Citations

Abstract Introduction Individuals with ostomies commonly report poor sleep quality years after ostomy surgery; however, little is known about the trajectory of insomnia and objective sleep characteristics in the early postoperative period. The purpose of this study was to describe the trajectory of insomnia and sleep characteristics in the first 3 months following ileostomy surgery. Methods We conducted a prospective, observational feasibility study of adults (18-65 years) undergoing ileostomy surgery. Sleep characteristics were obtained via Garmin smartwatches (vívosmart® 5) worn from 2 weeks to 3 months postoperatively. The Insomnia Severity Index (ISI) was used to elicit insomnia severity perioperatively and at postoperative months 1, 2, and 3. Descriptive and univariate statistics were used. Results We enrolled 22 participants [Mean age 41.55 years (SD 10.77), 10 female (45.5%), 19 White (86.4%), 9 colorectal cancer (40.9%), and 8 inflammatory bowel disease (36.3%)]. There was little change in insomnia severity from the perioperative period (mean = 9.95, SD 5.57) to 3 months after surgery (∆ = 0.76). At the time of ostomy surgery, most participants (n = 13, 59.1%) had insomnia (ISI≥8). Fifteen participants completed the postoperative surveys. Of those, 2 participants (13.3%) experienced resolution of insomnia symptoms, 3 participants (20%) continued to report no insomnia symptoms, 5 participants (33.3%) developed new insomnia symptoms, and 5 (33.3%) experienced persistent insomnia symptoms. There was little change in sleep duration (m = 462.10 min, SD = 79.07, ∆ = -24.1), deep sleep (m = 81.21 min, SD = 16.97, ∆ = -8.01), light sleep (m = 297.93 min, SD = 44.26, ∆ = -3.93), REM sleep (m = 82.82 min, SD = 44.50, ∆ = -12.02), wake after sleep onset (m = 51.87 min, SD = 29.93, ∆ = -3.05), or sleep score out of 100 (m = 59.15, SD = 11.83, ∆ = -1.74) from month 1 to month 3 after surgery. Conclusion Individuals undergoing ileostomy surgery experience symptoms of insomnia which often persist throughout the early postoperative period. Future research should explore the impact of insomnia on ostomy outcomes and should test interventions to treat insomnia in the early postoperative period. Support (if any) LabfrontXGarmin

Abstract Introduction The World Health Organization (WHO) has categorized pulmonary hypertension (PH) in five groups. Obstructive sleep apnea (OSA) is an independent cause of group 3 PH. The prevalence of OSA in PH patients is approximately 20% and untreated OSA may contribute to pulmonary vascular remodeling, exacerbating PH. Regular use of positive airway pressure (PAP) can improve pulmonary artery pressures. We hypothesized that untreated OSA is associated with mortality in all five groups of PH, and that mortality is reduced with PAP therapy. Methods We performed a retrospective chart review of the PH patient registry at Mayo Clinic Jacksonville, comprised of 696 patients classified per WHO classification of PH. Mortality in each WHO group of PH was abstracted as well as the presence of OSA as a comorbidity. Compliance with positive airway pressure therapy (PAP) was assessed across all patients with OSA. Results Patients in the registry were followed for a mean of 101.2 months. The mortality across all groups was 36.8%, ranging from 22.6% in group 4 to 64.3% in group 5. OSA was present in 46.9% patients, and it ranged from 33% in group 5 to 58% in group 2. Mortality did not vary significantly in the patients with OSA versus those without OSA (p=0.56). Of patients with OSA, 45.9% was deemed compliant with PAP therapy. Overall, the compliant patients had reduced mortality compared to the noncompliant ones (p=0.045), however this significance was due to pronounced effect in group 1 patients only. Conclusion Almost half of PH patients from our registry had OSA. Compliance with PAP therapy was associated with lesser mortality, primarily due to the effect seen in Group 1 PH patients. Support (if any)

