Moderate Sleep-disordered Breathing Research Articles

Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing.

Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, while the criteria recommended by the American Academy of Sleep Medicine requires either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these two definitions for men and women in a clinical setting. We reviewed polysomnography (PSG) reports for all patients who completed a diagnostic PSG study at one sleep disorders center in 2019. Every PSG was scored using both sets of criteria to determine AHI-4 and AHI-3A. Data from 279 women (64.7%), and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9±27.3, and the mean AHI-3A was 34.7±32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (p=0.001) for women and 21.7% (p=0.006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, while men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition. The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

Prevalence, type, severity and determinants of sleep disordered breathing in acute myocardial infarction patients: the AMI-Sleep study

Abstract Background Sleep Disordered Breathing (SDB) is highly prevalent in patients with ischemic heart disease and often remains undiagnosed. Purpose We aimed to assess the prevalence, type, severity and determinants of SDB in patient hospitalized for acute myocardial infarction (AMI). Methods We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB characteristics (central or obstructive) and severity based on Apnea-Hypopnea index (AHI). SDB was defined by an AHI≥15/h. Multivariable logistic regression (adjusted for age, sex, diabetes, hypertension, smoking, body mass index, severity of the coronary artery disease, left ventricular ejection fraction [LVEF] at admission [or at discharge if missing] and use of Ticagrelor) was used to analyze the associations between characteristics of the patients at inclusion and SDB. Results Among 1752 patients, 955 (54.5 [52.1;56.9] %) had an AHI≥15/h. The prevalences of mild (AHI= 5-14.9), moderate (AHI=15-29.9) and severe (AHI≥30) SDB were 30.9%, 24.2% and 30.3% respectively. SDB characterization was technically possible in 712 patients (74.6%), and was found central in 72.2% of cases, obstructive in 12.9% and mixed in 15.4%. Male sex, age, BMI, diabetes, degree of severity of CAD, LVEF≤40% and treatment with Ticagrelor were independently associated with SDB. Conclusion More than half of the patients hospitalized for AMI had at least moderate SDB with a majority of them characterized as central. SDB diagnosis should be considered in this setting and particularly in very high cardiovascular risk patients with severe CAD.SDB determinants in AMI patients

Sleep disordered breathing and in-hospital prognosis in acute myocardial infarction patients: a subset of the AMI-Sleep study

Abstract Background Despite its high prevalence in patients with coronary artery disease (CAD), the association between sleep disordered breathing (SDB) and in-hospital prognosis is not well determined. Purpose We aimed to study in-hospital prognosis depending on the presence of SDB in patient hospitalized for acute myocardial infarction (AMI). Methods We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB severity based on Apnea-Hypopnea index (AHI). SDB screening was considered as positive for patients who have at least moderate SDB, defined by an AHI≥15/h. Results Among 1752 patients, 955 (54.5 [52.1;56.9] %) had at least moderate SDB. Compared with patients without SDB, SDB patients have major cardiac impairment including more 3-vessel CAD (26.8% vs 20.8%) and a lower admission left ventricular ejection fraction (52.2% vs 50.4%) associated with a higher use of non-invasive ventilation (3.8% vs 1.6% in non-SDB patients). SDB patients had also more in-hospital complications in particular more transfer to hospital intensive care (0.1% vs 0.9%) and an increased length of stay (4.8 vs 5.9 days). Conclusion More than half of the patients hospitalized for AMI had at least moderate SDB and presence of SDB was associated with more in-hospital morbidity. SDB screening should be considered to identify high risk sub-group of AMI patients.

Correlates of sleep-disordered breathing and Cheyne-Stokes respiration in patients with atrial fibrillation who have undergone pulmonary vein isolation.

