CPAP Devices Research Articles

Obstructive sleep apnea and acute decompensated heart failure

Abstract Funding Acknowledgements None. Background Acute decompensated heart failure is a condition with a high frequency of hospitalizations and mortality. Screening and treatment for obstructive sleep apnea can be helpful in these patients. Purpose To determine the frequency of obstructive sleep apnea in patients with acute decompensated heart failure. To add CPAP home therapy to standard medical treatment for heart failure. To follow patients for 1 year. Methods We conducted a single-centre, prospective cohort study form 150 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. 81 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) > 5, Epworth Sleepiness Scale (ESS) > 8, NYHA class II/III and NTproBNP>900 pg/ml. Patients with OSA were offered to purchase a CPAP device for the home. They were divided into two groups with CPAP and no-CPAP. All patients receiving optimal medical treatment. The follow-up period was 1 year. At the end of the period, patients underwent a physical examination, an echocardiography, and ESS. In the non-CPAP group, 29 patients were followed up and 13 patients dropped out due to mortality. In the CPAP group, 16 patients were followed up, with 1 dropped out. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio. Results From 81 with sleep apnea 72.8% (n=59) has obstructive sleep apnea (OSA) and 27.2% (n=22) has central sleep apnea (CSA). Of the 59 patients with OSA, 17 patients (28.8%) purchased a device and continued therapy at home, while 42 patients (71.2%)on optimal drug therapy without CPAP. There is a statistically significant difference in BMI in the group with CPAP compared to the no-CPAP group at the beginning and at the end of the follow-up (CPAP group at the start 36.47±7.3 vs. the end 33.3±5.7, p=0.001 and no-CPAP group at the start 36.35±7.34 vs. the end 35.74±7.46 , p=0.356). A similar relationship is found in systolic blood pressure(SBP) and diastolic blood pressure(DBP). SBP in CPAP group at start 136.2±6.2 mmHg vs. end 123.1±5.9 mmHg; р<0.001. relative to no-CPAP group – start 131.2±9.8 mmHg vs. end 131.3±7.7 mmHg; р=0.965. DBP in CPAP group at start 85.9±6.7 mmHg vs. end 77.3±5.3 mmHg; р<0.001 and no-CPAP group start 82.1±7.4 mmHg vs. end 81.7±5.7 mmHg, р=0.644. There is a significant change in LVEF between the two groups at the beginning and at the end of the follow-up (in CPAP group at start 47.5±8.7, vs. at end 50.07±7.5; р=0.005, between no-CPAP at start 52.5±6.9 vs. at end 52.2±7.1; р=0.389). The CPAP group had a median survival of 11.7 months vs. 10.1 months in no CPAP group(Log Rank (Mental-Cox) p=0.044 ). Conclusion Obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improved BMI, SBP, DBP and increases LVEF. All this improves the prognosis for these patients.

Impacto de la telemonitorización como sistema para una adecuada titulación y adaptación de la CPAP domiciliaria en la apnea obstructiva del sueño (proyecto T-CPAP)

IntroductionContinuous Positive Airway Pressure (CPAP) constitutes the most effective treatment for Obstructive Sleep Apnea (OSA). Automatic titration systems (ATS) are predominantly used to achieve adaptation to the equipment. Home CPAP devices allow telemonitoring (TM) of the same parameters as those provided by ATS but with access to continuous usage data. Under this premise, we conducted a study on the potential validity of TM for home CPAP devices as a titration system, its direct impact on proper adaptation (AD) to the equipment, and secondarily on the healthcare resources employed to achieve it. Material and methodsAn observational study involving 318 patients with OSA who were titrated using TM to achieve AD to CPAP. Patients with OSA were consecutively recruited and evaluated at 1, 3, and 6 months after initiating treatment. Results were compared with a historical group of 307 patients with OSA who achieved AD to CPAP using ATS. Additionally, we assessed the impact on required healthcare resources. ResultsPatients with OSA who initiated CPAP treatment with TM over the first six months showed a similar AD rate compared to the historical group titrated using ATS, with lower resource usage in the TM group. ConclusionData provided by TM of home CPAP devices allow for titration and achieving similar AD as with ATS in non-complex patients.

