Mild OSA Research Articles

The association between serum vitamin D and obstructive sleep apnea: an updated meta-analysis

BackgroundThe objective was to determine whether OSA patients have a low serum vitamin D level by systematic review and meta-analysis.MethodsThis study searched the following electronic bibliographic databases: Embase, Medline, Web of Science, PubMed, VIP, Wanfang, CNKI and SinoMed. All data were searched between January 2000 and August 2020. The quality of the included studies was estimated by two researchers according to the Newcastle–Ottawa Scale and Agency for Healthcare Research and Quality. All qualified studies and statistical analyses were conducted using RevMan 5.2.ResultsTwenty-nine eligible studies compromising 6717 participants met the inclusion criteria of the meta-analysis. The results revealed that the serum 25(OH)D level was significantly lower in OSA patients than the controls. According to the severity of the disease, subgroup analysis was performed; the results demonstrated that the serum 25(OH)D level was not decreased in mild OSA patients compared with the controls, while the serum 25(OH)D level in moderate and severe OSA patients was lower than that in the controls. Furthermore, based on ethnicity, BMI, PSG type, study quality and latitude, the subjects were divided into different subgroups for meta-analysis. The results revealed that the serum 25(OH)D level in all OSA subgroups was decreased compared with that in the control group.ConclusionsThe present meta-analysis shows that the serum vitamin D level was different between OSA patients and healthy people. OSA patients could have a low serum vitamin D level.

Is snoring during pregnancy a predictor of later life obstructive sleep apnoea? A case–control study

BackgroundObstructive sleep apnoea (OSA) appears common in pregnancy. Complications of pregnancy such as gestational diabetes and hypertension predispose women to cardiometabolic disease in later life. It is unknown if snoring during pregnancy is a risk marker for later-life OSA. MethodsWe analysed data from N = 897 women in the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), which recruited patients attending sleep clinics at 11 sites. There were 577 cases with current OSA and 320 controls. Cases were further categorised into mild, moderate, and severe OSA based on apnoea-hypopnoea index. Retrospective self-report of snoring during pregnancy was the exposure of interest and was reported by 2.9% of cases and 3.4% of controls. ResultsMultinomial regression demonstrated that snoring during a previous pregnancy was not significantly associated with mild (OR 0.34, 95% CI 0.09–1.25, p = 0.10), moderate (OR 0.69, 95% CI 0.21–2.19, p = 0.52), or severe OSA (OR 1.86, 95% CI 0.77–4.48, p = 0.17) compared to no snoring during pregnancy. Results were unchanged after adjustment for age, body mass index, and ethnicity. 79% of women reported current snoring but all who snored during pregnancy reported current snoring. ConclusionsWomen who snore during pregnancy continue snoring in later-life but do not appear more likely to develop OSA. These findings are limited by self-reported data, recall bias, and small numbers of women who reported snoring during pregnancy. A prospective study with objective measurement of sleep and snoring during pregnancy is needed to examine the links between sleep disorders in pregnancy with health in later life.

Normal and obstructive breathing physiology during sleep.

To estimate the severity of flow limitation in patients withOSA, the number of breaths with flattened inspiratory flow curves should be identified. Attempts to do a quantitative analysis of the flattening degree for all breaths in a nighttime recording havefailed up to now. SOMNOmedics (Randersacker, Germany) developed an automated flattening analysis parameter calledthe obstructive coefficient (OC). Polysomnographic measurement including esophageal manometry was done in 25 subjects (10 healthy, 9patients with mild OSA, and 6 withsevere OSA). For each breath, the data couple of OC and esophageal pressure (EP) was used for analysis. Data couples of OC and EP were recorded for 104,608 breaths. Airway patency histogram profiles for each study group showed no remarkable differences between each other. Increase in EP with increasing RDI was identified as the only marker of OSA severity. A strong shift was observed in N3 breaths from maximum OC/lowest EP values in healthy subjects to low OC values in association with maximum EP values in OSA. The OC enables quantification of all breaths of a nighttime recording according to their degree of flattening. The relation of strong limited to less strong limited breaths is the same across the three study groups. The analysis of the corresponding EP to a given OC value for each study group identified the EP that is necessary to cause a given flow as the only parameter that discriminates degrees of severity of OSA. The trial registration number is DRKS00018095 from 2019 to 10-09.

