Elevated Apnea-hypopnea Index Research Articles

Polysomnographic Findings into Sleep Disorders in Essential Tremor and Essential Tremor Plus: A Comparison with Healthy Controls.

To explore sleep patterns in individuals with Essential Tremor (ET) and Essential Tremor Plus (ET-Plus), compared to healthy controls, and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. We conducted a prospective cross-sectional study at NIMHANS, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using TETRAS and FTMTRS, and sleep symptoms with ESS, PSQI, Mayo Sleep Questionnaire, RLS-Q, BQ, GAD-7 and PHQ-9. All cases and controls underwent overnight video PSG. Sleep scoring was manually done by a technically adequate sleep researcher and the first author following AASM (2022) guidelines with data analysed using R studio. ET patients exhibited younger onset age (30.8 ± 16.7 years) compared to ET-Plus patients (46.8 ± 11.1 years). ET-Plus had higher TETRAS and FTMRS scores (P < 0.001) than ET. Both ET and ET-Plus patients exhibited poorer sleep quality, excessive daytime sleepiness, REM sleep behavior disorder (RBD), and Restless Legs Syndrome (RLS) symptoms compared to controls. PSG findings supported these clinical observations, showing elevated Apnea-Hypopnea Index (AHI), reduced Total Sleep Time (TST), prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients as compared to healthy controls, with no differences between the ET groups.

Does obstructive sleep apnea–induced intermittent hypoxia increase the incidence of solitary pulmonary nodules, thyroid nodules, and other disorders? A retrospective study based on 750 cardiovascular disease patients

BackgroundObstructive sleep apnea (OSA) has been shown to be an important risk factor for cardiovascular disease (CVD), and intermittent hypoxia is an important pathogenetic factor for it. In the clinic, it was found that most CVD patients combined with OSA were also combined with solitary pulmonary nodules (SPN) or thyroid nodules (TN). Are these disorders related to intermittent hypoxia? One study showed that intermittent hypoxia is a pathogenic factor for lung cancer in mice, but there have been no clinical reports. So we conducted a retrospective study to explore whether intermittent hypoxia caused by OSA increases the incidence of SPN, TN, and other disorders.MethodsWe selected 750 patients with cardiovascular disease (CVD), who were divided into the control group and the OSA group according to the result of portable sleep monitoring. Retrospectively analyzed the comorbidities that patients with OSA are prone to and explored the correlation between OSA and those comorbidities.ResultsThe incidence of SPN, TN, cervical spondylosis, and carotid-artery plaques was higher in the OSA group than in the control group. These diseases are significantly associated with OSA (p < 0.05), and their incidence increased with an elevated apnea–hypopnea index. After excluding interference from age, gender, BMI, smoking history, history of lung disease, and history of tumors, OSA showed a significant correlation with SPN. After excluding age, gender, BMI, and thyroid disease, OSA was associated with TN. Patients with comorbidities have lower nocturnal oxygen saturation and more extended periods of apnea. Logistic multiple regression results revealed that male, advanced age, obesity, CS, and nasal septum deviation were independent risk factors for OSA.ConclusionsPatients combined with OSA may further develop more comorbidities, such as SPN, TN, and carotid-artery plaques. It may be related to intermittent hypoxia caused by OSA.

Prevalence of Obstructive Sleep Apnea in Head and Neck Squamous Cell Carcinoma Patients before and after Treatment.

Background and Objectives: Obstructive sleep apnea (OSA) is common not only in the general population but even more so in patients with tumors of the head and neck region. Untreated, it leads to reduced quality of life, increased daytime sleepiness, and other comorbidities. The aim of this study was to determine the difference in the occurrence of OSA in the patient population with head and neck tumors compared with the general population as represented by the Trend cohort of the Study of Health in Pomerania (SHIP), and to assess the influence of tumor treatment. Materials and Methods: Between July 2018 and December 2021, preoperative polysomnography was conducted in 47 patients with histologically confirmed squamous cell carcinoma in the oropharynx, hypopharynx, or larynx. A follow-up polysomnography was performed in 23 patients 2-11 months after completing treatment. The collected data were correlated with tumor treatment and tumor size. Results: Of the included patients, 43 were male and 4 were female. Age ranged from 54 to 90 years. The pretherapeutic measurement found no significant difference in the prevalence of a pathologically elevated apnea-hypopnea index (AHI) in our patients compared with the SHIP Trend cohort. In the follow-up measurement after completion of treartment, a significant deterioration in AHI was observed. Initially, 70% of patients had an AHI > 5; after therapy, this increased to 87% (p = 0.008). The effect was particularly pronounced in the group of patients with advanced tumor stages who had received primary chemoradiation. Conclusions: OSA is a relevant condition in patients with head and neck cancer. Tumor treatment can lead to an increased occurrence of sleep-related breathing disorders, especially in patients with advanced tumor stages undergoing primary chemoradiation. Additional studies are necessary to better understand the exact mechanism involved.

