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Predictors of initial acceptance of continuous positive airway pressure (CPAP) in obstructive sleep apnea patients after intensive educational–behavioral program
Abstracts/Sleep Medicine 16 (2015) S2–S199
respectively. Following the RCMP sleep study, patients received a customised two-piece MAS with instructions to incrementally titrate the device over a 2-month acclimatisation period until maximum comfortable advancement limit is reached. Final protrusive limit is confirmed by the dentist and full night polysomnography with MAS in situ is performed to determine MAS treatment response (AHIMAS). Results: To date 15 RCMP studies have been completed (four females). Patients were on average 54.9 ± 13.1 years [ ± SD] and overweight (BMI 29.0 ± 2.7 kg m2) with AHI 30.4 ± 17.2 h−1 (7 severe, 4 moderate, 4 mild OSA). The RCMP device was not tolerated in one patient. Of the remaining 14 studies, based on the AHIsupineREM prediction rule, 7 are predicted “success”, 6 predicted “failure” and 1 “inconclusive” (no REM sleep). AHIRCMP was 7.9 ± 10.0 h−1 (n = 14) with 10/14 achieving maximum protrusion limit during the study night. Nine out of 14 patients achieved an AHIRCMP <5 h−1, 11/14 achieved AHIRCMP <10 h−1 with 50% reduction from baseline AHI and 13/14 achieved 50% reduction in AHIRCMP compared with baseline AHI. Two patients have completed a MAS sleep study to date, both were predicted “failure” based on the AHIsupineREM prediction rule. In one patient, AHIMAS was 9.5 h−1 compared with AHIRCMP 13 h−1 (baseline AHI 38.2 h−1) and in the other, AHIMAS was 13.5 h−1 compared with AHIRCMP 7.7 h−1 (baseline AHI 38.2 h−1). Conclusion: Preliminary work indicates tolerance of the RCMP study and reduced AHIRCMP and two MAS treatment completers have shown a >50% reduction in AHI as indicated by AHIRCMP. Work is ongoing to determine whether the addition of patient-specific phenotypic data can enhance the predictive ability of the RCMP methodology. Acknowledgements: Royal North Shore Hospital sleep laboratory staff and Zephyr Sleep Technologies, Calgary, Canada. http://dx.doi.org/10.1016/j.sleep.2015.02.507
Predictors of initial acceptance of continuous positive airway pressure (CPAP) in obstructive sleep apnea patients after intensive educational–behavioral program J. Pengjam 1, V. Tantrakul 2, W. Suwansathit 1 1 Ramathibodi Hospital Sleep Disorder Center, Thailand 2 Ramathibodi Hospital Sleep Disorder Center, Pulmonary and Critical Care Unit, Medicine Department, Ramathibodi Hospital, Mahidol University, Thailand
Introduction: Continuous positive airway pressure (CPAP) therapy is the most cost-effective treatment for obstructive sleep apnea (OSA) to-date. However acceptance for this treatment remained problematic for some patients, despite rigorous effort of trials. Materials and methods: A prospective observational study conducted at Ramathibodi Hospital Sleep Disorder Center, Bangkok, Thailand during 6 month period. Patients newly diagnosis with OSA, referred for the intensive educational–behavioral program were included. Prescription of CPAP was indicated if patients have AHI ≥ 15 events/hour, regardless of symptoms or AHI 5–15 with co-morbidity or symptoms. The intensive education–behavioral program comprised of educational program regarding OSA, its consequence and treatment with CPAP using audio-visual aids and hands-on demonstration. Behavioral modification and trials of CPAP were given each week, in which patients were allowed to use CPAP weekly at home for three trials. At the end of the program, patients decide by themselves whether or not to get their own machines. During each trial records of CPAP use and questionnaire
S195
assessment were performed. Data are shown as mean and standard deviation (mean ± SD) if they have normal distribution; nonnormal distribution is shown as median and interquartile range (median, IQR). Results: Two-hundred and forty seven OSA patients (62% male) were included with mean age 55.36 ± 13.0 years, and AHI [median, IQR 41.5 (46.4)]. Overall, 210 (85%) patients accepted CPAP with rates according to OSA severity of 89.8% in severe (AHI ≥ 30); 80.0% in moderate (AHI15–30); and 70.0% in mild (AHI 5–15) groups, respectively, p = 0.009. While only three patients refused to try any CPAP, rate of acceptance increased with number of CPAP trials (1-trial 77.5%; 2-trials 89.3%; and 3-trials 95.5%, p < 0.001). Financial coverage affected CPAP acceptance rates; government reimbursement (89.8%); self-affordable (91.3%); and no reimbursement (48.4%), p < 0.001. CPAP-acceptance and denial groups were similar with regard to gender (male 51.4% versus 64.8%), education level, age (55.85 ± 12.7 