Effects of smokıng on patıents wıth obstructıve sleep apnea syndrome.

We aimed to investigate the relationship between the presence and severity of obstructive sleep apnea (OSAS) and smoking using pulmonary function tests and polysomnographic data. This analytical cross-sectional study was done by retrospectively examining the files of patients who applied to the Meram Medical Faculty Chest Diseases Sleep Laboratory between 07.01.2016 and 30.12.2018. Three-hundred and thirty-three patients who were diagnosed with OSAS or simple snoring by polysomnography (PSG) were included in the study. Those involved in the study; 17.1% were simple snoring [apnea-hypopnea index (AHI)<5]; 15.3% were mild OSAS (AHI: 5-15); 30.6% were moderate OSAS (AHI: 16-30); 36.9% were severe OSAS (AHI>30), and 48.6% of the study participants never smoked. There was a significant correlation between the number of pack-years, minimum O2 saturation, mean O2 saturation, ratio of sleep time to total sleep time with oxygen saturation below 90%, %NREM 3 sleep time, Hb, HTC values, and FEV1/FVC values. According to the results of multiple linear regression analysis; the effect of package-year, age, and BMI on OSAS severity was found to be statistically significant (β=0.153 P=0.004, β=0.123 P=0.025, β=0.208 P<0.001, respectively). It was revealed that patients with severe OSAS were heavy smokers, and increased smoking increased the OSAS severity both by increasing the AHI and by reducing the oxygen saturation overnight. One unit increase in the package-year results in a 15.3% increase in the AHI.

Association between obstructive sleep apnea and multiple involuntary job loss history among recently unemployed adults

BackgroundObstructive sleep apnea (OSA) has been associated with negative occupational outcomes including absenteeism and poor work productivity. This analysis explored whether the severity of OSA was associated with multiple involuntary job loss history among recently unemployed adults. MethodsThis is a cross-sectional analysis of data from the screening visit of the Assessing Daily Activity Patterns Through Occupational Transitions study. Information was collected from 261 participants who recently involuntarily lost their jobs. Data included demographics, employment, medical history, and results from a limited channel home sleep apnea test. The respiratory event index was categorized as <5 events per hour (no-OSA), 5 to <15 (mild OSA), and ≥15 (moderate to severe OSA). Logistic regression and propensity score matching were used to identify factors associated with multiple involuntary job loss. ResultsA total of 44.8% of participants reported multiple involuntary job loss. Those with mild OSA had 1.85 (95%CI: 1.04, 3.28) increased odds of reporting multiple involuntary job loss as compared to participants with no OSA in the unadjusted model; while participants with moderate-to-severe OSA had 2.71 (95%CI: 1.33, 5.70) increased odds. After adjusting for age, sex, ethnicity, beginning work between 7 and 9 AM, job type, and, compensation type, the odds of involuntary job loss among participants with moderate-severe OSA were 2.46 (95%CI: 1.13, 5.52) as compared to having no OSA. ConclusionsIn a sample of recently unemployed adults, having OSA significantly increased the odds of reporting previous involuntary job losses. This study suggests OSA could be a risk factor for job loss.

Sensitivity of a sequential model based on a questionnaire (STOP-Bang vs Dixon) and nocturnal pulse oximetry for screening obstructive sleep apnea in patients with morbid obesity candidates for bariatric surgery

