CPAP compliance – the first year and beyond

CPAP compliance – the first year and beyond

e128 Abstracts / Sleep Medicine 14S (2013) e93–e164 CPAP compliance – the first year and beyond L. Fordyce 1, A. Siemens 2, R. Rousseau 1, E. Becerra...

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e128

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

CPAP compliance – the first year and beyond L. Fordyce 1, A. Siemens 2, R. Rousseau 1, E. Becerra 1 1 Sound Sleep Solutions Inc., Respiratory Homecare Solutions, Canada 2 Respiratory Homecare Solutions, Canada

Introduction: For moderate to severe obstructive sleep apnea, the most common treatment is the use of a Continuous Positive Airway Pressure (CPAP) or Automatic Positive Airway Pressure (APAP) device. This device ‘splints’ the patient’s airway open during sleep by means of a flow of pressurized positive air into the throat. Despite the effectiveness of this therapy, long-term compliance with CPAP/ APAP therapy has been difficult for many patients. The purpose of this study was to determine the CPAP/APAP compliance of patients after one year of starting on CPAP/APAP therapy. Materials and methods: Initially, patients were referred to private sleep diagnostic testing facilities (Respiratory Homecare Solutions {RHS}) by their primary care physician. Qualified professionals (RRTs and/or RPSGTs) completed Level III instruction and review of results (interpreted by a Board Certified Sleep Physician). If PAP therapy was prescribed, the patient was given a one month, Auto-CPAP (APAP) trial. During this APAP trial, patients were closely followed by a sleep clinician. At the start of the APAP trial, all patients were put on a wireless modem. This was done to monitor overall compliance and how the patient was doing on therapy. Each patient was given a phone call within 1–3 days of starting therapy. They were also scheduled and seen in office for a one month follow-up visit. If there were any problems that could not be addressed over the phone or via the modem, an office visit was scheduled in between this time. At the end of the APAP trial, patients were then scheduled to be seen again one month after they purchased. At this time, they were then given a 6 month follow-up phone call as well as a scheduled annual office visit the following year. At all office visits, the compliance card from the APAP machine was downloaded to obtain average hourly usage including compliance, the Apnea Hypopnea Index (AHI), and leak. The Epworth sleepiness scale (ESS) was also completed by the patient to assess their degree of sleepiness in comparison to their previous visit. Results: The results revealed that there were 73 female and 225 male patients (N = 298) that met inclusion criteria. There were 275/298 (92.3%) patients that completed their one month PAP trial. At the end of the one month therapy trial visit, patients showed continued therapy use for an average of 5.40 h a night for 93.0% of the time. At the one month post purchase visit, patients showed continued therapy use for an average of 6.51 h a night for 97.0% of the time. After one year, there were 201/275 (73.9%) patients (76 female and 125 male) still on PAP therapy. Conclusion: The preliminary results revealed that with close followup for APAP/CPAP patients, it is possible to obtain successful compliance of a minimum of 4 h/night, 70% of the time over a 30 day period. Our compliance for the 201 patients on APAP/CPAP after one year of PAP therapy was 6.33 h a night for 94.0% of the time. Acknowledgements: All sleep staff at Respiratory Homecare Solutions – Calgary. http://dx.doi.org/10.1016/j.sleep.2013.11.286

Optogenetic and pharmacogenetic probing of rapid eye movement (REM) sleep circuitry J. Fraigne 1, Z. Torontali 1, A. Adamantidis 2, J. Kim 3, J. Peever 1 1 University of Toronto, Dept. Cell & System Biology, Canada 2 McGill University, Douglas Institute, Canada 3 University of Toronto, Dept. Psychology, Canada Introduction: Rapid eye movement (REM) sleep is characterized by the activation of cortical electroencephalogram (EEG) and loss of

muscle tone (atonia). The exact neuronal circuit mediating the generation and timing of this state is not fully understood. The subcoeruleus (Sub-C) neurons are hypothesized to generate REM sleep and its characteristics. Here we aimed to determine how optogenetics and pharmacogenetic stimulation impacts REM sleep expression. Materials and methods: Study#1: To precisely control the neuronal activity of the Sub-C region, we bilaterally infused 200 nL of an adenoassociated viral vector (AAV) containing a light-sensitive opsin (AAVhsyn- hChR2(H134R)-eYFP) virus into the Sub-C of 4 mice. Animals were instrumented for EEG and EMG recordings. Neurons were stimulated with short blue light pulses (5 ms) at 1 and 10 Hz either independently of behavioral state or specifically during REM sleep. Study#2: To stimulate the Sub-C population for longer time periods, we bilaterally microinjected 400 nL of an AAV harboring a modified muscarinic G-protein coupled receptor (AAV-HSYN-HA-hm3D(Gq)IRES-mCitrine) into the Sub-C of 3 mice. Administration of clozapine-N-oxide (CNO, 5 mg/kg) activated neurons in the Sub-C. Only animals that had histological verification of ChR2 and hm3D(Gq) receptor expression in the Sub-C region were used for analysis. Results: We found that semi-chronic bilateral light activation of Sub-C neurons at 10 Hz, but not 1 Hz, triggered REM sleep-like EEG activity (theta, 4–8 Hz) during light stimulation, and increased EEG Theta power by 64 ± 16% compared to baseline. Under some conditions, light stimulation prolonged the duration of REM sleep episodes by almost 2-fold. Pharmacogenetic manipulation of the neurons in the Sub-C caused a change in behavioural phenotype where the distribution of EEG frequencies shifted towards a REM sleep-like pattern (theta, 4–8 Hz) independent of the behavioural state. Moreover, the average duration of REM sleep-like periods were greater than REM sleep periods under control condition (i.e., saline). Conclusion: These results support the hypothesis that the Sub-C region is involved in controlling REM sleep and its associated phenomena. Acknowledgements: This research was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC), the Canadian Institutes of Health Research (CIHR) and theCIHR Sleep and Biological Rhythms Toronto. http://dx.doi.org/10.1016/j.sleep.2013.11.287

Cognitive characteristics of children with narcolepsy A. Guignard-Perret 1, C. Inocente 1, S. Mazza 2, S. Bayard 3, V. Herbillon 1, P. Franco 1 1 Pediatric Sleep Unit, National Reference Center for Narcolepsy, Hôpital Femme Mère Enfant & Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, University Lyon 1, Lyon, France 2 Laboratoire EMC, Institut de Psychologie, Université Lyon 2, France 3 Inserm U1061, Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France

Introduction: To conduct a descriptive analysis of cognitive characteristics in children and adolescents with narcolepsy. Materials and methods: Clinical and electrophysiological characteristics of de novo patients from the Pediatric Lyon’s Reference Center for narcolepsy were collected from 2008 to 2013.Due to the high frequency of school difficulties, intellectual ability (WISC-IV, full scale, verbal comprehension index (VCI), perceptual reasoning index (PRI), processing speed index (PSI), working memory index (WMI)) was usually proposed after the diagnosis.Some of these children were already treated at this time with stimulants (modafinil or methylphenidate). Results: The cohort included 56 children (35 boys) with a median age of 12 years (range 5–17) (51.7% < 10 years).All children