Evaluation Of Obstructive Sleep Apnea Research Articles

Interexaminer agreement among pediatric dental specialists in assessment of tonsil size, Friedman tongue position, and Friedman staging of obstructive sleep apnea in children: An observational study.

The evaluation of tonsil size, Friedman Tongue Position (FTP), and Friedman staging in pediatric obstructive sleep apnea (OSA) holds significant clinical importance, offering manifold advantages in diagnosis and surgical management. This study aimed to assess the reliability of pediatric OSA evaluation by determining inter-examiner agreement among pediatric dental specialists. Conducted at the Department of Pediatric Dentistry, PMS College of Dental Science and Research Hospital (2023-2024), this observational study utilized conventional consulting rooms, headlights, and examination chairs. Thirteen medical practitioners reviewed video recordings of the oropharyngeal regions of twelve pediatric patients exhibiting mouth breathing. Friedman staging was determined based on tonsil size and tongue position gradings.Inter-examiner agreement was evaluated using Fleiss kappa analysis. Observers, including residents and practitioners in pediatric dentistry, demonstrated poor agreement regarding FTP and tonsil grading. Understanding the nuances of tonsil size and FTP in pediatric OSA evaluation, along with identifying avenues for refinement, can enhance medical decision-making among healthcare providers, including pediatric dentists.

Home sleep apnea tests: Conflicts of interest and funding

ObjectivePediatric otolaryngologists rely on HSAT literature to guide their diagnostic methods related to obstructive sleep apnea (OSA). Our objectives were to review the rates of presence of funding and/or potential conflict of interest (COI), as well as its relationship to the overall quality of HSAT publications in the literature over the last two decades. Data sourcesMedline, Web of Science and Embase databases. Review methodsA review was performed reviewing publications from January 2000 to December 2021. Oxford Level of Evidence (OLE) was used as a quality metric. COI and funding were recorded verbatim as self-declared in the text of the manuscript. ResultsLiterature search yielded 4257 articles with 400 articles included in final analysis. The odds of higher quality studies (LOE 1 or 2) were higher in the last five years from 2016 to 2021 (OR, 3.6; 95% CI 1.4 to 6.9). Nearly half of all articles (43.0%) lacked a statement regarding funding or COI. There was a positive correlation between level of evidence and industry funding. The largest source of funding was from industry, comprising 39.6% of all studies that had a funding statement. Of these industry-funded studies, 37.5% reported no COI or lacked a COI statement. ConclusionDespite a growing interest in HSATs for OSA evaluation, there is heterogeneity in reporting of COI and high prevalence of industry funding and COI. Re-evaluation and consensus amongst journals on guidelines for reporting disclosures are needed. Level of evidence4

0266 An mHealth intervention to deliver personalized messages to increase adherence to OSA care among transportation workers

Abstract Introduction Transportation workers are at risk for obstructive sleep apnea (OSA), yet OSA is commonly undiagnosed in this population. In a two-phase study, we design and evaluate a tailored, mobile health (mHealth) intervention aimed at achieving OSA awareness, including changes in OSA beliefs, among operators of large highway maintenance vehicles. Methods In Phase 1, we recruited highway maintenance vehicle operators employed at worksites in the US northeast for focus groups to examine OSA beliefs and barriers. Results of the Phase 1 focus groups were used to inform the tailored intervention. In Phase 2, we evaluated the tailored approach, “Sleep Strong, Live Long,” in a mini-RCT. Worksites were randomized to intervention (Sleep Strong, Live Long) or control. Employees at both worksites completed baseline questionnaires and follow-up questionnaires 2-months post-baseline. Employees at the intervention worksite received a 30 minute in-person education session, access to an interactive website including video success stories, then follow-up text messages over 2 months as part of the Sleep Strong, Live Long program. The control condition received the intervention after completing follow-up surveys. We compared responses on the follow-up surveys between intervention and control conditions using linear regression with baseline responses as covariates. Results Phase 1 themes included common sleep complaints, inconsistent work schedules, and misconceptions about OSA (n=45). 75% of Phase 1 participants reported resistance to OSA behavior change. Phase 2 mini-RCT participants (n= 38) were on average 43.4 (sd=12.1) years old. Participants were 86.8% male and 67.6% reported an annual household income of $50,000 or more. Exposure to the intervention was associated with an improvement in OSA literacy (b=0.14, p=0.037), but not OSA self-efficacy (b=0.12, p=0.330) or OSA readiness to change (b=0.76, p=0.336). Conclusion We provide preliminary support for improving OSA literacy among a sample of transportation workers. Future research may evaluate the tailored program in a larger sample of workers and with a longer follow-up period to consider whether OSA literacy and self-efficacy mediate actual OSA behaviors, such as changes in OSA evaluation and treatment. Support (if any) This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH, Grant # K01HL150339).

