0608 Concordance Between Current AASM And CMS Scoring Criteria for Obstructive Sleep Apnea in Hospitalized Persons with TBI: A NIDILRR and VA Model System Study

Introduction The objective of this study was to compare OSA, demographic, and TBI characteristics across the American Academy of Sleep Medicine (AASM) and Centers for Medicare and Medicare (CMS) scoring rules in moderate to severe TBI undergoing inpatient neurorehabilitation. Methods This is a secondary analysis from a prospective clinical trial of sleep apnea at six TBI Model System study sites (n=248). Scoring was completed by a centralized center using both the AASM and CMS criteria for OSA. Hospitalization and injury characteristics were abstracted from the medical record and demographics obtained by interview by trained research assistants using TBI Model System standard procedures. Results OSA was prevalent using the AASM (66%) and CMS (41.5%) criteria with moderate to strong agreement (weighted kappa = 0.64 (95%CI = 0.58, 0.70). Significant differences were observed for participants meeting AASM and CMS criteria (Agreement Group; AG) compared to those meeting criteria for AASM but not CMS (Disagreement Group; DG). At AHI ≥ 5, the DG (n=61) had lower Emergency Department Glasgow Coma Scale Scores consistent with greater injury severity (median 5 vs. 13, p = 0.0050), younger age (median 38 vs 58, p<0.0001), and lower BMI (median 24.8 vs 22.1, p = 0.0007) compared to the AG (n=103). At AHI ≥ 15, female gender and but no other differences were noted possibly due to the smaller sample size. Conclusion The underestimation of sleep apnea using CMS criteria is consistent with prior literature; however, this is the first study to report the impact of the criteria in persons with moderate to severe TBI during a critical stage of neural recovery. Management of comorbidities in TBI has become an increasing focus for optimizing TBI outcomes. Given the chronic morbidity after moderate to severe TBI, the impact of CMS policy for OSA diagnosis for persons with chronic disability and young age are considerable. Support PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).