Risk Factors For Sleep-disordered Breathing Research Articles

Risk factors of sleep-disordered breathing and poor asthma control in children with asthma

BackgroundSleep-disordered breathing (SDB) may lead to poor asthma control in children.ObjectiveTo identify risk factors of SDB in children with asthma and assess its impact on asthma control.MethodsIn this cross-sectional study, we collected data of outpatients with asthma at the Children’s Hospital of Chongqing Medical University from June 2020 to August 2021. The Pediatric Sleep Questionnaire—Sleep-Related Breathing Disorder and the age-appropriate asthma control tests Childhood Asthma Control Test and Test for Respiratory and Asthma Control in Kids were completed.ResultsWe enrolled 397 children with a male-to-female ratio of 1.7:1 and a mean age of 5.70 ± 2.53 years. The prevalence of SDB was 21.6%. Allergic rhinitis (odds ratio OR = 3.316), chronic tonsillitis (OR = 2.246), gastroesophageal reflux (OR = 7.518), adenoid hypertrophy (OR = 3.479), recurrent respiratory infections (OR = 2.195), and a family history of snoring (OR = 2.048) were risk factors for the development of combined SDB in children with asthma (p < 0.05). Asthma was poorly controlled in 19.6% of the children. SDB (OR = 2.391) and irregular medication use (OR = 2.571) were risk factors for poor asthma control (p < 0.05).ConclusionsAllergic rhinitis, chronic tonsillitis, gastroesophageal reflux, adenoid hypertrophy, recurrent respiratory infections, and a family history of snoring were independent risk factors for the development of SDB in children with asthma. SDB and irregular medication use were independent risk factors for poor asthma control.

Prevalence and associated factors of increased risk for sleep-disordered breathing and its relationship with body mass index among medical students, intern doctors, and residents

BackgroundPoor sleep quality among medical professionals due to study demands and shift work significantly impacts health. Additionally, this group has a higher obesity prevalence compared with the general population. This study aims to evaluate the prevalence and associated factors of increased risk for sleep-disordered breathing (SDB) and its relationship with body mass index (BMI). MethodsA cross-sectional study was conducted using online self-assessment questionnaires. PSQI scores over 6.5 were categorized as an increased risk for SDB. Multivariable logistic regression analysis was performed to identify factors associated with an increased risk of SDB. Linear regression analysis was conducted to establish the relationship between PSQI and BMI. ResultsOverall, there were 307 participants, comprising 114 medical students, 120 intern doctors, and 73 residents. One-third of participants (36.5%, 95%CI:31.1–41.9%) had an increased risk of SDB. Residents had the highest proportion of obesity class 2 (13.9%). The risk factors of SDB included medical students (adjusted odds ratio [aOR]:3.17, 95%CI:1.09–9.24), having inadequate exercise (aOR:2.08, 95%CI:1.08–4.00) and sleeping less than 7 h a day (aOR:12.50, 95%CI:5.00–33.33), working more than 40 h per week on shift increased the odds of SDB (aOR:2.97, 95%CI:1.29–6.85). Furthermore, an inverse dose-response relationship between BMI and PSQI score was observed among female participants (β = −0.03, 95%CI: (-0.052)-(-0.005)). ConclusionTo enhance sleep quality, it is advisable to include both adequate exercise and 7–8 h of sleep. Adjusting protected sleep periods is recommended. Implementing lifestyle modification strategies would benefit physicians in training and promote a healthier environment.

Fetal Heart Rate Responses to Maternal Sleep-Disordered Breathing

(Am J Obstet Gynecol. 2023;228(4):459.e1–459.e8) The physical changes inherent in pregnancy can amplify underlying comorbidities. One common problem worsened in pregnancy is sleep-disordered breathing. Sleep-disordered breathing has been investigated in relation to pregnancy and found to have a host of negative outcomes associated with it, including gestational diabetes, preeclampsia, preterm delivery, and stillbirth. Risk factors for sleep-disordered breathing often overlap with risk factors for other pregnancy complications, and thus relationships can be difficult to characterize. One area needing investigation is the effect of sleep-disordered breathing on fetal heart rate (FHR), which is an indicator of wellbeing during pregnancy. This study was designed to examine the FHR response to sleep-disordered breathing in pregnant women with obesity. The authors hypothesized that apnea or hypopnea would elicit a detectable response in FHR that would be potentiated in women with more severe symptoms.

