Risk Of Apnea Research Articles

Indeks Masa Tubuh Dan Lingkar Pinggang Dengan Risiko Obstructive Sleep Apnea Pada Pasien Diabetes Mellitus

Diabetes mellitus (DM) is a disease that continues to increase every year and is one of the world's death threats. The triad of DM symptoms includes drinking, eating and urinating frequently as well as drastic weight loss which causes a decrease in body muscle mass in the nasopharynx and oropharynx resulting in collapse and Obstructive sleep apnea (OSA). This study aims to analyze the relationship between body mass index and waist circumference with the risk of obstructive sleep apnea (OSA) in diabetes mellitus patients in the working area of ​​the Karang Pule Health Center, Mataram City. This study uses a correlation research design. The number of samples used was 87 respondents with a purposive sampling technique. Data analysis in this study used the Spearman rank test. The results showed that there was a relationship between body mass index and the risk of obstructive sleep apnea (OSA) in diabetes mellitus patients with a p value of 0.043 (< α 0.05) and there was a relationship between waist circumference and the risk of obstructive sleep apnea (OSA) with a p value of 0.028 (< α 0.05). Based on the results of this study, it is necessary to support the family and diabetics themselves to maintain a good and regular lifestyle and diet in accordance with the 7 pillars of management of diabetes mellitus to prevent various complications.

1098-P: Association of Sleep with ß-Cell Response and Insulin Sensitivity in Youth

Poor sleep may be associated with reduced β-cell response or decreased insulin sensitivity in youth. We explored whether sleep duration, sleep quality or obstructive sleep apnea (OSA) risk factors were associated with measures of β-cell response or insulin sensitivity in youth. At baseline, 88 youth (10-19 yrs of age) with recently diagnosed T2D or prediabetes completed validated questionnaires (Sleep Disturbances Scale and Cleveland Adolescent Sleepiness) in the Restoring Insulin Secretion (RISE) Study. Hyperglycemic clamps measured insulin sensitivity (steady state glucose infusion rate/insulin [M/I]) and β-cell responses: acute (0-10 min) C-peptide response to glucose (ACPRg), steady-state C-peptide at a glucose of 11.1 mmol/L (SSCP), and arginine-stimulated maximum C-peptide responses at glucose >25 mmol/L (ACPRmax). Linear regression models explored the independent association between sleep variables and clamp measures, adjusted for age, race/ethnicity, sex, Tanner stage, metformin use and BMI. Models including β-cell responses were adjusted for M/I to account for the role of insulin sensitivity in β-cell function. The cohort was 70% female, 28% white, 25% black, 36% Hispanic; age 14.3±2.0 yrs and BMI 36.9±6.4 kg/m2 (mean±SD). Using ADA criteria, 60% had prediabetes and 40% had T2D; 27% reported metformin use. Sleep duration <8 h was reported in 59%; 57% reported daytime sleepiness; 28% reported poor sleep quality; 29% had high risk for OSA. Low sleep duration (<8 h) was associated with a trend for lower ACPRg (p=0.069). No sleep variables (sleep duration or quality, OSA risk) were associated with clamp-derived outcomes in unadjusted or adjusted linear regression models. In youth with prediabetes or T2D, subjective measures of sleep quantity, sleep quality and OSA risk were not independently associated with β-cell response or insulin sensitivity. Further research using objective measures of sleep may better delineate the relationship between sleep and β-cell function in youth. Disclosure K.A.Temple: None. A.H.Tjaden: None. S.Manchanda: Advisory Panel; Inspire. D.Ehrmann: None. K.J.Nadeau: None. S.Edelstein: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. B.Mokhlesi: None. Rise consortium: n/a. Funding American Diabetes Association (1-20-RISE-01 to S.E.); National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute

163-LB: Youth with Delayed Sleep Phase Have Reduced Insulin Sensitivity

Background: U.S. adolescents have short and delayed sleep, which may have metabolic consequences. We hypothesized that shorter sleep duration and later sleep phase are associated with decreased insulin sensitivity (SI) and worse glucose tolerance in overweight youth. Methods: We enrolled healthy youth aged 12-21y with BMI ≥80%ile (or ≥23kg/m2 if ≥18y). We obtained 14 days of wrist actigraphy (ActiGraph GT3XP-BTLE), a frequently-sampled 180 min OGTT (fsOGTT) with 10 samples, and administered validated questionnaires to estimate obstructive sleep apnea (OSA) risk. From actigraphy, we derived average sleep duration (SLD), mid-sleep time (MST), and sleep onset (SO). From the fsOGTT, we estimated SI using the OGTT Minimal Model and the disposition index (DI = SI x incremental insulin AUC 180min). We used multivariable linear regression to examine associations between sleep patterns and glycemic outcomes adjusting for confounders. Results: To date, we enrolled 24 youth (13F) with a median (IQR) age of 20.6y (19.2, 21.5), BMI of 25.2kg/m2 (24.3, 28.9), and fsOGTT glucoses of: fasting 91mg/dL (86, 95), 1h 141mg/dL (113, 179), and 2h 117mg/dL (78, 144). Participants had a median SLD of 7.3h (6.8, 8.1) per night, with SO of 1:13am (12:27am, 2:09am) and MST of 4:48am (4:23am, 6:01am). Age, race, and sex were not associated with sleep outcomes and not included in regressions. We found that (1) later MST [β=10.3, p=0.01] and SO [β=11.4, p=0.01] were each associated with higher fsOGTT 2h glucose, (2) later SO was associated with lower log-transformed SI [β= -0.27, p=0.04], and (3) later MST trended towards lower log-transformed DI [β= -0.1, p=0.055] adjusting for BMI and OSA risk. SLD was not related to any fsOGTT variables. Conclusions: To our knowledge, this is the first study in overweight youth to show that delayed sleep phase (SO and MST), but not short SLD, was associated with lower SI using the rigorous OGTT minimal model. Further studies are needed to examine if delayed sleep is a modifiable risk factor for diabetes prevention in youth. Disclosure T. A. Hitt: None. D. Stefanovski: None. A. Kelly: None. S. Malina: None. C. X. D. Wang: None. F. P. Sgambati: None. B. S. Zemel: None. J. Jun: None. S. N. Magge: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115648); National Institutes of Health (UL1TR001878, UL1TR001079)

Automatic three-dimensional nasal and pharyngeal airway subregions identification via Vision Transformer

ObjectivesUpper airway assessment requires a fully-automated segmentation system for complete or sub-regional identification. This study aimed to develop a novel Deep Learning (DL) model for accurate segmentation of the upper airway and achieve entire and subregional identification. MethodsFifty cone-beam computed tomography (CBCT) scans, including 24,502 slices, were labelled as the ground truth by one orthodontist and two otorhinolaryngologists. A novel model, a lightweight multitask network based on the Swin Transformer and U-Net, was built for automatic segmentation of the entire upper airway and subregions. Segmentation performance was evaluated using Precision, Recall, Dice similarity coefficient (DSC) and Intersection over union (IoU). The clinical implications of the precision errors were quantitatively analysed, and comparisons between the AI model and Dolphin software were conducted. ResultsOur model achieved good performance with a precision of 85.88–94.25%, recall of 93.74–98.44%, DSC of 90.95–96.29%, IoU of 83.68–92.85% in the overall and subregions of three-dimensional (3D) upper airway, and a precision of 91.22–97.51%, recall of 90.70–97.62%, DSC of 90.92–97.55%, and IoU of 83.41–95.29% in the subregions of two-dimensional (2D) crosssections. Discrepancies in volume and area caused by precision errors did not affect clinical outcomes. Both our AI model and the Dolphin software provided clinically acceptable consistency for pharyngeal airway assessments. ConclusionThe novel DL model not only achieved segmentation of the entire upper airway, including the nasal cavity and subregion identification, but also performed exceptionally well, making it well suited for 3D upper airway assessment from the nasal cavity to the hypopharynx, especially for intricate structures. Clinical significanceThis system provides insights into the aetiology, risk, severity, treatment effect, and prognosis of dentoskeletal deformities and obstructive sleep apnea. It achieves rapid assessment of the entire upper airway and its subregions, making airway management—an integral part of orthodontic treatment, orthognathic surgery, and ENT surgery—easier.

Loss of larger hypoglossal motor neurons in aged Fischer 344 rats

The intrinsic (longitudinal, transversalis and verticalis) and extrinsic (genioglossus, styloglossus, hyoglossus and geniohyoid) tongue muscles are innervated by hypoglossal motor neurons (MNs). Tongue muscle activations occur during many behaviors: maintaining upper airway patency, chewing, swallowing, vocalization, vomiting, coughing, sneezing and grooming/sexual activities. In the tongues of the elderly, reduced oral motor function and strength contribute to increased risk of obstructive sleep apnoea. Tongue muscle atrophy and weakness is also described in rats, yet hypoglossal MN numbers are unknown. In young (6-months, n = 10) and old (24-months, n = 8) female and male Fischer 344 (F344) rats, stereological assessment of hypoglossal MN numbers and surface areas were performed on 16 µm Nissl-stained brainstem cryosections. We observed a robust loss of ∼15 % of hypoglossal MNs and a modest ∼8 % reduction in their surface areas with age. In the larger size tertile of, age-associated loss of hypoglossal MNs approached ∼30 % These findings uncover a potential neurogenic locus of pathology for age-associated tongue dysfunctions.

