PAP Compliance Research Articles

Effect of melatonin on insomnia and daytime sleepiness, in patients with obstructive sleep apnea and insomnia (COMISA): A randomized double-blinded placebo-controlled trial

BackgroundCOMISA is a common disorder that results in nighttime awakenings ,daytime sleepiness and PAP intolerance. Cognitive behavioral therapy for insomnia is used to improve PAP adherence and no medication has been evaluated in such population yet. Melatonin with its chronobiotic and antioxidant effects may have potential benefits on COMISA consequences at the appropriate dose and time. This study aimed to evaluate the effect of melatonin on sleep quality, daytime sleepiness and PAP Compliance in patients with COMISA.MethodsThis double-blind placebo trial randomly assigned eligible OSA patients who suffered from insomnia despite using PAP for over a month to receive either melatonin 10 mg or placebo. The primary outcomes were measured by changes in the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ-10) over one month. Adherence to PAP was measured by the results of the PAP device reports on the average length of time and number of nights that the device was used.ResultsThirty patients were enrolled in the study after randomization. The melatonin arm showed significant improvement in all four primary outcomes compared to the placebo arm. The PSQI score was 3.836±1.839 in the melatonin arm versus 10.522±3.626 in the placebo arm (Pvalue<0.001). The ISI score was 8.476±3.568 in the melatonin arm versus 14.47±4.50 in the placebo arm (Pvalue<0.001). The ESS score was 6.854±4.334 in the melatonin arm versus 13.298±5.119 in the placebo arm (Pvalue<0.001). The FOSQ-10 score was 24.93±5.02 in the melatonin arm versus 19.87±4.24 in the placebo arm (Pvalue= 0.006). Additionally, nighttime consequences such as sleep latency and awakenings showed significant improvement in the melatonin arm. PAP devices results revealed improvement in duration of PAP use overnight. ConclusionsAdministering melatonin has been shown to improve self-reported sleep quality and PAP adherence in patients with COMISA.Trial registrationRegistration number IRCT20220105053635N1 was issued by the Iranian Registry of Clinical Trials (IRCT).

0580 Predictors of PAP Compliance One Month After Bariatric Surgery

0580 Predictors of PAP Compliance One Month After Bariatric Surgery

0447 Study of PAP response and compliance in patients with ILD and OSA: A case-control single center cohort

Abstract Introduction Interstitial lung disease (ILD) is a heterogenous group of parenchymal lung disorders with multiple etiologies. ILD often affects the quality of life and survival of patients. OSA is commonly diagnosed among ILD patients with reported prevalences of 50-90%, and a prevalence of moderate to severe OSA as high as 65%. There is also concern that patients with ILD may be less tolerant of PAP therapies. We aim to identify differences in PAP treatment response and adherence in patients with ILD and OSA compared with a group of matched OSA controls. Methods A retrospective cohort analysis was conducted on patients ≥ 18 years-old that were evaluated at Mayo Clinic Center for Sleep Medicine between July 2012 to June 2022. Inclusion criteria were patients with a diagnosis of ILD per ATS criteria also diagnosed with OSA by HSAT or PSG. Control OSA patients were matched to ILD/OSA patients by age, BMI, and AHI ranges. Exclusion criteria included comorbid conditions of asthma or COPD. Patients with early non-adherence to CPAP or those who didn't have sleep follow up were also excluded. Follow-up sleep visits were assessed to determine CPAP adherence, change in PAP pressure, addition of oxygen, and change in Epworth sleepiness scale. Results We compared 51 patients with ILD/OSA and 51 OSA matched-controls. Twenty-five ILD/OSA patients were diagnosed by PSG and 26 by HSAT. Median treatment follow-up for the ILD group was 7 months (IQR of 3 to 18 months). Baseline characteristics, including oxygen desaturation index (ODI), oxygen saturation, time spent below 89% during overnight oximetry, and baseline Epworth scale, were similar between ILD/OSA and non-ILD OSA patients. Importantly, there was no statistically significant difference in PAP adherence, median PAP levels, PAP pressure change, residual AHI, or change in Epworth after treatment Conclusion There was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence in ILD patients with OSA compared with matched non-ILD OSA controls. Outcome assessment may be limited by sample size and the shorter follow-up period. Future studies should include longer-term follow-up with a larger ILD cohort to assess the impact of ILD progression on PAP adherence over time. Support (if any)