EXAMINING THE PREVALENCE OF UNDIAGNOSED SLEEP APNEA AND ITS ASSOCIATION WITH BLOOD BIOMARKERS FOR ALZHEIMER’S

Abstract Obstructive sleep apnea (OSA) prevalence increases with age, but is often undiagnosed. Recent findings suggest association between OSA and Alzheimer’s Disease (AD). OSA may impact alterations in amyloid-beta (Aß) protein possibly through interactions with the glymphatic system, thereby unraveling underlying AD mechanisms. In a crossover study conducted 06/22-04/23, older adults (55-65, mean 61.9) without diagnosis of OSA or cognitive impairment(N=33) completed MRIs and blood draws for AD-biomarkers across evening, morning, and midday time points. Polysomnography (PSG) using Philips Sleepware measured Apnea-hypopnea-index (AHI). Morning Trails A&amp;B assessed cognitive function, and abeta40-42-42/40 levels were calculated using Immunoprecipitation-Mass-Spectrometry (IP-MS). Descriptive statistics, ANOVA, and linear regression were utilized. AHI scores averaged 10.5(SD:10.09), with 30% meeting ‘normal’ (0-5) and 52% mild (5-15) criteria. While not significant(p=.113), males(M:12.5,SD:9.7) averaged higher AHI scores than females (M:8.2 SD:10.3). AHI had a linear relationship with Abeta40 values(R2=0.18,F(2,33)=6.71,p=0.012). However, no significant association between AHI, Abeta42(p=0.09), and Abeta42.40(p=0.54) was found. Neither AHI sum scores [Trails A(p=0.09), Trails B(p=0.67)], nor severity rankings [TrailsA(p=0.74),TrailsB(p=0.14)] were significantly associated with Trails A&amp;B performance. Elevated AHI was associated with higher levels of Aß40 but not cognitive test performance. Though implications are limited by sample size, findings suggest connection between OSA and initiation of AD processes, necessitating additional research.

0973 HGNS Sensing Lead Damage After 3D Mammogram Requiring HGNS IPG and Lead Re-Implantation

Abstract Introduction Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, nocturnal hypoxemia, and daytime fatigue. Standard therapy is with positive airway pressure (PAP) therapy. If this is unsuccessful or poorly tolerated, a hypoglossal nerve stimulator (HGNS) can be surgically implanted for treatment. The goal of HGNS treatment is to advance the tongue with each respiration during sleep to relieve oropharyngeal obstruction causing OSA. This therapy has been shown to be efficacious and well tolerated for moderate to severe sleep apnea with a low complication rate. Report of case(s) A 61 year-old female with history of obesity and severe OSA presented to the sleep clinic with complaint of excessive daytime sleepiness and persistently elevated apnea-hypopnea index (AHI) of 42 events/hour despite adequate usage of CPAP therapy. She underwent an HGNS placement for treatment. Following HGNS activation she used it nightly and three months after implantation underwent an HGNS titration study which was successful (AHI 5.7) and the patient was started on optimal treatment settings with resulting resolution of OSA symptoms. After a period of successful device usage, she presented for follow up and reported complaints of excessive fatigue and sleepiness that was sudden. She attributed these changes to a 3D mammography study she underwent for breast cancer surveillance. Repeat home sleep apnea testing showed sudden worsening of her AHI to 50.6. During a thorough investigation of her device, HGNS sensing waveforms indicated possible sensing lead fracture. The patient was taken to the operating room for implanted pulse generator removal and replacement with new sensing and stimulation leads. Intra-operatively, it was noted that the distal sensing lead had several tears of the polyurethane insulation near the hub of the sensor. Following successful re-implantation sensing returned to normal and she has continued HGNS treatment. Conclusion We present a case of an unusual complication of HGNS sensing lead damage following a 3D mammography study. This led to surgical exploration with removal of a torn sensing lead and re-implantation of the HGNS generator and leads. Attention should be brought to patients and providers in the future regarding this rare, but potentially serious complication. Support (if any)