A hospital based study to assess risk of obstructive sleep apnea in a population visiting dental out patient department

Studies focusing on subjective assessment of risk of obstructive sleep apnea in general population are sparse. The purpose of this cross- sectional study was to assess the risk of obstructive sleep apnea in a population visiting dental Out Patient Department. Three hundred consenting participants between the age group of 18-65yrs reporting to the dental OPD were enrolled in the study. Polysomnography is the gold standard of diagnosis of OSA, however, due to cost and elaborate procedure other methods of diagnosis and risk assessment were used as tools. STOP BANG questionnaire was evaluated for the participants and grouping was done into high, moderate and low-risk OSA patients. Anthropometric patient measurements, including Body Mass Index (BMI), age, neck circumference and gender, were recorded. Blood pressure was assessed by a digital blood pressure instrument to check the systolic and diastolic levels. Data was collected and statistically analyzed. The BMI for males was 24.5±3.9, and for females, it was 24.5±4.6. The mean neck circumference in males was higher (14.4±1.2) compared with females (13.1±1.4). 4.1% of males had a high risk of neck circumference, whereas 3.7% of females had a high risk. 16.1% of males reported hypertensive systole compared with 8.2% of females and 23.9% of males reported hypertensive diastole compared with 18% of females. Risk assessment of OSA based on STOP-BANG scoring revealed that 63.6% of the total study population were at low risk of developing OSA, 32% at high risk and, 4.4% of the study population at very high risk of developing OSA. Males were at higher risk than females. OSA has a high prevalence and a higher tendency to remain underdiagnosed due to a lack of awareness amongst the population as well as dental and healthcare professionals. There can be an essential role of a dentist in identifying the risk factors of OSA and referring those patients to sleep, specialists. In the long run, the dentists' early diagnosis of OSA patients may prevent OSA complications and aid in managing the condition.

The Efficacy of Caudal Anesthesia in Pediatric Surgery

Background: Despite a long history of safety, spinal anesthesia (SA) is still seldom used outside of specialist pediatric institutions and is sometimes debated as a primary anesthetic approach for children. To lessen the risk of postoperative apnea, it is often used on previously preterm newborns who have not yet reached viability (60 weeks post- conception) (GA). There is, however, a wealth of evidence indicating its safety and effectiveness for appropriate operations in adolescents. Objective: The primary purpose of this investigation is to assess the efficacy of Caudal anesthesia pediatric surgery. Method: Tertiary care hospital was the setting for this prospective investigation. 200 children, ages 4 to 10, were included in the research because they were all given different types of anesthesia for infraumbilical or lower extremities surgery during the study's 1-year time frame. The research participants had a thorough preoperative assessment. During the study 50 patients of each were given different anesthesia including Endotracheal intubation, LMA, Caudal block and local anesthesia. Results: Majority was belonged to 4-6 years age group, 70% and 60% were male. Plus, majority of the patients were undergone circumcision, 35% and Herniorrhaphy, 28%. Followed by 20% undergone appendectomy and 5% undergone hypospadias repair. Besides, anesthesia induction and recovery on the operating room table, was lowest in the local anesthesia group (P = 0.015), whereas the results were comparable in the other groups. However, patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit (P < 0.001). In fact, patients who got Caudal block had less complication where only 1% had Convulsions, Bloody puncture and vomiting. Conclusion: Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

Evaluation of pharyngeal airway space after orthodontic extraction treatment in class II malocclusion integrating with the subjective sleep quality assessment

Orthodontic treatment with premolar extractions is typically used to relieve dental crowding and retract anterior teeth for lip profile improvement. The aim of the study is to compare the changes in regional pharyngeal airway space (PAS) after orthodontic treatment with Class II malocclusion and to identify the correlations between questionnaire results and PAS dimensions after orthodontic treatment. In this retrospective cohort study, 79 consecutive patients were divided into normodivergent nonextraction, normodivergent extraction, and hyperdivergent extraction groups. Serial lateral cephalograms were used to evaluate the patients’ PASs and hyoid bone positions. The Pittsburgh Sleep Quality Index and STOP-Bang questionnaire were used for sleep quality evaluation and obstructive sleep apnea (OSA) risk assessment, respectively, after treatment. The greatest airway reduction was observed in hyperdivergent extraction group. However, the changes in PAS and hyoid positions did not differ significantly among three groups. According to questionnaire results, all three groups had high sleep quality and low risk of OSA, with no significant intergroup differences. Moreover, pretreatment-to-posttreatment changes in PAS were not correlated with sleep quality or risk of OSA. Orthodontic retraction with premolar extractions nither exhibit significant reduction in airway dimensions nor increase their risk of OSA.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.

