Clinical Sleep Medicine Research Articles

Sleep, Sleep Apnea, and Fatigue in People Living With HIV.

People living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown. Academic university-affiliated HIV and Sleep Medicine Clinics. PLWH, aged 18-65 years, with a body mass index of 20-35 kg/m2 and viral suppression (RNA <200 copies per mL), were recruited to undergo daytime questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue Scale and Epworth Sleepiness Scale, 7 days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms), and an in-laboratory polysomnography to assess for the presence and severity of OSA. Of 120 subjects with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria, with an apnea-hypopnea index >5/h. There was no difference in Functional Assessment of Chronic Illness Therapy scores between those with and without OSA, although those with OSA did report more daytime sleepiness as measured using the Epworth Sleepiness Scale. In a multivariable model, predictors of fatigue included more variable daily sleep durations and decreased mean activity counts. Sleepiness was predicted by the presence of OSA. OSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.

Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea.

There is a dearth of research inclusive of African Americans living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, such as hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers. This longitudinal pilot study aimed to characterize fatigue symptom presentations among African Americans newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension. Adult African Americans newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status. Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix-metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first three months after diagnosis. Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African Americans. Fatigue in persons with hypertension improved after treatment. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in those with OSA regardless of hypertension status.

Psychometric Assessment of Anxiety Measures in a Pilot Study of African American Patients with Obstructive Sleep Apnea.

African American patient populations are disproportionately diagnosed with severe obstructive sleep apnea (OSA) compared to non-Hispanic white adults. Research suggests a link between OSA and anxiety. However, OSA and anxiety symptoms may present differently across minority groups. Research examining the reliability and validity of measures used to assess anxiety symptom severity in African American patient populations living with OSA is needed. This pilot study evaluated the reliability and validity of the Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety short form and the longer State-Trait Anxiety Inventory-State (STAI-S) in a sample of African American adults recently diagnosed with OSA. In this cross-sectional pilot study, 32 African American patients newly diagnosed with OSA were recruited from an academic sleep medicine clinic in the Southeastern United States to complete survey measures. Participants completed the 6-item PROMIS Anxiety short form and 20-item STAI-S. Cronbach's alphas assessed the internal reliability of measures, and concurrent validity between measures was assessed using correlation coefficients (rs). Both PROMIS Anxiety and STAI-S showed excellent internal consistency with Cronbach's α ≥.90. The PROMIS Anxiety T-scores and STAI-S scores were positively moderately correlated with each other (rs = .68; p < .0001), indicating concurrent validity. These results illustrate that both the PROMIS Anxiety and STAI-S scales have strong internal reliability in this sample of African American adults with co-occurring OSA and prediabetes. The brief PROMIS Anxiety short-form measure is validated to the longer STAI measure in this sample. An advantage of the PROMIS Anxiety scale is that it has a lower participant burden when completing questionnaires, contributing to a more refined approach to diagnosis and management when both OSA and anxiety coexist. These findings also underscore the importance of validating psychometric measures in marginalized populations, such as African Americans, who have historically been underrepresented in psychometric research.

Assessing non-dysfunctional attitudes toward sleep: psychometric properties of the Charlotte Attitudes Toward Sleep scale in Portuguese samples

ObjectivesTo adapt the Charlotte Attitudes Toward Sleep (CATS) scale, the only self-assessment instrument measuring non-dysfunctional attitudes toward sleep, into Portuguese and to study its psychometric properties in a Portuguese sample.MethodA sample of 1858 participants, recruited through non-probabilistic methods, was randomly split in two subsamples; one was used to develop the CATS model, the other for testing model invariance. We used structural equation models to assess factorial validity, measurement invariance, and relationships with other variables (e.g., the Karolinska Sleep Questionnaire) through confirmatory factorial analysis and causal models using a robust maximum likelihood method with Satorra-Bentler correction.ResultsThe CATS factorial model showed excellent evidence of factorial validity (robust CFI = 0.987, TLI = 0.979, SRMR = 0.026, RMSEA = 0.043), good reliability indicators (α and ώ1 > 0.75), and strict invariance of measurement (|∆CFI|< 0.01). CATS factors were weak-to-moderate predictors of sleep behaviors (β < 0.4). The scale showed evidence of divergent validity with the Karolinska Sleep Questionnaire. Some items had significant sensitivity problems and/or did not have adequate factorial weights and had to be dropped from the model.ConclusionsThe CATS is a new and promising scale with solid evidence of validity in terms of internal structure, but with sensitivity issues at item level. Further work should be carried out at item level to increase sensitivity and predictive validity, and further research with other samples, such as clinical sleep medicine patients, should be conducted.

