Sleep-related Breathing Disorders Research Articles

Detection of episodic nocturnal hypercapnia in patients with neurodegenerative disorders.

Episodic nocturnal hypercapnia (eNH) in transcutaneous carbon dioxide pressure (PtcCO2) corresponding to rapid eye movement sleep hypoventilation is a useful biomarker for detecting nocturnal hypoventilation. However, the relationship between eNH and neurodegenerative diseases with sleep-related breathing disorders (SRBDs) is unknown. The aim of this study was to evaluate the relationship between eNH and nocturnal hypoventilation in neurodegenerative diseases. Patients with neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), multiple system atrophy (MSA), Parkinson's disease, progressive supranuclear palsy, corticobasal syndrome, and idiopathic normal pressure hydrocephalus, were enrolled and received overnight PtcCO2 monitoring. The patients were divided into groups for eNH and sleep-associated hypoventilation (SH) prevalence analysis: A (ALS), B (MSA), and C (others). Among 110 patients, twenty-three (21%) and 10 (9%) of the patients met eNH and SH criteria, respectively. eNH and SH were significantly more frequent in groups A and B than in C. The prevalence of SH in the patients with eNH was 39% whereas most of patients with SH (90%) presented with eNH. Among patients withdaytime carbon dioxide pressure in arterial blood ≤ 45mmHg, eNH frequency was 13%, whereas none of the patients met SH criteria. The frequency of noninvasive positive pressure ventilation after PtcCO2 monitoring was significantly higher in those with than without eNH. eNH is common in patients with MSA and ALS who present with SRBD. eNH with overnight PtcCO2 monitoring is a useful biomarker to detect hypoventilation among neurodegenerative diseases with different SRBD mechanisms.

Circadian Rhythm Disturbance in Acute Ischemic Stroke Patients and Its Effect on Prognosis

Introduction: Poststroke sleep disturbances are common and can affect stroke outcomes, but the clinical studies mainly focus on breathing-related sleep disorders, while the bidirectional impact of circadian rhythm dysfunction in ischemic stroke remains unknown. This study observed the characteristics of melatonin secretion in acute ischemic stroke patients and evaluated whether melatonin rhythm impacts the prognosis after stroke by assessing the neurological function, cognition, emotion, and quality of life 3 months after stroke. Methods: Acute ischemic stroke patients were selected from the Department of Neurology Inpatients of the Second Hospital affiliated with Soochow University from October 2019 to July 2021. Healthy control subjects were recruited at the same time. Demographic and clinical data were collected, and relevant scale scores (including neurological function, cognition, emotion, and sleep) were assessed within 2 weeks of onset and followed up 3 months later. All participants collected salivary melatonin samples on the 4th day of hospitalization and dim light melatonin onset (DLMO) was calculated according to melatonin concentration. Stroke patients were then divided into three groups based on their DLMO values. Results: A total of 74 stroke patients and 33 control subjects were included in this analysis. Compared with healthy controls, stroke patients exhibited a delayed melatonin rhythm during the acute phase of stroke (21:36 vs. 20:38, p = 0.004). Stroke patients were then divided into three groups, namely normal (n = 36), delayed (n = 28), or advanced DLMO (n = 10), based on their DLMO values. A χ² test showed that there were significant differences in the rate of poor prognosis (p = 0.011) and depression tendency (p = 0.028) among the three groups. A further pairwise comparison revealed that stroke patients with delayed DLMO were more likely to experience poor short-term outcomes than normal DLMO group (p = 0.003). The average melatonin concentration of stroke patients at 5 time points was significantly lower than that of the control group (3.145 vs. 7.065 pg/mL, p < 0.001). Accordingly, we split stroke patients into three groups, namely low melatonin level (n = 14), normal melatonin level (n = 54), or high melatonin level (n = 6). Unfortunately, there were no great differences in the clinical characteristics, cognition, emotion, sleep quality, and short-term outcome among groups. Conclusions: This is a preliminary study, and our results indicate that changes in melatonin secretion phase of stroke patients may have effect on their short-term prognosis.

Acceptance of and adherence with long-term positive airway pressure treatment in adults with chronic obstructive pulmonary disease: A systematic review protocol.

Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment for sleep-related breathing disorders and chronic hypercarbic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). PAP treatment may be delivered as continuous positive airway pressure or noninvasive ventilation. Success in initiating PAP treatment and barriers to its use in adult patients with COPD are largely unknown. This systematic review aims to identify the acceptance of and adherence to PAP treatment prescribed for long-term use in adult patients with COPD and to summarize variables associated with these measures. Seven online electronic databases will be searched by an experienced medical librarian to identify records containing the concepts "obstructive airways disease" and "noninvasive positive airway pressure" and "acceptance" or "adherence". Randomized and non-randomized studies of interventions will be included. Citation lists from relevant articles will be reviewed, and experts will be contacted regarding unpublished studies. Abstracts from key conferences between 2018-2023 and Google Scholar search results will be reviewed for inclusion. Titles, abstracts and full texts will be reviewed independently for inclusion by two reviewers. Data extraction will be completed by one author using a pre-established form and primary outcomes confirmed by a second author. Methodological quality will be evaluated. If sufficient data are available for meta-analysis, a pooled summary statistic for the primary outcome will be calculated using a random-effects generic inverse-variance meta-analysis, weighted proportion or weighted medians-based approach. Subgroup analysis will explore clinically meaningful sources of heterogeneity. Variables that are associated with acceptance and adherence will be described. Long-term PAP treatment is a complex intervention prescribed to patients with COPD for several indications. Synthesis of the evidence on success with PAP treatment and variables associated with acceptance or adherence will inform program and policy development for supporting patients with COPD who are prescribed this therapy. Systematic review registration: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on July 13, 2021 (registration number CRD42021259262), with revisions submitted on April 17, 2023.

The assessment and management of obstructive sleep apnoea–hypopnoea syndrome and obesity hypoventilation syndrome in obesity

Obesity is associated with respiratory dysfunction. It is a key risk and contributory factor in the sleep related breathing disorders, obstructive sleep apnoea/hypopnoea syndrome (OSAHS) and obesity hypoventilation syndrome (OHS). Weight management is an integral part of the management of these disorders, in addition to continuous positive airways pressure (CPAP) and non-invasive ventilation (NIV). Untreated, these conditions are associated with a high disease burden and as treatment is effective, early recognition and referral is critical. Best practice in on-going care is multidisciplinary.

Atypical Catathrenia Mimicking Sleep Choking Sound of Obstructive Sleep Apnea

Catathrenia is a rare type of sleep-related breathing disorder with benign course and generally does not require treatment. However, the psychological burden on patients and bed partners is not light. In most cases, due to the sound characteristic of identifiable harmonics, it can be easily diagnosed; however, in some cases, it has non-typical sounds, and polysomnography is essential to diagnose. Here, I report a middle-aged woman with choking sounds like an obstructive sleep apnea patient during sleep, with typical polysomnography features of catathrenia.

Candidate genes for obstructive sleep apnea in non-syndromic children with craniofacial dysmorphisms - a narrative review.

Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of the upper airway is considered a risk factor for POSA development. The craniofacial features associated with sleep-related breathing disorders (SRBD) - craniosynostosis, retrognathia and micrognathia, midface and maxillary hypoplasia - have high heritability and, in a less severe form, could be also found in non-syndromic children suffering from POSA. As genetic factors play a role in both POSA and craniofacial dysmorphisms, we hypothesize that some genes associated with specific craniofacial features that are involved in the development of the orofacial area may be also considered candidate genes for POSA. The genetic background of POSA in children is less explored than in adults; so far, only one genome-wide association study for POSA has been conducted; however, children with craniofacial disorders were excluded from that study. In this narrative review, we discuss syndromes that are commonly associated with severe craniofacial dysmorphisms and a high prevalence of sleep-related breathing disorders (SRBD), including POSA. We also summarized information about their genetic background and based on this, proposed 30 candidate genes for POSA affecting craniofacial development that may play a role in children with syndromes, and identified seven of these genes that were previously associated with craniofacial features risky for POSA development in non-syndromic children. The evidence-based approach supports the proposition that variants of these candidate genes could lead to POSA phenotype even in these children, and, thus, should be considered in future research in the general pediatric population.

Dental sleep medicine education among undergraduate dental students in France.