0531 Excessive mask leak and its association with poor PAP compliance in women. A secondary analysis of the AWARE study

Abstract Introduction Studied have shown that continuous positive airway pressure(CPAP) adherence is lower in women. However, understanding of the specific challenges faced by woman when starting therapy remains poor. Specifically, is there any relationship between leak and women’s characteristics that could influence adherence? Methods The AWARE-study is a longitudinal pilot-study with the objective to identify in women modifiable barriers to initiating/adhering to treatment over 3-months. Adherence was considered when using CPAP for a minimum 4-hours 70% of the nights. But, is there any association between leak, mask type and other patient’s characteristics that could influence adherence in women? This is a secondary analysis looking at leak as a consequence of poor adherence in women within the AWARE-study. We gathered data directly from the PAP-data-base and evaluated adherence within the first 3-months after starting therapy and usage at-present-time. We investigated leakage (&amp;gt;25 L/min) and gathered information about severity of OSA, age, BMI, and race. Our aims: to evaluate for leak as a cause of poor adherence and to identify characteristics that could potentiate leak in women. Results Data from 49 women from the AWARE-study between the ages of 28-85, with a recent diagnosis of OSA who started CPAP was analyzed. Adherence, leakage, age, OSA severity, and mask type was gathered. Chi-squared test of independence suggests a relationship between leakage and present adherence, Chi2(1)=11.34, p=0.001. Of those women experiencing high leakage, 83% were non-adherent to therapy. Logistic regression was run to compute an odds ratio with 95% CI. Those experiencing high leakage have about 92% times lower odds to still be compliant than those not experiencing high leakage [OR=0.08, 95% CI: 0.007, 0.478]. Overall, mask type relates to adherence, 72% of nasal mask wearers were still being adherent versus 38% when using facial masks. The prediction of adherence from leakage does not significantly differ across mask type. Age was found to be related to adherence; 57% of women under 50-years were not adherent to CPAP versus 26% in women over 50-years. Conclusion This information could guide us in suggesting strategies for better mask choosing and possibly to implement more specific strategies that can increase adherence in women. Support (if any)

The clinical influence of nasal surgery on PAP compliance and optimal application among OSA subjects uncomfortable with PAP device wear

This study aimed to evaluate the alteration of PAP compliance after nasal surgery and to determine the optimal indications of nasal surgery in obstructive sleep apnea (OSA) subjects. Among OSA subjects using PAP devices, 29 subjects who underwent septoturbinoplasty due to nasal obstruction were included and their pre- and postoperative medical and PAP records were reviewed retrospectively. Postoperative autoPAP usage data was further assessed by grouping the compliance (the percentage of days with usage ≥ 4 h) data (group 1: the good compliance group; group 2: the poor compliance group). The data showed that 56% of subjects in group 1 complained of nasal obstruction as the only barrier to using a PAP device and about 89% reported experiencing the efficacy of PAP usage. Both the mean and peak average PAP pressures were significantly reduced in group 1 following nasal surgery. Group 2 had multiple subjective problems that interfered with wearing a PAP device and reported a lack of experiencing the efficacy of PAP usage. Preoperative nasal cavity volume values were smaller and absolute blood eosinophil counts were significantly lower in group 1. The current data demonstrate that nasal surgery might increase the compliance of PAP device wear in OSA subjects who complained of only nasal obstruction as a barrier to wearing PAP and who had small nasal cavity volumes combined with allergic inflammation.

Factors influencing automatic PAP compliance: what really matters?

Factors influencing automatic PAP compliance: what really matters?

The Positive Airway Pressure Therapy Compliance In Mild OSAS

Introduction: This study is designed to determine the factors for predicting the PAP compliance in mild obstructive sleep apnea syndrome (OSAS) for improving the cost-effectiveness in the treatment choices of these patients.&#x0D; Method: The study group comprises 27 mild OSAS patients who underwent automatic positive airway pressure (APAP) titration between July 2016 and December 2017. Demographic, clinic and polysomnographic characteristics of the patients were retrospectively evaluated. Compliance with PAP treatment was defined as the usage of 5 nights/week and 4 hours/night at least. Data of compliant patients were statistically compared with non-compliant patients.&#x0D; Results: Most of the patients (23 patients, 85,2%) were prescribed APAP devices. Acceptable compliance at the end of the first year of therapy was achieved by 11 patients (40,2%) whereas 8 patients used PAP device 2 months at most (29,6%) The remaining 8 patients had not taken the device at all and were considered as non-adherent to PAP treatment (29,6%). The nonadherent/non-compliant group showed statistically the same demographic, clinic, and polysomnographic characteristics when compared to the compliant group. The level of maximum pressure during the titration test was lower in the compliant group (p=0,040). &#x0D; Conclusion: The sleep-related symptoms, scores of ESS or polysomnographic parameters can not be used to predict compliance for mild OSAS. The patients with mild OSAS, especially the ones who reach higher maximum pressure on titration test, must be followed up closely during the first 2 months of PAP treatment to detect nonadherence/non-compliance earlier.

