Sleep Disorders Center Research Articles

Tracking continuous positive airway pressure adherence in obstructive sleep apnea patients before, during, and after the COVID-19 lockdown

Abstract: BACKGROUND: This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence. METHODS: A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using “mask-on on-time monitoring” data from the CPAP machines. RESULTS: The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence. CONCLUSION: The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.

Co-morbid Insomnia and Sleep Apnea (COMISA) in a large sample of Iranian: prevalence and associations in a sleep clinic population.

Sleep apnea (SA) and insomnia (INS) are prevalent sleep disorders among referrals to sleep clinics. People with comorbid insomnia and sleep apnea (COMISA) suffer both disorders simultaneously. The epidemiology of COMISA is not well known in the Middle East including Iran. We hypothesized that COMISA is prevalent in metropolitan sleep clinic cohorts in Iran. The records of patients aged < 95 years referred to sleep disorders centers in four large metropolitan areas including Kermanshah, Tabriz, Shiraz, and Ahvaz were examined. Polysomnography (PSG) was performed in all these patients in specialized centers and the results were scored by a trained technician and interpreted by a sleep specialist. SA was defined as an Apnea-Hypopnea Index (AHI ≥ 5), INS was defined by psychiatrists according to self-report and clinical interviews, and COMISA was defined if both disorders were present. Participants with neither condition were included in as comparator group. One-way ANOVAs, correlation, and linear/logistic regression analyses were used. This study included 1807 patients (Mean age 49.3, SE ± 13.7; 38.8% Female). Comparator, INS, SA and COMISA made up 7.2%, 16%, 50.2% and 26.6% of the sample, respectively. Logistic regression analyses showed that male gender, older age, and increasing neck circumference, but not BMI, were associated with COMISA. Epworth Sleepiness Scale scores were lower in INS (5.39 ± 5.78) compared to the other three groups. COMISA is a prevalent condition in metropolitan sleep centers in Iran among participants referred to sleep centers. The data showed that male gender and age were associated significantly with COMISA.

The relationship between obstructive sleep apnea syndrome severity and vitamin D levels in sera

Aims: Obstructive Sleep Apnea Syndrome (OSAS) is a disorder characterized by complete or partial upper airway obstruction episodes and frequently decreased arterial oxygen saturation. Etiological factors and risk factors of OSAS are still investigated and studies in this topic continue. Until recently, researches were focused on the major effects of vitamin D on the bone metabolism and calcium homeostasis. Today; it has been found that vitamin D plays roles in many cells and tissues of human body additional to its functions in the musculoskeletal system. In our study, we aimed to examine vitamin D levels in patients who are diagnosed as OSAS and to investigate the relationship between OSAS and vitamin D deficiency. Methods: 83 volunteers, who were suspected to have OSAS, were included in the study. They all underwent polysomnography (PSG) in the Sleep Disorders Center in Pulmonary Department, between January 2015 – May 2015. Twenty cases with apnea hypopnea index (AHİ) &lt; 5/hour were evaluated as simple snoring/control group. Cases with AHİ &gt; 5/hour were diagnosed as OSAS; 22 patients were diagnosed as mild, 20 patients were diagnosed as moderate and 21 patients were diagnosed as severe OSAS. Blood samples of these patients were studied for the measurement of vitamin D [25(OH)D3], parathormone (PTH) , calcium (Ca), phosphor (P) levels and the samples were quickly delivered to biochemistry laboratory Results: A statistically significant difference in vitamin D levels were observed (p&lt;0.05) between the control and OSAS groups. However, no statistically significant difference was found in PTH, Ca, P levels among these groups (p&gt;0.05). Vitamin D levels in the control group were significantly higher than the mild and the severe OSAS patients. No statistically significant difference was observed in PTH, Ca, P levels between these patients. Conclusion: Our study indicates that there is a significant relationship between vitamin D deficiency and OSAS. This finding suggests that vitamin D deficiency may play a role in the OSAS physiopathology. There are few studies exists about the association between vitamin D deficiency and OSAS. In this regard, we think our study will contribute to the literature. Moreover; prospective, randomized, controlled studies with large series were needed.

