PAP Therapy Research Articles

Waiting for in-Lab Polysomnography May Unnecessarily Prolong Treatment Start in Patients with Moderate or Severe OSA at Home Sleep Apnea Testing.

The gold standard in obstructive sleep apnea (OSA) diagnostics is nocturnal full-night polysomnography (PSG). Due to high costs and high time effort portable respiratory polygraphy (PG or home sleep apnea testing-HSAT) has been developed. In contrast to PG the PSG gains relevant further information concerning sleep stages, arousals and leg movements. However, the role of PG in the diagnostic of OSA remains largely undefined. The aim of this study was to investigate the difference of PG- and PSG- related metrics in OSA, to understand if there is a difference in PG and PSG-based treatment decision and show up the time between performed PG and PSG. 99 consecutive patients with existing outpatient performed PG and followed PSG in our tertiary care otorhinolaryngology department between February 2020 and December 2023 were retrospectively assessed. All patients were treatment-naive at the time of consultation. The time between performed outpatient PG and PSG was calculated. Furthermore, clinical baseline parameter and PG as well as PSG data were evaluated. All data were then blinded presented with relevant comorbid diseases to two experts in sleep medicine in our tertiary care centre to decide whether PAP therapy was indicated or not. Mean AHI was significantly higher in PSG (32.32 ± 22.78/h) compared to PG (22.60 ± 15.12/h) (p<0.001). Mean duration between performed PG and PSG was 194.99 ± 131.96 days (range between 37 and 842 days). Only in two patients PAP-therapy was indicated with PG results but not with PSG results. Only in one case PAP-therapy was not indicated with PG results but with PSG results. These data suggest initiating OSA therapy based on PG results for patients with at least moderate OSA on PG, followed by a confirming PSG and a control PSG under treatment to avoid unnecessary prolongation of treatment start.

0888 Characterization and Outcomes in Patients with Bronchiectasis and Obstructive Sleep Apnea with PAP Therapy

0888 Characterization and Outcomes in Patients with Bronchiectasis and Obstructive Sleep Apnea with PAP Therapy

0672 Sleepiness, Psychomotor Vigilance and Cognition in People with OSA Adherent to PAP Therapy

0672 Sleepiness, Psychomotor Vigilance and Cognition in People with OSA Adherent to PAP Therapy

0585 PAP Therapy Impact on Bariatric Surgery Complications: A 30-Day Pre-Operative Evaluation

0585 PAP Therapy Impact on Bariatric Surgery Complications: A 30-Day Pre-Operative Evaluation

Monomeric pilose antler peptide improves depression-like behavior in mice by inhibiting FGFR3 protein expression

Ethnopharmacological relevanceIt has been found that pilose antler peptide has an antidepressant effect on depression. However, the exact molecular mechanism of its antidepressant effect is still unclear. Aim of the studyThe study sought to determine the impact of monomeric pilose antler peptide (PAP; sequence LVLVEAELRE) on depression as well as investigate potential molecular mechanisms. Materials and methodsChronic unexpected mild stress (CUMS) was used to establish the model, and the effect of PAP on CUMS mice was detected by the behavioral test. The influence of PAP on neuronal cells and dendritic spine density was observed by immunofluorescence and Golgi staining. FGFR3 and the CaMKII-associated pathway were identified using quantitative real-time polymerase chain reaction, and Western blot analysis was utilized to measure their proteins and gene expression levels. Molecular docking and microscale thermophoresis were applied to detect the binding of PAP and FGFR3. Finally, the effect of FGFR3's overexpression on PAP treatment of depression was detected. ResultsPAP alleviated the changes in depressive behavior induced by CUMS, promoted the growth of nerve cells, and the density of dendritic spines was increased to its original state. PAP therapy successfully downregulated the expression of FGFR3 and ERK1/2 while upregulating the expression of CREB, BDNF, and CaMKII. ConclusionBased on the current research, PAP has a therapeutic effect on depression brought on by CUMS by inhibiting FGFR3 expression and enhancing synaptic plasticity.

The Emergence of Inpatient Sleep Medicine: Screening for Sleep Disordered Breathing to Reduce the Burden of Cardiovascular Disease.

