SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science I. Sleep Disorders – Breathing
Results: For patients with CpxA - means: age 61.7, BMI 30.8, AHI 47.9,
and low SaO2 - 75.6. For non- CpxA patients - means: age 57.8, BMI
34.1, AHI 44.8, and low SaO2 - 74.3. Using the above protocol in CpxA
patients, an optimal or good titration (AASM criteria - Kushida et. al.
2008) was attained during the initial split night study in 55/107 (51%),
and attained for 20/24 additional patients when they returned for a full
night 02>cpap/bipap titration. 4/79 (5 %) of CpxA patients could not be
adequately treated using this protocol. 28/52 (54%) did not return for
their recommended repeat titration to these laboratories (this return rate
was consistent for all laboratories). Overall treatment success using this
protocol was 75/107 (72%). Excluding non-returning patients, this protocol
achieved an optimal/good titration in 75/79 (95 %) of CpxA patients.
Conclusion: The above described 02>cpap/bipap titration protocol can
be utilized to achieve an optimal/good titration in 95% of OSA patients
living at altitude and developing central apneas (CpxA) on treatment
with PAP.
0404
THERAPY-EFFICACY OF A NEW MODE OF AUTOMATIC
SERVO VENTILATION IN SUBJECTS WITH COMPLICATED
BREATHING PATTERNS DURING SLEEP
Hardy W 1 , Randerath W 2 , Banerjee D 3,4 , Treml M 2 , Taheri S 3
1
Philips Respironics, Monroeville, PA, USA, 2 Institute of Pneumology,
Bethanien Hospital, Solingen, Germany, 3 Heartlands BioMedical
Research Unit Birmingham, Heartlands Hospital, Birmingham, United
Kingdom, 4 School of Life and Health Sciences, Aston University,
Birmingham, United Kingdom
Introduction: Cheyne-Stokes respiration (CSR) is a form of sleep disordered
breathing (central apnea, periodic breathing) seen in approximately
40% of congestive heart failure patients with a left ventricular
ejection fraction less than 40%.CSR is an independent risk factor for
death. Auto SV is a mode of pressure support to treat obstructive, central
and complex breathing patterns during sleep which may be seen in patients
with CHF. The aim of the study was to determine if the Auto SV
device adequately treated CSA and CSR. We evaluated the efficacy of an
enhanced AutoSV algorithm in previously untreated patients with heart
failure and central apnea
Methods: After providing consent, participants had a diagnostic polysomnography
followed by a full night of treatment on the enhanced
BiPAP autoSV ADVANCED (Respironics, Murrysville, PA USA)algorithm
to determine the effect of treatment on the respiratory disturbance
index (RDI), central apnea index (CAI), CSR, apnea-hypopnea index
(AHI) during both REM and non-REM sleep, hypopnea index (HI) and
respiratory arousals. The device was set to automatically determine expiratory
and inspiratory pressures and a minimum respiratory rate with
maximum pressures limits available. A maximum expiratory pressure
relief setting of 3 was provided. Data were analyzed with paired t-tests.
Results: Data (mean ± SD) are presented on eight male participants. The
average age was 67±12.4 years, BMI was 29.2± 5.8 Kg/m2 and the ejection
fraction was 25.3% ± 5.6. Sleep time and sleep efficiency were not
significantly different. The RDI on the treatment night (5.2±4.9 events
per hour) was significantly lower (p=0.0001) than that on the diagnostic
night (45.4±13.6 events per hour). The enhanced AutoSV also lowered
the CAI (0.5±1.0 vs. 20.9±16.7, (p=0.01)), the CSR Index (1.0±3.0 vs.
26.1±17, (p=0.002)). The AHI during REM with treatment (2.8± 3.3)
was significantly lower than that during the diagnostic PSG(21.6±19.9.
(p=0.032)). There was a significant reduction in the AHI during non-
REM as well (AHI with treatment = 5.7±5.7 and 48.3±13.8 without
treatment, p=0.0001). The HI was 4.3±3.9 with therapy compared to
17.1±10.8 on the diagnostic night (p=0.018) and the respiratory arousal
index (5.3±5.8 vs. 95.8±69, (p=0.007)) decreased significantly.
