Undiagnosed Obstructive Sleep Apnea Research Articles

Sex-specific prevalence and correlates of possible undiagnosed obstructive sleep apnea in rural Canada

BackgroundObstructive Sleep Apnea (OSA) has been under-investigated in rural communities, particularly through a sex/gender lens. The purpose of this study was to examine the prevalence and correlates of OSA risk among rural-dwelling women and men in Saskatchewan, Canada.MethodsParticipants for this cross-sectional study were 2340 women and 2030 men living in rural Saskatchewan, Canada and were without a prior diagnosis of OSA. The dependent variable, OSA risk, was estimated from self-reported symptoms of OSA and percentage body fat. Independent variables included socio-demographic characteristics, health behaviors, comorbidities, and quality of life indicators. Multivariable logistic regression was the primary statistical technique employed, conducted separately for women and men.ResultsA greater proportion of men (30.1%) than women (19.4%) were at high risk of OSA. While many of the correlates of OSA risk were similar for women and men, sex differences emerged for marital status, educational attainment, financial strain, depression, asthma, and perceptions of community support.ConclusionA sizable minority of rural women and men may have possible undiagnosed OSA, which in turn, is associated with substantial comorbidity and reduced quality of life. Additional research with enhanced measurement and a longitudinal design is required to test the veracity of these findings and further clarify the role of sex/gender in relation to OSA risk in rural adults.

Predicting Obstructive Sleep Apnea Based on Computed Tomography Scan Using Deep Learning Models.

The incidence of clinically undiagnosed obstructive sleep apnea (OSA) is high among the general population due to limited access to polysomnography. Computed tomography (CT) of craniofacial regions obtained for other purposes can be beneficial in predicting OSA and its severity. To predict OSA and its severity based on paranasal CT using a 3-dimensional deep learning algorithm. One internal dataset (n=798) and two external datasets (n=135 and 85) were used in this study. In the internal dataset, 92 normal, 159 mild, 201 moderate, and 346 severe OSA participants were enrolled to derive the deep learning model. A multimodal deep learning model was elicited from the connection between a 3-dimensional convolutional neural network (CNN)-based part treating unstructured data (CT images) and a multi-layer perceptron (MLP)-based part treating structured data (age, sex, and body mass index) to predict OSA and its severity. In four-class classification for predicting the severity of OSA, the AirwayNet-MM-H model (multimodal model with airway-highlighting preprocessing algorithm) showed an average accuracy of 87.6% (95% confidence interval [CI] 86.8-88.6) in the internal dataset and 84.0% (95% CI 83.0-85.1) and 86.3% (95% CI 85.3-87.3) in the two external datasets, respectively. In the two-class classification for predicting significant OSA (moderate to severe OSA), The area under the receiver operating characteristics (AUROC), accuracy, sensitivity, specificity, and F1 score were 0.910 (95% CI 0.899-0.922), 91.0% (95% CI 90.1-91.9), 89.9% (95% CI 88.8-90.9), 93.5% (95% CI 92.7-94.3), and 93.2% (95% CI 92.5-93.9), respectively, in the internal dataset. Furthermore, the diagnostic performance of the Airway Net-MM-H model outperformed that of the other six state-of-the-art deep learning models in terms of accuracy for both four- and two-class classifications and AUROC for two-class classification (p<0.001). A novel deep learning model, including a multimodal deep learning model and an airway-highlighting preprocessing algorithm from CT images obtained for other purposes, can provide significantly precise outcomes for OSA diagnosis.

Occult, undiagnosed obstructive sleep apnea is associated with increased health care resource utilization and costs among older adults with comorbid depression: a retrospective cohort study among Medicare beneficiaries.

Wickwire EM, Albrecht JS. Occult, undiagnosed obstructive sleep apnea is associated with increased health care resource utilization and costs among older adults with comorbid depression: a retrospective cohort study among Medicare beneficiaries. J Clin Sleep Med. 2024;20(5):817-819.