A Novel CPAP Device With an Integrated Oxygen Concentrator for Low Resource Countries: In Vitro Validation and Usability Test in Field.

Goal: To develop and validatea novel neonatal non-invasive respiratory support device prototype designed to operate in low-resource settings. Methods: The device integrates a blower-based ventilator and a portable oxygen concentrator. A novel control algorithm was designed to achieve the desired fraction of inspired oxygen (FiO2) while minimizing power consumption. The accuracy of the delivered FiO2 and the device power consumption were evaluated in vitro, and a formative usability test was conducted in a rural hospital in Uganda. Results: The agreement between the set and delivered FiO2 was high (limit of agreement:-5.6 ÷ 3.8%). For FiO2 below 60%, the control algorithm reduced the power drain by 50%. The device was also appreciated by intended users. Conclusion: The prototype proved effective in delivering oxygen-enriched continuous positive airway pressure in the absence of compressed air and oxygen, holding promise for a sustainable and effective implementation of neonatal respiratory support in low-resource settings.

Ab. No. 125 Effect of Repetitive Transcranial Magnetic Stimulation Along With Conventional Physiotherapy Treatment on Sleep Parameters Using Polysomnography: A Sleep Study in Individuals With Sleep Apnea: A Single Case Study

Introduction: The purpose is to find the effectiveness of rTMS along with conventional physiotherapy on polysomnography (PSG)-sleep analysis in individuals with sleep apnea. The study attempts to widen the horizons of the physiotherapy profession in the field of sleep apnea. The improved quality of sleep may improve various domains of the quality of life of affected individuals. Methods: Study design is a case report of an individual with sleep apnea. A 45-year-old male has been diagnosed with sleep apnea for 4 years and has been using a CPAP device for the last 5 months. The patient had excessive daytime sleepiness, loud snoring, and difficulty wearing a CPAP mask at night. The physical examination showed obesity (BMI – 25.5 kg/m2), an inappropriate breathing pattern (more mouth breathing instead of nasal breathing), and tightness of accessory respiratory muscles (scalene, trapezius, pectoral, and sternocleidomastoid) on palpation. Then the patient was intervened with rTMS along with conventional physiotherapy for 5 sessions a week for the duration of 3 weeks. Pre- and post-objective assessment were done using polysomnography and subjective assessment were done using Pittsburgh Sleep Quality Index (PSQI). Results: Significant reduction in apnea-hypopnea index (AHI) was observed after the intervention. Sleep disturbance also decreased during the night and PSQI score also decreased from 8 to 6. Conclusion: The study concluded that rTMS, along with conventional physiotherapy, was found to be an effective treatment and can be used for management of sleep apnea.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2022.

To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. Publicly available FDA data on drugs and devices approved in 2022. A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.

The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example

IntroductionContinuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain. Material and methodsA time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1–3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway. ResultsCompared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3h/night and the proportion of individuals defined as adherent increased from 79% to 91%. ConclusionsImplementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes.

Feasibility of neck electrical impedance tomography to monitor upper airway dynamics during sleep

BackgroundThere is a lack of non-invasive methods for monitoring the upper airway patency during sleep. Electrical impedance tomography (EIT) is a non-invasive, radiation-free tool that has been validated to monitor lung ventilation. We hypothesized that electrical impedance tomography (EIT) can be used for monitoring upper airway patency during sleep.MethodsSleep was induced in 21 subjects (14 males, age 43 ± 13 years, body mass index 32.0 ± 5.3 kg/m2) with suspected obstructive sleep apnea (apnea-hypopnea index: 44 ± 37 events/h, range: 1–122 events/h) using low doses of midazolam. Patients wore a nasal mask attached to a modified CPAP device, allowing variable and controlled degrees of upper airway obstruction. Confirmation of upper airway patency was obtained with direct visualization of the upper airway using nasofibroscopy (n = 6). The changes in total neck impedance and in impedance in four cranio-caudal regions of interest (ROIs) were analyzed.ResultsTotal neck impedance varied in concert with breathing cycles and peaked during expiration in all patients. Group data showed a high cross-correlation between flow and impedance curves (r = −0.817, p < 0.001). Inspiratory peak flow correlated with simultaneous neck impedance (r = 0.866, p < 0.001). There was a high correlation between total neck impedance and velopharynx area (r = 0.884, p < 0.001), and total neck impedance and oropharynx area (r = 0.891, p < 0.001).ConclusionsNeck EIT is sensitive and captures pharyngeal obstruction under various conditions. Neck EIT is a promising method for real-time monitoring of the pharynx during sleep.

