Researchers will present studies through oral presentations and abstracts at SLEEP 2024, covering topics including CPAP withdrawal effects, hypoxic burden in OSA treatment, and new diagnostic tools.


Summary: Researchers from Mount Sinai Health System will present their latest sleep disorder research at SLEEP 2024 through oral presentations and abstracts. The studies cover various topics, including the effects of CPAP withdrawal on sleep, the predictive power of hypoxic burden in obstructive sleep apnea (OSA) treatment, and the development of new diagnostic tools.

Key Takeaways:

  • A study investigates the relationship between thalamic activity and excessive daytime sleepiness in individuals with OSA, offering new insights into the neurological impacts of sleep fragmentation and intermittent hypoxia.
  • Researchers explore whether hypoxic burden, a metric for OSA-related hypoxemia, can more accurately predict improvements in sleepiness and cognitive functions in OSA patients undergoing CPAP treatment compared to the traditional apnea-hypopnea index (AHI).
  • Mount Sinai’s use of AI for simulating EEG during polysomnography and automating sleep stage classification aims to enhance diagnostic accuracy and efficiency.

Experts from Mount Sinai Health System will present research at SLEEP 2024, highlighting advancements in understanding and treating sleep disorders. 

The presentations will cover a range of topics, such as the effects of CPAP withdrawal on sleep, the predictive power of hypoxic burden in obstructive sleep apnea (OSA) treatment, and diagnostic tools for sleep disorders. 

Presentation Details

Details of the presentations are as follows: 

Monday, June 3

0460 – Dose-response Relationship Between Thalamic Activity During Sustained Attention and Excessive Daytime Sleepiness

  • Obstructive sleep apnea (OSA) is characterized by sleep fragmentation and intermittent hypoxia. Both are known causes of sleepiness and poor sustained attention, i.e., lapses in vigilance, which can be measured using the psychomotor vigilance test. Crucial to vigilance, the thalamus plays a key role by regulating sensory information essential for sustaining attention. However, to date, the relationship between thalamic activity underlying psychomotor vigilance test and its relationship to sleepiness in OSA has not been investigated systematically until now.
  • Poster Session: P-08, Board #129
  • 10-11:45 am CT 
  • Presenter: Dishari Azad, clinical research coordinator at Mount Sinai

0461 – Parietal EEG Slow Wave Activity During NREM is Associated with Overnight Spatial Memory Performance in CPAP-treated OSA

  • Sleep disturbance from obstructive sleep apnea impairs overnight memory processing which may be mediated by changes to slow wave sleep. Indeed, reduced region-specific EEG slow activity during non-REM sleep has been associated with worse overnight declarative, motor, and spatial memory. Using a polysomnologically verified model of SWS-specific CPAP-withdrawal to create three conditions of 1) stable-slow wave sleep on CPAP, 2) slow wave sleep-fragmentation with intermittent hypoxemia (OSAsws), and 3) slow wave sleep-fragmentation with reduced hypoxemia (OSAsws+O2), Mount Sinai researchers investigate whether CPAP withdrawal during slow wave sleep induces acute changes in EEG slow wave activity that is associated with overnight spatial navigational memory performance.
  • Presenter: Daphne Valencia, MA, research manager at the Mount Sinai Integrative Sleep Center, and senior author Anna E. Mullins, RPGST, PhD, assistant professor of medicine (pulmonary, critical care and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Poster Session: P-08, Board #130
  • 10-11:45 am CT 

0485 – Can Hypoxic Burden Predict Improvement in Sleepiness and Cognition in Response to CPAP Treatment in OSA Patients?

  • The current method for measuring (obstructive sleep apnea) OSA severity, the apnea-hypopnea index (AHI), is poorly correlated to symptom burden and clinical improvement. Hypoxic burden, which quantifies and characterizes OSA-related hypoxemia, has been suggested as an alternative OSA measure. However, more research is needed to understand hypoxic burden’s predictive ability. This study investigated whether hypoxic burden could predict which OSA patients, prescribed CPAP, will have the greatest improvement in measures of sleepiness and cognition.
  • Presenter: Kaveh Gaynor-Sodeifi, MS, clinical research coordinator at Mount Sinai
  • Poster Session: P-08, Board #125
  • 10-11:45 am CT

1157 – Obstructive Sleep Apnea Symptoms Caused by an Occult Seizure Disorder with a Brain Tumor Focus