0865 Feasibility of a Disposable Home Sleep Test Device in a Chronic Pain Population Prescribed Opioids

Abstract Introduction Opioids are a common pain treatment in the United States with approximately 143 million prescriptions dispensed in 2020. Long-term opioids for chronic pain increase risk of misuse and overdose. Opioids can also disrupt sleep and cause respiratory depression while poor sleep can exacerbate pain. In-lab polysomnography is the standard for diagnosing sleep disorders. However, polysomnography is less effective for observing patterns over multiple days and is not always representative of at-home sleep. This study investigates the feasibility of using a disposable home sleep test device with adults prescribed opioids for chronic pain and its ability to screen for sleep disorders and overnight oxygenation. Methods Participants were recruited from clinics and public advertisements. Key inclusion criteria were: ≥18 years of age, moderate daily level of pain (≥5 on the 0-10 Numeric Pain Scale [NPS]), prescribed opioids, and internet access. The NightOwl mini disposable home sleep test (Ectosence, Leuven, Belgium) was used to record total sleep time (TST), time in bed (TIB), sleep efficiency (SE), oxygen saturation (SaO2) and apnea-hypopnea index (AHI) for 5 consecutive nights. Results All enrolled participants (N=9) completed 5 days with no missing data. The sample was 66% female with an average age of 60±12 (Mean ± SD). Mean NPS scores indicated moderate pain intensity (6.3±1.9). Participants spent an average of 8.0±1.4h TIB and slept for 5.4+/-1.3h TST resulting in a SE of 68.5±17.9%. On average, AHI was 7.3±7.7 (mild range for sleep apnea). 56% of participants displayed a SaO2 nadir below 88%, the recommended threshold for supplemental oxygen. All individuals agreed that they were at least somewhat satisfied with the ease and amount of time participating in the study. All agreed or strongly agreed that they felt comfortable participating. Conclusion Participants used the disposable sleep test device at home with relative ease as indicted by complete data recording, values within expected norms, and satisfaction survey responses. The device could be an acceptable screening tool for sleep disorders and respiratory events that may otherwise go undetected in this population prescribed opioids and at risk for apnea and respiratory depression. Support (if any) NCATS/NIH # Ul1 TR002319 and The Rayce Rudeen Foundation

0389 Co-sleeping with pets does not worsen insomnia symptoms among US veterans with sleep disorders

Abstract Introduction Little is known about the association of pets and insomnia symptoms among US veterans. The aim of this study was to examine the association between pets sleeping in the bedroom environment and insomnia symptoms in a sleep clinic cohort of US veterans. Methods The sample consisted of US veterans at risk for sleep apnea (SA) evaluated at the Miami VA Sleep Center between 9/2019 and 10/2020. Veterans completed home polysomnography and questionnaires which queried demographics, pet characteristics, insomnia (insomnia severity index [ISI]), and mental health symptoms (PROMIS-29 anxiety and depression). Three linear regression models were constructed evaluating the associations between pet ownership (pet sleeping in bedroom or bed vs no pet) and a) total ISI score, b) nocturnal symptoms only (first 3 ISI items), c) daytime impairment symptoms (last 4 ISI items). Models were adjusted for relevant covariates (age, gender, race, apnea-hypopnea index, depression, anxiety, during or before COVID). Results The sample consisted of 411 veterans (age 51 ±14, BMI 32 ± 6 Kg/m2, 41% black, 87% male). Sixty-seven veterans (16%) reported sleeping with a pet in the bedroom (57% co-sleeping with their pet). Of these, 19% sleep with a cat, 76% sleep with a dog, 6% sleep with both, and 31% sleep with multiple pets. The mean ISI was 18 ± 7 while the mean AHI 21 ±19 events / hour, and 81% of the sample had SA. In adjusted analyses, relative to veterans without pets, sleeping with a pet in the bedroom (outside of the bed) was not associated with any insomnia symptoms. However, co-sleeping with a pet in bed was associated with a lower total ISI (β = -2.1, p = 0.032) and less daytime impairments (β = -1.5, p = 0.016), but co-sleeping with a pet was not associated with nocturnal insomnia symptoms. Conclusion Among veterans with a high prevalence of SA, co-sleeping with pets in bed mitigated daytime impairments and did not worsen nocturnal insomnia symptoms. Further studies are needed to clarify the mechanisms of why co-sleeping with pets may lessen daytime impairments among veterans with SA and insomnia complaints. Support (if any) None

