ResMed (Netherlands)

Abstract Introduction Chronic conditions such as cardiovascular disease, diabetes, and chronic obstructive pulmonary disease are associated with obstructive sleep apnea (OSA). These conditions are more prevalent in older adults, who may be at heightened risk for OSA. Studies on OSA prevalence have primarily focused on individuals aged up to 70 years, leaving a significant gap in data regarding the population >70 years. Therefore, it is crucial to assess the prevalence of OSA in this group. We aimed to estimate the prevalence of OSA among older adults across the United States through 2050. Methods A dynamic open-cohort Markov model was constructed to simulate changes in population structure from 2020 to 2050. Parameters for population growth, the progression of OSA, body mass index (BMI) trajectories, all-cause mortality, and mortality linked to OSA and BMI were based on estimates from existing literature and were modeled across various subgroups categorized by age, sex, and BMI trends, updated every five years. OSA prevalence was adjusted according to age, sex, and BMI subgroups. The projection of OSA prevalence (defined as AHI >5) was focused on individuals aged 70-85 years. Results From 2020 to 2050, the prevalence of OSA in older adults is projected to increase substantially. The overall prevalence of OSA with AHI ≥ 5 is expected to rise by 136%, from 11.9 (33%) million cases in 2020 to 28.2 (53.7%) million cases in 2050. For older females, the prevalence of OSA (AHI ≥ 5) will see an increase of 159%, from 4.7 million (23% of females 70-85 years) cases in 2020 to 12.1 million (45.0%) cases in 2050. For older males, the increase will be more moderate than for females, with a rise of 121%, from 7.3 million (45.7%) cases in 2020 to 16.1 million (63.4%) cases in 2050. Conclusion The prevalence of OSA in older adults is expected to rise significantly through 2050, with the most pronounced increase among older females. The potential clinical implications of these findings highlight the need for targeted healthcare strategies in the United States to address the anticipated growth in OSA burden in the aging population. Support (if any) ResMed

Abstract Introduction Obesity is a modifiable risk factor for obstructive sleep apnea (OSA). Weight management interventions have been shown to reduce OSA symptoms and severity for some patients. This retrospective analysis aimed to evaluate the impact of weight reduction surgery or procedure (WRS/P) on pressure changes in positive airway pressure (PAP) treated patients as a proxy for changes in OSA severity following surgery. Methods We analyzed administrative claims data from 2015 to 2021 of adult (≥18 years) OSA patients linked to PAP device data. The date on which the first ICD-10/9 or CPT code appeared for a WRS/P was the index date. Inclusion criteria were a categorical body mass index (BMI) ≥30 kg/m2 at baseline, at least 1 year of insurance coverage pre-index, and a minimum of 1 year of PAP therapy data post-index. Changes in PAP pressure were assessed as the difference between median PAP pressure 1 month pre-index and the most recent pressure post-index date. Only categorical BMI is coded in claims, so changes in BMI category following WRS/P were assessed using the difference between categorical midpoints. Results A total of 17,284 OSA patients underwent WRS/P (mean age 45.6 years; 74.7% female). Patients were categorized based on their pre WRS/P BMI (≥30 - < 35, ≥35 - < 40, ≥40 - < 45, ≥45 - < 50, ≥50 - < 60, and ≥60 kg/m2). The average baseline apnea-hypopnea index (AHI) was 16.9, 18.2, 19.9, 23.4, 25.1, and 27.0 events/h respectively. After WRS/P the average decrease in BMI was 3.3, 5.7, 6.8, 8.1, 10.3, and 13.0 kg/m2; and the average decrease in the median PAP pressure was 0.8, 0.9, 1.0, 1.3, 1.3, and 1.3 cm H2O respectively. Conclusion Patients with the highest baseline BMIs experienced the most weight loss after WRS/P. These individuals also had the greatest reductions in PAP pressures following surgery. Using PAP pressure as a proxy for OSA severity, in absence of post-surgery sleep testing, our findings suggest that patients with higher baseline BMIs are likely to achieve the most substantial, albeit not complete, reductions in OSA severity, compared to those with lower baseline BMI, after undergoing WRS/P. Support (if any) ResMed

