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P376 Elective tracheostomy is an alternative treatment in patients with severe OSAS and CPAP failure
Abstracts / Sleep Medicine 7 (2006) S1–S127
P375 Auto servo-ventilation in patients with obstructive sleep apnea syndrome and periodic breathing–A pilot study Wolfgang Galetke *, Kerstin Richter, Norbert Anduleit, Winfried Randerath Bethanien Hospital, Solingen, Germany Objectives: To evaluate auto servo-ventilation in patients with obstructive sleep apnea and periodic breathing. Design: Pilot study. Material and methods: Patients with a combination of obstructive sleep apnea and periodic breathing, defined as >20% of all respiratory events, were eligible for this study. After a diagnostic polysomnography patients were treated for one night with auto servo-ventilation (BiPAPÒ autoSV, Respironics, Murrysville, PA) and then discharged. After 6 weeks of treatment at home a full-in laboratory reevaluation was performed. Results: Fifteen male patients were enrolled (age 65.0 ± 11.9 years, body mass index 27.7 ± 6.9 kg/m2). Baseline apnea/hypopnea index (AHI) was 43.1 ± 21.2 / h, arousal index 27.8 ± 23.7 /h, snoring 99.7 ± 72.1 min/night and time <90% oxygen saturation 38.0 ± 37.7 min. With auto servo-ventilation AHI was 8.6 ± 5.7 /h at the fist night and 7.4 ± 5.3 /h after 6 weeks (p < 0.001 vs. baseline). Snoring was 0.2 ± 0.2 min and 1.0 ± 0.9 min, respectively (p < 0.001 vs. baseline). Arousal index decreased to 3.6 ± 1.8 /h after 6 weeks (p < 0.001 vs. baseline). Mean EPAP was 7.8 ± 2.3, mean IPAP mininum 8.7 ± 2.7 and mean IPAP maximum 16.1 ± 2.2 cm H2O. Conclusion: Auto servo-ventilation (BiPAPÒ autoSV) is a suitable treatment option for patients with obstructive sleep apnea syndrome and attendant periodic breathing. doi:10.1016/j.sleep.2006.07.184
P376 Elective tracheostomy is an alternative treatment in patients with severe OSAS and CPAP failure N. Browaldh 1,*, M. Lysdahl 2, A. Markstro¨m 2, D. Friberg 1 1
Department of ENT, Karolinska University Hospital, Sweden 2 Respiratory Unit, Danderyd University Hospital, Karolinska Institute, Sweden Objectives: To evaluate elective tracheostomy as a treatment of severe obstructive sleep apnea (OSAS) in obese patients. Outcomes were changes in daytime sleepiness and nocturnal respiration as well as compliance and complication rate. Materials and methods: Retrospectively, medical records from 2002 to 2005 were analyzed. Eight men, median age 55 years (range 33–77), Body Mass Index (BMI) 39 (range 33–50), median oxygen desaturation index (ODI) 75 (55–99) fulfilled the criteria: acceptance of elective tra-
S77
cheostomy, excessive daytime sleepiness, failure of CPAP-treatment and palatopharyngeal surgery (UPPP) considered too risky to perform or useless to attempt. Six of the men were hypertonic and four had had stroke or myocardial infarction. All were tracheostomized using a standard cannula, which was converted to a custommade after 2 weeks. Patients underwent monthly controls. Median follow up time to first sleep registration was 3.5 (1–23) months. Results: Five men reduced ODI, from median 63 (55–91) to 4 (1–14), and Epworth sleepiness scale (ESS) from median 19 (13–23) to 2 (0–6). Two of these five responders were operated with UPPP a year later, were cured and could thereafter be decannulated. One 77-year old hemiplegic man did not undergo a second sleep study, but still has cannula and is clinically a responder. Two non-responders did not reduce their ODI and were both decannulated. One was treated successfully with bi-level CPAP and the other remains untreated. The BMI was unchanged in all but one patient who reduced his BMI from 37 to 29 and later underwent UPPP. Post-operative complications such as severe cough, sputum infections and stoma granuloma were seen in all patients. Inspiratory bronchial collapse was observed during fiberendoscopy in one non-responder. Conclusion: Elective tracheostomy was an effective treatment in six of eight patients, four with permanent cannula and two with temporary. We recommend it as a final alternative in patients running risks of cardiovascular complications or airway obstruction after UPPP. doi:10.1016/j.sleep.2006.07.185
P377 Compliance of five years usage of continuous positive airway pressure for severe sleep apnea/hypopnoea syndrome Igor Jurikovic * Clinic of Respiratory Medicine and Chest Surgery, Prague, Czech Republic Objectives: Up to now are only patients with severe sleep apnoea hypopnoea syndrome treated by continuous positive airway pressure (CPAP) in the Czech republic. We wanted know what is the compliance of treatment of patients after five years. Materials and methods: During two years 1999 and 2000 we commenced CPAP therapy in 51 patients. The diagnoses was made by means of device MESAMIV. The determination of CPAP pressure was performed by AutoCPAP during one night in sleep laboratory. The controls were recommended to all patient by written and oral form. Results: We found in 24 patients with compliance more then 6 h per night five years, 12 patients did not come for check-up since the initiation of treatment, 8 patients came only during first year of treatment and mostly com-