0496 Factors Associated with the Report of Trouble Sleeping to Healthcare Providers in Adults at High Risk for Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is often underdiagnosed and untreated partially because only one-third of adults with symptoms of OSA talk to a healthcare provider (HCP) about their sleep. It is unclear how sociodemographic and clinical factors may influence communication with HCPs regarding sleep difficulties in adults at risk for OSA. This analysis examined associations between sociodemographics, comorbidities, and OSA-related symptoms and reporting trouble sleeping to an HCP in adults at high risk for OSA. Methods The sample comprised adults at high risk for OSA (STOP-Bang of &amp;gt;=5 or STOP &amp;gt;=2 + body mass index (BMI) &amp;gt;35 kg/m2 or male sex) from the 2015-2018 National Health and Nutrition Examination Survey (n=2009). Participants were asked, “Have you ever told a doctor or other health professional that you have trouble sleeping?” OSA-related symptoms included daytime sleepiness, fatigue, insomnia, nocturia, snoring, and snorting/gasping/breathing cessation during sleep. Weighted binomial logistic regression models were employed. Results Participants were middle aged (mean age = 53.21 years + 0.5), obese (mean BMI = 34.76 + 0.25 kg/m2), and primarily male (71.9%) and white (65.2%). Half of the sample (50.8%) never reported trouble sleeping to an HCP. Female sex, former smoking, and diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and/or snorting/gasping/breathing cessation during sleep were associated with higher odds of reporting trouble sleeping to an HCP. Snoring was not a significant predictor. Mexican American and non-Hispanic Asian race, having less than a high school education, and male sex were associated with lower odds of reporting trouble sleeping to an HCP. Conclusion Not reporting trouble sleeping to an HCP among adults at high risk for OSA is common. Differences in sex, race, education, smoking status, comorbidities, and OSA-related symptoms exist between whose who have and have not reported trouble sleeping to an HCP. Insomnia and snorting/gasping/breathing cessation during sleep were the strongest symptom-related factors associated with reporting trouble sleeping to an HCP. It is important for HCPs to ask all adults about sleep problems, recognizing that men, racial minorities, and persons with lower educational attainment may be less likely to initiate a conversation about trouble sleeping. Support (if any) None

0686 High prevalence of sleep apnea in mental disorders – a need for use of sleep evaluation tools in psychiatric health care

Abstract Introduction Sleep apnea is a prevalent disorder but it is frequently overlooked in diagnosing mental disorders. The aim of the present study was to screen for sleep apnea in a group of patients referred for diagnosing mental disorders or non-restorative sleep and to assess the accuracy with which such testing can be replaced with commonly used screening questionnaires for sleep apnea. Methods 104 patients were investigated – 58 with mental disorders (26 with affective disorders, 26 with schizophrenia spectrum disorders, 3 with anxiety disorders, 3 with neurocognitive disorders; mean age 37.5±9.5 years, 24% females, BMI 32.8±6.5 kg/m2) and 46 with non-restorative sleep (mean age 41.2±14.6, 39% females, BMI 26.3±4.8 kg/m2). The patients were screened for sleep apnea with a home sleep apnea test (HSAT) based on peripheral arterial tonometry (PAT) and were asked to fill in the Sleep Apnea Scale from Sleep Disorders Questionnaire (SDQ-SA), the STOP-BANG and the Berlin questionnaires (BQ), and the Epworth Sleepiness Scale (ESS). Results Apnea-Hypopnea Index of &amp;gt; 5/h was found in 57 (55%) patients: 36 (62%) patients with mental disorders and 21 (45%) patients with non-restorative sleep. An increased risk for sleep apnea was found in 45 patients (43.3%) using SDQ-SA, 64 (61.5%) using BQ, 80 (76.9%) patients using STOP-BANG with the cut-off of 3 points and 30 (28.8%) with the cut-off of 5 points. Positive predictive values were: 65.9% for SDQ-SA, 71.0% for BQ, 68.8% for STOP-BANG with the cut-off of 3 point and 75.9% with the cut-off of 5 points. Negative predictive values were 49.1%, 63.0%, 83.3% and 51.4% respectively. Diagnostic accuracy was highest for STOP-BANG with the cut-off of 3 points – 72.3% and lowest for SDQ-SA – 56.6%. Excessive Daytime Sleepiness was found in 44 (42.3%) of patients. Three patients (2.9%) refused or did not complete the HSAT. Conclusion Inclusion of HSAT in the diagnostic process revealed high prevalence of sleep apnea in patients with mental disorders. Psychiatrists should be encouraged to include HSAT in evaluation of patients. Such testing is patient-friendly and using only screening questionnaires does not provide high enough diagnostic accuracy. Support (if any)