Treatment of obstructive sleep apnea (OSA) has historically been centered on outpatients given sleep testing is performed on an outpatient basis. Much of this practice originates from insurers only covering sleep testing on an outpatient basis. Over the last decade, there have been innovations made in the portability of sleep monitors which have allowed sleep testing on inpatients to be facilitated. There is also emerging data that inpatient sleep testing may reduce readmissions and healthcare costs in certain cardiovascular conditions. Accordingly, this review aims to provide comprehensive coverage of recent advances in the practice of inpatient sleep medicine and its effect on reducing the burden of cardiovascular disease. Chief cardiovascular diseases that intersect with OSA in inpatients are stroke, atrial fibrillation, and heart failure. There is data from the National Inpatient Sample comparing arrhythmia burdens in patients with OSA and HFpEF showing that OSA patients have higher mortality rates, hospital durations, and medical costs. Also, OSA is associated with higher burdens of arrhythmia. It is currently unknown whether treatment of inpatients with PAP therapy lowers the occurrence of arrhythmias. Recent data suggests that costs for heart failure patients with OSA that are readmitted are higher than those for heart failure patients without OSA. A recent analysis of patients with HFpEF (heart failure with preserved ejection fraction) and OSA showed that the PAP adherent patients had fewer healthcare related costs, lower readmission rates, and fewer emergency room visits than those that were nonadherent. In broader terms, rapid initiation of PAP therapy in a large administration database query of 23 million Medicare patients appears to reduce annual healthcare costs and reduce readmissions although further study is required. OSA is globally underdiagnosed, with an estimated one billion individuals affected. OSA's pathogenesis involves a combination of risk factors, such as obesity, age, and increased neck circumference that contribute to fragmented sleep patterns and in turn, numerous cardiovascular comorbidities, such as stroke, atrial fibrillation, and coronary artery disease. Recently, inpatient sleep medicine programs have emerged as a promising avenue for improving diagnosis, patient safety, and potentially reducing readmissions. Integrating inpatient sleep medicine into healthcare systems to address the significant health and economic burden associated with undiagnosed OSA. Improved coverage of inpatient sleep testing and services will be a key driver of addressing inpatient gaps in sleep medicine care. The current research findings provide a bedrock from which further investigations may proceed in a prospective and randomized, controlled fashion to further clarify the effects of treatment of OSA on cardiovascular outcomes of inpatients.

Performance of Claims-Based Algorithms for Adherence to Positive Airway Pressure Therapy in Commercially Insured Patients With OSA

BackgroundPositive airway pressure (PAP) therapy is first line therapy for obstructive sleep apnea (OSA), but consistent use is required for it to be effective. Previous studies have used Medicare fee-for-service claims data (e.g., device and equipment charges) as a proxy for PAP adherence to assess its effects. However, this approach has not been validated in a United States (US) commercially insured population, where coverage rules are not standardized. Research QuestionIn a commercially insured population in the US, how well do claims-based algorithms for defining PAP adherence correspond with objective PAP device usage? Study Design and MethodsDe-identified administrative claims data of commercially insured patients (18-64 years) with OSA were linked to objective PAP therapy usage data from cloud-connected devices. Adherence was defined based on device use (using an extension of Centers for Medicare and Medicaid Services 90-day compliance criteria) and from claims-based algorithms to compare usage metrics and identify potential misclassifications. ResultsThe final sample included 213,341 patients. Based on device usage, 48% were adherent in the first year. Based on claims, between 10 and 84% of patients were identified as adherent (accuracy, sensitivity, specificity ranges: 53-68%, 12-95%, 26-92%, respectively). Relative to claims-adherent patients, device-adherent patients had consistently higher usage across all metrics (mean: 339.9 vs. 260.0-290.0 days of use; 6.6 vs. 5.1-5.6 days per week; 6.4 vs. 4.6-5.2 hours per day). Consistent PAP users were frequently identified by claims-based algorithms as non-adherent, while many inconsistent users were classified by claims-based algorithms as adherent. InterpretationIn aggregate US commercial data with non-standardized PAP coverage rules, concordance between existing claims-based definitions and objective PAP use was low. Caution is warranted when applying existing claims-based algorithms to commercial populations. Clinical Trials Registration NumberNot applicable

A comparison of two obesity-related hypoventilation disorders: Impact on sleep, quality of life and neurocognitive outcomes and the effects of positive airway pressuretherapy.

