Positive Airway Pressure Compliance Research Articles

Challenges of Positive Airway Pressure Treatment for Patients With Obstructive Sleep Apnea at a Veterans Medical Center.

Positive airway pressure (PAP) compliance is important in treating obstructive sleep apnea. Previous studies have suggested that patients with economic burdens, discomfort using machines, and insufficient education have difficulty tolerating PAP machines. This study explored the factors affecting short-term adherence to PAP in a veterans medical center. The medical records of patients who underwent polysomnography at the Veterans Health Service Medical Center, Seoul, Republic of Korea, between July 2018 and January 2021 were reviewed retrospectively. Patients with an apnea-hypopnea index (AHI) ≥15 were included (n=579). PAP adherence was defined as continuous use for ≥21 days for ≥4 hours daily for 30 consecutive days for 90 days from the date of PAP prescription. The PAP-adherent group (n=265, age 66.16±11.28 years) was younger and had more years of education, higher body mass indices, and lower scores in the Insomnia Severity Index and Beck Depression Inventory-II (BDI-II) than those of the PAP-nonadherent group (n=314, age 68.93±10.91 years). Patients who tolerated PAP had a higher AHI, longer duration of oxygen desaturation (less than 90%), and less dream enactment behavior (DEB) than that in those who did not. After adjusting for age, years of education, BDI-II, duration of oxygen desaturation, and presence of DEB, there were more patients with National Health Insurance (NHI) in the PAP-adherent group than in the PAP-nonadherent group (p<0.001). We showed that patients with NHI recorded significantly higher adherence compared to that in patients without NHI, among other factors.

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

Positive Airway Pressure Therapy Compliance in Patients With Comorbid Insomnia and Sleep Apnea.

This study aimed to compare positive airway pressure (PAP) therapy compliance between patients with comorbid insomnia and sleep apnea (COMISA) and those with obstructive sleep apnea (OSA) alone. It also assessed the influence of insomnia clinic visits on PAP compliance. Patients diagnosed with OSA and initiated on PAP therapy between January 2012 and December 2021 were included. The COMISA group (n=43) comprised patients with insomnia, while the control group (n=86) consisted of OSA patients without insomnia, matched 1:2 based on age and sex. COMISA patients were further categorized into group A (n=20), with at least two insomnia clinic visits, and group B (n=23) with one or no visits. PAP compliance in each group was evaluated at 3 and 9 months. No significant differences were observed in PAP compliance between the COMISA patients and OSA patients without insomnia. Within the COMISA group, the impact of insomnia clinic visits on PAP compliance was not significant. No significant difference was observed in daily PAP usage between the two groups at 3 months (265.5±145.9 minutes in group A vs. 236.3±152.3 minutes in group B, P=0.760) or 9 months (213.4±155.3 minutes in group A vs. 166.3±158.3 minutes in group B, P=0.538). The percentages of PAP users and nights with PAP use exceeding 4 hours also showed no significant differences at either time point. This study demonstrated no significant disparity in PAP compliance between the COMISA and OSA groups at either 3 or 9 months. Furthermore, insomnia clinic visits did not significantly impact PAP compliance in COMISA patients during 3- and 9-month intervals.

Continuous positive airway pressure compliance in patients with mild cognitive impairment.

Sleep apnoea (SA) is associated with accelerated cognitive decline in patients with mild cognitive impairment (MCI). Treatment of SA by continuous positive airway pressure (CPAP) may slow this decline if patients comply with the treatment. The aim of this study was to assess the rate of CPAP compliance in this population. In this single-centre retrospective study conducted in a tertiary care institution, patients with a diagnosis of MCI and SA initiating CPAP between January 2015 and August 2021 were included. Data from the initial sleep recording, the 3-month follow-up and compliance with at least 12months of CPAP were analysed. Compliance was defined as an average CPAP use of at least 4h per night. 55 patients were included (49% women, age 70.7 ± 8.9years, body mass index 28.9 ± 6.5kg/m2). Aetiology of MCI was vascular (45.5%), psychiatric (12.7%) and related to Alzheimer's disease (7.3%), with 47.3% of amnesic disorders and 45.5% of dysexecutive disorders. The MiniMentalState score was 26.7 ± 3.1. SA was mostly obstructive (81.8%) with a mean apnoea-hypopnoea index of 41.1 ± 16.4/h. At 3months, 38 patients were compliant (69%) with a CPAP median use of 5.9h per night and 83% of nights. Self-reported tolerance was better in compliant patients (75.7% vs 38.5% p = 0.017). Thirty-four patients remained compliant at 12months (62%). Our results suggest a high rate of CPAP compliance in patients suffering from MCI. Compliance was related to the device tolerance, emphasizing the need to closely monitor and improve this factor.

