0516 Effectiveness of Positive Airway Pressure Treatment in Veterans with Moderate to Severe Obstructive Sleep Apnea

Abstract

Introduction: Obstructive Sleep Apnea (OSA) is prevalent in Veterans leading to adverse cardiovascular outcomes. The effectiveness of Positive Airway Pressure (PAP) treatment is not well understood. We examined changes in functional outcomes, 24-hour blood pressure profile and sympathetic nervous system activity with 3-months PAP treatment in Veterans with OSA and hypertension. Method(s): Veterans with hypertension and moderate-to-severe OSA (Respiratory Event Index [REI] >=15/hour on type 3 Home Sleep Apnea Test) were enrolled in a trial that tested the effects of PAP therapy on blood pressure. Habitual sleep duration (average Total Sleep Time; TST) was measured by Actigraphy over 3?10 days. Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), psychomotor vigilance test (PVT), 24-hour Ambulatory Blood Pressure (ABP), Central Aortic Blood Pressure (CABP) and 24-hour urine cathecolamine levels (dopamine, epinephrine, and norepinephrine) were assessed at baseline and 3 months of Autoadjusting PAP treatment. Paired t-Tests or Wilcoxon sign rank tests were used to compare 3-month changes in ESS, FOSQ, PVT, ABP, CABP and urine cathecolamine levels. STATA version 14 was used for analyses. Result(s): Veterans (n=145) with age mean (standard deviation [SD]) 52.8 [10.5], Body Mass Index 34.6 [5.8] kg/m2 and REI 31.6 [18.6]/ hour were included. Majority were men (n=133, 91.7%) and African- American (n=95, 65.5%). Participants were on average 1.5 [1.2] antihypertensive medications and 6 people had changes in their medications during the follow-up. Overall PAP usage was 2.68 [2.16] hours/day. At 3 months, ESS, FOSQ, and frequencies of the lapses were improved and sleep duration increased (vs. baseline, p<0.05). No changes were observed in blood pressure measurements (nocturnal blood pressure dipping, 24 hours and wake systolic, diastolic and mean arterial, and sleep systolic and diastolic) or urine cathecolamine levels. Conclusion(s): PAP treatment for 3 months improved subjective and objective sleepiness, and functional outcomes in Veterans with moderate- to-severe OSA.