Risk For Sleep-disordered Breathing Research Articles

Sleep-disordered breathing and risk of lung cancer: a meta-analysis longitudinal follow-up studies.

Consensus remains lack regarding whether sleep-disordered breathing (SDB) is an independent risk factor for lung cancer. We therefore conducted a meta-analysis to clarify the relationship of SDB and lung cancer. Longitudinal follow-up studies investigating the association between SDB and incidence of lung cancer were included by search of electronic databases including PubMed, Embase, and Cochrane's Library. A random-effects model was adopted to combine the results. Seven studies were included. Pooled results showed that presence of SDB was independently associated with higher incidence of lung cancer [adjusted risk ratio (RR): 1.28; 95% confidence interval (CI), 1.11-1.47; P < 0.001; I2 = 37%]. Sensitivity analysis limited to studies with adjustment of smoking showed consistent results (three studies, RR: 1.34; 95% CI, 1.22-1.48; P < 0.001; I2 = 8%). Subgroup analysis suggested that the association between SDB and higher risk of lung cancer was not significantly affected by study characteristics such as study design, source of population, sample size, evaluation methods for SDB, follow-up duration, methods for validation of lung cancer, or score of study quality (P values for subgroup difference all >0.05). No significant publication bias was observed (P for Egger's regression test = 0.258). These results suggested that SDB may be an independent risk factor of lung cancer in adult population. Intensive screening and prevention of lung cancer in subjects with SDB should be considered.

Nasal cavity structural anomalies in children and adolescents at high risk of sleep-disordered breathing: An exploratory cone-beam computed tomography study

In this study, we investigated the presence of structural anomalies in the nasal cavity (deviated nasal septum [DNS] and turbinate hypertrophy [TH]) in patients at high risk or not of sleep-disordered breathing (SDB). A retrospective study considering available cone-beam computed tomography scans of 99 patients was conducted. DolphinImaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) was used to process the craniofacial scans. A pediatric sleep questionnaire (PSQ) was used to suggest a high risk of SDB. Subjective and objective assessments of DNS and TH were considered. Good to excellent intrareliability and interreliability were attained. The prevalence of a PSQ score suggestive of a high risk of SDB in this sample was 59%. The prevalence of subjective DNS and TH assessment was 64% and 70%, respectively. In contrast, on the basis of objective assessments, 27% of patients presented with DNS and 25% with TH. Cross-tabulation of DNS and TH with PSQ score indicated a statistically significant association between subjective DNS and subjective TH and subjective TH and positive PSQ. A positive correlation between age and subjective and objective DNS assessments was also observed. Older patients are more likely to present with DNS. Only the presence of subjectively determined TH in patients is associated with a high risk for SDB. The study reveals that assessment of DNS and TH using cone-beam computed tomography imaging is not likely suitable to strongly suggest patients at high risk for SDB. DNS subjective assessments were capable of identifying less than 5% of deviation.

Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy.

Sleep disordered breathing (SDB) and depression are both common complications of pregnancy and increase risk for adverse maternal and neonatal outcomes. SDB precedes onset of depression in non-pregnant adults; however, the longitudinal relationship has not been studied in pregnancy. The present research examined temporal associations between SDB and depressive symptoms in 175 pregnant women at risk for SDB (based on frequent snoring and obesity), but without an apnea hypopnea index of ≥5 events per hour at enrollment. Women completed a self-report assessments of depressive symptoms using PHQ-9 and in-home level III sleep apnea monitoring at approximately 12- and 32-weeks’ gestation. We also assessed the risk for SDB using the Berlin Questionnaire in early pregnancy. Results revealed that measures of SDB in early pregnancy as assessed by in-home sleep study, but not by self-reported SDB, predicted elevated depressive symptoms in late pregnancy. SDB in late pregnancy was not associated with depressive symptoms. To conclude, these findings suggest that SDB may increase the risk for elevated depressive symptoms as pregnancy progresses.

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.