Dental sleep medicine (DSM) is an emerging discipline that studies the oral and maxillofacial causes and consequences of sleep-related problems. DSM is of upmost importance given the major medical challenge it represents. Therefore, to verify whether the future generation of dentists would be ready to face this challenge, the main objective of this study was to assess the degree of involvement of the French dental schools in teaching DSM at the undergraduate level. All 16 dental schools in France were asked to participate in the study by answering to an online survey concerning the DSM curriculum during the 2018-2019 academic year. The survey was addressed to the head of the dental school and/or to relevant course coordinators and contained 10 questions related to the type, content and amount of DSM teaching to undergraduate dental students. Nine of the 16 (56.2%) French dental schools responded to the questionnaire. All these nine reported the inclusion of DSM in their undergraduate curriculum. The total average hours dedicated to teaching DSM was 5.6 h (SD 4.2; range 1-15 h). Seven of the 9 dental schools spent most of their DSM curriculum teaching time in the fifth year. All of them reviewed obstructive sleep apnoea and sleep-related bruxism and covered some topics related to therapies for sleep-related breathing disorders, such as the use of oral appliance. The results of this survey showed that, although the average hourly volume is relatively high, the DSM teaching in French dental schools appeared to be non-standardised, heterogeneous and often lacunar. It is therefore essential to develop a common curriculum and implement it in all dental schools to provide undergraduate students a comprehensive and updated teaching in DSM.

Multi-Level 3D Surgery for Obstructive Sleep Apnea: Could It Be the Future?

(1) Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway, leading to reduced or absent breathing during sleep. A nocturnal upper airway collapse is often multi-levelled. The aim of this communication is to describe a 3D multi-level surgery setting in OSA pathology, introducing new surgical approaches, such as 4K-3D endoscopic visualization for the tongue base approach with the aid of a coblator and exoscopic visualization in the palatal approach. (2) Methods: Seven patients affected by OSA underwent 3D Barbed Reposition Pharyngoplasty (BRP) surgery associated with transoral coblation tongue base reduction and nose surgery. (3) Results: No patients experienced intra-operative, post-operative or delayed complications. For OSA multi-level 3D surgery, it took less than 2 h: the median 3D system setting time was 12.5 ± 2.3 min; the overall procedure time was 59.3 ± 26 min. (4) Conclusions: The use of the 4K-3D endoscope and coblator for tongue base resectioning and of the 3D exoscope for lateral pharyngoplasty represents an excellent system in multi-level OSA related surgery that could reduce the time and the costs compared to those of robotic surgery.

Prevalence of sleep disturbances in people with mild cognitive impairment: a systematic review protocol.

This review will determine the prevalence of sleep disturbances in individuals with mild cognitive impairment. Mild cognitive impairment is regarded as a transitional state between normal functioning and dementia, and has a high likelihood of conversion to dementia. Individuals with mild cognitive impairment may suffer more severe sleep disturbances compared with normal older people. In some studies, sleep disturbances were associated with significantly higher odds of mild cognitive impairment. There is a need for prevalence estimates of sleep disturbances in people with mild cognitive impairment based on the currently available literature to guide clinical health care professionals and public health policies. The review will consider studies reporting on the prevalence of sleep disturbances in individuals with mild cognitive impairment, using validated instruments, including subjective and/or objective measures. Studies will be excluded if the participants report sleep-related breathing or movement disorders. Studies using only the Mini-Mental State Examination to diagnose mild cognitive impairment will also be excluded. The review will follow the JBI methodology for systematic reviews of prevalence and incidence. The MEDLINE (Ovid), Embase, Cochrane Library (CDSR and CENTRAL), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and Web of Science Core Collection databases will be systematically searched from inception to the present with no language limitations. Analytical observational studies, including prospective and retrospective cohort, case-control, and cross-sectional studies, will be considered. Two reviewers will independently conduct the study selection, critical appraisal, and data extraction. Methodological quality will be evaluated using the JBI critical appraisal checklist for studies reporting prevalence data. A meta-analysis will be conducted to synthesize the prevalence data, where possible. PROSPERO (CRD42022366108).

Neurostimulation und Schlaf bei Epilepsie – Englische Version

Abstract Background Chronic sleep disturbance may affect seizure frequency and efficacy of treatment in epilepsy patients. Vagus nerve stimulation (VNS) and deep brain stimulation (DBS) can both induce sleep disturbance as a side effect. Aim The goal of this review is to provide information and clinical advice about potential interactions between DBS at the anterior nucleus of the thalamus (ANT) and sleep as well as between VNS and sleep. Materials and methods We provide an up-to-date overview of the currently available literature, giving insights for diagnostics and therapy based on clinical studies, and experience in two epilepsy centers with longitudinal cohorts of patients under chronic neurostimulation. Results In patients with chronic ANT-DBS and VNS, stimulation-correlated, probably dose-dependent sleep disturbances have been reported in several studies. The reason for this is assumed to be an accidental co-stimulation of the ascending reticular arousal system in the case of DBS, and an indirect effect via induction of sleep-related breathing disorders in the case of VNS. Furthermore, VNS might also influence sleep through modulation of noradrenergic and dopaminergic, arousal-inducing systems in the pons and midbrain. Reduction of stimulation amplitudes, changes in stimulation parameters, and localization of the active stimulation zone are discussed as treatment strategies in DBS. In the case of VNS-induced sleep disturbance, a nocturnal reduction of stimulation (bilevel therapy) can be offered. Conclusion As data are currently still sparse, it seems important to optimize treatment regimens for VNS and DBS in order not to antagonize their potential anticonvulsant effects by inducing sleep fragmentation.

1039 The Progression of Sleep-Related Breathing Disorders in a Patient with Joubert syndrome

Abstract Introduction Joubert syndrome (JS) is a rare autosomal recessive disease characterized by malformations of the cerebellar vermis, hypotonia, developmental delay, and respiratory variability. Among the potential health challenges that children with congenital malformations of the central nervous system including JS, may face, sleep concerns are frequent and may include sleep-related breathing disorders (SRBDs). Report of case(s) A 17-month-old female with JS was referred to the pediatric pulmonary clinic due to disrupted and fragmented sleep. She had frequent nocturnal awakenings, snoring, mouth breathing, and witnessed apneas. There was no family history of SRBDs. Physical exam was notable for high-arched palate, diffuse hypotonia, and intermittent periods of tachypnea followed by apneas, even when awake. Her polysomnography (PSG) demonstrated an apnea-hypopnea index (AHI) of 27.1/hour, with the obstructive apnea-hypopnea index (oAHI) of 18/hr with central apnea index (CAI) of 9.1/hr and nadir oxygen saturation (SpO2) of 87%. An attempt was made to initiate supplemental oxygen; however, the patient did not tolerate the cannula. At that time, neither adenoid nor tonsillar hypertrophy were noted and surgical intervention was not indicated. The repeat PSG one year later demonstrated AHI of 9.1/hour, oAHI of 4.7/hr with CAI of 4.4/hr and nadir SpO2 of 84%. At this time, she did demonstrate enlarged adenoids and tonsils and underwent adenotonsillectomy with some clinical improvement in snoring. Her mother noted continued pauses in breathing and post operative PSG demonstrated AHI of 12.8/hour, oAHI of 1.4/hr and CAI of 11.4/hr and nadir SpO2 of 79%. The patient had demonstrated worsening episodic tachypnea and central apneas and the decision was made to attempt initiation of a respiratory assist device to regulate breathing and ventilation. Due to the patient’s age, intensive therapy desensitization is required to allow her to tolerate positive airway pressure therapy. Conclusion Patients with JS are at high risk for complex SRBDs as part of their clinical presentation. It is therefore important to carefully monitor the character of sleep-disordered breathing, offering appropriate treatments where indicated. It is important to note the added challenges of young pediatric patients who often require deliberate desensitization interventions to proceed with successful treatment. Support (if any)

0471 Having a Surgical Aortic Valve Replacement? You Very Likely Have Obstructive Sleep Apnea

Abstract Introduction Patients with advanced aortic stenosis (AS) have a high risk of sleep-related breathing disorders (SRBD), yet prior research is limited to type III sleep apnea tests. Whereas the American Academy of Sleep Medicine recommends polysomnography for SRBD diagnosis in patients with significant cardiorespiratory disease, unattended studies are often more acceptable, especially to surgical candidates. We conducted this study to address the need for comprehensive sleep testing in patients with advanced AS. Methods We conducted unattended type II sleep tests in 23 adults aged 50 and older scheduled for surgical aortic valve replacement (SAVR) and not using positive airway pressure. We obtained demographics and medical history and administered Clinical Dementia Rating, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 9-item Patient Health Questionnaire. We characterize this pre-surgical sample and report SRBD prevalence. Results Average age of the sample was 68.3 ± 7.2 (mean ± SD), and 74% were male. Charlson comorbidity index was 2.0 ± 2.0. Three (13%) had a global CDR of 0.5, consistent with mild cognitive impairment. Mean PSQI scores were 7.0 ± 3.6, ESS 6.7 ± 4.0, and PHQ-9 4.6 ± 5.3. No subject had an AHI &amp;lt; 5: 7 had a score of 5–14, 8 of 15–29, and 8 of 30 or greater. Mean obstructive AHI was 25.3 ± 20.7, central AHI 1.9 ± 3.4, and respiratory arousal index 8.7 ± 6.2. Total sleep time 362.7 ± 82.6 min with sleep efficiency of 82.1% ± 8.6%. Sleep stage data to be presented. Conclusion All subjects in this sample not using positive airway pressure had an AHI ≥ 5. Sixteen subjects (70%) had an AHI ≥ 15, indicating moderate to severe sleep apnea due to predominantly obstructive events. These results strongly suggest that patients with severe AS, especially those undergoing SAVR, would benefit from evaluation for SRBD. Support (if any) This research was supported in part by the National Institute on Aging, K23AG072383. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support provided by University of Rochester Medical Center funds through the Departments of Psychiatry and Cardiology/Cardiac Surgery.

1040 Sleep Hypoventilation with Daytime Eucapnia in COPD May Predict Hypercapnia During Exacerbation

Abstract Introduction Patients with severe Chronic Obstructive Pulmonary Disease (COPD) are known to be at risk for nocturnal hypoventilation1. We present a case of patient with severe COPD with near normalization of PaCO2 levels after exacerbation but persistent nocturnal hypoventilation. Report of case(s) 71-year-old woman with COPD Group 4D, on home oxygen, was seen in pulmonary clinic after two hospitalizations for hypercapnic respiratory failure, PcO2 &amp;gt;100 mm Hg requiring acute Noninvasive ventilation (NIV) support. Three weeks after discharge, ABG improved to 7.39/49/140 on 32% Fio2, preventing her from qualifying for long-term home NIV. Sleep study was negative for sleep apnea but showed hypoventilation during sleep. Wake supine transcutaneous CO2 was 45-47 mmHg, increasing to 51-55 mmHg during sleep, worse with supplemental oxygen to 66-67 mm. Conclusion Chronic hypercapnia is a poor prognostic indicator in COPD4. In patients with persistent hypercapnia following COPD exacerbation, NIV prolongs time to re-admission or death within 12 months2. Blunting of chemoreceptor response has been noted in hypercapnic patients3, possibly causing subsequent daytime hypercapnia and overt respiratory failure. However, nocturnal hypercapnia is present in some patients and may be a risk factor for profound, life-threatening hypercapnia during exacerbation. Future studies are needed to better phenotype patients such as ours who may be seemingly eucapnic in between exacerbations, but markedly hypercapnic during exacerbation, to determine if there is benefit in treating these patients with NIV as well. Support (if any) 1. The American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Report of American Academy of Sleep Medicine Task Force. Sleep 1999:22:667-689 2. Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, et al. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA. 2017:317:2177 3. Scano G,Spinelli A, Duranti R, et al. Carbon dioxide responsiveness in COPD patients with and without chronic hypercapnia. Eur Respir J 1995:8:78-85 4. Cooper CB, Waterhouse J, Howard P. Twelve-year clinical study of patients with hypoxic co pulmonale given long term domiciliary oxygen therapy. Thorax 1987:42:105-110

1027 Title: Hypersomnolence following resection of a craniopharyngioma

Abstract Introduction Craniopharyngiomas are rare tumors that arise from Rathke’s pouch remnants along the pituitary-hypothalamic axis. The tumor and its treatment can lead to significant neurological and endocrinological complications including alterations in appetite, endocrine insufficiency, circadian rhythms and sleep. We report the case of a woman who developed hypersomnia following resection of a craniopharyngioma Report of case(s) This 38-year-old female with neither significant past medical history of sleep, medical, neurological, or psychiatric disorders nor a family history of narcolepsy presented with galactorrhea and amenorrhea. Imaging showed a pituitary tumor. She underwent resection of the tumor with a tissue diagnosis of an adamantinomatous craniopharyngioma. MRI post procedure showed post-surgical changes without new lesions. Diabetes insipidus and panhypopituitarism developed for which appropriate replacement therapy was initiated. She gained approximately one hundred pounds in the weeks post-surgery. Her family described new onset snoring in supine sleeping position and witnessed apneas. She denied hypnagogic hallucinations, cataplexy, or sleep paralysis. She presented to the sleep medicine clinic a few months later for evaluation of persistent hypersomnolence. Conclusion The most common sleep disorders post craniopharyngioma resection are sleep-related breathing disorder, hypersomnia, and circadian rhythm disorder. Sleep and appetite are felt to be altered because of direct surgical compression, injury or vascular compromise of structures involved in the control of sleep, wakefulness, and appetite. This can produce hypothalamic dysfunction induced obesity with secondary sleep-related breathing disorder and worsening hypersomnolence. In this woman the temporal relationship between the surgery and the onset of symptoms is most suggestive of this hypothalamic injury, resulting in abnormal regulation of both appetite and sleep. Improvements in weight control and hypersomnia with use of stimulant therapy in the setting of secondary obstructive sleep apnea have been reported and in addition to standard positive airway pressure therapies give hope for the management of these complications of craniopharyngioma resection. Support (if any)

0459 Cardiovascular Endpoints for Obstructive Sleep Apnea with Twelfth Nerve Stimulation: Measures of Sleep-Related Function

Abstract Introduction Obstructive sleep apnea (OSA) is an increasingly prevalent sleep-related breathing disorder linked to cognitive dysfunction and daytime sleepiness. Positive airway pressure (PAP) therapy, the first-line treatment for OSA, may improve cognitive function and sleepiness, but responses vary. Hypoglossal nerve stimulation (HGNS) is a novel and effective PAP alternative, but its effect on mitigating cognitive decline secondary to OSA is unknown. In the first sham-controlled HGNS trial, we evaluated the effect of HGNS therapy on cognitive measures and patient-reported outcomes (PROs) in patients with moderate-severe OSA. Methods In a double-blind, sham-controlled, randomized crossover therapy trial, patients already stabilized on HGNS therapy underwent four weeks of active and four weeks of sham HGNS, each with a 1-week washout period. Sham therapy was defined as the lowest voltage at which HGNS was sensed by the patient or visualized by the clinician. Cognitive measures (Psychomotor Vigilance Test [PVT], Digit Symbol Substitution Task [DSST]) and sleep-related PROs (Epworth Sleepiness Scale [ESS], Snoring Visual Analog Scale [VAS], Insomnia Severity Index [ISI], Functional Outcomes of Sleep Questionnaire [FOSQ]) were assessed after each 4-week period and compared between active and sham therapy. Results Sixty randomized patients were included. On average, participants were elderly (67.3±9.9 years), overweight (BMI 28.7±4.6 kg/m2) and had severe OSA prior to HGNS therapy (AHI 33.1±14.9 events/hour). Patients’ AHI decreased to 23.0±15.6 events/hour with sham therapy (p=0.0001) and 18.1±14.8 events/hour with active therapy (p&amp;lt; 0.0001), with a 4.9 event/hour decrease between active and sham therapy (p=0.014). There were no significant differences in performance measures on PVT or DSST between active and sham HGNS. All sleep-related PROs were statistically significant with moderately large (effect sizes ~0.41-0.56) improvements following active HGNS. Conclusion The HGNS system permits a unique investigation of the therapy “on/off” effect on measures of cognitive function. In the first sham-controlled, randomized crossover trial of patients using HGNS, all sleep-related PROs, but not objective measures of cognition, were significantly different between sham and active (therapeutic) levels. These findings warrant additional investigation examining the relationship between subjective and objective measures of function in OSA. Support (if any) American Heart Association (17SDG33670349) American Sleep Medicine Foundation (176-JF-17) National Institutes of Health (P01-HL094307)

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.