Mortality in obstructive sleep apnea syndrome (OSAS) and overlap syndrome (OS): The role of nocturnal hypoxemia and CPAP compliance

BackgroundObstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two chronic diseases that afflict many individuals worldwide with negative effects on health that may overlap in Overlap Syndrome (OS). The aim of our study was to investigate the differences in mortality between OSAS alone and OS and the risk factors involved. MethodsThe study was conducted on patients with OSAS or OS diagnosis that completed 15-year follow-up between 2005 and 2023. Of these, the clinical, functional, sleep and survival data were registered and analysed. Risk factors were found by regression analysis. Results501 patients (428 OSAS and 73 OS) were enrolled. Patients with OS had higher mortality than OSAS (p < 0,001). The morality risk factors for the overall population found were age >65 years (odds ratio (OR) = 10.69 (95%CI 3,85–29,69), p < 0,001) and low forced-expiratory volume in 1-s (FEV1) (OR = 10.18 (95%CI 2,32–44,68), p = 0,002). In patients with OSAS, age and nocturnal hypoxemia (NH) (OR = 2.41 (95%CI 1,07–5,41), p = 0,03) were risk factors, while adherence to nighttime positive airway pressure (PAP) reduced mortality (OR = 0,36 (95%CI 0,15–0,83), p = 0,017). Multivariate analysis confirmed age and FEV1 as risk factors in OS. Conversely, the risk factors for the overall population under 65 years were NH, which is confirmed in patients with OSAS alone (OR = 4,72 (95%CI 1,07–20,77), p = 0,04) in whom, on the other hand, PAP compliance reduced the mortality risk. ConclusionsThe study suggests that NH is a risk factor for all-cause mortality in sleep disorders by excluding the age; conversely, nighttime PAP improves the survival.

Positive airway pressure treatment affects respiratory symptoms and gastro-oesophageal reflux: the Icelandic Sleep Apnea Cohort Study.

To study the effect of positive airway pressure (PAP) treatment on nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms among clinical obstructive sleep apnoea (OSA) patients. 822 patients newly diagnosed with OSA referred for PAP treatment were recruited. 732 patients had a 2-year follow-up visit with continuous PAP compliance data (366 full PAP users, 366 partial/non-PAP users). They answered questionnaires, including reporting of nGOR, sleep and respiratory symptoms and general health. Patients with nGOR symptoms once a week or more were defined as "with nGOR". Those without nGOR symptoms and nGOR medication were defined as "no nGOR". Others were defined as "possible nGOR". At 2-year follow-up, PAP treatment among full users resulted in decreased nGOR (adjusted OR 0.58, 95% CI 0.40-0.86) and wheezing (adjusted OR 0.56, 95% CI 0.35-0.88) compared with partial/non-PAP users. Decreased nGOR, among both full and partial/non-users of PAP treatment, was associated with a decrease in productive morning cough (adjusted OR 4.70, 95% CI 2.22-9.99) and a decrease in chronic bronchitis (adjusted OR 3.86, 95% CI 1.74-8.58), but not decreased wheezing (adjusted OR 0.90, 95% CI 0.39-2.08). A mediation analysis found that PAP treatment directly led to a decrease in wheezing, not mediated through nGOR. Conversely, PAP treatment decreased productive cough mediated through a decrease in nGOR. In an unselected group of OSA patients, PAP treatment for 2 years was associated with a decrease in nGOR and respiratory symptoms. The PAP treatment itself was associated with less wheezing. A decrease in nGOR through PAP treatment was associated with a decrease in productive cough.