718 Investigating Decreased Positive Airway Pressure Compliance in a Veteran Affairs Sleep Medicine Clinic During the 2020 Pandemic

IntroductionPositive airway pressure (PAP) compliance for the treatment of sleep apnea at the Albuquerque Veterans Affairs (VA) Sleep Medicine clinic has been observed to be lower in new setup patients after the onset of the COVID-19 pandemic. The reasons for decreased PAP compliance during the COVID-19 pandemic are unclear. The primary outcome will be to identify if there is a common reason that patients at the Albuquerque VA were less compliant with PAP after the onset of the COVID-19 pandemic.MethodsCompliance data for 4/1/2020 through 9/30/2020 was compared to compliance data for 4/1/2019 through 9/30/2019. Compliance after PAP machine setup was confirmed to be lower during the 2020 time period. Noncompliant patients will be selected by setup type, new versus machine replacement, and surveyed for reasons for noncompliance. The survey will be conducted at the Albuquerque VA Sleep Center and will include questions regarding beliefs, barriers, and challenges with the use of PAP therapy during the coronavirus pandemic. The definition for initial PAP compliance will be the use of PAP therapy for greater than or equal to four hours per night on at least 70% of nights.ResultsFor the 6-month time period of 4/1/2019 through 9/30/2019, there were 758 PAP setups at the Albuquerque VA. The 30-day compliance for the 758 setups was found to be 61.4%. Comparatively, for the six-month period of 4/1/2020 through 9/30/2020, there were 462 setups with a 30-day compliance result of 49.7%. A survey consisting of questions designed to elicit barriers to use as well as beliefs regarding PAP and COVID-19 will be administered to 20% (n = 46) of the non-compliant patients who were set up with a PAP machine during the 2020 study period.ConclusionPAP compliance after machine setup was lower at the Albuquerque VA sleep center in 2020 versus 2019 (49.7% versus 61.4%). The reasons for the lower observed compliance are attributed to the effects of the coronavirus pandemic. A random sampling of the non-compliant patients during the 2020 time period will be performed and the results will be presented once available.Support (if any)None

430 Outcome of Sleep-Wake Pattern in Obstructive Sleep Apnea Patients after Positive Airway Pressure Therapy using Actigraphy

Abstract Introduction The initial phase of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) may affect sleep parameters and PAP compliance. Actigraphy is a validated method using accelerometer to objectively measure sleep parameters in patients with a range of sleep disorders, including OSA, particularly to follow-up after treatment. We compare sleep parameters from actigraphy, sleep log, sleep diary, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients before and after CPAP therapy for 1 week. Methods This pilot study have been prospectively performed at Central Chest Institute of Thailand (CCIT) since June to November 2020. Adult OSA patients, diagnosed by ICSD-3 criteria and achieved optimal or good CPAP pressure titration from split-night polysomnography (PSG), were informed and consent to wear actigraphy before and after CPAP therapy each for 1 week. Clinical and sleep parameters were recorded and analyzed using Wilcoxon matched-pair signed-rank and Mann Whitney U test. P-value &amp;lt; 0.05 was considered to have statistical significance. Results All 11 OSA patients participated in this study. Most patients were male (63.6%), hypertension (54.5%) and dyslipidemia (45.4%). Means of age, body mass index (BMI), ESS, PSQI, apnea hypopnea index (AHI), nadir SpO2, and CPAP usage were 45.5 ± 15.9 years, 29.1 ± 5.2 kg/m2, 10.8 ± 3.9, 7.7 ± 2.9, 65.2 ± 37.7 events/h, 82.3 ± 10.8 % and 9.5 ± 3.1 cmH2O, respectively. Comparing before and after 1-week CPAP therapy, an average number of wake bouts ((NWB), 48.4 vs 38 events, p=0.010), ESS (11 vs 9, p=0.035) and PSQI (8 vs 4, p=0.005) were significantly decrease. Additionally, when comparing between poor and good CPAP compliance group, NWB (55.1 vs 36.3 events, p=0.036) and the difference of wake after sleep onset (WASO, 10.5 vs -0.11 min, p=0.035) were significantly decrease. Conclusion OSA patients treated with CPAP for 1-week experienced marked improvement in sleepiness, sleep quality and nighttime awakening. Support (if any):

