PAP Use Research Articles

Telehealth use and receipt of recommended services within one-year postpartum.

In obstetrics, telehealth is widely used in the provision of prenatal and postpartum care. The objective was to compare the utilization of commonly recommended services after delivery among individuals receiving telehealth versus in-person postpartum care. We performed a retrospective cohort study of individuals receiving postpartum care at a single institution between 1 July 2020 and 30 June 2023. The primary exposure was the exclusive use of telehealth versus an in-person visit for postpartum care. Two primary outcomes were assessed between 0 and 365 days after the delivery: 1) long-acting reversible contraceptive (LARC) method use and 2) pap smear screening. Secondary outcomes occurring between 0 and 365 days after delivery included: clinic-based weight assessment, clinic-based blood pressure assessment, any prescription contraception use, primary care visit, and pregnancy within 1 year. Among the 9953 individuals, 9058 (91.0%) had a postpartum visit. 1811 (19.9%) utilized telehealth exclusively, which peaked during the COVID-19 pandemic. Exclusive telehealth users were less likely to have a pap smear (21.6 vs. 40.1%, p < 0.001) or use LARCs (8.6 vs. 19.4%, p < 0.001) than those receiving in-person care. In the adjusted analysis, the odds ratio for receiving a pap smear was 0.38 (95% confidence interval [CI] 0.32-0.47) and for using a LARC was 0.38 (95% CI 0.31-0.47) when comparing telehealth to in-person care. Reduced odds of all secondary outcomes were seen in the exclusive telehealth use compared to the in-person cohort, with the exception of subsequent pregnancy within 1 year, which was not significantly different. Acknowledging that telehealth now has become an important means for patients to access medical care, these findings should prompt clinicians to consider when an in-person postpartum visit should be offered or recommended over telehealth, especially when a patient may not have a preference or reported barriers to accessing an in-person visit.

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).

Penerapan Penilaian Beracuan Patokan dan Norma pada Pelajaran Sejarah Kebudayaan Islam di Madrasah Aliyah Swasta Darul Hadits Huta Baringin

The research method chosen was qualitative, with a descriptive analysis method, because the researcher wanted to analyze based on the teacher's verbal statements from each type of daily test, Mid-Semester Examination (UTS), and Final Semester Examination (UAS). This research aims to describe the results of teacher assessments which are then analyzed and compared with the theory of learning outcomes assessment related to the Benchmark Reference Assessment Approach (PAP) and Norm Reference Assessment (PAN). In the Benchmark Assessment Approach (PAP), teachers are responsible for helping students towards achieving predetermined standards. Students are considered to have graduated if they achieve or exceed the predetermined success criteria. This approach helps teachers design improvement programs and provide consistent feedback to students. On the other hand, the Norm Referenced Assessment Approach (PAN) measures a student's abilities relative to his or her group. PAN considers the normal distribution of students' abilities and places students in certain categories such as "top", "middle", or "bottom". The use of PAN in assessing learning outcomes allows adjustments to pure National Examination scores to improve them. The differences between PAP and PAN include the assessment focus, measurement approach, and assessment objectives. Although both can be used in educational contexts, their application differs depending on the assessment needs. In assessing the results of learning the History of Islamic Culture in Madrasas, the use of PAP and PAN must be adjusted to the characteristics of the students and the learning objectives to be achieved.Top of Form

1056 Medical Record Alert to Increase PAP Use in Hospitalized Patients on Home PAP for Sleep Disordered Breathing

1056 Medical Record Alert to Increase PAP Use in Hospitalized Patients on Home PAP for Sleep Disordered Breathing

Performance of Claims-Based Algorithms for Adherence to Positive Airway Pressure Therapy in Commercially Insured Patients With OSA