Sleep Disordered Breathing in Neurodevelopmental Disorders

Sleep problems are common in children with neurodevelopmental disorders (NDD). In addition to insomnia, sleep disordered breathing (SDB) is ubiquitous and an important therapeutic target within this population. In this review, we discuss the evaluation and management of SDB in children with NDDs, with a particular emphasis on syndrome-specific considerations. Common NDDs that have increased risk of SDB include autism spectrum disorder, Down syndrome, myelomeningocele and Chiari malformation, attention deficit hyperactivity disorder, Prader–Willi syndrome, epilepsy, and 22q deletion syndrome. We discuss a variety of treatment options and advocate the need for a personalized treatment plan contingent on the underlying disease characteristics of the child and family preferences. Advancements in drug-induced sleep endoscopy and hypoglossal nerve stimulation represent exciting new surgical options for those children who cannot tolerate positive airway pressure. Children with a myriad of NDDs are at increased risk for SDB, for which treatment may result in clinically important changes in quality of life. Clinicians need to consider syndrome-specific features of SDB in both the evaluation and treatment phases of management.

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 disturbances in children with functional gastrointestinal disorders: demographic and clinical characteristics.

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

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.

Sleep-disordered breathing among Saudi children seeking orthodontic treatment.

Aims:The aim of this research is to assess the prevalence of sleep disordered breathing (SDB) and evaluate the risks and symptoms in children seeking orthodontic treatment in a Saudi dental center.Settings and Design:It is a cross-sectional survey-based study.Methods and Material:Pediatric sleep questionnaire (PSQ) was used to survey 285 children and adolescents aged 5 to 18 years old who are undergoing orthodontic screening in a Saudi Dental Center.Statistical Analysis Used:PSQ scores were tested with multiple variables including gender, parents' education, academic performance using Mann-Whitney-U test. Correlation of study sample scores with age were calculated using the Spearman rank correlation coefficient (rho).Results:In this study 136 (47.7%) of the participants were deemed to be high risk for developing SDB and 149 (52.3%) were low risk, males were significantly at higher risk compared to females (P ≤ 0.05). Participants with previous adenoidectomy surgery were more likely to be identified as high-risk for SDB (P-value = 0.000) as well as participants with a family history of snoring (P-value = 0.000).Conclusions:Sleep disordered breathing was prevalent among Saudi children seeking orthodontic therapy, it is important to screen children and adolescents in dental pediatric and orthodontic clinics for SDB risk as this is a prevalent disorder among this population, early detection of SDB will improve patients' quality of life and prevent future complications associated to this disorder.

Assessment of Predicting Factors for Pediatric Sleep Disordered Breathing

The aim of this study was to evaluate the association between various predicting tools and Apnea-Hypopnea Index (AHI) to identify children with sleep disordered breathing (SDB). From 5 to 10 years old who came for orthodontic counseling, 61 children, whom had lateral cephalograms, pediatric sleep questionnaire (PSQ) records, and portable sleep monitoring results, were included in this study. A total of 17 measurements (11 distances and 6 angles) were made on lateral cephalograms. The measurements of lateral cephalograms, PSQ scales and portable sleep monitoring results were statistically analyzed. 49 of 61 (80%) patients showed AHI &gt; 1, which suspected to have SDB and their mean AHI was 2.75. In this study, adenoid size (A/N ratio), position of the hyoid bone from mandibular plane, gonial angle, and PSQ scale were related to a higher risk of pediatric SDB. Also, oxygen desaturation index (ODI) and snoring time from sleep monitoring results were statistically significant in children with SDB using Mann-Whitney test (&lt;i&gt;p&lt;/i&gt; ＜ 0.05).&lt;br/&gt;In conclusion, evaluation of hyoid bone position, adenoidal hypertrophy, gonial angle in lateral cephalogram, and PSQ scale was important to screen out potential SDB, especially in children with frequent snoring.

Children with Down syndrome and sleep disordered breathing have altered cardiovascular control.

Sleep disordered breathing (SDB) in typically developing (TD) children is associated with adverse cardiovascular effects. As children with Down syndrome (DS) are at increased risk for SDB, we aimed to compare the cardiovascular effects of SDB in children with DS to those of TD children with and without SDB. Forty-four children with DS (3-19 years) were age and sex matched with 44 TD children without SDB (TD-) and with 44 TD children with matched severity of SDB (TD+). Power spectral density was calculated from ECG recordings, for low frequency (LF), high frequency (HF), total power and the LF/HF ratio. Children with DS had lower HF power, and higher LF/HF during sleep and when awake. There were no differences between groups for LF power. SpO2 nadir, average SpO2 drop and SpO2 > 4% drop were larger in the DS group compared to the TD+ group (p < 0.05 for all). Our findings demonstrate significantly reduced parasympathetic activity (reduced HF power) and increased LF/HF (a measure of sympathovagal balance) in children with DS, together with greater exposure to hypoxia, suggesting SDB has a greater effect in these children that may contribute to an increased risk of adverse cardiovascular outcomes. Sleep disordered breathing in children with Down syndrome exacerbates impaired autonomic control and increases exposure to hypoxia, compared to typically developing children. In typically developing children sleep disordered breathing has adverse effects on autonomic cardiovascular control. The prevalence of sleep disordered breathing is very high in children with Down syndrome; however, studies on the effects on cardiovascular control are limited in this population. This study supports screening and early treatment of sleep disordered breathing in children with Down syndrome.