Symptom impact and neurocognitive function have not been previously compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome [OHS]) and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life, and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes. Epworth Sleepiness Scale (ESS), Pittsburgh Sleepiness Quality Index (PSQI), SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function, and blood gas data from participants with OHS and participants with OHAD, were included in the analysis. These data were originally collected in their respective randomized clinical trials, comparing the efficacy of different PAP modes (bilevel PAP vs. CPAP) in resolving hypercapnia. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modeling. 45 OHS participants (mean age 51 years old, 33% female, BMI 52kg/m2, FER 0.81, PaCO2 54 mmHg, AHI 87/h) and 32 OHAD participants (mean age 61years old, 31% female, BMI 43kg/m2, FER 0.60, PaCO2 54 mmHg, AHI 59/h) were included in the analysis. Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs. 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar ESS, Global PSQI, and SF36 improvements in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group. The symptom impact between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life, and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.Nocturnal ventilatory support in OHS.

Prevalence of central sleep apnea among veterans and response rate to continuous positive airway pressure therapy.

Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans. Veterans were screened from a single VA medical center who had polysomnography (PSG) study from 2017 to 2021 to ascertain the presence, severity, and type of SDB by measuring the apnea-hypopnea index (AHI) and central apnea index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/hour. Diagnostic "CSA only" was defined as AHI ≥ 10 events/hour and CAI ≥ 50% of AHI. "OSA only" was defined if AHI ≥ 10 events/hour and CAI < 5 events/hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI ≥ 10 events/hour and CAI > 5 events/hour but < 50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/hour on the titration study. A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p < 0.05). Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.

Trends in obstructive sleep apnea disease severity over nearly two decades: update on the VA San Diego experience.

The Sleep Program at the VA San Diego Healthcare System (VASDHS) started a patient database over twenty years ago for its home sleep apnea testing (HSAT) program. An analysis of ten years of diagnostic HSAT data was reported on over 12500 patients in 2014. Over this time period, severe obstructive sleep apnea (OSA) decreased in frequency. In contrast, mild OSA increased in frequency and was the most frequently reported severity in our analysis. In more recent times, the 2021 continuous positive airway pressure (CPAP) crisis created difficulties in dispersing CPAP therapies to individuals including Veterans with OSA, prompting our group to reexamine the HSAT database. A retrospective review was performed of the local clinical database of HSAT diagnostic testing of 8,928 sleep studies from 2018 to 2022. The overall mean apnea-hypopnea index (AHI) decreased from 40.4/hour (2004) to 24.3/hour (2022) (p < .001). The two time periods were examined separately. For 2004-2013, it was found that the mean AHI in 2004 was not significantly different from the mean AHI in 2005, 2006, or 2007 but was significantly different from the mean AHI in each year from 2008 (mean AHI = 30.7/h) to 2013 (mean AHI = 26.1/hour). For 2019-2022, the mean AHI did not significantly differ between the 4 years. These findings have implications for OSA therapies. Additionally, the high prevalence of mild sleep apnea, which is typically associated with lesser adherence to PAP therapy, further highlights the importance of non-PAP alternatives to improve treatment effectiveness.

Hypoglossal Stimulation: Indication, Surgical Technique and Clinical Results

Hypoglossal stimulation is a safe and effective treatment option for patients with obstructive sleep apnea and unsuccessful PAP therapy. A number of criteria must be met for the indication: proof of failed PAP therapy and ineffectiveness of the other therapy alternatives, AHI of 15-65/h (a relevant number of central and/or mixed apneas should be excluded) and BMI up to max. 35kg/m2. In the case of the respiratory-synchronous and bilateral stimulation system, a complete concentric collapse at the velum level should currently be ruled out in DISE. In the future, stimulation of the branch of the ansa cervicalis innervating the sternothyroid muscle and the ramus internus of the superior laryngeal nerve could open up additional treatment options.

P065 A Comparison of Two Obesity Related Hypoventilation Disorders – Impact on Sleep, Quality of Life and Neurocognitive Outcomes and the Effects of PAP Therapy

Abstract Introduction Symptom burden and neurocognitive function have not been previous compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome, OHS), and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes. Methods ESS, PSQI, SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function and blood gas data from 45 patients with OHS and 32 patients with OHAD, were included in the analysis. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modelling. Results Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar improvements in ESS, Global PSQI, and SF36 in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group. Discussion The symptom burden between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.

