Exploring sleep difficulties, alcohol, illicit drugs, and suicidal ideation among adolescents with a history of depression.

Sleep difficulties and misuse of drugs/alcohol have been associated with suicidal ideation in young people. Using cross-sectional representative surveys of adolescents in the United States, we conducted adjusted logistic regression modeling to assess the relationships between sleep difficulties, substance use, and suicidal ideation among adolescents with a history of depression (n = 38,418) between 2015 and 2020. Sleep difficulties were associated with thinking about (aOR=1.6,95%CI:1.3-1.9), planning (aOR=1.8,95%CI:1.2-2.6), or attempting (aOR=1.7,95%CI:1.2-2.5) suicide. In those reporting alcohol abuse/dependence, sleep difficulties were associated with attempting suicide (aOR=3.1,95%CI:1.2-8.5). In those reporting illicit drug abuse/dependence, sleep difficulties were associated with thinking about (aOR=2.1,95%CI:1.1-4.1) and attempting (aOR=2.2,95%CI:1.2-4.1) suicide.

A Protocol to Determine Circadian Phase by At-Home Salivary Dim Light Melatonin Onset Assessment.

Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep-wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep-Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool.

Obstructive Sleep Apnea is a Risk Factor for Incident COVID-19 Infection.

Cross-sectional studies suggest that obstructive sleep apnea (OSA) is a potential risk factor for incident COVID-19 infection, but longitudinal studies are lacking. In this study, two surveys from a large general population cohort, the COVID-19 Outbreak Public Evaluation (COPE) Initiative, undertaken 147 ± 58 days apart were analyzed to determine whether the pre-existing OSA was a risk factor for the incidence of COVID-19. Of the 24,803 respondents completing the initial survey, 14,950 were negative for COVID-19; data from the follow-up survey were available for 2,325 respondents. Those with incident COVID-19 infection had a slightly higher prevalence of OSA (14.3 vs. 11.5%, p=0.068). Stratification by treatment status revealed that those untreated for their OSA were at greater risk for developing COVID-19 infection (OSA Untreated, 14.2 vs. 7.4%, p≤0.05). In a logistic regression model adjusted for comorbidities, demographic and socioeconomic factors and the interaction between vaccination status and OSA, incident COVID-19 infection was 2.15 times more likely in those with untreated OSA (aOR: 2.15, 95% CI: 1.18-3.92, p≤0.05). Stratification by treatment status revealed only untreated OSA participants were at greater risk for COVID-19 (aOR: 3.21, 95% CI: 1.25-8.23, p≤0.05). The evidence from this study confirms untreated OSA as a risk factor for acquiring COVID-19 infection and highlights the importance of actively treating and managing OSA as a preventative mechanism against COVID-19 disease.

Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions.

Study Objectives: Insomnia, poor sleep quality and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Methods: Cross-sectional survey of a general population of 24,803 U.S. adults to determine the association of insomnia, poor sleep quality and sleep duration with PASC. Results: Prevalence rates of PASC among previously COVID-19 infected participants for three definitions of PASC were COPE (21.9%), NICE (38.9%) and RECOVER PASC Score (15.3%). PASC was associated with insomnia in all 3 models in fully adjusted models with adjusted odds ratios (aORs) and 95% confidence intervals (CI) ranging from 1.30 (95% CI: 1.11-1.52, p≤0.05, PASC Score) to 1.52 (95% CI: 1.34-1.71, p≤0.001, (NICE). Poor sleep quality was related to PASC in all models with aORs ranging from 1.77 (95% CI: 1.60-1.97, p≤0.001, NICE) to 2.00 (95% CI: 1.77-2.26, p≤0.001, COPE). Sleep <6 hours was associated with PASC with aORs between 1.59 (95% CI: 1.40-1.80, p≤0.001, PASC Score) to 1.70 (95% CI: 1.53-1.89, p≤0.001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality and short sleep duration with PASC in any of the models. Conclusions: Insomnia, poor sleep quality and short sleep duration are potential risk factors for PASC. Interventions to improve sleep may decrease the development of PASC.

Mid-life sleep is associated with cognitive performance later in life in aging American Indians: data from the Strong Heart Study.