Are Depressive Symptoms in Obstructive Sleep Apnea Attributable to a Syndrome of Dysregulation of Rhythms and Hyperactivity (DYMERS)?

Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea-hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari's sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS).

Digital cognitive–behavioural therapy application compared with zolpidem for the treatment of insomnia: protocol for an exploratory randomised controlled trial

IntroductionInsomnia is a common health problem and cognitive–behavioural therapy (CBT) is recommended as a treatment. As there is a critical shortage of CBT-trained therapists, we developed a digital CBT application...

The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control. Fifty diabeticand 42 non-diabetic patientsdiagnosed with OSAS at the Sleep Disorders Center ofSüreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated. No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity. The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients.

Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM10) and particulate matter with a diameter of less than 2.5 microns (PM2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM10 and PM2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM10, PM2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA). We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients' electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM10 and PM2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors. There was no effect of an increase in PM10 and PM2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM10 and PM2.5, respectively]. There was no effect of particulate matter on CPAP adherence in OSA patients.

Single sessions of transcranial direct current stimulation and transcranial random noise stimulation exert no effect on sleepiness in patients with narcolepsy and idiopathic hypersomnia.

Hypersomnia poses major challenges to treatment providers given the limitations of available treatment options. In this context, the application of non-invasive brain stimulation techniques such as transcranial electrical stimulation (tES) may open up new avenues to effective treatment. Preliminary evidence suggests both acute and longer-lasting positive effects of transcranial direct current stimulation (tDCS) on vigilance and sleepiness in hypersomniac patients. Based on these findings, the present study sought to investigate short-term effects of single sessions of tDCS and transcranial random noise stimulation (tRNS) on sleepiness in persons suffering from hypersomnia. A sample of 29 patients suffering from narcolepsy or idiopathic hypersomnia (IH) was recruited from the Regensburg Sleep Disorder Center and underwent single sessions of tES (anodal tDCS, tRNS, sham) over the left and right dorsolateral prefrontal cortex on three consecutive days in a double-blind, sham-controlled, pseudorandomized crossover trial. The primary study endpoint was the mean reaction time measured by the Psychomotor Vigilance Task (PVT) before and directly after the daily tES sessions. Secondary endpoints were additional PVT outcome metrics as well as subjective outcome parameters (e.g., Karolinska Sleepiness Scale; KSS). There were no significant treatment effects neither on objective (i.e., PVT) nor on subjective indicators of sleepiness. We could not demonstrate any clinically relevant effects of single sessions of tDCS or tRNS on objective or subjective measures of sleepiness in patients with hypersomnia. However, we cannot exclude that repeated sessions of tES may affect vigilance or sleepiness in hypersomniac patients.

Fine particulate matter and sleep-disordered breathing severity in a large Italian cohort.

Air pollution and obstructive sleep apnea (OSA) are both linked with cardiovascular co-morbidities and share similar pathophysiological mechanisms. A causal association between the two has been postulated. However, the results of the studies on this topic are conflicting mainly because of the lack of adjustment for important confounders such as seasonality and temperature. We aimed to evaluate if such an association exists in a highly polluted area like Lombardy region (Italy) when accounting for all confounders. Data of adult patients seen at the Sleep Disorder Centre in Milan from 2010 to 2020 were analysed and the main polygraphic data were retrieved. Air pollutant concentrations of the following pollutants NO2, O3, PM2.5, and PM10 were collected through monitoring stations. A total of 3493 patients were included: males (2358, 67.5%) mean age 60.1 (SD = 14.3) years, BMI 29.2 (6.2) kg/m2, mean AHI 16.5 (18.1) events/h. After adjusting for all confounders, in the multivariable analysis, the only associations that remained significant were long-term exposure to O3 with indexes of OSA severity (AHI and ODI) but only in spring. Furthermore, a positive association was seen between long-term exposure to PM10 and ODI but in springtime only. The findings of the current study does not support an association between fine particulate matter and OSA severity.

