0551 BILEVEL PAP EXPERIENCE IN A COMMUNITY SLEEP CENTER

Abstract

Bilevel titration in OSA is used for patients with CPAP intolerance, or for incomplete correction with maximal CPAP pressure. We present our one year experience with BiLevel use in a community sleep lab. Retrospective data evaluation of all Bilevel patients. Patients undergoing re-titration were excluded from the study. Variables measured included demographics, comorbidities, baseline RDI and titration RDI, use of supplemental oxygen, type of device and interface, presence of leaks, patient’s subjective sensation of sleepiness (ESS), average REM percentage, and time spent under 90% and 88% of oxygen saturation. Patients were subdivided into four subgroups based on lowest achieved RDI: Excellent with RDI < 5, Good RDI < 10, Fair RDI < 15, and Poor with RDI > 15. Of the 133 patients who underwent Bilevel titration, 73 (55%) had excellent RDI, 25 (19%) good RDI, 14 (10%) fair RDI, and 21 (16%) had a poor RDI. In comparison to the excellent RDI group, patients in the poor RDI group had higher overall post RDI and ESS, arousal index, oral leaks, treatment emergent events and central apnea index. They had lower sleep efficiency and spent more time under O2 saturation of 88% (24% vs 17%). Although they had a higher percentage of patients with no leaks, they still had an overall higher percentage of oral leaks. No difference was noted with device type or interface used. 1. 16% of patients did not achieve effective pressure on the first night of titration. 2. As a group they had lower sleep efficiency, higher arousal index, and spent increased time under 88% oxygen saturation. 3 . Oral leaks may have played a role. 4. Would analyse if ineffective EPAP played any role. None.