IntroductionObstructive sleep apnea (OSA) has a high incidence in patients with morbid obesity (MO) who are candidates for bariatric surgery (BS). Adequate screening would decrease the number of respiratory polygraphies (RPs). ObjectiveTo analyze the value of a sequential model consisting of a questionnaire (modified Dixon (DXM VS STOP-Bang) and nocturnal pulse oximetry (POX) in patients who were candidates for BS. MethodsA prospective study was conducted from July 1, 2014 to July 1, 2015 on candidates for BS, excluding those who have already undergone RP. Variables: questionnaires (Epworth, STOP-Bang, and DXM), anthropometric measurements, RP, and blood and gas tests. The sample was divided into patients with no or mild OSA (no OSA) and those with moderate to severe OSA (AHI>15). ResultsA total of 70 patients were analyzed, 46 (65.7%) of them females. Moderate to severe OSA was diagnosed in 26 (37.1%) patients. STOP-Bang and DXM were compared using ROC curves, and greater area under the curve (AUC) was found for the latter (0.873(0.74−0.930) vs 0.781(0.673−0.888)). STOP-Bang had greater sensitivity, 100%, as compared to 73.1% for DXM. ODI3% showed greater diagnostic yield (AUC=0.982 (0.970-1). Use of the sequential model with STOP-Bang>3, DXM>5, and DXM>3 would have avoided 41 (58.5%), 50 (71.4%), and 41 (58.5%) RPs and 0, 7 (10%), and 0 false negatives respectively. ConclusionUse of a sequential model based on the STOP-Bang and nocturnal POX is a useful tool for screening OSA in patients with MO candidates for BS, decreasing the number of RPs.

Factors affecting the severity of the apnea hypoapnea index: a retrospective study on 838 Egyptian patients diagnosed with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) is a common condition in the general population that is highly correlated to obesity, and it is associated with major cardiovascular morbidity and mortality. In Egypt, obesity rates are known to be high; however, OSA remains largely under-diagnosed, and data on its current magnitude is very scarce. Thus, the aims of the study were to identify the percentage of OSA in a large sample of patients referred for polysomnography and to determine the effect of different demographic data on the severity of the disease.ResultsThis retrospective study included 1012 patients. Medical data were reviewed by sleep specialists. The correlation between age, body mass index (BMI), and neck circumference (NC) with apnea hypoapnea index (AHI) was explored. Also, gender differences were analyzed. A total of 838 patients (81% males, 19% females) were diagnosed with OSA. Patients with mild, moderate, and severe OSA were 204 (24%), 146 (17%), and 488 (58%), respectively. Females were older than males (58.87 ± 10.25 versus 54.39 ± 22.96, p = 0.001) and BMI was not significantly different between both sexes (34.18 ± 13.53 versus 36.73 ± 23.25, p = 0.07), but NC was higher in men (43.56 ± 5.3 versus 39.34 ± 4.41, p = 0.001). AHI was significantly increased in men compared to women (47.97 ± 31.22 versus 37.95 ± 31.72, p = 0.001) and severe OSA was commonly diagnosed in men than women (p = 0.001). A positive significant correlation was found between BMI, NC with AHI, arousal index, average SpO2, and desaturation index.ConclusionOSA is highly prevalent among our patients. Additionally, BMI and NC independently affected the severity of their disease.

Our Experience with Using WatchPat® (Itamar Medical, Ltd.), Home Sleep Testing (HST) for the Diagnosis of Sleep Apnea in Advanced Heart Failure Patients

IntroductionSleep apnea is widely reported as an independent predictor for the development of heart failure (HF), with a 2.6-fold increase in incidence after adjusting for age, sex, body mass index (BMI) and smoking. The accepted gold standard for sleep apnea diagnosis is polysomnography (PSG); however, access to PSG is limited and more so in the COVID-19 pandemic crisis. WatchPAT Home Sleep Testing (WPHST) has been validated to accurately detect both obstructive (OSA) as well as central sleep apnea (CSA) in the general population. However, to date no studies have reported its use in the advanced HF population.MethodsThis was a single center, retrospective, observational analysis, beginning December of 2019-April 2020. All subjects that screened positive on the STOP-BANG sleep apnea questionnaire and assigned the HST were analyzed.Results62 subjects (HF, LVAD, Orthotopic Heart Transplant [OHT]) were assigned HST. 93% (n=58) completed testing. 77% (n=7/9) of patients with LVAD had testing that was deemed inconclusive, thus patients with LVAD were censored from our analysis. Of the 44 patients that tested positive for at least mild OSA, 32 % (n=14) of the patients were post OHT. Over 45% of both OHT and HF patients tested, were documented to have severe sleep apnea (See table1).DiscussionWatchPat® is the only HST that proports calculations of total sleep time. It appears to be a viable option for advanced HF and OHT patients with limited access to in-lab PSG. However, WPHST was unable to provide conclusive data for LVAD patients, hypothesized due to lack of native pulsatility. Strikingly, severe sleep apnea was documented in >45% of all patients, and no significant differences when comparing OHT patients to the advanced heart failure population. Continued research and emphasis on testing and treatment of HF patients being considered for advanced therapies is warranted, especially with the current proclivity towards minimum contact post Covid19.