Risk of obstructive sleep apnea among health workers: results of a screening in a large Italian University Hospital.

Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and injuries. Studies on the risk of OSA (rOSA) among health workers (HW) are scant. The aims of this study were to investigate this issue in a large University Hospital and to assess the effectiveness of a screening program. The STOP-BANG questionnaire (SBQ) was sent via e-mail to the 5031 HW employed at the University Hospital of Verona. HW who completed the SBQ were classified at low, moderate, and high rOSA. HW at high rOSA were invited to undergo nocturnal polygraphy. The determinants of rOSA were studied by non-parametric Kruskal-Wallis test, Pearson's chi-squared, and multinomial logistic model. Of 5031 HW, 1564 (31.1%) completed the online questionnaire. Responders with low, moderate, and high rOSA were 72.7%, 13.7%, and 13.6%. Male gender, older age, and higher body mass index (BMI) were significant predictors of high rOSA, as expected. Physicians had the lowest probability of being in the high-risk category. Polygraphy was performed in 64 subjects. The positive predictive value of the self-administered SBQ was 68.8% (95%C.I. 55.9-79.8%) but raised to 96.9% (95%C.I. 89.2-99.6%) when re-administered by medical staff. SBQ showed its effectiveness as a screening tool in detecting undiagnosed OSA in HW. Systematic screening for OSA in work settings could allow early diagnosis and treatment, reducing short- and long-term health effects of OSA.

Undiagnosed obstructive sleep apnea syndrome as a treatable cause of new-onset sleepiness in some post-COVID patients.

Infection with COVID-19 can lead to persistent sequelae, such as fatigue, daytime sleepiness or disturbed sleep, that can remain for more than 12 weeks and that are summarized as post-COVID syndrome. The causes remain unclear. The present study investigated the presence of sleep disorders in patients with post-COVID syndrome using polysomnography. Thirty-four patients with post-COVID syndrome and new-onset fatigue and sleepiness after a SARS-CoV2 infection underwent polysomnography in accordance with American Association of Sleep Medicine (AASM) standards as part of their clinical workup. Analysis was performed visually based on AASM criteria (scoring manual version 2.6, 2020). Polysomnography revealed a sleep efficiency of <80% in 50% of patients and a mean respiratory disturbance index (RDI) of 9.9 ± 15.4/h. Excluding central apneas, 12 patients (35%) had an RDI of ≥5/h, pointing to obstructive sleep apnea syndrome (OSAS; AASM 2014). Patients with a high RDI were significantly older (p = 0.01) and showed a trend towards a higher body mass index (p = 0.08) than patients with a normal RDI but had no other risk factors for OSAS. Six patients agreed to long-term treatment of their OSAS and all reported discontinuation of daytime symptoms. Post-COVID symptoms such as daytime sleepiness, fatigue and memory and concentration problems may in part be a result of reduced sleep efficiency and sleep apnea in a relevant percentage of patients. This possibly treatable cause of the symptoms should be kept in mind in patients presenting with post-COVID syndrome.

The potential of clinical prediction model development from a change in cardiac repolarization and pulse oximetry data in patients with undiagnosed obstructive sleep apnea undergoing coronary artery bypass grafting.

The potential of clinical prediction model development from a change in cardiac repolarization and pulse oximetry data in patients with undiagnosed obstructive sleep apnea undergoing coronary artery bypass grafting.

"Count on Sleep": an OSA awareness project update.

Martin JL, Rowley J, Goel N, etal. "Count on Sleep": an OSA awareness project update. J Clin Sleep Med. 2024;20(2):303-307.