Patient accessibility and utilization of behavioral sleep medicine referrals in an academic center.

Behavioral sleep medicine (BSM) is a subspecialty that combines behavioral psychology and sleep medicine specialties. The objective of this study was to analyze referral patterns to a BSM clinic. The three specific aims were: (1) describe factors that predict referral acceptance, (2) identify barriers to attending initial appointment, and (3) describe variables associated with the number of visits attended. Retrospective chart reviews were conducted as part of a quality improvement project by this study team's clinical setting. Adults over 21 years of age who were referred to a behavioral sleep medicine clinic in an urban Midwestern academic healthcare system between 2014-2019 were included in this study. Sleep medicine was the main referral source for BSM patients (74.2%), followed by internal medicine (9.3%) and neurology/psychiatry (7.3%). Thirty-eight percent of patients did not schedule an appointment after a referral for BSM was initiated. Younger age, longer distance from clinic, commercial insurance and out of network insurance were all significantly greater for non-schedulers. Eighty-three percent of patients did attend the initial intake session with BSM providers. Older age was associated with lower likelihood of not attending scheduled BSM appointments. Patient characteristics of older age, closer distance from clinic, and in network insurance coverage were found to significantly increase the likelihood of BSM scheduling, while younger age, Black race and not getting a primary sleep disorder diagnosis (versus a diagnosis of Insomnia Disorder) and shorter days from referral to appointment were associated with an increased likelihood of not attending the scheduled BSM treatment engagement.

Sleep Medicine Clinics: A Solution for Obstructive Sleep Apnea and Sleep Disorders in Pakistan

Sleep Medicine Clinics: A Solution for Obstructive Sleep Apnea and Sleep Disorders in Pakistan

REM sleep behaviour disorder (RBD): Personal perspectives and research priorities.

The formal identification and naming of rapid eye movement (REM) sleep behaviour disorder (RBD) in 1985-1987 is described; the historical background of RBD from 1966 to 1985 is briefly discussed; and RBD milestones are presented. Current knowledge on RBD is identified with reference to recent comprehensive reviews, allowing for a focus on research priorities for RBD: factors and predictors of neurodegenerative phenoconversion from isolated RBD and patient enrolment in neuroprotective trials; isolated RBD clinical research cohorts; epidemiology of RBD; traumatic brain injury, post-traumatic stress disorder, RBD and neurodegeneration; depression, RBD and synucleinopathy; evolution of prodromal RBD to neurodegeneration; gut microbiome dysbiosis and colonic synuclein histopathology in isolated RBD; other alpha-synuclein research in isolated RBD; narcolepsy-RBD; dreams and nightmares in RBD; phasic REM sleep in isolated RBD; RBD, periodic limb movements, periodic limb movement disorder pseudo-RBD; other neurophysiology research in RBD; cardiac scintigraphy (123I-MIBG) in isolated RBD; brain magnetic resonance imaging biomarkers in isolated RBD; microRNAs as biomarkers in isolated RBD; actigraphic, other automated digital monitoring and machine learning research in RBD; prognostic counselling and ethical considerations in isolated RBD; and REM sleep basic science research. RBD research is flourishing, and is strategically situated at an ever-expanding crossroads of clinical (sleep) medicine, neurology, psychiatry and neuroscience.