General nomenclature of air leak patterns: A proposal

Leakage is a common issue with PAP therapy and may contribute to short-term non-compliance with treatment. PAP manufacturers use different methods to estimate and report air leaks (median, mean, p90, p95, % of important air leak, time spent on major leaks), which makes the analysis and comparisons challenging. Leak intensity is a well-known parameter of major importance as it can significantly affect the performance of PAP devices. However, there is a lack of knowledge regarding another leakage parameter, namely the leakage pattern. As of now, there is no standard classification for leak patterns in real-life settings. Our objective was to develop and propose a comprehensive nomenclature for leakage patterns observed during nasal auto-PAP therapy.We examined 50 ventilatory polygraphy recordings conducted with auto-PAP, based on data from a prior study in which the unintentional leak flow was precisely measured over time. We have categorized leaks into two main types: continuous leaks, which appear and persist for an extended period, and discontinuous leaks, which vanish more rapidly. Continuous leaks can have both abrupt or gradual apparitions and terminations. Their "shape" can be either interrupted or constant. Discontinuous leaks can have both abrupt or gradual apparitions and terminations. Due to the relatively short observation scale (less than 5 min minutes), this type of leakage is not characterized by a specific shape between apparition and termination.This nomenclature could be a valuable tool that facilitates comparative bench tests or clinical studies. This tool could support manufacturers in developing precise algorithms for leak compensation, residual AHI estimation and the accuracy of CPAP monitoring data. Lastly, establishing a standardized approach for describing and categorizing air leakage patterns could assist clinicians in identifying device-related issues, such as patient discomfort arising from specific types of leakage.

The effect of obstructive sleep apnea severity on PTSD symptoms during the course of esketamine treatment: a retrospective clinical study.

Intranasal administration of esketamine is Food and Drug Administration-approved for treatment-resistant depression. In a recent retrospective case series, we show that it has promise in reducing symptoms of posttraumatic stress disorder (PTSD) as well. Untreated obstructive sleep apnea (OSA) is prevalent among veterans with PTSD and has been shown to interfere with other PTSD treatments. In the current study, we examined whether OSA impacts esketamine's effectiveness in reducing symptoms of PTSD or depression. Participants were 60 veterans with a diagnosis of major depressive disorder and PTSD who received intranasal esketamine treatment at the San Diego Veterans Affairs (VA) Medical Center. We used growth-curve modeling to examine changes in depression and PTSD symptoms following esketamine treatments and, in the subset of individuals screened for OSA (n = 24, all prescribed positive airway pressure therapy), examined the impacts of OSA severity on these trajectories. We first showed that both PTSD and depressive symptoms significantly decreased over the course of esketamine treatment. In the subset of veterans screened for OSA, individuals with lower OSA severity reported the greatest reduction in PTSD symptoms, while veterans with the most severe OSA reported the least reduction in PTSD symptoms. Depression response was not affected by severity of OSA in this analysis. Veterans with PTSD and depression tend to benefit from esketamine treatment, but OSA may interfere with esketamine effectiveness. Comorbid OSA should be assessed for and treated to maximize esketamine's benefits in PTSD. Titone MK, Hunt C, Bismark A, etal. The effect of obstructive sleep apnea severity on PTSD symptoms during the course of esketamine treatment: a retrospective clinical study. J Clin Sleep Med. 2023;19(12):2043-2051.

Depicting and defining sleep disturbed breathing associated with vagal nerve stimulation