Factors influencing continuous positive airway pressure adherence in elderly with obstructive sleep apnea.

Continuous positive airway pressure (CPAP) is the most effective treatment for symptomatic obstructive sleep apnea (OSA). The identification of actual predictors of CPAP adherence in real-world practice is essential since it enhances more individualized management for the patient. CPAP acceptance and adherence in elderly patients with OSA have the same challenges but the conclusion remains unclear. Therefore, our aim was to explore the factors influencing the adherence of CPAP in elderly OSA patients. The retrospective observational study was conducted from OSA patients' computerized medical records at Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University Hospital, Chiang Mai, Thailand between 2018 and 2020. Multivariable risk regression analyses were performed to evaluate the independent factors associated with CPAP non-acceptance and CPAP non-adherence. Of the 1,070 patients who underwent overnight polysomnography (PSG), 336 (31.4%) were elderly. Of 759 patients who accepted CPAP treatment, 221 (29.1%) were elderly, including 27 (12.2%) non-adherences, 139 (62.9%) adherences and 55 (24.8%) loss follow-up. Elderly patients with adverse attitudes toward CPAP use affected adherence to treatment [adjusted risk ratio (RR) =4.59, 95% CI: 1.79, 11.78, P=0.002]. Female was also associated with low CPAP adherence with adjusted RR =3.10 (95% CI: 1.07, 9.01), P=0.037. In our largest cohort to date, elderly OSA patients treated with CPAP over long-term follow-ups demonstrated that adherence rates were associated with personal life issues and adverse attitudes towards treatment as well as health problems. Female was also associated with low CPAP adherence. Therefore, in the elderly with OSA, the indication and treatment of CPAP should be customized individually, and if prescribed, regular monitoring to address noncompliance and tolerance should be considered.

0582 Polysomnography Parameters Predict Mean Sleep Latency Test Results Using Machine Learning

Abstract Introduction The mean sleep latency test (MSLT) objectively measures mean sleep latency (MSL) and sleep onset during REM periods (SOREMPs) in the absence of external alerting factors used for diagnoses of central hypersomnolence disorders. Polysomnography (PSG) is routinely performed the night before an MSLT. We explored the use of PSG variables at the individual level to predict MSL and SOREMPs assisted by machine learning methods. Methods 802 PSG/MSLTs from 796 patients (75% female, age 34 years[SD:12.1], BMI 27.9[SD:7.6], ESS 13.9[SD:4.9]) performed at Cleveland Clinic Sleep Disorder Center from 2012 to 2022 were included. We used 5-fold cross-validation experimental settings where five types of machine learning models (logistic regression, support vector machine, multilayer perceptron, random forest, XGBoost) were trained for two separated binary classification tasks: predict MSL&amp;lt; 8 minutes (343 out of 802) and SOREMP&amp;gt;=2 (234 out of 802). Within each fold, we performed a feature selection analysis on the training set in 39 PSG and demographic variables based on Analysis of Variance (ANOVA) with p &amp;lt; 0.05. A random search approach with 1000 combinations was used for machine learning hyperparameter tuning. The area under the ROC (AUC-ROC) score was used to rank the methods based on the test set of each fold (mean+SD). We retrained the best machine learning configuration in a new single train/test (80%/20%) split to evaluate the top 5 features that were more relevant to the best model by computing their Shapley Additive Explanations values (SHAP). Results XGBoost had the best average AUC-ROC for predicting MSL of 0.71 + 0.04. Its most important features out of 14 selected were total recording time, percentage of sleep time, total wake time after sleep onset, non-supine sleep time, and sleep efficiency. Random forest was the best for SOREMP prediction with AUC-ROC of 0.75 + 0.05, and the most important features were REM latency, age, and Epworth Sleepiness Scale score, percentage of time on REM, minimum oxygen saturation, out of 13 selected. Conclusion PSG the night prior to MSLT provides predictive information that can be leveraged to anticipate MSLT results on the individual level. This work provides the foundation to better identify patients with central hypersomnolence disorders. Support (if any)