Obstructive sleep apnea induced bilateral tonic- clonic seizure of unknown origin: A case series of a novel association

BackgroundObstructive sleep apnea is a highly prevalent disorder, characterized by recurrent events of upper airway obstruction during sleep and associated with recurrent cycles of desaturation and re-oxygenation, sympathetic hyperactivity, and intra-thoracic pressure fluctuations, resulting in fragmentation of sleep and subsequent daytime fatigue with excessive sleepiness. Obstructive sleep apnea-induced bilateral tonic–clonic seizures are unheard of. We aimed to report 3 patients with previously undiagnosed obstructive sleep apnea who presented to the emergency department with new onset bilateral tonic–clonic seizure without any evidential neurological or metabolic cause. MethodsPatient data were obtained from medical records from the Department of Internal Medicine, IPGMER and SSKM Hospital, Kolkata, and Belle Vue Clinic, Kolkata, India. ResultsThree male patients (67, 58, and 44 years old) presented with bilateral tonic–clonic seizure disorder without any underlying cause of seizures after rigorous investigations except for moderate to severe obstructive sleep apnea on polysomnography. All 2 patients were seizure-free after being treated with levetiracetam, chronic continuous positive airway pressure therapy in 2, and only continuous positive airway pressure in the other. The patients remained seizure-free on continuous positive airway pressure, even when levetiracetam was withdrawn, suggesting obstructive sleep apnea's causality in their new-onset acute seizures. ConclusionAlthough further investigation is required to clarify this association, underlying obstructive sleep apnea should be ruled out in patients with a first-ever bilateral tonic–clonic seizure. Whether or not continuous positive airway pressure alone could effectively treat hypoxia and deranged cortical excitability, which may lead to seizures in cases with long-standing obstructive sleep apnea, is yet to be explored.

Rethinking the distribution of sleep services: discrepancy of obstructive sleep apnoea in rural compared with metropolitan men in Australia - a large national survey.

Geographical location is increasingly recognised as a contributor to health inequity, with barriers including travel distances and a shortage of healthcare services. Individuals living in rural areas are known to have increased illness and comorbidities. Obstructive sleep apnoea (OSA) is one such illness. OSA is a condition where a person repeatedly pauses breathing while asleep due to their airways becoming wholly or partially blocked, and it is associated with various chronic diseases. Exploration into the effects of these barriers on OSA is limited. This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural compared to metropolitan areas. This was a cross-sectional, secondary analysis of the Australian Ten to Men dataset. The present study looked at men aged over 18 years diagnosed with OSA in their lifetime from wave 2 (n=10 513) and wave 3 (n=7262) of the dataset. Wave 2 data were collected between November 2015 and May 2016, and wave 3 between July 2020 and February 2021. In wave 2, a higher proportion of rural men were diagnosed with OSA than metropolitan men (OR, 1.47, 95%CI 1.22-1.78, p<0.001), but not regional men. In addition, a significantly higher proportion of men in rural areas were at risk for OSA than metropolitan men (37.7% v 32.6%, p<0.0001). However, men living rurally were older, had higher BMI and lower socioeconomic status. Location was no longer a significant predictor of OSA after controlling for age, BMI and socioeconomic status. In wave 3, rate of diagnosis of OSA during the lifetime was no longer significantly associated with location (p=0.057) or being diagnosed with OSA in the previous 12 months (p=0.062). This study highlights the need to ensure adequate services in rural areas, given the higher proportion of men diagnosed with, or at risk of, OSA in rural areas. OSA is also associated with an increase risk of comorbidities such as heart disease, hypertension and diabetes, which are diseases also seen more prevalently in rural men. Rethinking the distribution of healthcare services will go some way to addressing this problem.

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions.