Study of the prevalence and predictive factors of sleep-disordered breathing in patients with interstitial lung diseases

BackgroundInterstitial lung diseases (ILDs) are parenchymal lung conditions that are chronic, progressive, and have a high morbidity and mortality rate. Due to restrictions in their gas exchange and ventilatory dysfunction, ILD patients are probably at risk for sleep-disordered breathing (SDB).MethodologySixty-nine patients with diffuse parenchymal lung diseases identified by high-resolution computed tomography (HRCT) chest were included in the study. All patients were assessed by the STOP-BANG questionnaire (SBQ), Epworth sleepiness scale (ESS), and full-night polysomnography (PSG) for diagnosis and classification of SDB. The aim of the study is to examine the prevalence and risk factors for SDB in ILD.ResultsAmong the study group hypersensitivity pneumonitis (HP) was the most prevalent ILD, accounting for 63.8% of cases. Out of 69 individuals, 42 (60.9%) had SDB, 57.1% of those with SDB had obstructive sleep apnea (OSA), and the majority of those with OSA had mild degrees (21.7%, n = 15).ConclusionOSA is significantly common in ILD patients. Higher left atrium diameter and oxygen desaturation index (ODI) are predictive factors of SDB. To facilitate early diagnosis and therapy, PSG should be performed on ILD patients at high risk (such as males, individuals with high ESS scores, SBQ scores, and left atrium diameter).Trial registrationRetrospectively registered, registration number is NCT06012526, date of registration August 25, 2023.

Multilevel Risk Factors for Sleep-Disordered Breathing-Related Symptom Burden in an Urban Pediatric Community-Based Sample

Pediatric sleep-disordered breathing (SDB) disproportionately affects children with low socioeconomic status (SES). The multilevel risk factors that drive these associations are not well understood. What are the associations between SDB risk factors, including individual health conditions (obesity, asthma, and allergies), household SES (maternal education), indoor exposures (environmental tobacco smoke [ETS] and pests), and neighborhood characteristics (neighborhood disadvantage), and pediatric SDB symptoms? Cross-sectional analyses were performed on 303 children (aged 6-12 years) enrolled in the Environmental Assessment of Sleep Youth study from 2018 to 2022. Exposures were determined by caregiver reports, assays of measured settled dust from the child's bedroom, and neighborhood-level Census data (deriving the Childhood Opportunity Index to characterize neighborhood disadvantage). The primary outcome was the SDB-related symptom burden assessed by the OSA-18 questionnaire total score. Using linear regression models, we calculated associations between exposures and SDB-related symptom burden, adjusting for sociodemographic factors, then health conditions, indoor environment, and neighborhood factors. The sample included 303 children (39% Hispanic, Latino, Latina, or Spanish origin; 30% Black or African American; 22% White; and 11% other). Increasing OSA-18 total scores were associated with low household SES after adjustment for demographic factors, and with asthma, allergies, ETS, pests (mouse, cockroach, and rodents), and an indoor environmental index (sum of the presence of pests and ETS; 0-2) after adjusting for sociodemographic factors. Even after further adjusting for asthma, allergies, and neighborhood disadvantage, ETS and pest exposure were associated with OSA-18 (ETS: β = 12.80; 95% CI, 7.07-18.53, also adjusted for pest; pest exposure: β = 3.69; 95% CI, 0.44-6.94, also adjusted for ETS). In addition to associations with ETS, a novel association was observed for indoor pest exposure and SDB symptom burden. Strategies to reduce household exposure to ETS and indoor allergens should be tested as approaches for reducing sleep health disparities.

The effect of diet-induced obesity on sleep and breathing in female mice.