  • Complex nocturnal behaviors are one of the most difficult diagnostic challenges in sleep medicine. The sensitivity of electroencephalography (EEG) varies with the study duration, epileptogenic lesion location, electrode placement, and the presence of events. A normal isolated EEG is insufficient to exclude an underlying seizure disorder particularly when diagnostic uncertainty remains. Polysomnography is the gold standard for the evaluation of OSA, and that has demonstrated a bidirectional relationship between OSA and comorbid epilepsy. This report highlights an adolescent male with seizure-like symptoms initially diagnosed with OSA with refractory nocturnal episodes on continuous positive airway pressure (CPAP) for years until his eventual clinical diagnosis that was prompted by a repeat polysomnography.
  • Presenters: Nikhita Jain, MD, sleep medicine fellow at Mount Sinai; and Jason Bronstein, MD, medical director of the Mount Sinai Pediatric Sleep Medicine Program and director of the Mount Sinai Children’s Integrative Sleep Center
  • Poster Session: P-15, Board #318
  • 10-11:45 am CT 

1173 – Unmasking Severe OSA After Transvenous Phrenic Nerve Stimulation for Central Sleep Apnea

  • In the absence of reversible etiology, central sleep apnea may be treated with positive airway pressure (CPAP or BPAP), adaptive servo-ventilation, or supplemental oxygen. In 2017, a transvenous phrenic nerve stimulator, the remedē System, was FDA-approved for moderate-to-severe central sleep apnea. Five-year outcomes data confirmed the device’s sustained efficacy, with improvements in symptoms, apnea-hypopnea index, and central apnea index. While the device effectively treats central sleep apnea, unrecognized upper airway obstruction may hinder clinical success. This report describes a patient whose polysomnography suggested candidacy for phrenic nerve stimulator; however, his airway collapsibility led to severe obstructive sleep apnea, unmasked after PNS implantation.
  • Presenter: Nikhita Jain, MD, sleep medicine fellow at Mount Sinai
  • Poster Session: P-15, Board #334
  • 1011:45 am CT 

0275 – Effect of Acutely Induced OSA During SWS on AD Plasma Biomarkers

  • OSA induces both sleep fragmentation and intermittent hypoxemia and has been associated with Alzheimer’s disease progression. Mount Sinai experts hypothesize that slow wave sleep-specific obstructive sleep apnea can influence plasma Alzheimer’s disease biomarkers.
  • Presenter: Andrew W. Varga, MD, PhD, associate professor of medicine (pulmonary, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Oral Presentation: Sleep in Aging and Alzheimer’s Disease
  • 5-5:15 pm CT 

Tuesday, June 4

1004 – Predicting Incident Parkinson’s disease and Dementia with Lewy Bodies from Nocturnal Wrist Actigraphy

  • “Isolated” REM sleep behavior disorder (iRBD) is an early marker of Parkinson’s disease and dementia with Lewy bodies that affects 1-2% of individuals after 60 years of age. Mount Sinai researchers have published on a classifier using nocturnal wrist actigraphy data which achieved >90% accuracy for iRBD detection. Here, the experts applied the same iRBD classifier in a population sample, the UK Biobank data to predict risk of incident Parkinson’s disease or dementia with Lewy bodies.
  • Presenter: Emmanuel During, MD, associate professor of neurology (movement disorders) and medicine (pulmonary medicine, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Oral Presentation: O-09
  • 8:30-8:45 am CT

0319 – Using Generative AI as a Tool for Simulating EEG During Nocturnal Polysomnography

  • Artificial intelligence-based, generative networks-based, synthetic data generation has become increasingly popular. Deep learning generative models can be trained to model complex data distributions and generate diverse and realistic outputs. Mount Sinai experts aim to present a generative model that can generate an artificial 30-second epoch of non-REM sleep whose power spectrum is identical to that of a real sleep EEG.
  • Presenter: Sajila Wickramaratne, PhD, postdoctoral fellow at the Icahn School of Medicine at Mount Sinai, and senior author Korey Kam, PhD, assistant professor of medicine  (pulmonary medicine, critical care, and sleep medicine) at Icahn Mount Sinai   
  • Poster Session: P-20, Board #105
  • 10-11:45 a.m. CT

0320 – Foundational Transformers with Linear Probing for Sleep Stage Classification Using Time Series Sleep Study Data 