An Integrated Approach Toward the Clinical and Polysomnographic Characteristics of OSA Accompanying IPF.

Coincidance of idiopathic pulmonary fibrosis (IPF) and the obstructive sleep apnea syndrome (OSA) may have important effects on the pathogenesis of each other. Our aim is to define clinical characteristics of patients with IPF and OSA and to identify a combined index to determine the severity of both diseases together. The clinical and polysomnographic characteristics of 22 patients with OSA and IPF who underwent nocturnal polysomnography (NPSG) were retrospectively evaluated and compared with 23 OSA patients without any other pulmonary comorbidities. We demonstrated high frequency of OSA within our study group (94,7%) all of whom had at least one of the majör symptoms of OSA. Lower AHI, lower neck circumference, higher percentage of deep sleep (nREM3) and less comorbidities were observed in the study group when compared to OSA with no other pulmonary comorbidities (p<0,05). When restaged into a compound index according to the gender, age and physiology (GAP) index, the patients with mild IPF and OSA showed the same life and sleep quality with the patients who have higher GAP index. All patients with IPF must be questioned for the major symptoms of sleep related breathing disorders (SRBD). Clinical suspicion for OSA must prompt NPSG. With the presence of moderate-severe OSA, the life and sleep quality of patients with mild IPF can be at the same level of patients with severe IPF.

Incidence of cure and residual obstructive sleep apnea in obese children after tonsillectomy and adenoidectomy stratified by age group

ObjectivesCurrent clinical guidelines by the American Academy of Pediatrics recommends adenotonsillectomy (T&A) as the first-line treatment for pediatric OSA. However, obese children experience a decreased incidence of cure from T&A compared to non-obese children, with obesity increasing risk of residual post-operative OSA by up to 3.7-fold. In addition to obesity, increased age has also been linked to more severe baseline OSA, among other factors. In this study, we examined how age effects the post-operative outcome in obese children with OSA. MethodsA retrospective chart review was performed to assess post-operative T&A polysomnography outcomes of obese children. Inclusion criteria included patients who were 17 years old and younger, underwent T&A, were obese and had both pre- and post-operative sleep studies. The patients were split into 3 different groups based on their age: Group 1 (0–6 years old), Group 2 (7–11 years old), and Group 3 (12–17 years old). Results55 patients were included in the study: 13 in Group 1, 20 in Group 2, and 22 in Group 3. For Groups 1, 2, and 3 respectively, data averages were BMI percentile 99.20, 98.49, and 98.92 (P = 2.77); z-score 2.79, 2.36, and 2.45 (P = 0.026), tonsil size 3.17, 3.15, and 3.23 (P = 0.898), adenoid size 2.42, 2.05, and 1.77 (P = 0.015), time between the preoperative and postoperative PSG 179, 240, and 202 days (P = 0.481), and time from surgery to postoperative PSG 126, 170, and 127 days (P = 0.544). The average preoperative oAHI was 52.56, 41.23, and 43.49 (P = 0.732), post-operative oAHI was 1.94, 4.79, and 4.44 (P=.417); and change in oAHI was 50.62, 36.44, and 39.25 (P = 0.617). When comparing the age group of 0-6-year-olds to the older remaining patients, the post-operative oAHI was the only variable to show a significant difference between the two-groups with a P value of 0.038. The percentage of patients with post-operative resolution of OSA (oAHI<2), mild, moderate, and severe OSA, respectively, were 53%, 29%, 9%, and 9% for all patients, 70%, 23.1%, 7%, and 0% for group 1; 50%, 35%, 5%, and 10% for group 2; and 45%, 27%, 13%, and 13% for group 3. The percent of the patients requiring post-surgical nighttime airway support were 18%, 7%, 15%, and 26% for Groups All, 1, 2, and 3, respectively. ConclusionWe found that despite having the highest rates of obesity and the most severe OSA, obese patients under 7 years old performed better following T&A, with greater cure rate, overall reduction of oAHI, and decreased need for post-surgical nighttime airway support.

