SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
tion were eligible to participate. Subjects used each treatment arm for
2-weeks; AHI and ESS data was collected at the end of each treatment
period. Paired t-tests were used to test for differences between standard
and flx modes.
Results: Results: Data on nine (of 28) subjects (5 male), age 43.2 (±
15.1), BMI 35.6 (± 6.2) and baseline ES 14.9(±3.4) is presented. Both
groups achieved comparable use (flx: 4.95±1.28; std 5.22±1.01 hrs; p
0.56). Auto-Adjust derived AHI on flx was 6.4 ±3.2 and on std 5.4±2.9
(p 0.38). ES on flx was 10.3±3.6 and on std 9.6±3.5 (p 0.49).
Conclusion: Conclusions: Interim analysis shows comparable outcomes
on respiratory event indices among OSA subjects treated with an Auto-
Adjust device with EPR or with standard pressure delivery. Consistent
with these results is the comparable improvement in daytime alertness
documented during the therapeutic trial.
Support (If Any): This study was supported by DeVilbiss Healthcare.
Inc
0401
SLEEP DISORDERED BREATHING (SDB) IS SIGNIFICANTLY
MORE DIFFICULT TO TREAT WITH POSITIVE AIRWAY
PRESSURE AT ALTITUDE
Pagel JF 1,2,3,4 , Perez A 4,6 , Parnes B 5 , Kawaikowski C 4
1
Family Medicine, University of Colorado School of Medicine,
Pueblo, CO, USA, 2 Sleep Disorders Center of Southern Colorado,
Parkview Medical Center, Pueblo, CO, USA, 3 Colorado Springs
Sleep Laboratory, Sleepworks, Colorado Springs, CO, USA, 4 Rocky
Mt. Sleep Disorders Center, , Pueblo, CO, USA, 5 Family Medicine,
Colorado Health Science Center, Denver, CO, USA, 6 Psychology,
Colorado State University - Pueblo, Pueblo, CO, USA
Introduction: Based on clinical concerns as to the difficulty of treating
SDB with increasing elevation in the Mountain West, split night polysomnography
results were compared between three sites differing primarily
as to altitude: (site a) 4662 feet (1421 meters), (site b) 5930 feet
(1808 meters) and (site c) 7100 feet (2165 meters).
Methods: Patients included in this retrospective study were individuals
living at the altitude of study between the ages of 40 & 79 completing
a split night study with a diagnostic AHI > 15. (site a - #150) (b -#150)
(c - #142). Mean age - 58.6, mean BMI - 33.2, 33.6% female - no significant
demographic differences noted between sites. The three locations
utilize the same interpreting medical director, and diagnostic/treatment
protocols. The quality of PAP titration obtained was rated as 1-optimal,
2-good, 3-adequate, or 4-unacceptable based on AASM clinical guidelines
(Kushida et. al. 2008).
Results: Rated titration quality at site a was 1.437 (sd 0.821), site b
1.569 (sd 0.96), and site c 1.772 (sd 1025). Titration quality at site c is
significantly worse than at site a (t=3.22, p > 0.01) and at site b (t=2.55,
p>0.02). Analysis of covariance comparing titration across three altitude
levels, controlling for age, was significant for the effect of altitude
p=0.017. At site a (4/150 - 2.7%) of patients required repeat pap titration
while at site b (12/150 - 8%) and at site c (15/142 -10.6%) of patients returned
for repeat titration due to inadequate titrations during initial split
night studies (P=.025). Mean numbers of central apneas/hr developing
on treatment with PAP varied from 4.8/hr. at site a, to 9.79/hr. at site b,
to 19.25/hr. at site c (significant at P < .000). At site a 16/150 (10.6%) a
central apnea index CAI > 5.0 on PAP therapy, while at site b, 33/150
(22%), and at site c, 52/142 (36.6%) of patients met this criteria for the
development of “complex” apnea.
Conclusion: The results demonstrate that increasing altitude has a negative
effect on the quality of SDB treatment obtained during pap titration
for patients living at altitude. This finding is apparently secondary to the
development of central apnea on treatment with PAP (complex apnea)
significantly more common with increasing altitude.