  • Sleep disorders and deprivation disrupt people’s daily activities, mental health, and longevity and are related to widespread conditions. Currently, sleep disorders are diagnosed via polysomnography, where electrophysiological data is collected and manually annotated by a clinician. State-of-the-art machine learning models, such as the transformer, are particularly well suited for modeling time-series polysomnography data. Specifically, self-supervised models with linear probing could assist with any relevant sleep predictive task including automating sleep stage classification, which would save clinicians time, reduce variability in manual scoring, and help scale to treat more people. Mount Sinai experts have developed a self-supervised training approach to classify sleep stages accurately.
  • Presenter: Ben Fox, MS, graduate student in the augmented intelligence in medicine and sciences lab at Icahn School of Medicine at Mount Sinai
  • Poster Session: P-20, Board #108
  • 10-11:45 am CT

0689 – Automated Detection of Isolated REM Sleep Behavior Disorder Using Computer Vision

  • Isolated Rapid Eye Movement (REM) Sleep Behavior Disorder (iRBD) is a marker of neurodegeneration and is currently diagnosed based on REM sleep without atonia and a history of dream enactment. However, even for sleep experts, scoring REM sleep without atonia can be challenging and incidental RBD cases are easily missed. Previous research focused on the automatic identification of iRBD using 3D-video analysis. This study aims at developing a machine learning classifier to detect iRBD using only conventional 2D cameras and evaluating its performance on an expanded cohort.
    Presenter: Emmanuel During, MD, associate professor of neurology (movement disorders) and medicine (pulmonary medicine, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Poster Session: P-28, Board #281
  • 10-11:45 am CT 

0448 – Upper Airway Collapsibility is Associated with Fluid Shifts in Patients with Sleep Apnea and Diastolic Dysfunction

  • Left ventricular systolic dysfunction contributes to sleep-disordered breathing pathophysiology through overnight rostral fluid shifts leading to fluid accumulation in the neck (increasing upper airway collapsibility) and pulmonary vasculature (increasing ventilatory control instability). In contrast to systolic dysfunction, the relationship of left ventricular diastolic dysfunction (LVDD) to overnight fluid shifts and sleep-disordered breathing pathophysiology is less well characterized. In an ongoing prospective clinical study of patients with risk factors for or established LVDD and untreated sleep-disordered breathing, Mount Sinai experts use Phenotyping Using Polysomnography (PUP) analysis to investigate the relationship of overnight fluid shifts to upper airway collapsibility and ventilatory control instability.
  • Presenter: Thomas M. Tolbert, MD, assistant professor of medicine (pulmonary medicine, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Oral Presentation: Outcomes in Patients with Sleep-Related Breathing Disorders
  • 4:30-4:45 pm CT

Wednesday, June 5

0894 – Effects of Chronic Rhinosinusitis (CRS) on Sleep Duration and Variability in World Trade Center (WTC) Responders

  • 43.5% of World Trade Center rescue and recovery workers demonstrate symptoms of chronic rhinosinusitis. People with chronic rhinosinusitis report increased sleep complaints and shorter subjective sleep duration, compared to those without chronic rhinosinusitis. Discomfort from nasal symptoms during sleep may result in shorter sleep duration and an increased night-to-night variability. Mount Sinai experts compare actigraphic assessment of sleep duration and variability in subjects with and without chronic rhinosinusitis.
  • Presenter: Sri Saranya Ravi, clinical research coordinator at the Icahn School of Medicine at Mount Sinai, and senior author Indu A. Ayappa, PhD, professor of medicine (pulmonary medicine, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Poster Session: P-44, Board #338
  • 10-11:45 am CT 

0589 -Evaluating The Impact of Sleep Position on Efficacy of Hypoglossal Nerve Stimulation

  • Current literature supports hypoglossal nerve stimulation as a treatment option for select patients with moderate-to-severe OSA. However, in about a third of implanted patients, hypoglossal nerve stimulation is ineffective. To date, few publications have investigated how sleep position impacts hypoglossal nerve stimulation efficacy. In 2019, the researchers found that hypoglossal nerve stimulation had a greater impact on non-supine AHI versus supine AHI; the data was limited to 11 patients monitored in the sleep lab and did not incorporate full-night data. Mount Sinai experts explored the effect of sleep position on hypoglossal nerve stimulation efficacy in a larger sample by comparing pre- and post-operative overnight sleep studies.
  • Presenter: Horacio Romero Castillo, MD/MSCR candidate at the Icahn School of Medicine at Mount Sinai, and senior author Emmanuel During, MD, associate professor of neurology (movement disorders) and medicine (pulmonary medicine, critical care, and sleep medicine) at the Icahn School of Medicine at Mount Sinai
  • Poster Session: P-41, Board #237
  • 10-11:45 am CT

Photo 103423235 © Wellphotos | Dreamstime.com