Background: Sleep-related disorders have been associated with cognitive decline and neurodegeneration. American Indians are at increased risk for dementia. Here, we aim to characterize, for the first time, the associations between sleep characteristics and subsequent cognitive performance in a sample of aging American Indians. Methods: We performed analyses on data collected in two ancillary studies from the Strong Heart Study, which occurred approximately 10 years apart with an overlapping sample of 160 American Indians (mean age at follow-up 73.1, standard deviation 5.6; 69.3% female and 80% with high school completion). Sleep measures were derived by polysomnography and self-reported questionnaires, including sleep timing and duration, sleep latency, sleep stages, indices of sleep-disordered breathing, and self-report assessments of poor sleep and daytime sleepiness. Cognitive assessment included measures of general cognition, processing speed, episodic verbal learning, short and long-delay recall, recognition, and phonemic fluency. We performed correlation analyses between sleep and cognitive measures. For correlated variables, we conducted separate linear regressions. We analyzed the degree to which cognitive impairment, defined as more than 1.5 standard deviations below the average Modified Mini Mental State Test score, is predicted by sleep characteristics. All regression analyses were adjusted for age, sex, years of education, body mass index, study site, depressive symptoms score, difference in age from baseline to follow-up, alcohol use, and presence of APOE e4 allele. Results: We found that objective sleep characteristics measured by polysomnography, but not subjective sleep characteristics, were associated with cognitive performance approximately 10 years later. Longer sleep latency was associated with worse phonemic fluency (ß = -0.069, p = 0.019) and increased likelihood of being classified in the cognitive impairment group later in life (odds ratio 1.037, p = 0.004). Longer duration with oxygen saturation < 90% was associated with better immediate verbal memory, and higher oxygen saturation with worse total learning, short and long-delay recall, and processing speed. Conclusion: In a sample of American Indians, sleep characteristics in midlife were correlated with cognitive performance a decade later. Sleep disorders may be modifiable risk factors for cognitive impairment and dementia later in life, and suitable candidates for interventions aimed at preventing neurodegenerative disease development and progression.

Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a highly prevalent, yet underdiagnosed, condition. Due to its adverse impact on risk for cardiopulmonary disorders, there is interest in proactive screening of OSA in hospitalized patients. We studied the long-term outcome of such screened patients who were initiated on positive airway pressure therapy. METHODS: Hospitalized patients who screened positive for OSA and were confirmed with postdischarge polysomnography were dichotomized by positive airway pressure therapy adherence and followed for a period of 12 months to evaluate for the composite end point of hospital readmissions and emergency department visits for cardiopulmonary reasons. Cost analysis between the 2 groups was also conducted. RESULTS: A total of 2,042 hospitalized patients were assessed for OSA as part of a hospital sleep medicine program from August 2019-June 2023. Of these, 293 patients were diagnosed with OSA and prescribed positive airway pressure therapy. Of these 293 patients, 108 were adherent to therapy and 185 were nonadherent. The overall characteristics of the groups included a mean (standard deviation) age of 58 years (12.82), mean body mass index (kg/m2) of 39.72 (10.71), 57% male sex, and apnea-hypopnea index of 25.49 (26). Of the patients, 78%, 41%, and 43% had hypertension, congestive heart failure, and diabetes mellitus, respectively. The composite end point of hospital readmissions and emergency department visits for cardiovascular and pulmonary reasons was significantly higher in the nonadherent group than in the adherent group (hazard ratio, 1.24; 95% confidence interval, 1-1.54) (P = .03). The cost of care for both hospital billing as well as professional billing was higher for the nonadherent group ($1,455.60 vs $1,723.50, P = .004 in hospital billing cost and $130.90 vs $144.70, P < .001 in professional billing). Length of stay was higher for nonadherent patients (2.7 ± 5.1 days vs 2.3 ± 5.9 days). CONCLUSIONS: Hospitalized patients diagnosed with OSA and adherent to therapy have reduced readmissions and emergency department visits for cardiopulmonary reasons 12 months after discharge. Adherent patients have reduced cost of health care and length of stay during hospitalizations. CITATION: Sharma S, Stansbury R, Srinivasan P, et al. Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study. J Clin Sleep Med. 2024;20(8):1313-1319.

Association of Chronotype and Shiftwork With COVID-19 Infection.

OBJECTIVE: This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: This study used a cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration, and comorbidities, morning chronotype was associated with a higher (adjusted odds ratio [aOR]: 1.15, 95% CI: 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.

Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 Infection.

BACKGROUND: Obstructive sleep apnea is associated with COVID-19 infection. Less clear is whether obstructive sleep apnea is a risk factor for the development of post-acute sequelae of SARS-CoV-2 infection (PASC). STUDY DESIGN: Cross-sectional survey of a general population of 24,803 US adults to determine the association of obstructive sleep apnea with PASC. RESULTS: COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence of persistent (>3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models, obstructive sleep apnea was associated with all putative PASC-related symptoms with the highest adjusted odds ratios being fever (2.053) and nervous/anxious (1.939). In 4 logistic regression models of overall PASC derived from elastic net regression, obstructive sleep apnea was associated with PASC (range of adjusted odds ratios: 1.934-2.071); this association was mitigated in those with treated obstructive sleep apnea. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. CONCLUSION: In a general population sample, obstructive sleep apnea is associated with the development of PASC-related symptoms and a global definition of PASC. Treated obstructive sleep apnea mitigates the latter risk. The presence of 3 or more PASC symptoms may be useful in identifying cases and for future research.