1045 Resolution of Sexsomnia with Positive Airway Pressure

Abstract Introduction Sexsomnia is an infrequently encountered non-rapid eye movement (NREM) arousal disorder that can overlap with obstructive sleep apnea (OSA). Treatment of underlying OSA has been reported to resolve sexsomnia episodes. Report of case(s) A 26-year-old overweight man was referred to our Sleep Disorders Center for evaluation of possible “REM sleep behavior disorder.” The patient’s wife reported that he would fondle her breasts while he slept. Episodes began 6 months prior to his referral and occurred once every 1-2 months. During episodes, the patient did not get out of bed. He did not recall the events and denied dream recall. The patient had an infant at home with resultant sleep deprivation. He slept between 5-7 hours a night and stated episodes were more common with decreased total sleep time. Additionally, he reported recent increase in stressors after moving in with his in-laws. On evaluation, patient endorsed bruxism for which he wore a mouth guard. He reported history of sleepwalking in elementary school. He denied excessive daytime sleepiness, snoring, witnessed apneas, gasping arousals, morning headaches, unrefreshing sleep, insomnia, or substance use. He was advised to increase total sleep time and pursue a baseline polysomnogram to evaluate for sleep-disordered breathing. The polysomnogram demonstrated moderate OSA (apnea/hypopnea index of 17). Excessive arousals out of N3 sleep were not reported. He was initiated on auto-titrating positive airway pressure (APAP) and maintained moderate adherence for 2 months. At his follow-up visit, he reported no further episodes of nocturnal fondling after PAP initiation despite persistent sleep deprivation and home stressors. Conclusion This case highlights the importance of screening for sleep-disordered breathing which can coexist with NREM parasomnias such as sexsomnia. Even in patients without clear symptoms of sleep-disordered breathing, the evaluation, diagnosis, and treatment of possible OSA could decrease the frequency of sexsomnia episodes. Although this case study was mainly limited by short follow-up duration, the patient’s resolution of sexsomnia in that time demonstrates the importance of treatment of concurrent sleep-related breathing disorders. Support (if any) None.

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis.

Approximately 20% of patients with chronic rhinosinusitis (CRS) have comorbid obstructive sleep apnea (OSA). Patients with undiagnosed OSA are at high risk for perioperative complications. The Sinonasal Outcomes Test (SNOT-22) Questionnaire is commonly administered to CRS patients, whereas OSA screening tools are less routinely employed. This study compared SNOT-22 sleep subdomain (Sleep-SNOT) scores among non-OSA CRS versus OSA-CRS patients undergoing ESS, and assessed sensitivity, specificity, and diagnostic accuracy of the Sleep-SNOT for OSA screening. Retrospective review of patients that underwent endoscopic sinus surgery (ESS) for CRS from 2012 to 2021. Patients either carried a reported OSA diagnosis and completed the SNOT-22, or had undocumented OSA status and completed both STOP-BANG and SNOT-22. Demographics, questionnaire scores, and OSA status were collected. A receiver operating characteristic (ROC) curve assessed cutoff scores, sensitivity, and specificity of the Sleep-SNOT for OSA screening. Of 600 patients reviewed, 109 were included. 41% had comorbid OSA. OSA patients had a higher BMI (32.1 ± 7.7 vs. 28.35 ± 6.7 kg/m2 ; p = 0.02), Sleep-SNOT (21.96 ± 12.1 vs. 16.8 ± 11.2; p = 0.021) and STOP-BANG (3.1 ± 1.44 vs. 2.06 ± 1.27; p = 0.038) scores. A Sleep-SNOT score of 17.5 had a sensitivity of 68.9%, specificity of 55.7%, and diagnostic accuracy of 63% for OSA detection (p = 0.022). Sleep-SNOT scores are greater for CRS-OSA patients. The Sleep-SNOT ROC curve demonstrates a high sensitivity, specificity, and accuracy for OSA screening in CRS patients. A Sleep-SNOT score of ≥17.5 should prompt further OSA evaluation. The Sleep-SNOT may be considered as a surrogate OSA screening tool when other validated tools are not employed. Retrospective chart review, Level 3 Laryngoscope, 133:2029-2034, 2023.