Obstructive sleep apnoea (OSA) is an increasingly common pathology that all those involved in perioperative care will come across. Patients with the condition present a challenge at many stages along the perioperative journey, not least because many patients living with OSA are unaware of their diagnosis.Key interventions can be made pre, intra-, and postoperatively to improve outcomes. Knowledge of screening tools, diagnostic tests, and the raft of treatment options are important for anyone caring for these patients. Recent literature has highlighted the increasing complexity of surgical patients and significant underdiagnosis of OSA in this patient population. Work has demonstrated how and why patients with OSA are at a higher perioperative risk and that effective positive airways pressure (PAP) therapy can reduce these risks, alongside evidencing how best to optimise adherence to therapy, a key issue in OSA. OSA, and particularly undiagnosed OSA, presents a huge problem in the perioperative period. Perioperative PAP reduces the risk of postoperative complications but adherence remains an issue. Bespoke perioperative pathways should be developed to identify and optimise high risk patients, although at present evidence on how best to achieve this is lacking.

Sleep Testing and Mortality in a Propensity-matched Cohort of Patients with Chronic Obstructive Pulmonary Disease.

Rationale: Many advocate the application of propensity-matching methods to real-world data to answer key questions around obstructive sleep apnea (OSA) management. One such question is whether identifying undiagnosed OSA impacts mortality in high-risk populations, such as those with chronic obstructive pulmonary disease (COPD). Objectives: Assess the association of sleep testing with mortality among patients with COPD and a high likelihood of undiagnosed OSA. Methods: We identified patients with COPD and a high likelihood of undiagnosed OSA. We then distinguished those receiving sleep testing within 90 days of index COPD encounters. We calculated propensity scores for testing based on 37 variables and compared long-term mortality in matched groups. In sensitivity analyses, we compared mortality using inverse propensity weighting and instrumental variable methods. We also compared the incidence of nonfatal events including adverse outcomes (hospitalizations and COPD exacerbations) and routine services that are regularly indicated in COPD (influenza vaccination and pulmonary function testing). We compared the incidence of each nonfatal event as a composite outcome with death and separately compared the marginal probability of each nonfatal event independently, with death as a competing risk. Results: Among 135,958 patients, 1,957 (1.4%) received sleep testing. We propensity matched all patients with sleep testing to an equal number without testing, achieving excellent balance on observed confounders, with standardized differences < 0.10. We observed lower mortality risk among patients with sleep testing (incidence rate ratio, 0.88; 95% confidence interval [CI], 0.79-0.99) and similar results using inverse propensity weighting and instrumental variable methods. Contrary to mortality, we found that sleep testing was associated with a similar or greater risk for nonfatal adverse events, including inpatient COPD exacerbations (subhazard ratio, 1.29; 95% CI, 1.02-1.62) and routine services like influenza vaccination (subhazard ratio, 1.26; 95% CI, 1.17-1.36). Conclusions: Our disparate findings can be interpreted in multiple ways. Sleep testing may indeed cause both reduced mortality and greater incidence of nonfatal adverse outcomes and routine services. However, it is also possible that our findings stem from residual confounding by patients' likelihood of accessing care. Given the limitations of propensity-based analyses, we cannot confidently distinguish these two possibilities. This uncertainty highlights the limitations of using propensity-based analyses to guide patient care and policy decisions.

Association between undiagnosed obstructive sleep apnea and severe course of COVID-19: a prospective observational study

