0595 Obstructive Sleep Apnea Characteristics in Younger Versus Older Women

Introduction

There are few large studies of obstructive sleep apnea (OSA) comparing the clinical and polysomnographic characteristics between men and women, and between younger and older women.

Methods

The current study involves retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a prospective multicenter randomized controlled trial in persons with OSA. The mean age of the 1105 participants was 51.6 ± 12 years (range 18-83 years). The participants included 723 men (65.4%) and 382 women (34.6%). Of all women, 25% were <=45 years of age (likely pre-menopausal) and 50% were above >=53 years of age (likely post-menopausal). We used these 2 groups to define younger women and older women, respectively.

Results

The overall mean body mass index (BMI) and apnea hypopnea index (AHI) were 32.2 ± 7.1 Kg/m2 and 40.1 ± 25.2 (range 6-156/hour), respectively. Women had a higher BMI and Epworth Sleepiness Scale (ESS) than men but a lower AHI and lower arousal index (AI). The Hamilton Rating Scale for Depression (HAMD) score was also significantly higher in women. Younger men and women had no other PSG differences including total sleep time (TST), Sleep Efficiency (SE), Sleep Onset Latency (SOL). Older women had lower AHI, higher TST and higher SE than older men. Morningness-Eveningness Questionnaire (MEQ) scores were lower in women than in men in all age groups (suggestive of eveningness). Compared to the older women, younger women had higher BMI, HAMD score and ESS, but lower MEQ score. On PSG, younger women had higher TST and SE but similar SOL, AHI and AI.

Conclusion

In this cohort with OSA, the prevalence of sleepiness and depression is higher in women than in men despite a lower AHI and lower AI. Sleepiness and depression are more common in younger compared to older women with OSA despite similar AHI and AI and a higher SE. Women with OSA demonstrate more ‘eveningness’ compared to men with OSA, as do younger women compared to older women.

Support

Contract 5UO1-HL-068060 from the National Heart, Lung and Blood Institute

0578 Incident Hypertension Rates in OSA Identified Using American Academy Of Sleep Medicine (AASM) Hypopnea Criteria, but Misclassified by Medicare (CMS) Hypopnea Definition

Introduction

The impact of not treating OSA identified using AASM standards (hypopneas scored using a minimum 3% O2 desaturation or arousal), but misclassified by CMS standards (hypopneas scored only if minimum 4% O2 desaturation) remains unclear. This analysis determined the ~5 year incident hypertension rates using the new 2018 ACC/AHA blood pressure (BP) guidelines in these individuals.

Methods

Data were analyzed from all Sleep Heart Health Study exam 2 study participants (N=1219) who were normotensive (BP≤120/80) at exam 1. The apnea hypopnea index (AHI) at exam 1 was classified into 4 categories of OSA severity: <5, 5 ≤15, 15 ≤30 and ≥30/hour using both the AASM or CMS definitions. Three definitions of hypertension were used: Elevated BP (>120/80), Stage 1 (>130/80) and Stage 2 (>140/90) to determine incidence rates at exam 2.

Results

Five year follow-up data were available for 476 participants classified as having OSA (AHI ≥5) by AASM criteria, but not by CMS standards at exam 1. Incident hypertension rates in these misclassified participants for ACC/AHA defined BP categories were 15% (Elevated BP), 15% (Stage 1) and 6% (Stage 2). 4% of normotensive participants used hypertensive medications. Overall incidence rate of at least an elevated BP was 40% (191/476) in those with OSA defined using AASM, but not by CMS criteria and 17% (191/1219) of the overall population at risk. In comparison to those with incident hypertension and OSA identified by CMS standards, BMI (27.7 vs 30.1 kg/m2, p<.001) and % men were lower (45 vs 58%, p=.012), but age and race were not different.

Conclusion

Use of the CMS hypopnea definition as a component of the AHI resulted in the failure to identify a significant number of individuals with OSA who eventually developed hypertension and could have benefited from earlier diagnosis and treatment.

Support

HL53938

0807 NREM Parasomnias: Retrospective Analysis Of Treatment And Outcomes

Introduction

NREM parasomnias are relatively common among children and sometimes persist in adulthood. These behaviors may result in injury or have negative impacts on functioning and quality of life thus necessitating treatment. The treatment is challenging given the lack of evidence for frequently used medications such as benzodiazepines (BDZ) or tricyclic antidepressants (TCA). The aim of this retrospective analysis is to determine the most frequently prescribed medications for treatment of NREM parasomnias and evaluate reported outcomes.