Sleep disordered breathing (SDB) is a common comorbidity in patients with atrial fibrillation (AF). Patients undergoing pulmonary vein isolation (PVI) for AF have a high prevalence of SDB. In previous studies, some patients with AF had Cheyne-Stokes respiration (CSR). The aim of the present study was to assess the prevalence of SDB and the correlates of SDB severity and CSR in AF patients who have undergone PVI. The study was conducted using a single-center observational design. All participants underwent a home sleep apnea test (ApneaLink Air, ResMed, Australia), which could determine the severity of SDB as assessed by the apnea-hypopnea index (AHI) and the percentage of CSR (%CSR) pattern. 139 AF patients who underwent PVI were included in the study. Overall, 38 (27.3%) patients had no SDB (AHI < 5), 53 (38.1%) had mild SDB (5 ≤ AHI < 15), 33 (23.7%) had moderate SDB (15 ≤ AHI < 30), and 15 (10.8%) had severe SDB (AHI ≥ 30). Correlates of the increased AHI included male sex (β = 0.23, p = 0.004), age (β = 0.19, p = 0.020), high body mass index (β = 0.31, p < 0.001), and β blockers usage (β = 0.18, p = 0.024). Conversely, correlates with the %CSR rate included male sex (β = 0.18, p = 0.020), age (β = 0.19, p = 0.015), non-paroxysmal AF (β = 0.22, p = 0.008), and high glycohemoglobin A1c (β = 0.36, p < 0.001) and N-terminal pro-brain natriuretic peptide (β = 0.24, p = 0.005) levels. SDB is prevalent in patients with AF who have undergone PVI; predisposing factors for SDB include male sex, older age, and obesity. CSR occurs in patients with AF who have undergone PVI; predisposing factors for CSR include male sex, older age, high left ventricular filling pressure, and abnormal blood glucose level.

Variability in sleep architecture and alterations in circadian rhythms in patients with acute cerebral infarction accompanied by sleep-disordered breathing.

To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms. Patients with ACI within 48h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated. 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1-2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05). Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient's sleep circadian rhythm and increase its IV.

Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in...

Effects of Tongue Strength Training on Patients with Mild to Moderate Sleep-disordered Breathing: A Randomized Controlled Trial.

: Several studies have reported that oropharyngeal myofunctional therapy (OMT) reduces the severity of obstructive sleep apnea (OSA). However, because OMT protocols are often complicated, they take time and effort to implement. The aim of this study was to determine the therapeutic effect of 8 weeks of simple tongue strength training with a training device. : Twenty patients with mild to moderate sleep-disordered breathing were randomized to the control group (n=10) or intervention group (n=10). The patients in the intervention group completed 8 weeks of daily tongue strength training using a training device. After 8 weeks, we evaluated each patient for sleep-disordered breathing by portable monitoring. We also evaluated each patient's body mass index (BMI), neck circumference, Epworth Sleepiness Scale (ESS) score, and tongue pressure. No significant difference was found in the change in apnea hypopnea index (AHI) from baseline to 8 weeks between the control and intervention groups (P=0.44). However, the changes in neck circumference (P=0.02) and maximum tongue pressure (P=0.03) from baseline to 8 weeks were significantly different between the two groups. No significant difference was found for changes in BMI and ESS scores from baseline to 8 weeks between the two groups. : Tongue strength training in patients with sleep-disordered breathing did not significantly improve AHI as measured by portable monitoring, although significant changes were observed for increased tongue pressure and reduced neck circumference.