Abstract Introduction Smartphone applications (Apps) offer a highly scalable, engaging, and cost-effective approach to improving sleep-promoting behaviors and attitudes. In this randomized wait-list controlled trial, we evaluated the efficacy of a novel smartphone app, the Dein Schlaf Dein Tag app from SleepScore Labs, designed to objectively measure sleep via PSG-validated sonar methods and improve sleep by providing personalized, dynamic, and evidenced-based sleep and circadian advice and education founded in the principles of sleep hygiene and cognitive-behavioral skills. Methods A preliminary analysis of 412 participants with subclinical poor sleep (Regensburg Insomnia Scale score 13-24) randomized to either an App/intervention group (n=128) or a waitlist control group (n=298) was conducted. Changes in subjective sleep quality, perceived stress, and quality of life were measured using validated questionnaires at baseline, 6-weeks, and 12-week time-points. Statistical significance was tested via the interaction of an ANOVA (factor 1: app group vs. waitlist control; factor 2: baseline vs. 6 and 12 weeks). Results At both 6 and 12-week follow-up assessments, perceived sleep quality as measured by the sleep quality component of the Schlaffragebogen-B (SF-B) significantly improved among the App/intervention group when compared with controls (12-week effect size 0.646 App vs. 0.250 control group, F: 11.7, p=0.0007). Overall sleep problems as measured by the PSQI also significantly improved at 6 and 12-weeks among the App group when compared with controls (12-week effect size -0.448 app vs. -0.172 control, F: 7.5, p=0.0065). Feelings of being refreshed after sleep significantly improved among the App/intervention group after both 6 and 12-week assessments as measured by the GES component of the SF-B (12-week effect size 0.429 app vs. 0.143 control, F: 5.4, p=0.002). At 12-weeks, perceived stress significantly improved among the App/intervention group as measured using the Perceived Stress Scale (12-week effect size -0.526 app vs. -0.235 control, F: 4.1, p=0.0436), but not at 6-weeks (p=0.08). No significant differences in quality of life as measured using the SF-12 were observed between groups. Conclusion This randomized controlled trial demonstrated that a personalized and dynamic sleep improvement and measurement App can improve perceived sleep and stress in individuals with poor sleep. Support (if any) SleepScore Labs and ResMed Science Center

Abstract Introduction Depression and obesity are both prevalent among patients with obstructive sleep apnea (OSA). Treating OSA has been shown to improve depressive symptoms. Routine treatment for OSA often includes positive airway pressure (PAP) therapy combined with weight management strategies, including glucagon-like peptide 1 receptor agonists (GLP-1s), which have been approved to treat type 2 diabetes (T2D) and obesity. Little is known about the relationship between GLP-1 use and OSA and depression treatment patterns, or how these may be affected by depression status and gender. Methods Administrative insurance claims from 2014-2023 for adult patients with OSA who filled a GLP-1 prescription with ≥1 year of enrollment before and after the first recorded GLP-1 fill (index date) were analyzed. Depression was defined based on ICD-10 diagnosis codes within the year prior to index. Antidepressant use and OSA treatment in the year pre- and post-index were described. Results Of 151,529 patients included (mean age 54.3 years; 48.9% female), 26.3% had depression prior to index. Those with depression were more often women (66.2% vs 42.8%). Prevalence of Medicaid insurance (40.9%) and class III obesity (65.7%) was highest among women with depression, compared to men or those without depression. T2D was common (85.7% overall), with higher prevalence among men. Prior to index, approximately 53% of women and 56% of men had evidence of PAP therapy; this decreased slightly to approximately 48% and 51%, respectively, in the year after index, regardless of depression status. Among patients with depression, prevalence of ≥1 antidepressant prescription was consistent pre- and post-index, but higher among women than men in both periods (pre: 86.0% vs 81.0%; post: 86.0% vs. 80.4%). In the year after index, approximately 41% of women and 39% of men discontinued GLP-1s, regardless of depression status. Conclusion Among patients with OSA starting GLP-1 therapy, prevalence of PAP-related claims were similar in patients with and without depression and by gender. Antidepressant use remained consistent among men and women with depression. Future research should evaluate the impact of GLP-1 use on treatment patterns by indication (T2D or obesity/overweight). Support (if any) ResMed