Small sleepers, big data: leveraging big data to explore sleep-disordered breathing in infants and young children.

Infants represent an understudied minority in sleep-disordered breathing (SDB) research and yet the disease can have a significant impact on health over the formative years of neurocognitive development that follow. Herein we report data on SDB in this population using a big data approach. Data were abstracted using the Cerner Health Facts database. Demographics, sleep diagnoses, comorbid medication conditions, healthcare utilization, and economic outcomes are reported. In a cohort of 68.7 million unique patients, over a 9-year period, there were 9,773 infants and young children with a diagnosis of SDB (obstructive sleep apnea [OSA], nonobstructive sleep apnea, and "other" sleep apnea) who met inclusion criteria, encompassing 17,574 encounters, and a total of 27,290 diagnoses across 62 U.S. health systems, 172 facilities, and 3 patient encounter types (inpatient, clinic, and outpatient). Thirty-nine percent were female. Thirty-nine percent were ≤1 year of age (6,429 infants), 50% were 1-2 years of age, and 11% were 2 years of age. The most common comorbid diagnoses were micrognathia, congenital airway abnormalities, gastroesophageal reflux, chronic tonsillitis/adenoiditis, and anomalies of the respiratory system. Payor mix was dominated by government-funded entities. We have used a novel resource, large-scale aggregate, de-identified EHR data, to examine SDB. In this population, SDB is multifactorial, closely linked to comorbid medical conditions and may contribute to a significant burden of healthcare costs. Further research focusing on infants at highest risk for SDB can help target resources and facilitate personalized management.

Ultrasonographic Measurement of Pharyngeal-Airway Dimension and Its Relationship with Obesity and Sleep-Disordered Breathing

Previous studies based on magnetic resonance imaging (MRI) or computed tomography (CT) have shown that pharyngeal airway diameter during wakefulness is different between healthy controls and patients with a high risk of sleep-disordered breathing (SDB). However, MRI and CT are expensive and not easily accessible. Conversely, ultrasonography is more accessible and is getting more attention as a point-of-care technology to assess physiologic systems, such as the pharynx. Thus, we aimed to evaluate the feasibility of ultrasonography in estimating the pharyngeal airway dimension. To evaluate the pharyngeal airway with ultrasonography, we measured the parasagittal anterior–posterior (PAP) diameter and transverse diameter. For PAP diameter measurements, the transducer probe was placed in a submandibular lateral oblique position, with its superior margin abutting the angle of the left mandible. For the transverse measurement, the ultrasound probe was positioned in a submandibular location, in a near-coronal plane, just above the hyoid bone so that the tongue could be seen in cross-section. The diameter measurements were performed manually by two technicians. The reliability of these measurements was assessed by the intra-class correlation coefficient (ICC). To validate our measurements, we compared the measured PAP diameter with the average pharyngeal airway cross-sectional area from vellum to glottis measured by acoustic pharyngometry. Furthermore, we compared the influence of obesity and SDB in the measured pharyngeal diameters. Eighteen controls and 13 individuals with a high risk of SDB participated in this study. Reliability analysis of the PAP measurements yielded an ICC of 0.97 (95% confidence interval: 0.94–0.98). Furthermore, measured PAP diameters were significantly correlated with the pharyngeal airway cross-sectional area (r = 0.76, p < 0.01). Moreover, obesity and SDB were associated with decreases in PAP diameter. Our study shows that ultrasonography measurement of the PAP diameter may provide a quantitative assessment of the pharyngeal airway and may be useful for screening of SDB.

Risk of major cardiovascular and cerebrovascular complications after elective surgery in patients with sleep-disordered breathing: A retrospective cohort analysis.