BackgroundPositive airway pressure (PAP) therapy is first line therapy for obstructive sleep apnea (OSA), but consistent use is required for it to be effective. Previous studies have used Medicare fee-for-service claims data (e.g., device and equipment charges) as a proxy for PAP adherence to assess its effects. However, this approach has not been validated in a United States (US) commercially insured population, where coverage rules are not standardized. Research QuestionIn a commercially insured population in the US, how well do claims-based algorithms for defining PAP adherence correspond with objective PAP device usage? Study Design and MethodsDe-identified administrative claims data of commercially insured patients (18-64 years) with OSA were linked to objective PAP therapy usage data from cloud-connected devices. Adherence was defined based on device use (using an extension of Centers for Medicare and Medicaid Services 90-day compliance criteria) and from claims-based algorithms to compare usage metrics and identify potential misclassifications. ResultsThe final sample included 213,341 patients. Based on device usage, 48% were adherent in the first year. Based on claims, between 10 and 84% of patients were identified as adherent (accuracy, sensitivity, specificity ranges: 53-68%, 12-95%, 26-92%, respectively). Relative to claims-adherent patients, device-adherent patients had consistently higher usage across all metrics (mean: 339.9 vs. 260.0-290.0 days of use; 6.6 vs. 5.1-5.6 days per week; 6.4 vs. 4.6-5.2 hours per day). Consistent PAP users were frequently identified by claims-based algorithms as non-adherent, while many inconsistent users were classified by claims-based algorithms as adherent. InterpretationIn aggregate US commercial data with non-standardized PAP coverage rules, concordance between existing claims-based definitions and objective PAP use was low. Caution is warranted when applying existing claims-based algorithms to commercial populations. Clinical Trials Registration NumberNot applicable

Supplementation with avian-derived polyclonal antibodies against Methanobrevibacter gottschalkii and M. ruminantium decreases ex vivo methane production and modifies ruminal fermentation in Angus crossbred steers.

The study aimed to investigate the effect of supplementing polyclonal antibodies (PAP) of avian origin against the ruminal methanogens Methanobrevibacter gottschalkii Ho (PAP-Ho) and M. ruminantium M1 (PAP-M1) on ruminal fermentation profile and methane production in Angus crossbred cattle (13 steers and 1 heifer). The experiment was conducted using a randomized block design with a 3 × 2+1 factorial arrangement, replicated in three periods. The factors included proportions of PAP against Ho and M1 in the mixture (100:0, 50:50, and 0:100 Ho:M1) and level of each mixture (3- or 6-mL per d). Cattle in control treatment did not receive PAP supplementation. Ruminal fluid was collected from the animals on d 0, 14 and 21 of treatment to determine of ruminal fermentation profile and ex vivo methane production. There was no effect of level of inclusion on ex vivo methane production. Supplementation with PAP-M1, either alone or in combination with PAP-Ho, decreased ex vivo methane output compared to the control group. Furthermore, in vivo molar proportion of propionate tended to be greater with PAP-M1, alone or combined with PAP-Ho, when compared with the control group. The study concluded that polyclonal antibodies against ruminal methanogens have the potential to decrease enteric methane emissions in cattle. The research provided important insights into the potential use of PAP as a strategy for reducing greenhouse gas emissions from cattle. Further research is needed to confirm these findings and to determine the practicality and feasibility of using PAP.

Cutibacterium acnes KCTC 3314 Growth Reduction with the Combined Use of Bacteriophage PAP 1-1 and Nisin.

Severe acne has high psychological impacts recorded worldwide, from depression to suicide. To control acne infection, bacteriophage could be used in synergy or combination with antibiotics/antimicrobials. Bacteriophages are specific to their hosts without interfering with the normal skin microbes and have the ability to lyse bacterial cells. In this current study, the bacteriophage PAP 1-1 was isolated, characterized, and tested against the pathogenic acne-causing bacterium Cutibacterium acnes. Examination under transmission electron microscopy (TEM) revealed that the newly isolated phage has a morphology typical of siphoviruses. Phylogenetic analysis, utilizing the maximum likelihood (ML) algorithm based on complete genome sequences, revealed that PAP 1-1 clustered together with bacteriophages active to Propionibacterium acnes (now known as C. acnes), forming a distinct evolutionary lineage. The genomic analysis further identified the presence of an endolysin gene in PAP 1-1, suggesting its potential to regulate the growth of C. acnes. Subsequent experiments conducted in RCM broth confirmed the ability of PAP 1-1 to effectively control the proliferation of C. acnes. In combination with bacteriocin from Lactococcus lactis CJNU 3001 and nisin, PAP 1-1 greatly decreased the viable cell counts of C. acnes in the broth.