PurposeObstructive sleep apnea (OSA) is associated with many long-term health consequences. We hypothesized that previously unrecognized and untreated OSA may be associated with more severe respiratory failure in hospitalized patients with COVID-19.MethodsPatients hospitalized in the Pulmonology Department with confirmed COVID-19, University Hospital in Kraków, Poland, between September 2020 and April 2021 were enrolled. OSA screening questionnaires including Epworth Sleepiness Scale (ESS), STOP-BANG, Berlin questionaire (BQ), OSA-50, and No-SAS were completed. Polygraphy was performed after > 24 h without requirement for supplemental oxygen.ResultsOf 125 patients with median age of 61.0 years, 71% of whom were male. OSA was diagnosed in 103 patients (82%) and was categorized as mild, moderate, and severe in 41 (33%), 30 (24%), and 32 (26%), respectively. Advanced respiratory support was introduced in 85 patients (68%), and 8 (7%) patients eventually required intubation. Multivariable analysis revealed that increased risk of requirement for advanced respiratory support was associated with higher respiratory event index (OR 1.03, 95%CI 1.00 to 1.07), oxygen desaturation index (OR 1.05, 95%CI 1.02 to 1.10), and hypoxic burden (1.02 95% CI 1.00 to 1.03) and lower minimal SpO2 (OR 0.89, 95%CI 0.81 to 0.98), but not with results of OSA screening tools like BQ score (OR 0.66, 95%CI 0.38 to 1.16), STOP-BANG score (OR 0.73, 95%CI 0.51 to 1.01), NoSAS score (OR 1.01, 95%CI 0.87 to 1.18), or OSA50 score (OR 0.84, 95%CI 0.70 to 1.01).ConclusionPreviously undiagnosed OSA was common among hospitalized patients who survived the acute phase of COVID-19. The degree of OSA was associated with the severity of respiratory failure.

Occult, undiagnosed obstructive sleep apnea increases risk of depression among a national sample of older adult Medicare beneficiaries

Study objectivesTo determine the association between occult, undiagnosed obstructive sleep apnea and incident depression among a nationally representative sample of older adult Medicare beneficiaries. MethodsOur data source was a random 5% sample of Medicare administrative claims data for the years 2006-2013. Occult, undiagnosed obstructive sleep apnea was defined as the 12-month period preceding receipt of one or more International Classification of Disease, Version 9, Clinical Modification diagnostic codes for obstructive sleep apnea. To determine the effect of obstructive sleep apnea on incident depression, beneficiaries with undiagnosed obstructive sleep apnea were matched on index date to a random sample of nonsleep disordered controls (ie, individuals without evidence of sleep-related testing, diagnosis, or treatment). After excluding beneficiaries with preexisting depression, the risk of depression was modeled as a function of occult, undiagnosed obstructive sleep apnea status over the 12months prior to obstructive sleep apnea diagnosis using log-binomial regression. Covariates were balanced between groups using inverse probability of treatment weights. ResultsThe final sample included 21,116 beneficiaries with occult, undiagnosed obstructive sleep apnea and 237,375 nonsleep disordered controls. In adjusted models, beneficiaries with occult, undiagnosed obstructive sleep apnea demonstrated a significantly higher risk of depression during the year prior to obstructive sleep apnea diagnosis (risk ratio 3.19; 95% confidence interval 3.00, 3.39). ConclusionsIn this national study of Medicare beneficiaries and relative to nonsleep disordered controls, occult, undiagnosed obstructive sleep apnea was associated with a significantly higher risk for incident depression.

Gender differences in obstructive sleep apnea with comorbid treatment-resistant depression

BackgroundA bidirectional relationship between major depression and obstructive sleep apnea (OSA) has been established, suggesting the possibility of overlapping and compounding disease processes. Depression, however, while more prevalent in women, is a highly heterogeneous disorder and can be difficult to treat regardless of gender. A common overlapping symptom of depression and OSA is fatigue. Gender differences in OSA symptomatology (and fatigue in particular) are also consistently observed. Here, we investigate OSA in specific relation to treatment-resistant depression.MethodsA cross-sectional exploratory design was used to analyse data from 94 patients with treatment-resistant depression from a subspecialist mood disorders outpatient service who had no previous sleep assessment. Participants completed overnight polysomnography and a battery of rating scales assessing mood, sleep, and daytime functioning. Linear regression models determined whether presence of fatigue in treatment-resistant depression predicted OSA severity.ResultsThere was a high prevalence (79%) of previously undiagnosed OSA in our sample of patients with treatment-resistant depression. Treatment-resistant depression was one factor to close the gap in obstructive sleep apnea prevalence between men and women in this group. Presence of OSA measured objectively by the Apnea Hypopnea Index was not associated with episode state (depressed vs. euthymic). Daytime sleepiness scores as measured by the Epworth Sleepiness Scale indicated higher than normal daytime sleepiness with no difference between genders. Men and women in our study reported similar amounts of fatigue as measured by the Profile of Mood States-Fatigue Subscale, however, daytime fatigue (but not sleepiness) predicted OSA severity in women only.ConclusionsWe argue that typical symptoms of treatment-resistant depression may overshadow key symptoms of undetected OSA. Specifically, we found that daytime fatigue may be one factor masking a potentially significant underlying sleep disorder in women only. Comprehensive assessment and screening for sleep apnea in patients with treatment-resistant depression is encouraged, and the importance of investigating severity of fatigue in this population is emphasized.