Effect of positive airway pressure compliance on laryngopharyngeal reflux in obstructive sleep apnea patients

ObjectivesTo determine the effect of continuous positive airway pressure (CPAP) compliance on symptoms and signs of laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA).ResultsThirty patients were included. The participants were divided into good compliance (n = 21) and poor compliance (n = 9) groups. After 6-month CPAP treatment, the reflux symptom index score significantly decreased in both the good compliance group (20 (17,24) vs. 14 (10,18), p < 0.001) and the poor compliance group (21 (18,25) vs. 10 (5,16), p < 0.05). Reflux finding score was significantly reduced in both the good compliance group (8 (6,9) vs. 4 (3,5), p < 0.001) and the poor compliance group (6 (4,8) vs. 3 (2,4), p < 0.05). However, there were no statistically significant differences between the groups. CPAP treatment reduces the symptoms and signs of LPR. However, CPAP compliance does not correlate with improvement in LPR in patients with OSA.

730-P: Effects of Obstructive Sleep Apnea Treatment on Whole-Body and Adipose Tissue Insulin Sensitivity—Role of Senescence and Mitigation by Adjuvant Metformin Therapy

Introduction: Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to high type 2 diabetes risk. Positive airway pressure (PAP) therapy is the standard of care for OSA, but it inconsistently improves glucose homeostasis. Senescent cells are common in adipose tissue (AT) of patients with OSA and may impair insulin signaling. However, the effects of PAP therapy on AT senescence are not known. Addition of metformin, an insulin-sensitizer with anti-senescent effects, may be a good adjuvant therapeutic strategy to improve glycemic control in patients with OSA. Methods: We randomly assigned 16 nondiabetic participants with OSA (Mean± SD; age: 50.9 ± 6.7 y, BMI: 36.5 ± 2.9 kg/m2) in a 1:1 ratio to receive either 2g metformin or placebo daily along with PAP therapy for 3 months in a double-blind pilot study. Whole body and AT insulin sensitivity was determined by 2h oral glucose tolerance test (OGTT). AT biopsy was obtained to estimate tissue insulin signaling and senescence. Results: The metformin and placebo groups had comparable age, BMI and OSA severity at baseline. PAP compliance was 38% and 75% in the metformin and placebo groups, respectively. Matsuda Index, glucose area under the curve (2h AUC), and free-fatty acid suppression at baseline and follow-up were not different in metformin or placebo treated groups. Compared to baseline, insulin AUC and insulin to glucose AUC ratio during OGTT was unchanged in the metformin but increased in the placebo group. Metformin, but not placebo, was associated with increased insulin mediated AKT phosphorylation and decreased senescence biomarkers (p21 and MCP1) in AT during the follow-up visit. Conclusion: Metformin, as adjunct to PAP therapy, attenuated insulin rises during OGTT, improved AT insulin signaling, and lowered senescence biomarkers in OSA patients. Larger trials of longer treatment duration are needed to determine if metformin can prevent diabetes in OSA patients. Disclosure S. Rodrigues: None. W.S. Dantas: None. R.A. Beyl: None. R.C. Hebert: None. I. Griffith: None. M. Tanksley: None. E.C. Mader: None. J.P. Kirwan: None. C.L. Axelrod: None. E. Ravussin: Research Support; Eli Lilly and Company, Novartis AG. Advisory Panel; Novartis. P. Singh: None. Funding National Institutes of Health (P30DK072476, U54GM104940); CAPES (88887.470405/2019-00 to S.R.)