0260 Establishment of a polysomnography databank for sleep disorders in Japan

Abstract Introduction Polysomnography (PSG) has been suggested to be useful as an objective indicator (biomarker) that contributes to the diagnosis and severity evaluation of various sleep disorders. However, its regular use is still limited to the specialized institutions for sleep disorders. Therefore, PSG is essential for clinical diagnosis of only some sleep disorders, and further application of PSG in conjunction with biomarker development of disorders including such as insomnia, and psychiatric disorders with comorbid sleep disorders is expected. The aim of this project is to establish a PSG databank for sleep disorders in collaboration with major PSG laboratories in Japan. Methods This project is collaborated with medical and research institutions that conduct PSG on a large scale in Japan. The National Center of Neurology and Psychiatry (NCNP) serves as the core institution. The initial collaborating institution is the Tokyo Medical University, which is in cooperation with the Yoyogi Sleep Disorder Center, the largest PSG facility in the Kanto region. We also collaborate with three other core PSG facilities in the Kanto, Tohoku and Kyushu regions: the Nihon University, the Akita University (in cooperation with the Akita Sleep Clinic), and the Kurume University. This project has been approved by the Ethics Committee of the NCNP. Results We have stored about 3,000 PSG data evaluated by the standard of the American Academy of Sleep Medicine clinical practice guideline or the traditional Rechtschaffen &amp; Kales standard with adjunct clinical metadata for the past 9 years at the NCNP, about 17,900 at the Tokyo Medical University, about 1,900 at the Nihon University, about 500 at the Akita University, and about 3,000 at the Kurume University. We are continuously collecting and banking data for enhancing research availability of the PSG databank for sleep disorders. Conclusion The collected data will be used for research on the development of objective indices for sleep disorders or neuropsychiatric disorders, for which objective indices are lacking in diagnosis and pathological evaluation. Support (if any) This work was supported by the Intramural Research Grant (#2-1) for Neurological and Psychiatric Disorders of NCNP.

1045 Resolution of Sexsomnia with Positive Airway Pressure

Abstract Introduction Sexsomnia is an infrequently encountered non-rapid eye movement (NREM) arousal disorder that can overlap with obstructive sleep apnea (OSA). Treatment of underlying OSA has been reported to resolve sexsomnia episodes. Report of case(s) A 26-year-old overweight man was referred to our Sleep Disorders Center for evaluation of possible “REM sleep behavior disorder.” The patient’s wife reported that he would fondle her breasts while he slept. Episodes began 6 months prior to his referral and occurred once every 1-2 months. During episodes, the patient did not get out of bed. He did not recall the events and denied dream recall. The patient had an infant at home with resultant sleep deprivation. He slept between 5-7 hours a night and stated episodes were more common with decreased total sleep time. Additionally, he reported recent increase in stressors after moving in with his in-laws. On evaluation, patient endorsed bruxism for which he wore a mouth guard. He reported history of sleepwalking in elementary school. He denied excessive daytime sleepiness, snoring, witnessed apneas, gasping arousals, morning headaches, unrefreshing sleep, insomnia, or substance use. He was advised to increase total sleep time and pursue a baseline polysomnogram to evaluate for sleep-disordered breathing. The polysomnogram demonstrated moderate OSA (apnea/hypopnea index of 17). Excessive arousals out of N3 sleep were not reported. He was initiated on auto-titrating positive airway pressure (APAP) and maintained moderate adherence for 2 months. At his follow-up visit, he reported no further episodes of nocturnal fondling after PAP initiation despite persistent sleep deprivation and home stressors. Conclusion This case highlights the importance of screening for sleep-disordered breathing which can coexist with NREM parasomnias such as sexsomnia. Even in patients without clear symptoms of sleep-disordered breathing, the evaluation, diagnosis, and treatment of possible OSA could decrease the frequency of sexsomnia episodes. Although this case study was mainly limited by short follow-up duration, the patient’s resolution of sexsomnia in that time demonstrates the importance of treatment of concurrent sleep-related breathing disorders. Support (if any) None.