0554 Racial Disparities in Healthcare Resource Utilization among Older Adult Medicare Beneficiaries With Comorbid OSA and Depression

Abstract Introduction Depression and obstructive sleep apnea (OSA) are highly comorbid and independently associated with increased economic burden. Evidence suggests important racial disparities in diagnosis and treatment of each condition. This study sought to evaluate the economic burden of occult OSA among Black and White older adults with depression. We hypothesized that the impact of occult OSA on healthcare resource utilization would differ by race. Methods Data were derived from a 5% sample of Medicare administrative claims data. Inclusion criteria were age &amp;gt;64 years, 12 months continuous enrollment prior to OSA diagnosis, depression, and Black or White race. Undiagnosed OSA and pre-existing depression were defined using ICD-10 codes during the 12 months prior OSA diagnosis. HCRU was defined as monthly counts of inpatient, outpatient, and emergency department (ED) visits in each of the 12 months before OSA diagnosis. The relationship between undiagnosed OSA and HCRU was modeled using negative binomial regression. Inverse probability of treatment (IPT) weighting was used to balance covariates between groups. Effect modification by race was evaluated using an interaction term; estimates were stratified by race. Results Of 39,192 beneficiaries with pre-existing depression, 4,353 suffered undiagnosed OSA (n=325 Black adults, 7.5%). Relative to White beneficiaries with undiagnosed OSA, Black beneficiaries with undiagnosed OSA were more likely to be female (76.6% vs. 68.6%, p=.002) and to suffer multimorbidity (&amp;gt;7 comorbid conditions [71.7% vs 52.7%, p&amp;lt;.001]). In IPT weighted models and relative to Black non-sleep disordered controls, Black beneficiaries with undiagnosed OSA had higher inpatient (RtR 1.89; 95% CI 1.33, 2.71), outpatient (RtR 1.38; 95% CI 1.04, 1.83) and ED (RtR 1.83; 95% CI 1.22, 2.75) utilization. Relative to White non-sleep disordered controls, White beneficiaries with undiagnosed OSA demonstrated higher inpatient (rate ratio (RtR) 1.51; 95% CI 1.38, 1.65)), outpatient (RtR 1.18; 95% CI 1.10, 1.26) and ED (RtR 1.45; 95% CI 1.34, 1.57) utilization. The interaction between race and undiagnosed OSA was significant in all models (p&amp;lt;.001). Conclusion Among Medicare beneficiaries with pre-existing depression, comorbid undiagnosed OSA is associated with increased HCRU across multiple points of service. The strength of this association is greater among Black (vs White) beneficiaries. Support (if any) ResMed Foundation

0483 Stakeholder Engagement Studios to Explore the Journey to Diagnosis of OSA Informed by Primary Care Providers and Patients

