B. Clinical Sleep Science and Practice
Sleep and Neurologic Disorders
1149
A PILOT QUALITY IMPROVEMENT (QI) STUDY TO
ASSESS WHETHER BILEVEL POSITIVE AIRWAY
PRESSURE (BIPAP) SUPPORT IN ACUTE ISCHEMIC
STROKE PATIENTS WITH SLEEP DISORDERED
BREATHING, CAN IMPROVE NEUROLOGICAL
RECOVERY DURING ACUTE STROKE CARE
Nadhim, A. N.1 wong, J.1 Gupta, D.1 Suhan, L.1 Siegel, M.1
Bhat, S.1 strauss, S.1 Fourcard, F.3 Pandya, V.3
1 ICD-9-CM code 331.0. Adjusted cox proportional hazard regres-
JFK Neuroscience institute, Edison, NJ, 2JFK Neuroscience
institute, Edison, NJ, 3JFK Neuroscience institute, perth amboy, NJ.
Introduction: Obstructive sleep apnea (OSA) has been associ-
ated with adverse outcomes in patients with stroke. While data
is limited, it suggests that treatment of OSA may improve neuro-
logical recovery. With this quality improvement (QI) project, we
aim to develop an interprofessional-team workflow process for
screening and correction of OSA in acute ischemic stroke, with the
goal to improve outcomes of neurological recovery.
Methods: This is an ongoing study to screen all eligible patients
admitted to JFK Medical Center stroke unit, with MRI-proven
Supratentorial acute ischemic stroke. The patients are screened
using an overnight Pulse Oximetry test. A 3% oxygen desaturation
index (ODI) of ≥10/hr or 4% ODI of ≥ 5/hr is considered at high
risk for OSA. Such Patients will receive nocturnal Auto-adjusting
BIPAP therapy during their acute care stay, for up to 5 days, for
at least 4 hours per night. Eligible Patients who refused BiPAP
therapy or were non-compliant will be considered as a controls.
Baseline NIH stroke scale (NIHSS), and bilateral MCA mean flow
velocity (MFV) in the morning, by transcranial doppler (TCD)
will be assessed at baseline for cases and controls, and after BiPAP
therapy, for the case group. The two groups of patients will also be
compared in terms of Modified Rankin Scale at time of discharge
and at phone follow-up after 6 weeks.
Results: Between Oct 17th, 2019 to current, 15 patients were ad-
mitted to the stroke unit with MRI confirmed stroke. Ages ranged
from 34 - 88 years (average age 66.5 years). 8 patients (60%) were
female. Of those, 6 patients consented to being screened for OSA.
Of these, 1 had 4%ODI >5/hr, and therefore received treatment with
BIPAP. However, compliance was < 4 hrs on 2 consecutive nights.
Conclusion: This is ongoing QI project and results will be available
after few more months of continued recruitment.
Support: Auto-adjusting BIPAP machines were provided by
RESMED.
1150
OBSTRUCTIVE SLEEP APNEA-DEPENDENT RACIAL/
ETHNIC AND SEX-SPECIFIC MECHANISMS
UNDERLYING ALZHEIMER’S DISEASE RISK:
A RETROSPECTIVE COHORT ANALYSIS OF IN-LAB PSG
SLEEP STUDY DATA
Bubu, O. M.1 Turner, A. D.1 Parekh, A.2 Mullins, A.2 Kam, K.2
Umasabor-Bubu, O. Q.3 Mbah, A. K.4 Williams, N. J.1
Varga, A. W.2 Rapoport, D. M.2 Ayappa, I.2 Jean-Louis, G.1
Osorio, R. S.1
1
NYU School of Medicine, New York, NY, 2Icahn School of Medicine
at Mount Sinai, New York, NY, 3SUNY Downstate Medical Center,
Brooklyn, NY, 4University of South Florida, Tampa, FL.
Introduction: We examined race and sex-specific biologic mech-
anisms of the relationship between obstructive sleep apnea (OSA)
and incident AD.
