SESSION TITLE: Aftermath of OSA and Its Treatment
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM
PURPOSE: Obstructive sleep apnea syndrome (OSA) is a well-established risk factor for a variety of medical conditions, and there is mounting evidence that treatment of OSA may reduce this risk. Despite the growing number of novel treatments for OSA, continuous positive airway pressure (CPAP) remains the gold standard. Newer generation CPAP machines have the ability to monitor not only compliance but also the degree of residual, untreated respiratory disturbances. We sought to determine the accuracy of the apnea-hypopnea index (AHI) as measured by CPAP machines when studied simultaneously with a home sleep testing device in patients suspected of having incompletely treated OSA.
METHODS: Over a 9 month period, 48 patients with OSA underwent a single night of home sleep testing using the WatchPAT 200 (Itamar Medical, Israel) while simultaneously using CPAP. All patients were tested because of clinical suspicion of incompletely treated OSA despite CPAP use. Clinical criteria for this suspicion included significant weight gain, residual daytime sleepiness or new or worsening medical comorbidities such as hypertension, diabetes, arrhythmias or thromboembolic disease. CPAP data reports were evaluated for pressure settings, usage (days per week and hours per night), AHI, and degree of air leak. WatchPAT data included recording time, total sleep time, sleep staging, total AHI, REM-related AHI, respiratory disturbance index (RDI), and pulse oximetry parameters.
RESULTS: The CPAP machine registered an AHI in the normal range (mean AHI 2.4, range 0.2-5.5) for all 48 patients. Simultaneous WatchPAT testing revealed that 15 patients had an elevated AHI (mean 10.9, range 5.1-21.9) and RDI (mean 16.4, range 6.9-32.7). In 7 patients, the REM-related AHI ranged from 15 to 32, and in 7 patients oxygen saturation fell below 88% (range 80-87%). There was no correlation between these discrepancies and the use of auto or fixed pressure settings, patient age, gender or BMI, baseline OSA severity, machine brand, duration of CPAP use or overall CPAP compliance.
CONCLUSIONS: We found significant differences in the degree of untreated OSA as determined by CPAP machines in comparison to simultaneous use of a home sleep testing device. Based on our findings, home sleep testing may be useful to evaluate patients using CPAP when there is clinical suspicion of incompletely treated OSA.
CLINICAL IMPLICATIONS: CPAP machines may be inaccurate in determining optimal treatment pressures, which may have significant clinical implications for patients with OSA.
DISCLOSURE: The following authors have nothing to disclose: Matthew Epstein, Jacquelyn Costanzo, Christine Dunne, Federico Cerrone, Robert Capone
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