0733 Insomnia Severity Predicts Increased PAP Side Effects and Use in Women Veterans with Newly Diagnosed Apnea
Bibliographic record
Abstract
Abstract Introduction Despite positive airway pressure (PAP) being the gold-standard treatment for sleep disordered breathing (SDB), treatment adherence remains a challenge for providers and patients. Women with SDB are understudied, and understanding the difficulties associated with PAP use in this population is crucial to promoting treatment adherence. We aimed to assess the role of demographics and insomnia symptoms in PAP side effects and PAP use for women veterans. Methods We analyzed data from a randomized controlled trial of an Acceptance and Commitment Therapy-based intervention to promote PAP adherence vs. a sleep education control condition for women veterans newly diagnosed with SDB (NCT03377452). Data included demographics (age; body mass index, BMI; race/ethnicity), baseline assessment Insomnia Severity Index (ISI), PAP use data (days used, hours used at 30-, 60- and 90-days post-PAP initiation), and the PAP side effects subscale of the Calgary Sleep Apnea Quality of Life Index (SAQLI). Analyses included Pearson correlations and t-tests. Results Of the 90 participants (Mean age = 53.2±12.8), 83 (92.2%) attempted to use PAP and completed the questionnaires. The most common PAP side effects included: upper respiratory symptoms (stuffed/congested nose = 60.2%, excessive dryness of nose/throat = 55.4%, soreness = 39.8%), mask-related issues (discomfort = 56.6%, air leak =47.0%) and insomnia-like symptoms (waking frequently = 36.6%, difficulty returning to sleep = 31.3%). There was no relationship between age, BMI, or race/ethnicity and number of PAP-related side effects, nor was there a correlation between number of PAP side effects and PAP use variables. Elevated ISI prior to initiating PAP was associated with greater number of PAP side effects, F(1, 81)=5.29, p=0.02. Worse ISI was associated with fewer days of PAP use at 90 days post-PAP initiation, F(1, 88)=4.55, p=0.04. Conclusion Insomnia symptom severity prior to initiating PAP treatment for SDB is a significant contributing factor to increased endorsement of PAP-related side effects. Pre-existing insomnia symptoms prior to PAP initiation may play a role in fewer days of PAP use in the long term. Future research should explore the impact of insomnia treatment in PAP side effects and use in women. Support (if any) VA/HSR IIR-16-244; VA/HSR RCS20-191; NIH/NHLBI K24HL143055; NIH/NHLBI K23HL157754; VA/HSR CDA 20-227
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".