LOOK AHEAD SLEEP: STUDY DESIGN AND BASELINE CHARACTERISTICS

Abstract Older adults with obesity and type 2 diabetes (T2D) are at elevated risk for mild cognitive impairment (MCI) and dementia. Compared with younger persons, older adults are more likely to have sleep-disordered breathing (SDB), which is also common among adults with T2D and obesity and is associated with higher risk of dementia. The Look AHEAD Sleep (LA-Sleep) study investigates links of SDB and circadian rest/activity rhythms with cognitive performance, MCI, and dementia in older adults with T2D and obesity/overweight enrolled in Look AHEAD Aging (LA-A). LA-Sleep participants completed cognitive measures at baseline and were randomized to sleep measurement in the first (2022-2023) or second year (2023-2024). Sleep measures include assessments of SDB (WatchPAT), circadian rest/activity rhythms (ActiGraph) and daily sleep diary. Of those who enrolled in LA-A, 62.8% consented to LA-Sleep. To date in 203 participants have provided data from WatchPAT and 107 provided actigraphy data. Participants were a mean (±SD) age of 76.1±5.4 y, had a mean BMI of 34.2±6.7 kg/m2, 56.7% identified as female, and 75.4% were Non-Hispanic White, 12.3% Non-Hispanic Black, and 6.9% Hispanic. Approximately 90.2% had &amp;gt;high school education. Of participants with obesity in 2018-2020, 27.9% (41/147) had an apnea hypopnea index (AHI) of ≥15 to &amp;lt;30/h (moderate SDB) and 20.4% (30/147) had ≥30 events/h (severe SDB). Mean actigraphy-estimated total sleep time was 7.1±1.4 h, and mean wake after sleep onset was 62.5±31.0 min/night. Among adults with T2D and overweight/obesity, a high proportion have SDB and sleep fragmentation, potentially increasing risk for dementia.

Sleep-disordered breathing is related to retinal vein occlusion: A meta-analysis.

Previous studies suggest that sleep-disordered breathing (SDB) may be a potential risk factor of retinal vein occlusion (RVO). We conducted a meta-analysis to systematically explore the relationship between RVO and SDB. Observational studies assessing the relationship between SDB and RVO were retrieved by searches of electronic databases including the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wan Fang databases from database inception to August 9, 2023. In consideration of intra-study heterogeneity, a random-effects model was adopted to combine the results. Seven studies (1 retrospective cohort and 6 case-control studies) were included in this meta-analysis, and among 36,628 adults included in those studies, 6452 (17.6%) had SDB. The combined results indicated that SDB was associated with RVO [risk ratio (RR): 1.92, 95% confidence interval (CI): 1.60-2.30, P < .001] with no significant heterogeneity (I2 = 0%). Subgroup analyses showed consistent relationships between SDB and any RVO (RR: 1.73, 95% CI: 1.13-2.28, P < .001), central RVO (RR: 2.20, 95% CI: 1.57-3.08, P < .001), and branch RVO (RR: 1.85, 95% CI: 1.15-2.99, P = .01). Moreover, the relationship was consistent among patients with mild (RR: 1.82, 95% CI: 1.32-2.53, P < .001), moderate (RR: 2.17, 95% CI: 1.65-2.85, P < .001), and severe SDB (RR: 2.66, 95% CI: 1.96-3.62, P < .001). The association was consistent in studies that adjusted for age and sex (RR: 2.17, 95% CI: 1.50-3.13, P < .001), and in studies with additional adjustment for comorbidities (RR: 1.78, 95% CI: 1.42-2.25, P < .001). SDB is associated with RVO in adults.

Assessment of Sleep Disturbances and Sleep Disordered Breathing in Primary Immunodeficiency Disorders

IntroductionPatients with primary immunodeficiency disorders (PIDD) have lower health related quality of life (HRQoL) compared to the general population. Fatigue is a predominant symptom for PIDD patients and previous publications have demonstrated increased self-reported measures of fatigue in this population, including PROMIS-29 scores. Fatigue is also seen in patients with sleep related disorders including sleep disordered breathing (SDB). Thus, we examined the prevalence of sleep disturbances and SDB in patients with PIDD. MethodsPatients from our institution with a physician-confirmed diagnosis of PIDD were recruited for this IRB-approved study. Patients under 18 years of age, currently pregnant, or with previous diagnosis of SDB were excluded. Patients completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires via REDCap. Patients then completed a home sleep apnea test (HSAT) using the Watch-PAT One device. ResultsA total of 24 patients with PIDD were enrolled in the study. Median age was 49.4 (range: 22.5–68.7) years, 18/24 (75%) patients were female. 22 out of 24 patients completed the questionnaires. Median values for PSQI, ESS, and FSS were 9.0 (2–18), 7.5 (0–20), and 4.9 (1.0–7.0), respectively. The median PROMIS Fatigue score was 57.9 (33.7–75.8). 14 out of 24 patients completed HSATs at the time of abstract submission. Sleep disordered breathing was defined as having an apnea-hypopnea index (AHI) of 5 events/hour or greater. For patients who completed HSATs, 10 (71%) met the threshold for having SDB. Based on guidelines established by the American Academy of Sleep Medicine, 6 (43%) had mild SDB, 3 (21%) had moderate SDB, and 1 (7%) had severe SDB. ConclusionPatients with an established diagnosis of PIDD, without previously diagnosed SDB, show a higher burden of poor sleep quality, daytime sleepiness, and fatigue based on scoring of self-reported questionnaires as compared to the general population. Overall, these patients were also noted to have a higher burden of sleep disordered breathing. These results provide preliminary evidence that undiagnosed sleep disturbances and SDB may contribute to the increased burden of fatigue in patients with PIDD.

