B. Clinical Sleep Science II. Sleep-Related Breathing

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Jun 1, 2018 - tion during a) resting breathing, b) HNS, and c) CPAP pressures of. +10 cmH2O applied by a full facemask. Sagittal slices were recon- structed ...
B. Clinical Sleep Science

II. Sleep-Related Breathing Disorders

of the sleepiness symptom as falling asleep in soporific situations and can replace the ESS when necessary. Support (If Any): -

0507 EFFECT ON RETRO-PALATAL AND RETRO-GLOSSAL DIMENSIONS WITH PRESSURE FORCING COMPARING TO HYPOGLOSSAL NERVE STIMULATION Elshebiny T, Strohl K, Palomo J Case Western Reserve University, Cleveland, OH Introduction:  The retro-palatal and retro-glossal regions are considered the most common collapsible regions of the upper airway. These regions are affected by the more selective active treatment- unilateral hypoglossal nerve stimulation (HNS)- as well as by CPAP, which improves patency using internal airway forces. The aim of this study was to compare volumetric effects on both regions induced by HNS vs. CPAP. Methods:  Seven adult patients (4M, 3F: age range 39 to 68 year) with moderate or severe OSA who had HNS (Inspire Medical Systems, Maple Grove, MN) had cone beam CT collected in the seated position during a) resting breathing, b) HNS, and c) CPAP pressures of +10 cmH2O applied by a full facemask. Sagittal slices were reconstructed from 3D volumes and linear measurements were performed in both regions. Reconstruction algorithms calculated volumes for the total upper airway. Results:  HNS significantly increased the retro-palatal and retro-glossal regions 29% (from 6.60 to 8.5 mm, p0.018) and 51 % (from 7.01 to 10.64 mm, p 0.018) respectively, with the total airway volume increasing 48% (from 29.5 to 43.6 cc p 0.02). A pressure of 10cmH2O produced increases the retro-palatal and retro-glossal regions 21% (from 6.60 to 8.04mm, p0.018) and 51 % (from 7.01to 10.62mm, p 0.018) respectively. With the total airway volume increasing +36% (from 29.5 to 37.8 cc p 0.02). Conclusion: HNS and positive pressure have a similar effect on opening of the collapsible regions of the upper airway and total upper airway volume. Any difference between retro-palatal and retro-glossal regions with HNS appeared to parallel differences in airway compliance. Support (If Any): VA Medical Service, University Hospitals Cleveland Medical Center, Inspire Medical Systems.

0508 SLEEP APNEA AND ATRIAL FIBRILLATION - PHENOTYPE AND OUTCOMES Erhardt P, Thomas S, Gunn S, Thomas RJ Beth Israel Deaconess Medical Center, Boston, MA Introduction: Sleep apnea, especially central (CSA), is associated with atrial fibrillation (AF). We hypothesized that AF patients are at high risk for treatment-emergent/complex apnea, and residual disease during long-term therapy with positive airway pressure. Methods:  The sleep laboratory database at the Beth Israel Deaconess Medical center and affiliated services was queried, focusing on patients with AF, to extract polysomnographic information. The BIDMC Online Medical Records was used to collect co-morbid information. Residual apnea and related information was extracted from the EnocreAnywhere database; at the BIDMC, tracking is life-long, enabling assessment of outcomes beyond 6 months. Results:  Three hundred and eighteen patients had complete clinical/ polysomnographic data, and 212 were reviewed in EncoreAnywhere. Split night was 31%. Summary statistics: age 68.3 ± 11.1 years, 69.1% male, BMI 33.6 ± 8 Kg/M2, ejection fraction 53.5 ± 10.8 A189

(22% less than 50%), hypertension 68.6%. Baseline total sleep time (TST): 181.4 ± 116.3 minutes, sleep efficiency 62.9 ± 19.3 %, N1 24.3 ± 21.5% TST, N3: 9.7 ± 13.9 % TST, RDI: 39.4 ± 21.7, AHI4% 8.2 ± 11.9, minimum saturation 81.8 ± 10 %. Titration data: TST: 242 ± 98.9 minutes, sleep efficiency 66.9 ± 19.8 %, N1: 18 ± 15.2 %, RDI 27 ± 21.6, AHI4% 5 ± 8.5, minimum saturation 85.4 ± 6.9 %. CSA was noted in 4% on baseline, and treatment-emergent/complex apnea in 30%. The mean duration of use of positive airway pressure (93% continuous) was 21 ± 3 months, mean use 4.1 ± 2.1 hours. Residual AHI-flow was 11.6 ± 7.8 / hour of use, and periodic breathing of at least 10 minutes duration on visual waveforms inspection in 76.4 %. Conclusion:  Patients with AF have highly fragmented sleep during diagnostic and titration polysomnograms. Complex sleep apnea is common, as is residual sleep apnea and periodic breathing on waveforms. This likely reflects persistently elevated loop gain. AF patients with sleep apnea are at high risk for reduced treatment effectiveness, and may require a dedicated phenotype-driven clinical pathway for optimal management. Support (If Any): Beth Israel Deaconess Medical Center Chief Academic Officer’s Innovation Grant.

0509 IMPACT OF AUTOMATED WEB-EDUCATION AND CPAP TELE-MONITORING ON CPAP ADHERENCE AT 3 MONTHS AND 1 YEAR: THE TELE-OSA RANDOMIZED CLINICAL TRIAL Chang J1, Kim J1, Becker K1, Benjafield A2, Crocker M2, Woodrum R1, Arguelles J1, Derose S3, Hwang D1 1 Kaiser Permanente, Fontana, CA, 2ResMed Science Center, San Diego, CA, 3Kaiser Permanente, Pasadena, CA Introduction: The Tele-OSA study is a 4-arm randomized clinical trial evaluating the impact of two telemedicine mechanisms (OSA web education [Emmi, Emmi Solutions Inc] and; CPAP tele-monitoring with automated patient feedback [U-Sleep; ResMed Corp]) on CPAP adherence. Methods: This 4-arm randomized clinical trial was conducted at Kaiser Permanente sleep center (Fontana, CA) in patients referred for suspected OSA and appropriate for home sleep apnea testing; if indicated, CPAP was ordered with cellular connectivity. Patients were randomized into: 1) Traditional pathway (usual care); 2) Education pathway (usual care + web education); 3) Tele-monitoring pathway (usual care + automated patient feedback messaging via text/email/ phone triggered by CPAP data); 4) Both pathway (usual care + web education and tele-monitoring). CPAP adherence was compared at 3 months and 1 year. Results: 556 patients were prescribed CPAP (58.5% males; mean age 50.5 ± 12.1, BMI 34.5 ± 7.7, AHI 31.9 ± 25.8). There were no differences in baseline characteristics among the four groups. 90-day CPAP compliance (Medicare) was: Traditional 53.5%; Education 60.7%; Tele-monitoring 65.6%; Both 73.2%. Both groups receiving tele-monitoring had significantly better CPAP use compared to Traditional (Tele-monitoring pathway p=0.05; Both p