Methods

We performed a retrospective chart review of all patients with NREM parasomnia diagnosed within BWH clinics examining the date of diagnosis, date of starting therapy, comorbidities, type of medication prescribed, and the reported change in symptoms or side effects at the individual’s follow-up visits.

Results

From 2012 to 2019, 123 patients (64 females, 59 male) at BWH clinics received the diagnosis of NREM parasomnia, including sleepwalking and night terrors. Mean age was 44. Comorbidities included depression=16, anxiety=32, seizures=6, RLS=9, epilepsy=5, insomnia=29, and OSA=57. Initial treatment included safety counseling (72), BDZ (7), TCA (4), and treatment of comorbidity (23). Treatment of OSA only (n=15) was effective in 66% (n=10) and 33% were lost to follow up. Of those with OSA treatment plus BDZ (n=6), treatment was effective in 50% (n=3). Of those receiving BDZ only (n=7), treatment was effective in 43%. Of those receiving Melatonin (8),treatment was effective among 62.5% (n=5). TCAS (n=4) were effective in 3 patients (75%). Treatment of comorbid conditions without pharmacotherapy (23) was effective in 35% (n=8) while the remaining 65% (n=15) were lost to follow up.

Conclusion

Treating comorbid conditions such as OSA, insomnia, RLS, depression, and anxiety is a frequent treatment strategy. Additional pharmacologic treatment most commonly includes melatonin, BDZs, and TCAs.

Support

None

Phytoremediation: an overview of metallic ion decontamination from soil

In recent years, phytoremediation has emerged as a promising ecoremediation technology, particularly for soil and water cleanup of large volumes of contaminated sites. The exploitation of plants to remediate soils contaminated with trace elements could provide a cheap and sustainable technology for bioremediation. Many modern tools and analytical devices have provided insight into the selection and optimization of the remediation process by plant species. This review describes certain factors for the phytoremediation of metal ion decontamination and various aspects of plant metabolism during metallic decontamination. Metal-hyperaccumulating plants, desirable for heavily polluted environments, can be developed by the introduction of novel traits into high biomass plants in a transgenic approach, which is a promising strategy for the development of effective phytoremediation technology. The genetic manipulation of a phytoremediator plant needs a number of optimization processes, including mobilization of trace elements/metal ions, their uptake into the root, stem and other viable parts of the plant and their detoxification and allocation within the plant. This upcoming science is expanding as technology continues to offer new, low-cost remediation options.

Oxidative protein cross-linking reactions involving L-tyrosine in transforming growth factor-beta1-stimulated fibroblasts

The mechanisms by which ligand-stimulated generation of reactive oxygen species in nonphagocytic cells mediate biologic effects are largely unknown. The profibrotic cytokine, transforming growth factor-beta1 (TGF-beta1), generates extracellular hydrogen peroxide (H2O2) in contrast to intracellular reactive oxygen species production by certain mitogenic growth factors in human lung fibroblasts. To determine whether tyrosine residues in fibroblast-derived extracellular matrix (ECM) proteins may be targets of H2O2-mediated dityrosine-dependent cross-linking reactions in response to TGF-beta1, we utilized fluorophore-labeled tyramide, a structurally related phenolic compound that forms dimers with tyrosine, as a probe to detect such reactions under dynamic cell culture conditions. With this approach, a distinct pattern of fluorescent labeling that seems to target ECM proteins preferentially was observed in TGF-beta1-treated cells but not in control cells. This reaction required the presence of a heme peroxidase and was inhibited by catalase or diphenyliodonium (a flavoenzyme inhibitor), similar to the effect on TGF-beta1-induced dityrosine formation. Exogenous addition of H2O2 to control cells that do not release extracellular H2O2 produced a similar fluorescent labeling reaction. These results support the concept that, in the presence of heme peroxidases in vivo, TGF-beta1-induced H2O2 production by fibroblasts may mediate oxidative dityrosine-dependent cross-linking of ECM protein(s). This effect may be important in the pathogenesis of human fibrotic diseases characterized by overexpression/activation of TGF-beta1.