cognitive normal Black/African-American older adults
Authors: Bubu Omonigho , White Payton , Gross Jordan , Pehel Shayna , Azad Dishari , Briggs Anthony , Parekh Ankit , Kam Korey , Mullins Anna , Rapoprt David , Varga Andrew , Ayappa Indu , Willaims Natasha , Jean-Louis Girardin , Osorio Ricardo 
Published: May 2022

Abstract

Introduction
The WatchPAT®️ is an innovative Home Sleep Apnea Device (HSAT) that utilizes the peripheral arterial signal (PAT®️) for OSA diagnosis. We examined the diagnostic validity of the WatchPAT and assessed the correlation between its sleep indices and those measured by PSG in a cognitive normal predominantly older Black/African-American sample.

Methods
Preliminary data analysis on a limited sample of 26 participants without a prior diagnosis of OSA who underwent HSAT and 2-nights of nocturnal polysomnography (NPSG). An apnea-hypopnea index (AHI) ≥ 15 events/h characterized moderate to severe OSA. Pearson correlation statistics (Fisher's z Transformation) for PAT/NPSG indices including respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (Spo2), REM Latency (min), awake period during sleep (WASO), and sleep onset latency (SOL) were determined.

Results
Of the 26 participants, 17 (65.4%) were Black/African-American, 9 (34.6%) were non-Hispanic White, and 19 (73.1% [13/19 (68.4%) Black/African-American]) were female. Mean (SD) age, BMI and education was 66.3 (4.5) vs. 69.9 (3.7) years, 29.6 (6.4) vs. 26.6 (5.5) kg/m2 and 15.6 (3.1) vs. 17.6 (1.3) years for Black/African-American vs. non-Hispanic White, respectively. 35.3% vs. 33.3% and 17.7% vs. 22.2% of participants met criteria for moderate to severe OSA based on HSAT and NPSG, for Black/African-American vs. non-Hispanic White, respectively. The HSAT had a sensitivity and negative predictive value of 100% for both races, specificity of 78.6% vs. 85.7%, and positive predictive value (PPV) of 50% vs. 66.7%, for Black/African-American vs. non-Hispanic White, respectively. Analyses stratified by sex suggested that the WatchPAT had better diagnostic validity in Black/African-American women than men, with specificity of 83.3% vs. 75.0%. Among Blacks/African-Americans, the correlation for PAT/NPSG AHI, ODI and RDI were modest ranging from r = 0.65 to 0.70 P = .004, and mild for Spo2 and Nadir oxygen desaturation (r = 0.53 [95%CI, 0.04-0.79]; P = .03 for both). WASO, REM Latency and SOL showed no significant correlations.

Conclusion
Our preliminary data show HSAT having lower specificity, PPV, insights on sleep architecture for OSA diagnosis, and respiratory indices’ correlations with those from PSG, in Blacks/African-Americans compared to general population samples. The measure performed better among women.

Support (If Any)
AASM 231-BS-20, AARGD-21-8488397, NIH/NIA/NHLBI (K23AG068534, L30-AG064670, CIRAD P30AG059303 Pilot, NYU ADRC P30AG066512 Developmental Grant, R25HL105444 SRG, R01AG12101, R01AG022374, R01AG13616, RF1AG057570, R01HL118624, R01AG056031)
0737 Factors Influencing Arousal Thresholds
Authors: Prasad Yashneel , Miller Stuart 
Published: May 2022

Abstract

Introduction
Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder with an estimated prevalence of approximately 15-30 percent in males and 10-15 percent in females. A low respiratory arousal threshold (ArTH) is one of several traits involved in OSA pathogenesis. This has been shown to be reliably predicted using an Arousal Score which is calculated using the patients overall Apnoea-Hypopnoea Index (AHI), nadir SpO2 and Hypopnoea:Apnoea ratio where a score of 2 or more predicts a low arousal threshold, and a score of 1 indicates a high arousal threshold. Our objective was to describe factors associated with high arousal thresholds in patients with OSA as determined by the Arousal Score in a metropolitan population.