0516 Biopsychosocial intervention using virtual multidisciplinary group with improved PAP adherence after 1 year post intervention

Abstract Introduction Prevalence of untreated sleep apnea among veterans is 22.2 %. Untreated patients are at risk for multiple adverse outcomes including chronic sleep deprivation, excessive day time sleepiness, chronic fatigue, depression, and cardiovascular complications including hypertension, coronary artery disease, cerebrovascular accidents, pulmonary hypertension as result of increased sympathetic activity during apnea episodes. Nonadherence to PAP therapy within the first week of treatment are up to 50 % of patients who use PAP device during the first week between 12-25 % discontinue by PAP use by year 3. Barriers to PAP use include physical problems with PAP hardware, knowledge gaps, and psychological issues. Methods Veterans from sleep medicine and sleep apnea clinics as well as multiple primary care clinics participated in the PAP adherence group following 6 weeks biopsychosocial model. The intervention included weekly synchronized video encounters of behavior sleep specialist, respiratory therapist and sleep clinic nurse with the targeted group of veterans with sleep apnea and poor PAP adherence. This approach has multiple benefits, including being patient centered, cost effective and efficient with ability to help veterans at various motivational levels, assist 6-10 veterans virtually in 6 one-hour group sessions and easy care coordination. Results A total of 21 veterans with sleep apnea participated in virtual multidisciplinary group to improve PAP adherence between September 2020 and January 2021. Patients PAP adherence before intervention, post intervention and 1year after intervention was evaluated. Percent of patients using PAP &amp;gt;2 hours before intervention was 5 %, immediately after intervention it increased to 20 %, and there was further increase up to 33% after 1 year post. Conclusion A structured multidisciplinary biopsychosocial intervention demonstrated statistically significant improvement in PAP adherence which persisted up till 1 year post intervention. In fact additional improvement of &amp;gt;2 hours of PAP usage was noted in this patient group suggesting possible long term benefit of psychosocial multidisciplinary intervention on PAP adherence. This study also demonstrated efficiency of utilization of virtual/telemedicine platform for psychosocial intervention and brief behavioral therapy. Support (if any)

0565 The Obstructive Sleep Apnea CPAP Therapy Compliance; Progressions, Challenges and Interventions

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep disorder affecting 26% of the United States adult population and is associated with adverse health outcomes. Despite the advent of an array of treatment options, PAP remains the primary treatment modality for OSA since the approach was introduced in 1981. The objective of this systematic review is to determine how we can increase compliance to PAP therapy as the gold standard of OSA treatment. Methods A systematic review was conducted to study meta-analyses performed to determine the clinical significance of using PAP in several modalities, PAP initiation strategies, educational and behavioral interventions, tele monitoring, humidification, level of AHI, different mask interfaces, and flexible or modified pressure profile PAP to treat OSA in adults. Results Data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Also systematic reviews show that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects. Finally, AHI level of 15 and above but not demographic variables payed a role in compliance. Conclusion All medical therapies have challenges with patient adherence. PAP therapy for OSA has unique challenges as available data indicate that optimal benefit is derived from continued use throughout the patient's sleeping period while clinical trials continue to demonstrate suboptimal group adherence ranging from 3–5 h/night. Given this, substantial work remains to be done to determine the optimal combination of strategies to maximize adherence. All researches on increasing adherence has evaluated outcomes at 3 months or less, despite evidence that usage continues to wane over time long-term. Evaluation of strategies to maintain adherence long term is a critical research priority. Other fields to focus are strategies for identification of patient-factors that place them at risk for nonadherence prior to PAP use, and the development and validation of specific algorithms to utilize with telemonitoring to identify nonadherent patients early after initiation of PAP. Comparative effectiveness studies will be needed to develop a comprehensive adherence program that can be deployed into routine clinical care. Support (if any)

Comorbidities and Presenting Symptoms in a Real-World Population With Obstructive Sleep Apnea

AbstractBackgroundObstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is often associated with numerous medical and psychiatric comorbidities. Patients with OSA experience a variety of symptoms that can be burdensome and affect their quality of life and satisfaction with care. Excessive daytime sleepiness (EDS) is a common symptom of OSA, and can persist despite primary airway therapy (e.g., positive airway pressure [PAP]). This analysis aimed to characterize common comorbidities, as well as symptoms present at OSA diagnosis and their burden in a real-world population of participants with OSA.MethodsUS residents (≥18 years of age, self-reported clinician diagnosis of OSA [from 1/1/2015 to 3/31/2020]) completed a survey in Evidation Health’s Achievement app that assessed self-reported sleepiness (Epworth Sleepiness Scale [ESS]), self-reported PAP usage, self-reported physician-diagnosed comorbidities, and information on their symptoms at time of OSA diagnosis. Self-reported PAP use was categorized as nonuse (no PAP use), nonadherent (&lt;4 h/night or &lt;5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk). EDS was defined as ESS score &gt;10. All data were summarized descriptively.ResultsIn total, 2289 participants completed the survey (50.3% female; 82.5% White; mean ± standard deviation [SD] age, 44.8 ± 11.1 years; mean ± SD age at OSA diagnosis, 40.7 ± 11.4 years; mean ± SD body mass index, 35.4 ± 8.7 kg/m2); 42.5% had EDS. Among the total population, 30.6% were PAP non-users, 6.7% were nonadherent, 9.8% were intermediate adherent, and 52.9% were highly adherent. Across the study population, the most common self-reported physician-diagnosed comorbidities were anxiety (44%) and depression (42%) followed by hypertension (39%), dyslipidemia (26%), and asthma (21%). Among the symptoms participants reported having had at the time of OSA diagnosis, the most common were EDS (79%), fatigue (79%), snoring (75%), and awakening with a dry mouth or sore throat (63%). Concentration/Memory problems (48%) and mood changes (46%) were also common. In the overall population, the symptoms present at the time of OSA diagnosis that were most likely to be highly burdensome were fatigue (53%), EDS (46%), snoring (35%), difficulty concentrating/memory issues (31%), and mood changes (25%).ConclusionsThese real-world survey data identify anxiety and depression as the most frequently reported comorbidities in a population of participants with OSA, each affecting over 40% of participants. In addition to classic OSA symptoms (e.g., EDS, fatigue, snoring, and awakening with dry mouth/sore throat), concentration/memory problems and mood changes were also common at the time of OSA diagnosis and were among the presenting symptoms most frequently reported as highly burdensome, along with fatigue, EDS, and snoring.FundingAxsome Therapeutics and Jazz Pharmaceuticals

Racial Differences in Positive Airway Pressure Adherence in the Treatment of Sleep Apnea.

Although data are limited, studies suggest on average lower positive airway pressure use in Black, indigenous, and people of color (BIPOC) compared with Whites in most but not all studies. Most of these observational studies are certainly limited by confounding by socioeconomic status and other unmeasured factors that likely contribute to differences. The etiology of these observed disparities is likely multifactorial, due in part to financial limitations, differences in sleep opportunity, poor sleep quality due to environmental disruptions, and so forth. These disparities in sleep health are likely related to chronic inequities, including experiences of racism, neighborhood features, structural, and contextual factors. Dedicated studies focusing on understanding adherence in BIPOC are lacking. Further research is needed to understand determinants of PAP use in BIPOC subjects and identify feasible interventions to improve sleep health and reduce sleep apnea treatment disparities.

Sleep Medicine: Its Imperfect Past

Sleep Medicine: Its Imperfect Past

0537 Symptom Improvement Reported with Some PAP Use in Non-adherent Pediatric Patients with OSA

Abstract Introduction Positive airway pressure (PAP) is commonly used in children to treat obstructive sleep apnea (OSA) when surgery is not an option or is ineffective1-3, but adherence is often poor. Observational studies suggest utilization of PAP improves symptoms, signs, and polysomnogram indices of OSA in at least 85% of children4-9. The Agency for Healthcare Research and Quality released the report “Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea”10. Conclusions of this report determined that the published evidence reviewed does not support that PAP affects long term outcomes. No pediatric studies were included in this report. Objectives of this study were to determine if pediatric patients with OSA who are non-adherent to PAP therapy report an improvement in symptoms with some use of PAP. Methods A retrospective chart review was performed on patients with OSA on PAP seen in the pediatric sleep clinic. Patients were considered adherent to PAP if usage was longer than 4 hours/night for 70% of nights or more. Follow up visits occurred around 3 months, 6 months, 1 year, and 18 months-2 years. Adherence data and reported improvement in symptoms were documented at each visit, and demographical information was obtained. Results 235 patients were included in the analysis (63.9% male, 32.3% female, 3.8% missing), with a mean age (SD) at PAP initiation of 12 years (4.5). The sample was predominately Caucasian (51.5%) or African American (38.3%), 85.9% were non-Hispanic, and 53.2% obese. The mean (SD) apnea-hypopnea index was 24.7(27.6)/hr. At first visit post-initiation, of the 138 patients that had adherence data available, 80.4% reported improvement in symptoms with PAP use. Of these patients, 55.86% were non-adherent but reported symptom improvement with some use of PAP. Visit 4 data was available for 74 patients. At visit 4, 91.9% reported improvement in symptoms. Of these, 48.53% were considered non-adherent but reported symptom improvement with some use of PAP. Conclusion Historically, PAP adherence in children has been relatively poor11. Utilizing PAP therapy to treat OSA may result in an improvement in symptoms when used in patients who are considered non-adherent to therapy. Support (If Any)

