Demographics, Sleep Apnea and Positive Airway Pressure (PAP) Treatment-Related Characteristics Associated with PAP Adherence: A Large Retrospective Community-Based Longitudinal Observational Study

Abstract Despite many years of research, multiple factors have inconsistently shown to be associated with positive airway pressure (PAP) adherence. We conducted a retrospective observational study to evaluate the association between selected demographics, obstructive sleep apnea (OSA) - and PAP treatment-related factors, generally available, and objective PAP therapy adherence.We considered all consented individuals with OSA who purchased a PAP device from a registered vendor (Ottawa, Ontario) between 2011 and 2017 who had usage data available. PAP adherence was measured objectively as PAP use for at least 4 hours on at least 70% of days on treatment. In our cohort, 7,147/11,634 (61.5%) of participants were deemed adherent to PAP. The median percentage of days PAP therapy was used was 82% (IQR: 48-97%), and the median number of days PAP therapy was used for greater than 4 hours was 95 (IQR: 28-372). In multivariable logistic regression considering all variables available, the effect of body mass index, age, and minimum SaO2 at baseline sleep study were significantly associated with PAP adherence.

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1244 A Curious Case of ASV Failure

SLEEP ◽

10.1093/sleep/zsaa056.1238 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A474-A474

Author(s):

Nishant Chaudhary ◽

Mirna Ayache ◽

John Carter

Keyword(s):

Sleep Apnea ◽

Airway Obstruction ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Central Sleep Apnea ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Neck Extension ◽

Sleep Study ◽

Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

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Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm9092802 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2802

Author(s):

Roxana Pleava ◽

Stefan Mihaicuta ◽

Costela Lacrimioara Serban ◽

Carmen Ardelean ◽

Iosif Marincu ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Observational Study ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Cpap Therapy ◽

Obstructive Sleep

Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy. Results: 33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. −1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients. Conclusions: In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes.

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467 Positive Airway Pressure Tracking Systems: Outcomes of Polysomnographic Testing Prompted by the Residual Apnea Hyponea Index

SLEEP ◽

10.1093/sleep/zsab072.466 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A184-A184

Author(s):

Komal Imtiaz ◽

Reeba Mathew ◽

Valentin Nuzhny ◽

Lilit Sargsyan ◽

Ruckshanda Majid

Keyword(s):

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Clinical Symptoms ◽

Tracking System ◽

Apnea Hypopnea Index ◽

Diagnostic Study ◽

Tracking Systems ◽

Sleep Study ◽

Obstructive Sleep

Abstract Introduction To assess positive airway pressure (PAP) adherence and efficacy, tracking systems have been developed to monitor hours of CPAP use, mask leak, and residual apnea-hypopnea index (AHI) while patients are on treatment. No formal guidelines however have been developed on how to interpret and utilize this information. We looked at treatment outcomes after an in-laboratory sleep study reevaluation was made based on clinical symptoms and the residual AHI. Methods We performed a retrospective chart review of adult patients evaluated with an in-laboratory polysomnogram (PSG) based on a clinical concern for inadequately treated obstructive sleep apnea (OSA) and the residual AHI obtained from the PAP tracking system. We documented the outcomes of the repeat study and follow-up AHI after the new intervention (if recommended). We excluded patients non-adherent to PAP. Results Nine patients were identified between January 2015 and 2020 at the McGovern Medical School Outpatient Sleep Clinic. All nine patients were male with an average age of 69.2 years (range 44–84). The average AHI on the diagnostic study (CMS criteria) was 37.1 events/hour (range 17.4–67.1). The average residual AHI prompting reevaluation was 9 events/hour (median 15.9). All patients had a change in treatment based on recommendations made after their sleep study. The clinical suspicion for central events on the tracking system was confirmed on PSG on three patients who were subsequently switched to adaptive servo-ventilation. Two patients were found to have central events without a previous suspicion for central events. Four were prescribed a higher pressure or BPAP for suspected untreated OSA confirmed on the repeat PSG. All of the patients had a decreased residual AHI (average 6.3 events/hour) after treatment changes were made. Conclusion Reevaluation with a PSG after concerns of the residual AHI led to a change in diagnosis (complex sleep apnea) or the need for higher treatment pressures in our cohort. This lead to the optimization of therapy and a decrease in AHI on the tracking system post-intervention, hence justifying the repeat PSG. Exact guidelines however need to be set to standardize the recommendations with a potential cut-off residual AHI after which a repeat PSG is the standard. Support (if any):

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439 Continuous Positive Airway Pressure and Cardiovascular Risk in a Large Clinical Sample of Obstructive Sleep Apnea Patients

SLEEP ◽

10.1093/sleep/zsab072.438 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A173-A174

Author(s):

Diego Mazzotti ◽

Aiyu Chen ◽

Jaejin An ◽

Jessica Arguelles ◽

Brendan Keenan ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Clinical Sample ◽

Lipid Lowering ◽

Sleep Study ◽

Obstructive Sleep

Abstract Introduction While studies support the beneficial short-term role of continuous positive airway pressure (CPAP) therapy on cardiometabolic risk in adults with obstructive sleep apnea (OSA), its sustained effect on cardiovascular disease (CVD) risk is unknown. CPAP use data linked to electronic health records (EHR) offer opportunities to understand the role of OSA treatment for preventing CVD. We evaluated the association between CPAP use and CVD incidence in patients referred to a sleep study at a large health system. Methods We included adult patients with available apnea-hypopnea index (AHI) between 01/2018-02/2020 in Kaiser Permanente Southern California. At baseline, eligible participants had >1 year of continuous insurance coverage allowing gaps <90 days and were free of CVD 1 year prior to OSA diagnosis. Participants were distributed into three groups: no OSA (AHI<5), OSA (AHI≥5) with any CPAP use (median[IQR] 2.5[0.7–5.0] h/day) and OSA without evidence of CPAP use. CVD incidence was defined as first occurrence of myocardial infarction, stroke, unstable angina, heart failure or CVD death, based on validated EHR algorithms. We used Cox proportional hazards models to assess the association between OSA with or without CPAP use and CVD incidence, adjusted for baseline age, sex, body mass index, race/ethnicity, Charlson comorbidity index, and use of anti-hypertensives and lipid-lowering medications. Stratified analyses were conducted based on OSA severity. Results We included 11,145 patients without OSA, 13,898 with OSA and CPAP use, and 20,884 patients without CPAP use. Median follow-up was 262 days (IQR=129–409). CVD incidence rates were, respectively, 0.26%, 0.45% and 0.56%. In adjusted models, moderate-severe OSA (AHI≥15) without CPAP use was associated with increased CVD incidence when compared to no OSA (HR=1.71; 95%CI=1.11–2.64; p=0.016). OSA with any CPAP use was associated with lower CVD incidence (HR=0.68; 95%CI=0.50–0.93; p=0.016) when compared to OSA patients with no CPAP use. Stronger effects were observed when restricting the sample to moderate-severe OSA (HR=0.56; 95%CI=0.39–0.81; p=0.002). Conclusion Our analysis in a large observational clinical sample suggests that moderate-severe OSA with no CPAP use is associated with increased CVD incidence. Moreover, OSA with CPAP use was associated with decreased CVD incidence relative to no CPAP use. Support (if any) AASM Foundation (194-SR-18;205-SR-19); AHA (20CDA35310360).

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