Cheung, Joseph

Abstract Introduction Consumption of diet rich in high saturated fats has been associated with a higher degree of daytime sleepiness. A whole-food, plant-based (WFPB) dietary pattern, which is low in saturated fat, has been shown to be beneficial in weight loss and other health conditions. Patients with obstructive sleep apnea (OSA) frequently experience excessive daytime sleepiness despite treatment. This study aims to assess the effect of a short term (21 days) WFPB diet on daytime sleepiness in patients with obstructive sleep apnea. Methods Patients were recruited from the Mayo Clinic Jacksonville sleep clinic who have a diagnosis of OSA who are on PAP therapy but have daytime sleepiness with Epworth Sleepiness Scale (ESS) score of 5 or above. Participants were asked to follow a strict WFPB diet for 21 days using the Fork Over Knives handbook as a guide. They were also asked to complete ESS before switching to and after completing a WFPB diet for 21 days. Results A total of 10 participants completed the 21-day WFPB diet. Eight out of ten participants had reported a reduction in daytime sleepiness. Overall, we found a mean decrease in ESS score of 3.8 in all participants, with 3 patients had a significant decrease in ESS score of ≥ 7. All participants completed the study with ≥ 90% adherence to a WFPB diet. In addition, participants also reported a mean weight loss of 4.2 kg. Two participants noted headaches during this 21-day period. Conclusion Significant improvement with daytime sleepiness was found in patients who switched to a WFPB diet for 21 days. No significant correlation between improvement in ESS and weight loss was found. Support (if any)

Abstract Introduction COVID-19 primarily affects the respiratory system, however, a number of clinical sequela have emerged in patients recovered from COVID-19. Besides the most commonly reported symptoms of fatigue and dyspnea, early studies have found that sleep disturbance is also a common complaint. The aim of this study is to survey for sleep disturbance, degree of fatigue and daytime sleepiness in a group of post-hospitalized COVID-19 patients. Methods Patients who were discharged from Mayo Clinic hospitals after COVID-19 hospitalization were recruited in this study. Patients who have an existing diagnosis of sleep apnea or other sleep disorders were excluded from this study. Mayo Clinic patients who never had COVID-19 infection, nor a history of sleep disorders or other sleep disorders were also recruited as controls. Patients completed Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) questionnaires via REDCap. Wilcoxon rank sum test was used to evaluate the difference between cases and controls in continuous variables and Fisher’s exact test was used to compare categorical variables. Multivariable linear regression model was used to evaluate the difference in sleep and fatigue scores between cases and controls with baseline characters adjusted. All tests were two-sided with p value <0.05 considered statistically significant. Results A total of 62 patients who completed the questionnaires were included in the analysis. Among them, 33 had COVID-19. Cases were significantly older with higher BMI compared to controls. Global PSQI score (median=10 vs 6, p=0.015), ESS total score (median=8 vs 5, p=0.018) and FSS total score (median=30 vs 22, p=0.009) were all significantly higher for cases compared to control patients. After adjusting for age and BMI, the difference stayed statistically significant. The mean difference between cases vs controls was found to be 2.7 (95%CI:0.2-5.2, p=0.038), 2.93 (95% CI: 0.66-5.2, p=0.014), and 12.62 (95% CI:5.22-20.03, p=0.001) for PSQI, ESS, and FSS scores, respectively. Conclusion Preliminary results showed that sleep disturbance (PSQI) and daytime symptoms (measured by ESS and FSS) are found to be significantly higher among post COVID-19 hospitalized patients compared to controls. Support (If Any) This work is supported by the Mayo Clinic in Florida Department of Medicine Catalyst for Advancing in Academics award and the Mayo Clinic in Florida Research Accelerator for Clinicians Engaged in Research Program.

Abstract Introduction Orexin deficiency in cerebrospinal fluid (CSF) was first reported in human narcolepsy in 2001, included in diagnostic criteria for narcolepsy in 2014, and made clinically available at the Mayo Clinic in 2019. The purpose of this publication is to report orexin test utilization and results, and other clinically relevant findings from patients evaluated at Mayo Clinic. Methods We retrospectively reviewed CSF orexin samples and clinical records from patients evaluated at Mayo Clinic from 2019 to 2021. Results A total of 98 internal samples (Rochester, n=56; Arizona, n=25, and Florida, n=17) from 95 patients (mean age 32.4 +/- 16.6 years with 20 %, 52 %, and 28 % of patients < 18, 18 – 40, and > 40 years, respectively, at time of CSF collection; 62 % female) have been submitted for CSF orexin measurement (mean CSF orexin 335.17 +/- 158.3 pg/ml; deficient < 110 pg/ml, n=11, 64 % <=40 years with mean age 32.9 +/- 17.0 years; intermediate 110 – 200 pg/ml, n=8, 100 % <= 40 years with mean age 21.1 +/- 12.8 years; normal > 200 pg/ml, n=79, 57 % <=40 years with mean age 33.5 +/- 16.7). No significant correlation was found between orexin levels, and time of collection (i.e., diurnal variation), gender, or age. Repeat testing was performed on three individuals (ages 10, 14, and 19 years) with a change in category of orexin level found in one patient from an intermediate to a normal level. Conclusion Orexin deficiency was found in 12 % of the patients (64 % of the deficient samples were found at ages <= 40 years). This result may reflect the fact that this test is frequently pursued in clinical patients presenting with inconclusive findings and/or comorbidities. Intermediate orexin levels found in 8 % of the samples (100 % <= 40 years). Although most of the patients tested were female (62.2%) and most were 40 years or younger (72%), no significant correlation was found between orexin levels, and time of collection (i.e., diurnal variation), gender, or age. Support (If Any) none

Abstract In patients with breast hypertrophy, excessive breast weight applies pressure on the thorax, which may disrupt the normal breathing. The purpose of this study is to evaluate the impact of the breast hypertrophy and reduction mammoplasty on respiratory function. A comprehensive search of 3 databases, PubMed, Ovid, and Scopus databases, was performed. “Mammoplasty” and “respiration or pulmonary function tests” were the keywords used to search for relevant articles. Ten studies involving 280 patients with breast hypertrophy were included in the final review. Seven articles demonstrated an increase in at least 1 pulmonary function test value after the surgery. This systematic review revealed that, preoperatively, pulmonary function test values of the patients are usually in the normal range. Nonetheless, reduction mammoplasty still improves lung function parameters. Additionally, patients with respiratory complaints felt improvement in their symptoms after the surgery. However, future studies are needed, as heterogeneity among studies was observed.