SLEEP 2011 Abstract Supplement

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B. Clinical Sleep Science XV. Healthcare Services, Research and Education 0987 UNDERSTANDING SLEEP PATTERNS IN BRAZILIAN IMMIGRANTS IN LOWELL, MA: PERSPECTIVES FROM COMMUNITY HEALTH WORKERS AND HEALTHCARE CONSUMERS Phillips McEnany G 1 , Siqueira E 2 , Garibaldi E 3 , Foley L 1 1 Department of Nursing, University of Massachusetts Lowell, Lowell, MA, USA, 2 Department of Community Health & Sustainability, University of Massachusetts Lowell, Lowell, MA, USA, 3 Massachusetts Alliance of Portuguese Speakers, Lowell, MA, USA Introduction: The purpose of this study is to collect pilot data on the sleep and medical/psychiatric health of immigrants from the Brazilian community in Lowell, Massachusetts. Studies on Brazilian immigrants are rare in the United States. Factions of the immigrant community in Lowell are at great risk for medical comorbidity due to sleep dysregulation from a number of causes including the need for multiple jobs with irregular scheduling. Brazilian immigrants in the United States are especially at risk for physical and mental health issues due to loss of familiar surroundings and lack of social, financial and emotional support in the community where they live after immigration. Methods: The first objective is to seek information related to sleep, sleep dysregulation and medical/psychiatric health from consumers of healthcare from the Brazilian immigrant community. The second objective is to seek information from Brazilian community lay health workers (Promotoras) regarding their impressions of factors related to sleep dysregulation with members of the Brazilian immigrant community in Lowell. Both groups participated in focus groups. In addition, the immigrant healthcare consumers completed a Health Questionnaire, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Results: Data analysis is currently in progress. Initial results reveal that sleep dysregulation is common in the sample (n=28) and that the causes are multifaceted and complex. Conclusion: Brazilian immigrants may be at significant risk for comorbidities related to sleep dysregulation. This immigrant group is poorly studied in the United States and appears to be at great risk for health disparities related to sleep deprivation and dysregulation. Support (If Any): University of Massachusetts Lowell, School of Health & Environment 0988 FACTORS ASSOCIATED WITH REFERRALS FOR OSA EVALUATION AMONG COMMUNITY PHYSICIANS Murray Bachmann R 1 , Crew E 1 , Pierre Louis M 1 , Oulds F 1 , Zizi F 1 , Nunes J 1 , Ogedegbe G 4 , Jean-Louis G 1,2,3 1 Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA, 2 Sleep Disorders Center, Department of Medicine, SUNY Downstate, Brooklyn, NY, USA, 3 Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA, 4 Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, NY, USA Introduction: This study assessed knowledge and attitude towards Obstructive Sleep Apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation. Methods: RRespondents were 105 community physicians in SUNY Downstate Medical Center’s catchment area. Average age was 48±14 years, 68% was male, 70% black, 24% white, and 6% other. Specialties included: Internal Medicine 28%, Family Medicine 22%, Psychiatry 16%, Anesthesiology 12%, Pediatrics 8%, OB 7%, and other 7%; 90% provided care to black patients. Medical students/residents visited community-based primary-care clinics collecting data using the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire. OSA- KA is a self-administered questionnaire eliciting responses in two domains: knowledge of OSA epidemiology, pathophysiology, symptoms, diagnosis, and treatment (18 true/false statements) and attitudes (5 statements on importance of OSA and ability to identify/manage OSA patients using a 5-point Likert scale, from 1 strongly disagree to 5 strongly agree; sociodemographic data was collected. Results: OSA referral rate was 75%; 68% of patients inquired about OSA. Knowledge and attitude scores ranged from 5 to 18 (mean=14±2) and from 7 to 20 (mean=13±3), respectively. Greater OSA knowledge was associated with white race/ethnicity [rp=0.26, p
B. Clinical Sleep Science XV. Healthcare Services, Research and Education Support (If Any): This work was supported by National Institutes of Health grant HL007913. 0990 VALIDATION OF PROCEDURE AND DIAGNOSIS CODES FOR SLEEP APNEA IN THE NATIONAL VA DATABASE Canales M 1,2 , Wang X 3 , Jia H 3 , Berry RB 1,2 , Beyth RJ 1,2,3,4 1 Medicine, Malcom-Randall VAMC, Gainesville, FL, USA, 2 Medicine, University of Florida, Gainesville, FL, USA, 3 Rehabilitation Outcomes Research Center, Malcom-Randall VA, Gainesville, FL, USA, 4 Geriatric Research Education Clinical Center, Malcom-Randall VA, Gainesville, FL, USA Introduction: The National VA Outpatient Dataset (OPC) provides fertile ground for research in veterans but is limited to use of procedure and diagnosis codes. Sleep Apnea(SA) is of particular relevance to veterans, affecting nearly 1 in 5 US adults and, in particular, older men. We validated CPT and ICD-9 codes for SA diagnosis in the OPS as a stepping stone to SA-related health outcomes among veterans. Methods: We identified all individuals in the OPC FY2000-2003 who were part of the NF/SGVHS and had at least one CPT code for polysomnography(PSG). Of these, a random sample of 100 veterans was selected. We then determined which individuals had a subsequent ICD-9 for SA within a year of the ICD-9 code. Finally, we reviewed the VA computerized medical record (CPRS) to confirm PSG and diagnosis of SA by ICD-9 and clinic note. Results: Mean age was 56±11 y; 95% were male; 62% were white, 10% black. Average BMI was 36± 8. Of NF/SGVHS veterans with CPT for PSG in the OPC, 95% had CPT95811(PSG with CPAP titration); the remainder had CPT95806-10(varying levels of PSG). Of those with CPT for PSG in OPC, 99% had a subsequent diagnosis of SA by ICD- 9 within a year of original CPT; 49% had ICD-9 780.53(Hypersomnia with SA), 49% had ICD-9 780.57(Unspecified SA) and 780.53, and 1% had 780.57(SA NOS). CPRS review revealed sensitivity of 92%, specificity of 12.5% for this algorithm; PPV of this algorithm was 92%, NPV was 100%. Conclusion: An algorithm using CPT and subsequent ICD-9 coding from OPC is a sensitive method for identifying individuals with SA diagnosed by PSG. However, this algorithm may not identify individuals referred for PSG but without SA. Therefore, future studies utilizing codes in OPC may require selection of a control group from the general pool of veterans to capture individuals without disease. 