0862 Effect of meditation and relaxation on physiological markers of stress and sleep

Abstract Introduction Both breathing based meditation (interoceptive) and relaxation by improving blood circulation using heat and massage (exteroceptive) are known to reduce physiological stress. In this study, we determined the effect of stress-reduction on sleep. Our main population of interest was peri- and post- menopausal women who may develop sleep disorders correlated with early-life physical abuse. Methods 20 adults (15 peri- and post-menopausal females), 13 with high risk of sleep apnea (determined by Berlin questionnaire, age mean±SEM, 54±3 years, waist-by-neck 2.6±0.07, BMI 26±1 kg/m2, Insomnia Severity Index (ISI) Scale 5.71±1.23, Generalized Anxiety (GAD-7) Score 5.33±1.22, Early Trauma Inventory Self-Report Short Form (ETISR-SF)physical 3±0.17. Dreem3 headband was used to get breathing rate (BR), sleep efficiency, sleep staging. Plethysmography was used to obtain mean and nadir oxygen saturation %, heart rate (HR), oxygen desaturation (4%) event index (ODI). BMI, age, waist/neck were recorded. Baseline sleep measures were compared against sleep after administration of 10 minutes rest, 10 minutes relaxation and 10 minutes of Ujjayi pranayama with repeats of 4 in-, 4 hold-, 6 out- breaths. ETISR-physical was correlated with all measures. Paired t-tests were conducted on sleep measures at baseline and after meditation/relaxation. One-sample t-tests were conducted on average % changes during meditation/relaxation compared to rest. Results Early-life physical trauma correlated positively with BR during REM sleep (Pearson R= 0.68). Deep sleep significantly (p=0.04) increased by 5% on the sleep after meditation/relaxation. Both meditation and relaxation techniques significantly (p&amp;lt; 0.01) lowered HR by 1.5% and 4.5%, and BR by 20% and 15% respectively during Ujjayi pranayama and relaxation. We observed significant increase (p&amp;lt; 0.05) in oxygen saturation with the Ujjayi pranayama by 0.3%. Conclusion Early-life physical abuse was correlated with faster breathing during REM sleep validating existing literature. Both HR and BR were reduced during meditation and relaxation techniques, thus validating their stress-reduction effects. % of deep sleep improved on the night when meditation/relaxation session was administered. Mind-body practices could improve deep sleep if practiced regularly even in peri- and post-menopausal women having early-life physical abuse trauma. Support (if any) Sleep Research Society (SRS) Small Research Grant 2022.

0690 People without any sleep complaints achieve results that exceed the cut-off thresholds in standardized sleep assessment

Abstract Introduction With increasing prevalence of sleep problems in the general population, a question arises on whether standardized clinical sleep assessment shows results exceeding the cut-off thresholds in healthy subjects who do not report any sleep complaint. The aim of this ongoing study is to assess a sample of healthy subjects who report good sleep quality, for each gender in age groups 18-30, 31-40, 41-50, 51-60, 61-75 years old. Methods Up to now 70 healthy subjects have taken part in the project (38 females, 32 males, mean age 39.5 ±12.5, median 37 years). Assessment of sleep, and mental health related symptoms was performed using actigraphy, sleep diaries and clinical ratings scales: the Insomnia Severity Index (ISI), Epworth Sleepiness Scale(ESS), Morningness Eveningness Questionnaire(MEQ), Ford Insomnia Response to Stress Test (FIRST), International Physical Activity Questionnaire (IPAQ), STOP-Bang Questionnaire, Sheehan Disability Scale (SDS), Quick Inventory of Depressive Symptoms (QIDS-16SR), Generalized Anxiety Disorders Scale (GAD7), World Health Organization Quality of Life Scale (WHOQOL-BREF). Results In ISI scale 20 subjects (28,6%) reported mild and 2 subject (2,8%) moderate insomnia symptoms. In ESS 7 subjects (10.0%) were found to have mild, 5 (7,1%) moderate and 3 (4,3%) severe excessive daytime sleepiness. Anxiety symptoms reported 15 (21,4%) subjects and depressive symptoms 18 (22,9%) subjects. Moderate for risk for sleep apnea was found in 9 (12,8%) and high in one (1,4%) subject. In sleep diaries sleep latency above 30 minutes was found in 4 (5,6%) subjects, WASO above 30 minutes in 7 (10.0%) subjects, total sleep time below 6,5 hours in 22 (31,4%) subjects. Average time in bed was 474 ±55 minutes and average sleep efficiency 86,8 ±7,5%. ISI correlated with FIRST (r=0.496, p&amp;lt; 0.001), GAD-7 (r=0.445, p&amp;lt; 0,001), QIDS-SR16 (r=0,483, p&amp;lt; 0.001), sleep latency (r=0,313, p&amp;lt; 0,05), WASO (r=0,270, p&amp;lt; 0,05). ESS corelated with FIRST (r=0.316, p&amp;lt; 0,01), GAD-7 (r=0,275, p&amp;lt; 0,05). Conclusion Substantial proportion of subjects from the general population who did not initially report any sleep complaints obtained results exceeding suggested threshold in standard clinical scale and sleep parameters below normal valse in sleep diaries. Poor sleep indices are most related to scales measuring stress, anxiety and depressive symptoms. Support (if any)