There is limited and conflicting data on whether sleep-disordered breathing (SDB) is associated with postoperative major cardiovascular and cerebrovascular events (MACCE), and mortality. To determine whether SDB is associated with increased risks of MACCE, mortality and length of hospital stay. Retrospective cohort analysis from the Nationwide Inpatient Sample. Adults who underwent elective abdominal, orthopaedic, prostatic, gynaecological, thoracic, transplant, vascular or cardiac surgery in the United States of America between 2011 and 2014. The study cohort included 1813 974 surgical patients, of whom 185 615 (10.2%) had SDB. Emergency or urgent surgical procedures were excluded. The incidences of MACCE, respiratory and vascular complications, in-hospital mortality and mean length of hospital stay were stratified by SDB. Linear and logistic regression models were constructed to determine the independent association between SDB and outcomes of interest. The incidences of MACCE [25.3 vs. 19.8%, odds ratio (OR) 1.20, P < 0.001] and respiratory complications (11.75 vs. 8.0%, OR 1.43, P < 0.001) were significantly higher in patients with SDB than in those without SDB. SDB was associated with higher rates of atrial fibrillation (14.7 vs. 10.8%, P < 0.001), other arrhythmias (6.0 vs. 5.4%, P < 0.001) and congestive heart failure (9.8 vs. 7.1%, P < 0.001). SDB patients had a lower rate of myocardial infarction (3.1 vs. 3.4%, OR 0.69, P < 0.001), lower mortality (0.6 vs. 1.3%, P < 0.001) and shorter length of hospital stay (4.8 vs. 5.2 days, P < 0.001). SDB was associated with increased risks of MACCE, and respiratory and vascular complications, but had a lower incidence of in-hospital mortality and shorter length of hospital stay.

Long-Term Changes in Sleep Disordered Breathing in Renal Transplant Patients: Relevance of the BMI.

Sleep disordered breathing (SDB), as defined by the Apnea Hypopnea Index (AHI), is a highly prevalent disturbance in end stage kidney disease. SDB improves early on after renal transplantation but long-term changes in AHI in these patients have not been studied. We studied the long-term changes in AHI in a series of 221 renal transplant patients (mean age: 47 ± 12 years; 70% males) over a median follow up of 35 months. Data analysis was made by the generalized estimating equations method (GEE). On longitudinal observation, the median AHI rose from 1.8 (Interquartile range: 0.6–5.0) to 2.9 (IQR: 1.0–6.6) and to 3.6 (IQR: 1.7–10.4) at the second and third visit, respectively (p = 0.009 by the GEE model and the proportion of patients with moderate to severe SDB rose from 8% to 20%. Longitudinal changes in minimum oxygen saturation (minSaO2) mirrored those in the AHI. In adjusted analyses, repeated measurements of BMI (p < 0.009) emerged as the strongest independent longitudinal correlate of AHI and MinSaO2. The AHI worsens over time in renal transplant patients and longitudinal changes of this biomarker are directly related to simultaneous changes in BMI. Overweight/obesity, a potentially modifiable risk factor, is an important factor underlying the risk of SDB in this population.

1459-P: NMR-Based Metabolomics for the Screening of Sleep-Disordered Breathing in Type 2 Diabetes