Methods
208 unselected, consecutive, adult, overnight polysomnography with prospectively calculated arousal scores were assessed from 2019 – 2020. Demographic and anthropometric data including Age, Sex, BMI, Epworth Sleepiness Score (ESS), AHI, SpO2 nadir, Hypopnoea:Apnoea ratio and arousal index was recorded. The arousal score was calculated by assigning one point for meeting each of the following requirements: AHI &lt;30; SpO2 nadir &gt; 82.8%; Hypopnoea:Apnoea ratio &gt; 58.3, with a score &lt;2 considered low. Spearmann correlation was performed to determine the factors associated with the Arousal Score.

Results
208 patients were included in the study. 35.6% of patients had mild sleep apnoea, 23.1% moderate sleep apnoea, 22.6% severe sleep apnoea with 18.8% of patients with no sleep apnoea. Mean arousal score was 2.47 (Std Dev 0.839). Spearman correlation indicated that disease severity, BMI (rs -.374, p-value &lt; 0.01) and STOP-BANG (r2 -0.419, p-value &lt; 0.01) had a statistically significant relationship with Arousal Score. That is, a higher AHI, BMI and STOP-BANG was associated with a low arousal score. Moreover, Gender and Epworth Sleepiness Score exhibited an insignificant association with arousal score. We found increasing severity of disease was associated with lower arousal score and therefore a higher arousal threshold

Conclusion
Our study demonstrates that worsening sleep apnoea severity, higher BMI and higher STOP-BANG are associated with a lower arousal score and therefore higher arousal threshold. Gender and ESS do not appear to be significantly associated.

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0738 Clinical and Physiological Relevance of Computational Studies of Obstructive Sleep Apnea: A Systematic Literature Review
Authors: Hartfield Phillip , Sparapani Rodney , Woodson B , Rhee John , Garcia Guilherme 
Published: May 2022

Abstract

Introduction
Structural interventions for obstructive sleep apnea (OSA) have unpredictable success rates. Anatomically accurate computer simulations of airflow and soft tissue dynamics may be used in future virtual intervention planning tools to identify the optimal patient interventions. The objective of this study is to review the existing literature on the correlation between computer-derived biomechanical variables and clinical measures of OSA severity.

Methods
Scientific papers written in English that correlated the apnea-hypopnea index (AHI) with computer-derived biomechanical variables were identified by searching on the PubMed and SCOPUS databases the search phrase “sleep apnea” AND “computational fluid dynamics” OR "finite element” OR “fluid structure interaction”.

Results
A total of 19 articles were identified that reported correlations between computer-derived biomechanical variables and AHI, which was the metric of OSA severity reported in most studies. These studies demonstrated that several anatomic and physiologic variables correlate with OSA severity, including airspace cross-sectional areas, airspace volumes, and airflow resistance. No studies were found that correlated computer-derived dynamic measures of upper airway mechanical stability, such as tissue compliance, to OSA severity.

Conclusion
Computer-derived anatomic and physiologic variables may serve as useful predictors of surgical outcome or mandibular device treatment response in OSA patients. Further research is needed to test the hypothesis that virtual surgery planning based on computer-derived measures of upper airway stability can improve outcomes of OSA interventions.

Support (If Any)
This project was funded in part by the Advancing a Healthier Wisconsin Endowment.
0747 Polysomnogram characteristics associated with artificial Intelligence enabled electrocardiogram algorithm predicted probability of atrial fibrillation in patients with obstructive sleep apnea
Authors: Mudrakola Harsha , Morgenthaler Timothy 
Published: May 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with atrial fibrillation (AF). Several features of OSA are thought to play role in the development of AF. A recently developed artificial intelligence (AI) enabled electrocardiogram (ECG) algorithm predicts the probability of future development of AF from a single ECG. We sought to examine the relationship between polysomnogram (PSG) and clinical features of patients with OSA and the probability of future AF (P-AF).

Methods
Consecutive adults (age ≥ 18) with OSA and with an ECG obtained within 2 years of their attended polysomnograms (PSG) were examined. We excluded patients with AF, left ventricular ejection fraction &lt; 50%, implanted pacemaker or cardioverter defibrillator. We recorded demographics, apnea-hypopnea index (AHI), respiratory arousal threshold (RAT), percent sleep time with SpO2 &lt; 89%, arousal index, and a comorbidity score composed of presence of coronary artery disease (CAD), hypertension (HTN), diabetes mellitus (DM), stroke, and chronic lung disease. One and two-way ANOVA was used to examine the relationship of OSA severity (mild, moderate, or severe) with P-AF. Multiple linear regression further characterized associations with P-AF.

