SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
neas or nighttime gasping; insurance; presence of bed partner; physician
visits during first 3 months of treatment; titration method; and attended
titration quality. The association of adherence with categorical variables
was evaluated using the chi-square test; continuous variables were compared
with the t-test.
Results: Fifty-five patients (37 males), ages 30-83, 35% Caucasians,
27% Hispanic, 18% African-American, 18% unknown, 2% Asian were
identified. The average body mass index was 33.1 kg/m2. Twenty-six
(47%) had severe, 11(20%) moderate, and 13 (24%) mild OSAS. Five
(10%) had upper airway resistance syndrome. Seventeen (31%) were
compliant. Attended titrations were successful in 59%. No variable was
significantly associated with compliance. A trend toward significance
was seen for increased compliance in 11 patients on APAP, with 6 /11
being compliant (p=0.07), 5/11 (45%) with severe OSAS, 1/11(10%)
with moderate OSAS and 5/11 (45%) with mild OSAS. Average # of
visits for APAP patients was 1.9; for attended titration patients was 0.8.
Medicaid insured 7/11 APAP patients.
Conclusion: No factors reviewed were significantly associated with
CPAP adherence. Autotitration devices may not adversely affect compliance.
0398
RELATIONSHIP OF APAP ADHERENCE IN COMMERCIAL
TRUCK DRIVERS AT THE INITIATION OF TREATMENT
AND AFTER 270 DAYS
Licata C, Nolte CM, McWhirter DY, Bessler M, Eisenstadt ML
Sleep Associates of East Tennessee, Knoxville, TN, USA
Introduction: Obstructive Sleep Apnea (OSA) screening, testing, and
treatment of commercial drivers is not only recommended, and is anticipated
to become an upcoming requirement of the Department of Transportation.
Given its morbidity and mortality, as well as its link to fatal
crashes, it is of critical importance to identify and treat drivers who have
OSA. To effectively do so treatment adherence must be maintained.
Methods: Recruited drivers were administered screening questionnaires
(Berlin, Epworth Sleepiness Scale, SF-36 and the Functional Quality of
Sleep Questionnaire), followed by history and physical. Drivers with a
high pre-test probability for OSA underwent in-cab type 3 portable monitoring
that followed by APAP titration during their 34-hr restart. In-lab
polysomnography was performed for AHI < 15 and when portable test
results were technically suboptimal. Drivers were assessed for adherence
within the first 14 days of treatment and every 90 days for 270 days.
Adherence for 14 day was defined as use of APAP for 10 or more days
for 4 hours or more. Adherence for 90 days used the Medicare standard.
Results: Twenty-six drivers were included in the study. Fifteen of the
subject completed the full 270 days and were used for analysis. Of the 7
(47% of subjects) that did not meet adherence during the 14 day start, 2
(13%) did not meet adherence during the last 90 day period and 5 (33%)
did. Of the 8 (53% of the subjects) that did meet adherence during the
14 day start, 1 (7%) did not meet adherence during the last 90 day period
and 7 (47%) did. Ten of the subjects (66%) were in adherence every 90
days for 270 days based on Medicare, with 3 of the drivers not being in
adherence during the first 14 day period.
Conclusion: Adherence during the first 14 days of treatment is a good
indicator of long term compliance, but not for all drivers. Detailed analysis
can give guidance for maintaining adherence in initially adherent and
in converting non-adherent drivers to become adherent drivers. Continuous
monitoring and timely intervention are essential to successfully
manage drivers with OSA.
0399
VARIATIONS IN AUTOCPAP RECOMENDED CPAP
PRESSURES
Chang JW 1 , Becker K 1 , Kim JB 1 , Shah N 1 , Gomez R 1 , Ayappa I 2 ,
Rapoport DM 2 , Hwang D 1,2
1
Sleep Medicine, Kaiser Permanente/SCPMG, Fontana, CA, USA,
2
Pulmonary, Critical Care, and Sleep Medicine, NYU School of
Medicine, New York, NY, USA
Introduction: AutoCPAP (APAP) devices are frequently used to determine
optimal CPAP pressure for home OSA therapy, although optimal
parameters and accuracy require further validation. We investigate these
issues by using APAP devices to perform in-lab CPAP titrations and
compare device generated data to physician assessment.
Methods: Four REMStarAuto with A-Flex (Respironics, “R”) and two
S8 AutoSet II (ResMed, “RM”) APAP devices were interfaced with the
Sandman (Embla) acquisition system and randomly assigned to perform
in-lab CPAP titrations in OSA patients; APAP range was set to
4-20cmH20. Technicians temporarily switched to manual titration if
APAP failed to increase for obstructive apneas/hypopneas/persistent
flow limitation or if intermittent flow limitation was absent with APAP
pressure “step-down” procedures. Device recommended pressure (Device
Pressure-based on 90th percentile for R and 95th percentile for RM)
was compared to pressure recommended by the interpreting physician
blinded to the APAP generated data (Physician Pressure).
Results: 146 OSA patients underwent in-lab APAP titration (103 R, 43
RM). Mean Device Pressure (11.7±3.5cmH20) was higher than Physician
Pressure (10.1±3.3cmH20) by an average of 1.6±2.2cmH20
(1.2±2.2 R, 2.2±2.1 RM, p=0.009). Device Pressure was equal to Physician
Pressure in 19.2%; It was over by ≥2cmH20 in 43.8% (37.9% R vs
58.1% RM, p=0.02) and over by ≥4cmH20 in 4.1% (5.8% R vs 14.0%
RM, p=0.10); It was under by ≥2cmH20 in 6.3% (8.7% R vs 0.0% RM,
p=0.05). Median polysomnography derived residual AHI4% were similar
and normalized with both devices.
Conclusion: Compared to physician recommended pressures, using
APAP recommended pressures results in a low under-titration rate;
Under-titration was seen only with R devices while RM devices had
a higher over-titration rate. Clinical follow-up is important to identify
treatment with insufficient pressure and manage potential pressurerelated
discomfort. However, the gold standard method of determining
optimal pressure is still yet to be determined.
0400
COMPARISON OF EXHALATION PRESSURE RELIEF TO
STANDARD PRESSURE DELIVERY AMONG OSA SUBJECTS
ON AUTO-ADJUST THERAPY
Rosenthal L 2 , Woidtke R 1 , Andry J 3 , Garcia M 2 , Nunez H 2 , Rafati S 3 ,
Gordon N 4
1
Sleep For Nurses, Castro Valley, CA, USA, 2 Sleep Medicine
Associates of Texas, Dallas, TX, USA, 3 Sleep Therapy and Research
Center, San Antonio, TX, USA, 4 Gordon and Associates, Berkeley, CA,
USA
Introduction: CPAP represents the gold standard in the treatment of
OSA. Expiratory pressure relief (EPR) and Auto-Adjust devices were
developed to improve patient comfort but may result in sub-therapeutic
pressure settings. The aim of this study was to determine if the Smart-
Flex technology (DeVilbiss Healthcare Inc, Somerset, PA) is “at least
as good as” standard delivery of PAP among subjects receiving Auto-
Adjust Therapy
Methods: Two center, randomized, prospective, double-blinded, crossover
study compared outcomes (AHI and Epworth scores [ES]) between
flexible EPR (flx, at a setting of 3) and standard (std) Auto-Adjust therapy
(6-15 cm H2O.IRB approval was obtained. Subjects age≥18, AHI
≥15, CPAP naïve with ESS ≥10 and no other sleep co-morbidity or acute
medical condition, and adequate response to in-laboratory CPAP titra-
SLEEP, Volume 34, Abstract Supplement, 2011
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