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

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

Exploring the Potential of Pulse Transit Time as a Biomarker for Sleep Efficiency through a Comparison Analysis with Heart Rate and Heart Rate Variability.

The relationship between sleep dynamics and blood pressure (BP) changes is well established. Moreover, sleep efficiency and wakefulness during sleep (WASO) events have a significant impact on BP dipping. Despite this knowledge, there is limited research on the measurement of sleep dynamics and continuous blood pressure (CBP). This study aims to explore the relationship between sleep efficiency and cardiovascular function indicators such as pulse transit time (PTT), as a biomarker of CBP, and heart rate variability (HRV), measured using wearable sensors. The results of the study conducted on 20 participants at the UConn Health Sleep Disorders Center suggest a strong linear relationship between sleep efficiency and changes in PTT (r2 = 0.8515) and HRV during sleep (r2 = 5886). The findings of this study contribute to our understanding of the relationship between sleep dynamics, CBP, and cardiovascular health.

0898 Title: Test - Retest Reliability of the Multiple Sleep Latency Test in Non-cataplectic Central Hypersomnia Disorders

Abstract Introduction Differentiation of narcolepsy type II (NT2) and idiopathic hypersomnia (IH) is challenging in clinical practice. Diagnostic criteria rely on the multiple sleep latency test (MSLT), previously shown to have poor reproducibility in these disorders. We leveraged a large polysomnographic database to study test-retest reliability in non-cataplectic central hypersomnia disorders. Methods Patients evaluated at Cleveland Clinic Sleep Disorders Center from 2008-2021 with suspected central hypersomnia disorders excluding narcolepsy type I with &amp;gt;1 PSG/MSLT were included. Studies not meeting validity criteria (&amp;lt; 7hr sleep time on PSG, &amp;lt; 5 MSLT trials, use of REM suppressants/alerting medications within 14 days) were excluded. Diagnostic groupings included NT2, IH and Normal/Indeterminate based on ICSD-3. Reliability and correlation between tests was performed using intra-class and Spearman’s correlations, respectively. Data is presented as mean+SD or median [25th,75th percentiles] for continuous variables and N(%) for categorical variables. Results A total of 58 patients (62.1% female, age 31.9 yr [18.5, 48.6]) were included. Interval between MSLTs was 3.6 + 3.18 yr (same diagnosis on both tests: 3.24 + 3.15; changed diagnosis: 3.98 + 3.22). Diagnosis based on MSLT 1 was NT2 8(13.8%), IH 20(34.5%) and Normal/Indeterminate 30(51.7%). Overall, 33(56.9%) patients remained in the same diagnostic category including 3(5.2%) NT2, 12(20.7%) IH and 18(31.0 %) Normal/Indeterminate. Of 25(43.1%) cases changing diagnosis, 3(5.2%) changed from NT2 to IH and 2(3.4%) to Normal/Indeterminate; 4(6.9%) changed from IH to NT2 and 4(6.9%) to Normal/Indeterminate; 5(8.6%) changed from Normal/Indeterminate to NT2 and 7(12.1%) to IH. Median MSL on tests 1 and 2 were 10.8 [4.6,12.9] and 9.0 [4.5,13.1], respectively. Correlation was moderate MSL [0.59 (0.39, 0.73), p&amp;lt; 0.001] and fair for SOREMPs [0.32 (0.07, 0.53), p=0.015]. Intra-class correlation showed moderate reliability in test-retest for MSL [0.56 (0.36, 0.72)] and SOREMPs [0.54 (0.33, 0.70)]. Conclusion MSLT test-retest reproducibility in non-cataplectic central hypersomnias was moderate in a tertiary care clinic population. While more favorable than prior studies, these findings underscore diagnostic challenges that may contribute to misdiagnosis of patients with hypersomnia. Support (if any)

Investigation of spatial pattern of apnea disorder using geographic information system (GIS)-case study of Kermanshah metropolis.

