0786 Assessing the Adequacy of Auto Titrating Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea Diagnosed on Home Sleep Testing

Abstract

Abstract Introduction Auto titrating positive airway pressure (Auto-PAP) therapy has been increasingly prescribed to treat obstructive sleep apnea (OSA) without reliance on in-laboratory PAP titration studies. Given the current pandemic and the limited use of in laboratory titrations, Auto-PAPs have been prescribed increasingly. The ability to achieve optimal control of obstructive events with Auto-PAP for patients with severe OSA (respiratory disturbance index (RDI) >30/hour of recording) on home sleep apnea testing (HSAT) has not been systematically investigated. Our study looks at the success of treatment on Auto-PAP in patients diagnosed with severe OSA on HSAT. Methods We retrospectively reviewed charts of patients who were diagnosed with severe OSA on HSAT and were prescribed an Auto-PAP at the Memorial Hermann – Texas Medical Center Sleep Disorders Center between September 2019 and May 2020. The usage data, residual AHI and adherence was assessed. Successful treatment was determined as a residual AHI (rAHI) <15. We excluded patients those who were non-adherent to PAP therapy. This study was conducted as a quality improvement initiative at our institution. Results We identified 24 patients diagnosed with severe OSA on HSAT and prescribed Auto-PAP. Nine patients were excluded due to non-adherence to Auto-PAP (37%). Of the remaining 15 patients, 80% were male, the average age was 53.7 years (range 36-69) and the average RDI on HSAT was 51.4 events/hour (SD 17.1). The average usage >4 hours was 76% in the adherent patients. The median pressure on Auto-PAP was 9 cm H2O (range 5.3-16.3). The average rAHI of 1.8 events/hour (range 0.3- 6.1). Usage data revealed only 1 patient with rAHI>5 and central apnea index of 3.9, who was then referred for an in-lab PAP titration study. Conclusion Sensors in the airway circuit of PAP devices measure airflow, vibration, and flattening of the airflow profile. Auto-adjusting PAP devices use this feedback to make online adjustments in pressure to maintain upper airway patency. Our study suggests that Auto-PAP is an effective initial therapy even for severe OSA, permitting both timely and adequate control of OSA especially when in laboratory titrations are limited. Close monitoring is however recommended to ensure adherence, and also to assess the potential emergence of central events. Support (If Any)