Descriptive account of the first use of the LeVe CPAP System, a new frugal CPAP System, in adult patients with COVID-19 Pneumonitis in Uganda

BackgroundContinuous positive airway pressure (CPAP) has been a key treatment modality for Coronavirus Disease 2019 (COVID-19) worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP System was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. Prior to formal trial approval, received in November 2021, these devices were used in extremis to support critically unwell adult patients requiring non-invasive ventilatory support.MethodsThis is a retrospective descriptive review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Uganda. Patients were treated with the LeVe CPAP System, Elisa CPAP and/or AIRVO™ HFNO. Treatment was escalated per standard local protocols for respiratory failure, and CPAP was the maximum respiratory support available. Data were collected on patient characteristics, length of time of treatment, clinical outcome, and any adverse events.ResultsOverall 333 patients were identified as COVID-19 positive, 44 received CPAP ± HFNO of which 43 were included in the study. The median age was 58 years (range 28–91 years) and 58% were female. The median duration of advanced respiratory support was 7 days (range 1–18 days). Overall (all device) mortality was 49% and this was similar between those started on the LeVe CPAP System and those started non-LeVe CPAP System devices (50% vs 47%).ConclusionsThe LeVe CPAP system was the most used CPAP device during the pandemic, bringing the hospital’s number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well-tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP System; therefore, formal comparative studies are required to inform further use.

Practice of continuous positive airway pressure application in Neonatal Intensive Care Unit. Cross sectional study

BackgroundContinuous positive airway pressure (CPAP) is a simple, inexpensive, and gentle mode of respiratory support for neonates.This is beneficial for spontaneously breathing neonates by maintaining functional residual capacity in the alveoli to prevent atelectasis and improve oxygen exchange. The aim of this study was to assess the practice of continuous positive airway pressure application in neonatal intensive care. MethodsA hospital based prospective observational descriptive study was conducted on 60 neonates from March 15, 2022 to July 30, 2022 at NICU Unit at XXX Comprehensive Specialized Hospital, July 2022, North-west Ethiopia.Descriptive statistical analysis with SPSS version 25 was used. ResultsThe overall practice of CPAP use were (73.4%), with assessment of parameters such as initial nursing care before initiation of CPAP (82.2%), Setting up of CPAP (94.1%), preparing the Baby for CPAP (65.3%), Connecting the nasal prong system to the neonate (50%), Methods of Securing CPAP device (96.7%), Performing safety check for Troubleshooting in CPAP (78.3%) and Monitor of CPAP and On-going assessments (46.6%). ConclusionThe practice of CPAP application was good at Initial nursing care before initiation of CPAP, Setting up of CPAP, and Methods of Securing CPAP device. However, there was poor practice in connecting the nasal prong system to the neonate, preparing the Baby for CPAP, performing safety checks for troubleshooting in CPAP, Monitoring of CPAP and On-going assessments.

Features of Cheyne-Stokes respiration automatically extracted from CPAP airflow signal raw data: Identification of discriminating features to detect heart failure

BackgroundContinuous positive airway pressure (CPAP) telemonitoring data is collected daily from millions of sleep apnea patients. This huge amount of data can be used for the early detection of treatment failures and could reveal incident acute or chronic cardiovascular events. However, the available automatically computed metrics do not fully characterize sleep-disordered breathing. ObjectiveTo find methods to process metrics characterizing Cheyne-Stokes respiration (CSR) that are able to discriminate between CSR related to heart failure (HF) and CSR related to other underlying conditions. MethodsThe raw airflow signals recorded by CPAP devices were analysed. Change point detection methods were used to isolate each respiratory cycle and CSR cycle. Simple algorithms were implemented to extract key features from the signal. Binary logistic regression was performed to identify the characteristics of the CSR airflow signal that is associated with the presence of underlying HF. ResultsLonger CSR cycles, a longer CSR episode, a greater variation in the amplitude of inspiration, a smaller increase in big breaths, a lower inter-cycle variability and a shorter breath duration were features associated with the occurrence of CSR in the context of HF. ConclusionThe proposed automated computation of CSR characteristics presents a novel tool to include in the CPAP software or remote monitoring platforms for monitoring patients’ treatment and comorbidities; and a step towards cross-disciplinary patient management.