1057 A Tale of Two Languages: Evaluating Caregiver Satisfaction with Telemedicine in a Pediatric Sleep Medicine Clinic

1057 A Tale of Two Languages: Evaluating Caregiver Satisfaction with Telemedicine in a Pediatric Sleep Medicine Clinic

Response to Hypoglossal Nerve Stimulation Changes With Body Mass Index and Supine Sleep

Hypoglossal nerve stimulation (HGNS) is a potential alternative therapy for obstructive sleep apnea (OSA), but its efficacy in a clinical setting and the impact of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) on treatment response remain unclear. To investigate whether HGNS therapy is effective for patients with OSA, whether HGNS can treat supine OSA, and whether there are associations between BMI and treatment response. In this cohort study, adult patients with OSA implanted with HGNS at the Washington University Medical Center in St Louis from April 2019 to January 2023 were included. Data were analyzed from January 2023 to January 2024. HGNS. Multivariable logistic regression was performed to assess associations between HGNS treatment response and both BMI and supine sleep. Treatment response was defined as 50% reduction or greater in preimplantation Apnea-Hypopnea Index (AHI) score and postimplantation AHI of less than 15 events per hour. Of 76 included patients, 57 (75%) were male, and the median (IQR) age was 61 (51-68) years. A total of 59 patients (78%) achieved a treatment response. There was a clinically meaningful reduction in median (IQR) AHI, from 29.3 (23.1-42.8) events per hour preimplantation to 5.3 (2.6-12.3) events per hour postimplantation (Hodges-Lehman difference of 23.0; 95% CI, 22.6-23.4). In adjusted analyses, patients with BMI of 32 to 35 had 75% lower odds of responding to HGNS compared with those with a BMI of 32 or less (odds ratio, 0.25; 95% CI, 0.07-0.94). Of 44 patients who slept in a supine position, 17 (39%) achieved a treatment response, with a clinically meaningful reduction in median (IQR) supine AHI from 46.3 (33.6-63.2) events per hour preimplantation to 21.8 (4.30-42.6) events per hour postimplantation (Hodges-Lehman difference of 24.6; 95% CI, 23.1-26.5). In adjusted analysis, BMI was associated with lower odds of responding to HGNS with supine AHI treatment response (odds ratio, 0.39; 95% CI, 0.04-2.59), but the imprecision of the estimate prevents making a definitive conclusion. This study adds to the growing body of literature supporting the use of HGNS for OSA treatment. Sleep medicine clinicians should consider informing patients that higher BMI and supine sleeping position may decrease therapeutic response to HGNS. Future research is needed to replicate these findings in larger, more diverse cohorts, which would facilitate the optimization of treatment strategies and patient counseling for HGNS therapy.

Prevalence of Obesity among Adults Visiting Otorhinolaryngology Clinics for Snoring

Abstract Introduction: This study aims to assess the prevalence of obesity and to estimate the risk of obstructive sleep apnea (OSA) among adults visiting otorhinolaryngology (ORL) clinics for snoring. Methods: We conducted a retrospective chart review of adult patients who visited ORL clinics at King Fahd Military Medical Complex for snoring in the period between October 2019 and March 2022. We utilized STOP and STOP-BANG screening tools to stratify OSA risk in the included subjects. Results: Eighty-five patients were included in this study. Most of the subjects were male (80%). Obesity was detected in 63 (74.1%) of the included subjects. Seventy-seven subjects (90.6%) were independently at risk of OSA based on the STOP-BANG questionnaire and STOP questionnaire. Conclusion: Obesity is common in adults visiting ORL clinics for snoring. The rate of OSA risk is high among adult patients visiting ORL clinics for snoring. Therefore, it is important for ORL practitioners to utilize OSA risk assessment tools and to have enough knowledge or access to sleep medicine clinics for diagnostic and therapeutic purposes.

Improved subjective sleep quality after three months of balance learning in older adults

Improved subjective sleep quality after three months of balance learning in older adults

Longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome.