0796 Safety and efficacy of the combination of atomoxetine and oxybutynin for OSA treatment in children with Down Syndrome

Abstract Introduction Children with Down syndrome (DS) are at very high risk for obstructive sleep apnea (OSA), with a prevalence of OSA of 50-79%. Current OSA treatments for children with DS have limited effectiveness, as positive airway pressure therapy is poorly tolerated and adenotonsillectomy is not curative in most children with DS. The combination of atomoxetine and oxybutynin (ato-oxy) is a promising OSA treatment in adults. Ato-oxy has been shown to improve upper airway hypotonia, a key feature of OSA in children with DS, thus it may be particularly effective for OSA in children with DS. Methods We performed a randomized, double-blind, crossover pilot trial examining the short-term efficacy of ato-oxy in 15 children aged 6 to 17 years with DS and OSA. Participants received 4 weeks of low dose (0.5 mg/kg atomoxetine and 5 mg oxybutynin) as well as 4 weeks of high dose (1.2 mg/kg atomoxetine and 5 mg oxybutynin) in random order. Participants underwent polysomnography as well as parent-reported health-related quality of life assessment using the OSA-18 at baseline and at the end of each dosing period. The primary study endpoint was reduction in obstructive apnea-hypopnea index (oAHI) from baseline. Paired t-tests were used to compare baseline to low and high dose ato-oxy. Results 15 participants qualified for randomization and 11 participants had complete data at all points. Baseline oAHI was 7.4 ± 3.7 (mean ± standard deviation), oAHI with low dose ato-oxy was 3.6 ± 3.3 (p=0.001 vs baseline) and oAHI with high dose ato-oxy was 3.9 ± 2.8 (p=0.003 vs baseline). There were no differences in sleep architecture or sleep efficiency between baseline and either dose of ato-oxy. OSA-18 total score was 51.5 ± 18.5 at baseline; improved to 44.6 ± 17.0 (p=0.09) at the end of 4-weeks of low dose ato-oxy; and improved to 45.5 ± 15.7 (p=0.37) at the end of high-dose ato-oxy therapy. The most common adverse effects were irritability and fatigue, and these were generally mild. Conclusion Ato-oxy is a promising treatment for OSA in children with DS. Support (if any) Funding provided by NIH (HL151254 and HD109777) as well as the Lumind-IDSC foundation.

0289 A PICTURE ON THE SLEEP OF THE PORTUGUESE HEALTH SYSTEM: PRELIMINARY FINDINGS OF A WORK IN PROGRESS

Abstract Introduction Sleep difficulties are commonly referred by health care workers that can affect quality of life and productivity, both in patients and healthy individuals. This study firstly aimed to evaluate sleep quality in distinct groups of health care workers as well as the impact of shift work and health related habits on the sleep of such professionals. Methods This prospective, cross sectional, observational study involved health care workers (Physicians, Residents, Nurse Staff, Psychologists and Therapeutic and Diagnostic Technicians - TDT) from the Portuguese Health System (public or private) aged from 25 and 65 years old. A General Health Survey was followed by Standard validated sleep questionnaires for assessment of sleep quality (Pittsburgh Sleep Quality Index - PSQI), insomnia (Insomnia Severity Index - ISI), risk of obstructive sleep apnea (STOP-BANG), and excessive daytime sleepiness (Epworth Sleepiness Scale - ESS). Results From the pretended pool of 425 health care workers to whom questionnaires where sent, 160 (131: 81.9% females) responded (37.7% of response rate). From those, 30% of those professionals were Residents, 30.6% were TDT, 21.9% Physicians, 10.6% Nurses, and 6.9% Psychologists. 46.5% assumed itself with a morning-type profile whereas 39.5% were intermedium and 14% evening-type persons. From the global sample, 62.5% had poor sleep quality with 37.5% in the insomnia threshold whereas 14.4% presented with either moderate or severe forms of insomnia. Regarding the risk for sleep disordered breathing, 6.5% where at high risk for Obstructive Sleep Apnea - OSA, and 15.6% complained from mild to moderately forms of excessive sleepiness (ESS&amp;gt;10). In this sample, psychologists achieved the better sleep quality scores while nurses had the poorest scores for the same parameter. Conclusion This preliminary findings on the sleep of the portuguese health care workers, suggest that such professionals experience a poor sleep quality in general with a prevalence of major sleep disorders similar to the general population. Although the majority seemed to denie a significant degree of daytime sleepiness, those within a shift work regimen are likely to perform worse. Support (if any)