0540 First Year PAP Trajectories among Treatment-Naive Youth with Sleep Disordered Breathing

Abstract Introduction Little is known about the time course for youth adjusting to and achieving optimal PAP adherence. Methods This retrospective study identified 12-month PAP trajectories and treatment persistence following treatment initiation in youth. Participants were first-time PAP initiators receiving care at Cincinnati Children’s Hospital from 07/2017-12/2019. Electronic downloads provided monthly PAP use. Adherence indicators were frequency (percentage of nights PAP used each month) and duration of use (average usage hours on nights used each month). Persistence of group-level adherence (frequency and duration) was measured via descriptive statistics in SPSS. Adherence sub-groups were identified using longitudinal mixed models in MPlus. Results The sample was 169 youth ages 2-22yrs started on PAP. Within the first month, 55% of participants were using PAP &amp;gt;50% of nights and 43% were using for &amp;gt;4 hours/night. Adherence (frequency and duration, respectively) decreased by month as follows: month 3 - 48% and 42%; month 6 - 41% and 41%; month 12 - 36% and 32%. Longitudinal mixed models identified 5 trajectories for frequency of use (based on the model of best fit using BIC index): “starts high, stays high” (34% of sample); “starts high, slowly decreasing” (7%); “starts high, rapidly decreasing” (12%); “starts low, slowly increasing” (8%); “starts low, stays low” (39%). Two trajectories were identified for duration (average hours worn on nights used, also based on model of best fit) and included: “starts high, slowly increasing” (40%) and “starts low, stays low” (60%). Conclusion At the group level, PAP adherence was sub-optimal in the first month of use (around half of participants using PAP &amp;gt;50% of nights or for &amp;gt;4 hours) and declined over the subsequent 11 months. However, mixed models identified distinct adherence subgroups, with about 40% of the sample falling into subgroups with relatively high adherence by month 12. This suggests acclimation to PAP takes time in a pediatric population. Findings may help clinicians/policy makers set realistic expectations around time to achieve optimal PAP adherence among youth, and highlights the need for further PAP adherence promotion interventions. Support (If Any) First, and fourth authors’ time supported by NIH post-doctoral training grants (T32 DK063929 and T32HD068223, respectively).

0767 Clinical implementation of a program to improve PAP acceptance and adherence for sleep disordered breathing among Veterans: Preliminary results

Abstract Introduction Positive airway pressure (PAP) is the gold standard in treating sleep disordered breathing (SDB); however, consistent use of this therapy has challenges such as comfort and equipment optimization. Despite various educational, technological, psychosocial and pharmacological strategies, the average adherence rate of 34% have changed very little over the past 20 years. A recent study of 3013 US veterans determined a baseline average PAP adherence rate of 50%. We developed and implemented a novel PAP readiness education program (PREP) for veterans newly diagnosed with SDB in a Veterans Administration sleep clinic to promote greater PAP acceptance and adherence. Methods Patients (N=63, Mean age 62.2±12.4 years) with newly diagnosed SDB were offered a 1-hour telehealth session prior to initiating PAP therapy that included psychoeducation about SDB and PAP treatment expectations, with troubleshooting techniques (i.e. scheduled practice, mindfulness). A 1-week follow-up call was conducted to communicate PAP data and address treatment barriers. PAP use reports were downloaded and analyzed at 1-7 days (first week), 1-30 days (first month), and 31-60 days (60-days) post-PAP initiation. PAP acceptance was defined as ≥1 day of use and adherence as ≥4 hours of use at each timepoint. Results Among 63 Veterans offered PREP, 66.6% (n=42) participated in PREP. Among participants, acceptance of PAP was as follows: 57.1% used ≥1 day in the first week, 64.3% used ≥1 day in the first month, and 45.2% used ≥1 day at 60-days post-PAP initiation. Percent of days with use ≥4 hours was 28.9% ±30.4 in the first week and 24.9% ±30.0 in the first month. PAP adherence at 60-days post-PAP initiation was 34.3% ±38.5 at 60-days. Conclusion Implementation of a 1-session plus 1-week follow-up call PAP readiness education program within a sleep medicine clinic was well received by patients and resulted in PAP acceptance by 2/3 of veterans in the first month post-PAP initiation. PAP adherence results may have reflected the impact of a nationwide PAP device recall that occurred during the study period. Further work is needed to test this intervention in a clinical population and to identify predictors of PAP acceptance and adherence in real-world clinical settings. Support (If Any) AASM Foundation #211-FP-19, VAGLAHS GRECC and CSHIIP

