The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

POSITIVE AIRWAY PRESSURE (PAP) TREATMENT OF OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): PRELIMINARY RESULTS OF A NON- ATTENDED AMBULATORY PROTOCOL

Andrea Lanza1, Sara Mariani1, Lino Nobili1, Giovanna Beretta2, Maurizio Sommariva2; 1Department of Neuroscience, Niguarda Hospital, Centre of Sleep Medicine, Milan, Italy; 2Physical Therapy and Rehabilitation Centre, Niguarda Hospital, Milan, Italy

Backgrounds: Obstructive Sleep Apnea Syndrome (OSAS) occurs in about 4% of the adult population. OSAS increases the risk of road accidents, of coronary and cerebrovascular diseases. Therefore it is both medically and economically important to diagnose and treat OSAS patients. Positive Airways Pressure (PAP) is the cornerstone of therapy for OSAS however only 50% of patients use the prescribed device and about 30% of OSAS patients utilize PAP for less than 4 hours/night. Here we report the preliminary results of a non attended ambulatory protocol combined with an educational program aimed to increase the awareness on the benefits of PAP treatment and the ability to use PAP and interfaces. Patients and Methods: 65 consecutive patients: 54 M, 11 F; age 52.0 ± 11.6; Body Mass Index (BMI) 33.6 ± 8.0; Apnea-Hypopnea Index (AHI) 46.1 ± 23.4; Oxygen Desaturation Index (ODI) 42.9 ± 23.1; Mean SaO2 89.9 ± 4.4; Epworth Sleepiness Scale (ESS) score 10.2 ± 5.1. Diagnosis of OSAS was confirmed monitoring patients at home with a portable system including 6 channels: airflow, snoring, respiratory movements, SpO2, heart rate and body position. OSAS patients were assigned an Auto-CPAP treatment for four consecutive nights at home to determine the Continuous PAP optimal fixed pressure level. During the fifth night, monitored at home with a portable system, patients underwent CPAP treatment. Results: After the first night of CPAP treatment AHI was 5.5 ± 5.2, ODI 5.6 ± 5.7; mean SaO2 94.6 ± 2.0. Only three patient did not accept CPAP treatment. Five patients switched to a Bi-level and three to an Adaptive Servo Ventilation device. After one month of CPAP usage AHI was 4.7 ± 4.6, ODI 4.6 ± 4.7; mean SaO2 95.0 ± 1.7; ESS 4.9 ± 4.3; the amount of PAP utilization was 5.6 ± 1.9 hours/night. Only 14% of patients used PAP less than 4 hours/night. At the moment only 14 patients have reached 6 months of PAP treatment. In these patients AHI was 3.4 ± 3.1, ODI 3.3 ± 3.4; mean SaO2 95.9 ± 1.4; ESS 3.7 ± 2.9; the amount of PAP utilization was 5.9 ± 2.1. Conclusions: The current standards of practice for PAP titration in OSAS patients require overnight in-laboratory polysomnography, a costly and technically complex approach that presents scheduling difficulties considering the high demand. Our non attended PAP titration protocol seems to produce good results in terms of efficacy and compliance and at the same time it reduces the costs and the waiting list for treatment. Sponsored Research - None

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