Feasibility and performance of home sleep apnea testing in youth with Down syndrome.

In-laboratory polysomnography is recommended for the evaluation of obstructive sleep apnea (OSA) in youth with Down syndrome. However, insufficient sleep laboratories are available, particularly for youth with neurocognitive disabilities such as Down syndrome. We hypothesized that level II home sleep apnea testing (HSAT) would be feasible, acceptable, and accurate in detecting polysomnography-defined moderate-severe OSA in youth with Down syndrome. Youth 6 to 25 years old with Down syndrome were recruited to undergo in-home level II HSAT with electroencephalogram and in-lab polysomnography. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored blinded to polysomnography result, were compared to reference polysomnography. Forty-three youth (23 female) aged [median (range)] 15.5 (6.1, 25.1) years participated in the study. Forty-one participants were able to complete HSAT and 41 completed polysomnography, with 40 who underwent both tests. HSAT was preferred to polysomnography by 73.7% of parents. Total sleep time for HSAT was 437 ± 123 minutes vs 366 ± 90 minutes for polysomnography (P = .003). Obstructive apnea-hypopnea index by polysomnography was 12.7 events/h (0.2, 113.8), and 32 youth (80%) who completed all testing had OSA. Compared to polysomnography, sensitivity of HSAT was: 0.81, specificity was 0.75, accuracy was 0.8 including 2 youth whose HSAT demonstrated OSA when polysomnography did not. In youth with Down syndrome, level II HSAT was well-tolerated, preferred compared to in-lab polysomnography, and had good accuracy for detecting moderate-severe OSA. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with Down syndrome. Cielo CM, Kelly A, Xanthopoulos M, etal. Feasibility and performance of home sleep apnea testing in youth with Down syndrome J Clin Sleep Med. 2023;19(9):1605-1613.

Respiratory Monitoring after Opioid-Sparing Bariatric Surgery in Patients with Obstructive Sleep Apnea (OSA)