0266 An mHealth intervention to deliver personalized messages to increase adherence to OSA care among transportation workers

Abstract Introduction Transportation workers are at risk for obstructive sleep apnea (OSA), yet OSA is commonly undiagnosed in this population. In a two-phase study, we design and evaluate a tailored, mobile health (mHealth) intervention aimed at achieving OSA awareness, including changes in OSA beliefs, among operators of large highway maintenance vehicles. Methods In Phase 1, we recruited highway maintenance vehicle operators employed at worksites in the US northeast for focus groups to examine OSA beliefs and barriers. Results of the Phase 1 focus groups were used to inform the tailored intervention. In Phase 2, we evaluated the tailored approach, “Sleep Strong, Live Long,” in a mini-RCT. Worksites were randomized to intervention (Sleep Strong, Live Long) or control. Employees at both worksites completed baseline questionnaires and follow-up questionnaires 2-months post-baseline. Employees at the intervention worksite received a 30 minute in-person education session, access to an interactive website including video success stories, then follow-up text messages over 2 months as part of the Sleep Strong, Live Long program. The control condition received the intervention after completing follow-up surveys. We compared responses on the follow-up surveys between intervention and control conditions using linear regression with baseline responses as covariates. Results Phase 1 themes included common sleep complaints, inconsistent work schedules, and misconceptions about OSA (n=45). 75% of Phase 1 participants reported resistance to OSA behavior change. Phase 2 mini-RCT participants (n= 38) were on average 43.4 (sd=12.1) years old. Participants were 86.8% male and 67.6% reported an annual household income of $50,000 or more. Exposure to the intervention was associated with an improvement in OSA literacy (b=0.14, p=0.037), but not OSA self-efficacy (b=0.12, p=0.330) or OSA readiness to change (b=0.76, p=0.336). Conclusion We provide preliminary support for improving OSA literacy among a sample of transportation workers. Future research may evaluate the tailored program in a larger sample of workers and with a longer follow-up period to consider whether OSA literacy and self-efficacy mediate actual OSA behaviors, such as changes in OSA evaluation and treatment. Support (if any) This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH, Grant # K01HL150339).

0797 Correlation between Obstructive Sleep Apnea and Echocardiography Parameters in Infants and Preschool Children with Down Syndrome

Abstract Introduction Down syndrome (DS) is one of the most common genetic disorders caused by the Trisomy of chromosome 21. Children with DS secondary to the unique airway anatomy and hypotonia, are at risk for obstructive sleep apnea (OSA). Untreated OSA in children can lead to serious complications because of chronic hypoxia leading to Pulmonary hypertension (PHTN) and Cor pulmonale. An overnight polysomnogram (PSG), the gold standard for diagnosing OSA in children, should be performed within 4 years per American Academy of Pediatrics recommendations. However, OSA in DS has been observed at a much younger age. Methods In this single-center retrospective study, data was collected by reviewing the medical records and PSG REDCap database from 2019-2021. Patients with ICD code 10 diagnosis of DS between 0 to 4 years of age who underwent PSG and echocardiography were included. Our primary aim was to assess the severity of OSA in preschool children and describe echocardiogram parameters in DS patients with OSA. We hypothesized that there will be differences in polysomnogram parameters of DS children with and without PHTN. Results 61 patients met the criteria for the study with the mean age being 11.3 months. 3 patients (5.4%) did not have OSA (apnea hypopnea index (AHI)&amp;lt; 1/hr), 11 patients (19.6%) had mild OSA (AHI 1-4.9/hr), 12 patients (21.4%) had moderate OSA (AHI 5-10/hr), 30 patients had severe OSA (AHI &amp;gt;10/hr). Five patients with missing AHI values were excluded for subsequent analyses. Echocardiogram parameters were compared using the described AHI cut offs to define severity of OSA. OSA was observed to be significantly higher in the group with elevated RV systolic pressure. Conclusion Although our study did not find any difference in PSG findings in young children with DS with and without PHTN, obstructive apnea index was significantly elevated in young children with elevated RV systolic pressure. OSA is a significant contributor to the development of PHTN in children with DS. Children with DS are at higher risk for PHTN due to their unique pulmonary vasculature. As PHTN is a significant comorbidity of DS, it is important to perform PSGs early during childhood to detect and treat OSA. Support (if any)

0666 Need a novel method to reduce anger after combat? Treat sleep apnea

Abstract Introduction Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. Methods The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1,263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Results Multiple regression model results revealed that PTSD symptoms (β = 0.517, p &amp;lt; .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p &amp;lt; .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for associations between PTSD and pain interference with anger. Conclusion Treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Support (if any) This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC and with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED