Treatment Of Sleep-disordered Breathing Research Articles

Early sleep apnea treatment in stroke (eSATIS) - a multicentre, randomised controlled, rater-blinded, clinical trial: The association of post-stroke cognition with sleep-disordered breathing and its treatment.

Sleep-disordered breathing (SDB) is linked to cognitive dysfunction. Although SDB is common in stroke patients, the impact of SDB and its early treatment on cognitive functioning after stroke remains poorly investigated. Therefore, we explored the association between SDB and post-stroke cognitive functioning, including the impact of early SDB treatment with adaptive servo-ventilation (ASV) on cognitive recovery from acute event to 3 months post-stroke. We used data from two studies, which included ischaemic stroke patients (n = 131) and no-stroke controls (n = 37) without SDB (apnea-hypopnea index, AHI <5/h) and with SDB (AHI≥20/h). Cognitive functioning was assessed within 7 days and 3 months post-stroke in stroke patients, or at study inclusion in no-stroke control group, respectively. Stroke patients with SDB were randomized to ASV treatment (ASV+) or usual care (ASV-). Linear regression adjusted for main confounders assessed the impact of SDB and its treatment on cognitive recovery. The intention-to-treat analysis did not show significant associations of SDB ASV+ (n = 30) versus SDB ASV- (n = 29) with cognitive recovery. In an exploratory subanalysis, compliant SDB ASV+ (n = 14) versus SDB ASV- showed improvements with ASV in visual memory and cognitive flexibility. Combining the stroke and non-stroke datasets, SDB (n = 85) versus no-SDB (n = 83) was associated with deficits in visual memory and response inhibition independently of stroke. SDB ASV- versus no-SDB (n = 51) was associated with less improvement in visual memory. There was no substantial evidence for benefits of intention-to-treat ASV on cognitive recovery. Exploratory analysis indicated that compliant ASV treatment could benefit visual memory and cognitive flexibility, whereas untreated SDB could contribute to a poor recovery of visual memory.

Treatment of sleep apnoea early after myocardial infarction with adaptive servo-ventilation: a proof-of-concept randomised controlled trial.

Sleep disordered breathing (SDB) has been associated with less myocardial salvage and smaller infarct size reduction after acute myocardial infarction (AMI). The Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation (TEAM-ASV I) trial investigated the effects of adding adaptive servo-ventilation (ASV) for SDB to standard therapy on the myocardial salvage index (MSI) and change in infarct size within 12 weeks after AMI. In this multicentre, randomised, open-label trial, patients with AMI and successful percutaneous coronary intervention within 24 h after symptom onset plus SDB (apnoea-hypopnoea index ≥15 events·h-1) were randomised to standard medical therapy alone (control) or plus ASV (starting 3.6±1.4 days post-AMI). The primary outcome was the MSI at 12 weeks post-AMI. Cardiac magnetic resonance (CMR) imaging was performed at ≤5 days and 12 weeks after AMI. 76 individuals were enrolled from February 2014 to August 2020; 39 had complete CMR data for analysis of the primary end-point. The MSI was significantly higher in the ASV versus control group (difference 14.6% (95% CI 0.14-29.1%); p=0.048). At 12 weeks, absolute (6.6 (95% CI 4.8-8.5) versus 2.8 (95% CI 0.9-4.8) % of left ventricular mass; p=0.003) and relative (44 (95% CI 30-57) versus 21 (95% CI 6-35) % of baseline; p=0.013) reductions in infarct size were greater in the ASV versus control group. No serious treatment-related adverse events occurred. Early treatment of SDB with ASV improved the MSI and decreased infarct size at 12 weeks after AMI. Larger randomised trials are required to confirm these findings.

Sleep Disordered Breathing and Exercise in Pulmonary Hypertension

Exercise intolerance is a common feature of many cardiopulmonary diseases including pulmonary hypertension (PH) and sleep disordered breathing (SDB), which includes obstructive sleep apnea and obesity hypoventilation syndrome. Physiologic abnormalities in both PH and SDB can drive exercise intolerance, and biological mechanisms overlap among the conditions including systemic inflammation, oxidative stress, metabolic dysfunction, and endothelial dysfunction. Despite this understanding, evidence establishing clear causal relationships among PH, SDB, and exercise intolerance is lacking. Data show that treatment of SDB may improve exercise capacity, and exercise training likely improves SDB, although these relationships specifically in PH remain understudied. In this manuscript, we summarize existing data of mechanisms and clinical observations in PH, SDB and exercise and identify gaps and opportunities for future investigation.

Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in...

Potential determinants of nocturnal hypoxemic burden and its association with atrial fibrillation recurrence after catheter ablation

Abstract Background Sleep-disordered breathing (SDB) is present in approximately half of patients with atrial fibrillation (AF) scheduled for catheter ablation (CA) and coincides with an elevated nocturnal hypoxemia. Purpose To evaluate determinants of nocturnal hypoxemic burden metrics and its association with AF recurrence after CA in patients undergoing a systematic SDB management and treatment pathway. Methods Consecutive AF patients scheduled for CA without history of SDB and/or SDB screening were included. Patients were referred to a virtual SDB management pathway including mobile health supported overnight home sleep test. An apnoea-hypopnoea index (AHI) of 5 to &amp;lt;15 and ≥ 15 were interpreted as mild and moderate-to-severe SDB, respectively. Oximetry data from home sleep tests were analyzed by a computer algorithm to evaluate metrics of nocturnal hypoxemic burden: time spent below 90% oxygen desaturation (T90) based on acute desaturations (T90 desat) or non-specific drifts in oxygen desaturation (T90 non-spec). Patients were monitored for AF recurrences through standard 12-lead ECG or Holter ECG and/or smartphone-based photophletysmography (PPG) performed at 3- and 12-month follow up. Multiple regression analysis was employed to (1) evaluate determinants of nocturnal hypoxemic burden metrics and (2) identify predictors of AF recurrence during 12 months after CA (excluding 3 months blanking period). Results The analysis included 210 patients (42% female, mean age 64± 9 years). Median AHI was 14.7 [6.7-24.7], median T90desat was 0.25 [0.03-1.42] minutes, T90non-spec 0.26 [0.08-0.78] minutes. Overall, 101 (48%) patients were diagnosed with moderate-to-severe SDB and 68 (32%) had mild SDB. Of patients with moderate-to- severe SDB and mild SDB, 87% and 46%, respectively, received a SDB therapy recommendation. Multiple linear regression analysis identified diabetes mellitus (B 8.611 95%CI 1.350-15.871, p=0.020) and AHI ≥ 15 (B 5.886, 95%CI 1.793-9.979, p= 0.005) as predictors of T90non-spec. Thyroid dysfunction (B 1.849, 95%CI 0.623-3.075, p=0.003) and AHI ≥ 15 (B 2.161, 95%CI 1.320-3.001, p&amp;lt;0.001) were significant predictors of T90desat. During 12 months after CA, 65 (31%) patients had experienced at least one AF recurrence after the blanking period. After multiple Cox-regression, age (HR 1.032, 95%CI 1.002-1.063, p= 0.035) and BMI ≥ 25 (HR 2.029, 95%CI 1.032-3.989, p=0.040) remained predictors for AF recurrences. Conclusions In AF patients scheduled for CA, SDB (AHI ≥ 15) and thyroid dysfunction were predictors for nocturnal hypoxemic burden with repetitive desaturations (T90desat). SDB and diabetes mellitus were predictors for nocturnal hypoxemic burden without repetitive desaturations (T90non-spec). In patients with AF who followed a virtual SDB management and treatment pathway, SDB presence and nocturnal hypoxemic burden metrics did not emerge as predictors, whereas age and BMI (≥25) remained significant predictors for AF recurrence.

Intensive support does not improve positive-airway pressure use in spinal cord injury/disease: a randomized clinical trial.

Treatment of sleep-disordered breathing (SDB) with positive airway pressure (PAP) therapy has unique clinical challenges in individuals living with spinal cord injuries and diseases (spinal cord injury [SCI]/D). Interventions focused on increasing PAP use have not been studied in this population. We aimed to evaluate the benefits of a program to increase PAP use among Veterans with SCI/D and SDB. Randomized controlled trial comparing a behavioral Intervention (n = 32) and educational control (n = 31), both including one face-to-face and five telephone sessions over 3 months. The intervention included education about SDB and PAP, goal setting, troubleshooting, and motivational enhancement. The control arm included non-directive sleep education only. Primary outcomes were objective PAP use (nights ≥4 hours used within 90 days) and sleep quality (Pittsburgh Sleep Quality Index [PSQI] at 3 months). These did not differ between intervention and control (main outcome timepoint; mean difference 3.5 [-9.0, 15.9] nights/week for PAP use; p = .578; -1.1 [-2.8, 0.6] points for PSQI; p = .219). Secondary outcomes included fatigue, depression, function, and quality of life. Only fatigue improved significantly more in the intervention versus the control group (p = .025). Across groups, more PAP use was associated with larger improvements in sleep quality, insomnia, sleepiness, fatigue, and depression at some time points. PAP use in Veterans with SCI/D and SDB is low, and a 3-month supportive/behavioral program did not show significant benefit compared to education alone. Overall, more PAP use was associated with improved symptoms suggesting more intensive support, such as in-home assistance, may be required to increase PAP use in these patients. Title: "Treatment of Sleep Disordered Breathing in Patients with SCI." Registration number: NCT02830074. Website: https://clinicaltrials.gov/study/NCT02830074?cond=Sleep%20Apnea&term=badr&rank=5.

Abstract 140: Sleep-Disordered Breathing Shortly After Stroke Does Not Predict Post-Stroke Fatigue at 3-months

Background: Post-stroke fatigue (PSF) is a common and often disabling symptom, the causes of which are poorly understood. Sleep-disordered breathing (SDB) is highly prevalent among stroke survivors, and can cause fatigue. We examined whether SDB measured shortly after stroke predicted PSF at 3-months, and thus whether SDB might represent an intervention target for the treatment/prevention of PSF. Methods: Ischemic stroke (IS) patients within the Brain Attack Surveillance in Corpus Christi (BASIC) project were identified through active and passive surveillance, and were offered SDB screening with a well-validated cardiopulmonary sleep apnea testing device. The primary exposure was the respiratory event index (REI; sum of apneas plus hypopneas per hour of recording), measured shortly after stroke. The primary outcome was PSF, measured 3-months post-stroke, using the SF-36 vitality scale. Linear regression was used to evaluate the association between baseline REI and 3-month PSF, adjusting for clinical and sociodemographic factors listed in the Table, which were obtained from chart review and interviews. Results: A total of 355 IS participants completed baseline SDB screening and 3-month PSF assessments from May 2016 to December 2019. Participants were 44% female, 60% Mexican American (MA), and had a median NIHSS of 2 (IQR: 1-5). Multivariable regression model results are presented in the Table. No association between baseline REI and 3-month PSF was observed in unadjusted (β=0.95, 95% CI=-1.16, 3.05) or fully adjusted models (β=0.66, 95% CI=-1.40, 2.73). In the fully adjusted model, female sex and depression were associated with greater fatigue, while older age and MA ethnicity were associated with less fatigue. Conclusions: SDB in the immediate post-stroke period, at least in this predominantly MA sample, does not predict PSF at 3-months. Though identification and treatment of post-stroke SDB may be important, these efforts are unlikely to impact PSF.

A multicenter clinical trial for the treatment of sleep-disordered breathing with a non-permanent orthodontic slow expansion oral appliance in children

A multicenter clinical trial for the treatment of sleep-disordered breathing with a non-permanent orthodontic slow expansion oral appliance in children

Revisiting the Role of Serotonin in Sleep-Disordered Breathing.

Serotonin or 5-hydroxytryptamine (5-HT) is a ubiquitous neuro-modulator-transmitter that acts in the central nervous system, playing a major role in the control of breathing and other physiological functions. The midbrain, pons, and medulla regions contain several serotonergic nuclei with distinct physiological roles, including regulating the hypercapnic ventilatory response, upper airway patency, and sleep-wake states. Obesity is a major risk factor in the development of sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA), recurrent closure of the upper airway during sleep, and obesity hypoventilation syndrome (OHS), a condition characterized by daytime hypercapnia and hypoventilation during sleep. Approximately 936 million adults have OSA, and 32 million have OHS worldwide. 5-HT acts on 5-HT receptor subtypes that modulate neural control of breathing and upper airway patency. This article reviews the role of 5-HT in SDB and the current advances in 5-HT-targeted treatments for SDB.

ДИХАЛЬНІ РОЗЛАДИ ПІД ЧАС СНУ У ДОРОСЛИХ: ТЕМИ ПОТОЧНИХ НАУКОВИХ ДОСЛІДЖЕНЬ ТА ОСНОВНІ ОНОВЛЕННЯ ПРАКТИЧНИХ РЕКОМЕНДАЦІЙ

Respiratory disorders during sleep are an urgent and multifaceted problem of clinical medicine, in which the insufficient practical implementation of medical care for patients does not correspond to fundamental scientific achievements. The aim of this review was to assess the significant updates of practical recommendations for the diagnosis and treatment of sleep-disordered breathing in adults. The global lack of practical success in the treatment of patients with sleep-related breathing disorders supports the high relevance of the problem and prompts new research in pathology (biomarkers, structural disorders, risk factors, etc.) and modification of devices for diagnosis and therapy. Today, the classification of sleep-related breathing disorders has been updated. The functional criteria of polysomnography in determining ventilation disorders have been clarified. Diagnostic criteria for disorders associated with obstructive and central sleep apnea have undergone minor changes. Updated practice guidelines for obstructive sleep apnea include failure of CPAP therapy, revised indications for positional therapy, and upper airway or bariatric surgery. Updates in the treatment of central sleep apnea relate to the functional state of the heart and the type of respiratory disorder. In heart failure with a reduced ejection fraction adaptive servo-ventilation is contraindicated, in hypercapnia and/or hypoventilation during the rapid phase of sleep non-invasive lung ventilation is required. Current updates recommend positive airway pressure therapy (CPAP-therapy for concomitant severe obstructive sleep apnea) in stable outpatients with obesity-hypoventilation syndrome, and noninvasive ventilation in hospitalized patients with respiratory failure. General approaches to treatment remain constant: ventilatory disorders require appropriate mechanical correction. Key words: sleep-related breathing disorders, obstructive sleep apnea, central sleep apnea.

Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study

The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P<0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P<0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Sleep in pediatric neuromuscular disorders

Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.

Identifying barriers to obstructive sleep-disordered breathing care: Parental perspectives.

Despite established clinical practice guidelines for pediatric obstructive sleep-disordered breathing (SDB), disparities persist for this common condition. Few studies have investigated parental experiences about challenges faced in obtaining SDB evaluation and tonsillectomy for their children. To better understand parent-perceived barriers to treatment of childhood SDB, we administered a survey to assess parental knowledge of this condition. A cross-sectional survey was designed to be completed by parents of children diagnosed with SDB. Two validated surveys were administered: 1) Barriers to Care Questionnaire and 2) Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents. Logistic regression modeling was performed to assess for predictors of parental barriers to SDB care and knowledge. Eighty parents completed the survey. Mean patient age was 7.4±4.6 years, and 48 (60%) patients were male. The survey response rate was 51%. Patient racial/ethnic categories included 48 (60.0%) non-Hispanic White, 18 (22.5%) non-Hispanic Black, and 14 (17.5%) Other. Parents reported challenges in the 'Pragmatic' domain, including appointment availability and cost of healthcare, as the most frequently described barrier to care. Adjusting for age, sex, race, and education, parents in the middle-income bracket ($26,500 - $79,500) had higher odds of reporting greater barriers to care than parents in the highest (>$79,500) income tier (OR 5.536, 95% CI 1.312-23.359, P=0.020) and lowest income tier (<$26,500) (OR 3.920, 95% CI 1.096-14.020). Parents whose children had tonsillectomy (n=40) answered only a mean 55.7%±13.3% of questions correctly on the knowledge scale. Pragmatic challenges were the most encountered barrier that parents reported in accessing SDB care. Families in the middle-income tier experienced the greatest barriers to SDB care compared to lower and higher income families. In general, parental knowledge of SDB and tonsillectomy was relatively low. These findings represent potential areas of improvement to target interventions to promote equitable care for SDB.

Early screening and treatment methods of pediatric sleep-disordered breathing(SDB) in dental office

Pediatric sleep-disordered breathing(SDB) is a common sleep disorder in children caused by obstruction of upper airway during sleep. It is often unrecognized early in life and causes various complications, including abnormal craniofacial growth and oral muscle dysfunctions. Dentist can play a significant role in managing SDB by early screening SDB risk factors and timely referring for diagnosis. SDB risk factors can be easily screened in dental office through medical history, sleep history, physical factors, sleep questionnaire, and cephalometric x-ray. In case of abnormal craniofacial development, rapid maxillary expansion, oral appliances, and myofunctional therapy can be used to reduce SDB symptoms and restore normal craniofacial development and muscular tones. Understanding continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB is important in managing pediatric SDB. The ultimate goal of pediatric SDB treatment is to change mouth breathing to nasal breathing, and a multidisciplinary approach in medicine and dentistry is necessary.

0806 Treatment of sleep disordered breathing improves quality of life in children with Down syndrome

Abstract Introduction Children with Down syndrome (DS) are at increased risk of obstructive sleep disordered breathing (SDB), which is associated with sleep disruption affecting daytime functioning. We examined the effects of treatment of SDB on sleep and daytime functioning in children with DS. Methods Children with DS and SDB (n=34) completed a baseline and follow-up study which included 7 days of actigraphy in conjunction with a parental sleep diary. Parents also completed a number of questionnaires assessing sleep, behaviour, daytime functioning and quality of life (QOL). All children had overnight polysomnography (PSG) at baseline and 24 had PSG at follow-up. Results 15 children (44%) were treated. At baseline the treated group had more severe SDB at baseline compared to the untreated group: obstructive apnoea hypopnoea index (OAHI) 29.3 ± 38.2 events/h vs 3.3 ± 5.2 events/h (p&amp;lt; 0.01). Actigraphy showed no significant differences in total sleep time or sleep efficiency from baseline to follow up in either the treated or untreated group. Wake after sleep onset increased at follow-up in the untreated group (p&amp;lt; 0.01). The sleep disturbance (p&amp;lt; 0.01) and total problems (p&amp;lt; 0.05) scales on the OSA-18 and the SDB subscale on the Pediatric Sleep Problem Survey Instrument (p&amp;lt; 0.01) improved in the treated children. No changes were seen in any of the measures in the untreated children. Conclusion Treatment of SDB improves QOL, despite treatment having no demonstrable impacts on actigraphic sleep measures. In contrast despite having less severe SDB children who were untreated had no improvements in QOL and increased sleep disruption. Support (if any) Jerome Lejeune Foundation

1003 Immediate Improvement of Second Degree Heart Block With Effective Treatment of Sleep-Disordered Breathing

Abstract Introduction Cardiac arrhythmia and heart block in particular is commonly found in association with obstructive sleep apnea (OSA). Here we describe real-time responsivity of 2nd degree heart block to treatment of OSA with positive airway pressure (PAP) during a titration study. Report of case(s) Our patient is a 70-year old man without significant cardiovascular disease. He presented with loud snoring and excessive daytime sleepiness. A home sleep apnea test in July 2020 revealed obstructive sleep apnea (respiratory event index 20, oxygen saturation nadir 86%). The patient was treated with auto-adjusting continuous positive airway pressure (APAP) and had symptomatic benefit. His most recent machine data download suggested an elevated residual respiratory event index (REI) of 19.6, 16.5 of which were central. A split-night study was performed to re-characterize the nature of the patient’s obstructive sleep apnea and treatment needs. The baseline portion of the study (AHI 50.8, oxygen saturation nadir 86%) was notable for the presence of frequent 2nd degree heart block (171.0 events/hour of recording). During the titration portion of the study, frequent central sleep apneas emerged with the addition of PAP therapy, consistent with treatment-emergent central sleep apnea. The patient was transitioned to bilevel positive airway pressure spontaneous timed mode (BPAP ST), and a pressure setting of 13/6 cm of water with backup rate of 14 breaths per minute effectively controlled his sleep-disordered breathing. The heart block that had been observed during the baseline portion of the study dramatically improved with the start of BPAP ST. Once the patient’s sleep-disordered breathing was controlled, the patient’s heart block occurred at a rate of only 12.1 events/hour of recording. Conclusion Treatment of sleep apnea has been established to be beneficial for the improvement of cardiac arrhythmias. This case is remarkably instructive in that attainment of an effective treatment setting for sleep-disordered breathing resulted in an almost immediate improvement of heart block. Support (if any)

0446 Sleep Disordered Breathing Treatment is Associated with Improved Mental Health Symptoms and Quality of Life in Women Veterans

Abstract Introduction Sleep disordered breathing (SDB) is associated with poor mental health and lower overall quality of life (QOL); however, research examining these outcomes after positive airway pressure (PAP) therapy for SDB in women is limited. We studied a 6-session PAP adherence program that included behavioral sleep improvement strategies plus concepts of Acceptance and Commitment Therapy (ACT) to promote sustained PAP use, and evaluated the impact of this ACT-based program on daytime and mental health symptoms and quality of life in a sample of women veterans with SDB who were prescribed PAP. Methods Women veterans with SDB (n=90, mean = 53.2 years [range 26-80]) receiving care in an urban VA healthcare system were randomly assigned to a “control” SDB/PAP education program or the “Acceptance and Behavioral Changes to treat Sleep Apnea” (ABC-SA) program. All received PAP therapy. Measures included: Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient-Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder Questionnaire 7-item (GAD), and The World Health Organization Quality of Life Scale, Brief (WHOQOL BREF). Mixed-effect models assessed the main effect of time across groups and between-group changes in these measures at post-treatment and 3 month-follow up compared to baseline. Results For the main effect of time, participants in both groups had significant improvements at post-treatment and 3-month follow-up in sleepiness, fatigue, depression, anxiety, and QOL (all p&amp;lt; 0.05). Compared to controls, women who received ABC-SA reported greater improvements in daytime sleepiness (ESS) at post treatment (p=0.04) and in fatigue (FFS) at 3-month follow-up (p=0.008). Conclusion PAP treatment in women with SDB was associated with improvements in measures of mental health and QOL. There was some evidence of even greater benefits with ABC-SA. Further work is needed to understand the relationship between SDB treatment and improved mental health outcomes in women and other underrepresented populations. Support (if any) VA HSR&amp;D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&amp;D COIN; VAGLAHS GRECC and VA Office of Academic Affiliations

Parental Experiences With Access to Care for Obstructive Sleep-Disordered Breathing: A Qualitative Study.

Despite evidence-based guidelines for obstructive sleep-disordered breathing (SDB), recent studies continue to highlight treatment inequities. We used qualitative research methods to examine parental facilitators and barriers to SDB treatment. Qualitative interviews. Tertiary care center. Semistructured interviews were conducted (January-April 2022) with parents of children with SDB who underwent tonsillectomies to understand the processes of SDB detection and accessing specialty care. Interviews were conducted until thematic saturation was reached and coded using NVivo software. Of the 17 parents who completed the key informant interviews, 6 (35%) were of non-Hispanic black race, and 3 (17.6%) interviews were conducted in Spanish. Parents noted that the more knowledge their primary care provider (PCP) had about SDB, the easier it was to obtain a diagnostic workup (41%). The most common barrier included difficulty obtaining a specialist (otolaryngology or sleep medicine) referral from their PCP and encountering providers who were dismissive of parent-reported symptoms related to SDB, leading them to seek a second opinion or self-refer (53%). Medicaid coverage was a strong facilitator to receipt of care (59%). Three (17.6%) parents noted alienation in the process due to racial bias or language barriers. Parental interviews revealed that facilitators of SDB treatment included high clinician knowledge and perceived importance of SDB as well as Medicaid insurance which decreased financial strain. Parents also cited the attainment of referrals as a significant barrier to obtaining specialty evaluation. These findings identify potential modifiable areas to tailor future interventions for timely and equitable SDB care.

0925 Population Health and Data Analytics as an Opportunity for Improving Care Quality in Sleep Medicine

Abstract Introduction The volume and diversity of sleep-related and quality of life complaints in sleep medicine has increased through improved availability of data from wearables and public education on sleep health. Future shifts away from quantity and towards quality-based compensation by insurance payors will require practices to understand and actively monitor population health and outcomes data and implement data-driven practices to improve diagnostic efficiency. Currently, prevalence and population health data benchmarks are incomplete or absent in many aspects of sleep disorders treatment. The integrated care model of sleep medicine, with board-certified primary sleep physicians, an in-house Positive Airway Pressure (PAP) Therapy clinic and certified sleep medicine Dentist, is uniquely positioned to improve care by characterizing the impact of clinical decision-making on care cost and quality. Methods Population health data was gathered in the course of patient care in the integrated care model. Baseline/Diagnostic Home Sleep Apnea Test (HSAT) results from 2018-2021 were included. Diagnostic severity was categorized based on AASM treatment guidelines. Matched therapy visits were included from PAP Therapy Initiation or Compliance visit and treatment outcomes, as well as non-PAP treatments for sleep-disordered breathing, Oral Appliance (OA) and Inspire Therapy. Results 20% of 8531 Diagnostic HSAT results were non-diagnostic for sleep apnea, 35% were Mild, 21% Moderate and 24% Severe. Of non-diagnostic tests, 81% had no sleep apnea treatment associated. Of Mild diagnostic tests, 49% had associated PAP initiation or compliance, 9% had associated OA, and 42% had no treatment associated. The relationship between diagnostic severity and associated treatment was significant (Χ2 &amp;lt; 0.0001). Further, Moderate and Severe resulting diagnostic tests had no associated treatment in 24% and 28% of cases, respectively. Conclusion Sleep medicine patients are commonly symptomatic and often have major quality of life complaints. Yet as these data demonstrate, there is a substantial proportion of patients who do not have an associated treatment after a positive diagnostic home sleep apnea test. Future studies should include additional demographic and follow up data to better understand care pathways both for patients who receive a positive diagnostic test but pursue alternative treatment methods, as well as more complicated non-diagnostic sleep disorders patients. Support (if any)

Evaluation of polysomnography findings in children with genetic skeletal disorders.

Children with genetic skeletal disorders have variable conditions that can lead to sleep-disordered breathing, and polysomnography is the gold standard for diagnosing this condition. We aimed to review polysomnography findings, to assess the severity of sleep apnea, and to investigate the clinical variables predictive of sleep-disordered breathing in these patients. We retrospectively collected the medical records of patients with genetic skeletal disorders who underwent polysomnography for 5 years. Twenty-seven children with various genetic skeletal disorders, including achondroplasia (14), Crouzon syndrome (3), acromesomelic dysplasia Maroteaux type (3), Apert syndrome (2), osteopetrosis (1), Jeune dysplasia (1), Desbuquois dysplasia (1), acrodysostosis (1), and spondyloepiphyseal dysplasia (1) were enrolled. The median age at the first polysomnography was 58 (1st-3rd quartile: 31-113) months. The overall sleep-disordered breathing results were: 19 (70.3%) had obstructive sleep apneas (OSA) (4 mild, 6 moderate, 9 severe), 2 (7.4%) had central apneas, 4 (14.8%) had nocturnal hypoventilation. There was a significant correlation between non-ambulatory status with both total AHI and OSA (p < 0.001, rho: -0.66/p = 0.04, rho: 0.38, respectively). Nine patients received positive airway pressure titration, and the oAHI values of all returned to the normal range. These patients were started with positive airway pressure treatment. Our cohort showed that the majority of the patients with skeletal dysplasia had sleep apnea syndrome characterised mainly by OSA, highlighting the importance of polysomnography screening for sleep disorders. Positive airway pressure therapy represents an effective treatment for sleep-disordered breathing in those patients.