Rosen, Ilene M.

Abstract Introduction Identifying central sleep apnea (CSA) during home sleep apnea testing is important to guide appropriate treatment for sleep-disordered breathing (SDB) and underlying cardiovascular conditions, including heart failure and atrial fibrillation. SANSA (Huxley Medical, Inc.) is a multi-diagnostic chest-worn monitor capable of detecting SDB, cardiac arrhythmias, and heart function. Using polysomnography (PSG) as a reference, we developed a machine learning (ML) method to classify respiratory events from this monitor as central or obstructive. Methods Data was analyzed from ninety-five subjects with suspected SDB who wore the chest monitor simultaneously with PSG overnight. To address known scoring heterogeneity of CSA, PSG records were scored for central apneas by two core laboratories (Core 1 and Core 2). Core 1 annotations from twenty-eight records were first used to train a random forest classifier to differentiate obstructive (N=680) and central events (N=388). The model used oximetry, respiratory effort, and snoring to classify events based on effort, duration, and other features. A five-fold cross validation was used to evaluate event-level performance. The model was then used to estimate subject-level CAI for all subjects and compared with Core 2 scores. Results Algorithm event-level sensitivity and specificity to detect central events was 72.7% and 81.0%. Subject-level CAI for all records between the chest monitor and Core 2 had a correlation coefficient of 0.90 and root mean squared error (RMSE) of 4.6 events/hour, versus 0.82 and 4.7 events/hour comparing Core 1 and Core 2. Sensitivity and specificity to detect CAI≥10 events/hour was 80.0% (4/5) and 98.9% (89/90), compared to 100% (3/3) and 98.9% (91/92) for CAI≥15. Conclusion An ML algorithm to differentiate obstructive and central events collected from the chest-worn monitor demonstrated favorable event-level performance and comparable CAI agreement to that between two PSG core laboratories. Home-based CSA detection alongside cardiac monitoring could identify high risk patients for expedited therapy, cardiology referral, or follow-up PSG. These results motivate further validation in a larger cohort as well as investigation of outcomes related to time to evaluation and management. Support (if any) National Science Foundation; Georgia Research Alliance; Huxley Medical, Inc.

ABSTRACT Background Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence‐based review (EBR), or evidence‐based review with recommendations (EBR‐R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA‐associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence‐based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Abstract Introduction Advanced Practice Providers (APPs; Advanced practice registered nurses, physician assistants) and physicians-in-training (residents, fellows) receive inadequate education on obstructive sleep apnea (OSA)/perioperative OSA risks. However, they are front-line providers assessing these patients. Failure to mitigate this risk has led to significant postoperative morbidity/mortality. We assessed these providers’ perceptions to OSA/perioperative OSA training. Methods Surveys were sent to three provider roles, APPs, residents, and fellows, in four categories of practice at nine academic institutions between May 9-June 30, 2021. Chi-square and Fisher’s exact tests assessed association between survey responses and participant characteristics. False discovery rate adjustment accounted for multiple comparisons, threshold of q<0.05 for statistical significance. Cochran-Mantel-Haenzsel tests evaluated associations stratified by institution. Results 2236 of 6724 (33.3%) participants responded: 48.4% APPs, 11% Fellows and 40.6% Residents. Primary category of practice included: 20.3% Anesthesiology, 8.9% Family Medicine, 34.1%, Internal Medicine (IM)/IM subspecialties, 6.7% Obstetrics/Gynecology/Gynecologic Oncology, 25.9% Surgery/Surgery subspecialties, 4.1% Other.While 93.2% of respondents believed OSA is a risk factor for perioperative complications, fewer respondents reported that they felt adequately trained to assess for OSA (50.9%) in general, with significant differences noted by provider role (range 42-70%, q=0.001) and across the categories of practice (range 12-82%, q=0.001). Even fewer felt adequately trained to assess for OSA in perioperative patients (38.2%) with significant differences noted by provider role (range 31-52%, q=0.001) and across the categories of practice (range 15-84%, q=0.001).Across all categories of practice, respondents indicated that they would like additional educational training about OSA (76.7%). This varied by clinical role (range 64-82%, q=0.003), but not categories of practice (range 73-84%, q=0.13). Furthermore, respondents indicated they also desired additional education about OSA in the perioperative patient (75.5%). This extended across all clinical roles (range 68-77%, q=0.09) and categories of practice (range 72-80%, q=0.09). Conclusion We found significant differences in APP and physician-in-training perceptions of the adequacy of their current training and desire for further OSA/perioperative OSA education. Our study identifies a critical gap and opportunity to improve provider understanding and patient care. Support (If Any) American Academy of Sleep Medicine Foundation (AASMF) award.