Results
Mean AI determined P- AF was 0.052±0.012 (mean±SE) in mild, 0.064±0.014 in moderate, and 0.105 + 0.014 in severe OSA, demonstrating a significant association of OSA severity with P-AF (p = 0.01). Post-hoc pairwise tests showed a significant difference in P-AF between mild and severe (p = 0.008) but not between moderate and severe OSA (p = 0.083). Multiple linear regression with all the variables listed above showed the association between OSA severity and P-AF remains significant (P = 0.044). Age (p&lt;0.001) and comorbidity score (p&lt;0.001) were the only other variables significantly associated with P-AF.

Conclusion
OSA severity determined by AHI was significantly associated with P-AF as determined by a novel ECG-based AI algorithm independent of other variables. Given the strength of association with age and the comorbidity score, OSA severity may have been associated as it is known to increase with age and comorbid conditions. Future directions include incorporating AI enabled algorithms to identify individuals with the highest risk of AF in whom the role of OSA treatment in reducing risk of AF may be examined.

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0750 Performance Testing of a Novel Oral Appliance Material; A New Standard for OAT
Authors: Murphy Mark , Carollo John 
Published: May 2022

Abstract

Introduction
Traditionally, oral appliances for treating obstructive sleep apnea have borrowed from the disciplines of removable prosthetics and orthodontics. The materials, design and manufacturing have evolved little. Today, precision milled devices using innovative materials and designs have leapt past artisanal legacy devices. The use of artificial intelligent design to accurately replicate tooth surface anatomy and robotic manufacturing to insure precision are requiring higher table stakes to ‘get in the game’. Mill-able polymethylmethacrylate, MG6™ Technology materials and printed nylons have replaced cold cured acrylics, Thermacryl, soft liners and suck down platforms. The testing and material standards should also evolve as well.

Methods
Typically, no specific ISO testing is performed on legacy device compositions. This new medical grade class VI (the highest category) material promised to be more robust, safer and to have the highest biocompatibility. ISO testing was performed in the following arenas: ISO tests 10993-4 Hemolysis, 10993-4 in vitro hemocompatibility, 10993-5 cytotoxicity, 10993-6 short-term intramuscular implantation, 10993-10 intracutaneous injection, 10993-11 system toxicity and USP 38 physiochemical testing.Similarly, no specific durability testing is done beyond the safety requirement designs set by the FDA. This material was exposed to all the tradition stress, bend and compression testing as well as the MIL-STD-810H Military Free Fall Drop Test. Finally, stain, biogunk and the ease of keeping a device clean are always a concern with legacy device materials. Milled PMMA has been shown previously to be nearly impervious to stain and bioburden uptake. This material was tested along with predicates and PAP mask materials for comparison.

Results
ISO TestingThe Material passed all the tests as indicated in reports nos. BIO-ATX 1856,1857,1858, and BIO-GNT 8321. 832, 833. Military Drop TestThis material passed the military drop test (40 cases, each dropped 6 times). Method Test 810H section 4.6.5 Procedure IV Table 516.8-X Unpackaged handling. Stain TestingMilled Iterative PMMA DE = 3.06Milled Iterative EVO material DE = 3.20CPAP Mask plastic DE = 7.54Milled PMMA w/ soft Liner/Fulcrum Strap DE = 8.27CPAP Mask silicone DE = 11.60PMMA + Liner Anterior Hook DE = 19.05PMMA with Liner Herbst DE = 32.05Nylon with Airway DE = 90.70Nylon with Straps DE = 96.99

Conclusion
Medical grade class VI material sets new standard for oral appliance material performance

Support (If Any)
Data provided by ProSomnus, ISO.org and the DOD.
0753 Predictors of Residual sleep apnea in OSA patients on PAP
Authors: Ni Yuenan , Thomas Robert 
Published: May 2022

Abstract

Introduction
Positive airway pressure (PAP) is the first line therapy for patients with obstructive sleep apnea (OSA). However, clinical OSA may have multiple disease drivers beyond upper airway collapse, such as high loop gain and a low arousal threshold. The burden of residual sleep apnea in patients treated with PAP and it’s predictors remained to be fully defined.

