Neurological Institute Outcomes

289 obstructive sleep apnea (OSA) patients treated with positive airway pressure (PAP) had at least 2 visits from 2022–2023 with ESS data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 100), 36% (N = 36) improved, 55% (N = 55) remained stable, and 9% (N = 9) worsened. Median duration of follow-up was 176 days (range, 2-593 days). Clinically meaningful change was defined as a total score change of 3, based on one-half the standard deviation.¹

396 OSA patients treated with PAP had at least 2 visits from 2022–2023 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 93), 39.8% (N = 37) improved, 49.5% (N = 46) remained stable, and 10.7% (N = 10) worsened. Median duration of follow-up was 321 days (range, 28-658 days). Clinically meaningful change was defined as a total score change of 5.²

482 OSA patients treated with PAP had at least 2 visits from 2022–2023 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 223), 28.2% (N = 63) improved, 61.9% (N = 138) remained stable, and 9.9% (N = 22) worsened. Median duration of follow-up was 365 days (range, 45-681 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

479 OSA patients treated with PAP had at least 2 visits from 2022–2023 with PROMIS Physical Health data available for analysis. Among those patients whose baseline PROMIS Physical Health score ≤ 45 (N = 265), 37% (N = 98) improved, 54% (N = 143) remained stable, and 9% (N = 24) worsened. Median duration of follow-up was 367 days (range, 35-660 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

315 OSA patients treated with PAP had at least 2 visits from 2022–2023 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance score ≥ 55 (N = 138), 43.5% (N = 60) improved, 42.7% (N = 59) remained stable, and 13.8% (N = 19) worsened. Median duration of follow-up was 182 days (range, 2-607 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

214 OSA patients treated with PAP had at least 2 visits from 2022–2023 with Sleep Time data available for analysis. Among those patients whose baseline Sleep Time ≤ 24 hours (N = 213), 26.3% (N = 56) improved, 44.6% (N = 95) remained stable, and 29.1% (N = 62) worsened. Median duration of follow-up was 306 days (range, 35-661 days). Clinically meaningful change was defined as a 1-hour change, based on one-half the standard deviation.¹

34 OSA patients treated with HNS had at least 2 visits from 2022–2023 with ESS data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 13), 53.8% (N = 7) improved, 23.1% (N = 3) remained stable, and 23.1% (N = 3) worsened. Median duration of follow-up was 216 days (range, 57-581 days). Clinically meaningful change was defined as a total score change of 3, based on one-half the standard deviation.¹

38 OSA patients treated with HNS had at least 2 visits from 2022–2023 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 7), 57.1% (N = 4) improved, 28.6% (N = 2) remained stable, and 14.3% (N = 1) worsened. Median duration of follow-up was 326 days (range, 57-542 days). Clinically meaningful change was defined as a total score change of 5.²

41 OSA patients treated with HNS had at least 2 visits from 2022–2023 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 8), 50% (N = 4) improved, 50% (N = 4) remained stable, and 0% (N = 0) worsened. Median duration of follow-up was 416 days (range, 76-543 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

40 OSA patients treated with HNS had at least 2 visits from 2022–2023 with PROMIS Physical Health data available for analysis. Among those patients whose baseline PROMIS Physical Health score ≤ 45 (N = 15), 26.7% (N = 4) improved, 53.3% (N = 8) remained stable, and 20% (N = 3) worsened. Median duration of follow-up was 520 days (range, 76-657 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

38 OSA patients treated with HNS had at least 2 visits from 2022–2023 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance score ≥ 55 (N = 19), 47.4% (N = 9) improved, 52.6% (N = 10) remained stable, and 0% (N = 0) worsened. Median duration of follow-up was 290 days (range, 57-584 days). Clinically meaningful change was defined as a 5-unit change in T-score, based on one-half the standard deviation.¹

27 OSA patients treated with HNS had at least 2 visits from 2022–2023 with Sleep Time data available for analysis. Among those patients whose baseline Sleep Time ≤ 24 hours (N = 27), 25.9% (N = 7) improved, 63% (N = 17) remained stable, and 11.1% (N = 3) worsened. Median duration of follow-up was 258 days (range, 77-615 days). Clinically meaningful change was defined as a 1-hour change, based on one-half the standard deviation.¹

The objective was to investigate sex-specific differences in inpatient diagnosis approaches (Type III sleep test vs polysomnogram (PSG)) to provide insights into the diagnosis and treatment of obstructive sleep apnea (OSA) in hospitalized patients.

The STARLIT Registry (Sleep Signals, Testing, and Reports Linked to Patient Traits) was utilized. Models were constructed with demographics, comorbidities, and sleep study measures to determine whether study type was predictive of OSA and hypoxia. OSA was defined by apnea hypopnea index (AHI) and divided into categories (≥5, ≥15, and ≥30). Hypoxia was defined by median percentage of sleep time spent at <90% oxygen saturation (TST<90%, ≥11%).

The N=778 patients had a mean age of 56.1±16.1 years; 44.5% were female and 72.2% were Caucasian. Women had increased odds of mild OSA (AHI≥5) (OR=2.04, 95% CI=1.24-3.35, p=0.005) with type III sleep testing vs PSG compared to men. Men had decreased odds of moderate to severe OSA (AHI≥15) (OR=0.60, 95% CI=0.39-0.90, p=0.015) with type III sleep testing vs PSG compared to women (OR=1.15, 95% CI=0.72-1.85, p=0.56). In this model, an interaction of sex and sleep study type was significant (p-value=0.040). both sexes had increased odds of TST<90 ≥ 11% (OR=2.60, 95% CI=1.60-4.21, p≤0.001; OR=3.46, 95% CI=1.97-6.05, p<0.001) with Type III sleep testing vs PSG. No sex interaction was observed. These results were attenuated when the analysis was restricted using the 3% hyypopnea scoring rule. Men and women had higher odds of TST (<0.001) with Type III sleep study versus PSG, albeit no sex interaction was observed.

There are known gender disparities in OSA diagnosis, I.E. more women with OSA are undiagnosed than men, leading to treatment delays and underrepresentation in clinical trials. It is shown above that women were more likely to show mild OSA with type III sleep testing bs PSG compared to men and men were less likely to show moderate to severe OSA relative to women with type III sleep testing compared to PSG. No differences in hypoxia were shown. Ambulatory sleep testing tends to underestimate OSA severity in general. The findings suggest this may be sex-specific. Sex-specific differences in diagnostic performance of sleep study type in the inpatient setting should be considered according to level of OSA severity which are influenced by hypopnea-related desaturation extent.