Conclusion: These data indicate that the enhanced Auto SV algorithm
successfully treats central apnea and Cheyne-Stokes respiration in patients
with severe heart failure.
Support (If Any): Support provided by Philips Respironics.
0405
THE IMPACT OF CPAP ON OBSTRUCTIVE SLEEP APNEA
ON THE FIRST POSTOPERATIVE NIGHT: A PILOT STUDY
Auckley D 1 , Khanna G 2 , Shaman Z 1 , Cox R 1 , Brar I 3
1
Division of Pulmonary, Critical Care and Sleep Medicine,
MetroHealth Medical Center, Case Western Reserve University,
Cleveland, OH, USA, 2 Division of Pulmonary, Critical Care and Sleep
Medicine, University of Cincinnati, Cincinnati, OH, USA, 3 Affinity
Medical Center, Akron, OH, USA
Introduction: Obstructive Sleep Apnea (OSA) is considered a risk factor
for perioperative complications. Limited data suggests that CPAP
may be protective in the perioperative setting. However, little is known
about the postoperative sleep in patients with OSA who use their CPAP
following surgery. This pilot study describes the effects of CPAP on
sleep and OSA on the first night after surgery.
Methods: Patients with known OSA on fixed pressure CPAP therapy at
home admitted for elective extremity and lower abdominal surgery were
enrolled. Patients were randomized to their fixed pressure CPAP vs. autoadjusting
CPAP (ACPAP) for the night after surgery and underwent
full attended PSG. Descriptive statistics, t-tests and Fishers exact test
were used where appropriate.
Results: Eleven patients were enrolled. Demographics: 9 women, age
51.2 years old, BMI 37.6 kg/m2 (range 20.4-54.0), baseline AHI 42.9
(range 5.7-116.4), and baseline CPAP setting of 10.0 cm H2O (range
6-14). Three of the 11 slept 10 minutes or less (all on fixed pressure
CPAP) and were excluded from analysis. Due to logistical issues, only
3 of the remaining 8 patients were randomized to ACPAP. All 8 of
these patients slept at least 2 hours (average 300 minutes, range 136-
446 minutes) with average sleep efficiency 60%. Slow wave sleep was
seen in 3 patients (average 8.5%) and REM sleep in 4 patients (average
8.6%). The average residual AHI (while on CPAP or ACPAP) was
1.5 (range 0 to 5.5, infrequent central apneas). There were no significant
differences on the postoperative PSG between CPAP or ACPAP
patients. Due to persistent hypoxemia during sleep, 4 patients (50%)
required nocturnal supplemental oxygen. There were no significant
differences between those requiring oxygen and those not in terms of
severity of baseline OSA, known pulmonary disease, tobacco use history,
BMI or age.
Conclusion: In this small pilot study, patients with OSA undergoing
elective surgery slept poorly while on CPAP the night after surgery.
Despite this, OSA appeared well-controlled with either fixed pressure
CPAP or ACPAP. However, significant hypoxia still occurred in half the
patients and suggests monitoring is warranted.
Support (If Any): Support provided by ResMed and CleveMed.
0406
PREDICTABLE FACTORS OF RESIDUAL SLEEPINESS IN
OBSTRUCTIVE SLEEP APNEA PATIENTS WHO WERE
TREATED WITH NASAL CPAP
Koo D 1 , Ji K 1 , Kim D 1 , Song P 1 , Byun S 1 , Kim J 2 , Joo E 1 , Hong S 1
1
Neurology, Sleep Center, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Republic of Korea, 2 Neurology,
Dankook University Hospital, Dankook University College of
Medicine, Cheonan, Republic of Korea
Introduction: Some patients with obstructive sleep apnea (OSA) remain
sleepy despite adequate use of continuous positive airway pressure
(CPAP). The aim of this study was to investigate the clinical and polysomnographic
determinants of residual daytime sleepiness in CPAPtreated
OSA patients more than 6 months.
Methods: We enrolled consecutively 70 patients, who were diagnosed
with OSA by polysomnography and prescribed nasal CPAP therapy.
Among them, 36 patients continued to wear CPAP adequately (≥ 70%
of nocturnal sleep time, ≥ 5 days a week) for more than 6 months. They
were divided into Sleepy (Epworth sleepiness scale, ESS ≥10) or Non-
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