Obesity and male sex are main risk factors for sleep-disordered breathing (SDB). We have shown that male diet-induced obesity (DIO) mice develop hypoventilation, sleep apnea, and sleep fragmentation. The effects of DIO on breathing and sleep architecture in females have not been investigated. We hypothesized that female mice are less susceptible to the detrimental effects of DIO on sleep and SDB compared to males. Female DIO-C57BL/6J and lean C57BL/6J mice underwent 24-hour metabolic studies and were exposed to 8% CO2 to measure the hypercapnic ventilatory response (HCVR), and sleep studies. Ventilatory response to arousals was calculated as ratio of the average and peak minute ventilation (VE) during each arousal relative to the baseline VE. Breathing stability was measured with Poincaré plots of VE. Female obesity was associated with decreased metabolism, indicated by reduced oxygen consumption (VO2) and CO2 production (VCO2). VE in 8% CO2 and HCVR were significantly attenuated during wakefulness. NREM sleep duration was reduced in DIO mice, but REM sleep was preserved. Ventilation during NREM and REM sleep was augmented compared to lean mice. Arousal frequency was similar between groups. Obesity increased the frequency of spontaneous arousals, whereas the apnea index was 4-fold reduced in DIO compared to lean mice. Obesity decreased pre- and post-apnea arousals. Obese mice had more stable breathing with reduced ventilatory response to arousals, compared to lean females. We conclude that obese female mice are protected against SDB, which appears to be related to an attenuated CO2 responsiveness, compared to the lean state.

The buccal corridor as a possible morphological risk indicator for sleep disordered breathing.

To explore a possible morphological relationship between buccal corridor, gingival display, transpalatal molar width, palatal height, and a cephalometric measurement (PV-A Line) as a risk indicator for sleep-disordered breathing. Thirty subjects were enrolled. Full face maximum smile images and CBCT scans were taken. A Pearson correlation coefficient was used to identify any relationships between the variables. No correlations were identified between any of the variables investigated in this study as they relate to risk factors for sleep-disordered breathing. The amount of buccal corridor space in relation to a patient's smile and the amount of gingival display does not appear to be a reliable metric in identifying certain morphological risk factors for sleep-disordered breathing. Assessing the amount of buccal corridor space in relation to a smile does not appear to be a reliable predictor of morphological risk for certain risk factors of sleep-disordered breathing. In addition, utilizing the amount of gingival display in a patient's maximum smile does not appear to relate directly to risks in sleep-disordered breathing. Other tests and discovery may be necessary to identify these types of patients.

On the origins of sleep disordered breathing, cardiorespiratory and metabolic dysfunction: which came first, the chicken or the egg?

Sleep disordered breathing (SDB) is a complex, sex specific and highly heterogeneous group of respiratory disorders. Nevertheless, sleep fragmentation and repeated fluctuations of arterial blood gases for several hours per night are at the core of the problem; together, they impose significant stress to the organism with deleterious consequences on physical and mental health. SDB increases the risk of obesity, diabetes, depression and anxiety disorders; however, the same health issues are risk factors for SDB. So, which came first, the chicken or the egg? What causes the appearance of the first significant apnoeic events during sleep? These are important questions because although moderate to severe SDB affects ∼500million adults globally, we still have a poor understanding of the origins of the disease, and the main treatments (and animal models) focus on the symptoms rather than the cause. Because obesity, metabolic dysfunction and stress-related neurological disorders generally appear progressively, we discuss how the development of these diseases can lead to specific anatomical and non-anatomical traits of SDB in males and females while considering the impacts of sex steroids. In light of the growing evidence indicating that the carotid bodies are important sensors of key metabolic and endocrine signals associated with stress and dysmetabolism, we propose that these organs play a key role in the process.

Sleep-Disordered Breathing among Saudi Primary School Children: Incidence and Risk Factors

This study aimed to identify the incidence and risk factors of sleep-disordered breathing (SDB) using an Arabic version of the pediatric sleep questionnaire (PSQ). A total of 2000 PSQs were circulated to children aged 6-12 years who were randomly selected from 20 schools in Al-Kharj city, Saudi Arabia. The questionnaires were filled out by the parents of participating children. The participants were further divided into two groups (younger group: 6-9 years and older group: 10-12 years). Out of 2000 questionnaires, 1866 were completed and analyzed (93.3% response rate), of which 44.2% were from the younger group and 55.8% were from the older group. Among all the participants, a total of 1027 participants were female (55%) and 839 were male (45%) with a mean age of 9.67 ± 1.78 years. It showed that 13% of children were suffering from a high risk of SDB. Chi-square test and logistic regression analyses within this study cohort showed a significant association between SDB symptoms (habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting) and risk of developing SDB. In conclusion: habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting strongly contribute the to development of SDB.

Sex transition from female to male as a risk factor for sleep-disordered breathing

AimThe female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. Patients and methodsAll reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. ResultsIn all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects’ age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48–43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. ConclusionSDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.