Sleep-disordered breathing (SDB) is common in type 2 diabetes (T2D). This study aimed to develop a screening tool to detect SDB in T2D. Method: SDB was screened in 95 patients by an overnight monitor and diagnosed if apnea-hypopnea index ≥ 5. Anthropometric and HbA1c data, and SDB risk by questionnaire were obtained. Quantitative NMR experiment was performed on a Bruker AVANCE 400 Ascend NMR spectrometer. Carr−Purcell−Meiboom−Gill (CPMG) pulse sequence at 310 K was applied to serum samples to enhance signal-to-noise ratio and hence detect low-molecular weight metabolites. Models based on six machine learning methods (e.g., learned vector quantization, stochastic gradient boosting model, support vector machines, decision tree, partial least squares, generalized linear model, and logistic regression) were constructed to predict SDB, tuned with the CARET R package, and evaluated using three repeats of 10-fold cross validation. Results: Seventy-six patients (80.0%) had SDB. Compared with those without, those with SDB were more likely to be male, have SDB risk, higher BMI and neck circumferences, longer diabetes duration, and higher HbA1c. NMR-based metabolic profiling identified significantly lower levels of branched-chain amino acids (BCAAs) (e.g., L-leucine and L-isoleucine), lactate and threonine metabolites in those with SDB, while level of D-glucose-6 phosphatase was higher than those without SDB. Accuracies for predicting SBD using clinical data alone were ∼80% for each machine learning model. L-leucine and D-glucose-6-phosphatase were identified as being independently associated with SDB using a logistic regression, in addition to clinical factors, with an improved accuracy of 86.3%, and a Cohen’s kappa of 0.429. Conclusions: Due to its high prevalence, clinical factors alone were not sufficient in predicting SDB in T2D. The discovery of metabolic profiles, including BCAAs and those involved in glucose metabolism, could facilitate a more precise and specific SDB prediction. Disclosure K. Lertdetkajorn: None. P. Poungsombat: None. S. Khoomrung: None. J. Phetcharaburanin: None. S. Hongthong: None. C. Kuhakarn: None. N. Siwasaranond: None. A. Manodpitipong: None. H. Ninitphong: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk Inc., Takeda Pharmaceutical Company Limited. S. Saetung: None. B. Ongphiphadhanakul: None. V. Reutrakul: None. S. Reutrakul: None. Funding Endocrine Society of Thailand; Ramathibodi Hospital; Mahidol University; Thailand Center of Excellence for Innovation in Chemistry

847Interim analysis of the device-detected cardiac tachyarrhythmic events and sleep-disordered breathing (DEDiCATES)" study; focused on baseline characteristics

Abstract Funding Acknowledgements This work is supported by Boston Scientific. Background/introduction: Sleep-disordered breathing (SDB) is one of the common comorbidities in cardiac implantable electronic devices (CIED) patients. It’s feasible to detect SDB using specialized diagnostic function of CIEDs showing comparable performance in diagnostic accuracy of SDB to conventional polysomnography. To date, few studies have investigated the prognostic value of CIED-detected SDB in cardiovascular risk. Purpose In the Device-Detected CArdiac Tachyarrhythmic events and Sleep-disordered breathing (DEDiCATES) study, we aim to determine whether device-detected sleep-disordered breathing (SDB) events are associated with increased risk of cardiac arrhythmias or other cardiovascular (CV) outcomes. Here, we present interim baseline data of the study population to investigate the baseline prevalence and severity of device-detected SDB in CIED patients. Methods The study was designed as a prospective, multicenter, and observational study to include 600 patients. Eligible patients have dual chamber CIEDs with SDB detection function which reports the average number of sleep disturbance events per hour per night in the form of a Respiratory Disturbance Index (RDI). The daily RDI values were collected to measure the severity and burden of SDB. The baseline severity of SDB was determined according to RDI data recorded during the first 1 week, 1 month, and 3 ± 1 months after CIED implantation; patients with RDI≥ 30/h for at least one night are classified into the severe SDB group. Results A total of 313 patients who completed the first device interrogation at 3 ± 1 months were included for analysis. The mean age and CHA2DS2VASc score were 69 and 3.1, respectively. Forty-nine percent of patients were men, and 35.5% were classified as high risk for SDB by Berlin questionnaire. The rate of severe SDB increased with longer monitoring period (83.8% at 1week, 91.6% at 1 month, and 96.4% at 3 ± 1 months). There was no baseline demographic difference between the severe and non-severe SDB groups, except that baseline body mass index (BMI) was higher in the severe group (24.5% vs. 21.5%, p = 0.01). The mean RDI was 36.3, 34.2, and 33.0 per night during the first 1 week, 1 month, and 3 ± 1 months, respectively. Considering the limitation of the categorical criteria of baseline severity, we arbitrarily reclassified the patients according to median mean RDI value. Men were more frequent and BMI was higher in the above-mean RDI group compared to the below-mean RDI group. Using logistic regression analysis, we identified that BMI and male gender were associated with patients with above-mean RDI. Conclusions Conventional categorical classification of SDB severity seems to be limited in its ability to discriminate high risk patients. Thus, more suitable RDI-related variables need to be identified in future outcome analysis. Abstract Figure. Prevalence of baseline severe SDB