Introduction with Aim: Postoperative respiratory depression can complicate a patient’s recovery after surgery. A predictive score (PRODIGY) was recently proposed to evaluate the risk of opioid-induced postoperative respiratory depression. For the first time, we applied this score to a cohort of patients receiving bariatric surgery, stratified by Obstructive Sleep Apnea (OSA) status. In addition, we recorded continuous postoperative capnography to evaluate respiratory depression and apnea episodes (Respiratory Events, RE). Materials and Methods: The present study was approved by our IRB and comprised continuous surveillance of respiratory variables during postoperative recovery (in PACU) after robotic bariatric surgery. We utilized continuous capnography and pulse oximetry (Capnostream 35, Medtronic Inc., and Profox Respiratory Oximetry software). Preoperative preparation included OSA evaluation for all bariatric patients, additional sleep studies for severe OSA grades, and evaluation of risk for respiratory depression (low, intermediate, or high) using the published PRODIGY score. In addition, we evaluated patients by OSA status. All patients received multimodal intraoperative non-opioid anesthesia from the same team. After surgery, all patients received continuous respiratory surveillance in PACU (average duration exceeding 140 min). Respiratory depression events were scored using a modified list of the five standard published categories. Events were measured according to analysis of continuously recorded tracing of the compiled respiratory variables by observers kept blind from the study patient’s group. Results: Of the 80 patients evaluated (18 male), 56 had obstructive sleep apnea and were using CPAP at home (OSA); 24 did not. OSA patients received CPAP via an oronasal mask or a nasal pillow pressure support immediately after arriving in PACU, utilizing their at-home settings. We encountered 115 respiratory depression events across 48 patients. The most frequent respiratory event recorded was a transient desaturation (as low as 85%), which usually lasted 20–30 sec and resolved spontaneously in 3 to 5 min; most episodes followed small boluses of IV opioid analgesia administered during recovery, on demand. All episodes resolved spontaneously without any nursing or medical intervention. OSA patients had significantly more events than non-OSA patients (1.84 (1.78–1.9) mean events vs. 0.50 (0.43–0.57) for non-OSA, p = 0.0002). The level of PRODIGY score (low, intermediate, or high), instead, was not predictive of the number of events when we treated this variable as continuous (p = 0.39) or categorical (high vs. low, p = 0.65, and intermediate vs. low, p = 0.17). Conclusions: We attribute these novel results, showing a lack of respiratory events requiring intervention, to opioid-free anesthesia, early CPAP utilization, and head-up positioning on admission to PACU. Furthermore, all these patients had light postoperative narcotic requirements. Finally, an elevated PRODIGY score in our patients did not sufficiently predict respiratory events, but OSA status alone did. Key Points Summary: We investigated the incidence of Respiratory Events (RE) in Obstructive Sleep Apnea patients after surgery (56 patients) and compared them to similar patients without OSA (24 patients). All patients received identical robotic-assisted surgery and low- or no-opiate anesthesia. Patients were pre-screened with the standard published PRODIGY scores and were monitored after PACU arrival with continuous oximetry and capnography (Capnostream 35 and Profox analysis). OSA patients showed more RE than non-OSA (1.8 vs. 0.5, p = −0.0002). However, patients with elevated PRODIGY scores did not develop more frequent RE compared to patients with low scores. We attribute these novel results to opioid-sparing anesthesia/analgesia and immediate CPAP utilization on admission to PACU.

Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea.

Obstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women. Eligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m²] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies. The average age of 51 participants was 34.5 years (27-44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI (r = 0.515, P < 0.001). The BMI (P < 0.005) and preeclampsia rate (P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1-171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery. OSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.

Detection and screening of obstructive sleep apnea in primary care

The most prevalent sleep-related breathing condition, obstructive sleep apnea (OSA), is linked to greater morbidity and poor cardiovascular outcomes. Even though sleep disorders are frequently present, primary care physicians hardly see or treat them. Better OSA symptom and intensity identification and classification to support OSA evaluation and diagnosis were the first outcomes of a task group of the American Academy of Sleep Medicine that produced quality metrics for the treatment of adult patients with the condition in 2015. The OSA screening tools (Berlin questionnaire, Epworth sleepiness scale, STOP Bang) have proven to be effective instruments for screening of sleep disorders. The present primary care practice approach for OSA screening and evaluation is disorganized and inadequate. Patients with OSA symptomatology are seen by primary care physicians, but they are not regularly screened, assessed, or referred to a sleep specialist. For the OSA screening assessments in general practice, more psychometric investigations are required. The findings from these investigations can be applied in real-world settings to improve OSA identification.

Comparative Efficacy of Obstructive Sleep Apnea Patients Undergoing Multilevel Surgery Followed by Upper Airway Stimulation Versus Isolated Upper Airway Stimulation