Apnea disorder is influenced by social and environmental factors. By assessing its hot spots and geography, the foci of this disorder and its at-risk groups can be identified for health interventions. This study was conducted to investigate the spatial pattern of apnea disorder using GIS in the Kermanshah metropolis. In cross-sectional study was conducted in kermanshah, the statistical population were 119 people (73.95% male and 26.05% female) of Kermanshah residents, which referred to the sleep center from 2012 to 2018 due to apnea disorder. Information was collected from the records of patients referred to the Sleep Disorder Center of Farabi Hospital, which is the only service center in the west part of Iran. The statistical tests were the mean center, standard distance, Getis-Ord Gi * index, nearest neighbor index, and kernel density estimation test in GIS software. The spatial pattern of patients with apnea disorder has cluster formation in the Kermanshah metropolis. The age group of 50-54 had more apnea disorder than other age groups. In this age group, women were more prone to apnea than men. In terms of education, people with high education are more affected by this disorder; So that with the increase in education level, apnea disorder had also increased. Also, the findings showed that the disorder was more common in unemployed, married, overweight people with BMI (25-30), and obese people (30-40). The spatial pattern of patients with apnea disorder was clustered and does not correspond to the high population density centers located in the marginal and slum areas of the city. These can be used by stakeholders, including governmental organizations and health authorities at the national-regional level.

Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation.

The major goal of the study was to determine whether changes in tongue morphology under selective hypoglossal nerve therapy for obstructive sleep apnea were associated with alterations in airway patency during sleep when specific portions of the hypoglossal nerve were stimulated. This case series was conducted at the Johns Hopkins Sleep Disorders Center at Johns Hopkins Bayview Medical Center. Twelve patients with apnea implanted with a multichannel targeted hypoglossal nerve-stimulating system underwent midsagittal ultrasound tongue imaging during wakefulness. Changes in tongue shape were characterized by measuring the vertical height and polar dimensions between tongue surface and genioglossi origin in the mandible. Changes in patency were characterized by comparing airflow responses between stimulated and adjacent unstimulated breaths during non-rapid eye movement sleep. Two distinct morphologic responses were observed. Anterior tongue base and hyoid-bone movement (5.4 [0.4] to 4.1 [1.0] cm (median and [interquartile range]) with concomitant increases in tongue height (5.0 [0.9] to 5.6 [0.7] cm) were associated with decreases in airflow during stimulation. In contrast, comparable anterior hyoid movement (tongue protrusion from 5.8 [0.5] to 4.5 [0.9] cm) without significant increases in height (5.2 [1.6] to 4.6 [0.8] cm) were associated with marked increases in airflow during sleep. Tongue protrusion with preservation of tongue shape predicted increases in patency, whereas anterior movement with concomitant increases in height were associated with decreased pharyngeal patency. These findings suggest that pharyngeal patency can be best stabilized by stimulating lingual muscles that maintain tongue shape while protruding the tongue, thereby preventing it from prolapsing posteriorly during sleep. Fleury Curado T, Pham L, Otvos T, etal. Changes in tongue morphology predict responses in pharyngeal patency to selective hypoglossal nerve stimulation. J Clin Sleep Med. 2023;19(5):947-955.

The effect of a change from face-to-face to remote positive airway pressure education for patients with sleep apnoea during the coronavirus disease-2019 pandemic: a prospective cohort study.