0991 CHANGES IN HEALTH SERVICES UTILIZATION IN PATIENTS DIAGNOSED WITH OBSTRUCTIVE SLEEP APNEA AND TREATED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE IN A COUNTY HOSPITAL SETTING Mathew R 1 , Krishna V 1 , Thachuthara-George JK 2 , Majid R 1 1 Pulmonary, Critical Care and sleep medicine, University of Texas, Houston., Houston, TX, USA, 2 Internal Medicine, University of Texas, Houston, Houston, TX, USA Introduction: Obstructive sleep apnea (OSA) has been associated with an increase in co morbidities. Health care utilization (i.e. hospitalizations, emergence room visits and clinic visits) may be higher as a result. Whether there is a decrease in health care utilization after Continuous Positive Airway Pressure (CPAP) treatment is questionable. Methods: We performed a retrospective review of patients diagnosed with OSA (AHI >5) that were studied at our county hospital. Currently patients purchase their own CPAP machines (only 18% of patients actually obtain CPAP). We looked at healthcare utilization (as defined above) 1 year prior to and after the diagnosis of OSA and compared patients who obtained a CPAP machine to those who did not. Results: We compared 54 patients that had received CPAP with 120 patients that had not received treatment (controls). There was a pre- dominance of African Americans and Latin Americans in each group (70% in the CPAP group and 84% in the control group). The age (mean 49.2 years, SD +/-10.1, p=0.78), BMI (mean 40.9, SD +/-14, p=0.24) and AHI (mean 49.3, SD +/-25, p=0.83) were not statistically different between the two groups. The mean number of medical diagnoses was high in both groups (7 in the CPAP group and 6 in the controls). When comparing the average number of admissions prior to the diagnosis of OSA between the two groups, it was not statistically different (mean 0.32, p=0.31), as neither were the pre diagnosis clinic visits (mean 8.5, p=0.38) or emergency room visits (mean 0.5, p=0.12). At a 1 year follow up, these hospital encounters were again not statistically different between the two groups (mean hospital admissions 0.37 with p=0.21, mean clinic visits 8.8 with p=0.08, mean emergency room visits 0.45 with p=0.23). When we analyzed the CPAP group comparing hospital admissions prior to and after being diagnosed with OSA, there again was no statistical difference (p=0.85). Conclusion: We did not see any difference in health care utilization in patients that received CPAP. This may be a true effect (perhaps a longer follow up is needed to see a decrease in health care utilization). This may alternatively be a consequence of the population type we were studying i.e. lower socio economic groups with multiple existing co morbidities. The other variable that we were unable to determine was CPAP compliance, which may also be lower in this population. Further long term studies with compliance data are needed to clearly evaluate for any differences. 0992 IS CPAP ALWAYS THE ANSWER? A COST-EFFECTIVENESS ANALYSIS OF SURGICAL TREATMENT MODALITIES FOR OBSTRUCTIVE SLEEP APNEA Tan K 1 , Toh S 2 , Holty JC 3 1 Management Science and Engineering, Stanford University, Palo Alto, CA, USA, 2 Otolaryngology, Singapore General Hospital, Singapore, Singapore, 3 Pulmonary, Critical Care and Sleep, Palo Alto VA, Palo Alto, CA, USA Introduction: Obstructive sleep apnea (OSA) is a prevalent disorder associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of and ultimately reject CPAP. We explore whether surgical modalities developed for those intolerant of CPAP (i.e. uvulopalatopharyngoplasty (UPPP), multi-level surgery (MLS), maxillomandibular advancement (MMA)) are cost-effective. Methods: We construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease and motor vehicle collisions in those with untreated OSA. Using this model, we compare the cost effectiveness of (1) no treatment, (2) CPAP only and (3) CPAP followed by surgery (either UPPP, MLS or MMA) for those intolerant to CPAP. Results: CPAP therapy is cost-effective over no therapy at an incremental cost-effectiveness ratio (ICER) of $396 per quality-adjusted life year (QALY) for a 30-year old male with severe OSA. Compared with the CPAP only strategy, CPAP followed by surgery for those intolerant is cost effective with an ICER of $9,636/QALY to $29,079/QALY for the various surgical options (i.e. UPPP, MLS, MMA). The CPAP-UPPP strategy adds 0.28 QALYs for an increase of $2,726 (discounted 2010 dollars) over the CPAP only strategy for an ICER of $9,636/QALY. The CPAP-MMA strategy is most effective, and adds a further 0.70 QALYs for $11,211 (ICER: $16,084/QALY) more compared to CPAP-UPPP. The CPAP-MLS protocol is dominated by the CPAP-UPPP and CPAP- MMA protocols. In older OSA patients, surgery remains cost-effective (ICERs of $5,888/QALY for the CPAP-UPPP and $10,344/QALY for the CPAP-MMA protocols compared with CPAP alone). Conclusion: CPAP therapy for OSA is highly cost-effective. Amongst surgical options, UPPP and MMA are cost-effective in CPAP intolerant A339 SLEEP, Volume 34, Abstract Supplement, 2011
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