0558 Upper Airway Stimulation In US Veterans With Obstructive Sleep Apnea With And Without Insomnia: A Preliminary Study

Abstract

Insomnia is a common comorbidity in veterans with obstructive sleep apnea (OSA) known to interfere with adherence to PAP. However, whether insomnia symptoms (INS) influence adherence to upper airway stimulation (UAS) therapy in US veterans with OSA is unknown. Our aim was to better understand the influence of INS on 1) OSA symptoms following treatment and 2) UAS adherence.Twenty veterans were selected using the STAR clinical trial criteria. The following sequence was followed: UAS implantation, sub-therapeutic activation of UAS, titration with PSG and post-treatment follow up. Each of these procedures occurred 1 month apart. Data collection occurred at 3 timepoints: 1) Baseline 2) UAS titration night and 3) 1-month post-treatment. Data collected at each time point included Sleep Diaries (SD) Insomnia Severity index [ISI], Epworth Sleepiness Scale [ESS], Fatigue Severity Scale [FSS], and Functional Outcomes of Sleep Questionnaire [FOSQ]. Objective UAS adherence was obtained PSG night and post-treatment. Those with baseline sleep efficiency < 85% from SD were categorized as INS. Repeated measure ANOVA were used to compare differences due to insomnia status over the timepoints.Twenty veterans (95% male, age 55 ± 12, body mass index 29 ± 3 kg/m2) with mean AHI of 37 (± 17) participated. Eleven veterans had INS. For ESS, FSS, ISI, FOSQ, both groups showed similar improvements from baseline to titration night. However, results diverged after the titration. Symptoms in those without INS continued to improve following titration but those with INS experienced dampened improvements. Although not statistically significant, a large effect size for adherence was observed between veterans with and without INS (-5.8 hrs/weekly; p=.037; partial eta2=0.05) indicating less use in subjects with INS.Veterans with INS appear to be less adherent to UAS than those without INS. Although not statistically significant, large effect sizes were observed for UAS adherence and blunted improvements in subjective sleep measures with optimally titrated UAS in this small sample. Larger studies are needed comparing UAS outcomes in veterans with INS.None