821 An Unusual Pediatric PAP Compliance Obstacle, Even When the Mask Fits

Abstract Introduction Proper mask fitting is an important factor for compliant and effective use of PAP therapy. However, we present 2 patients whose masks became a barrier to PAP therapy despite a well-fitting mask. Report of case(s) Case 1 A 12-year-old female with ADHD, Chiari I malformation status-post decompression, and persistent mixed central and obstructive sleep apnea is managed with BPAP S/T. Despite absence of upper airway structural abnormalities, she is a mouth-breather during sleep and only tolerates full face masks. Despite ensuring a good mask fit and optimal BPAP settings to control her AHI, she sleeps with her neck hyperextended, resulting in her lower jaw pushing caudally and the mask liner slipping into her mouth. This stimulated chewing and resulted in damage to several masks. Case 2 An 8-year-old male with congenital central hypoventilation syndrome is managed with BPAP S/T during sleep. Similar to case 1, he is a mouth-breather during sleep and can only tolerate full face masks. Although his mask and headgear fit him well, he drools in sleep which results in the silicone liner slipping into his mouth, stimulating chewing. This has led to the need for replacement of several masks. Of note, drooling did not occur when he was previously using assisted ventilation via tracheostomy, and bruxism was not identified during polysomnography. Conclusion To our knowledge, this is the first report of PAP mask chewing, thus its incidence is unknown. We suspect that the mask liner slipping into the mouth touches the anterior surfaces of the teeth stimulating the chewing reflex. The frequency of mask chewing and consequent damage is unpredictable and often necessitates mask replacement. Insurance companies should consider this unique mask complication when determining their mask coverage policies since the typical 6-months interval for authorization of a new mask can impair the patient’s health, PAP compliance, and become an out-of-pocket financial burden for families. Although it did not occur in our patients, mask chewing may pose a potential choking hazard. Awareness of mask chewing may help in improving pediatric PAP mask development to ensure masks are safe. Support (if any):

444 Enhancing PAP Compliance Efficacy with Early Closer Follow-ups (2–3 days vs others): A Retrospective Single-Centre Review

Abstract Introduction PAP is an effective gold standard for OSA treatment; however, compliance remains an issue. Centre for Medicare defines compliance as PAP usage of ≥4hrs daily and ≥70% in a 30-day period. This study aimed at evaluating the effectiveness of early patient-centred follow-ups (2–3 days mandatory versus 4 weeks mandatory and/or as needed basis). Methods Retrospective data analysis of 100 consecutive patients (≥18 years) over a year in an interrupted time series with pre-test (Group1) and post-test (Group2) of 50 patients each. All patients included were symptomatic (ESS ≥10), CPAP naive, diagnosed with OSA, and diagnostic AHI ≥5. All received a post diagnostic sleep questionnaire assessing their overall quality of sleep with PAP therapy. Therapeutic AHI was collected from updated 90-day compliance report thru web enabled online RESMED AIRVIEW’s secure database. Initial follow-up for Group1 was in 4 weeks and/or earlier if patient initiated and for Group2 in 2–3 days following PAP set up. Additionally, non-compliant patients in Group2 received monthly follow-ups. Results Following findings were reported for Group1 - (Male=24, Female=26), mean age 65.79±13.21, and BMI 36.12±7.50; and Group2 - (Male=25, Female=25), mean age 62.8±12.32, and BMI 36.90±9.29. During diagnostic testing &amp;gt;50% patients in both groups rated their overall sleep to be worse than usual. Compliance for Group1 was significantly worst than Group2 (64% and 91%, respectively). Group1 had 8=AHI≥5, 29=AHI≤5 and had 13 lost to followup (11 behavioural in-adaptations, 2 financial constrains) soon after commencing CPAP. Group2 had 3 lost to financial constraints, 4=AHI≥5, and 43=AHI&amp;lt;5. Chi-square (5.4265) indicated p-value=.019, chi-square Yates-correction (4.502) calculated p-value=.033. Significant at p&amp;lt;.05, Chi-square test revealed dependant relationship between PAP unsatisfactory patient evaluation during diagnostic polysomnography to PAP non-compliance. Group1’s RR=3 and OR=4.45; Group2’s RR=0.33 and OR=0.22, indicated higher probability of non-compliance in Group1. Conclusion Provider-patient contact within 2–3 days versus any other intervals (4 weeks mandatory and/or as needed in this case), soon after commencing PAP therapy not only increases compliance efficacy but also reduces patient dropouts and anxiety with PAP therapy. Considerable fraction of patients are uncomfortable using CPAP; therefore, closer follow-ups versus 4 weeks is warranted to maintain CPAP adherence. Support (if any):