0974 Limitations of Hypoglossal Nerve Stimulation in Patients with Down Syndrome

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep disorder affecting up to 80% of people with Down Syndrome (DS). Tonsillectomy and adenoidectomy (T&amp;A) are commonly utilized as the first line of treatment of OSA in patients with DS. However, even after T&amp;A, OSA can persist in up to 60% of patients. Positive airway pressure (PAP) compliance is low in patients with DS, limiting treatment efficacy. Hypoglossal nerve stimulation (HNS) is FDA-approved for the treatment of select adult patients with OSA. Limited research is available on HNS in people with DS; however, the limited data suggests that HNS may be a safe and effective treatment in this patient population. We describe two cases of patients with DS and HNS with unique challenges with treatment. Report of case(s) Case 1: A 36-year-old male with a history of DS presented for follow-up after activation of the HNS. The patient had been living part-time in a group home. While the patient’s mother thought he was using HNS every night, the download from the remote showed 41% usage over a three-week time frame. With further investigation, it was determined that the device was turned on the nights when the patient was at home with his parents, but not when he was at the group home despite detailed caregiver education. Case 2: A 19-year-old male with OSA and DS returned for a follow-up of his HNS. Upon exam, the patient’s HNS was already “on” in clinic, which the mother was unaware of. Download from the remote showed a usage time of 13+ hours, and the HNS was commonly “on” into the afternoon well after the patient had left for school in the morning, indicating that the HNS was commonly left on while the patient was awake. Despite significant education, the caregiver was not correctly turning the HNS off. Conclusion HNS offers a therapeutic alternative in patients with DS, who are refractory to T&amp;A and PAP. The success of the treatment is dependent on multiple factors, including therapy mechanics, patient tolerance, and caregiver education/compliance. Additional caregiver instruction may be necessary to ensure optimal use. Support (if any)

0925 Population Health and Data Analytics as an Opportunity for Improving Care Quality in Sleep Medicine

Abstract Introduction The volume and diversity of sleep-related and quality of life complaints in sleep medicine has increased through improved availability of data from wearables and public education on sleep health. Future shifts away from quantity and towards quality-based compensation by insurance payors will require practices to understand and actively monitor population health and outcomes data and implement data-driven practices to improve diagnostic efficiency. Currently, prevalence and population health data benchmarks are incomplete or absent in many aspects of sleep disorders treatment. The integrated care model of sleep medicine, with board-certified primary sleep physicians, an in-house Positive Airway Pressure (PAP) Therapy clinic and certified sleep medicine Dentist, is uniquely positioned to improve care by characterizing the impact of clinical decision-making on care cost and quality. Methods Population health data was gathered in the course of patient care in the integrated care model. Baseline/Diagnostic Home Sleep Apnea Test (HSAT) results from 2018-2021 were included. Diagnostic severity was categorized based on AASM treatment guidelines. Matched therapy visits were included from PAP Therapy Initiation or Compliance visit and treatment outcomes, as well as non-PAP treatments for sleep-disordered breathing, Oral Appliance (OA) and Inspire Therapy. Results 20% of 8531 Diagnostic HSAT results were non-diagnostic for sleep apnea, 35% were Mild, 21% Moderate and 24% Severe. Of non-diagnostic tests, 81% had no sleep apnea treatment associated. Of Mild diagnostic tests, 49% had associated PAP initiation or compliance, 9% had associated OA, and 42% had no treatment associated. The relationship between diagnostic severity and associated treatment was significant (Χ2 &amp;lt; 0.0001). Further, Moderate and Severe resulting diagnostic tests had no associated treatment in 24% and 28% of cases, respectively. Conclusion Sleep medicine patients are commonly symptomatic and often have major quality of life complaints. Yet as these data demonstrate, there is a substantial proportion of patients who do not have an associated treatment after a positive diagnostic home sleep apnea test. Future studies should include additional demographic and follow up data to better understand care pathways both for patients who receive a positive diagnostic test but pursue alternative treatment methods, as well as more complicated non-diagnostic sleep disorders patients. Support (if any)

Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.

The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials.

Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients. We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms. PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included. Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005). At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.