A transformer-based diffusion probabilistic model for heart rate and blood pressure forecasting in Intensive Care Unit.

BACKGROUND AND OBJECTIVE: Vital sign monitoring in the Intensive Care Unit (ICU) is crucial for enabling prompt interventions for patients. This underscores the need for an accurate predictive system. Therefore, this study proposes a novel deep learning approach for forecasting Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) in the ICU. METHODS: We extracted 24,886 ICU stays from the MIMIC-III database which contains data from over 46 thousand patients, to train and test the model. The model proposed in this study, Transformer-based Diffusion Probabilistic Model for Sparse Time Series Forecasting (TDSTF), merges Transformer and diffusion models to forecast vital signs. The TDSTF model showed state-of-the-art performance in predicting vital signs in the ICU, outperforming other models' ability to predict distributions of vital signs and being more computationally efficient. The code is available at https://github.com/PingChang818/TDSTF. RESULTS: The results of the study showed that TDSTF achieved a Standardized Average Continuous Ranked Probability Score (SACRPS) of 0.4438 and a Mean Squared Error (MSE) of 0.4168, an improvement of 18.9% and 34.3% over the best baseline model, respectively. The inference speed of TDSTF is more than 17 times faster than the best baseline model. CONCLUSION: TDSTF is an effective and efficient solution for forecasting vital signs in the ICU, and it shows a significant improvement compared to other models in the field.

Sleep and mental health among unpaid caregivers of children, adults, and both: United States, 2022.

OBJECTIVES: We sought to characterize sleep and mental health, and their relationship, among unpaid caregivers. METHODS: During March through August 2022, four waves of cross-sectional surveys were administered to US adults using demographic quota sampling and weighting to improve representativeness of the US adult population. RESULTS: Among 19,767 respondents, 6260 (31.7%) identified as serving one or more unpaid caregiving roles. Compared to people without caregiving roles, caregivers more commonly reported sleep duration outside the healthy range (7-9 hours), insomnia symptoms, diagnosed sleep disorders, and more commonly screened positive for anxiety, depression, and burnout symptoms. Multivariable analyses adjusted for demographics characteristics revealed unpaid caregivers had several-fold elevated odds of adverse mental health symptoms; associations were attenuated but remained significant after adjusting for impaired and nonoptimal sleep. CONCLUSIONS: Both sleep and mental health challenges are disproportionately experienced by and commonly co-occur among unpaid caregivers, especially those who care for both children and adults. These populations, which serve critical societal roles, may benefit from enhanced support services to address sleep and mental health.

Public opinion of resident physician work hours in 2022.

OBJECTIVE: The purpose of this study was to characterize public awareness and opinion regarding resident physician work hours in the United States. METHODS: We conducted a nationally representative cross-sectional survey among adults in the United States. Demographic quota-based sampling was conducted by Qualtrics to match 2020 United States Census estimates of age, sex, race, and ethnicity. Descriptive statistics are presented. Hypothesis testing was conducted to identify characteristics associated with agreement with current resident physician work-hour policies. RESULTS: 4763 adults in the United States participated in the study. 97.1% of the public believes that resident physicians should not work 24-hour shifts and 95.6% believe the current 80 hours resident work week is too long. 66.4% of the participants reported that the maximum shift duration should be 12 consecutive hours or fewer, including 22.9% who recommended a maximum shift length of 8 hours. Similarly, 66.4% reported that maximum weekly work hours should be 59 or fewer, including 24.9% who recommended a maximum of 40 weekly work hours. CONCLUSIONS: Nearly all US adults disagree with current work-hour policies for resident physicians. Public opinion supports limiting shifts to no more than 12 consecutive hours and weekly work to no more than 60 hours, which is in sharp contrast to current regulations that permit of 28 hours shifts and 80 hours of work per week.

Effects of sleep on breakfast behaviors in recently unemployed adults.