Early Diagnosis of Respiratory Disease in Light of COVID-19 Infection and Use of Oxygen Concentrators and CPAP Devices for the Treatment of Respiratory Failure

The need for early diagnosis of respiratory diseases, especially in the context of the COVID-19 coronavirus infection pandemic, by means of pulse oximetry screening and monitoring has been substantiated. The expediency of using portable pulse oximeters by therapists and general practitioners is shown. The main respiratory diseases accompanied by respiratory failure, which can be promptly detected by pulse oximetry, are chronic obstructive pulmonary disease and obstructive sleep apnea-hypopnea syndrome. Early detection of these diseases is an urgent task due to the low severity of symptoms of these diseases in the early stages and, as a consequence, the prevalence of late diagnosis. Pulse oximetry to detect coronavirus infection COVID-19 deserves special attention, since this infection is also accompanied by respiratory failure. The use of oxygen concentrators and CPAP devices for the treatment of respiratory failure has been argued. The effectiveness of the appointment of long-term oxygen therapy using oxygen concentrators in patients with chronic obstructive pulmonary disease, CPAP therapy using automatic CPAP devices in patients with obstructive sleep apnea-hypopnea syndrome with mandatory pulse oximetry monitoring has been confirmed. A retrospective analysis of 120 cases of treatment of moderate and severe COVID-19 infection complicated by the development of pneumonia was carried out. The efficiency of using oxygen concentrators to supply patients with oxygen at a flow rate of up to 5 l / min has been proven. It was found that no more than 10% of patients needed an oxygen flow at a rate of more than 5 l/min. At the same time, the possibility of using CPAP devices for non-invasive ventilation of the lungs using full-face masks has been shown. The expediency of using oxygen concentrators and CPAP devices for the rehabilitation of patients who have undergone COVID-19 was noted.

0491 Use of Neuromuscular Stimulation device of Tongue to treat Mild obstructive sleep apnea in Veteran population

Abstract Introduction Approximately 30 million adults in United States suffer from obstructive sleep apnea (OSA), with much higher prevalence in veterans. However, the treatment options of sleep apnea are currently limited due to CPAP device shortage, hence, unravelling a significant gap for alternative user-friendly therapeutic options. Neuromuscular stimulation device of the tongue is a novel FDA approved therapy becoming more relevant with the ongoing CPAP device shortage. Methods Neuromuscular stimulation device of tongue procured through regulatory process at VA Minneapolis, is offered to veterans with Mild OSA( AHI 5-15) on home sleep apnea testing.Baseline and post therapy data including patient's snoring, Epworth sleepiness score(ESS),Apnea - Hypopnea Index(AHI) was collected. Post therapy data was collected after initial 6 weeks of at least 20-minute daily followed by maintenance of 2 weeks of twice weekly use. Results A total of 112 patients with Mild OSA were offered the device as an alternative option of treatment during the period of December 2021 to August 2022. Of these, 39 patients completed therapy with mean age of 54.5 years (age ranging from 28y-80y), 36 were males and 3 were females. Among a total of 31 patients who completed their ESS pre and post questionnaire, and 22 patients who had pre and post AHI available, a paired t-test was obtained. In the 31 patients with pre and post ESS, the results of paired t- test showed a mean difference in ESS score of 1.90 with 95% CI (0.55 -3.25) with statistically significant P value of 0.0073. In the 22 patients with pre and post AHI, results of paired t -test showed Mean difference in AHI score of 2.54 with 95% CI (0.24-4.84) with statistically significant P value of 0.0316. Conclusion Findings suggest that the alternative treatment to CPAP provided to patients did result in improvement of Mild OSA both in subjective sleepiness symptoms and objective degree of residual apnea, and hence can be used as a feasible alternative therapy. However, the study is limited by small size (112) with a relatively low response rate from the participants (39), and availability of matched data (ESS -31, AHI -22). Therefore, larger studies are warranted. Support (if any)