Association between sleep-disordered breathing and periodontitis: a meta-analysis.

Systemic inflammation is a feature of sleep-disordered breathing (SDB) as well as periodontitis. The association between SDB and periodontitis, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies with SDB diagnosed with the objective polysomnography examination were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Ten cross-sectional or case-control studies with 43,296 participants contributed to the meta-analysis. Pooled results showed that SDB was significantly associated with periodontitis (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.52 to 2.20, I2 = 40%, p < 0.001). Sensitivity analysis showed consistent association for severe periodontitis (OR: 1.39, 95% CI: 1.20 to 1.61, I2 = 0%, p < 0.001). Subgroup analyses showed consistent results in patients with mild (OR: 1.66, p < 0.001), moderate (OR: 2.23, p = 0.009), and severe SDB (OR: 2.66, p < 0.001). Moreover, the association between SDB and periodontitis was consistent in Asian and non-Asian studies, in cross-sectional and case-control studies, in studies with univariate and multivariate regression models, and in studies with different quality scores (p for subgroup effects all < 0.05). Polysomnography confirmed diagnosis of SDB is associated with periodontitis in adult population.

Prevalence and Predictors of Sleep-Disordered Breathing in Men Participating in the Multicenter AIDS Cohort Study

Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown. Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups? Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n= 466; 92%virologically suppressed) and without (n= 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions:≥ 5 events/h based on an ODI with a 3%(ODI3) or 4%(ODI4) oxygen desaturation, or an AHI with a 3%oxygen desaturation or EEG arousal (AHI3a) or with a 4%oxygen desaturation (AHI4). SDB prevalence was similar in men with and without HIV using the ODI3 and AHI3a definitions. However, SDB prevalence was higher in men with than without HIV using the ODI4 (55.9%vs47.8%; P= .04) and the AHI4 definitions (57.9%vs50.4%; P= .06). Mild and moderate SDB were more common in men with than without HIV. Associations between SDB prevalence and age, race, and BMI were similar in men with and without HIV. Among men with HIV, viral load, CD4 cell count, and use of antiretroviral medications were not associated with SDB prevalence. SDB prevalence was high overall but greater in men with than without HIV using the ODI4 threshold definition. Efforts to diagnose SDB are warranted in people with HIV, given that SDB is associated with daytime sleepiness and impaired quality of life.

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure.

Background: Sleep-disordered breathing (SDB) is a highly common comorbidity in patients with heart failure (HF), and a known risk factor for ventricular tachycardia (VT) development. However, little is known about the impact of SDB treatment on VT burden in HF patients to date. Therefore, this study investigated VT burden, as well as implantable cardioverter-defibrillator (ICD) therapies in HF patients with SDB treatment, in comparison to untreated SDB HF patients. Methods: This retrospective study analyzed VT burden, rate of antitachycardia pacing (ATP), and the number of shocks delivered in a propensity score-matched patient cohort of patients with SDB treatment or control. Patients had moderate or severe SDB (n = 73 per each group; standardized mean difference of 0.08) and were followed for a minimum of one year. In addition, survival over 4 years was assessed. Results: Mean patient age was 67.67 ± 10.78 and 67.2 ± 10.10, respectively, with 15.06% and 10.95% of the patients, respectively, being female. Regarding SDB subtypes in the control and SDB treatment group, central sleep apnea was present in 42.46% and 41.09% of the patients, respectively, and obstructive sleep apnea was present in 26.02% and 31.50% of the patients, respectively. Mixed type sleep disorder was present in 31.50% and 27.40% of cases. Among the SDB treatment group, a significantly lower number of VTs (28.8% vs. 68.5%; p = 0.01), ATP (21.9% vs. 50.7%; p = 0.02), as well as a lower shock rate (5.5% vs. 31.5%; p < 0.01), was observed compared to the control group. Furthermore, the VT burden was significantly lower in the SDB treatment group when compared to the time prior to SDB treatment (p = 0.02). Event-free survival was significantly higher in the SDB treatment group (Log-rank p < 0.01). Conclusion: SDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. Thus, HF patients should be generously screened for SDB and treated appropriately.