Abstract Introduction Narcolepsy is a rare, chronic sleep disorder associated with decreased quality of life and multiple comorbid conditions, including sleep-related and psychiatric or mood disorders. This study used aggregate electronic health record (EHR) data to characterize the demographics and comorbidities of patients with narcolepsy. Methods An EHR-based search identified first-time Duke Health patients between January 1, 2012, and March 31, 2024. Included patients had ≥1 narcolepsy-specific ICD-9 (347.*) and ICD-10 (G47.4*) codes and ≥1 disease-supportive statement in clinical notes, identified using a natural language processing algorithm. A control cohort was propensity-matched for birth year, age at first institutional encounter, sex, race, number of diagnosis code instances, and mortality. Common comorbidities were compared and ranked between cohorts by odds ratio (OR). Statistical significance was determined using a chi-squared test; P values were corrected for multiple comparisons using Bonferroni correction. Results Within the EHR database of 2,617,188 patients, 1659 patients with a narcolepsy diagnosis were identified (mean age at first presentation, 32.4 years; white, 69%; female, 69%); the propensity-matched control cohort included 1659 patients (mean age at first presentation, 32.3 years; white, 69%; female, 69%). Comorbidities that occurred statistically significantly more frequently (all P< 0.0001) among the narcolepsy vs control cohort (OR [95% CI]) included sleep disorders: sleep-related movement disorders (26.26 [10.71-64.40]), hypersomnia (16.56 [12.54-21.87]), and circadian rhythm sleep disorders (15.43 [6.73-35.38]); psychiatric or mood disorders: posttraumatic stress disorder (3.08 [2.10-4.52]), attention deficit hyperactivity disorder (2.90 [2.28-3.68]), and depression (2.66 [2.27-3.11]); and pain disorders: trigeminal neuralgia (6.63 [2.80-15.70]), fibromyalgia (5.30 [3.58-7.85]), and chronic pain syndrome (3.37 [2.46-4.61]). Postural orthostatic tachycardia syndrome occurred statistically significantly more frequently (P< 0.0001) in the narcolepsy vs control cohort (7.24 [3.59-14.61]). Conclusion Consistent with prior EHR research, sleep, psychiatric, mood, and pain disorders were among the most frequently reported comorbidities of patients with narcolepsy. The results of this analysis of real-world demographic and clinical information of patients with narcolepsy may further inform clinicians of the most relevant concomitant disease states to consider when evaluating potential therapies. Support (if any) Avadel Pharmaceuticals

Abstract Introduction Obstructive sleep apnea (OSA) is common but often underdiagnosed and undertreated. Expanding the role of primary care providers (PCPs) may improve timely diagnosis and treatment of OSA, but patients report higher positive airway pressure (PAP) therapy adherence when cared for by specialists at centers accredited by the American Academy of Sleep Medicine. At Mayo Clinic, PCPs are now authorized to order home sleep apnea testing (HSAT) and subsequent therapy; HSAT is reviewed and interpreted by Sleep Medicine specialists (SMSs), but patients receive diagnoses and treatment recommendations through their PCP. This retrospective study evaluates whether patients diagnosed with OSA through primary and specialty care pathways experience comparable timeliness of care, counseling about therapeutic options, and PAP adherence. Methods Fifty-five patients were selected from each of two groups, based on whether their HSAT was ordered and initially managed by a PCP or SMS. Initial sleep metrics, PAP therapy adherence data, and other management details (treatments offered and key dates in the care pathway) were compared across groups. Results Once HSAT had been ordered, provider type was not associated with meaningful discrepancies in diagnosis and treatment timeliness; PCP-managed patients waited just one additional day after the interpretation of their HSAT to be offered treatment (p=0.025). However, consultation with Sleep Medicine introduced upfront delays caused by limited access to specialty care. The total time in the OSA care pathway, between referral to a SMS or pre-HSAT evaluation to the offering of treatment was 113 days for SMS patients versus 28 days for PCP patients (p< 0.001). Additionally, SMSs identified more co-occurring sleep disorders and discussed a broader range of treatment options with their patients, who demonstrated nightly PAP usage of 1.15 hours longer on average. Conclusion Despite differing modes of patient communication, PCPs offer timely OSA testing and diagnosis, allowing patients to bypass lengthy specialty care wait times. However, future efforts are needed to address variations in the counseling provided, and to ensure that all patients are equipped to succeed with PAP therapy. These findings support primary care pathways for uncomplicated OSA while highlighting the need for enhanced education and support to optimize patient outcomes. Support (if any)