Methods
Adult patients who were diagnosed with OSA through a split-night polysomnography (PSG) in the AASM accredited sleep center at the Beth Israel Deaconess Medical Center, Harvard Medical School and followed using the EncoreAnywhereTM system were prospectively included. Monthly visual/manual scoring of residual events was done. The ratio of patients with residual sleep apnea (defined as a manually-scored respiratory event index (REI) ≥ 15 times/hour in the 3rd month and 12th month were calculated. A linear regression model was used to explore the predictors of residual sleep apnea on PAP.

Results
One hundred and ninety five patients were included. In the 3rd month, there were 166 patients still on PAP. There were 74 (44.58%) with a residual AHI ≥ 15 times/h. In the 12th month, there were 93 patients still on PAP and 41 (44.09%) had residual AHI ≥ 15. In the short term, treatment CAHI (β= 0.511, SE=0.123, p=0.001), age (β= 0.123, SE=0.054, p=0.025), and hypertension (β= 3.627, SE=1.536, p=0.019) were the predictors for residual sleep apnea. In the long term, treatment CAHI (β= 0.598, SE=0.163, p=0.001), male gender (β= -5.117, SE=2.005, p=0.013) and baseline mean arousal duration (β= -0.601, SE=0.184, p=0.002) were predictors for residual sleep apnea.

Conclusion
There was a high percentage of patients with OSA on PAP who have residual sleep apnea. Treatment CAHI is a strong predictor, and may reflect high loop gain effects.

Support (If Any)
Category-I Strategic Research Award from the AASM Foundation to R. J. Thomas
0754 Effects of Atomoxetine plus a Hypnotic on Obstructive Sleep Apnea (OSA) Severity in Patients with a Moderately Collapsible Pharyngeal Airway
Authors: Corser Bruce , Rucosky Gregg , Eves Erica 
Published: May 2022

Abstract

Introduction
The combination of atomoxetine and oxybutynin has demonstrated efficacy in the treatment of OSA. Oxybutynin may play a role as an upper airway dilator muscle activator and/or a hypnotic to improve sleep quality. We assessed the effectiveness of atomoxetine when combined with one of two hypnotics. Trazodone is a known hypnotic with possible effects on pharyngeal muscle activity. The other is lemborexant, an orexin antagonist. The effects of both combinations were assessed in patients with OSA and a moderately collapsible pharyngeal airway.

Methods
Recruited patients were 18 – 65 years of age, with an AHI 4 (4% desaturation criteria) of 10 – 55 and a BMI &lt; 40 kg/m2. Each had to have a moderately collapsible pharyngeal airway using previously defined criteria based on the average percent desaturation during obstructive events (&lt; 8%) and the ratio of hypopneas to total events (&gt; 50%). After a qualifying PSG, each patient spent three nights in the sleep laboratory with approximately one week between studies. Nights were randomized to placebo, atomoxetine 80 mg plus trazodone 100 mg, and atomoxetine 80 mg plus lemborexant 10 mg. Primary outcomes were AHI 4 and the sleep apnea specific hypoxic burden (HB), the area under the SpO2 curve associated with disordered breathing events.

Results
Fifteen patients completed the trial (median [interquartile range] age was 52 [48-55] and BMI was 33.6 [30 – 35.1] kg/m2. Atomoxetine plus trazodone showed a strong trend for AHI 4 reduction from placebo (from 18.2 [11.8 – 31.3] to 7.4 [5.4 – 16.1] events/h, p=0.064), a significant reduction in HB from placebo (from 48.2 [31.2 – 79.6] to 18.7 [14.9 – 43.5] % min/h) and a trend for a reduction in HB with atomoxetine plus lemborexant (from 34.1 [12.1 – 128.8] to 18.7 [14.9 – 43.5] % min/h, p=0.055). There was no change in total sleep time or arousal index between treatment arms. Mild adverse events were reported on atomoxetine plus trazodone (2/15 sinusitis, 1/15 heartburn).

Conclusion
In OSA patients with a moderately collapsible upper airway, the combination of atomoxetine plus trazodone yielded clinically meaningful improvements in measures of sleep disordered breathing and oxygenation while atomoxetine plus lemborexant produced smaller effects.

Support (If Any)
This study was supported by Apnimed.