Abstract 12026: Correlates of Sleep Disordered Breathing and Cheyne-Stokes Respiration in Patients With Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Background: Sleep disordered breathing (SDB) is known as a common comorbidity in patients with atrial fibrillation (AF). Indeed, patients undergoing pulmonary vein isolation (PVI) for AF had a high prevalence of SDB in particular, Cheyne-Stokes respiration (CSR). The aim of the present study is to assess the correlates of SDB severity and CSR in AF patients undergoing PVI. Methods and Results: The study was conducted under a single-center, observational design. We enrolled 140 consecutive patients undergoing PVI. All participants underwent home sleep apnea test (ApneaLink Air, ResMed, Australia) which could determine the severity of SDB as assessed by apnea-hypopnea index (AHI) and the percent of CSR (%CSR) pattern. Overall, 33 (27.9%) patients was no SDB (AHI&lt;5), 53 (37.9%) patients was mild SDB (5≦AHI&lt;15), 33 (23.6%) patients was moderate SDB (15≦AHI&lt;30), and 15 (10.7%) patients was severe SDB(30≦AHI). Correlates of the increased AHI includes male sex (β=0.27, p=0.001), high age (β=0.19, p=0.0028), high body mass index (BMI) (β=0.29, p=0.0013), hypertension (β=0.18, p=0.038), and non-paroxysmal AF (β=0.17, p=0.047). On the other hand, correlates to %CSR rate includes male sex (β=0.17, p=0.026), high age (β=0.22, p=0.0054), non-paroxysmal AF (β=0.27, p=0.0005), high value of HbA1c (β=0.3, p&lt;0.0001), and greater N-terminal fragment of the Brain natriuretic peptide (NT-proBNP) (β=0.26, p=0.0007). Conclusion: Increased SDB severity correlated with male sex, high age, obesity, hypertension and chronicity of AF in patients with PVI. Correlates the percent of %CSR were male sex, high age, the chronicity of AF, high value of HbA1c, and greater NT-proBNP. Treatment for SDB should be consider for these AF patients, because SDB increases the recurrence ratio of AF after PVI.

Classification of Factors Effect on Sleep in Individuals with Down Syndrome.

Background: Sleep disordered breathing (SDB) is a frequent disorder with serious adverse health consequences in people with Down syndrome (DS). This study aims to evaluate and classify sleep and physical activity (PA) characteristics in adults with DS. Methods: Forty participants with DS wore an accelerometer for seven consecutive days to measure physical activity and sleep–wake patterns. The corresponding data were also obtained by survey and polysomnography. The apnea-hypopnea index (AHI) is calculated from the number of apneas and hypopneas per hour of sleep according to international guidelines. Results: Polysomnography showed SDB based on AHI in 95% of adults: 50% had severe SDB, 22.5% presented moderate and 22.5% mild SDB, predominantly in males. They had poor sleep quality (80.1%) and low PA levels. Using statistical classification methods, we observed three clusters with two opposite profiles. Clusters 2 and 3 showed low PA indices (daily steps: 5719 and 5310, respectively) and severe SDB (AHI = 33.6 and 55.5 events/h), high age and high gonial angle. Cluster 1 showed high PA (mean count of daily steps: 6908) and mild to moderate SDB (AHI = 16.8 events/h), low age and low gonial angle. Conclusions: Our findings suggest that there are different profiles (age, gender, obesity, gonial angle) that are associated with SDB in adults with DS. These results suggest that this may represent important factors to consider when planning health promotion and prevention.