Abstract Introduction While Large Language Models (LLMs) offer generative capabilities, generic models often lack domain-specific grounding, leading to hallucinations in high-stakes contexts. However, LLMs can serve as clinical decision support tools if augmented with specific domain data. This study evaluates the utility of Retrieval-Augmented Generation (RAG) applied to open-source LLMs, utilizing a curated knowledge base of authoritative sleep medicine textbooks, to quantify improvement in performance. Methods We evaluated four open-source models—Llama-70B, Llama-8B, Qwen-14B, and Qwen-235B, linked to a RAG system indexing five standard textbooks, including ICSD-3 TR. Models were tested on sleep board–style MCQs and clinical vignettes diagnostic accuracy. Performance was assessed across nine configurations derived from three factors: RAG pipeline complexity (Plain vs. Complicated), textbook preprocessing (Uncleaned vs. Cleaned/TOC-aligned), and retriever type (Dense-only vs. Hybrid). Metrics included MCQ Accuracy and the rates at which the correct diagnosis appeared as the top result or within the top 5 differential diagnosis lists for vignettes. Results RAG consistently outperformed the no-RAG baseline, yielding absolute performance gains of 5.6%–10.7% for MCQs and 8.1%–10.2% for the top diagnosis in cases across all models. For MCQs, Qwen-235B achieved the highest accuracy of 87.3% (vs. 81.7% baseline) using the Plain RAG configuration with Cleaned (TOC-aligned) Hybrid retrieval. Llama-70B followed with 83.6% in the same configuration. For case vignettes, Qwen-235B achieved a correct top diagnosis rate of 66.3% and a correct diagnosis rate within the top 5 differential diagnosis lists of 90.8% using Cleaned Hybrid retrieval configurations. Hybrid retrieval (Dense + Sparse) consistently surpassed Dense-only methods. Notably, while larger models benefited from Cleaned text, smaller models (e.g., Qwen-14B) achieved higher top diagnosis rates with Uncleaned text (57.1% vs. 51.0%), suggesting a dependency on redundant context in lower-parameter settings. Conclusion RAG significantly enhances knowledge performance of open-source LLMs in sleep medicine. Hybrid retrieval and curated, TOC-aligned knowledge bases yield optimal results for large models, whereas smaller models benefit from the redundancy of uncleaned text. These findings suggest that RAG systems can augment LLMs in domain specific knowledge for clinical decision support. Support (if any)

Abstract Introduction The remedē System® Therapy Study (reST) is a real world evaluation using transvenous phrenic nerve stimulation (TPNS) to treat adults with moderate-to-severe central sleep apnea (CSA). Based on previous clinical trials, it was expected that most patients with CSA would have heart failure (HF). However, recent CSA prevalence publications demonstrated the opposite. We present the baseline characteristics of patients with CSA treated with TPNS. Methods Adult subjects determined eligible for a commercial TPNS device implant by routine clinical PSGs were consented to participate in the trial. Baseline assessments were performed and medical history collected. Patients will be followed for ≥1 year following therapy activation; follow-up is ongoing. This report describes the baseline characteristics of the patient population. Results Twenty-nine sites enrolled a total of 197 subjects (171 United States & 26 the Netherlands) between July 2019 and March 2025. Median [Q1-Q3] age was 70 [61-76] years, 82% were male, and 97% white race. Body mass index was 28.7 [25.8-31.6] kg/m2, with neck size 41 [28-44] cm. Patients had moderate-to-severe CSA with site-reported apnea-hypopnea index of 46/hour [30-64], including central apnea index of 24/hour [13-38]. Despite a range of comorbidities among patients, HF was documented in just 23%. Other cardiovascular conditions were more prevalent, including hypertension (70%), hyperlipidemia (65%), coronary artery disease (37%), atrial fibrillation (34%), and prior stroke (14%). Non-cardiac issues such as depression (27%), diabetes (26%), and renal disease (18%) were also present. Additionally, 22% of patients used narcotics, and 89% had previously failed another CSA therapy, most often CPAP (79%), Bi-PAP (39%), or ASV (32%). Lastly, almost 20% were from high altitude locations (>5,000 feet). Conclusion Patients implanted with TPNS had significant co-morbidities. However, HF was much less common than anticipated. This finding could be due to CSA being present in clinical practice with a wider range of underlying causes beyond HF, or undiagnosed early-stage HF. Alternatively, it may reflect referral bias for this specific therapy, with patients selected because of prior treatment failures or other comorbidities. These possibilities highlight the importance of recognizing CSA in a diverse patient population and underscore the need for multidisciplinary team management. Support (if any) ZOLL Respicardia, Inc.

