SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
0338
EXPLORING PATTERNS OF CIRCADIAN USAGE
OF POSITIVE AIRWAY PRESSURE DEVICES
COLLABORATIVELY WITH PATIENTS WITH OSA AIDS IN
INDIVIDUALIZED TROUBLESHOOTING AND INCREASES
ADHERENCE - TREASURES AT OUR FINGER TIPS
Dahm C
Internal Medicine/PACCSM, University of Minnesota, St. Paul, MN,
USA
Introduction: Positive airway pressure (PAP) therapy is commonly
prescribed for obstructive sleep apnea. However patients have often difficulties
adhering to therapy. Newer generations of PAP devices track usage
and treatment parameters. Summary statistics and graphic displays
of different parameters are available for download. In this report, typical
patterns of use in graphic circadian usage displays and identification of
individual barriers are described.
Methods: Case series. Exploration of variability in circadian usage displays
in clinic visits.
Results: Limited adherence to PAP therapy can be related to behavioral,
technical or comorbid conditions. Graphic circadian usage displays offer
insight into usage patterns such as variability in usage onset, usage
interruptions and usage off-set. Collaborative exploration of graphic
circadian usage patterns with open-ended, non-judgmental questioning
allows identification of individual patient’s barriers. Behavioral barriers
(e.g. delaying PAP usage by falling asleep viewing TV or ending usage
early after nocturia) can be identified. Technical difficulties - such as
inappropriate pressure settings, mask fit, device malfunction (e.g. “water
damage”) - and comorbid conditions (e.g. chronic liver disease) can
lead to easily noticeable variability in usage pattern and other download
parameters. Six examples of different typical circadian usage patterns
demonstrate how patient-centered recognition of barriers, subsequent
troubleshooting and collaborative goal setting can lead to improved adherence
measurable in repeat downloads. Depending on the importance
of the identified barrier and success of the chosen interventions increases
in median daily usage of up to 4 hours can be observed.
Conclusion: Collaborative exploration of circadian usage patterns,
identification of individual barriers to PAP therapy, collaborative goal
setting and repeat download are helpful steps in increasing individual
adherence to PAP therapy. Circadian usage data and other elements of
downloads are valuable in identifying device malfunction. Downloads
can be used as feed-back, motivational and educational tool.
0339
THE EFFECT OF 3-4 WEEKS OF CONTINUOUS POSITIVE
AIRWAY PRESSURE ACCLIMATIZATION ON EARLY
COMPLIANCE
Cotton J, Hand S, Mohan G, Zarrouf FA
Sleep Medicine, AnMed Health, Anderson, SC, USA
Introduction: Effectiveness of Continuous Positive Airway Pressure
(CPAP) as a treatment for Obstructive Sleep Apnea (OSA) can be limited
by poor compliance. Potential PAP titration candidates should receive
adequate PAP education, hands-on demonstration, careful mask fitting,
and acclimatization during the night of the titration study. Our research
evaluates the effect of 3-4 weeks of acclimatization after PSG but before
the titration night, on CPAP compliance.
Methods: Consecutive adult OSA patients were included in two groups.
Group A: Patients who had an acclimatization of 3-4 weeks on CPAP
pressures of 8-10 cmH2O before their titration studies, and Group B:
Patients who underwent CPAP titration studies after the initial diagnostic
polysomnograms without acclimatization (control). Compliance was
evaluated for the first month of CPAP use after titration. Compliance
measures obtained from the digital electronic compliance card included
percent of days with more than 4 hours of use (CPAP-4H) and average
hours the device was used: (CPAP- H), using bivariate correlations and
independent sample- t tests.
Results: 40 (20 in each group) patients were enrolled at the time of submission
of this abstract. 25 males and 15 females) had compliance card
information and were included in the data analysis. Mean (SD) for age
=54.93 (12.69), and AHI= 32.98 (31.77). There were no significant differences
of baseline characteristics (age, AHI, Lowest O2, PLMI) between
the two groups. Although there were trends for higher CPAP-4H
and CPAP- H in group A, when compared to group B, but they were not
statistically significant. CPAP-4H (SD) = [68.27 % (23.34) vs. 62.95
% (28.42); p=0.522], CPAP-H (SD)=[ 5.45 (1.621) vs. 4.70 (1.89); p=
0.185].
Conclusion: We find no significant differences in compliance outcomes
among OSA patients who were acclimated on 3-4 weeks of CPAP prior
to their titration studies when compared to control. We find a trend of
higher compliance in these patients and enrolling more patients will help
increase the power of our study.
0340
THE ASSOCIATION OF POSITIVE AIRWAY PRESSURE
(PAP) ADHERENCE WITH EPWORTH SLEEPINESS SCALE
(ESS) AND QUALITY OF LIFE (QOL) IN SUBJECTS WITH
OBSTRUCTIVE SLEEP APNEA (OSA) PARTICIPATING IN
THE HOMEPAP STUDY
Mohan A 1 , Andrews ND 1 , Auckley D 2 , Benca R 3 , Iber C 4 , Kapur VK 5 ,
Redline S 6 , Rosen CL 7 , Zee P 8 , Foldvary-Schaefer N 1
1
Sleep Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA,
2
MetroHealth Medical Center, Case Western Reserve University,
Cleveland, OH, USA, 3 University of Wisconsin, Madison, WI,
USA, 4 Hennepin County Medical Center, University of Minnesota,
Minneapolis, MN, USA, 5 UW Medicine Sleep Center, University
of Washington, Seattle, WA, USA, 6 Brigham and Women’s Hospital
and Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, USA, 7 University Hospitals, Case Western Reserve
University, Cleveland, OH, USA, 8 Northwestern University, Feinberg
School of Medicine, Chicago, IL, USA
Introduction: While PAP is efficacious in the treatment of OSA, resistance
and intolerance to treatment limit its effectiveness. We investigated
the association between PAP adherence with changes in ESS and SF-36
in the HomePAP study, a multi-center trial comparing PAP adherence in
subjects with moderate to severe OSA (with an ESS >12) randomized to
Lab- or Home-based evaluation and treatment.
Methods: 135 subjects completing 3-month follow-up were included.
Associations between PAP adherence with percentage of subjects
achieving ESS normalization (4 hr of use >70% of nights.
Results: Sample characteristics: age 48±12 yr, 62% Caucasian, 65%
male, BMI 38.5±8.7 kg/m2, 39% ≥ college-educated, baseline ESS 14
± 4, and AHI 43±26. ESS normalization was achieved in 65%, 78%
and 92% of subjects with average nightly use of 0-4 hr, >4-6 hr, and
>6 hr, respectively (p=0.003 for trend). After multivariable adjustment,
subjects with PAP use ≥4 hr were 3-fold (OR: 3.0 [1.17, 7.71] more
likely to have a normalized ESS score compared to subjects with poorer
adherence. No association was observed between ESS and adherence
defined as >4 hr of use >70% of nights. Younger subjects (p=0.023)
and those with higher baseline AHI (p=0.013), and lower baseline ESS
(p=0.043) were significantly more likely to achieve ESS normalization.
No significant associations were seen for absolute/% ESS change or
absolute/%SF-36 change.
Conclusion: Increased PAP adherence defined by >4 hr of use per night
is associated with greater likelihood of ESS normalization but unassoci-
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SLEEP, Volume 34, Abstract Supplement, 2011