versus 52.6 ± 14.4 years), BMI (29.0 ± 5.9 versus 28.2 ± 5.8 kg/m2) and ESS (10.6 ± 4.8 versus 11.2 ± 5.1). However, CPAP-acceptance group had higher AHI [median, IQR 43.1 (46.5) versus 25.5 (42.1), p = 0.01] and lower minimum O2 desaturation (78.6 ± 11.1 versus 84.8 ± 8.5, p < 0.001). Multivariate analyses for predictors for CPAP acceptance were severe OSA odd ratio (OR) 4.1, 95% CI (1.20–13.88), p = 0.024, financial coverage (self-affordable OR 12.1, 95% CI (3.37–43.31), p < 0.001; government reimbursement OR 8.1, 95% CI (2.91–22.36), p < 0.001), and numbers of trials (two-trials OR 2.8, 95% CI (1.05–7.53), p = 0.04; three-trials OR 8.6, 95% CI (2.09–35.35), p = 0.003). Conclusion: Intensive educational–behavioral program resulted in high initial acceptance rate of CPAP in OSA patients. Multiple trials of CPAP should be offered as more success occurred with increasing numbers of trials. Predictors of CPAP acceptance were severe OSA and no financial shortage. Alternative OSA treatment should be available for CPAP-denial patients. Acknowledgements: We would like to express our appreciation to Prof. Aroonwan Preutthipan, Director of Ramathibodi Sleep Disorder Center, and Associate Professor Kanit Muntarbhorn. http://dx.doi.org/10.1016/j.sleep.2015.02.508
Different protein expression in the serum of Chinese patients with OSA Z. Wang, X. Wu, Q. Sun, Y. Lv, Y. Piao The First Hospital of Norman Bethune Medical College of Jilin University, China
Introduction: In order to study the differential protein expression in the serum of Chinese patients with obstructive sleep apnea (OSA), and their correlation to clinical syndroms and the parametre of PSG. Materials and methods: To establish a database to provide baseline information for the prospective study, we used iTRAQ technology (isobaric tags for relative and absolute quantification) in Northeast of China for a preliminary study. The subjects were divided into groups of non-OSA control group (apnea–hypopnea index, AHI <5) and the OSA group (AHI ≥ 5). OSA group were dividid into three subgroups accorrding to the severity of which: A: 5 < AHI < 15; B: 15 < AHI < 30; C: AHI ≥ 30). Blood samples were collected, packaged and frozen in −80 °C. Digestion, iTRAQ4plex labeling and mass spectrometric analysis of proteins were then performed (MALDI TOF/TOF). Subjects included 19 cases in the control group (age: 31–78 years old), 27 patients were included in the OSA group (age: 29–79 years of age). Select highly expressed
respectively. Following the RCMP sleep study, patients received a customised two-piece MAS with instructions to incrementally titrate the device over a 2-month acclimatisation period until maximum comfortable advancement limit is reached. Final protrusive limit is confirmed by the dentist and full night polysomnography with MAS in situ is performed to determine MAS treatment response (AHIMAS). Results: To date 15 RCMP studies have been completed (four females). Patients were on average 54.9 ± 13.1 years [ ± SD] and overweight (BMI 29.0 ± 2.7 kg m2) with AHI 30.4 ± 17.2 h−1 (7 severe, 4 moderate, 4 mild OSA). The RCMP device was not tolerated in one patient. Of the remaining 14 studies, based on the AHIsupineREM prediction rule, 7 are predicted “success”, 6 predicted “failure” and 1 “inconclusive” (no REM sleep). AHIRCMP was 7.9 ± 10.0 h−1 (n = 14) with 10/14 achieving maximum protrusion limit during the study night. Nine out of 14 patients achieved an AHIRCMP <5 h−1, 11/14 achieved AHIRCMP <10 h−1 with 50% reduction from baseline AHI and 13/14 achieved 50% reduction in AHIRCMP compared with baseline AHI. Two patients have completed a MAS sleep study to date, both were predicted “failure” based on the AHIsupineREM prediction rule. In one patient, AHIMAS was 9.5 h−1 compared with AHIRCMP 13 h−1 (baseline AHI 38.2 h−1) and in the other, AHIMAS was 13.5 h−1 compared with AHIRCMP 7.7 h−1 (baseline AHI 38.2 h−1). Conclusion: Preliminary work indicates tolerance of the RCMP study and reduced AHIRCMP and two MAS treatment completers have shown a >50% reduction in AHI as indicated by AHIRCMP. Work is ongoing to determine whether the addition of patient-specific phenotypic data can enhance the predictive ability of the RCMP methodology. Acknowledgements: Royal North Shore Hospital sleep laboratory staff and Zephyr Sleep Technologies, Calgary, Canada. http://dx.doi.org/10.1016/j.sleep.2015.02.507
Predictors of initial acceptance of continuous positive airway pressure (CPAP) in obstructive sleep apnea patients after intensive educational–behavioral program J. Pengjam 1, V. Tantrakul 2, W. Suwansathit 1 1 Ramathibodi Hospital Sleep Disorder Center, Thailand 2 Ramathibodi Hospital Sleep Disorder Center, Pulmonary and Critical Care Unit, Medicine Department, Ramathibodi Hospital, Mahidol University, Thailand