0840 Be Wary Of Adjustment Disorder with Anxiety In Patient With Insomnia And Discomfort With Positive Pressure Airway Therapy

Abstract Introduction Insomnia is a common complaint. When it occurs in the context of treatment with continuous positive airway pressure (CPAP), it can complicate treatment and lead to dissatisfaction with CPAP therapy. Adjustment disorder with anxiety (ADWA) is a condition that develops following an identifiable stressor and can be associated with insomnia. We describe a case of ADWA causing disrupted sleep and dissatisfaction with CPAP therapy. Report of Cases: The patient is an 80-year-old man with history of severe obstructive sleep apnea (OSA) and chronic obstructive lung disease, under stable management with CPAP. During a routine follow up visit, he reported the recent onset of frequent, and often prolonged, nocturnal awakenings associated with daytime sleepiness and fatigue. Insomnia was associated with discomfort with breathing, especially during exhalation, while using CPAP. His machine report indicated a significant decrement in compliance. Upon questioning, he reported that a few of his family members had died unexpectedly, following which he began to experience significant anxiety. His wife noted that he had become moody and irritable. On examination, the patient was visibly anxious; his speech was accelerated and animated, and he displayed psychomotor activation. Affect also displayed despondency. The patient was diagnosed with ADWA leading to insomnia and discomfort with CPAP use. He was prescribed buspirone 10 mg twice daily. On two week follow up patient reported no improvement in symptoms and was switched to escitalopram 10 mg daily. Following approximately three weeks, his clinical evaluation revealed significant improvement in mood; anxiety had dissipated, and sleep was more continuous with infrequent and brief awakenings. Daytime alertness had been restored. Of interest was the temporary return of anxiety and insomnia symptoms following the brief discontinuation of escitalopram because of hospitalization. Conclusion ADWA can occur in the setting of recent stressors and can result in sudden onset of insomnia, compromise CPAP adherence and decrease subjective benefit from PAP therapy. This case highlights the importance of questioning patients for the possibility of recent stressors and traumatic events when they develop difficulties with PAP use. These may indicate the presence of ADWA, whose management can restore CPAP compliance and improve sleep quality and daytime functioning. Support (If Any)

Evaluation of the Activity of Prostate Cancer Biomarkers in Post-massage Urine

Evaluation of the Activity of Prostate Cancer Biomarkers in Post-massage Urine

A colorimetric alkaline phosphatase biosensor based on p-aminophenol-mediated growth of silver nanoparticles

Alkaline phosphatase (ALP) is an enzyme that catalyzes the dephosphorylation of proteins, nucleic acids, and biomolecules. It is a potential biomarker for diverse diseases such as breast cancer, osteopenia, and hepatobiliary. Herein, we developed a colorimetric sensor for the ALP assay based on its enzymatic activity to dephosphorylate the p-aminophenol phosphate (pAPP) into pAP. In a solution containing silver nanoparticles (AgNPs) and Ag+ ions prepared using a low concentration of NaBH4, pAP mediates the growth of AgNPs by reducing the concentration of Ag+ ions to enhance the intensity of localized surface plasmon resonance as the pAPP cannot induce a reduction of the remaining Ag+ due to the masking of the hydroxyl with phosphate. The quantitative assay of the ALP was demonstrated via the colorimetric detection of the pAP-mediated growth of AgNPs in the presence of an ALP. The highly sensitive enzymatic growth of AgNPs provided a wider dynamic linear range of 0.5–225 U/L with a lower limit of detection of 0.24 U/L than that previously reported. The use of pAP resulted in excellent selectivity of the sensor for the ALP assay in human serum, yielding a high recovery rate and a high precision of 99.2 ± 1.5 % for the standard addition method.