Arterial Stiffness in Patients with Sarcoidosis and Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA) and sarcoidosis have both been implied to be risk factors for increased arterial stiffness. However, it is unclear whether an elevated apnea–hypopnea index (AHI) in sarcoidosis patients increases arterial stiffness and thus the cardiovascular risk. Methods: We performed non-invasive applanation tonometry in 57 adults with sarcoidosis. The participants underwent SphygmoCor to assess arterial stiffness using an aortic augmentation index with a heart rate of 75/min (AIx) and level-3 respiratory polygraphy. An AHI of ≥5/h, ≥15/h, and ≥30/h defined mild, moderate, and severe OSA, respectively. Multivariate regression analysis was used to investigate the association between AIx and AHI, adjusted for prespecified risk factors for AIx. Results: 23 (40%) sarcoidosis patients had at least mild OSA (AHI ≥ 5), while 7 (12%) patients showed AHI ≥ 15/h. AHI was significantly associated with AIx (coef. (95%CI) of 0.31 (0.09/0.52), p = 0.006) even after adjustment for known risk factors of arterial stiffness. While severe OSA was positively associated with increased AIx, mild and moderate OSA were not associated with increased AIx after adjusting for known risk factors. Conclusions: Increased AHI is independently associated with increased arterial stiffness in sarcoidosis patients. Further investigations are needed to underline the association between OSA severity and the magnitude of arterial stiffness.

Prognostic Significance of Obstructive Sleep Apnea in a Population of Subjects with Interstitial Lung Diseases.

Obstructive sleep apnea (OSA) is often observed in subjects with interstitial lung disease (ILD). It may have a negative impact on the course of ILD, but its prognostic significance in relation to other known indicators of poor outcome is unclear. After a detailed work-up, including overnight unattended type III polygraphy, all subjects newly diagnosed with ILDs referred to our clinics were followed-up for at least 1.5years or until death or progression of disease [> 10% decline in forced vital capacity (FVC) below baseline]. We analyzed relationships between some prespecified variables of interest, including sleeping results, to establish parameters predictive of progressive course. Our population consisted of 46 subjects (mean age 59.6years; males 61%); 23.9% and 41% had idiopathic pulmonary fibrosis and ILD associated with systemic diseases, respectively. Mean baseline forced vital capacity and diffusion capacity of carbon monoxide were 83% and 57% of predicted, respectively. Mean (± SE) Apnea-Hypopnea Index (AHI) was 17 (± 3) events/h. AHI in the ranges 5-14.9, 15-29.9, and ≥ 30 was recorded in 14 (31%), 6 (13%), and 9 (20%) subjects, respectively. Mean distance covered in the 6-MWG walk test (6MWT) was 302 (± 19) m and 26 subjects (57%) showed exertional oxyhemoglobin desaturation. The median follow-up was about 18months. Multivariate logistic regression analysis showed that exertional desaturation (HR 8.2; 1.8-36.5 95% CI; p = 0.006) and AHI ≥ 30, namely the threshold of severe OSA (HR 7.5; 1.8-30.6; p = 0.005), were the only independent variables related to progressive disease course. We conclude that exertional desaturation and elevated AHI had independent negative prognostic significance in our ILD population.

Obstructive sleep apnea, myocardial perfusion and myocardial blood flow: A study of older male twins.