Risk factors of sleep-disordered breathing among Public Transport Drivers of Kochi, India

Introduction: Sleep-disordered breathing (SDB) appears to be a major occupational health concern among transport drivers as it increases the chance of road traffic crashes. The study aimed to determine the prevalent risk factors of sleep-disordered breathing in public transport drivers of Kochi, India. Methods: A descriptive cross-sectional study was performed among 50 public transport drivers who satisfied the inclusion criteria and were categorized as high and low-risk groups using the STOP-BANG questionnaire. Physical examination recorded Neck circumference, waist-hip ratio, body mass index, blood pressure, and facial profile. Excessive daytime sleepiness was evaluated using the Epworth sleepiness scale. Mann Whitney and Chi-square tests were used to test for significance. Logistic regression was also done by including the significant variables. Results: The high risk (n= 27) and low-risk groups (n=23) were identified. Among the high-risk group; age, body mass index, neck circumference, blood pressure, snoring and tiredness showed statistically significant results (p&lt;0.05) when compared to the low-risk group. Excessive daytime sleepiness was present among 29.6% of high-risk subjects. Logistic regression confirmed that age (OR=1.176; p=0.001) and body mass index (OR=1.348; p=0.050) were independent predictors of developing a high risk of SDB. Conclusion: mong public transport drivers in Kochi, India; older age and increased body mass index were significant contributing factors to developing sleep-disordered breathing. Obstructive sleep apnea (OSA), whether diagnosed or undiagnosed, is a major public health concern and a proven risk factor for vehicle crashes. Applicants for public transport driver's licenses should be thoroughly examined for the risk of OSA/SDB. A standardized screening protocol for OSA risk assessment should be advisable for public transport drivers to ensure road safety.

High prevalence of sleep-disordered breathing in the intensive care unit - a cross-sectional study.

Sleep-disordered breathing may be induced by, exacerbate, or complicate recovery from critical illness. Disordered breathing during sleep, which itself is often fragmented, can go unrecognized in the intensive care unit (ICU). The objectiveof this study was to investigate the prevalence, severity, and risk factors of sleep-disordered breathing in ICU patients using a single respiratory belt and oxygen saturation signals. Patients in three ICUs at Massachusetts General Hospital wore a thoracic respiratory effort belt as part of a clinical trial for up to 7days and nights. Using a previously developed machine learning algorithm, we processed respiratory and oximetry signals to measure the 3% apnea-hypopnea index (AHI) and estimate AH-specific hypoxic burden and periodic breathing. We trained models to predict AHI categories for 12-h segments from risk factors, including admission variables and bio-signals data, available at the start of these segments. Of 129patients, 68% had an AHI ≥ 5; 40% an AHI > 15, and 19% had an AHI > 30 while critically ill. Median [interquartile range] hypoxic burden was 2.8 [0.5, 9.8] at night and 4.2 [1.0, 13.7] %min/h during the day. Of patients with AHI ≥ 5, 26% had periodic breathing. Performance of predicting AHI-categories from risk factors was poor. Sleep-disordered breathing and sleep apnea events while in the ICU are common and are associated with substantial burden of hypoxia and periodic breathing. Detection is feasible using limited bio-signals, such as respiratory effort and SpO2 signals, while risk factors were insufficient to predict AHI severity.

0701 STOP-BANG Score, Age, and Body Mass Index Predict Severity of Sleep Disordered Breathing in Women Veterans

Abstract Introduction Despite increasing evidence that sleep disordered breathing (SDB) is common in women veterans, little is known of how to screen for SDB in this population. Some evidence suggests there are sex-related differences in SDB presentation, where women may be more likely to present with fatigue or depression, compared to men who may present with daytime sleepiness. The goal of this study was to evaluate whether commonly used measures predict SDB in women veterans. Methods Women veterans (N=179) without treated SDB, but with 1 or more SDB risk factors (identified from electronic medical records) completed baseline assessment as part of an ongoing controlled trial of treatment for SDB. Measures included: age, body mass index (BMI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FSS), Insomnia Severity Index (ISI), Patient-Health Questionnaire 9-item (PHQ-9), STOP-BANG score, and apnea-hypopnea index (AHI via WatchPAT home sleep apnea testing). Descriptive statistics and bivariate correlations testing the relationship between AHI and other measures were performed. Results Mean age was 49.8 [±13.8] years and BMI 29.6 [±6.0] kg/m2. Mean ESS was 8.1, FFS 13.9, ISI 14.0, PHQ-9 7.1, and STOP-BANG score 2.7. Mean AHI was 15.4 [±13.2], where higher AHI correlated with higher BMI (r=0.3, p&amp;lt;0.001), higher STOP-BANG score (r=0.4, p&amp;lt;0.001) and older age (r=0.4, p&amp;lt;0.001). Conclusion These findings support the use of the STOP-BANG score to predict SDB severity in women veterans with risk factors for SDB. Age and BMI may be particularly important predictors of SDB in this population. Sleepiness, depression, insomnia, and fatigue questionnaires were not related to SDB severity. Further work is needed to understand the role of patient-reported symptoms in those at-risk for SDB and to inform guidelines for the recognition of SDB in this important and understudied population. Support (If Any) VA HSR&amp;D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&amp;D COIN; VAGLAHS GRECC.

