1071 Does Significant Central Sleep Apnea and Periodic Breathing on Home Sleep Apnea Testing Require In-Laboratory Positive Airway Pressure Titration?

Abstract

Introduction: Driven by long wait times, limited access, and patient preference, home sleep apnea testing (HSAT) is accepted as an alternative to level 1 PSG for diagnosing obstructive sleep apnea (OSA) in adults with a moderate-to-high pretest probability for OSA who do not have comorbid conditions which require level 1 PSG. Patients who have a HSAT positive for OSA (REI ≥ 5/h TRT) can then be prescribed an auto-adjusting CPAP device (APAP). Some patients empirically prescribed APAP will have residual REI on compliance downloads. Most bothersome are residual central sleep apnea (CSA) and periodic breathing (PB). The focus of this study was to evaluate whether CSA and PB on HSAT predicted later need for level 1 PAP titration. Methods: Retrospective study of a deidentified population of veterans in the Albuquerque New Mexico VA Health Care System. HSAT (Apnealink) was recorded using Airview software, automatically scored and over-read by two board-certified sleep physicians. Retrospective review then done of Sleep Center Database and Electronic Medical Records after receiving IRB approval. Identified those who had central apnea index (CAI) >;5/h total recording time (TRT), response to PAP, and whether level 1 PSG was needed. Results: Between January and July 2017, 1,021 consecutive HSATs were recorded: with a 2-night HSAT failure rate of 1.3% (n= 13), 12.3% (n= 126) had REI <5, and 11.7% (n=119) had CAI >; 5. The Mean CAI in this group was 16.6 (range 5-74.5). Patients with periodic breathing or CAI greater than 15/h on HSAT were more likely to later require in-lab titration for the treatment of CSA, and may provide guidance in treatment. Conclusion: In patients determined as appropriate for HSAT testing, a portion of these patients will be found to have CSA and may not be appropriate for home titration with APAP. CAI is now being used to guide treatment following HSAT regarding when to perform an in-lab titration due to central apneas.