Upper Airway Stimulation (UAS) of the hypoglossal nerve is a rapidly growing management option for patients with obstructive sleep apnea (OSA). Our study compares the treatment efficacy of UAS between those who were initially ineligible for UAS but subsequently met eligibility after multilevel surgery versus those who underwent isolated UAS for the treatment of moderate to severe OSA. The investigators implemented a retrospective single-center cohort study of patients aged 18+ years who presented for surgical evaluation of OSA from 2016-2019 and underwent UAS implantation. The predictor variable was eligibility status for UAS. Initially ineligible subjects were defined as having an apnea-hypopnea (AHI) > 65 events/hr, body mass index (BMI) > 32kg/m2, or complete concentric collapse (CCC) on drug-induced sleep endoscopy. Eligible subjects were defined as having an AHI between 15 and 65, with no CCC on drug-induced sleep endoscopy. The primary outcome was change in AHI which was measured preoperatively and 6months post UAS implantation. Secondary outcomes were change in Epworth sleepiness scale and Fatigue severity scale. Covariates were age, sex, and BMI. Data analysis involved descriptive statistics and multivariable statistical models; P<.05 was considered significant. Thirty six patients underwent UAS implantation from 2016-2019. Eighteen patients who were initially ineligible for UAS underwent multilevel surgery, including uvulopalatopharyngoplasty, distraction osteogenesis maxillary expansion, or maxillomandibular advancement. Mean age was 62.4±9years and BMI of 29.1±4kg/m2 with 5 female patients. The cohort of 17 patients who met criteria for UAS from the start had a mean age of 62.9±14years and mean BMI of 26.7±4kg/m2 with 2 female patients. Mean AHI reduction for the multilevel group was 37.6±21.2 events per hour (P<.001). Mean AHI reduction for the UAS-only group was 31.5±13 events per hour (P<.001). When adjusted for age, BMI, and sex, the multilevel group had a more significant reduction (18 AHI events) compared to the isolated group (P<.001). For patients who are ineligible for UAS due to severity of OSA or CCC of the velum, multilevel surgery including maxillomandibular advancement followed by UAS confers effective post-treatment results, which was superior to the UAS-only group.

Evaluation of obstructive sleep apnea: an analysis based on aberrant genes.

Obstructive sleep apnea (OSA) is an upstream disorder that frequently causes multisystem disorders. Much research has revealed the pathogenesis of OSA, but there is still a lack of research on the complications caused by OSA. The mRNA expression and methylation dataset based on peripheral blood mononuclear cells (PBMCs) were downloaded from the Gene Expression Omnibus (GEO) database. All differential expressed genes (DEGs) were ranked using the Robust Rank Aggregation (RRA) algorithm. A weighted gene co-expression network analysis (WGCNA) was constructed. Subsequently, we used immune infiltration, enrichment analysis, and least absolute shrinkage and selection operator (LASSO) regression analysis for apnea and hypopnea index (AHI) and hypertension and excessive daytime sleepiness (EDS) and constructed diagnostic model using random forest algorithm. In the present study, we identified 318 DEGs in PBMCs involved in pathogenesis or continuous positive airway pressure (CPAP) therapy. Pathway enrichment identified DEGs associated with protein regulation and metabolism. Notably, through intra group analysis, we found that the immune disorder was more significant for OSAin males, non-daytime sleepy, or non-hypertensive OSA. The area under the ROC curve of model for EDS prediction is 0.889 and 0.852 for hypertension. Notably, we found that the diagnostic model had a high linear predictive value for AHI. Our results indicate that PBMCs are a significant component of alterations in OSA and are expected to explain the mechanism of multisystem diseases caused by OSA. The present study provides new insights for symptom evaluation, classification and treatment of OSA from the molecular level.

Correlation between Neck Circumference and Continuous Positive Airway Pressure among Patients of Obstructive Sleep Apnea

Objective: To investigate the relationship between neck circumference (NC) and continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), as well as to assess CPAP requirements based on the neck circumference. Material and methods: This study was carried out in the pulmonary, vascular, and sleep disorders department of the Dow University Hospital in Karachi. The study was done for six months of duration from January 2022 to June 2022. All of the patients who had obstructive sleep apnea (OSA), between the ages of 18 and 60 years, both genders and underwent CPAP therapy were chosen for this study. The polysomnography database was utilized in order to do an analysis on the Apnea-Hypopnea Index for the OSA. Neck circumference was measured at the neck’s middle sit in every participant. The neck circumference was correlated with the CPAP therapy. The structured study proforma was used to collect all the data. Results: A total of 181 individuals who presented with OSA were studied. Mean age of the cases were 52.86+12.26 years and mean neck circumference was 43.45+3.58 cm. Males were 58.0% and females were 42.0%. Majority of the cases 56.4% had severe OSA. There was a strong significant positive correlation between neck circumference and CPAP (r= 0.177, p-value 0.017) and significant positive correlation between neck circumference and CPAP (r= 0.366, p-value 0.001). Average of CPAP pressure was significantly high according to severity of OSA (p-0.0001). Conclusion: The neck circumference was observed to be the most reliable marker that significantly positively correlated with CPAP therapy and measurements of OSA and its severity, by AHI alone, seem to have a positive correlation with CPAP therapy. However, OSA evaluation and treatment can be measured for their responsiveness to CPAP based on their neck circumference. Keywords: OSA, NC, CPAP, Relationship