Differences between subjective and objective sleep duration according to actual sleep duration and sleep-disordered breathing: the Nagahama Study.

Since subjective sleep duration (SSD) is considered to be longer than objective sleep duration (OSD), results of SSD minus OSD (SSD-OSD) might always be thought to be positive. Some recent reports showed different results, but exact results have not been obtained. The difference between SSD and OSD may change according to OSD. We investigated this difference and its association with sleep-disordered breathing (SDB) or nonrestorative sleep. This cross-sectional study evaluated 6,908 community residents in Nagahama, Japan. SSD was determined by self-administered questionnaire. OSD was measured by wrist actigraphy and sleep diary. SDB was assessed according to the 3% oxygen desaturation index adjusted for OSD. Worthy of notice was that SSD was shorter than OSD for those with SSD longer than 6.98 hours in all participants, 7.36 hours in males, and 6.80 hours in females. However, SSD was longer than OSD (mean ± SD: 6.49 ± 1.07 vs 6.01 ± 0.96; P < .001) overall, as SSD is considered to be longer than OSD. In patients with SDB, the difference between SSD-OSD was greater when OSD was shorter. The difference also depended on SDB severity. The degree of positivity between OSD and SSD was a significant factor in nonrestorative sleep (odds ratio: 2.691; P < .001). When OSD was slightly less than 7 (6.98) hours, participants reported or perceived SSD > OSD. When OSD was > 6.98 hours, participants reported or perceived SSD < OSD. Patients with SDB reported longer SSD than OSD according to severity of SDB. Evaluating SSD, OSD, and their differences may be useful for managing sleep disturbances, including nonrestorative sleep. Takahashi N, Matsumoto T, Nakatsuka Y, etal. Differences between subjective and objective sleep duration according to actual sleep duration and sleep-disordered breathing: the Nagahama Study. J Clin Sleep Med. 2022;18(3):851-859.

Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences?

Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.

479 The association of QTc and QT Variability with Severity of Sleep Disordered Breathing

Abstract Introduction The apneas and hypopneas that characterize sleep-disordered breathing (SDB) are associated with QTc prolongation and increased QT variability. There have been mixed results as to whether QTc and QT variability increase with increasing SDB severity. This study assesses whether QTc prolongation and QT variability are likely to increase with increasing severity of SDB in a large multi-center cohort. Methods 200 subjects with no SDB and approximately 600 with three levels of SDB (mild, moderate, severe) were randomly selected from the Sleep Heart Health study and matched by age, gender and BMI. SDB was defined as an apnea/hypopnea index ≥5. Respiratory and electrocardiograms (ECG) signals from polysomnography studies were analyzed. Bazett’s heart rate correction was used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and short-term interval QT variability (STVQT), at 5-minute intervals. Subjects were excluded if there were missing data or low-quality ECG. Results Seven hundred and seventy-one subjects (age 68±10 years, 51% female, 92% Caucasian) were included. One hundred and sixty-five subjects had no SDB, 235 mild, 195 moderate and 176 had severe SDB. The mean (SD) QTc was 422(29), 411(26), 419 (34) and 418 (36) ms for the no SDB, mild, moderate, and severe SDB groups, respectively (p=0.017). The mean (SD) STVQT was 7 (9), 11 (16), 8 (9) and 9 (11) for the no SDB, mild, moderate severe SDB groups, respectively (p=&amp;lt;0.001). The mean (SD) STVQT was 3 (2), 4 (4), 4 (3) and 4(4) for the no SDB, mild, moderate severe SDB groups, respectively (p=&amp;lt;0.001). There was no statistically linear relationship between QT prolongation or QT variability and SBD severity. Conclusion QTc duration and QT variability were not increased with SDB severity. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)

Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders.

