Compliance with nasal continuous positive airway pressure (cpap) in epilepsy and obstructive sleep apnea

Compliance with nasal continuous positive airway pressure (cpap) in epilepsy and obstructive sleep apnea

e96 Abstracts / Sleep Medicine 14S (2013) e93–e164 category) with a multilateral bedside scoring system wherein physicians with no training in sleep...

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e96

Abstracts / Sleep Medicine 14S (2013) e93–e164

category) with a multilateral bedside scoring system wherein physicians with no training in sleep medicine may be able to use in order to enhance the awareness of OSAH and expedite referrals to sleep medicine specialists and sleep laboratories. Materials and methods: Given known correlations of snoring, body mass index (BMI), Epworth Sleepiness Scale (ESS), Mallampati classification, and age with OSAH, we assigned simplified weighted values to the listed variable factors. The total Chan score is the sum of the weighted values that corresponds to each variable. Analyses of 315 patients (Male:Female – 175:140), picked at random with scored in-lab polysomnograms, were retrospectively correlated to individual factors and used to optimize the weighting of the Chan score. Ordinal regression analyses were carefully executed using AHI-categories (1 – AHI <5, 2 – AHI 5–14.99, 3 – AHI 15–29.99, 4 – AHI 30–49.99, 5 – AHI P50) to obtain values for interpretation. Results: We found that Age, ESS, Mallampati classification, BMI, and Snoring when analyzed individually proved to have less statistical significance in ordinal regression using AHI-categories (Age: pvalue < 0.00001, ESS: p-value = 0.10, Mallampati: p-value = 0.007, Snoring: p-value = 0.02, BMI: p-value < 0.00001) than the multilateral Chan score (p-value < 0.0000000001) which accurately predicted over 50% of the population’s AHI-category (1–5) exactly, and diagnosed over 80% of the population’s OSAH. Conclusion: Our scoring system, Chan score, predicts the presence and severity of OSAH at the bedside and correlated remarkably well with polysomnogram results. It is a simple, valuable clinical tool for physicians, who may have no training in Sleep Medicine, to quickly identify patients who may have OSAH and predict its severity. Acknowledgements: ROSALIA CABE, RPSGT for scoring the sleep tests.

than 4 h usage) was obtained via a monitoring card within the CPAP system. Results: Sixty-five epilepsy patients were identified, forty-one (65%) of which were diagnosed with concomitant OSA. Thirty-two patients from the control group and fourteen epilepsy patients met inclusion criteria. Mean age was 50.7 and 60.4 (p = 0.018), BMI was 32.3 and 32.4 (p = 0.48), Epworth Sleepiness Scale was 8.4 and 9.8 (p = 0.23), spontaneous arousal index 10.0 and 7.7 (p = 0.19), sleep efficiency was 80.7% and 78.7% (p = 0.35), optimal CPAP pressure was 11.4 and 10.6 cm H2O (p = 0.22), and AHI 30.2 and 41.0 (p = 0.075), in the epilepsy-OSA and OSA-only groups, respectively. One month compliance rates were 65.7% in epilepsy patients and 78.3% in the control group (p = 0.038), and 2 month compliance rates were 68.3% and 71.5%, respectively (p = 0.33). Conclusion: Short-term compliance rates were decreased in epilepsy patients with concomitant OSA, most notably within the first month after beginning CPAP. This study demonstrates the importance of providing early and aggressive support, in this particularly vulnerable group. Acknowledgements: We thank the staff at New York Sleep Institute for their dedication and support.

http://dx.doi.org/10.1016/j.sleep.2013.11.203

Introduction: Adequate flow support without oxygen desaturation is the main goal during titration test for continuous positive pressure support (CPAP). In addition to hypopnea or apnea, evidence has shown that correction of flow limitation without dropping of oxygen can improve the outcome of treatment for patients. However, mild flow limitation is hard to differentiate from normal flow. Cyclic alternating pattern (CAP) has been proposed to assess the stability of sleep which can be compromised in subjects with upper airway resistance syndrome or snoring. We hypothesized that CAP is also an important marker for determining optimal level of pressure during CPAP titration test. Materials and methods: The patients with severe obstructive sleep apnea (OSA) starting CPAP treatment after the titration test were screened and the levels of pressure of CPAP in the patients were re- evaluated annually for two years. For the patients with successful treatment (e.g. lowering the CPAP pressure) in first revaluation, they were enrolled to the study. After the second-year revaluation, those patients were subdivided into relapse and success groups. Conventional parameters including sleep efficiency, respiratory disturbance index (RDI), ratio of NREM stage 3 sleep, ratio of REM sleep, arousal index as well as alternative parameter, CAP rate, of those patients were calculated. Results: There were totally 23 subjects (N = 10 for relapse and N = 13 for success groups) recruited in this study. The age and body mass index did not differ between relapse and success groups during baseline (p > 0.05). All of the parameters were significantly improved after CPAP treatment for 1 year (p<0.05) compared to baseline. While other conventional parameters showed no differences between relapse and success groups, CAP rate was significantly higher in relapse group (29.7  21.6 vs 14.2  14.8, p = 0.036). Conclusion: Although the apnea and hypopnea events were significantly improved after CPAP treatment, some episodes of mild degree flow limitation might not be fully treated which

Compliance with nasal continuous positive airway pressure (cpap) in epilepsy and obstructive sleep apnea C. Cheng 1, V. Chiang 2, M. Bernbaum 1, E. Koziorynska 3, A. Rodriguez 4 1 Department of Neurology, NYU School of Medicine, United States 2 NYU School of Medicine, United States 3 Department of Neurology, SUNY Downstate Medical Center, United States 4 Department of Neurology, NYU School of Medicine, New York Sleep Institute, United States

Introduction: Obstructive sleep apnea (OSA) is prevalent in nearly a third of patients with epilepsy. Treatment with Continuous Positive Airway pressure (CPAP) is associated with improvement in seizure control. However, CPAP is often difficult to tolerate for various reasons, and it has been suggested that noncompliant patients with epilepsy and OSA are at higher risk of recurrent seizures than are CPAP-compliant patients. Our objective is to determine short-term compliance, which predicts long-term adherence, to CPAP therapy in patients with OSA and epilepsy. Materials and methods: We retrospectively identified patients with moderate to severe OSA (AHI P15) started on nasal CPAP between 2012–2013 at the New York Sleep Institute. We divided them into OSA-only (control) and epilepsy-OSA groups. Patients with history of non-epileptic seizures, poor compliance with anti-epileptic drugs, greater than ten seizures a day, diagnosis of epilepsy within the past six months, a significant history of medical, psychiatric or substance abuse, or a two month compliance rate of less than ten percent were excluded. CPAP compliance (defined as percent of days with greater

http://dx.doi.org/10.1016/j.sleep.2013.11.204

Using cyclic alternating pattern as a marker for cpap treatment in patients with obstructive sleep apnea C. Chen 1, C. Lin 1, C. Lin 2, M. Lo 2, C. Lai 1 1 Shin Kong Wu Ho-Su Memorial Hospital, Sleep Center, Taiwan 2 National Central University, Center for Adaptive Data Analysis, Taiwan