Impact of a Nursing Intervention Bundle of Care on Nasal-CPAP-Related Nasal Injuries in Preterm Infants: A Quality Improvement Initiative

AIM: The objective is to assess the effect of the application of a nasal injury prevention bundle on the incidence and severity of nasal-continuous positive airway pressure (nCPAP)-related nasal injuries in preterm infants. METHODS: We conducted a prospective controlled before-after study in a preterm neonate, <37 weeks gestation, who required nCPAP in the neonatal intensive care unit, at Mansoura University Children’s Hospital, between September 2018 through October 2019. After 2 months of nursing staff training, a nasal trauma prevention bundle was implemented. The nursing intervention bundle comprised nasal barrier dressing, regular focused checking for evolving nasal skin injury, and proper application of the CPAP device. nCPAP-related nasal injuries per 1000 days and grading of nasal injury severity were the primary outcomes. Time to onset of nasal injury after initiation of CPAP; duration of nCPAP use, duration of oxygen dependency; incidence of pneumothorax, broncho-pulmonary dysplasia; intraventricular hemorrhage; periventricular leukomalacia; late-onset sepsis; length of hospital stay; and in-hospital mortality were the secondary outcomes. RESULTS: Data from 62 preterm neonates were analyzed (31 in each group). The nasal trauma prevention bundle of care was associated with reduced nasal injury incidence per 1000 nCPAP-days (140 vs. 148.94, p = 0.03) with improved nasal injury severity staging (p = 0.003) compared to the pre-bundle era. Nasal injury developed earlier in the control group (1 [1–1] vs. 2 [1–3] days, p = 0.002) compared to the intervention group. No statistically significant differences were reported between groups regarding any of the other secondary outcomes. Longer duration of CPAP use (p = 0.009) and lack of bundle application (0.03) were the independent risk factors associated with nCPAP-related nasal injuries in preterm neonates. CONCLUSION: The implementation of a bundle of nursing interventions is associated with a substantially improved incidence and severity of nasal injuries in preterm infants receiving nCPAP.

Safety And Efficacy Evaluation Of The Oxyjet Cpap Device Compared To High-flow Nasal Oxygen For Treating Hypoxemic Covid-19 Patients In General Hospital Wards: A Randomized Controlled Trial

Background: During the COVID-19 pandemic, general wards generally were capable of providing up to 15L/ min of oxygen. Shortage of Intensive Care Unit (ICU) beds, High-Flow Nasal Oxygen (HFNO), and other intermediary devices have caused many premature deaths during the pandemic. During this period, we have developed OxyJet CPAP, a locally-made 3D printed continuous positive airway pressure (CPAP) device that can provide up to 60 liters/min of oxygen without electric power. This study assessed whether the OxyJet CPAP could be a non-inferior alternative to an HFNO device in COVID-19 wards. Methods: We performed an open-label, parallel-assignment, randomized controlled trial in 45 patients admitted to the general COVID- 19/suspected wards of Dhaka Medical College Hospital (DMCH), Bangladesh, between April 17, 2021, and July 9, 2021. Eligible patients were confirmed/suspected COVID-19 aged between 18—65 with oxygen saturation (SpO2) between 85—90% while being treated with a non-rebreather mask at 15L/min of 100% oxygen. We used a computerized pseudorandom sequence generator for randomization. The sample size was calculated based on a non-inferiority margin of 1.5 days. Analysis was intention-to-treat. Results: The primary outcome of the trial was ventilator-free days (VFDs) within a 10-day period assessed after study completion. A total of 180 patients were screened, and 45 eligible patients were enrolled. We randomly assigned 23 (51.11%) patients to receive CPAP and 22 (48.89%) patients to receive HFNO. For the CPAP and HFNO arms, the mean value of the primary outcome was found to be 7.41 (STD 3.68) and 6.6 (STD 3.69) days, respectively. The mean difference in the primary outcome was 0.81 (95% CI -1.41—3.03), with the lower bound above the non-inferiority margin, thus, establishing the non-inferiority hypothesis (p = 0.021). Adverse events (AE) were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE) scale (1—5). In the CPAP and HFNO arms, the mean CTCAE scale was found to be 1.39 (STD 0.499) and 1.59 (STD 0.503), respectively, showing no significant difference (p = 0.189). In Post Hoc analysis, we found that, on average, the OxyJet CPAP requires significantly less oxygen per patient compared to HFNO with a median difference of -16.11 L/min (95% CI -24.63—-6.67, p=0.001). Conclusion: The results show that the OxyJet CPAP treatment was non-inferior compared to the HFNO treatment. In the context of many hospitals in Bangladesh, especially in rural areas, using the locally made OxyJet CPAP could provide significant benefits due to its lower cost and usability. This device can be used as an effective bridging therapy reducing ICU admissions in the general ward settings or preserving life while awaiting resource availability. In addition, the device can also be used in emergencies and ambulances. The Directorate General of Drug Administration (DGDA) has provided limited approval of the device for hospital use. Currently, we are using the device in different hospitals for hypoxemic patients. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 206-207

