Sleep Disorders: Sleep Disorders 2 |

Ambulatory Management of Adaptive Servo-Ventilation: A Single-Site Experience FREE TO VIEW

Kaitlyn Fung, BS; John Rossettie, MD; Cameron Fung; Carl Stepnowsky, PhD; Tania Zamora, BS; Kathleen Sarmiento, MD
Author and Funding Information

University of California San Diego, San Diego, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1285A. doi:10.1016/j.chest.2016.08.1399
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SESSION TITLE: Sleep Disorders 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Ambulatory models of sleep testing and treatment for obstructive sleep apnea (OSA), which limit the use of in-lab polysomnography, have increased in recent years. Home sleep apnea testing and long-term therapy with auto-adjusting positive airway pressure (APAP) is a combined strategy recognized to reduce wait times, lower cost, and increase patient convenience. A subset of patients with OSA develop PAP emergent central sleep apnea and may benefit from a change in therapy to adaptive servo-ventilation (ASV). Traditionally in-lab titration is done to determine settings. This study sought to compare subjective and objective outcomes in patients who transitioned from APAP to ASV either in an ambulatory pathway (AM) or traditional in-laboratory pathway (IL).

METHODS: All patients on ASV therapy were identified within our clinical database (n=154). Patients were categorized as AM if they were empirically changed from APAP to ASV or as IL if they underwent titration to determine pressures. Chart review was done to obtain sleepiness scores, adherence and efficacy before and after the change to ASV. T-tests were used to compare change within each group from baseline to follow up, and to compare the means of both groups at baseline and follow up.

RESULTS: There were no differences between AM and IL patients related to gender, sleepiness score, compliance, or perceived benefit at baseline. Prior to ASV initiation, patients in both pathways had elevated residual apnea-hypopnea indices (mean AHI, AM 17.4/h, IL 22.4/h, p=0.041), clinically significant sleepiness scores (means, AM 9.7, IL 10.5, p=0.391) and excellent adherence with APAP therapy (mean percent days used AM 75.3%, IL 80.8%, p=0.325; mean average hours/day used AM 4.9h/d, IL 4.7h/d, p=0.733). Although both AM and IL pathways resulted in an improvement in residual AHI at first follow up, there was no difference between the groups in the overall mean reduction of the AHI (AM -9.6/h, IL -11.9/h, p=0.284). There was no overall change in perceived benefit in patients in either arm (p=0.372), though more patients endorsed feeling subjective benefit in the IL arm at first ASV follow up (p=0.045). There was no difference in sleepiness between AM and IL after ASV (p=0.542).

CONCLUSIONS: Results suggest transitioning patients from APAP to ASV can be done effectively in an ambulatory manner. This study did not select patients for either pathway based on comorbidities, and certain patient populations may still be more appropriate for IL transition. Future clinical trials are needed to clarify effectiveness and identify appropriate candidates for AM management of ASV.

CLINICAL IMPLICATIONS: Ambulatory management of ASV may reduce cost without compromising patient satisfaction or treatment efficacy.

DISCLOSURE: The following authors have nothing to disclose: Kaitlyn Fung, John Rossettie, Cameron Fung, Carl Stepnowsky, Tania Zamora, Kathleen Sarmiento

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