The effects of nasal breathing on the development of snoring and apnea

Since the nose is the entrance gate of the upper airway, its stuffiness can contribute to sleep disturbance. The results of a number of case-control studies have shown that nasal congestion frequency associated with snoring and mild OSA. However, there is no strong correlation between the degree of nasal obstruction and the severity of OSA. Randomized controlled trials have shown that in patients with rhinitis, both allergic and non-allergic, the use of nasal steroids can improve sleep quality and may be useful for patients with mild OSA, but they themselves are not an adequate treatment. Surgical correction of nasal breathing disorders also reduces the apnea index and improves sleep quality.

Detection of obstructive sleep apnea in young patients suffering from coronary artery disease by performing portable polysomnography studies

BackgroundObstructive sleep apnea (OSA) is known to be an important contributory factor of coronary artery disease (CAD), but the extent of contribution of OSA in young patients suffering from CAD is not known. Thus, with an aim to detect OSA in young patients suffering from CAD by performing portable polysomnography (PSG), the present study was carried out at a tertiary care chest center. MethodsA prospective study was carried out from June 2015 to June 2018, wherein 100 consecutive young (age less than 40 years), non-smoking patients with angiographically confirmed CAD, with no identifiable risk factors for cardiovascular diseases except obesity, were subjected to level 3 portable PSG studies. ResultsOf 100 patients with CAD, 80% had OSA (24% with mild OSA, 28% with moderate OSA, and 28% with severe OSA). Body weight and severity of OSA showed a significant correlation with a P-value of 0.033. SPSS software was used for statistical analysis. The categorical variables were compared using Fischer's exact test. ConclusionThe study detected a significant number of young patients with angiographically confirmed CAD having OSA. A significant correlation was also observed between weight and severity of OSA, suggesting that overweight patients and patients with obesity have higher grades of OSA.

Correlation between peripheral blood Th17 cells and carotid intima-media thickness in OSA patients

Objective:To study the carotid intima-media thickness （IMT） level of OSA patients of different severity, the proportion of Th17 cells in peripheral blood and the mRNA level of nuclear transfer factor RORγt, and to explore the relationship between Th17 cells and atherosclerosis in OSA patients. Method:Sixty-two patients who underwent respiratory and sleep monitoring were selected and divided into three groups according to the AHI index: 15 patients in the normal control group（AHI<5）, there were 22 cases in the mild group（AHI 5-15） and 25 cases in the moderate and severe group（AHI≥15）. Carotid intima-media thickness（IMT） was measured in all subjects, the ratio of Th17 cells in peripheral blood monouelear cells（PBMC） were analysed by flow cytometry. The expression of RORγt mRNA were detected by real-time polymerase chain reaction. Result:The carotid IMT of patients in the normal control group, the mild OSA group and the moderate to severe OSA group were （0.74±0.21） mm, （1.09±0.23） mm and （1.60±0.30） mm, respectively. The moderate to severe group was higher than the mild group and the normal control group, the difference was statistically significant （P<0.01）. The proportion of Th17 in peripheral blood of the three groups was（2.54±0.20）%, （4.34±0.30）%, and （8.27±0.31）%, respectively. The moderate to severe group was significantly higher than the mild group and the control group （P<0.01）, the difference was statistically significant. The relative mRNA expression levels of RORγt in the three groups were 0.92±0.24, 2.60±0.59, and 4.93±0.72, respectively. The moderate to severe group was significantly higher than the mild group and the control group （P<0.01）, the difference was statistically significant. The proportion of Th17 in peripheral blood and the relative expression of RORvt mRNA were positively correlated with the carotid IMT （r value was 0.80, 0.78, respectively, all P<0.01）. Conclusion:Th17 cells differentiation is increased in OSA patients, and Th17 cells are correlated with indicators reflecting the progression of atherosclerosis. Th17 cells may be involved in the development of atherosclerosis in OSA patients.