Treatment of obstructive sleep apnea with a simple CPAP device

PurposeCPAP is the “gold standard” treatment for obstructive sleep apnea (OSA). Current CPAP models have developed additional functions including automatic CPAP and pressure relief. However, CPAP adherence has not improved over the last three decades. Many patients in low-income countries cannot afford these CPAP devices. A novel simple CPAP device with a fixed pressure without pressure controller was developed.MethodsManual CPAP pressure titration was performed in 127 patients with OSA. Six patients with a titration pressure higher than 11 cmH2O and 14 patients who could not tolerate CPAP were excluded, leaving 107 participating in the following 2 studies. In study one, 54 of 107 patients were treated by both conventional fixed CPAP and simple CPAP in random order. In the second study, another 53 patients were treated by both autoCPAP in automatic function and simple CPAP in random order. Simple CPAP was fixed at 10 cmH2O, 8 cmH2O, and 6 cmH2O for patients whose titration pressure was between 9–10, 7–8, and ≤ 6 cmH2O, respectively. Conventional fixed CPAP device was set exactly the same as manual titration pressure.ResultsAll patients whose manual titration pressure ≤ 10 cmH2O were effectively treated by simple CPAP (AHI 40.7 ± 2.3 events/h before vs 2.5 ± 0.3 events/h after, p < 0.001). Patients expressed similar preferences for simple CPAP, autoCPAP, and conventional fixed CPAP (p > 0.05).ConclusionsWe conclude that a novel simple CPAP is an alternative treatment for most patients with OSA, which may widen access to CPAP therapy in the developing countries because of its low cost.

0656 Evaluating the Interrelationship Between Insomnia, Sleep Apnea and Nightmares in Veterans With Posttraumatic Stress Disorder

Abstract Introduction Observational research demonstrates a strong association between nightmares, insomnia, and sleep apnea in veterans with posttraumatic stress disorder (PTSD), supportive of the notion of a “complex sleep disturbance”. Relations between sleep disturbances and PTSD are often bi-directional and disturbed sleep affects non-sleep PTSD outcomes. We aimed to examine relationships between nightmares, respiratory events, CPAP use, and insomnia in trauma-exposed veterans with frequent nightmares. Methods Three weeks of app-based daily sleep diaries and weekly insomnia severity index (ISI) reports were collected from 41 veterans with a history of trauma and frequent nightmares. Relationships between weekly nightmares (total number), CPAP use, sleep efficiency, and ISI scores were analyzed using linear regression with standard errors adjusted for clustering of weeks within participants. Of the 41 participants, a subset of 15 participants completed 6-9 nights of at-home objective sleep measurements (Sleep Profiler) to examine the relationship between apnea events and nightmare awakenings. Measurements involved EEG integrated with airflow, respiratory effort, oxygen saturation, and actigraphy with event marker for real-time reporting of nightmares preceding awakenings. Results 41 veterans (mean age 48 (SD=16), 30% female) participated. Higher prior week ISI score predicted reduced CPAP adherence (β=-.53, p=.005). In turn, increased frequency and duration of CPAP use was associated with a significant increase in sleep efficiency the same week (β=.53, p=.018 and β=.56, p=.026, respectively). Analysis of respiratory events indicates that 20 of the 64 nightmare awakenings (31%) were preceded (i.e., within seconds of awakening) by apnea or hypopnea events. Of these 20, 11 events were reported by participants with a diagnosis of OSA and a CPAP device. Amongst these 11 events, 7 (64%) occurred on nights during which the participant reported use of their CPAP. Conclusion Analyses demonstrated statistically significant and clinically meaningful relationships among insomnia, nightmares, respiratory events and CPAP adherence in our sample, highlighting their interrelationships in trauma subjects. These data support the hypothesis that OSA contributes to nightmare experiences by demonstrating an immediate temporal relationship between apnea/hypopnea events and nightmare awakenings, and they underscore the importance of detecting and adequately treating sleep apnea for the treatment of nightmares in veterans. Support (if any)

