Stuart F Quan

Stuart F Quan
Harvard University | Harvard · Office of Technology Development

Doctor of Medicine

About

570
Publications
115,942
Reads
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30,219
Citations
Introduction
Stuart F Quan is currently at Harvard Medical School. Stuart does research in Sleep Medicine epidemiology and clinical trials.

Publications

Publications (570)
Preprint
Background: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear. Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gyneco...
Preprint
Objectives: This study assessed the associations between parent intent to have their child receive COVID-19 vaccination, and demographic factors and various child activities including attendance at in-person education or childcare. Methods: Persons undergoing COVID-19 testing residing in Minnesota and Los Angeles County, California with children ag...
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Restorative sleep is a commonly used term but a poorly defined construct. Few studies have assessed restorative sleep in nationally representative samples. We convened a panel of 7 expert physicians and researchers to evaluate and enhance available measures of restorative sleep. We then developed the revised Restorative Sleep Questionnaire (REST-Q)...
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Rationale Despite increased recognition of sleep disordered breathing in hospitalized patients, studies are lacking on the impact of inpatient adherence with positive airway pressure (PAP) therapy on post-discharge adherence. Objectives To assess the predictive value of inpatient adherence to PAP therapy on post-discharge compliance and adherence....
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Introduction Sleep deficiency and undiagnosed or untreated sleep disorders are pervasive among employed adults, yet are often ignored in the context of workplace health promotion. Smartphone applications (apps) are a promising, scalable approach to improving sleep among employees. We evaluated an online sleep education program followed by access to...
Article
Introduction Positive airway pressure (PAP) therapy is the mainstay treatment for obstructive sleep apnea (OSA). Continuous PAP (CPAP) therapy has been shown to decrease QTc length in electrocardiograms in patients with OSA in small studies. The impact of higher pressures of CPAP and Bilevel PAP (BPAP) on ventricular repolarization—QTc length and Q...
Article
Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychia...
Preprint
Study Objectives The American Academy of Sleep Medicine recommends scoring hypopneas in adults when there is a ≥3% oxygen desaturation Or when the event is associated with an arousal. However, there is no rule regarding the duration of the interval between the event termination and the associated arousal. The purpose of this study is to explore the...
Article
Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychiat...
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The novel corona virus that is now known as (SARS-CoV-2) has killed more than six million people worldwide. The disease presentation varies from mild respiratory symptoms to acute respiratory distress syndrome and ultimately death. Several risk factors have been shown to worsen the severity of COVID-19 outcomes (such as age, hypertension, diabetes...
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Purpose This study aimed to develop a machine learning–based questionnaire (BASH-GN) to classify obstructive sleep apnea (OSA) risk by considering risk factor subtypes. Methods Participants who met study inclusion criteria were selected from the Sleep Heart Health Study Visit 1 (SHHS 1) database. Other participants from the Wisconsin Sleep Cohort...
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Study objectives: The long-term effect of continuous positive airway pressure (CPAP) on 24-hour blood pressure (BP) in high-risk patients with obstructive sleep apnea (OSA) is uncertain. We aimed to determine the effect of CPAP treatment on ambulatory BP in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD ri...
Preprint
Background Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychiatr...
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Introduction Variability and prolongation of ventricular repolarization – measured by changes in QT interval and QT variability are independently associated with ventricular arrhythmias, sudden death, and mortality but such studies did not examine the role of sleep-disordered breathing. We aimed to determine whether sleep-disordered breathing moder...
Chapter
Continuous positive airway pressure (CPAP) is currently the most effective treatment for obstructive sleep apnea (OSA) and is considered the “gold standard” for patient care. The most common indications for treatment are excessive daytime sleepiness, disruption in sleep quality, and reduction in overall quality of life. In addition, CPAP is used to...
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Objectives This exploratory study examines workplace factors, sleep, sleep disorders, and safety among older (age 50 years and above) yellow taxi drivers in New York City (NYC) of South Asian descent. Methods Using street intercept methods, quantitative data was collected among yellow taxi drivers in NYC (n = 27) from January–March 2020. Results...
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Objectives To determine factors that are associated with OSA therapy outcomes with auto-titrating positive airway pressure (APAP). Methods We sequentially grouped patients from a retrospective cohort based on APAP efficacy (sufficiently vs. insufficiently treated; insufficiently treatment defined as residual AHI of ≥ 5), therapy adherence (adheren...