SLEEP, Volume 43, Abstract Supplement, 2020
X.
Methods: Retrospective cohort analysis utilizing in-lab PSG sleep
study data conducted among older adults between 2001 and 2005.
OSA was defined using AHI4%. Participants had no history of
cognitive decline or AD at baseline and included 663 (284 Non-
Hispanic White (NHW), 207 Black/African-American (AA) and
172 Hispanic) OSA-patients matched on age, sex, race, BMI, 1:1
ratio to 663 (unexposed cohort I from sleep clinic) and 1:4 ratio to
2652 (unexposed cohort II from non-sleep clinics) non-OSA indi-
Downloaded from https://academic.oup.com/sleep/article/43/Supplement_1/A438/5846408 by Carleton University Library user on 02 November 2020
viduals. Incident AD was assessed annually from 2001-2013 with
sion models examined race and sex-specific biologic mechanisms
including hypoxia, fragmentation and duration measures of OSA
and AD risk.
Results: Of the 3,978 participants, 2,148 (54%) were women. Mean
age at baseline was 72.6 (7.3) years. Over a mean follow-up time of
8.6 (1.4) years, 358 (9%) individuals (212 female) developed AD
(119 NHW, 134 AAs, and 105 Hispanics). Relative to non-OSA
individuals, OSA-patients had a higher risk of incident AD, with
AAs and females showing stronger risk estimates (aHR: 2.24, 1.83,
and 1.73, P <.001 for all, for AAs, Hispanics and NHW respect-
ively; and aHR: 2.38, and 1.37, P <.001 for all, for female and male
respectively). Measures of hypoxia, sleep fragmentation and sleep
duration were associated with increase AD risk (P <.01 for all).
Relative to NHW, AAs and Hispanics demonstrated up to 20%
stronger effects/estimates on hypoxia and sleep duration measures.
Relative to males, females demonstrated up to 25% stronger ef-
fects/estimates on sleep fragmentation measures, and 15% weaker
effects/estimates on hypoxia measures (P <.01 for all).
Conclusion: Among OSA-patients, mechanisms related to hyp-
oxia, sleep fragmentation and duration measures increase AD risk
and may underlie race/ethnicity and sex disparities in AD.
Support: NIH/NIA/NHLBI (L30-AG064670, CIRAD
P30AG059303 Pilot, T32HL129953, R01HL118624,
R21AG049348, R21AG055002, R01AG056031, R01AG022374,
R21AG059179, R01AG056682, R01AG056531, K07AG05268503,
K23HL125939)
1151
IS TIMING OF LIGHT EXPOSURE DIFFERENT IN
WOMEN WITH CHRONIC MIGRAINE?
Dawson, S. C.1 Kim, M.1 Reid, K.1 Burgess, H. J.2 Wyatt, J. K.3
Hedeker, D.4 Park, M.5 Rains, J. C.6 Espie, C. A.7 Taylor, H. L.8
Ong, J. C.1
1
Department of Neurology, Northwestern University, Chicago,
IL, 2Department of Psychiatry, University of Michigan, Ann
Arbor, MI, 3Rush University Medical Center, Chicago, IL,
4
University of Chicago, Chicago, IL, 5Chicago Sleep Health,
Advocate/Illinois Masonic Hospital, Chicago, IL, 6Center for
Sleep Evaluation, Elliot Hospital, Manchester, NH, 7Nuffield
Department of Clinical Neurosciences, University of Oxford,
Oxford, UNITED KINGDOM, 8The Maine Sleep Center at
Chest Medicine Associates, South Portland, ME.
Introduction: Light avoidance is a common coping behavior of in-
dividuals with migraine headaches. It is not known whether timing
of light exposure is different in individuals with chronic migraine
(CM) compared to those without migraine and how this may relate
to headache frequency and severity. We tested this by examining
timing of the brightest and darkest light and headaches in women
with chronic migraines and healthy controls.
Methods: Sixteen women with CM (mean age = 33.07) and 18
female healthy controls (HC; mean age = 32.22) completed daily
A438