P375 Auto servo-ventilation in patients with obstructive sleep apnea syndrome and periodic breathing–A pilot study Wolfgang Galetke *, Kerstin Richter, Norbert Anduleit, Winfried Randerath Bethanien Hospital, Solingen, Germany Objectives: To evaluate auto servo-ventilation in patients with obstructive sleep apnea and periodic breathing. Design: Pilot study. Material and methods: Patients with a combination of obstructive sleep apnea and periodic breathing, defined as >20% of all respiratory events, were eligible for this study. After a diagnostic polysomnography patients were treated for one night with auto servo-ventilation (BiPAPÒ autoSV, Respironics, Murrysville, PA) and then discharged. After 6 weeks of treatment at home a full-in laboratory reevaluation was performed. Results: Fifteen male patients were enrolled (age 65.0 ± 11.9 years, body mass index 27.7 ± 6.9 kg/m2). Baseline apnea/hypopnea index (AHI) was 43.1 ± 21.2 / h, arousal index 27.8 ± 23.7 /h, snoring 99.7 ± 72.1 min/night and time <90% oxygen saturation 38.0 ± 37.7 min. With auto servo-ventilation AHI was 8.6 ± 5.7 /h at the fist night and 7.4 ± 5.3 /h after 6 weeks (p < 0.001 vs. baseline). Snoring was 0.2 ± 0.2 min and 1.0 ± 0.9 min, respectively (p < 0.001 vs. baseline). Arousal index decreased to 3.6 ± 1.8 /h after 6 weeks (p < 0.001 vs. baseline). Mean EPAP was 7.8 ± 2.3, mean IPAP mininum 8.7 ± 2.7 and mean IPAP maximum 16.1 ± 2.2 cm H2O. Conclusion: Auto servo-ventilation (BiPAPÒ autoSV) is a suitable treatment option for patients with obstructive sleep apnea syndrome and attendant periodic breathing. doi:10.1016/j.sleep.2006.07.184
P376 Elective tracheostomy is an alternative treatment in patients with severe OSAS and CPAP failure N. Browaldh 1,*, M. Lysdahl 2, A. Markstro¨m 2, D. Friberg 1 1
Department of ENT, Karolinska University Hospital, Sweden 2 Respiratory Unit, Danderyd University Hospital, Karolinska Institute, Sweden Objectives: To evaluate elective tracheostomy as a treatment of severe obstructive sleep apnea (OSAS) in obese patients. Outcomes were changes in daytime sleepiness and nocturnal respiration as well as compliance and complication rate. Materials and methods: Retrospectively, medical records from 2002 to 2005 were analyzed. Eight men, median age 55 years (range 33–77), Body Mass Index (BMI) 39 (range 33–50), median oxygen desaturation index (ODI) 75 (55–99) fulfilled the criteria: acceptance of elective tra-
S77
cheostomy, excessive daytime sleepiness, failure of CPAP-treatment and palatopharyngeal surgery (UPPP) considered too risky to perform or useless to attempt. Six of the men were hypertonic and four had had stroke or myocardial infarction. All were tracheostomized using a standard cannula, which was converted to a custommade after 2 weeks. Patients underwent monthly controls. Median follow up time to first sleep registration was 3.5 (1–23) months. Results: Five men reduced ODI, from median 63 (55–91) to 4 (1–14), and Epworth sleepiness scale (ESS) from median 19 (13–23) to 2 (0–6). Two of these five responders were operated with UPPP a year later, were cured and could thereafter be decannulated. One 77-year old hemiplegic man did not undergo a second sleep study, but still has cannula and is clinically a responder. Two non-responders did not reduce their ODI and were both decannulated. One was treated successfully with bi-level CPAP and the other remains untreated. The BMI was unchanged in all but one patient who reduced his BMI from 37 to 29 and later underwent UPPP. Post-operative complications such as severe cough, sputum infections and stoma granuloma were seen in all patients. Inspiratory bronchial collapse was observed during fiberendoscopy in one non-responder. Conclusion: Elective tracheostomy was an effective treatment in six of eight patients, four with permanent cannula and two with temporary. We recommend it as a final alternative in patients running risks of cardiovascular complications or airway obstruction after UPPP. doi:10.1016/j.sleep.2006.07.185
P377 Compliance of five years usage of continuous positive airway pressure for severe sleep apnea/hypopnoea syndrome Igor Jurikovic * Clinic of Respiratory Medicine and Chest Surgery, Prague, Czech Republic Objectives: Up to now are only patients with severe sleep apnoea hypopnoea syndrome treated by continuous positive airway pressure (CPAP) in the Czech republic. We wanted know what is the compliance of treatment of patients after five years. Materials and methods: During two years 1999 and 2000 we commenced CPAP therapy in 51 patients. The diagnoses was made by means of device MESAMIV. The determination of CPAP pressure was performed by AutoCPAP during one night in sleep laboratory. The controls were recommended to all patient by written and oral form. Results: We found in 24 patients with compliance more then 6 h per night five years, 12 patients did not come for check-up since the initiation of treatment, 8 patients came only during first year of treatment and mostly com-