SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
ated with changes in the SF-36. OSA severity and age also affect ESS
normalization.
Support (If Any): American Sleep Medicine Foundation 38-PM-07
Grant: Portable Monitoring for the Diagnosis and Management of OSA
0341
EFFECT OF AN INTERNET INTERVENTION ON CPAP
ADHERENCE
Stepnowsky C 1,2 , Edwards C 2 , Zamora T 2 , Agha Z 1,2 , Ancoli-Israel S 3 ,
Loredo JS 1,2
1
HSRD (111n-1), VA San Diego Healthcare System, San Diego, CA,
USA, 2 Medicine, University of California, San Diego, San Diego, CA,
USA, 3 Psychiatry, University of California, San Diego, San Diego, CA,
USA
Introduction: CPAP is the gold-standard treatment for OSA and it is
generally accepted that CPAP adherence can be substantially improved.
A key advantage to using CPAP is its ability to objectively measure and
store both treatment adherence and efficacy data. New methods utilizing
this data are needed to help increase CPAP adherence.
Methods: The Patient-Centered Collaborative Care (PC3) intervention
is a multi-component intervention that is comprised of telemonitoring
of objective CPAP adherence and efficacy data, an interactive website,
and clinical support on an as needed basis. The PC3 patients were given
access to an interactive website that provided nightly CPAP adherence,
OSA and CPAP education; basic troubleshooting, and reference information
about their CPAP device. Providers tracked PC3 patients’ CPAP
adherence via the ResTraxx Data Center website. The PC3 intervention
was designed to supplement and not replace the clinical care process.
The study was a randomized, controlled trial of Usual Care compared to
PC3. Usual Care was comprised of a one-week phone call, a one-month
visit (inclusive of data download and review), and any extra support
requested by the participant.
Results: 241 patients newly diagnosed with OSA and prescribed CPAP
were studied. At baseline, mean age=52.1±13.3, mean Apnea-Hypopnea
Index=36.4±26, and mean body mass index= 32.4± 8.0 (mean±SD).
There were no baseline differences in AHI, BMI or ESS between the
groups. Nightly CPAP adherence measured at the 2-month timepoint
was 3.3±2.4 and 4.1±2.3 hrs/night (p=.016) and at the 4-month timepoint
was 3.2±2.3 and 3.9±2.3 hrs/night (p=.035) for UC and PC3, respectively.
There were no differences between the groups on follow-up
measures of Patient Assessment of Chronic Illness Care, sleep apnea
symptoms (e.g. Epworth Sleepiness Scale and Sleep Apnea Quality of
Life Index), or depressive symptoms (e.g. Center for Epidemiologic
Studies Depression Scale).
Conclusion: The PC3 intervention has the potential to help improve
CPAP adherence in clinical settings.
0342
REM REBOUND AND CPAP COMPLIANCE
Wiggins RG 1,2 , Molina C 2,1 , Koo BB 1,2
1
Pulmonary/Sleep medicine, Case Medical Center, Cleveland, OH,
USA, 2 pulmonary/sleep medicine, Cleveland VA, Cleveland, OH, USA
Introduction: Obstructive sleep apnea causes significant disruption in
sleep architecture and can lead to little to no REM sleep. Research suggests
that REM rebound during initial CPAP treatment correlates with
subjective improvement in sleep quality. This study examines whether
REM rebound during initial CPAP treatment in a split night study also
predicts better compliance with CPAP.
Methods: All split night studies performed in the Cleveland VA during
2008 and 2009 were examined. Excluded were studies that did not
identify an optimal pressure setting or ended prematurely and patients
did not follow up. Demographic and PSG findings including diagnostic
and treatment REM percent and duration of longest REM period were
examined. CPAP compliance, defined as percentage of days used more
than 4 hours, was obtained from the medical record. The cohort was
divided into those with and without REM rebound in the treatment portion,
defined as a single REM period ≥45 minutes or ≥30% treatment
REM sleep that was ≥20% increase from baseline. Overall compliance
was compared using two-sided student’s t testing.
Results: 43 records were studied, 17 with REM rebound (RR) and 26
with no REM rebound (NRR). There was no difference in age, BMI
or ESS between the two groups (p>0.05), There was no significant difference
in diagnostic AHI between RR 42.3±26.8 and NRR 35.1±23.2,
p=0.37. As defined there were significant differences in longest treatment
REM period duration in RR and NRR groups, 55.1±17.4 and
18.6±12.4, respectively, p