The coronavirus disease-2019 (COVID-19) pandemic and national lockdowns necessitated a change in service delivery including positive airway pressure (PAP) education protocols, with no data on how this may impact subsequent PAP adherence. We aim to quantify adherence of PAP initiated during the COVID-19 pandemic and compare the effects of remote versus face-to-face (FTF) education in patients with obstructive sleep apnoea (OSA). This prospective cohort study in a tertiary National Health Service (NHS) hospital sleep disorders centre in London, United Kingdom, included 141 patients aged >18 years with newly diagnosed OSA initiating PAP during the COVID-19 pandemic; 71 patients receiving standard FTF education compared to 70 patients educated on PAP remotely at the start of lockdown. Adherence over a consecutive 30-day period within the first three months of PAP usage was measured, secondary outcomes included average nightly usage, usage per nights used, percentage of nights used, and percentage of nights used for ≥4 hours. In 141 patients (two-thirds male, 56% of at least 45 years of age and 48.9% sleepy at baseline), 114 patients (81%) were diagnosed with moderate or severe OSA. 54 patients (38.3%) achieved good adherence (≥70% of nights with ≥4 hours usage), with an average of 4.7 hours of PAP usage per night used. Patients receiving FTF PAP education had a comparable level of good adherence (38% versus 38.6%, P=0.915), and hours per nights used (4.7 versus 4.6 h/night, P=0.711) to remotely educated patients. More severe OSA, lower mask leak, and a nasal mask were associated with achieving good PAP adherence. PAP adherence of newly diagnosed individuals with OSA during the COVID-19 pandemic was modest at 38.30%, and not significantly affected by remote PAP education delivery.

Carbonic Anhydrase IX as a Marker of Disease Severity in Obstructive Sleep Apnea.

Background and Objectives: Carbonic anhydrase (CA) enzymes are a family of metalloenzymes that contain a zinc ion in their active sites. CA enzymes have been implied in important situations such as CO2 transport, pH regulation, and oncogenesis. CA-IX is a transmembrane glycoprotein and stimulates the expression of hypoxia-inducible factor-1 (HIF-1) CA-IX. This study aimed to determine serum CA-IX levels in OSA patients in whom intermittent hypoxia is important and to investigate the relationship between serum CA-IX levels and disease severity. Materials and Methods: The study included 88 people who applied to Malatya Turgut Özal University Training and Research Hospital Sleep Disorders Center without a history of respiratory disease, malignancy, and smoking. Patients were divided into three groups: control (AHI &lt; 5, n = 31), mild-moderate OSA (AHI = 5-30, n = 27) and severe OSA (AHI &gt; 30, n = 30). The analysis of the data included in the research was carried out with the SPSS (IBM Statistics 25, NY, USA). The Shapiro-Wilk Test was used to check whether the data included in the study had a normal distribution. Comparisons were made with ANOVA in multivariate groups and the t-test in bivariate groups. ANCOVA was applied to determine the effect of the CA-IX parameter for OSA by controlling the effect of independent variables. The differentiation in CA-IX and OSA groups was analyzed regardless of BMI, age, gender, and laboratory variables. ROC analysis was applied to determine the parameter cut-off point. Sensitivity, specificity, and cut-off were calculated, and the area under the curve (AUC) value was calculated. Results: Serum CA-IX levels were 126.3 ± 24.5 pg/mL in the control group, 184.6 ± 59.1 pg/mL in the mild-moderate OSA group, and 332.0 ± 39.7 pg/mL in the severe OSA group. Serum CA-IX levels were found to be higher in the severe OSA group compared to the mild-moderate OSA group and control group and higher in the mild-moderate OSA group compared to the control group (p &lt; 0.001, p &lt; 0.001, p &lt; 0.001, respectively). In addition, a negative correlation between CA-IX and minimum SaO2 and mean SaO2 (r = -0.371, p = 0.004; r = -0.319, p = 0.017, respectively). A positive correlation between CA-IX and desaturation index (CT90) was found (r = 0.369, p = 0.005). A positive correlation was found between CA-IX and CRP (r = 0.340, p = 0.010). When evaluated by ROC curve analysis, the area under the curve (AUC) value was determined as 0.940 (95% CI 0.322-0.557; p &lt; 0.001). When the cut-off value for CA-IX was taken as 254.5 pg/mL, it was found to have 96.7% sensitivity and 94.8% specificity in demonstrating severe OSA. Conclusions: Our study found that serum CA-IX value was higher in OSA patients than in control patients, and this elevation was associated with hypoxemia and inflammation. CA-IX value can be a fast, precise, and useful biomarker to predict OSA.