0543 The association of sleep-disordered breathing and daytime asthma burden among former premature school age children with bronchopulmonary dysplasia

Abstract Introduction Sleep-disordered breathing (SDB) and asthma have a bidirectional relationship. Almost half of former premature school age children with bronchopulmonary dysplasia (BPD) have asthma or asthma-like symptoms. Prematurity is a known risk factor for sleep-disordered breathing. However, little is known about the association of SDB and asthma symptoms in former premature school age children with BPD. Methods Study sample comprised of participants in an ongoing cohort study, the AERO-BPD study. Participants were 6-12 years old, were born &amp;lt; 32 weeks gestational age and had been diagnosed with BPD. We administered the Pediatric Sleep Questionnaire (PSQ) and asthma symptom questionnaires. The prevalence of SDB was determined based on a PSQ &amp;gt; 0.33. The relationship between SDB and daytime asthma symptoms was assessed by multivariate logistic regression, adjusting for sex, race, BMI, rhinitis, asthma controller medication and days on respiratory support in the NICU. Results There were 33 subjects with a mean age of 8.8 years, roughly half were male and one third were overweight/obese. About half (48.5%) had daytime asthma symptoms and 39.4% had SDB. About half were on controller medication (inhaled corticosteroid or leukotriene receptor antagonist) and 39.4% had rhinitis. Among the 13 subjects with SDB, 11 reported daytime asthma symptoms and 5 of the 20 subjects without SDB reported daytime asthma symptoms. Subjects with SDB had over 17 times the odds of daytime asthma symptoms (OR 17.61, 95% CI [1.23, 251.76], p=0.035) compared to subjects without SDB, while adjusting for sex, race, BMI, rhinitis, controller medications and days on respiratory support in the NICU. Conclusion Our findings suggest that SDB is highly prevalent among former premature school age children with BPD. The findings suggest a relationship between SDB and daytime respiratory symptom burden among these patients rather than mere co-existence. Support (If Any)

Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report

BackgroundAdaptive support ventilation (ASV) is a proposed treatment option for central sleep apnea (CSA). Although the effectiveness of ASV remains unclear, some studies have reported promising results regarding the use of ASV in patients with heart failure with preserved ejection fraction (HfpEF). To illustrate the importance of suspecting and diagnosing sleep-disordered breathing (SDB) in older adults unable to recognize symptoms, we discuss a case in which ASV was effective in a patient with CSA and HfpEF, based on changes in the Holter electrocardiogram (ECG).Case presentation.An 82-year-old man presented to our hospital with vomiting on April 19, 2021. Approximately 10 years before admission, he was diagnosed with type 1 diabetes mellitus and recently required full support from his wife for daily activities due to cognitive dysfunction. Two days before admission, his wife was unable to administer insulin due to excessively high glucose levels, which were displayed as “high” on the patient’s glucose meter; therefore, we diagnosed the patient with diabetic ketoacidosis. After recovery, we initiated intensive insulin therapy for glycemic control. However, the patient exhibited excessive daytime sleepiness, and numerous premature ventricular contractions were observed on his ECG monitor despite the absence of hypoglycemia. As we suspected sleep-disordered breathing (SDB), we performed portable polysomnography (PSG), which revealed CSA. PSG revealed a central type of apnea and hypopnea due to an apnea–hypopnea index of 37.6, which was > 5. Moreover, the patient had daytime sleepiness; thus, we diagnosed him with CSA. We performed ASV and observed its effect using portable PSG and Holter ECG. His episodes of apnea and hypopnea were resolved, and an apparent improvement was confirmed through Holter ECG.ConclusionMedical staff should carefully monitor adult adults for signs of or risk factors for SDB to prevent serious complications. Future studies on ASV should focus on older patients with arrhythmia, as the prevalence of CSA may be underreported in this population and determine the effectiveness of ASV in patients with HfpEF, especially in older adults.

Value of Interceptive Orthodontic Treatment for the Management of Sleep Disordered Breathing: A Prospective Longitudinal Study

Background: The paediatric population has a high incidence of sleepdisordered breathing (SDB). One notable risk factor for SDB is the presence of craniofacial abnormalities. The aim of this study was to evaluate the prevalence of SDB by means of questionnaires in patients who received interceptive treatment, to determine whether there is a relationship between the nature and duration of treatment and the prevalence of SDB, and to correlate cephalometric changes with the type of orthopaedic treatment received and questionnaire results. Materials and Methods: Prospective study of 203 patients who required interceptive treatment. Two sleep questionnaires (the Paediatric Sleep Questionnaire (PSQ) and the Sleep Disturbance Scale for Children (SDSC)) were used which were completed by the parents at baseline (T1) and after completion of interceptive treatment (T2). The results of the questionnaires were analysed, grouped according to the type of treatment received and related to 12 cephalometric variables on cephalometric radiography at T1 and T2. Results: The prevalence of SDB at T1 was 21.2% according to PSQ and 33% according to SDSC. The mean age at T1 was 8.5 years and the mean duration of treatment was 13.8 months. Between 10.8% (PSQ) and 17.2% (SDSC) of patients showed improvement in SDB after interceptive treatment (p&lt;0.05). Treatment led to statistically significant cephalometric changes in the variables of mandibular length, maxillary length and overbite, with no significant differences between treatment groups or in relation to questionnaire results. Conclusion: Interceptive treatment achieves significant improvements in SDB. The type and duration of treatment do not affect the prevalence of SDB, although RPE is associated with a higher rate of improvement. The improvement in SDB is independent from the type of treatment and the cephalometric changes effected.

471 Identifying gaps in evaluation, treatment, and treatment adherence in women Veterans with sleep disordered breathing risk factors

Abstract Introduction In our recent national survey study, 13% of women Veterans reported a diagnosis of Sleep Disordered Breathing (SDB), of whom 65% used positive airway pressure (PAP) treatment. We also found many women Veterans at high risk for SDB were undiagnosed (43%). The current study builds upon this survey research to identify rates of evaluation, diagnosis, treatment, and treatment adherence among women Veterans with risk factors for SDB. Methods We analyzed telephone screening data from an ongoing SDB treatment adherence intervention study for women Veterans in Los Angeles county. A total of 173 women Veterans, identified by retrospective chart review as having at least one risk factor for SDB (i.e. high blood pressure, diabetes, obesity, depression, or &amp;gt; 50 years old), completed the screener. Screening questions included 1) previous diagnostic testing for SDB, 2) SDB diagnosis 3) SDB treatment type, and 4) past week SDB treatment use. Descriptive statistics regarding evaluation and treatment of SDB are reported. Results In total, 31% of respondents endorsed having previously completed diagnostic testing, of whom, 54% reported an SDB diagnosis. Of those with diagnosed SDB, 82.8% were prescribed treatment (PAP [72.4%], oral appliance [6.9%], surgery [3.5%]), and 17.2% did not report being prescribed any SDB treatment. Of the 21 (72.4%) women Veterans diagnosed with SDB that were prescribed PAP, only 33% reported using treatment in the past week. Of the 2 women Veterans (6.9%) prescribed an oral appliance, 0% reported past week use. Conclusion Less than 1/3 of women Veterans with at least one risk factor for SDB had previously been evaluated for SDB; however, over 1/2 of women Veterans who were evaluated tested positive for SDB. Additionally, most women Veterans had not used PAP or oral appliance therapy in the past week. Greater clinical attention is needed to identify, evaluate, and diagnose SDB in women Veterans. Moreover, further research is needed to evaluate and inform interventions to address SDB treatment adherence barriers in women Veterans. Support (if any) VA HSR&amp;D IIR 16–244 and RCS 20–191; NIH/NHLBI K24 HL143055, VAGLAHS GRECC and VA Office of Academic Affiliations.