Obstructive sleep apnea (OSA) has been associated with incidence of cardiovascular disease and with nocturnal angina, but evidence of a link with coronary atherosclerosis and myocardial ischemia is limited and previous studies may have been affected by selection bias or unmeasured confounding factors. We performed overnight polysomnography in 178 older male twins. The Apnea/Hypopnea Index (AHI) was calculated to assess OSA from the overnight sleep evaluation. AHI ≥15 was used as indicator of moderate/severe OSA. The following day, twins underwent myocardial perfusion imaging with [82Rb]-chloride positron emission tomography. Quantitative and semiquantitative measures of myocardial perfusion and absolute myocardial blood flow were obtained. The mean age was 68 years and 40% of the sample had an AHI≥15, which indicates moderate to severe OSA. Abnormal myocardial perfusion, both with stress and at rest, was more common in twins with elevated AHI. After adjusting for clinical, lifestyle and behavioral factors, and previous history of cardiovascular disease, twins with AHI ≥15 had 3.6 higher odds (95% CI, 1.5-8.9) of an abnormal total severity score, defined as a score ≥100, and for each 5-point increment in AHI, the odds of abnormality increased by 20% (95% CI, 7%-34%). Twin pairs where both twins had OSA exhibited the greatest risk. There were no differences in measures of ischemia and absolute myocardial blood flow and flow reserve by AHI status. OSA is associated with myocardial perfusion abnormalities that suggest prior subclinical myocardial scarring or infarction. Early environmental factors that affect both twins equally may play a role and should be further explored.

Blowing past the apneic threshold.

An 81-year-old man with severe obstructive sleep apnea (OSA) on auto-titrating bilevel positive airway pressure (BPAP) with 2 LPM nocturnal oxygen presented for an initial sleep evaluation. His device download showed a residual apnea-hypopnea index (AHI) of 5.9 events/h with a clear airway index of 4.3 events/h. The auto-titrating BPAP was changed to a fixed pressure with a goal of decreasing his AHI and managing his hypoxia without oxygen. At follow-up, the patient had a severely elevated AHI and clear airway index. The objective of this report is to enlighten readers about the pathophysiology of hyperventilation, arterial PCO2 (PaCO2) and the apneic threshold.

OBESITY HYPOVENTILATION SYNDROME, OSA, AND COVID-19 INFECTION IN A YOUNG MALE

TYPE: Case Report TOPIC: Sleep Disorders INTRODUCTION: Obesity is one of the comorbidities associated with an increased risk for mortality in COVID-19. CASE PRESENTATION: a case of a 23-year-old male with no previous diagnosed disease, morbidly obese (Body mass index (BMI) of 86 kg/m2), admitted in the intensive care unit (ICU) for shortness of breath. Chest x-ray showed bilateral infiltrates suggestive of pneumonia and COVID-19 Reverse transcription – polymerase chain reaction (RT-PCR) oronasopharyngeal swab showed positive results. Arterial blood gas showed elevated PaCO2 and HCO3 levels. COVID-19 treatment regimen and Bilevel positive airway pressure (BiPAP) was provided. Once condition improved and serial COVID-19 RT-PCR swab was negative, polysomnogram was done showed an elevated apnea-hypopnea index (AHI) of 34.7 events/hour and maximum end tidal CO2 of 56 mmHg during sleep. He was prescribed use of bi-level PAP device every night during sleep, weight reduction, lifestyle management and possible bariatric surgery. DISCUSSION: Risk for severe COVID-19 infection is observed in obesity (BMI more than 40 kg/m2).1-3 Obesity Hypoventilation Syndrome (OHS) is the combination of obesity and daytime hypercapnia occurring in the absence of alternative explanation of hypoventilation accompanied by a breathing disorder during sleep.2 It is diagnosed when there is acute-on-chronic hypercapnic respiratory failure in a morbidly obese patient.2 The interplay of impaired immune response, systemic chronic inflammation, and compromised lung ventilation brought by abdominal obesity poses a challenge to their management. Treatment of OHS are reversal of sleep breathing disorder, weight reduction and possibly pharmacotherapy.1-3 CONCLUSIONS: Timely multi-disciplinary management of OHS, OSA, and COVID are necessary in order to achieve good outcomes. DISCLOSURE: Nothing to declare. KEYWORD: obesity hypoventilation syndrome