Exercise as a treatment for sleep apnea

Citation:Lee-Iannotti JK, Parish JM. Exercise as a treatment for sleep apnea. J Clin Sleep Med. 2020;16(7):1005–1006.

Vitamin D deficiency in patients evaluated for obstructive sleep apnea: is it associated with disease severity?

The aim of the present study was to assess vitamin D levels in a large cohort of OSA patients and to investigate possible correlations with clinical and polysomnographic parameters. In this cross-sectional study, 685 consecutive patients underwent type 1 polysomnography (PSG) for OSA diagnosis. They were grouped according to apnea-hypopnea index (AHI) as mild, moderate, and severe. Patients with AHI < 5 served as controls. Demographic, PSG data, and serum levels of vitamin D were measured and compared between groups. OSA was diagnosed in 617 of the patients (90%). Of those, 94 (15%) had mild OSA, 150 (24%) moderate OSA, and 373 (61%) severe OSA. The risk of vitamin D deficiency (< 20ng/mL) was observed in 38% of the cohort. OSA patients had lower vitamin D levels compared to controls (23ng/mL vs 26ng/mL, p = 0.006). The lowest levels of vitamin D [mean 21] (p < 0.001 among all groups) and the higher prevalence for vitamin D deficiency (45%) were observed in severe OSA patients. After multiparametric adjustments for age, gender, obesity, and comorbidities, severe OSA showed significant independent associations with the risk of vitamin D deficiency [OR (95% CI) 2.002 (1.049-3.819), p = 0.035]. A large proportion of patients referred for OSA evaluation had vitamin D deficiency, which was independently associated with severe OSA. However, further research is needed in order to determine the role of vitamin D in OSA patients.

Sensibilidad de un modelo secuencial basado en cuestionario (STOP-Bang vs. Dixon) y pulsioximetría nocturna para el screening de apnea obstructiva del sueño en pacientes obesos mórbidos candidatos a cirugía bariátrica

IntroductionObstructive sleep apnea (OSA) has a high incidence in patients with morbid obesity who are candidates for bariatric surgery (BS). Adequate screening would decrease the number of respiratory polygraphies (RPs). ObjectiveTo analyze the value of a sequential model consisting of a questionnaire (modified Dixon [DXM] vs STOP-Bang) and nocturnal pulse oximetry in patients who were candidates for BS. MethodsA prospective study was conducted from July 1, 2014 to July 1, 2015 on candidates for BS, excluding those who have already undergone RP. Variables: questionnaires (Epworth, STOP-Bang, and DXM), anthropometric measurements, RP, and blood and gas tests. The sample was divided into patients with no or mild OSA (no OSA) and those with moderate to severe OSA (AHI>15). ResultsA total of 70 patients were analyzed, 46 (65.7%) of them females. Moderate to severe OSA was diagnosed in 26 (37.1%) patients. STOP-Bang and DXM were compared using ROC curves, and greater area under the curve (AUC) was found for the latter (0.873 [0.74 -0.930] vs 0.781 [0.673-0.888]). STOP-Bang had greater sensitivity, 100%, as compared to 73.1% for DXM. ODI3% showed greater diagnostic yield (AUC=0.982 [0.970-1]). Use of the sequential model with STOP-Bang>3, DXM>5, and DXM>3 would have avoided 41 (58.5%), 50 (71.4%), and 41 (58.5%) RPs and 0, 7 (10%), and 0 false negatives, respectively. ConclusionUse of a sequential model based on the STOP-Bang and nocturnal pulse oximetry is a useful tool for screening OSA in patients with morbid obesity candidates for BS, decreasing the number of RPs.

Performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort.

Peripheral arterial tonometry (PAT)-based technology represents a validated portable monitoring modality for the diagnosis of OSA. We assessed the diagnostic accuracy of PAT-based technology in a large point-of-care cohort of patients studied with concurrent polysomnography (PSG). During study enrollment, all participants suspected to have OSA and tested by in-laboratory PSG underwent concurrent PAT device recordings. Five hundred concomitant PSG and WatchPat tests were analyzed. Median (interquartile range) PSG AHI was 18 (8-37) events/h and PAT AHI3% was 25 (12-46) events/h. Average bias was + 4 events/h. Diagnostic concordance was found in 42%, 41%, and 83% of mild, moderate, and severe OSA, respectively (accuracy = 53%). Among patients with PAT diagnoses of moderate or severe OSA, 5% did not have OSA and 19% had mild OSA; in those with mild OSA, PSG showed moderate or severe disease in 20% and no OSA in 30% of patients (accuracy = 69%). On average, using a 3% desaturation threshold, WatchPat overestimated disease prevalence and severity (mean + 4 events/h) and the 4% threshold underestimated disease prevalence and severity by -6 events/h. Although there was an overall tendency to overestimate the severity of OSA, a significant percentage of patients had clinically relevant misclassifications. As such, we recommend that patients without OSA or with mild disease assessed by PAT undergo repeat in-laboratory PSG. Optimized clinical pathways are urgently needed to minimize therapeutic decisions instituted in the presence of diagnostic uncertainty.

0901 Role of Nasopharynx Radiography in Diagnosis of Sleep Disordered Breathing in Children

Abstract Introduction Sleep disordered breathing (SDB) in children comprises a wide spectrum of presentation ranging from primary snoring (prevalence 6-12%) to obstructive sleep apnea (OSA; prevalence 1-3%). In younger children, SDB is often secondary to adenotonsillar hypertrophy. Polysomnography is the gold standard test for evaluation of sleep disordered breathing. Yet, many providers order ancillary tests such as Radiography of Nasopharynx (NPX-ray) to assess for adenoidal hypertrophy. Previous studies evaluating efficacy of NPX-rays to diagnose airway obstruction have shown mixed results. Methods Retrospective chart review of 65 consecutive normally developed children who have had diagnostic polysomnography and NPX-rays over the past 3 years was performed. Data on age, sex, Obstructive Apnea Hypopnea Index (OAHI) and NPX-ray findings were collected. Our cohort mostly had the following diagnosis such as GERD, Asthma, Allergic rhinitis, ADHD and Obesity. Our cohort did not have neurological disorders or medications that could affect tone of upper airway. Standard pediatric AHI criteria was applied to categorize mild, moderate and severe OSA. Results Our cohort’s age ranged from 3-18 years (median age 10 years); 43 were males. Of the 24 children with normal sized adenoids with no obstruction; 6 had severe OSA and 4 had moderate OSA. 3 had hypertrophied adenoids on X-ray with occlusion of nasopharynx but only had mild OSA. Of the 15 children with prominent adenoids with some narrowing but no occlusion; 9 had severe OSA. Of the 9 children that had hypertrophied adenoids with no occlusion; 3 had moderate OSA and 3 had severe OSA. Of the 12 with mild enlargement, 4 had severe OSA. None of the 19 children with severe OSA showed airway occlusion by adenoids. Conclusion In our study, the size of the adenoids on X-ray of the Nasopharynx did not correlate with severity of SDB in children. Airway obstruction in OSA is dynamic and can occur at multiple sites affected by anatomical factors and upper airway collapsibility. As use of Nasopharyngeal radiography involves exposure to radiation, it should be used judiciously in diagnosis of SDB in children. Polysomnography is the gold standard test for evaluation of SBD in children. Support None.