0402
COMPLEX SLEEP APNEA IN OSA PATIENTS FIRST TIME
TREATED WITH CPAP
Ringel D, Blau A, Schoebel C, Sebert M, Baumann G, Fietze I,
Penzel T
Cardiology and Angiology, Center of Sleep Medicine, Charité-
Universitätsmedizin Berlin, Berlin, Germany
Introduction: Some patients develop central apneas during the attempt
to treat obstructive events with continuous positive airway pressure
(CPAP). This is called complex sleep apnea (CompSA). The aim of this
study was to evaluate the occurence of CompSA and characterize relevant
patients during first two nights of CPAP treatment in a retrospective
study in our sleep lab.
Methods: We included 150 patients (age 58.6 ± 10.9 years; BMI 30.9 ±
5.84kg/m2; (117 male, 33 females) with a first time diagnosis of moderate
to severe OSA and underwent CPAP titration for two nights. An
inclusion in the group of patients with CompSA required a central apnea
index of more than 5 per hour. The AHI was determined using polysomnography
before treatment and under CPAP. CPAP was titrated using
standard criteria (range 4 - 15 cmH2O).
Results: We found CompSA in 27 patients (18%). Compared with the
group with no CompSA there were more mixed apneas (35.4 ± 61.6
vs. 11.5 ± 27.1/h, p = 0.011) before treatment. More men were affected
(92.6 vs. 74.8%, p = 0.011), a tendency that the patients with CompSA
were older (60.4 ± 10.9 vs. 58.2 ± 10.9 years, p = 0.268) and they had a
higher severity of OSA (AHI 39.7 ± 19.8 vs. 36.2 ± 19.3 /h, p = 0.377).
The events predominantly occured in light NREM sleep and in the first
night with CPAP (CAI in the CompSA group first night 9.1 ± 4.8 vs.
second night 6.6 ± 2,6/h).
Conclusion: We found a high prevalence of CompSA in our group of
patients. CompSA may lead to residual symptoms and intolerance to
CPAP therapy. Some patients with CompSA may benefit from other
modes of PAP therapy. Our data support that in most patients CompSA
is limited to first night with CPAP and is already reduced in the second
night of treatment.
0403
TREATMENT OF COMPLEX APNEA WITH SUPPLEMENTAL
OXYGEN AND PAP
Pagel JF 1,3,4,5 , Parnes B 2
1
Family Medicine, University of Colorado School of Medicine,
Pueblo, CO, USA, 2 Family Medicine, University of Colorado Health
Science Center, Denver, CO, USA, 3 Sleep Disorders Center of Souther
Colorado, Parkview Medical Center, Pueblo, CO, USA, 4 Sleep Center,
Heart of the Rockies Medical Center, Salida, CO, USA, 5 SW Colorado
Springs Sleep Laboratory, Sleepworks, Colorado Springs, CO, USA
Introduction: Complex apnea [CpxA] (defined for this study as the development
a cental apnea index (CAI) > 5.0/hr. during split-night PAP
titration) occurs frequently among patients being treated for obstructive
sleep apnea at altitude. In this study of the effects of altitude on PAP
titration, > CAI > 5.0 on treatment with PAP was present in 107/444
OSA patients evaluated with split-night polysomnography(24.1%). This
finding is significantly more common with increasing altitude, and has
significant negative effects on PAP titration quality (Pagel et. al. APSS
Abstract 2011).
Methods: Because of the frequency of central apneas occring with PAP
titration at altitude, the medical director of these sites has developed a
treatment protocol for such patients described clinically as an 02>cpap/
bipap titration: PAP is discontinued, low flow oxygen is administered for
30 min and PAP titration is restarted with 02. Patients (107) included in
this retrospective study were between the ages of 40 & 79 being clinically
evaluated with split night polysomnography for suspected OSA
with a diagnostic AHI > 15 and developing a component of CpxA (CAI
> 5.0) on treatment with PAP.
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SLEEP, Volume 34, Abstract Supplement, 2011