SLEEP 2011 Abstract Supplement

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B. Clinical Sleep Science I. Sleep Disorders – Breathing 0422 CLINICAL EFFICACY OF A NASAL EXPIRATORY POSITIVE AIRWAY PRESSURE (EPAP) DEVICE FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA Massie C, Hart RW Chicago Sleep Group, Elk Grove Village, IL, USA Introduction: PROVENT® Therapy (Ventus Medical Inc.) is a novel and effective nasal EPAP treatment for patients with OSA. It is well tolerated, easy to use and less cumbersome than traditional therapies. Methods: Eligible patients in this community based sample had OSA and were treatment naive, or they had tried and failed CPAP. A total of 123 patients were offered nasal EPAP. Polysomnography was recommended if patients intended to use nasal EPAP as a primary treatment, OSA severity was moderate to severe, or OSA severity was mild and accompanied by medical co-morbidities. Results: Of the 123 patients offered nasal EPAP, 64% were CPAP failures, 32% were treatment naive and 4% had tried therapies other than CPAP. There were no differences in age (51 yrs ± 10), gender (72% men) or BMI (32 ± 6) between the entire sample and those patients with PSG data. Follow-up is pending for 53 patients. In the analysis of the remaining 70 patients, 41 (59%) accepted therapy after an initial trial. Eleven are continuing with nasal EPAP therapy based on physician evaluation and subjective symptom relief. Polysomnographic data were available for 30 patients. Treatment success was defined as a reduction in AHI ≥ 50% or an AHI < 10. Twenty four patients (80%) were effectively treated. The median AHI was reduced from 17.1 to 4.9 (p < .0001). There was a trend toward lower mean Epworth scores [7.2 to 5.5 (p=0.07)]. Conclusion: Nasal EPAP is an effective and well tolerated initial treatment option for patients with mild to moderate OSA or for patients who cannot tolerate CPAP. Support (If Any): This study was supported in part by Ventus Medical Inc. 0423 NASAL EPAP THERAPY FOR SLEEP APNEA: ESTIMATION OF TREATMENT RESPONSE Schweitzer PK 1 , Colrain IM 2,3 , Rosenthal L 4 , Berry RB 5 , Rapoport DM 6 , Walsh JK 1,7 1 Sleep Medicine and Research Center, St Luke’s Hospital, Chesterfield, MO, USA, 2 Human Sleep Research Program, SRI International, Menlo Park, CA, USA, 3 Department of Psychology, The University of Melbourne, Parkville, VIC, Australia, 4 Sleep Medicine Associates of Texas, Dallas, TX, USA, 5 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA, 6 Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY, USA, 7 Department of Psychology, Saint Louis University, St. Louis, MO, USA Introduction: Studies of a novel EPAP device (PROVENT, Ventus Medical) have shown improved sleep disordered breathing in OSA patients overall but the number of patients with meaningful treatment response is unclear. The current analysis was undertaken to better estimate the proportion of patients meeting a standard definition of treatment response and to investigate predictors of response across five studies. Methods: Data from studies involving 199 subjects with AHI > 5 (AASM scoring) or > 10 (Chicago scoring) who had 1 baseline and 1-3 EPAP PSGs were evaluated. Treatment response was defined as a decrease in AHI ≥ 50% and AHI < 10 (AASM scoring) or < 20 (Chicago scoring). Results: EPAP decreased AHI (29.9 ± 24.9 to 16.9 ± 21.0), percent stage N1 (24.0 ± 16.4 to 21.6 ± 15.1), and arousal index (26.5 ± 24.3 to 19.3 ± 21.0; P < .007 for all). Forty-seven percent met treatment response criteria (Responders) and an additional 11% showed a decrease in AHI ≥ 50%. Mean AHI with EPAP was 4.7 ± 3.3 for Responders and 27.8 ± 24.0 for all others. At baseline, Responders had lower AHI (21.3 ± 12.4 vs 37.6 ± 30.3, P < .001) and BMI (31.7 ± 6.4 vs 33.6 ± 6.4, P = .03) and a trend for a higher REM/nonREM AHI ratio (4.1 ± 10.4 vs 2.2 ± 3.0, P = .07). Responders did not differ from other subjects in sex, age, neck size, Mallampati rating, CPAP pressure requirements, or baseline Epworth, FOSQ, or supine/non-supine AHI ratio. Regression analysis found that AHI was the only significant predictor of treatment response. Responders comprised 54% of subjects with mild, 68% with moderate, and 25% with severe OSA. Conclusion: EPAP produced a meaningful treatment response in 47% of OSA patients and decreased AHI at least 50% in an additional 11%. Lower baseline AHI was associated with a positive treatment response. 0424 RETROSPECTIVE CASE SERIES ANALYSIS OF A NASAL EXPIRATORY POSITIVE AIRWAY PRESSURE (EPAP) DEVICE TO TREAT OBSTRUCTIVE SLEEP APNEA IN A CLINICAL PRACTICE Adams G 1,2,3 1 Sleep, Pulmonary, Critical Care Medicine, Sleep Medicine Specialists, PLLC, Sarasota, FL, USA, 2 Medical Director, Sleep Disorders Center, Sarasota Memorial Hospital, Sarasota, FL, USA, 3 Clinical Assistant Professor, Florida State University Medical School, Sarasota, FL, USA Introduction: Continuous positive airway pressure (CPAP) is considered the gold standard treatment for patients with obstructive sleep apnea (OSA). However, other treatment alternatives for OSA are needed to provide increased compliance and additional choices for patients and prescribing physicians. Prior studies have reported that a nasal expiratory positive airway pressure (EPAP) device (PROVENT® Therapy, Ventus Medical, Inc) significantly reduced the apnea-hypopnea index (AHI) as well as improved oxygenation and subjective daytime sleepiness. This retrospective analysis was conducted to evaluate real-world patient acceptance and outcomes of this new therapeutic option in a clinical setting. Methods: Patients with a diagnosis of obstructive sleep apnea (AHI > 10/hour) were approached to try nasal EPAP. 97% of the patients were either CPAP failures or current CPAP users. Patients received 10 nights of sample devices for in-home acclimation evaluation. Patients that acclimated were asked to return for efficacy confirmation using standard in-lab polysomnography (PSG). During the PSGs, adjunctive therapy (e.g. chin straps, positional therapy) was used, when necessary, to achieve optimal efficacy. Patients with demonstrated efficacy were given a prescription for nasal EPAP. Results: At a single center, 151 patients sampled nasal EPAP and 131 are in the analysis group (16 patients pending follow up and 4 status unknown). Of the analysis group, 98 patients (75%) acclimated to the device. Effectiveness (AHI < 10) was achieved in 80.7% of all patients and 90.6% of mild/moderate OSA patients. AHI was reduced to < 5 in 56.3% of all patients (63.9% of mild/moderate OSA patients). The median AHI was reduced from 25.8 to 4.2 (p
B. Clinical Sleep Science I. Sleep Disorders – Breathing here our clinical sleep center experience using nasal EPAP (nEPAP) as a major therapeutic option.Treatment efficacy, predictors of response and acceptance are also assessed. Methods: Patients with OSA intolerant of CPAP were eligible for nE- PAP evaluation. They underwent a clinic orientation session, in-home acclimation assessment, and portable monitoring to evaluate effectiveness (nEPAP “post-test”). Treatment response was defined as ≥50% AHI4% improvement and AHI4%
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JOURNAL OF SLEEP AND SLEEP DISORDER
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EDITORIAL In June of 1986, roughly
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