This paper describes the longitudinal change in sleep, functional, and behavioural characteristics in a cohort of children with Down syndrome, including the effect of sleep interventions in a subset. A prospective longitudinal cohort study was undertaken in children with Down syndrome aged 3-16 years comparing (1) children referred to a tertiary sleep medicine clinic who received sleep hygiene advice and an additional sleep treatment (DSref_I) with (2) children attending the same clinic who only received sleep hygiene advice (DSref_N) and (3) children recruited from the community who, were not receiving any treatment (DScomm). Data collected included demographic and medical history information, Child Sleep Habits Questionnaire-Abbreviated (CSHQ-A), Life-Habits Questionnaire (Life-H) and Child Behaviour Checklist (CBCL) at baseline and then 6-monthly for a total of 18 months. Any sleep interventions during this time were recorded. A total of 57 children were included (DSref_I, n = 16; DSref_N, n = 25; DScomm, n = 16). At recruitment, the median CSHQ-A total score was high (>41) in all three subgroups, but highest in the DSref_I subgroup (median [interquartile range] Dsref_I score 58 [53-66] versus DSref_N score 49 [43-53], p = 0.019). Although improved, 80% of participants in the DSref_I subgroup still had a CSHQ-A total score >41 at the last assessment point. The median total Life-H and total CBCL scores were not significantly different between groups at baseline and there was no significant time, group, or interaction effect seen through the study. Over an 18-month period, sleep problems were seen to persist in children with Down syndrome. Treatment resulted in only modest improvements in sleep.

O023 Quality of Life in Central Disorders of Hypersomnolence

Abstract Background Whilst sleep disorders are common, with up to 5.8% of Australian adults experiencing excessive daytime somnolence due to a sleep disorder, there is a relative paucity of quality-of-life data in those with central disorders of hypersomnolence. The available evidence suggests a significant impact attributable to these disorders, though it is also noted that much of this data was obtained through patient associations as opposed to sleep medicine clinics with potentially more security of diagnosis. Methods A retrospective, single-centre review will be undertaken of patients seen as new cases in the sleep clinic between January 2013 and December 2022 with a diagnosis of a central disorder of hypersomnolence. Quality of life at baseline will be assessed using metrics collected as standard-of-care, including the Epworth Sleepiness Scale, Short-Form 36, FOSQ, and PSQI. Demographics, comorbidity, baseline pharmacotherapy will also be analysed. Progress to date Planning in conjunction with co-investigators and key stakeholders has been undertaken, and a complete protocol has been drafted and submitted for ethics committee approval. Data collection is anticipated to commence and be complete by end of July 2023. Intended outcome and impact It is hypothesised that baseline quality of life in these patients will be poorer than in the general population. This study will improve upon the volume and quality of existing data, and serve to assist in planning for a potential subsequent investigation into the impact of cognitive behavioural therapy for hypersomnia.

THU413 Does Continuous Positive Airway Pressure Affect Bone Loss Process In The Population Of Sleep Apnea?

Abstract Disclosure: Y. Chen: None. A. Suresh: None. S. Haile: None. Z. Perciuleac: None. B. Soni: None. A. Cuevas Velazquez: None. A. Amirian: None. C. Udeh: None. L. Sangha: None. B. Ravichander: None. K. Aljassani: None. R. Joshi: None. A. Atrash: None. N. Ramesh: None. J. Sta. Cruz: None. S. Al-saadi: None. Introduction: Patients with obstructive sleep apnea (OSA) were reported to have higher risk of developing osteoporosis or increased bone loss. One of the theories suggested nocturnal hypoxia led to imbalanced osteoclastic activity and contributed to bone loss. Continuous Positive Airway Pressure (CPAP) is the first-line treatment for OSA, which improves airway obstruction and limits hypoxia. This study attempts to evaluate if compliant with CPAP therapy reduces bone loss. Methods: This retrospective study included patients who visited UPMC Central Pa. sleep medicine clinic from January 2010 to October 2022 with diagnosis of OSA and have at least two dual-energy X-ray absorptiometry (DEXA) after the OSA diagnosis. Patients’ records of CPAP usage on two databases, Respironics and Resmed, were used to assess the compliance of the therapy. The definition of compliance is average usage of 4hrs/night; frequency of use being 70% or above. Patient demographics, CPAP compliance, bone mineral density (BMD) and T-scores of two DEXAs were obtained. All data after diagnosis of active malignancy, hyperparathyroidism, end stage renal disease, or after patient received osteoporosis pharmacological treatment are excluded. Annual change of BMD was calculated with the difference of BMD between the two DEXA scans divided by the study interval. Two-sample t-test and chi-square test were used for analysis. Results: 265 patients were included for analysis, with 254 female (95.8%), 92.1% Caucasian, mean age 68.3 years old, mean BMI 36.7kg/m2. 165 patients were compliant and 100 were non-compliant. The two groups were identical on demographic data including age, sex, ethnicities. The median of annual BMD changes at L-spine, left femur neck, left femur total, and left radius were 0.003, −0.003, −0.002, −0.002 g/cm2 respectively in compliant group and 0.003, 0, −0.006, −0.002 g/ cm2 in non-compliant group. The annual changes of T-scores were 0, −0.043, 0, −0.036 for the compliant group and 0, 0, −0.051, −0.034 for non-compliant group. No significant within-group or between-group difference in annual bone density reduction on BMD or T-score was noted in our analysis. Discussions: Our study did not reveal the benefit of treating OSA on bone loss. Small sample size could be the leading factor for the limited effect size. Retrospective study design also restricted our study population to predominantly postmenopausal Caucasian female. Further adjustments for possible confounding factors including BMI and age might be beneficial. Future study with prospective design, larger sample size, and diverse population is encouraged to discover the effect of CPAP therapy on BMD preservation. Presentation: Thursday, June 15, 2023