Abstract Introduction Once-nightly sodium oxybate (ON-SXB [LUMRYZ™]) is approved to treat excessive daytime sleepiness (EDS) or cataplexy in patients ≥7 years of age with narcolepsy. Real-world demographic/clinical characteristics and treatment adherence in patients with narcolepsy who received ON-SXB from a specialty pharmacy were assessed. Methods Baseline demographic/clinical data were collected from Optum Frontier Therapies pharmacy for patients with ≥1 filled ON-SXB prescription, ≥1 ON-SXB-related clinical assessment, and baseline Epworth Sleepiness Scale (ESS) score from 6/1/2023-9/30/2024. Adherence (≥80% of days covered) was assessed for patients with ≥3 months of ON-SXB use. Data were stratified by narcolepsy subtype (narcolepsy type 1 [NT1] and 2 [NT2] when available) and prior oxybate use (transitioned from prior oxybate therapy to ON-SXB ≤30 days of index [switch]/were oxybate-naive or discontinued oxybate >30 days before index [not-on-oxybate]). Data were analyzed descriptively. Results 452 patients were identified (NT1, 55%; NT2, 37%; NT unknown, 9%; switch, 40%; not-on-oxybate, 60% [oxybate-naive, n=147/271]). Mean (range) age was 38.9 (16.0-88.0) years. Most patients were female (68%) and had commercial insurance (78%). Overall, 67% of patients had prior oxybate use (NT1, 72% [n=179/247]; NT2, 59% [n=98/166]; switch, 100%; not-on-oxybate, 46% [n=124/271]); for these patients, the most common oxybate (65%) was mixed-salt oxybates (NT1, 61%; NT2, 70%; switch, 61%; not-on-oxybate, 70%). Overall, 64% of patients used stimulants/wake-promoting agents (WPAs) (NT1, 64%; NT2, 65%; switch, 60%; not-on-oxybate, 67%). Overall, the mean (SD) baseline ESS score was 12.0 ([5.5]; NT1, 11.7 [5.5]; NT2, 12.5 [5.3]; switch, 11.0 [5.7]; not-on-oxybate, 12.7 [5.3]). At baseline, 29% of patients experienced severe EDS (ESS score ≥16: NT1, 26%; NT2, 30%; switch, 20%; not-on-oxybate, 34%). Of 269 patients with ON-SXB use ≥3 months, 84% (NT1, 84%; NT2, 89%; switch, 94%; not-on-oxybate, 76%) demonstrated adherence. Conclusion Patients not on an oxybate had the highest baseline ESS scores and proportion with severe EDS, despite greater stimulant/WPA utilization. Patients with NT1 used oxybates more frequently than those with NT2 despite those with NT2 having higher baseline ESS scores and a greater proportion having severe EDS, suggesting oxybates merit earlier consideration in patients with NT2. Most patients demonstrated ON-SXB adherence, indicating they would likely receive full therapeutic benefit. Support (if any) Avadel Pharmaceuticals

Abstract Introduction Sleep-disordered breathing (SDB) is a potentially modifiable risk factor for the prevention of dementia, of which Alzheimer’s disease (AD) is the most common cause. However, there is a lack of longitudinal evidence relating SDB to AD pathology >20 years later. We examined the association between late-midlife SDB and late-life brain β-amyloid (Aβ) deposition—a hallmark of AD—assessed approximately 23 years later. Methods The Atherosclerosis Risk in Communities (ARIC) Study is an ongoing prospective cohort study initiated in 1987. Participants at two ARIC sites (Washington County, Maryland; Minneapolis, Minnesota) with primarily White participants also completed polysomnography (PSG) in the Sleep Heart Health Study (SHHS) in 1995-98. SDB measures included apnea-hypopnea index (AHI; number of apneas + hypopneas with ≥3% oxygen desaturation/hour of sleep), arousal index, and percentage of total sleep time in apnea, in hypopnea, and with oxygen saturation < 90%. A subset of participants completed florbetapir positron emission tomography (PET) scans through several ARIC ancillary studies (2011-2025 including the ARIC Sleep-PET study). We defined Aβ deposition as a global standardized uptake value ratio (SUVR) >1.2 (vs. SUVR ≤1.2). We used Poisson regression with robust standard errors to estimate relative risk (RR) of Aβ deposition by SDB, adjusting for demographics and vascular risk factors, and applied inverse probability attrition weighting to account for selective drop-out. Results Among 186 dementia-free participants (mean age=59 years at PSG and 82 years at PET scan, 58% female, 98% White), every 10% increase in total sleep time in hypopnea was associated with higher risk of Aβ deposition (RR=1.40, 95% confidence interval [CI]: 1.03, 1.91). When compared to no SDB (AHI < 5), moderate to severe SDB (AHI ≥15) was associated with elevated Aβ deposition (RR=2.36, 95% CI: 1.22, 4.57); mild SDB (AHI 5 to < 15) was not (RR=1.05, 95% CI: 0.53, 2.07). Conclusion SDB in late midlife was associated with greater risk of Aβ deposition approximately 23 years later. SDB may play a role in the early stages of AD pathogenesis. Future longitudinal studies are needed to optimize strategies for screening and treating SDB for dementia prevention. Support (if any) Supported in part by RF1AG050745.