Cardiovascular correlates of sleep apnea phenotypes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BackgroundIdentifying Obstructive Sleep Apnea (OSA) phenotypes among middle-aged and older Hispanics/Latinos can facilitate personalized care, better inform treatment decisions, and could lead to improved clinical outcomes.MethodsWe focused on middle-aged and older adults (ages ≥45–74 years at baseline) with an apnea-hypopnea index (AHI) ≥5 from the HCHS/SOL (2008–2011) (unweighted n = 3,545). We used latent class analyses (LCA) to identify empirical and clinically meaningful OSA phenotypes. Sleep variables included AHI, percent sleep time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS) score, self-reported average sleep duration, restless legs symptoms, napping frequency, and self-reported sleep quality. We used survey logistic and Poisson regression to test the associations between our OSA phenotypes and prevalent and incident cardiovascular measures (cardiovascular disease, heart failure, Stroke/TIA, hypertension, diabetes, and the Framingham Cardiovascular Risk Score).ResultsAverage AHI, ESS, WHIIRS, and sleep duration were 18.1±19.5, 6.3±6.1, 7.4±6.6, and 7.8±1.7 hours, respectively, and 2.9% had zero percent time SpO2 <90%. We identified a three-class solution that clustered individuals into (1) insomnia OSA (44.3%), (2) asymptomatic mild OSA, (36.2%) and (3) symptomatic OSA (19.5%). Elevated WHIIRS and AHI scores primarily drove classification into groups one and three, respectively. In covariate adjusted models, OSA phenotypes were differentially associated with prevalence (baseline and seven years later) and incidence of cardiovascular measures.ConclusionsOSA subtypes in diverse U.S. Hispanic/Latino adults have different cardiovascular complications. More targeted research, that takes these variations into account, could help ameliorate Hispanic/Latino sleep and cardiovascular health disparities.

543 EEG-Based Deep Neural Network Model for Brain Age Prediction and Its Association with Patient Health Conditions

Abstract Introduction Electroencephalogram (EEG) provides clinically relevant information for personalized patient health evaluation and comprehensive assessment of sleep. EEG-based indices have been associated with neurodegenerative conditions, psychiatric disorders, and metabolic and cardiovascular disease, and hold promise as a biomarker for brain health. Methods A deep neural network (DNN) model was trained to predict the age of patients using raw EEG signals recorded during clinical polysomnography (PSG). The DNN was trained on N=126,241 PSGs, validated on N=6,638, and tested on a holdout set of N=1,172. The holdout dataset included several categories of patient demographic and diagnostic parameters, allowing us to examine the association between brain age and a variety of medical conditions. Brain age was assessed by subtracting the individual’s chronological brain age from their EEG-predicted brain age (Brain Age Index; BAI), and then taking the absolute value of this variable (Absolute Brain Age Index; ABAI). We then constructed two regression models to test the relationship between BAI/ABAI and the following list of patient parameters: sex, BMI, depression, alcohol/drug problems, memory/concentration problems, epilepsy/seizures, diabetes, stroke, severe excessive daytime sleepiness (e.g., Epworth Sleepiness Scale ≥ 16; EDS), apnea-hypopnea index (AHI), arousal index (ArI), and sleep efficiency (SE). Results The DNN brain age model produced a mean absolute error of 4.604 and a Pearson’s r value of 0.933 which surpass the performance of prior research. In our regression analyses, we found a statistically significant relationship between the ABAI and: epilepsy and seizure disorders, stroke, elevated AHI, elevated ArI, and low SE (all p&amp;lt;0.05). This demonstrates these health conditions are associated with deviations of one’s predicted brain age from their chronological brain age. We also found patients with diabetes, depression, severe EDS, hypertension, and/or memory and concentration problems showed, on average, an elevated BAI compared to the healthy population sample (all p&amp;lt;0.05). Conclusion We show DNNs can accurately predict the brain age of healthy patients based on their raw, PSG derived, EEG recordings. Furthermore, we reveal indices, such as BAI and ABAI, display unique characteristics within different diseased populations, highlighting their potential value as novel diagnostic biomarker and potential “vital sign” of brain health. Support (if any):