Abstract Introduction Barriers to obstructive sleep apnea (OSA) diagnosis include operational misalignments and miscommunications among patients, providers, industry, insurers, and the healthcare system. To explore this, we engaged stakeholders to examine determinants of OSA diagnosis in primary care to optimize trial planning. Methods We conducted two, separate, virtual, 1-hour stakeholder engagement studio sessions with Penn Medicine Primary Care Providers (n=6) and patients referred for OSA diagnostics within prior year (n=3). Facilitation guides were used to elicit barriers/facilitators to reaching diagnosis. Sessions were facilitated by a sleep physician and advanced practice sleep nurse with two note-takers in attendance. Rapid matrix analysis approach identified consistent themes within diagnosis barrier and facilitator categories. Themes were categorized by Safety Engineering Initiative for Patient Safety (SEIPS) work system domains: people (P), environment (E), tools (T), and tasks (T), PETT. Results Fourteen facilitators (2P, 3E, 3T, 6T) and 15 barriers (2P, 4E, 3T, 6T) were identified for “getting to OSA diagnosis.” Provider-level barriers include: hesitancy to provide anticipatory guidance to patients due to ambiguous workflows after referral, excessive referral order options, no access to templated patient instructions or quality education resources, confusing order panels and use of electronic health record (EHR) workarounds, and fragmented communication. Patient-level barriers include: timeliness of communication and care, sleep health unawareness, low technology literacy for EHR messaging, financial considerations, and insufficient follow-up from healthcare team. Provider facilitators include: classic OSA presentation, diagnosis decision aids, patient education resources, easy to find results in EHR, and low threshold to order referral due to knowledge about sleep. Patient facilitators include: trusted primary care relationship, choice of visit type (telehealth vs. in-person) and communication mode (phone call vs. text vs. EHR portal), active outreach/engagement by healthcare team, and access to educational materials. Conclusion Repeated studios, including stakeholders from varied sites, will further refine determinants with more saturation and validity. Engaging with stakeholders is supporting the design of a contextually relevant, end-user valued study to address undiagnosed OSA. Given the estimated high prevalence of undiagnosed OSA and the multiple stakeholders that contribute to the diagnostic process and experience, research-driven solutions will be impactful and better optimized with multi-level partnered research. Support (if any) K12HS026372

Sleep Subdomain of the Sinonasal Outcome Test as a Potential Screening Tool for Sleep Apnea in Chronic Rhinosinusitis.

Approximately 20% of patients with chronic rhinosinusitis (CRS) have comorbid obstructive sleep apnea (OSA). Patients with undiagnosed OSA are at high risk for perioperative complications. The Sinonasal Outcomes Test (SNOT-22) Questionnaire is commonly administered to CRS patients, whereas OSA screening tools are less routinely employed. This study compared SNOT-22 sleep subdomain (Sleep-SNOT) scores among non-OSA CRS versus OSA-CRS patients undergoing ESS, and assessed sensitivity, specificity, and diagnostic accuracy of the Sleep-SNOT for OSA screening. Retrospective review of patients that underwent endoscopic sinus surgery (ESS) for CRS from 2012 to 2021. Patients either carried a reported OSA diagnosis and completed the SNOT-22, or had undocumented OSA status and completed both STOP-BANG and SNOT-22. Demographics, questionnaire scores, and OSA status were collected. A receiver operating characteristic (ROC) curve assessed cutoff scores, sensitivity, and specificity of the Sleep-SNOT for OSA screening. Of 600 patients reviewed, 109 were included. 41% had comorbid OSA. OSA patients had a higher BMI (32.1 ± 7.7 vs. 28.35 ± 6.7 kg/m2 ; p = 0.02), Sleep-SNOT (21.96 ± 12.1 vs. 16.8 ± 11.2; p = 0.021) and STOP-BANG (3.1 ± 1.44 vs. 2.06 ± 1.27; p = 0.038) scores. A Sleep-SNOT score of 17.5 had a sensitivity of 68.9%, specificity of 55.7%, and diagnostic accuracy of 63% for OSA detection (p = 0.022). Sleep-SNOT scores are greater for CRS-OSA patients. The Sleep-SNOT ROC curve demonstrates a high sensitivity, specificity, and accuracy for OSA screening in CRS patients. A Sleep-SNOT score of ≥17.5 should prompt further OSA evaluation. The Sleep-SNOT may be considered as a surrogate OSA screening tool when other validated tools are not employed. Retrospective chart review, Level 3 Laryngoscope, 133:2029-2034, 2023.