Air Sense Autoset for Her and Him

Introduction: Several studies have shown that Obstructive Sleep Apnoea (OSA) results in gender specific or gender typical symptoms. The algorithms of automated CPAP devices (APAP) up to now focus on the therapy of typical male OSA symptoms. The “Air Sense 10 Autoset for Her” device was developed to provide a therapy with the focus on the treatment of typical female OSA symptoms. In this study the efficiency of the “Air Sense 10 Autoset for Her” Algorithm (AfH) in treatment of female as well as of male OSA symptoms was investigated in comparison to the standard APAP mode (ASstd). Methods: In 40 women and 40 men a prospective randomized intraindividual cross-over trial was done where each OSA patient was half night treated with AfH algorithm and half night with ASstd algorithm. The flattening degree of each breath was calculated by deviding the relative inspiratory tidal volume by the relation of inspiration to expiration time (OC = Obstructive Coefficient© SOMNOmedics, Randersacker, Germany) in order to have analyzed all breaths of a whole night time recording because better treatment of inspiratory flattening is a major target of the AfH algorithm. The OC values under AfH/ASstd therapy were compared for each sleep stage separately for women and for men. Results: In women the AfH algorithm provided better flattening treatment during N2 sleep (p&lt;0.01, 104.115 breaths) and REM sleep (p&lt;0.01, 32.348 breaths) while the ASstd algorithm was superior during N3 sleep (p&lt;0.01, 57.286 breaths). No difference between the algorithms was observed during N1 sleep (15.803 breaths). In men the AfH algorithm was superior to the ASstd algorithm during each sleep stage (N1, N2, N3, REM, p&lt;0.01, 211.440 breaths). When looking only at the number of breaths treated, independent from the sleep stage, in women AfH was superior to ASstd in 43.8% of the breaths, ASstd superior to AfH in 32.8% of the breaths and no algorithm preference was observed in 23.5% of the breaths. In men 52.7% of the breaths were better treated by AfH, 29.2% by ASstd, and in 18.1% no algorithm preference was observed. Discussion: The AfH algorithm that has been especially developed for OSA treatment in women is only during N2- and REM-sleep more efficient in flattening treatment than the ASstd algorithm. The faster and more sensitive reaction to detected flow limitations did not provide better treatment in all sleep stages in women, but in the OSA treatment of men instead. The treatment of respiratory events was completely independent from this result and was similar effective in women as in men with no difference between the two APAP algorithms.

The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed.

Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA. This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA. We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback. During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal ("Goal: 100%"). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning. We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted.

94. Home CPAP device use in patients with facial fractures, is it safe?

94. Home CPAP device use in patients with facial fractures, is it safe?

P036 Rapid oscillatory ventilation seen during positive airway pressure titration studies: A case series

Abstract We have observed a phenomenon in some patients undergoing positive airway pressure implement/titration studies in our sleep lab, characterised by periods of extremely high respiratory rates of up to 80 breaths/min which appear to be device triggered. These episodes occur during periods of central apnoea and last up to 1.5-2.0 minutes. A possible related phenomenon has been reported in a case series of 4 patients published in the Journal of Clinical Sleep Medicine in 2018 (Gupta et al), however this was using a different CPAP device and respiratory rates were significantly lower than what we have observed. Apart from this, there are no reports in the literature that are consistent with the observations we have made in our lab. Correspondence from the device vendor have suggested that the episodes are due to a rare state in the motor control system which maintains correct pressure in the mask circuit and may have been influenced by our lab not using the vendor’s proprietary heated tubing system. In addition, the incidence rate of this is said to be extremely low at 0.00087%, although our lab has already observed at least 5 cases of this in the 6 months from August 2021 to February 2022. Our objective is to present a case series to inform the broader sleep community of our unique observations.