BackgroundVagal nerve stimulators (VNS), which have been approved for management of refractory epilepsy and depression, induce unique disturbances of breathing during sleep (SDBVNS) that are not captured well using standard criteria. The primary purpose of this retrospective study was to compare AASM definitions with alternative criteria to more accurately measure SDBVNS We also sought to assess outcome variables that may be clinically relevant and response to positive airway pressure therapy. MethodsWe analyzed the electronic medical records and comprehensive polysomnography results of all adult subjects with active VNS for epilepsy who were referred to the sleep center for suspected sleep apnea (2015–2020). We compared standard AASM criteria for defining apneas/hypopnea index (AHIAASM) with three novel scoring criteria for hypopnea according to degree of oxygen desaturation associated with VNS events: AHIVNS0 (none required); AHIVNS2 (2% required); and AHIVNS3 (3% required). ResultsTwenty-six subjects were included in the final analysis with 35 PSGs (14 females/12 males). The mean age was 33.6 years and mean body mass index (BMI) of 32.2 kg/m2. AHIAASM measured ≥ 15/hour in 7 (26.9%) subjects versus 21 (80.8%) by AHIVNS0; 15 (70.0%) by AHIVNS2; and 5 (19.2%) by AHIVNS3. Clinically significant hypoxemia was not present. The mean time SpO2<89% was 7 (20.8) minutes. Oximetry tracings often showed a desaturation pattern that resembled a sawfish rather than sawtooth. Arousals specifically linked to VNS activation were not elevated (2.9/hour). The baseline AHIVNS0 was 27.7/hour with a lowest AHIVNS0 on PAP of 27.9/hr. ConclusionsAASM scoring criteria significantly underestimated the degree of VNS induced respiratory disturbances. VNS events were not associated with increased arousals or significant hypoxemia. PAP therapy was an ineffective treatment in this population. This study adds to the increasing body of evidence of sleep disordered breathing related to VNS and questions the clinical significance of this finding.

Clinical outcomes of chronic heart failure patients with unsuppressed sleep apnea by positive airway pressure therapy.

Heart failure (HF) is an advanced stage of cardiac disease and is associated with a high rate of mortality. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. Beneficial effects of PAP therapy that is effective on reducing SA on cardiovascular events, were not yet established. However, a large-scale clinical trial reported that patients with central SA (CSA) which was not effectively suppressed by continuous positive airway pressure (CPAP) revealed poor prognosis. We hypothesize that unsuppressed SA by CPAP is associated with negative consequences in patients with HF and SA, including either obstructive SA (OSA) or CSA. This was a retrospective observational study. Patients with stable HF, defined as left ventricular ejection fraction of ≤50%; New York Heart Association class ≥ II; and SA [apnea-hypopnea index (AHI) of ≥15/h on overnight polysomnography], treated with CPAP therapy for 1 month and performed sleep study with CPAP were enrolled. The patients were classified into two groups according to AHI on CPAP (suppressed group: residual AHI ≥ 15/h; and unsuppressed group: residual AHI < 15/h). The primary endpoint was a composite of all-cause death and hospitalization for HF. Overall, data of 111 patients including 27 patients with unsuppressed SA, were analyzed. The cumulative event-free survival rates were lower in the unsuppressed group during a period of 36.6 months. A multivariate Cox proportional hazard model showed that the unsuppressed group was associated with an increased risk for clinical outcomes (hazard ratio 2.30, 95% confidence interval 1.21-4.38, p = 0.011). Our study suggested that in patients with HF and SA including either OSA or CSA, presence of unsuppressed SA even on CPAP was associated with worse prognosis as compared to those with suppressed SA by CPAP.

Why Many Patients Do Not Benefit from PAP Therapy: Reliability of REI Provided by PAP Devices

Why Many Patients Do Not Benefit from PAP Therapy: Reliability of REI Provided by PAP Devices

0519 Comparing the delta power during titration of INSPIRE therapy and PAP therapy

Abstract Introduction Delta power is a known indicator of sleep drive and sleep pressure. Non-REM sleep delta power is increased in patients with sleep-disordered breathing. Treatment of sleep-related breathing disorder reduces delta power. The purpose of this study is to investigate and compare delta power between individuals on INSPIRE therapy and individuals on PAP therapy. Methods A retrospective review was performed by selecting nine patients who underwent INSPIRE titration study at the MU HealthCare Sleep Disorders Center, between 8/1/2021 and 8/1/2022. Nine patients with similar age and gender who underwent PAP titration study were selected from the database (PolySmith®). Spectral analysis was performed using F4-M1 leads, and delta power was calculated for Stage N3 portion during the last sleep cycle. Results There were 3 patients on INSPIRE who did not have any N3 sleep and those were excluded. Thus, average delta power in 6 patients during INSPIRE titration was 541.88. In contrast, the average delta power for 9 patients during PAP titration was 554.93. Conclusion Results showed that there was minimal difference in patients’ delta sleep during titration of INSPIRE therapy as compared to patients during titration of PAP therapy. However, there were limitations including the amount and timing of N3 sleep, success of titration study, patient’s medications - which may have altered the sleep architecture, and comorbidities such as PLMS (which untreated can affect sleep). Support (if any) The authors have no sources of support to declare.