Compliance After Re-Prescription for Positive Airway Pressure in Obstructive Sleep Apnea Patients Who Failed Positive Airway Pressure Therapy

Background and Objectives: Little is known about studies evaluating positive airway pressure (PAP) compliance after re-prescription. Therefore, the aim of this study was to investigate PAP compliance after re-prescription in obstructive sleep apnea (OSA) patients who failed initial PAP therapy.Methods: We retrospectively reviewed OSA patients who had received a re-prescription for PAP from March 2020 to June 2021. We compared the compliance rate between initial prescription and re-prescription for PAP and investigated the reasons for PAP failure after the first prescription.Results: A total of 10 consecutive OSA patients (mean age=45.6±13.7 years and male:female=8:2) who received a re-prescription for PAP were included. Of them, 8 patients (80%) met the compliance criteria (i.e., Korean National Health Insurance criteria) for PAP after re-prescription. The compliance rate increased from 36.3±18.2% (initial prescription) to 61.3±28.8% (re-prescription); this was not of statistical significance (p=0.074). PAP/mask-related discomfort was the most common reason for PAP failure, followed by nasal obstruction, unintentional mask removal, and pressure-related discomfort.Conclusion: Even if initial PAP therapy fails, the proportion of patients who meet the compliance criteria may be improved through various forms of clinical aid and support after re-prescription of PAP.

Abstract 13554: Effect of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Heart Failure Patients With Reduced Ejection Fraction - Implications for Healthcare Resource Utilization

Introduction: Obstructive sleep apnea (OSA) is common in heart failure, although the impact of OSA treatment remains unclear. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and heart failure with reduced ejection fraction (HFrEF). Methods: Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFrEF were used to measure the association of PAP adherence and a composite clinical outcome of hospitalization and emergency room (ER) visits. US Medicare defines PAP compliance as usage of the device for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met these criteria for all 4 90-day periods, while PAP non-adherent patients did not meet these criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels. Results: The study cohort consisted of 3,182 eligible patients (69.9% male, mean age 59.7 years) of whom 39% were considered adherent to PAP therapy (29% intermediate-adherent, 31% non-adherent). In the year after PAP prescription, after propensity score matching, PAP adherent patients had fewer hospital visits than non-adherent patients, driven by a 24% reduction in ER visits for adherent patients (Table 1a). These results remained consistent with inverse probability weighting and furthermore showed there were no statistically significant differences between intermediate-adherent and non-adherent patients for any outcome (Table 1b). Conclusions: Treating OSA with PAP therapy in patients with HFrEF is associated with a reduction in the composite outcome of hospitalization and ER visits, driven primarily by a reduction in ER visits. Consistent adherence to PAP therapy is required to realize these benefits.

Abstract 11028: Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Heart Failure Patients With Preserved Ejection Fraction - Implications for Healthcare Resource Utilization

Introduction: Heart failure patients with preserved ejection fraction (HFpEF) frequently have co-morbid obstructive sleep apnea (OSA), although the impact of OSA treatment remains unclear in this patient population. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and HFpEF. Methods: Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to measure the association of PAP adherence and healthcare resource utilization, defined by hospitalizations and emergency room (ER) visits. US Medicare defines PAP compliance as use for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met this criteria for all 4 90-day periods, while PAP non-adherent patients did not meet this criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels. Results: The study cohort consisted of 4,237 eligible patients (54.0% female, mean age 64.1 years), of whom 40% were considered adherent to PAP therapy (30% intermediate-adherent, 30% non-adherent). After propensity score matching on prior year covariates, during the year after PAP prescription, PAP adherent patients had fewer hospital visits than non-adherent patients, with a 57% reduction in hospitalizations and a 36% reduction in ER visits for PAP adherent patients (Table 1a). These results remained consistent with inverse probability weighting, and furthermore showed a significant difference in hospitalizations between intermediate-adherent and non-adherent patients, but no significant difference in ER visits (Table 1b). Conclusions: Treating OSA with PAP therapy in patients with HFpEF is associated with a reduction in hospitalizations and ER visits. Adherence to PAP therapy is required to realize these clinical benefits.

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review.

Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.

Predictors for short-term and long-term automatic PAP compliance.