Article
Chronic sleep restriction (CSR) has been associated with adverse effects including cognitive impairment and increased risk of diabetes and cardiovascular disease. Yet, sleep restriction therapy is an essential component of most behavioral treatments for insomnia. Moreover, little is known about the impact of CSR on sleep continuity and structure in...
Article
The American Academy of Sleep Medicine (AASM) recommends that hypopneas be identified using a definition that is based on a ≥ 30% decrease in airflow associated with a ≥ 3% reduction in the oxygen saturation or an arousal (H3A) for diagnosis of obstructive sleep apnea (OSA) in adults. This conflicts with the Centers for Medicare & Medicaid Services...
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Background: Nearly 14% of Americans experience chronic circadian disruption due to shift work, increasing their risk of obesity, diabetes, and other cardiometabolic disorders. These disorders are also exacerbated by modern eating habits such as frequent snacking and consumption of high-fat foods. Methods: We investigated the effects of recurrent...
Preprint
Purpose This study aims to develop a machine learning based questionnaire (BASH-GN) to classify obstructive sleep apnea (OSA) risk by considering risk factor subtypes. Methods A total of 4,527 participants that met study inclusion criteria were selected from Sleep Heart Health Study Visit 1 (SHHS 1) database. Another 1,120 records from Wisconsin S...
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Purpose High-resolution pulse oximetry (HRPO) may offer a low-cost and simple screening option for sleep-disordered breathing (SDB) that could be vitally important in rural areas with limited healthcare resources and specialty care. Our team hypothesized that application of this technology to a broad cohort of rural dwelling hospitalized individual...
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Sleep deficiency is a hidden cost of our 24–7 society, with 70% of adults in the US admitting that they routinely obtain insufficient sleep. Further, it is estimated that 50–70 million adults in the US have a sleep disorder. Undiagnosed and untreated sleep disorders are associated with diminished health for the individual and increased costs for th...
Article
The COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few. To determine the impact of COVID-19 on changes in sleep behavior, data were analyzed from an online survey of adults recruited via social media that included questions asking whether the respo...
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To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss. Methods Adequate sleep and self-reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analyzed. Primary sleep indices used were total sleep time, time spent in bed...
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Study Objectives Clinical and population health recommendations are derived from studies that include self-report. Differences in question wording and response scales may significantly affect responses. We conducted a methodological review assessing variation in event definition(s), context (i.e., work- versus free-day), and timeframe (e.g., “in th...
Preprint
Objectives: To determine factors that predict OSA therapy outcomes with auto-titrating positive airway pressure (APAP). Methods: We sequentially grouped patients from a retrospective cohort based on APAP efficacy (sufficiently vs. insufficiently treated; insufficiently treatment defined as residual AHI of > 5); therapy adherence (compliant vs. non-...
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To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss. Methods; Adequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analyzed. Primary sleep indices used were total sleep time, time spent in bed...
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Insufficient sleep, which has been shown to adversely affect metabolism, is generally associated with prolonged exposure to artificial light at night, a known circadian disruptor. There is growing evidence suggesting that circadian disruption adversely affects metabolism, yet few studies have attempted to evaluate the adverse metabolic effects of i...
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Study objectives This analysis determined the association between obstructive sleep apnea (OSA) with hypopneas defined by a 3% O2 desaturation or arousal (3%A), but not by a hypopnea criterion of ≥ 4% (4%), and subjective sleepiness. Methods Data were analyzed from Sleep Heart Health Study participants who had polysomnography (N = 6307) regarding...
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Background The International Classification of Sleep Disorders (ICSD)-3 was developed to aid in the identification of these disorders. The core criterion A (ICSD-3A) to identify obstructive sleep apnea (OSA) requires the presentence of specific signs and symptoms. This study explores the predictive ability of the ICSD-3A for OSA as compared with ob...
Article
Study objectives: Obstructive sleep apnea (OSA) is considered to be an important risk factor for the development of cardiovascular disease (CVD). This study aimed to develop and evaluate a machine learning approach with a set of features for assessing the 10-year CVD mortality risk of the OSA population. Methods: This study included 2464 patient...
Article
Objective: To evaluate whether caregiving for older adults is associated with insomnia symptoms and diminished workplace productivity. Methods: We analyzed data collected from caregivers to older adults in the US. Participants self-reported awakenings from sleep (caregiving-related or spontaneous) and workplace measures (presenteeism, absenteeis...