July 2023 Sleep Case of the Month: Fighting for a Good Night’s Sleep

No abstract available. Article truncated after first 150 words. A 31-year-old man presented for follow-up in the Sleep Medicine clinic. He has a past medical history of a seizure disorder and supraventricular tachycardia (SVT) and was referred after complaining of excessive daytime sleepiness. Current medications include citalopram and diltiazem. Four months prior, he was diagnosed with severe obstructive sleep apnea characterized by an apnea-hypopnea index (AHI) of 34 and an oxygen saturation nadir of 86%. The patient was initiated on continuous positive airway pressure (CPAP) therapy; however, he reported ongoing mask discomfort and difficulty with exhalation while wearing CPAP. Despite partial improvement in sleep fragmentation and daytime sleepiness, the patient reported sleeping for only 4 hours per night. The patient's sleep schedule was irregular, with bedtime ranging between 9:30 pm and 12 am, waking up at 5 am, and taking a daily nap for 4-5 hours in the morning during which he continued to use CPAP. Additionally, he described …

Automatic sleep-stage classification of heart rate and actigraphy data using deep and transfer learning approaches

Manual sleep-stage scoring based on full-night polysomnography data recorded in a sleep lab has been the gold standard of clinical sleep medicine. This costly and time-consuming approach is unfit for long-term studies as well as assessment of sleep on a population level. With the vast amount of physiological data becoming available from wrist-worn devices, deep learning techniques provide an opportunity for fast and reliable automatic sleep-stage classification tasks. However, training a deep neural network requires large annotated sleep databases, which are not available for long-term epidemiological studies. In this paper, we introduce an end-to-end temporal convolutional neural network able to automatically score sleep stages from raw heartbeat RR interval (RRI) and wrist actigraphy data. Moreover, a transfer learning approach enables the training of the network on a large public database (Sleep Heart Health Study, SHHS) and its subsequent application to a much smaller database recorded by a wristband device. The transfer learning significantly shortens training time and improves sleep-scoring accuracy from 68.9% to 73.8% and inter-rater reliability (Cohen’s kappa) from 0.51 to 0.59. We also found that for the SHHS database, automatic sleep-scoring accuracy using deep learning shows a logarithmic relationship with the training size. Although deep learning approaches for automatic sleep scoring are not yet comparable to the inter-rater reliability among sleep technicians, performance is expected to significantly improve in the near future when more large public databases become available. We anticipate those deep learning techniques, when combined with our transfer learning approach, will leverage automatic sleep scoring of physiological data from wearable devices and enable the investigation of sleep in large cohort studies.