HOSPITAL SCREENING FOR MODERATE TO SEVERE OSA

HOSPITAL SCREENING FOR MODERATE TO SEVERE OSA

What are we missing in adult obstructive sleep apnea clinical evaluation? Review of official guidelines

Purpose: This article presents a narrative review of current recommendations for the clinical evaluation and management of adult patients with obstructive sleep apnea (OSA) to identify points missing from a myofunctional perspective. Methods: The authors reviewed current official guidelines for adult patients with OSA, searching clinical evaluation and treatment recommendations for myofunctional therapy. Results: None of the current guidelines for evaluation of adult OSA recommend performing a myofunctional evaluation. Only two guidelines consider myofunctional therapy (MFT) as a treatment modality for adult patients with OSA. Conclusion: Despite the role of the pharyngeal dilator muscles as an essential contributor to the pathogenesis of OSA, this review has shown that myofunctional assessment is still not a standard recommendation in current guidelines for adult OSA. Recent guidelines occasionally include MFT as a therapeutic tool for OSA. To strengthen the knowledge base and evidence for including MFT treatment for adult patients with OSA, the authors encourage physicians to incorporate myofunctional evaluation into their regular clinical practice.

Dizziness in Patients With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) and dizziness are common conditions observed in the general population, and several epidemiological studies have reported an association between OSA and dizziness. Vestibular dysfunction, autonomic instability, and cerebellar degeneration secondary to recurrent hypoxia are implicated as mechanisms underlying dizziness in patients with OSA. Moreover, OSA is a risk factor for many diseases associated with dizziness, including Meniere disease, stroke, and psychiatric conditions. A dizziness questionnaire, vestibular function tests, and tests for autonomic function are useful for evaluation of OSA and concomitant dizziness. A growing body of evidence has shown that effective treatment of OSA including continuous positive airway pressure therapy reduces dizziness in these patients. Greater attention to dizziness is warranted in patients with OSA.

Molecular Interactions between Gasotransmitters in Patients with Obstructive Sleep Apnea

Patients with obstructive sleep apnea (OSA) have an increased risk of cardiovascular disease (CVD). Nitric oxide (NO) and heme oxygenase-1 (HO-1) affect vascular tone and are vasoprotective. Furthermore, hydrogen sulfide (H2S), an HO-1 inducer, is known to be a major effector molecule driving apneas. This study was conducted to examine the molecular relationships between these gasotransmitters and HO-1 in patients with OSA. Individuals who presented for evaluation for possible OSA were recruited and underwent overnight polysomnography. Individuals with an apnea-hypopnea index (AHI) of &gt;5 per hour (OSA diagnosis) were considered cases (n = 19), while those with an AHI of &lt;5 per hour (n = 6) were the controls. Blood samples were obtained before sleep and again from OSA cases prior to initiating treatment. H2S, NO, and HO-1 levels were assayed. Patients with OSA showed lower NO and H2S levels at baseline compared to controls. NO levels further decreased significantly from baseline in patients at the time of OSA diagnosis, while H2S levels largely showed an increasing trend, which was observed only when the subjects showing a baseline H2S level of &gt;0.5 μM were excluded. Interestingly, analysis of HO-1 did not show a significant change from baseline, confirming the inverse relationship between the two gasotransmitters. The alterations in the bioavailability of endogenous H2S and its molecular interactions with NO and HO-1 regulating vascular tone may play a role in the pathogenesis of CVD in OSA patients.

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022.

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

The Management of Obstructive Sleep Apnea in Primary Care.

Approximately 30 million Americans suffer from sleep disorders. The incidence of and mortality rates associated with obstructive sleep apnea (OSA) have been increasing in recent years in the United States. OSA is associated with various health problems, including depression and hypertension, and it adversely affects occupational and academic performance. Hence, OSA is a major public health concern. Sleep specialists may be consulted for the evaluation and treatment of OSA. Continuous positive airway pressure (CPAP) is the mainstay of OSA treatment. The role of primary care physicians in such a scenario becomes vital, especially for choosing the most suitable approach for each patient, treating comorbidities and risk factors, and, if needed, referring them to sleep specialists for further management. In addition to medical management, primary care physicians serve as the main patient educator on this particular health condition.