Positive airway pressure (PAP) is considered a standard treatment for obstructive sleep apnea (OSA), but there are compliance issues. As compliance to PAP tends to decrease with time, it is necessary to consider reasons affecting compliance at each period. Therefore, this study aimed to define factors affecting short-term and long-term compliance to PAP therapy. One hundred eighty-seven patients with OSA who started PAP treatment between July 2018 to March 2020 were included. Acceptance and compliance rates were monitored. Demographics, polysomnography (PSG) profiles, cephalometric data, and physical examination results were analyzed to identify factors predictive of PAP compliance at short-term (3 months) and long-term (12 months) periods. The acceptance rate of PAP was 92.5%. Compliance at 3 months and 12 months was 79.1% and 51.3%, respectively. Higher apnea-hypopnea index (odds ratio [OR] 1.018, P = .049) and older age (OR 1.032, P = .039) were predictive factors of good automatic PAP (APAP) compliance at 3 months. However, long-term compliance was affected by the percentage of duration with O2 desaturation of < 90% (CT90; OR 1.032, P = .011) and baseline self-reported symptom scores such as nasal obstruction (OR 0.819, P = .038) and awakening (OR 0.796, P = .045). In PAP use, indicators of OSA severity such as apnea-hypopnea index affect short-term compliance. On the other hand, the mandibular plane to hyoid distance and self-reported symptoms such as nasal obstruction and awakening can affect long-term compliance. Park SI, Kim BK, Lee KE, Hong SD, Jung YG, Kim HY. Predictors for short-term and long-term automatic PAP compliance. J Clin Sleep Med. 2023;19(1):17-26.

Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer.

PurposeObstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity.DesignSingle center cross-sectional study.MethodsSixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance.ResultsNo significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping.ConclusionsOSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

Protocolizing perioperative OSA screening and management: moving in the right direction.

Protocolizing perioperative OSA screening and management: moving in the right direction.

0820 Sleep and Oculopharyngeal Muscular Dystrophy: disease progression affecting ventilatory needs and treatment of sleep-disordered breathing

Abstract Introduction Oculopharyngeal muscular dystrophy (OPMD) is an autosomal-dominant, late-onset, and progressive disease characterized by ptosis and dysphagia, sometimes proximal limb weakness and gait abnormalities. It often presents in patients in their 50s. The progressive functional decline of the pharyngeal muscles results in feeding difficulties and aspiration; however, patients may also have risk of nocturnal hypoventilation and sleep apnea, complicated by variable airway obstruction and compliance. Report of Cases: Using retrospective chart review, we identified patients with a known diagnosis of OPMD treated at the Raymond G. Murphy VA Sleep Center. We present a case where OPMD progression necessitated increased ventilatory support and affected positive airway pressure (PAP) compliance. A 58-year-old male with OPMD, DMT2, depression, and memory impairment underwent home sleep apnea testing showing severe OSA (REI 32.7, SpO2 nadir 72%). He started Auto-PAP 6-16 cwp and presented to discuss issues tolerating PAP. Pressures were lowered, but he continued to require maximum pressures without increased utilization. An in-lab CPAP titration showed treatment-emergent centrals but did not find optimal pressures due to limited sleep time. Having failed CPAP, he returned for an ASV titration which controlled his apnea in lateral position. Patient was switched to auto ASV to increase efficacy and comfort. Two months later he discontinued ASV due to frustration with disease progression and feeling unable to breathe deeply with the machine. Nocturnal oxygen at 1L was ordered while he awaited Neurology consult for OPMD. Later, concerned about progressive dyspnea, he resumed ASV, now with 3L O2 bleed. Given suspicion of hypoventilation (bicarbs 27-30), and that ASV could not adjust to his continually changing airway tone with his OPMD, he was switched to iVAPS. This resulted in good control of his sleep apnea, tidal volumes and minute ventilation. However, he reported pressures felt too high, returned to ASV for a period, then discontinued PAP altogether. Conclusion Patients with OPMD and sleep apnea require close follow-up as their disease progression may affect their ventilatory support needs. These patients may require more complex PAP modalities, such as AVAPs, and routine PFTs to help determine timing of ENT involvement for surgical airway planning. Support (If Any)