Blood pressure reduction following treatment with positive airway pressure in sleep apnea: data from the European Sleep Apnea Database

Abstract Introduction Positive airway pressure (PAP) treatment modifies blood pressure (BP) in patients with obstructive sleep apnea (OSA). We aimed to explore which factors that influence the BP response to PAP therapy in the European Sleep Apnea Database (ESADA). Methods A total of 2662 OSA patients with PAP therapy ≥90 days were included in the analysis (74% male, age 55±11 years, body mass index 32.3±6.1 kg/m2, 47% hypertensives, apnea-hypopnea index 40±24 events/h, treatment duration 1.0±1.1 years, PAP compliance 5.2±1.9 h/day). Anthropometric data, co-medications and office BP were assessed at baseline and follow-up visit. Results Systolic and diastolic BP were modestly reduced after PAP therapy compared to baseline (133±17 vs. 134±17 mmHg, 78±11 vs. 81±11 mmHg, p&amp;lt;0.001, respectively). In a generalized linear model controlling for anthropometric, PAP compliance and follow-up time, severe OSA at baseline (β [95% CI] −3.2 [−5.1 to −1.3], p=0.001), hypertension status (−2.0 [−3.3 to −0.7], p=0.003), weight reduction &amp;gt;2 kg at follow up (−2.0 [−3.7 to −0.4], p=0.016), and use of auto-adjusted PAP (−1.3 [−2.5 to −0.02], p=0.046) were associated with a reduction of systolic BP at follow-up. Conclusions BP reduction following PAP treatment in patients with moderate to severe OSA was modest. We identified several predictors of a favorable BP response including the use of auto adjusted PAP. Our findings suggest that weight reduction strategies in addition to PAP treatment should be considered to obtain adequate BP control in OSA patients. Funding Acknowledgement Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)

Interrelationship among Obstructive Sleep Apnea, Renal Function and Survival: A Cohort Study.

Previous studies showed a bidirectional relationship between renal function decline and obstructive sleep apnea (OSA) syndrome. Continuous Positive Airway Pressure (C-PAP) treatment was shown to preserve the kidney function in OSA patients. This study aims to investigate the progression of long-term renal function in OSA patients treated with different PAP strategies (patients were divided into two groups, fixed C-PAP or other PAP—automatic and bilevel pressure). Comorbidities and 10-years survival were also evaluated. We performed a retrospective, observational, single-center, cohort study, including the first 40 consecutive patients enrolled from 2009 in the Respiratory disease Unit at the Vercelli University Hospital database. The patient inclusion criteria were: age ≥ 18 years with OSA syndrome according to AASM (American Academy of Sleep Medicine) guidelines. Creatinine serum levels (mg/dL) and the estimated Glomerular Filtration Rate (eGFR, mL/min calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration equation)) were measured at 3 different time points: at baseline, 3 years and 8 years after PAP treatment. The Kaplan–Meier survival curves stratified according to PAP treatment and compliance have been reported together with log-rank test estimation. In our study, we found a significant creatinine serum level reduction after 3 years of fixed C-PAP treatment (p value = 0.006) when compared to baseline values. However, we observed that the long-term C-PAP benefit was not significant (p value = 0.060). Our data confirmed the progressive renal function decline in OSA patients, especially in those using other-PAP treatments; nevertheless, OSA treatment with a fixed C-PAP device has shown, in the short term, a significant improvement in renal function. By contrast, in our study, long-term benefits after 8 years are not been demonstrated probably because of the lack of compliance of the patients and the aging effect.

1273 Does a more personalized approach to desensitization and daytime titrations improve PAP compliance, PAP therapy satisfaction/efficacy, and perhaps even save resources?

Abstract Introduction Seventy three patients at the Raymond G Sleep Center within the New Mexico VA Healthcare System were identified as patients who were at high risk for PAP therapy non-compliance, were invited to participate in a new patient service program. Report of Case This program included an individualized daytime desensitization process coupled with a potential daytime titration. The final analysis of these data revealed co-morbid conditions that may serve as barriers to PAP usage as well as medical conditions which are known to benefit from compliance on PAP therapy. Special attention was paid to co-morbid psychiatric conditions. Conclusion This process resulted in a roughly 25% increase in PAP compliance, a 30 % change in PAP modality and improved access to in-lab titrations. This study elucidated factors that may help predict success or failure regarding PAP therapy.