0831 Identifying Sleep-Related Breathing Disorders in Underserved Demographics Using Commercial Portable Monitoring Devices: A Case Report

Abstract Introduction An estimated twenty-five percent of American women are at high risk of having obstructive sleep apnea (OSA). However, male sex is the predominantly reported risk factor. Women are less likely to report “classic” symptoms such as snoring that prompt referral for sleep evaluation. This dichotomy potentially represents a disparity in clinical evaluation and treatment of OSA in women. Consumer digital health devices are frequently used to monitor sleep in people with and without sleep disturbances. They are generally highly sensitive yet have lower specificity when compared with formal actigraphy or polysomnography. They may be used in conjunction with physician evaluation to guide decision-making. Report of Cases: A 33 year-old female with a pertinent past medical history of obesity (BMI 37.83 kg/m ), depression, chronic pain, and anxiety was referred to our sleep center with a multi-year history of excessive daytime fatigue and non-restorative sleep that persisted despite healthy habits counseling and unremarkable lab evaluation. She ultimately presented her primary care physician with biometric data collected by her Garmin watch and Oura ring. This data, which included a reported low SpO of 83%, motivated a referral to Sleep Medicine. Her presentation Epworth Sleepiness Scale (ESS) score and Insomnia Severity Index (ISI) were 14 and 17, respectively. Polysomnography revealed an AHI of 32.6/hr, oxygen nadir of 79%, ODI of 28.7/hr, and a 97.2% sleep efficiency. PLMS index was 23.2/hour but did not contribute to sleep fragmentation and there was increased proportion of stage N3 sleep (28.2%). Severe OSA was treated with APAP. The two month follow-up ESS and ISS improved to 9 and 4, respectively. Device data revealed greater than 6 hours of consistent nightly use with a residual AHI of 3.1/hr. She subjectively stated APAP “has been a life changer” personally and professionally, as well as spousal report of resolution of snoring. Her consumer devices similarly reported improved sleep measures. Conclusion Minorities and women may be underserved in evaluation, diagnosis, and treatment of OSA. Portable monitoring using readily available consumer biometric devices may be a viable strategy for patients to further identify high risk features and prompt referral by primary care. Support (If Any) This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the Air Force Research Laboratory, Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).

0522 Level II Home Sleep Apnea Testing Compared to In-Lab Polysomnography for the Evaluation of Obstructive Sleep Apnea in Youth with Down Syndrome

Abstract Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families. Methods Prospective comparative effectiveness study. Youth &amp;lt;18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater than 5 events per hour on either test. Results Thirty-five (17 female) youth aged [median (IQR)] 10.0 (6.1, 16.9) years completed testing. Total sleep time for HSAT was 7.9 (6.9, 8.9) hours versus 6.8 (5.9, 7.0) hours for PSG (p=0.002). PSG OAHI was 12.7/hr (5.3, 21.5). Twenty-six (74.3%) participants had OSA by PSG, 20 of whom were correctly identified by HSAT; one participant with OSA diagnosed by HSAT (OAHI=6.2/hr) was not identified by PSG (OAHI=3.9/hr). Accuracy of HSAT for identifying OSA was 80.0%, sensitivity 76.9%, and specificity 88.9% compared to PSG. Signal quality was good except for pulse oximetry, with median (IQR) adequate signal for 79.5% (57.5%, 86.3%) of the study. Compared to PSG, 83.3% of parents reported that youth had a more normal night’s sleep with HSAT, 70.0% of parents found HSAT easier, and 90.0% of youth preferred HSAT. Conclusion In youth with DS, HSAT has good accuracy for detecting moderate-severe OSA. Limitations may include night-to-night variability, differences in environment, or loss of oximetry signal. Youth slept more during HSAT than in-lab PSG and the majority of families preferred level II HSAT. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with DS. Support (If Any) NIH R21HD101003 (Tapia/Kelly)