0342 Are Clinical Trials for Insomnia Recruiting Real World Patients?

Abstract Introduction Studies that have resulted in recent approval of hypnotics for chronic insomnia disorder (CID) have extremely restrictive inclusion criteria. We sought to determine how many patients seen in a sleep medicine clinic would be eligible to participate in these trials in order to assess the generalizability of these findings to clinical populations. Methods Six-hundred and twenty-eight patients were screened to identify 100 patients who were ≥18 years old, had a diagnosis of CID, and were prescribed a hypnotic medication at a sleep medicine clinic in a quaternary level healthcare center. Information regarding age, sex, body mass index, comorbid diagnoses, sleep schedule, medications, alcohol/tobacco/illicit drug use, caffeine intake, as well as Epworth Sleepiness Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Insomnia Severity Index scores were abstracted. These data were compared against the inclusion and exclusion criteria for recent regulatory Phase III trials of orexin receptor antagonists (suvorexant, lemborexant, daridorexant). Results Of the 100 patients with CID (mean age=56.2 years; 57% female), only 3 patients met eligibility criteria for inclusion. A majority of patients (80%) would have been excluded due to a prior/concurrent trial of cognitive behavioral therapy for insomnia. If this criterion was set aside, only 11 patients would have been eligible to participate. The remaining top reasons for potential exclusion from the regulatory trials were: presence of medical comorbidities (36%), daytime napping (33%), and sleep apnea (30%). Conclusion A very small number of patients with CID seen in a clinical setting met eligibility criteria for clinical trials of hypnotic medications resulting in regulatory approval. This substantially limits the generalizability of findings from these trials and restricts our ability to determine the efficacy of these drugs in clinical populations. Future trials should enroll patients with less restrictive criteria to help determine the effectiveness of these medications in real world settings. Support (if any)

0495 Epworth Sleepiness Scale Worth for Sleep Apnea Screening: A Large Cohort of Polysomnographies via Natural Language Processing

Abstract Introduction Obstructive sleep apnea (OSA) is a major sleep disorder that presents with excessive daytime sleepiness (EDS). Epworth Sleepiness Scale (ESS) as a measure of EDS is used to monitor population sleep health. We aim to assess the association between ESS and apnea hypopnea index (AHI) extracted from polysomnography (PSG) reports using natural language processing (NLP) algorithms. Methods We curated 90,483 PSG notes from the nationwide Corporate Data Warehouse (CDW) of Veteran Affair (VA) from 10/1999 to 10/2020. We used rule-based nearest neighbor and forward-backward NLP techniques to extract ESS and AHI from PSG reports. We reported the performance of NLP algorithm compared to chart review. We used AHI&amp;gt;5 as the cut-point to identify OSA and incremented the threshold for abnormal ESS from 5 to 15 to find the best cut-point for stratification of EDS. We used logistic regression to report the performance of the ESS cut-point using the area under the curve (AUC). The model also adjusted for age, sex, BMI, race, ethnicity, and Charlson comorbidity index. Results 39,318 patient clinical notes’ (age 50±15 years; BMI 30±5) notes documented both AHI and ESS. (50±15 year; 30±5 BMI). NLP algorithms accuracy was ≥ 90%. We observed the same level of sensitivity (57%) or specificity (42%) for ESS of 5 and 10, but the ESS of 5 resulted in the best negative (27%) and positive (72%) predictive value for AHI prediction. The area under curve for prediction OSA based on ESS cut-off of 5 was 0.50 (95%CI, 0.49, 0.51) and the AUC improved to 0.65 (95%CI, 0.64, 0.65) after adjustment. Conclusion Our results suggest that ESS is not an effective tool for predicting AHI. Reducing the ESS cut-off to 5 may enhance its predictive value, but it does not have clinical implication in identifying patient with OSA. Sleep medicine clinicians may use other sleep questionnaires, such as the STOP-Bang questionnaire, which is reported to be a reliable, concise, and easy-to-use screening tool. Support (if any) This work is supported by the VA Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413); National Institute of Health (NHI) Grant # 1K25HL152006-01 (PI: Razjouyan) and Grant # R01NR018342 (PI: Nowakowski).