860 Variable Sleep Apnea Syndromes Complicated by Neurosurgeries in a Patient with Chiari Malformation Type 1

Abstract Introduction Chiari malformations (CM) are congenital conditions defined by craniocervical junction anatomic anomalies with downward displacement of cerebellar structures. Sleep-disordered breathing (SDB) including obstructive sleep apnea (OSA), bradypnea, central sleep apnea (CSA), and hypoventilation are described in CM patients. Report of case(s) 31-year-old male with history of CM type 1 presented to the sleep medicine clinic for management of OSA and CSA diagnosed at age 16. PSG showed an apnea-hypopnea index (AHI) of 14.2, RDI of 29, and no central events. He was started on auto-CPAP with pressures of 5–20 with subsequent visits showing high residual AHI. A subsequent CPAP-titration study resulted in a pressure of 16cm H2O yielding AHI of 0. CPAP pressure was fixed, but a high residual AHI persisted despite excellent compliance. A split-night study resulted in a BiPAP prescription, for which a titration study noted PAP-emergent CSA. He was started on auto Bilevel with IPAP of 30, EPAP of 8 and backup rate of 12bpm. Despite treatment, elevated AHI persisted so he was switched to adaptive servo-ventilation (ASV) with nightly oxygen blended in resulting in controlled complex sleep apnea. SDB management was complicated by multiple neurosurgical decompressions. During the most recent procedure, he was found to have syringomyelia, syringobulbia, and a mass at the brainstem. Surgery, including placement of a 4th ventricle stent and mass excision, initially led to a decrease of residual AHI to a low of 0.7, before progressively increasing to 15. A repeat PSG demonstrated severe OSA (AHI of 35), without evidence of CSA or nocturnal hypoventilation. ASV was resumed and patient’s AHI progressively decreased to an average of 8, with improvement in his sleep apnea symptoms. Conclusion SDM in CM patients can be explained by condition-related anatomical changes and depression of respiratory centers due to possible extrinsic compression leading to complex sleep apnea presentations. While it is unclear why this patient’s sleep apnea improved then worsened after his latest decompression surgery, we believe that CSF recirculation and postoperative inflammation may be responsible. Close monitoring of SDB in patients with CM is important as they may require advanced therapies for proper control. Support (if any):

Predictors of success in hypoglossal nerve stimulator implantation for obstructive sleep apnea.

ObjectiveCurrent guidelines for hypoglossal nerve stimulator (HGNS) implantation eligibility include drug-induced sleep endoscopy (DISE) findings and other patient characteristics but lead to highly variable rates of surgical success across institutions. Our objective was to determine whether additional factors seen on preoperative evaluation could be used as predictors of surgical success.Study designRetrospective chart review.SettingSingle-institution academic tertiary care medical center.Subjectsand Methods:This study included patients with obstructive sleep apnea (OSA) who underwent HGNS implantation between 2015 and 2018. Surgical success was defined as a postoperative apnea-hypopnea index (AHI) of less than 20 events per hour and an AHI reduction of at least 50%. Preoperative polysomnogram (PSG) results, DISE findings, and physical parameters were compared between surgical successes and failures.ResultsA total of 68 patients were included in the analysis. The overall surgical success rate was 79.4% (54/68). Elevated preoperative AHI was associated with an increased likelihood of treatment failure, with an AHI of (36.9 ± 16.8) events/hour in the success group compared to (49.4 ± 19.6) events/hour in the failure group (P = 0.05). Patients observed to have partial lateral oropharyngeal collapse on DISE was more frequently associated with the treatment failure group than in the success group (P = 0.04).ConclusionPatients who underwent HGNS implantation overall had a very high treatment response rate at our institution. Factors that may predispose patients to surgical failure included the presence of lateral oropharyngeal collapse and a significantly elevated preoperative AHI. These should be considered when determining surgical candidacy for HGNS implantation.

Comparative effects of psychotropic medications on sleep architecture: a retrospective review of diagnostic polysomnography sleep parameters.

Objective To study the effects of different psychotropic drugs on sleep architecture and sleep-related disorders.Material and Methods In this retrospective review of 405 consecutive de-identified diagnostic polysomnograms performed at a sleep laboratory from 2007 until 2011, we grouped 347 polysomnograms into five categories: controls, antidepressants (AD), antidepressants + anticonvulsants (ADAC), antidepressants + antipsychotics (ADAP), antidepressants + anticonvulsants + antipsychotics (ADACP). We conducted pairwise comparisons for demographic characteristics, medical history, specific psychotropic medication uses and sleep architecture variables, and adjusted for multiple testing. We used logistic regression to determine the odds ratio of having elevated apnea-hypopnea index (AHI) and periodic limb movement index (PLMI) within each group as compared to controls.Results Compared to controls, all groups had a significantly higher prevalence of benzodiazepines and trazodone use. AD and ADACP had significantly longer REM latency and lower REM percentage of total sleep time compared to controls. ADAP had a significantly lower AHI compared to controls, but that association was lost in the regression model. AD was associated with a higher PLMI compared to controls.Conclusion Psychotropic polypharmacy does not seem to be associated with significantly deleterious effects on sleep architecture. Adjunct anticonvulsants or antipsychotics to antidepressants may protect against periodic limb movement disorder.