0883 Impact of Implementation of a Comprehensive Positive Airway Pressure Program

Abstract Introduction The American Academy of Sleep Medicine (AASM) guidelines for treatment of Obstructive Sleep Apnea (OSA) with Positive Airway Pressure (PAP) state good practice standards involve adequate follow up with a clinician tele-monitoring efficacy through objective usage data to ensure acceptable treatment and compliance is met, and provide education, behavioral and/or troubleshooting interventions. In 2016, Dayton Children’s Hospital’s pap compliance was 29% due to limited staff support. Methods To efficiently implement the AASM guidelines, one dedicated Respiratory Therapist (RT) was assigned to help manage OSA patients at Dayton Children’s Sleep Medicine. The RT responsibilities include, PAP therapy education, arranging home PAP system, and a follow-up call within 7 days of setup. Through the tele-monitoring system, the RT assesses compliance and addresses equipment issues and mask fitting at the 4 to 6 week clinic visit. To enhance compliance, a welcome postcard and gift card were implemented. Monthly clinic visits occur until compliance is met, wearing device greater than 4 hours 60% of the time, then appointments are scheduled every 6 months to 1 year. Results Since 2016, compliance rate increased from 29% to 58%. There was a year over year growth of number of patients starting therapy from 2017 to 2019, 86 patients were added to the PAP program. In 2019, 60% of 6 to 12 years old met compliance and 51% of 13 to 18 years old. Conclusion A comprehensive PAP program resulted in improved compliance and substantial growth. Referring providers and families are more likely to accept PAP therapy when made aware of extensive education and follow up by RT staff. To further improve compliance, especially in the 13 to 18 age range, a desensitization program has recently been implemented. Support No support provided.

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

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)

1078 Machine Learning to Predict PAP Adherence and Compliance in Tele-Health Management

1078 Machine Learning to Predict PAP Adherence and Compliance in Tele-Health Management

Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans.

Posttraumatic stress disorder (PTSD) is common among veterans of the military, with sleep disturbance as a hallmark manifestation. A growing body of research has suggested a link between obstructive sleep apnea and PTSD, potentially due to obstructive sleep apnea (OSA) related sleep disruption, or via other mechanisms. We examined the hypothesis that treatment of OSA with positive airway pressure would reduce PTSD symptoms over 6 months. A prospective study of Veterans with confirmed PTSD and new diagnosis of OSA not yet using PAP therapy were recruited from a Veteran's Affairs sleep medicine clinic. All subjects were instructed to use PAP each night. Assessments were performed at 3 and 6 months. The primary outcome was a reduction in PTSD symptoms at 6 months. Fifty-nine subjects were enrolled; 32 remained in the study at 6 months. A significant reduction in PTSD symptoms, measured by PCL-S score was observed over the course of the study (60.6 ± 2.7 versus 52.3 ± 3.2 points; p < 0.001). Improvement was also seen in measures of sleepiness, sleep quality, and daytime functioning, as well as depression and quality of life. Percentage of nights in which PAP was used, but not mean hours used per night, was predictive of improvement. Treatment of OSA with PAP therapy is associated with improvement in PTSD symptoms, although the mechanism is unclear. Nonetheless, PAP should be considered an important component of PTSD treatment for those with concurrent OSA. Improving PAP compliance is a challenge in this patient population warranting further investigation. ClinicalTrials.gov, ID: NCT02019914. A commentary on this article appears in this issue on page 5.

Effect of PAP Compliance on Sexual Quality of Life

Effect of PAP Compliance on Sexual Quality of Life

Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors.

A chinstrap is potentially useful to reduce unintentional air leak by preventing mouth opening during PAP treatment. This study examines whether the addition of a chinstrap to PAP therapy has any effect on adherence, nightly duration of use, air leak, and residual AHI. This was a retrospective study performed at an AASM-accredited VAMC sleep center. Clinical sleep data of veterans (n = 124) prescribed PAP therapy for sleep apnea was evaluated, and the effect of chinstrap use vs non-use on the above parameters was assessed. Chinstrap users had significantly greater PAP adherence, longer nightly duration of PAP use, lower residual AHI and lower leak compared to chinstrap non-users at first follow up visit. The addition of a chin strap to PAP therapy is a simple and inexpensive method of increasing PAP adherence.