Abstract Introduction Klinefelter syndrome (KS) is a chromosomal condition marked by hypogonadism and disturbances in hormonal regulation. The relationship between KS and co-occurring sleep disorders has not been extensively characterized, creating a need for more detailed investigation. Methods We identified individuals with Klinefelter syndrome (KS) evaluated at our institution between January 2000 and December 2025 using ICD-9 and ICD-10-CM codes. Electronic health records were then manually reviewed to confirm KS status and to exclude miscoded entries. For confirmed cases, we extracted data on sleep-related complaints, diagnoses, diagnostic testing (overnight oximetry, polysomnography, home sleep testing), and treatment. Sleep disorders were categorized operationally: obstructive sleep apnea (OSA), central sleep apnea (CSA), insomnia, hypersomnia/narcolepsy, or other according to documented clinician diagnosis or diagnostic test results. When structured Sleep Center data were available, these were included. We summarized cohort characteristics using means (± SD) or medians (interquartile range) as appropriate. For comparison between subgroups (e.g., those with vs without documented sleep-disordered breathing), we applied Welch’s t-test and binomial proportion tests. Analyses were conducted using Python scripts and spreadsheet software. Results Nearly one-third of patients with confirmed KS in this series had either diagnosed or suspected obstructive sleep apnea (OSA), substantially exceeding prevalence estimates in the general population. The frequency of central sleep apnea (CSA) was comparable to that seen in the general population, however its occurrence without usual predisposing factors suggests a predisposition toward idiopathic CSA in KS. Circadian rhythm disorders were rare, occurring in < 1% of the cohort. Notably, nearly 75% of KS patients with documented sleep-related symptoms had never undergone formal evaluation in a Sleep Center. Conclusion The observed rate of presumed idiopathic CSA among individuals with KS suggests the possibility of KS-specific mechanisms affecting ventilatory control stability. Additionally, there appeared to be a larger prevalence of OSA in this patient population. Notably, approximately three-quarters of KS patients who reported sleep-related symptoms had never undergone a formal Sleep Medicine assessment, highlighting a significant gap in structured evaluation that may relate to limited access to specialized care, referral patterns, or other systemic barriers, and warrants additional study. Support (if any) None

Abstract Introduction Narcolepsy and idiopathic hypersomnia (IH) are characterized by excessive daytime sleepiness. They can be caused by deficiency of orexin/hypocretin, a neuropeptide that regulates sleep and wakefulness. It is estimated that 1 in 2000 people in the United States of America have been diagnosed with some form of narcolepsy or idiopathic hypersomnia. Around the world, about 3 million people are narcoleptic. Little data are available regarding the lifestyle factors in these patients. In this study, we sought to find whether lifestyle factors, including diet and physical activity are associated with the severity of sleepiness in narcolepsy and idiopathic hypersomnia. Methods We collaborated with “Hypersomnia Foundation” and “Wake Up Narcolepsy” who distributed our survey to their subscribers. The survey consisted of a series of four short subsurveys asking about the substance use, diet (MiniEAT screen), exercise (IPAQ questionnaire), and daytime sleepiness (Epworth Sleepiness Scale). The survey was anonymous and included baseline characteristics, diagnosis (Narcolepsy type 1 (NT1), Narcolepsy type 2 (NT2), or Idiopathic Hypersomnia (IH)). We considered hypersomnolence and moderate to severe hypersomnolence to be present if ESS >10 and ≥15, respectively. Results We received total of 377 individual responses. Of those, 191 responders had IH, 97 had NT1 and 89 had NT2. Median age was 31 (25, 42) and 323 identified as females, 44 males and 10 others. Median ESS was 15 (12, 18), where 285 responders had ESS >10 (76%) and 194 (51%) had ESS >/=15. The ressponders with NT1 had significantly higher median ESS: 17 (12,19), than NT2: 15 (10, 17), or IH: 15(12, 17) responders (p< 0.01). In multiple univariate analyses, none of the baseline characteristics, habits (smoking, alcohol or caffeine), dietary consumption (fruit, vegetable, legumes/nuts/seeds, whole or refined grains, dairy and fish/seafood) or exercise (vigourous, moderate or walking) had significant association with the degree of responders’ subjective sleepiness. Conclusion Most survey responders continue to be excessively sleepy, particularly those with NT1. There were no apparent univariate associations of underlying hypersomnolence with the baseline characteristics, habits, diet and exercise levels. Disorders of central hypersomnolence are of complex nature without easily identifiable modifiers. Support (if any) Mayo Clinic CRISP