0914 Sleep Disordered Breathing In Pediatric Patients Before And After Intrathecal Baclofen Therapy

Abstract Introduction Refractory spasticity in children is treated with intrathecal baclofen (ITB), which may worsen both central and obstructive breathing events. Sleep disordered breathing (SDB) is seldom investigated prior and/or subsequent to placement of ITB and there are currently no standardized protocols. This study aims to compare occurrence of SDB pre/post ITB placement. Methods Retrospective chart review revealed 104 patients started on ITB therapy from 2009-2019 and those who had pre and/or post ITB polysomnograms (PSG) were included. Medical history and PSG parameters were extracted. Comparison of paired results will occur using the Wilcoxon Signed Rank Sum Tests once collection is complete. Results Thirty-seven patients were identified having pre and/or post ITB PSGs. Results in mean ± SD show: age was 11 ± 4 years and 65% were male. Twenty-five pre ITB PSG had an oAHI of 4 ± 5 with 22/25 (88%) having SDB. There were 15/25 (60%) with mild OSA (oAHI &amp;gt;1 but &amp;lt; 5) and 7/25 (28%) with moderate-severe OSA (oAHI &amp;gt; 5/hr). CAI was 1 ± 2 and oxygen saturation nadir was 88 ± 9 %. Sixteen post ITB PSG had an oAHI of 8 ± 13 with 100% having SDB. There were 11/16 (69%) with mild OSA and 5/16 (31%) with moderate-severe OSA. CAI was 3 ± 7 and oxygen saturation nadir was 84 ± 8 %. Ten patients were initiated on non-invasive ventilation, one on supplemental oxygen and two had adenotonsillectomy. Conclusion Initial data shows high occurrence of SDB in patients pre and post ITB placement leading to medical or surgical intervention in 35%. Post ITB PSGs showed worsened oAHI and CAI and lower oxygen saturation nadir. Possible mechanisms include depression of central respiratory drive and decreased pulmonary reserves. This study may help stratify and address risks of ITB for those with refractory spasticity and SDB. Support None

0879 Outcomes of Adenotonsillectomy in Children with Down Syndrome and Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is highly prevalent in children with Down Syndrome (DS). The aim of this study was to assess the effectiveness of adenotonsillectomy (T&amp;A) on polysomnographic parameters of children with DS. Methods Retrospective chart review of children with DS who underwent T&amp;A between 2012-2019 was performed. Preoperative OSA severity was categorized by obstructive apnea-hypopnea index (OAHI): mild = 1-4.9 events/h; moderate = 5-9.9 events/h; severe ≥ 10 events/h. Results We identified 43 DS children with pre and post T&amp;A polysomnographic data in a population of 162 DS patients. A total of 25 were male, mean age 5.1 years (± 3.8 years) and 56% Caucasians. Preoperative data showed 19% mild OSA, 30% moderate and 51% severe. Postoperatively, apnea-hypopnea index (AHI) normalized in 9.3%, 37.2% had mild OSA, 18.6% moderate and 34.9% severe. Overall, T&amp;A resulted in significant improvement (p-value &amp;lt;0.05) in mean AHI, (18.51 ± 28.05 vs 11.72 ± 16.43), SaO2 nadir (80.00 ± 14.82 vs 85.51 ± 5.94), sleep efficiency (81.97 ± 11.15 vs 85.9 ± 8.28), arousal index (16.14 ± 10.23 vs 14.45 ± 12.34), and wake after sleep onset (67.19 ± 46.89 vs 50.55 ± 40.83) and no statistical difference (p-value &amp;gt;0.05) in end-tidal carbon dioxide (43.86 ± 9.56 vs 44.17 ± 3.78), Rapid Eye Movement (REM)% (15.86 ± 7.75 vs 15.92 ± 7.41), sleep latency (24.03 ± 34.39 vs 22.55 ± 21.11), and central apnea index (0.86 ± 1.38 vs 0.66 ± 0.82) in pre and post T&amp;A data. There was no statistically significant difference in pre and post T&amp;A polysomnographic parameters between 17 DS and 17 age and gender-matched non-DS control subjects. Conclusion Adenotonsillectomy resulted in improvement in AHI, oxygen desaturation nadir, sleep efficiency, arousal index and wake after sleep onset. However, a significant portion of children with DS continued to have moderate to severe OSA after T&amp;A. Support None.