0956 Evaluation of a novel automated oxygen desaturation analysis

Abstract Introduction The oxygen desaturation index (ODI) quantifies the number of desaturations per hour of sleep and is a valuable parameter in diagnosing sleep-related breathing disorders. While oximetry alone is insufficient for an accurate diagnosis, it provides meaningful insights for Obstructive Sleep Apnea (OSA) and the ODI has been shown to correlate with the Apnea-Hypopnea Index (AHI). The close relationship between the ODI and other parameters is especially interesting for home-based sleep studies and/or screening, which typically use a limited set of sensors (but almost always include oximetry) and are becoming increasingly more prevalent. An accurate and automated tool for oximetry analysis will thus be paramount for the sleep clinician. Methods The current study aims to evaluate a novel automated solution for oxygen desaturation scoring, provided by Somnilog. We selected 20 overnight recordings, a mix of hospital- and home-based recordings from a dataset from the Antwerp University hospital and an internal database collected from several French sleep centers. The analyzed population (10 females, age 53.0±16.7 years old, BMI of 28.8±4.8 kg/m²) had a variety of diagnoses, including non-apneic snoring and central and obstructive sleep apnea. Each recording was also scored for oxygen desaturations by a sleep expert, using the AASM guidelines and a 3% drop criterion. Results The automated solution accurately detected desaturation events with a precision and recall of 0.97 and 0.96, respectively. The reported ODI had an intraclass correlation (ICC) of 0.99 with the index found by the expert. The difference in the number of events reported by the automated solution and the expert was not significant between the lab- and home-recorded patients (p=0.23). We furthermore validated the novel solution with another well-used commercial package and obtained similar performance metrics: precision and recall of 0.96 and ICC of 0.99. Conclusion The current study demonstrates the validity of the novel commercial package for oxygen desaturation scoring. The automated tool achieved near-perfect agreement with the sleep experts, and a similar performance to another existing solution in the market. The tool is robust for home-based recordings which are typically more artifact-prone, thereby supporting the increasing demand for out-of-centre overnight studies. Support (if any) n/a

0523 Disparities in Discussion of Sleep-related Breathing Disorders with a Physician

Abstract Introduction Race, immigration status and healthcare access have known associations with sleep health in socially disadvantaged groups. The prevalence and severity of sleep disorders, such as obstructive sleep apnea (OSA) are higher among non-whites and underdiagnosed in socially disadvantaged groups. Associations between sleep health and country of birth have also been identified. Certain minority groups are known to be less likely to report symptoms of OSA or insomnia to a physician. It's therefore possible that propensity for sleep disorder self-report plays a role in disparities of sleep health in socially disadvantaged groups. To our knowledge the predictors of sleep disorder self-report have yet to be studied. We aim to assess the predictors of sleep disorder self-report and analyze for associations with race, immigration status and healthcare access. Methods We conducted a cross-sectional analysis of 9,163 adult (age &amp;gt;18) patients in the National Health and Nutrition Examination Survey 2017-2020 database who answered the sleep disorders questionnaire and had race, immigration status and healthcare access data. Any answer to “How often do you snort or stop breathing (during sleep)?” was used as a surrogate endpoint for symptoms of OSA. “Yes” to “Ever told a doctor that you had trouble sleeping?” was used as a surrogate endpoint for sleep disorder self-report. We analyzed this cohort for associations between demographic characteristics, symptoms of OSA and sleep disorder self-report with survey sampling weights in STATA 17.0. Results In patients with symptoms of OSA (24%), measures of limited healthcare access, such as lack of health insurance (OR=1.59, p=0.030), or lack of location routinely visited for healthcare needs (OR=1.77, p=0.024), predicted higher likelihood of sleep disorder symptom non-disclosure, after adjustment for sex, age, and BMI. Non-white race (OR=1.70, p&amp;lt; 0.001) and being an immigrant (OR=2.40, p&amp;lt; 0.001) predicted higher likelihood of sleep disorder symptom non-disclosure in patients without symptoms of OSA, but not in patients with symptoms of OSA, after adjustment for sex, age, and BMI. Conclusion Our findings indicate that patients with limited healthcare access should be considered more strongly for sleep health evaluation and that non-white and immigrant patients are less likely to discuss sleep health with a physician. Support (if any)

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.

Managing Obstructive Sleep Apnea With Positive Airway Pressure Therapy in Primary Care

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. The primary care provider (PCP) is in a prime position to identify sleep-related disorders during routine appointments. The steps provided in this article may alert the PCP when to have a high suspicion of sleep-related breathing disorders and help to understand which sleep study to order, what to include in a positive airway pressure order, and when referral to a pulmonary/sleep specialist is warranted. This article also provides documentation guidelines for follow-up and troubleshooting tips.