B. Clinical Sleep Science
Sleep-Related Breathing Disorders
regarding the relationship between the severity of OSA and gender on
the level of HB. We aimed to examine their interaction effects on the
level of HB in this work.
Methods: A total of 859 participants with suspected OSA were
included. All participants underwent overnight polysomnography
(PSG) followed by examining the levels of hemoglobin and erythro-
poietin (EPO) in the morning.
Results:  Of all patients, 626 (72.9%) had OSA (an apnea-hypopnea
index (AHI)≥5/h); 306 (35.6%) were women (age 46.7 ± 12.9 years,
body mass index (BMI) 25.5 ± 4.0 kg/m2), 523 (64.4%) were men (age
45.0 ± 11.7  years, BMI 26.2 ± 4.1 kg/m2). ANOVA analysis revealed a
significant interaction between AHI and gender on HB after adjusting
for age, BMI, current smoking, drinking, and percentage of time spent
in sleep below 90% oxygen saturation (F=6.87, p<0.01). For men,
there were no differences in the level of HB among three groups with
different levels of AHI (< 5/h, habitual snoring; 5–30/h, mild-moderate
OSA; ≥ 30/h, severe OSA). For women, the level of HB in patients with
severe OSA was significantly higher than those with habitual snoring
and mild-moderate OSA. A cumulative association with AHI level and
HB was only obtained in women (p<0.05 for linear trend), not in men.
Conclusion:  The results provide a novel evidence of mediated inter-
action between AHI and gender on the level of HB. The increasing
severity of OSA is independently associated with a higher level of HB
in women, but not in men.
Support (If Any): This research was funded by the National Basic
Research Program of China (2015CB856406), the National Key
Technology Research and Development Program of the Ministry of
Science and Technology of China (2015BAI13B01), and the National
Natural Science Foundation of China (81530002 & 81629002).
0601
DETECTION OF OBSTRUCTIVE SLEEP APNEA AND
ASSESSMENT OF SLEEP AND MOOD SYMPTOMS IN
ARRHYTHMIA CLINIC OUTPATIENTS
Abumuamar A1, Dorian P2, Newman D3, Shapiro C4
1
Toronto Western Research Institute, University of Toronto, Toronto,
ON, CANADA, 2Department of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, ON, CANADA, 3Department of
Cardiology, Sunnybrook Health Sciences Center, University of
Torotno, Toronto, ON, CANADA, 4Department of Psychiatry, Toronto
Western Hospital, Univerisy of Toronto, Toronto, ON, CANADA
Introduction:  Obstructive sleep apnea (OSA) is a sleep disorder with
serious cardiovascular consequences. OSA is associated with differ-
ent types of arrhythmia. We aimed to determine (1) The percentage
of patients with arrhythmia, not suspected/diagnosed with OSA, who
have OSA; (2) The percentage of patients in outpatient arrhythmia
clinics who show symptoms indicative of poor sleep, excessive day-
time sleepiness, decreased alertness, fatigue and/or depression; and
(3) If these symptoms predict the presence of OSA in these patients.
Methods:  We recruited non-selected consecutive patients from three
arrhythmia clinics. Patients with previously diagnosed and/or treated
OSA were excluded. Validated screening tools were administered: (1)
Epworth Sleepiness Scale (ESS); (2) Fatigue Severity Scale (FSS);
(3) The Non-Restorative Sleep Scale (NRSS); (4) Insomnia Severity
Index (ISI); (5) The Center for Epidemiological Studies-Depression
Scale (CES-D); and (6) Toronto Hospital Alertness Test (THAT).
Patients were diagnosed with OSA (AHI >5 /hour of sleep) by a home
sleep study.
Results:  We recruited 75 participants (72% Males). Mean age was
64. Mean BMI was 28 kg/m2. Twenty-seven percent had a BMI
>30, and 7% had a BMI >35 kg/m2. Sleep related instruments
A223
II.
showed: (1) Thirty-two percent of patients had an ESS score ≥8,
which indicates a high level of daytime sleepiness; (2) Forty-seven
percent showed a high level of fatigue as suggested by a FSS score
>3; (3) Symptoms of non-restorative sleep were detected in 15%
(NRSS score ≤46); (4) Seventeen percent had a CESD score ≥16,
which is suggestive of depression; (5) Thirty-three percent had an
ISI score suggestive of mild insomnia, 46% moderate insomnia, and
11% severe insomnia; (6) Four percent had a score <20 on THAT,
which indicates decreased alertness. Eighty-five percent of patients
were positive for OSA. A binary logistic regression analysis showed
that only age and male gender were predictors of OSA (p=0.002,
p=0.014 respectively).
Conclusion: Eighty-five percent of patients in general arrhythmia
clinics have undetected obstructive sleep apnea. High scores sugges-
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tive of daytime sleepiness, fatigue, insomnia, depression, and poor
sleep did not predict the presence of OSA. Sleep studies should be
considered for detection of OSA in arrhythmia clinic outpatients.
Support (If Any): 
0602
CENTRAL SLEEP APNEA IN THE ACUTE AND STABLE
PHASES OF STROKE
Isakov A1, Dudha N2, Pyatkevich YG1, Grimes J2, Plato Mv1,
Auerbach S1
1
Boston University, Boston, MA, 2Boston Medical Center, Boston,
MA
Introduction:  Current literature supports the idea that Obstructive
sleep apnea (OSA) is an independent risk factor for stroke. The AHA/
ASA recommend a sleep study be considered in patients who suffer
an acute stroke. Similar guidelines have not yet been established for
central sleep apnea (CSA) in the context of an ischemic event. It has
been postulated that CSA results after a stroke/TIA. We evaluated
prevalence of sleep disordered breathing (SDB) in patients who suf-
fered from stroke in the acute as well as stable phases, focusing on
CSA.
Methods:  Patients admitted to the stroke unit at our institution over
a 22-month period, who underwent a portable sleep study (PST) in
the acute phase of admission (ApneaLink Air, Resmed USA) and
subsequently a polysomnography (PSG) in the stable phases. SDB
was defined by an overall AHI of ≥5. Data collected included, sex,
age, BMI, opiate use, presence of heart failure, and vascular territory
involved.
Results:  47 patients met inclusion criteria. 36 (76.6%) patients who
underwent a PST were diagnosed with OSA. 18 (38.3%) were positive
for CSA. 12 (25.5%) were positive for CSB. Based on PSG results,
OSA was diagnosed in 42 (89.4%) patients, CSA in 14 (29.8%), and
CSB in 7 (14.9%).
Conclusion:  PSG remains more sensitive for diagnosis of SDB, with
PST more convenient as a screening method. The prevalence of CSA
may be higher in patients suffering from an acute stroke/TIA than pre-
viously suspected. Whereas the prevalence of OSA increases with the
more sensitive PSG, the prevalence of CSA decreases in the stable
phase. Thus, we postulate that central events could represent a conse-
quence of stroke/TIA. In most patients with CSA, stroke localized to
the anterior circulation. No demographic information reached statisti-
cal significance, suggesting that those cannot be used in acute stroke
patients to identify those who are at a higher risk of CSA. Given the
overall high prevalence of CSA in the stroke population and lack of
clearly identifiable risk factors, further studies into screening and treat-
ment may be considered.
Support (If Any): 
SLEEP, Volume 40, Abstract Supplement, 2017