Introduction: Continuous positive airway pressure (CPAP) therapy is the most cost-effective treatment for obstructive sleep apnea (OSA) to-date. However acceptance for this treatment remained problematic for some patients, despite rigorous effort of trials. Materials and methods: A prospective observational study conducted at Ramathibodi Hospital Sleep Disorder Center, Bangkok, Thailand during 6 month period. Patients newly diagnosis with OSA, referred for the intensive educational–behavioral program were included. Prescription of CPAP was indicated if patients have AHI ≥ 15 events/hour, regardless of symptoms or AHI 5–15 with co-morbidity or symptoms. The intensive education–behavioral program comprised of educational program regarding OSA, its consequence and treatment with CPAP using audio-visual aids and hands-on demonstration. Behavioral modification and trials of CPAP were given each week, in which patients were allowed to use CPAP weekly at home for three trials. At the end of the program, patients decide by themselves whether or not to get their own machines. During each trial records of CPAP use and questionnaire
S195
assessment were performed. Data are shown as mean and standard deviation (mean ± SD) if they have normal distribution; nonnormal distribution is shown as median and interquartile range (median, IQR). Results: Two-hundred and forty seven OSA patients (62% male) were included with mean age 55.36 ± 13.0 years, and AHI [median, IQR 41.5 (46.4)]. Overall, 210 (85%) patients accepted CPAP with rates according to OSA severity of 89.8% in severe (AHI ≥ 30); 80.0% in moderate (AHI15–30); and 70.0% in mild (AHI 5–15) groups, respectively, p = 0.009. While only three patients refused to try any CPAP, rate of acceptance increased with number of CPAP trials (1-trial 77.5%; 2-trials 89.3%; and 3-trials 95.5%, p < 0.001). Financial coverage affected CPAP acceptance rates; government reimbursement (89.8%); self-affordable (91.3%); and no reimbursement (48.4%), p < 0.001. CPAP-acceptance and denial groups were similar with regard to gender (male 51.4% versus 64.8%), education level, age (55.85 ± 12.7 versus 52.6 ± 14.4 years), BMI (29.0 ± 5.9 versus 28.2 ± 5.8 kg/m2) and ESS (10.6 ± 4.8 versus 11.2 ± 5.1). However, CPAP-acceptance group had higher AHI [median, IQR 43.1 (46.5) versus 25.5 (42.1), p = 0.01] and lower minimum O2 desaturation (78.6 ± 11.1 versus 84.8 ± 8.5, p < 0.001). Multivariate analyses for predictors for CPAP acceptance were severe OSA odd ratio (OR) 4.1, 95% CI (1.20–13.88), p = 0.024, financial coverage (self-affordable OR 12.1, 95% CI (3.37–43.31), p < 0.001; government reimbursement OR 8.1, 95% CI (2.91–22.36), p < 0.001), and numbers of trials (two-trials OR 2.8, 95% CI (1.05–7.53), p = 0.04; three-trials OR 8.6, 95% CI (2.09–35.35), p = 0.003). Conclusion: Intensive educational–behavioral program resulted in high initial acceptance rate of CPAP in OSA patients. Multiple trials of CPAP should be offered as more success occurred with increasing numbers of trials. Predictors of CPAP acceptance were severe OSA and no financial shortage. Alternative OSA treatment should be available for CPAP-denial patients. Acknowledgements: We would like to express our appreciation to Prof. Aroonwan Preutthipan, Director of Ramathibodi Sleep Disorder Center, and Associate Professor Kanit Muntarbhorn. http://dx.doi.org/10.1016/j.sleep.2015.02.508
Different protein expression in the serum of Chinese patients with OSA Z. Wang, X. Wu, Q. Sun, Y. Lv, Y. Piao The First Hospital of Norman Bethune Medical College of Jilin University, China
Introduction: In order to study the differential protein expression in the serum of Chinese patients with obstructive sleep apnea (OSA), and their correlation to clinical syndroms and the parametre of PSG. Materials and methods: To establish a database to provide baseline information for the prospective study, we used iTRAQ technology (isobaric tags for relative and absolute quantification) in Northeast of China for a preliminary study. The subjects were divided into groups of non-OSA control group (apnea–hypopnea index, AHI <5) and the OSA group (AHI ≥ 5). OSA group were dividid into three subgroups accorrding to the severity of which: A: 5 < AHI < 15; B: 15 < AHI < 30; C: AHI ≥ 30). Blood samples were collected, packaged and frozen in −80 °C. Digestion, iTRAQ4plex labeling and mass spectrometric analysis of proteins were then performed (MALDI TOF/TOF). Subjects included 19 cases in the control group (age: 31–78 years old), 27 patients were included in the OSA group (age: 29–79 years of age). Select highly expressed