Evaluation of obstructive sleep apnea among consecutive patients with all patterns of atrial fibrillation using WatchPAT home sleep testing

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and financial burden. Obstructive sleep apnea (OSA) is more common in individuals with AF and may impair the efficacy of rhythm control strategies including catheter ablation. However, the prevalence of undiagnosed OSA in all-comers with AF is unknown. This pragmatic, phase IV prospective cohort study will test 250-300 consecutive ambulatory AF patients with all patterns of atrial fibrillation (paroxysmal, persistent, and long-term persistent) and no prior sleep testing for OSA using the WatchPAT system, a disposable home sleep test (HST). The primary outcome of the study is the prevalence of undiagnosed OSA in all-comers with atrial fibrillation. Preliminary results from the initial pilot enrollment of approximately 15% (N=38) of the planned sample size demonstrate a 79.0% prevalence of at least mild (AHI≥5) OSA or greater in consecutively enrolled patient with all patterns of AF. We report the design, methodology, and preliminary results of our study to define the prevalence of OSA in AF patients. This study will help inform approaches to OSA screening in patients with AF for which there is currently little practical guidance. NCT05155813.

Evaluation of the Applicability of Artificial Intelligence for the Prediction of Obstructive Sleep Apnoea

Background Due to the large number of undiagnosed obstructive sleep apnoea (OSA) patients, our aim was to investigate the applicability of artificial intelligence (AI) in preliminary screening, based on simple anthropometric, demographic and questionnaire parameters. Methods Based on the results of the polysomnography performed, the 100 patients in the study were grouped as follows: non-OSA, mild OSA and moderately severe–severe OSA. Anthropometric measurements were performed, and the Berlin and Epworth questionnaires were completed. Results OSA prediction based on body mass index (BMI), gender and age was accurate in 81% of cases. With the completion of the questionnaires, accuracy rose to 83%. The Epworth questionnaire alone yielded a correct OSA prediction in 75%, while the Berlin questionnaire was correct in 62% of all cases. The best results for categorization by severity were obtained by combining BMI, gender and age parameters, together with responses to the questionnaires (71%). Supplemented with neck circumference, this result improves slightly (73%). Conclusion Based on the results, it can be concluded that OSA can be effectively and easily categorized using AI by combining anthropometric and demographic parameters, as well as questionnaire data.

Clinical and financial impact of sleep disordered breathing on heart failure admissions

BackgroundThe impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations.MethodsA sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization for HF at a single cardiac center. Readmission data and actual costs of readmissions were obtained from the institutional honest broker. Patients were classified based on the inpatient sleep study as having no SDB, obstructive sleep apnea (OSA), or central sleep apnea (CSA). Cumulative cardiac readmission rates and costs through 3 and 6 months post-discharge were calculated. Unadjusted and adjusted (age, sex, body mass index, and left ventricular ejection fraction) modeling of cost was performed.ResultsThe cohort consisted of 1547 patients, 393 (25%) had no SDB, 438 (28%) had CSA, and 716 (46%) had OSA. Within 6 months of discharge, 195 CSA patients (45%), 264 OSA patients (37%), and 109 no SDB patients (28%) required cardiovascular readmissions. Similarly, 3- and 6-month mortality rates were higher in both SDB groups than those with no SDB. Both unadjusted and adjusted readmission costs were higher in the OSA and CSA groups compared to no SDB group at 3 and 6 months post-discharge with the CSA and OSA group costs nearly double (~ $16,000) the no SDB group (~ $9000) through 6 months.InterpretationPreviously undiagnosed OSA and CSA are common in patients hospitalized with HF and are associated with increased readmissions rate and mortality.