Article
Study objectives: Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3%...
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Objectives: Due to the significant mortality and morbidity consequences of the coronavirus 2019 (COVID-19) pandemic among older adults, these individuals were urged to avoid going out in public and socializing with others, among other major disruptions to daily life. While these significant and often unavoidable disruptions have been shown to bear...
Article
Sleep difficulties have been implicated in the development and progression of dementia and in all-cause mortality. This study examines the relationship between sleep difficulties, incident dementia and all-cause mortality over 8 years of follow-up among a nationally representative sample of older (≥65 years) adults in the United States. We used dat...
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Study objectives: Obstructive sleep apnea (OSA) is an extremely common sleep disorder. A potential association between OSA and coronavirus disease 2019 (COVID-19) severity has been proposed on the basis of similar comorbid medical conditions associated with both OSA and COVID-19. Methods: We performed a retrospective review of 1,738 patients who...
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Introduction This study examines computer-mediated sleep education for health providers enrolled in a certified diabetes educator program in November 2020 in Mexico. Methods Data derived from pre/post ratings assessed knowledge of obstructive sleep apnea (OSA), insomnia, restless legs syndrome (RLS), short sleep duration (SSD), circadian rhythm di...
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Introduction Few studies have examined circadian phase after job loss, an event that upends daily routine. It is common that a daily routine begins with the consumption of breakfast, and breakfast behavior may contribute to health status in adults. Therefore, we sought to examine whether a later midpoint of sleep was associated with breakfast skipp...
Article
Study objectives: Attended manual CPAP titration is the standard practice for determining optimal positive airway pressures for OSA treatment. However, an unattended single night auto-titrating positive airway pressure (APAP) titration is an alternative. The goal of this study was to determine whether therapeutic CPAP pressures determined during m...
Preprint
Full-text available
Introduction The COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few. Methods Data were from an online survey of adults recruited via social media that included a question asking whether the respondent slept less or more after the onset of the pande...
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Pulmonary hypertension (PH) is an underdiagnosed and potentially fatal condition. The utility of screening for PH in hospitalized patients undergoing echocardiography is unknown. The goal of this study was to determine the prevalence of undiagnosed pulmonary hypertension (PH) and probable pulmonary arterial hypertension (PAH) in hospitalized patien...
Article
Study objectives: To evaluate predictions of moderate-to-severe-obstructive sleep apnea (MS-OSA) by the neck circumference height ratio (NHR) and waist circumference height ratio (WHR) and compare to the derived STOP-Bang Questionnaire (dSBQ) prediction. Methods: Included were 6,167 participants from the Sleep Heart Health Study (SHHS) baseline...
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Background: Sleep disturbance and deficiency are common among older adults and have been linked with dementia and all-cause mortality. Using nationally representative data, we examine the relationship between sleep disturbance and deficiency and their risk for incident dementia and all-cause mortality among older adults. Methods: The National He...
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Objective Unemployment is an established risk factor for obesity. However, few studies have examined obesity‐related health behavior after involuntary job loss specifically. Job loss confers a disruption in daily time structure that could lead to negative metabolic and psychological outcomes through chronobiological mechanisms. This study examines...
Article
Background Poor sleep health, including sleep deficiency and sleep disturbance, is common among employed adults in the U.S. and is associated with undesirable workplace outcomes. Adoption of workplace health promotion programs (WHPPs) is increasing, yet few programs aim to reduce fatigue or improve sleep among employees. Objective We analyzed data...
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Background: Studies have established that OSA defined using a hypopnea definition requiring a ≥4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a ≥3% oxygen desaturation or an arousal (AHI3%A) is associated...
Article
Background Obstructive sleep apnea (OSA) has been associated with negative occupational outcomes including absenteeism and poor work productivity. This analysis explored whether the severity of OSA was associated with multiple involuntary job loss history among recently unemployed adults. Methods This is a cross-sectional analysis of data from the...
Preprint
Full-text available
Background: Studies have established that OSA defined using a hypopnea definition requiring a >4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a >3% oxygen desaturation or an arousal (AHI3%A) is associated w...
Preprint
Full-text available
Background Clinical practice guidelines and population health recommendations are derived from studies that include self-reported data. Small semantic differences in question wording and response scales, may significantly affect the response. We conducted a methodological review to assess the variation in event definition(s), context (i.e., work- v...