OBJECTIVES: Skipping meals is linked to negative cardiometabolic health outcomes. Few studies have examined the effects of breakfast skipping after disruptive life events, like job loss. The present analyses examine whether sleep timing, duration, and continuity are associated with breakfast eating among 186 adults who recently (past 90 days) experienced involuntary unemployment from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study. METHODS: We conducted both cross-sectional and 18-month longitudinal analyses to assess the relationship between actigraphic sleep after job loss and breakfast eating. RESULTS: Later sleep timing was associated with a lower percentage of days breakfast was eaten at baseline (B = -0.09, SE = 0.02, P < .001) and longitudinally over 18 months (estimate = -0.04; SE = 0.02; P < .05). No other sleep indices were associated with breakfast consumption cross-sectionally or prospectively. CONCLUSIONS: Unemployed adults with a delay in sleep timing are more likely to skip breakfast than adults with an advancement in sleep timing. Future studies are necessary to test chronobiological mechanisms by which sleep timing might impact breakfast eating. With the understanding that sleep timing is linked to breakfast eating, the advancement of sleep timing may provide a pathway for the promotion of breakfast eating, ultimately preventing cardiometabolic disease.

Exploring Sleep in Caregivers of Children with Autism Spectrum Disorder (ASD) and the Relationship to Health-Related Quality of Life (HRQoL) and Family Quality of Life (FQoL).

Background and Objectives: To investigate (1) the prevalence of sleep disorder symptoms in caregivers of children with autism spectrum disorder (ASD) and (2) the relationships between caregiver sleep problems and their health-related quality of life and family quality of life. Materials and Methods: Descriptive cross-sectional study of caregivers (N = 62) of children aged 6 to 11 years old diagnosed with ASD and receiving care at a regional autism research and resource center. Results: Participants completed the Sleep Habits Questionnaire (SHQ), the Medical Outcomes Study (MOS) SF-12, and the Beach Center Family Quality of Life Scale (FQoL). Caregivers with longer sleep duration reported better mental health and better family quality of life. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. Caregivers with obstructive sleep apnea and restless legs syndrome experienced worse physical quality of life. Conclusions: The physical and mental health of the primary caregiver is essential to the support of the child with ASD and to the functioning of the family. The study findings point to the importance of future research and interventions to enhance sleep health in order to improve quality of life for caregivers of children with ASD.

Genetic QT Score and Sleep Apnea as Predictors of Sudden Cardiac Death in the UK Biobank.

Introduction: The goal of this study was to evaluate the association between a polygenic risk score (PRS) for QT prolongation (QTc-PRS), QTc intervals and mortality in patients enrolled in the UK Biobank with and without sleep apnea. Methods: The QTc-PRS was calculated using allele copy number and previously reported effect estimates for each single nuclear polymorphism SNP. Competing-risk regression models adjusting for age, sex, BMI, QT prolonging medication, race, and comorbid cardiovascular conditions were used for sudden cardiac death (SCD) analyses. Results: 500,584 participants were evaluated (56.5 ±8 years, 54% women, 1.4% diagnosed with sleep apnea). A higher QTc-PRS was independently associated with the increased QTc interval duration (p<0.0001). The mean QTc for the top QTc-PRS quintile was 15 msec longer than the bottom quintile (p<0.001). Sleep apnea was found to be an effect modifier in the relationship between QTc-PRS and SCD. The adjusted HR per 5-unit change in QTc-PRS for SCD was 1.64 (95% CI 1.16 - 2.31, p=0.005) among those with sleep apnea and 1.04 (95% CI 0.95 - 1.14, p=0.44) among those without sleep apnea (p for interaction =0.01). Black participants with sleep apnea had significantly elevated adjusted risk of SCD compared to White participants (HR=9.6, 95% CI 1.24 - 74, p=0.03). Conclusion: In the UK Biobank population, the QTc-PRS was associated with SCD among participants with sleep apnea but not among those without sleep apnea, indicating that sleep apnea is a significant modifier of the genetic risk. Black participants with sleep apnea had a particularly high risk of SCD.

Association of Chronotype and Shiftwork with COVID-19 Infection.

Objective: This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: Cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.

Associations Between Insomnia and Obstructive Sleep Apnea with Nutritional Intake After Involuntary Job Loss.

