0546 USE OF WIRELESS MODEM TECHNOLOGY FOR CPAP TREATMENT OF OSA IN VETERANS WITH TBI AND PTSD

Abstract

Introduction: Initiation and adherence to positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) can be challenging, especially among Veterans with neuropsychiatric conditions such as traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). We hypothesized that wireless modems with telehealth follow- up would improve initiation and adherence to PAP therapy in these populations. Method(s): Participants were consented from the VA Portland Health Care System Sleep Disorders Clinic over 18-months during the overnight sleep study. Midway through the study, the clinic changed from usual care-a clinic visit at 3 months after machine issue-to wireless modems with PAP therapy plus telephone follow-up at 9 days, 4 weeks, and 3 months after machine issue. Symptom data were assessed at baseline, 3, and 6 months using validated questionnaires on insomnia (ISI) and mood (PHQ-9, PCL-5). Result(s): Among 603 Veterans consented, 82.8% were diagnosed with OSA. Some receiving PAP therapy had no evidence of initiating use ("non-users": 23.2% usual care versus 11.3% modems). Those with PTSD and comorbid TBI+PTSD were more likely to be non-users (X2 = 9.52, P < 0.05). Adherence to therapy at 3 months was not significantly different between TBI, PTSD, or TBI+PTSD versus neither condition, and was not significantly different between modem and usual care. There was not a significant difference in symptom severity at 3 or 6 months between modem and usual care. Insomnia and depression were significantly worse at 3 and 6 months in those with untreated OSA compared to those on PAP therapy (ISI: t = 2.07, P < 0.05; PHQ- 9, t=2.83, P < 0.01). Conclusion(s): Our data suggests greater initiation of PAP therapy using modem technology with telehealth compared with usual care. Veterans with PTSD and TBI+PTSD are more likely to be non-users compared to those without PTSD. Early interventions addressing barriers to adherence in those with PTSD may be warranted. Trajectory and regression analyses of other factors that affect adherence are ongoing.