705 PAP Use Pattern Change During the COVID-19 Lockdown

IntroductionThe COVID-19 pandemic has greatly impacted not only the physical health of society, but also its social, mental, and economic health. The Illinois shelter in place orders enacted in March and April limited work and activities outside the home. Our aim for this study was to compare the effects of the COVID-19 shelter in place orders on PAP use patterns in patients with OSA.MethodsWe selected 30 patients seen between May and October 2020. Patients had been diagnosed with OSA for at least one year, prescribed PAP therapy and had been compliant with therapy as defined by 70% use greater 4-hour for 30 days prior to their clinic visit. Using data collected from chart review as well as online ResMed AirView cloud data, we evaluated PAP on/off and average use time during shelter in place order for a 90 day period (March through May 2020). We compared this data to a similar period in the year prior.ResultsAverage age of our study group was 58.6 years old with 19 men and 11 women. Mean AHI was 51.7. Reported average bedtime was 10:00pm with average wake time 7:30am during the shutdown compared with a bedtime of 9pm and wake up time 6:30am. Patients reported having more time to sleep and required less naps during the day. Average PAP use during shut down was 7 hours 20 minutes and average PAP use prior to shutdown was 6 hours and 50 minutes. An average of 30 additional PAP minutes was observed among patients during the shelter in place order. Only one of our patients was diagnosed with COVID during this time period.ConclusionFor patients with OSA on PAP therapy we observed an increase in PAP use. Among patients suddenly required to shelter in place, we observed a delayed sleep onset and wake time of more than 1 hour, resulting in a slightly longer overall PAP use time. This circadian phase shift was greater among working patients compared to retired patients. The health effects of longer PAP use and circadian phase shifting remain to be determined.Support (if any):

443 Intervention Among PAP Users Newly Diagnosed with OSA Improves Long-term Adherence in Veterans with Sleep Apnea and PTSD

Abstract Introduction Obstructive sleep apnea (OSA) and PTSD are commonly comorbid in veterans. While PAP is the first line treatment for sleep apnea, adherence is low among veterans (Collen et al, 2012). Studies have shown early adherence predicts later adherence (Budhiraja et al, 2007). The current study investigates the impact of intervention on PAP adherence over time. Methods Thirty-seven veterans with comorbid OSA and PTSD from VA Palo Alto clinics were randomly assigned to either cognitive behavioral therapy (CBT-OSA) or an education arm and also received usual treatment at VA or outside clinics. Twenty-six completed the study. Participants received weekly, individual visits during the first four weeks of PAP treatment, three subsequent quarterly booster sessions, and a final visit at 12 months. PAP data was downloaded at each time-point; prior PAP use was coded. Results Significant mean differences in mask-on time between treatment arms after weekly treatments (Kinoshita et al., 2020) were not maintained at 12 months. Linear mixed modeling showed weekly improvement in mean mask-on time (minutes) over the treatment period (Education: estimate = 13.7, SE = 3.2, 95% CI 7.3, 20.1; CBT-OSA: estimate = 11.4, SE = 3.6, 95% CI 4.3, 18.5); no significant difference between arms (estimate = -2.3, SE = 4.7, 95% CI -11.5, 6.9). Newly diagnosed participants had significantly higher mean mask-on time than prior-PAP users at the end of weekly treatments (F[1, 35] = 17.86, p &amp;lt; 0.001) and at 12-months (F[1, 24] = 19.60, p &amp;lt; 0.001). Average mask-on time following weekly treatments was significantly correlated with average mask-on time at 12-months (r = 0.75; p &amp;lt; 0.001). Conclusion Consistent with prior research, findings suggest that newly diagnosed individuals benefit from weekly individual treatments, regardless of type, and maintain higher mask-on times at 12 months relative to prior PAP users. Early intervention when starting PAP treatment is important to support adherence, especially in patients with comorbid PTSD, a barrier to adherence in the veteran population. Support (if any) RR&amp;D Merit Grant, Department of Veterans Affairs (Grant Number 1I01RX001799-01A2); Sierra Pacific MIRECC