1033 The link between vision loss and sleep

Abstract Introduction Non-arteritic ischemic optic neuropathy (NAION) is the most common optic nerve disorder among patients over the age of 50. Several risk factors have been associated with NAION including systemic hypertension, diabetes mellitus, advanced age, and certain optic disc morphologies. A significant association between obstructive sleep apnea (OSA) and NAION has also been reported. Here, we present a case of a middle-aged man with a recent diagnosis of NAION who was subsequently found to have OSA. Report of case(s) A 53-year-old man with a remote history of head injury with concussion and tobacco use was referred to the Sleep Medicine Clinic from Ophthalmology for evaluation of obstructive sleep apnea (OSA). The patient initially presented to Ophthalmology due to acute onset, painless, left-sided, inferior vision loss. The patient was otherwise healthy and denied a history of diabetes mellitus or hypertension. He did report alcohol and cigar use on the night prior to the acute onset vision loss. He denied fevers, chills, joint or jaw pain, scalp tenderness, or jaw claudication. On initial evaluation he was found to have significant left eye optic disc edema. Blood test revealed normal complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-Reactive protein (CRP). His orbit and brain magnetic resonance imaging with and without contrast revealed no significant findings. He was subsequently diagnosed with left NAION. Further review of symptoms was positive for snoring, dry mouth, nighttime awakenings, and unrefreshing sleep, concerning for OSA and leading to referral to our Sleep Medicine Clinic. During initial consultation in Sleep Medicine, he denied symptoms concerning for any other sleep disorders. He subsequently underwent a home sleep test (WatchPAT) which confirmed the diagnosis of OSA. The apnea-hypopnea index (AHI) was 7.9 and the lowest oxygen saturation was 88%. Conclusion Given the reported association between NAION and OSA, a careful history should be obtained to screen for OSA when NAION is diagnosed. Support (if any)

0980 A Child with Achondroplasia, Cervicomedullary Junction Compression, Severe Obstructive Sleep Apnea and Pulmonary Hypertension

Abstract Introduction Achondroplasia is a short stature autosomal dominant skeletal dysplasia. Children with Achondroplasia are at risk for multiple medical comorbidities including sleep disordered breathing due to midface hypoplasia and craniocervical junction compression. Recent guidelines from American Academy of Pediatrics on health supervision of children with achondroplasia recommend routine clinical screening for symptoms of obstructive sleep apnea (OSA) and craniocervical junction compression in which case a polysomnogram should be considered. Report of case(s) The patient is a now 15 month old male who was initially seen in sleep medicine clinic at age 4 months for snoring and respiratory distress while awake. Polysomnogram 2 days later demonstrated severe OSA. The study demonstrated an oAHI of 25.1/hour, O2 nadir of 77%, and TcCO2 with evidence of significant hypoventilation with TcCO2 max of 67mmHg. This was adequately treated with supplemental oxygen. The patient subsequently presented to the emergency department at age 7 months with hypoxemic respiratory failure and signs of right heart failure and was started on CPAP. Echocardiogram demonstrated significant pulmonary hypertension. Subsequent CPAP titration study during admission demonstrated adequate treatment of OSA and his pulmonary hypertension significantly improved with the patient requiring no pulmonary hypertension treatment at discharge. At age 9 months, the patient was again admitted with hypoxemic respiratory failure and subsequent brain MRI demonstrated foramen magnum stenosis requiring subsequent surgical decompression. He was discharged on CPAP, however, was not tolerating this at home. Therefore, repeat polysomnogram was obtained that demonstrated severe OSA that was not responsive to supplemental oxygen. The patient was then started on BPAP therapy which he has since been tolerating well. Conclusion Children with achondroplasia are at increased risk for sleep disordered breathing and craniocervical junction compression. Our patient experienced significant complications from OSA at a young age. His sleep apnea worsened significantly in a short period making it unresponsive to previous treatment recommendations. There is a need for further studies to determine better screening guidelines for craniocervical junction narrowing and OSA. This case highlights the dynamic nature of sleep disordered breathing in achondroplasia and need for close follow up and monitoring of symptoms at all clinical encounters. Support (if any)