Article
Full-text available
Study objectives: The study objective was to examine the effect of COVID-19 on treatment adherence and self-reported sleep duration among patients with Obstructive Sleep Apnea (OSA) treated with positive airway pressure (PAP) therapy. Methods: This was a retrospective review of medical records of patients seen in the Sleep and Circadian Clinic a...
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Objectives Sleep disruption and relaxation are commonly cited reasons for marijuana use. Job loss is a significant stressor associated with high risk for sleep disruption. Little is known about marijuana use in relation to other intervention choices for sleep/relaxation in individuals who have experienced recent, involuntary job loss. Methods This...
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Study objectives: This analysis determined the ∼5 year incident hypertension rates using the 2018 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guidelines in obstructive sleep apnea (OSA) individuals with hypopneas defined by a ≥3% O₂ desaturation or arousal (3%A), but not by a hypopnea criterion of ≥4% (4...
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Objective To examine the effect of COVID-19 on treatment adherence and self-reported sleep duration among patients with Obstructive Sleep Apnea (OSA) treated with positive airway pressure (PAP) therapy. Methods Retrospective review of medical records of patients seen in Sleep and Circadian Clinic at Brigham Health during the immediate period of one...
Article
Study Objective The frequency of cortical arousals is an indicator of sleep quality. Additionally, cortical arousals are used to identify hypopneic events. However, it is inconvenient to record electroencephalogram (EEG) data during home sleep testing. Fortunately, most cortical arousal events are associated with autonomic nervous system activity t...
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Background Sleep Disordered Breathing (SDB) is associated with a wide range of pathophysiological changes due, in part, to hypoxemia during sleep. We sought to identify gene transcription associations with measures of SDB and hypoxemia during sleep, and study their response to treatment. Methods In two discovery cohorts, Framingham Offspring Study...
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Introduction Involuntary job loss is an acute stressor that disrupts daily time structure and activity and exacerbates economic hardship and psychological distress. Studies show that unemployment is associated with negative obesity-related health outcomes, such as metabolic syndrome. However, very little is known about daily routine, depression, an...
Article
Introduction Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group q...
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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 pres...
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Introduction In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response sy...
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Introduction Obstructive sleep apnea (OSA) is a significantly underdiagnosed medical condition. A machine learning method known as SLIM (Supersparse Linear Integer Models) that can be extracted from the Electronic Health Record (EHR) has found to be superior to patient-reported sleep-related symptoms to diagnose OSA. Such an evaluation, however, wa...
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Introduction This work compares sleep knowledge of community-dwelling older adult men and women. Methods Data were derived from a community-based sleep training program that assessed pre- and post-test knowledge of obstructive sleep apnea (OSA), Insomnia, short sleep duration (SSD), restless leg syndrome (RLS), circadian rhythm disorders (CRD), an...
Article
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 multice...
Preprint
BACKGROUND Public health officials have acted swiftly to curb the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 2019 (COVID-19), often resulting in significant alterations to daily routines among the general population. Sleep deficiency adversely affects immune function and could negat...
Article
Background Amid the COVID-19 pandemic, public health policies to curb the spread of SARS-CoV-2 and its associated disease, COVID-19, have resulted in significant alterations to daily routines (eg, work-from-home policies) that may have enabled longer sleep duration among the general population. Objective We aimed to examine changes in estimated sle...
Article
Background Chronic Obstructive Pulmonary Disease (COPD) is the second most common cause of hospital admission in the United States. Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed condition which may impact the outcome of COPD. We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions...
Article
Examined differences in sleep knowledge of community-dwelling older adults. Findings indicate, prior to sleep training that women have greater knowledge of insomnia and short sleep duration, while men have more knowledge of drowsy driving. Women's greater understanding of insomnia persists even after sleep training; however, pre- to post-test score...
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Antecedentes: La calidad de vida relacionada con la salud (CVRS) se encuentra disminuida en la enfermedad renal en etapa avanzada (EREA) pero se conoce poco acerca del impacto de los trastornos del sueño, la modalidad de diálisis y los factores demográficos sobre la CVRS de pacientes mexicanos con EREA. Métodos: Se incluyeron 121 adultos con EREA p...
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Objectives: This study explored the feasibility and acceptability of a sleep health education intervention for caregivers of children with developmental disabilities (DD). Design: This mixed-methods pilot study utilized repeated measures and caregiver interviews. Setting: The intervention occurred in the homes of caregivers who live on the Nav...