0522 A Novel Wake-sensing CPAP Technology For Patients With PTSD And OSA

Abstract

Introduction: OSA is common in PTSD, often confounded by poor CPAP adherence with diminished response to therapy. Sensawake is a wake‐sensing CPAP algorithm that lowers pressure when wake is detected. We compared CPAP with and without Sensawake for co‐morbid OSA/ PTSD. The primary outcome was CPAP adherence at four and eight weeks. Secondary outcomes assessed sleep symptoms. Methods: This is a prospective, randomized, single blind, crossover study, comparing standard autoCPAP to autoCPAP with Sensawake. We enrolled OSA/PTSD patients who were CPAP naïve. Four weeks after randomization, patients crossed over to the other treatment group, with final follow‐up at eight weeks. Patients completed clinical sleep questionnaires (ESS, ISI, FSS, FOSQ‐10) at baseline and follow‐up. Results: We enrolled 85 patients with PTSD/OSA newly initiating CPAP. 54 subjects completed the study. The population was predominantly male with mild OSA and groups were similar at baseline. CPAP reduced the AHI effectively to <5/h in both groups. Intention to treat analysis (ITT) of Sensawake, adjusted for differences in ESS at baseline and PAP leak, was associated with significant increase in hours used per total nights (ß = 1.28 (95% CI: 0.02 ‐ 2.54); p = 0.047), and trends toward improvements in hours per nights used (ß = 0.89 (95% CI: ‐0.03 ‐ 1.8); p = 0.057), percentage nights used (ß = 17.2 (95% CI: ‐ 2.2 ‐ 36.6); p = 0.08) percentage nights used > 4 hours (ß = 16.8 (95% CI: ‐ 2.6 ‐ 36.2); p = 0.09) and adequate adherence (OR = 6.9 (95% CI: 0.7 ‐ 61.8); p =0.09). ESS, ISI, and FSS decreased by 3.0 ± 5.0 (p < 0.001), 4.7 ± 4.5 (p < 0.001), and 8.2 ± 11.1 (p < 0.001) respectively. The FOSQ10 increased by 4.3 ± 7.4 (p = 0.001). There were no differences in magnitude of improvement in any score between groups. Conclusion: Adherence to CPAP with Sensawake is significantly improved compared to standard therapy. Sensawake is non‐inferior to standard care for normalizing the AHI and improving sleep related symptoms and quality of life.