0877 Impact of Sleep-Disordered Breathing on Quality of Life in Pediatric Cystic Fibrosis

Abstract Introduction The frequency of sleep-disordered breathing (SDB) may be high among children with cystic fibrosis (CF), a life-shortening, genetic disease that affects 1/3400 Caucasian live-births. Yet, the potential impact of SDB on their quality of life has not been well-studied. Methods The Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders (PSQ-SRBD) Scale, a well-validated SDB screening tool, and two validated quality-of-life questionnaires, the Pediatric Quality of Life Inventory (PedsQL™) and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were administered to children 6-17 years of age with CF consecutively during a 2-week period during routine pulmonary clinic visits. Results Twenty-two children with CF and their parents completed the questionnaires. Mean age of the participants was 11.6±3.8(sd) years. Mean body mass index (BMI) percentile was 54.8±27.1%. Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was 86.6±22.5%. Five subjects (23%) showed high risk for SDB (PSQ-SRBD Scores &amp;gt; 0.33). Seven additional subjects had PSQ-SRBD Scores of 0.3. Mean BMI percentile was higher among subjects with vs. without positive PSQ-SRBD Scores (66% vs. 42% respectively, p=0.03). The groups did not differ with regards to FEV1. Pearson/Spearman correlation identified negative associations between PSQ-SRBD Scores and functioning in multiple parent PedsQL domains: physical (R=-0.45, p=0.03), social (R=-0.53, p=0.01), school (R=-0.56, p=0.008); two child PedsQL domains: physical (R=-0.41, p=0.06), school (R=-0.41, p=0.06); multiple parent CFQ-R domains: physical (R=-0.44, p=0.08), respiratory (R=-0.45, p=0.07), emotional (R=-0.54, p=0.02), school (R=-0.70, p=0.002); and one child CFQ-R domain: physical (R=-0.51, p=0.01). None of these domains were associated with FEV1. Conclusion Children with CF may have SDB symptoms independent of the extent of lung dysfunction. Although the current cross-sectional data cannot prove a causal effect, they raise the possibility that the SDB itself may have adverse impact on physical, emotional, social, and school functioning. Support NIH Training Grant (F32HL145915)

0892 Sleep Abnormalities in Cornelia De Lange Syndrome

Abstract Introduction Cornelia de lange is an autosomal dominant disorder (when associated with NIPBL, RAD21, or SMC3 genes) with an incidence of 1:10,000 to 1:50,000 live births, patients affected are known to have a wide variety of sleep disorders, those range from insomnia and abnormal circadian cycle to sleep disordered breathing and hypoventilation. The exact etiology of increased risk of sleep-disordered breathing in patients affected is not fully understood. It is possible that some facial features in these patients expose them to a higher risk (micrognathia, high arched palate, and short neck). We wanted to analyze the sleep related problems in CDLS. Methods We included 3 patients with the disorder, age range from 15 months to 16 years old. All patients met criteria for CDLS diagnosis, all had intellectual disability and behavioral associated symptoms. The somnology evaluation included questionnaires of diurnal behavior and sleep focused logs. We performed nocturnal polysomnography in only 2 patients due to inability to tolerate the test in one case. Results Sleep clinical information was abnormal in all the cases. Overnight behavioral video evaluation was done. The behavioral abnormalities were evident in all subjects and severe in one. Overnight polysomnography demonstrated a moderate to severe degree of OSA, delayed sleep onset suggestive of insomnia, sleep-wake transition disorder with elevated WASO time, and arousal disorder with elevated spontaneous arousal index. It is of interest the finding of sleep related hypoxemia with limited evidence of obstructive component in one patient. Conclusion The abnormalities in sleep are frequent in CDLS, there are wide and present in the sleep architecture and the sleep ventilation, sleep apnea syndromes are frequent but are not the only major sleep-related abnormalities. When CDLS is caused by mutations in the HDAC8 or SMC1A gene, the condition has an X-linked dominant pattern inheritance. Most cases result from new mutations in the HDAC8 or SMC1A gene and occur in people with no history of the condition in their family, likely our cases are related to this mode of transmission and potential different patters of sleep disruption are dependent on different genes involved. Support None

Association Between Sleep Disordered Breathing and Left Ventricular Function: A Cross-Sectional Analysis of the ECHO-SOL Ancillary Study.

Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1-0.3) lower E', 0.3 (0.1-0.5) greater E/E' ratio, and 1.07-fold (1.03-1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3-2.4) g/m2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.