Abstract Introduction Obesity and or obstructive sleep apnea (OSA) can impact awake breathing patterns, such as increments in the breathing rate. However, little is known about their associations with breathing dysregulations during sleep beyond the apnea-hypopnea events. Understanding this could help elucidate treatment mechanisms or different pathways for disease. Furthermore, there is a strong connection between breathing patterns and cardiovascular disease, thus it is also critical to understand the links between cardiovascular risk factors and disease (CVD) and sleep breathing patterns. Methods The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective multicenter study of diverse Latinos. A total of N=16,415 participants from four major metropolitan areas and six different Hispanic/Latino backgrounds were sampled for appropriate generalization to the target population. Participants were given an ARES unirecorder device (Carlsbad, San Diego) for a single night of unsupervised at home recording (N=12,022). Raw data from cannula channel (sampled at 10Hz) was processed using the python Bycycle package. Bycycle is a cycle-by-cycle approach to analyzing time series data. Bycycle finds all peaks and throughs in cycles and allows users to extract time dependent information of cycles. We extracted breathing rate (breaths per minute), breathing variability (interquartile range of breathing rate) and time spent in inhalation phase (percent time). Results In multivariable models (N=10,175), age was linked to decreased breathing rate, breathing variability, and time spent in inhalation phase. Compared to females, males had higher breathing variability and spent more time in the inhalation phase. Compared to Mexicans and? Central Americans, Cubans, Dominicans, and Puerto Ricans had less time spent in inhalation phase. Dominicans and Puerto Ricans also had increased breathing rate compared to Mexicans. Smoking, body mass index, and moderate to severe OSA were associated with increased breathing rate and variability. Systolic, but not diastolic blood pressure, was associated with increased breathing rate. We found no significant associations with cardiovascular disease. Conclusion Factors commonly linked to OSA were associated with increased breathing rate, a compensatory mechanism for optimal oxygenation, and breathing variability. Given cessation or reduced breathing during an apnea-hypopnea event, breathing variability may add more precision to account for varying oxygen demands. Support (if any)

<b>Background:</b> Patients with systolic heart failure (HFrEF) have a high prevalence of sleep-disordered breathing (SDB). Central sleep apnoea (CSA)/Cheyne-Stokes respiration (CSR) is an independent risk factor for poor prognosis and death in HF. The multinational, multicentre, randomised, parallel, event-driven SERVE-HF study (NCT00733343) investigated the effects of treating predominant CSA/CSR with ASV on morbidity and mortality in HFrEF patients. <b>Methods:</b> Patients with HF-rEF and predominant CSA/CSR were randomised to optimal medical management (control) or optimal medical management plus ASV at 91 centres in 11 countries. Clinic visits were scheduled at baseline, after 2 weeks, 3 and 12 months, and then every 12 months. The primary endpoint was the time to first event of all-cause death, unplanned hospitalisation for worsening HF, cardiac transplantation, resuscitation of sudden cardiac arrest or appropriate life-saving shock. Additional assessments included quality of life, NYHA class, 6-minute walk test, plus sleep and breathing parameters. The study was powered for 651 primary endpoints. <b>Results:</b> 1325 patients were enrolled with a median follow-up of 34 months, with the required number of events occurring during this period. Mean age was 69±10 years, 90% male, NYHA class II (30%) or III-IV (70%), LVEF 32±8%, ICD/CRT in 55%, mean apnoea-hypopnoea index 31±13/h (82±18% central events), average nocturnal oxygen saturation 93%, lowest nocturnal oxygen saturation 80%. The effects of ASV on mortality and morbidity will be presented. <b>Conclusion:</b> The clinical implications of the SERVE-HF trial results of ASV in HF-rEF patients will be discussed.