What Are the Factors Affecting Total Sleep Time During Video Polysomnography in Infants?

The aim of the study is to investigate factors affecting total sleep time (TST) during infant polysomnography (PSG) and assess if <4 hours of TST is sufficient for accurate interpretation. Overall, 242 PSGs performed in 194 infants <6 months of chronological age between March 2013 and December 2015 were reviewed to identify factors that affect TST, including age of infant, location and timing of study, presence of medical complexity, and presence of nasal tubes. A continuum of apnea-hypopnea index (AHI) in relation to TST was reviewed. Data were examined in infants who had TST <4 hours and low AHI. Greater TST (p < 0.001) was noted among infants during nocturnal PSGs, at older chronological and post-menstrual ages, and without medical complexity. The presence of nasogastric/impedance probes reduced TST (p = 0.002). Elevated AHIs were identified even in PSGs with TST <4 hours. Short TST may have affected interpretation and delayed initial management in one infant without any inadvertent complications. Clinical factors such as PMA and medical complexity, and potentially modifiable factors such as time of day and location of study appeared to affect TST during infant PSGs. TST < 4 hours can be sufficient to identify high AHI allowing physician interpretation. · Less than 4 hours of TST is enough for interpretation of infant polysomnography.. · Shorter TST appears related to infant age, medical complexity, and higher apnea-hypopnea index.. · Modifiable factors seen with higher TST were time of day, environment, and presence of nasal tubes..

0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract Introduction Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias). Methods Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2&amp;lt;90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality. Results Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 &amp;lt;90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2&amp;lt;90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2&amp;lt;90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds. Conclusion We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities. Support 5R01AG048642-05; R21AG056952; R21HL140437.

Effect of Venlafaxine on Apnea-Hypopnea Index in Patients With Sleep Apnea: A Randomized, Double-Blind Crossover Study

One of the key mechanisms underlying OSA is reduced pharyngeal muscle tone during sleep. Data suggest that pharmacologic augmentation of central serotonergic/adrenergic tone increases pharyngeal muscle tone. We hypothesized that venlafaxine, a serotonin-norepinephrine reuptake inhibitor, would improve OSA severity. In this mechanistic, randomized, double-blind, placebo-controlled crossover trial, 20 patients with OSA underwent two overnight polysomnograms≥ 4days apart, receiving either 50mg of immediate-release venlafaxine or placebo before bedtime. Primary outcomes were the apnea-hypopnea index (AHI) and peripheral oxygen saturation (Spo2) nadir, and secondary outcomes included sleep parameters and pathophysiologic traits with a view toward understanding the impact of venlafaxine on mechanisms underlying OSA. Overall, there was no significant difference between venlafaxine and placebo regarding AHI (mean reduction, -5.6 events/h [95%CI, -12.0 to 0.9]; P= .09) or Spo2 nadir (median increase,+1.0%[-0.5 to 5]; P= .11). Venlafaxine reduced total sleep time, sleep efficiency, and rapid eye movement (REM) sleep, while increasing non-REM stage 1 sleep (Pall< .05). On the basis of exploratory post hoc analyses venlafaxine decreased ("improved") the ventilatory response to arousal (-30%; P= .049) and lowered ("worsened") the predicted arousal threshold (-13%; [P= .02]; ie, more arousable), with no effects on other pathophysiologic traits (Pall≥ .3). Post hoc analyses further suggested effect modification by arousal threshold (P= .002): AHI improved by 19%in patients with a high arousal threshold (-10.9 events/h [-3.9 to -17.9]) but tended to increase in patients with a low arousal threshold (+7 events/h [-2.0 to 16]). Other predictors of response were elevated AHI and less collapsible upper airway anatomy at baseline (|r| > 0.5, P≤ .02). In unselected patients, venlafaxine simultaneously worsened and improved various pathophysiologic traits, resulting in a zero net effect. Careful patient selection based on pathophysiologic traits, or combination therapy with drugs countering its alerting effects, may produce a more robust response. ClinicalTrials.gov; No.: NCT02714400; URL: www.clinicaltrials.gov.