0454 A Specific STOP-BANG Score Cutoff is Not Predictive of Severe Obstructive Sleep Apnea in Bariatric Patients

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep disorder with obesity being a significant risk factor. Undiagnosed OSA increases the risk of complications at the time of surgery and those with severe OSA at increased risk of post-operative MI, stroke, arrhythmias, and death as well as readmission and acuity of post-operative care. Because of this, our Bariatric program screens all patients pre-operatively with a STOP-BANG questionnaire. Those with severe OSA (AHI or REI &amp;gt; 29) require pre-treatment with PAP therapy until compliance is reached before the patient is eligible for surgery. This study examines those that screened at high risk for OSA with a STOP-BANG score &amp;gt; 2 to see if there was a specific cutoff that predicts those having severe OSA in order to better expedite sleep testing as recent supply chain issues have greatly impacted the timeliness of care for these patients. Methods During the months of January to June 2022, demographic, clinical and sleep data was collected on all new patients being evaluated by the Bariatric Sleep clinic for use in quality assessment. Bariatric patients with BMI &amp;lt; 50 and no significant cardiac or pulmonary disease were tested using HSAT, whereas those who met one or more of the above comorbidities underwent PSG. Results There were 143 bariatrics patients who screened as “high risk” for OSA with a STOP-BANG score &amp;gt; 2 during these 6 months and 112 (78%) of them completed sleep testing. There were 25 patients (22%) with severe OSA. The average STOP-BANG score for those with severe OSA was 4.3. Women averaged 4.0 (range 3-6), while men averaged higher at 4.8 (range 4-6) likely reflecting that male gender garners an extra point with the STOP-BANG. STOP-BANG scores increased with age: 20s x=3, 30s x=4.1, 40s x=4.4, 50s x=4.6, 60s x=6. Conclusion There was no specific cutoff for the STOP-BANG score that predicted severe OSA in our bariatric patients to help our program triage those most at surgical risk in order to place them in an expedited sleep testing and PAP therapy pathway. Overall, STOP-BANG scores were impacted by gender and age. Support (if any)

0926 Teaching Medical Students About Insomnia: Early Results of a Brief Lecture for Third Year Medical Students

Abstract Introduction Insomnia affects 10 to 20 percent of Americans annually. Unfortunately, evidence-based training on the diagnosis and management of insomnia during U.S. undergraduate medical education is limited. This educational gap may promote use of off-label medications or supplements (e.g., melatonin) and contribute to the “medicalization of sleeplessness”. By contrast, cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation of the American Academy of Sleep Medicine and the American College of Physicians, and CBT-I is increasingly available in a digital format that can even be prescribed by primary care providers. Most physicians are not trained in how CBT-I works, however, and thus are ill-equipped to prescribe or refer this service. Therefore, this pilot study evaluated a brief educational intervention to improve medical student knowledge about insomnia. Methods The first author (AST) developed a 20-minute in-person lecture on insomnia which was delivered to 122 undergraduate medical students during their third-year medical curriculum. Topics included epidemiology, Spielman’s 3-P model of pathophysiology, and the treatment recommendations from the AASM with an emphasis on CBT-I. A total of 43 students (36%) provided informed consent and provided pre- and post-presentation ratings (0–100-point scale) of 1) their comfort in discussing insomnia with their patients, 2) the importance of insomnia for human health, 3) their familiarity with the pathophysiology of insomnia, and 4) their familiarity with treatments for insomnia. Participants were additionally asked to categorize a list of treatments as evidence-based or not. Results Following the presentation, students reported increased comfort in discussing insomnia with their patients, knowledge of the pathophysiology of insomnia, and knowledge of evidence-based treatments. In selecting treatments, more students chose CBT-I as an evidence-based treatment, while fewer students identified sleep hygiene, PAP therapy, diphenhydramine, hydroxyzine, melatonin, quetiapine, and trazodone. Conclusion A brief lecture on insomnia improved medical students’ knowledge of the disease process and evidence-based treatments for insomnia. Forthcoming analyses will determine whether students utilized this knowledge during subsequent clerkships. Future work will examine whether alternative formats (e.g., flipped-class, case-based instruction, interactive modules) are more effective for conveying this information. Support (if any)