Sleep-disordered breathing (SDB) is common in patients with neuromuscular disorders (NMD), developing before chronic hypercapnia appears. Polysomnography (PSG) is the diagnostic gold standard but is often impractical and poorly accessible for individuals with NMD. We sought to determine the diagnostic accuracy, feasibility, and patient preference of home sleep apnea testing (HSAT) compared with PSG for the detection of SDB in NMD. Participants with NMD at risk for SDB aged ≥ 13 years underwent HSAT followed by overnight PSG with concomitant laboratory sleep apnea testing (same device as HSAT). Sensitivity and specificity were calculated for standard apnea-hypopnea index cutoffs for mild (≥ 5 events/h), moderate (≥ 15 events/h), and severe SDB (≥ 30 events/h) and for an oxygen desaturation index ≥ 5 events/h. Receiver operating characteristic curves were built. A questionnaire assessed patient preference. Of 38 participants, 73% had moderate to severe SDB and 79% had technically acceptable HSAT. For an apnea-hypopnea index ≥ 15 events/h, HSAT sensitivity and specificity were 50% and 88%, respectively. For an oxygen desaturation index ≥ 5 events/h, HSAT sensitivity and specificity were 95% and 78%, respectively. The area under the receiver operating characteristic curve for an apnea-hypopnea index ≥ 15 events/h was 0.88 (95% confidence interval, 0.69-1.00) for HSAT. The HSAT underestimated the apnea-hypopnea index from PSG (bias, -10.7 ± 15.9 events/h). HSAT was preferred to PSG by 61% of participants. HSAT is feasible, preferred by patients, and reliable for detecting SDB in most patients, although it cannot definitively rule out SDB. Therefore, HSAT is a viable diagnostic approach for SDB in NMD when PSG is not feasible, recognizing that it does not accurately distinguish between upper-airway obstruction and hypoventilation. Additional work is needed to further optimize home sleep testing in NMD. Westenberg JN, Petrof BJ, Noel F, et al. Validation of home portable monitoring for the diagnosis of sleep-disordered breathing in adolescents and adults with neuromuscular disorders. J Clin Sleep Med. 2021;17(8):1579-1590.

Estimating sleep stages using cardiorespiratory signals: validation of a novel algorithm across a wide range of sleep-disordered breathing severity.

We have developed the CardioRespiratory Sleep Staging (CReSS) algorithm for estimating sleep stages using heart rate variability and respiration, allowing for estimation of sleep staging during home sleep apnea tests. Our objective was to undertake an epoch-by-epoch validation of algorithm performance against the gold standard of manual polysomnography sleep staging. Using 296 polysomnographs, we created a limited montage of airflow and heart rate and deployed CReSS to identify each 30-second epoch as wake, light sleep (N1 + N2), deep sleep (N3), or rapid eye movement (REM) sleep. We calculated Cohen's kappa and the percentage of accurately identified epochs. We repeated our analyses after stratification by sleep-disordered breathing (SDB) severity, and after adding thoracic respiratory effort as a backup signal for periods of invalid airflow. CReSS discriminated wake/light sleep/deep sleep/REM sleep with 78% accuracy; the kappa value was 0.643 (95% confidence interval, 0.641-0.645). Discrimination of wake/sleep demonstrated a kappa value of 0.711 and accuracy of 89%, non-REM sleep/REM sleep demonstrated a kappa of 0.790 and accuracy of 94%, and light sleep/deep sleep demonstrated a kappa of 0.469 and accuracy of 87%. Kappa values did not vary by more than 0.07 across subgroups of no SDB, mild SDB, moderate SDB, and severe SDB. Accuracy increased to 80%, with a kappa value of 0.680 (95% confidence interval, 0.678-0.682), when CReSS additionally utilized the thoracic respiratory effort signal. We observed substantial agreement between CReSS and the gold-standard comparator of manual sleep staging of polysomnographic signals, which was consistent across the full range of SDB severity. Future research should focus on the extent to which CReSS reduces the discrepancy between the apnea-hypopnea index and the respiratory event index, and the ability of CReSS to identify REM sleep-related obstructive sleep apnea.