Abstract P597: Growing Prevalence of Post-Stroke Sleep-Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) is common after stroke and is associated with poor functional and cognitive outcomes, and recurrent stroke. Despite increasing prevalence of SDB in the general population, no data are available about trends in post-stroke SDB. We therefore sought to assess changes in post-stroke SDB prevalence over a 10-year period. Methods: Within the Brain Attack Surveillance In Corpus Christi (BASIC) project, a population-based stroke surveillance study in south Texas, participants with acute ischemic stroke were offered assessment of SDB with the ApneaLink Plus device. Medical record abstraction and baseline interviews were conducted and included the Berlin questionnaire to assess SDB status in reference to the prestroke state. SDB testing was performed shortly after stroke presentation (median 12 days (IQR: (6, 21)). Respiratory event index (REI) was calculated as the sum of apneas and hypopneas per hour of overnight recording. SDB was defined as an REI ≥10. SDB assessment procedures remained unchanged throughout (2010-2020). Logistic (SDB) and linear (REI) regression were used to test associations with time (parameterized as years since 2010) adjusted for demographics, and stroke and SDB risk factors including BMI and pre-stroke SDB status. Results: Among the 1,197 participants, median age was 65, 53% were male, and 65% were Mexican American. SDB prevalence was 61% in 2010-2011 and 75% in 2018-2019. Median REI was 19 in 2010-2011 and 23 in 2018-2019. A linear association was identified between time and SDB (REI≥10), with an odds ratio of 1.123 (95% CI: 1.062, 1.187) per year, after adjustment. Similarly, a linear association was identified between time and REI, with an average increase of 0.504 (95% CI: 0.148, 0.860) per year, after adjustment. Based on models with interaction terms added, no differences in time trends were found by sex or ethnicity. Conclusions: Post-stroke SDB prevalence in this population-based sample has increased over the last 10 years. These data highlight the importance of post-stroke SDB and the pressing need to determine whether its treatment improves outcomes.

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease.

Sleep-disordered breathing (SDB) is a serious medical condition characterized by intermittent episodes of airflow limitation, intermittent hypoxia, and sleep disturbance triggering a pattern of autonomic dysfunction associated with hypertension, diabetes, and other adverse health conditions. SDB incidence is two to three times higher during pregnancy and is associated with an increased risk of cardiometabolic complications, including pre-eclampsia and gestational diabetes. Treatments to protect breathing during sleep are available, pointing to SDB as a potential therapeutic target to reduce maternal cardiometabolic morbidity. However, in clinical practice, the majority of SDB cases in pregnancy are undiagnosed, indicating a need to improve screening for SDB risk factors and referral for diagnostic testing. Furthermore, definitive clinical trials are needed to determine the extent to which SDB intervention reduces the risk of adverse cardiovascular and neonatal outcomes in pregnancy. This review article discusses an accumulation of research pointing to SDB as a prevalent risk factor for gestational cardiometabolic disease, as well as a potential therapeutic target to reduce cardiometabolic morbidity.

Polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis.

Objectives This study aims to evaluate polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis (SSc).Patients and methods Thirty-nine patients (2 males, 37 females; mean age: 51.1±12.5 years; range, 21 to 76 years) who attended to the Rheumatology Clinic of Trakya University Medical Faculty between March 2014 and May 2014 were included in the study. Thoracic computed tomography, pulmonary function tests, carbon monoxide diffusion tests, echocardiography, and all-night polysomnography in a sleep laboratory were performed in all patients. Demographic and clinical characteristics of the patients were recorded. The Apnea-Hypopnea Index (AHI) scores were calculated. Disease activity was examined using the Medsger Disease Severity Scale (MDSS). Possible risk factors for sleep-disordered breathing were evaluated.Results Using the AHI of ≥5 for obstructive sleep apnea (OSA), 21 (53.8%) of the patients were classified as having OSA. There were no significant differences between the groups with and without OSA in terms of steroid use (p=0.4), CT involvement (p=0.3), and Warrick (p=0.6) and MDSS scores (p=0.5). Age, body mass index (BMI), and mean oxygen desaturation index were found to be significant in the univariate analysis (p<0.1); however, the multivariate analysis revealed only BMI as significant risk factor of OSA (p=0.028). In the multivariate analysis, the mean saturation was found to be significant risk factor for high pulmonary artery pressure (p<0.001).Conclusion Although OSA is common in SSc, only increased BMI is a significant risk factor of OSA, but not lung involvement, Warrick scores, or MDSS scores.