0868 Patients with PTSD and OSA Treated with APAP: Evaluating Compliance Based on Mask Type in the New Mexico VA Population: Quality Improvement Project to Help in Ordering DME Mask Supplies

Abstract

Approximately 40-50% of patients with PTSD also have OSA. Overall, this population is less compliant with PAP therapy. This is likely multifactorial related to hypervigilance, claustrophobia, nightmares, patient therapy perception, and healthcare response to patients with PTSD. Patients with worse nightmares have poorer PAP compliance. Additionally, REM-rebound can be seen in patient’s initially starting therapy leading to perceived heightened nightmares with PAP use. With better compliance, over time, a decrease in nightmare frequency is associated with better PAP compliance. In the first week of wearing PAP, patients with claustrophobia had a fivefold increase in the odds of using PAP therapy less than 4 hours/night. Current literature supports a bidirectional relationship between PTSD and OSA, such that PTSD is an obstacle in OSA treatment whereas, untreated OSA can be an obstacle in treating PTSD successfully. It was hypothesized that patients using APAP with PTSD would have better compliance with masks that did not obscure the patient’s peripheral vision. The primary evaluation assessed OSA with PTSD, APAP compliance, and mask type. In October 2018 appointments, veterans diagnosed with OSA, concurrent PTSD, and APAP treatment were reviewed on mask selection and compliance of greater than 4 hours of usage for 70% of the time. Mask usage determined by prosthetic inventory. Masks not interfering with patient’s peripheral vision did not elevate around the patient’s nose. Of 34 patients, 17 met this criteria. Less restrictive masks were not associated with improved compliance. Results showed higher compliance to severer OSA regardless of mask usage. My hypothesis was not supported. Multiple identifiable study limitations were present including male veterans only, sleep technologist’s mask preference, and patients’ length of time with APAP usage prior to visit. This short timeframe analysis and only patients seen with an identifiable PAP problem, created a selection bias. An additional study could include a longer time frame, patient’s BMI, the severity of PTSD, and APAP settings. Support (If Any)