Referral indications and prevalence of sleep abnormalities in children with early onset scoliosis.

This study describes the utility of overnight sleep studies in children with early onset scoliosis (EOS). Children with EOS have diminished respiratory reserve which is associated with abnormal breathing and sleep quality in children. Currently, there are no criteria for referral of these children to evaluate breathing during sleep or data on the use of sleep treatments as part of their supportive care. A review of the 159 patients with EOS who were followed at a single institution from 2003 to 2016 identified 68 who underwent overnight polysomnograms (PSGs). Sixty-five of 68 (96%) had elevated apnea-hypopnea index (AHI) and a majority (56%) were prescribed nighttime respiratory support. A majority of young children (< 5years) with PSG were referred for a history of snoring, apnea, or restless sleep; all 30 had abnormal PSGs. Twenty-seven (90%) had nighttime hypoxemia (nadir oxygen saturation values < 92%). Eighteen (60%) were referred to otolaryngology, of whom 11 (37%) subsequently underwent tonsil and/or adenoid removal. In older children (≥ 5years), those referred for PSGs had more severe restrictive chest wall disease [lower forced vital capacity (FVC) values] than those who were not sent for PSG. Correlation between FVC and apnea-hypopnea index, however, was not significant. Pre-operative coronal curve magnitude did not strongly correlate with nadir SaO2 or AHI in either age group. These results suggest that sleep studies are underutilized in the management of children with EOS. Inadequate and poor-quality sleep adversely affects growth, behavior, and cognitive function in children. This study suggests that screening for sleep abnormalities should be incorporated into assessment and treatment of more patients with EOS.

Interaction effect of obstructive sleep apnea and periodic limb movements during sleep on heart rate variability

We aimed at assessing cardiac autonomic function by heart rate variability during sleep in patients with obstructive sleep apnea and periodic limb movements during sleep, and to compare it with that of patients with obstructive sleep apnea only, periodic limb movements during sleep only, and controls. We also aimed at investigating the interaction effect between apnea-hypopnea index and periodic limb movement index on heart rate variability. Four groups of patients (n = 42 each, total = 168) were identified based on the presence/absence of obstructive sleep apnea and periodic limb movements during sleep: + obstructive sleep apnea/- periodic limb movements during sleep (5 ≤ apnea-hypopnea index < 30 events per hr), - obstructive sleep apnea/+ periodic limb movements during sleep (periodic limb movement index> 15 events per hr), + obstructive sleep apnea/+ periodic limb movements during sleep, - obstructive sleep apnea/- periodic limb movements during sleep (controls). All groups were matched for age, sex and body mass index. Time- and frequency-domain heart rate variability measures were calculated over 5-min periods of stable stage 2 non-rapid eye movement sleep. In patients with both obstructive sleep apnea and periodic limb movements during sleep, LFnu and LF/HF ratio were higher than in those with obstructive sleep apnea only, periodic limb movements during sleep only, and controls, while HFnu was the lowest among the four groups. LFnu, HFnu and LF/HF ratio were significantly and independently associated with minimal oxygen saturation in the + obstructive sleep apnea/+ periodic limb movements during sleep group. There was a significant interaction effect between apnea-hypopnea index and periodic limb movement index on LF/HF ratio (p = 0.038) in patients with obstructive sleep apnea. Patients with elevated apnea-hypopnea index and elevated periodic limb movement index exhibited higher sympathovagalbalance compared with those with high apnea-hypopnea index and low periodic limb movement index, and compared with those with low apnea-hypopnea index (regardless of periodic limb movement index). Increased sympathetic activation and decreased parasympathetic control appear to be related to the severity of oxygen desaturation. Apnea-hypopnea index and periodic limb movement index had interactive effects on increased sympathovagal balance in patients with obstructive sleep apnea.