Objectives: Involuntary job loss is a stressful life event that can result in changes in nutritional intake. Both insomnia and obstructive sleep apnea (OSA) also are associated with alterations in dietary intake, but the extent to which this occurs in those who have experienced involuntary job loss is unclear. This study assessed nutritional intake in recently unemployed persons with insomnia and obstructive sleep apnea in comparison to those without a sleep disorder. Methods: Participants from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study were screened for sleep disorders using the Duke Structured Interview for Sleep Disorders. They were classified as having OSA, acute or chronic insomnia or no sleep disorder. Dietary data was collected using United States Department of Agriculture Multipass Dietary recall methodology. Results: A total of 113 participants had evaluable data and were included in this study. The cohort was comprised mainly of women (62%) and 24% were non-Hispanic white. Participants with OSA had a higher BMI compared with no sleep disorder (30.6 ± 9.1 vs 27.4 ± 7.1 kg/m2, p≤0.001). Those with acute insomnia had significantly decreased consumption of total protein (61.5 ± 4.7 vs. 77.9 ± 4.9 g, p≤0.05) and total fat (60.0 ± 4.4 vs. 80.5 ± 4.6 g, p≤0.05). Among the participants with chronic insomnia, there was little overall difference in nutrient consumption compared to the no sleep disorder group although there were several gender specific differences. There were no overall differences between participants with OSA in comparison to no sleep disorder, but women consumed less total fat (89.0 ± 6.7 vs. 57.5 ± 8.0 g, p≤0.01). The Healthy Eating Index of all groups was below the average value of Americans. Conclusion: Unemployed persons compared to those with sleep disorders differ in their consumption of major nutrients; the dietary composition of those with acute insomnia exhibited the greatest divergence. Additionally, the overall nutritional intake of recently unemployed persons is poor.

Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults.

STUDY OBJECTIVES: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? METHODS: This was a cross-sectional survey of a diverse sample of 15,057 US adults. RESULTS: COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. CONCLUSIONS: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization. CITATION: Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.

Quantifying the impact of the Philips recall on patients with sleep apnea and clinicians.

STUDY OBJECTIVES: Philips Respironics issued a voluntary recall of positive airway pressure devices used to treat obstructive sleep apnea in June 2021. We surveyed sleep medicine clinicians from the American Academy of Sleep Medicine membership to assess the impact of the recall on clinicians and patients. METHODS: One hundred thirty-six clinicians participated between June 2022 and November 2022. Participants reported their treatment recommendations for patients affected by the recall, their patients' behaviors regarding the recall, the recall's impact on them as clinicians and on their patients, and the approximate time their patients were waiting for a replacement device. RESULTS: Clinicians most commonly reported first learning about the recall from Philips (25.0%), and patients most commonly first heard about the recall from news sources (34.5%). Most clinicians (62.4%) reported that they recommended patients continue using a recalled device. In comparison, only 9.3% of clinicians reported encouraging patients to stop using their recalled device. Clinicians reported that 59.9% of patients continued treatment with their recalled device, whereas 26.5% stopped treatment. Clinicians reported that over one-third of their patients were still waiting for a replacement machine. Most (86.8%) clinicians reported their stress levels were affected due to the recall, and 91.5% of clinicians reported the recall affected their patients' health and well-being. Most (83.3%) clinicians reported the recall affected their patients' trust in medicine. CONCLUSIONS: Clinicians reported that the Philips recall impaired the vast majority of their patients' health and trust in medicine and that many patients were still waiting for replacement devices. CITATION: Robbins R, Epstein LJ, Pavlova MK, et al. Quantifying the impact of the Philips recall on patients with sleep apnea and clinicians. J Clin Sleep Med. 2023;19(9):1677-1683.

Biomarkers of gut barrier dysfunction in obstructive sleep apnea: A systematic review and meta-analysis.

We conducted this systematic review and meta-analysis to evaluate the impact of obstructive sleep apnea (OSA) on gut barrier dysfunction as represented by the following biomarkers: zonulin, lipopolysaccharide, lipopolysaccharide binding protein, intestinal fatty acid binding protein, and lactic acid. A comprehensive search of the literature was conducted in Ovid MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov without language restrictions from inception to October 2022. The analysis of all outcomes was performed using a random-effects model. We included eight studies (seven cross sectional and one case control) in the final quantitative synthesis with a total of 897 patients. We concluded that OSA was associated with higher levels of gut barrier dysfunction biomarkers [Hedges' g = 0.73 (95%CI 0.37-1.09, p < 0.01). Biomarker levels were positively correlated with the apnea-hypopnea index [r = 0.48 (95%CI 0.35-0.6, p < 0.01)] and oxygen desaturation index [r = 0.30 (95%CI 0.17-0.42, p < 0.01)], and negatively correlated with the nadir oxygen desaturation values [r = -0.45 (95%CI - 0.55 - - 0.32, p < 0.01). Our systematic review and meta-analysis suggests that OSA is associated with gut barrier dysfunction. Furthermore, OSA severity appears to be correlated with higher biomarkers of gut barrier dysfunction. PROSPERO REGISTRATION NUMBER: CRD42022333078.