0562 Evaluation of Habitual Sleep Duration and PAP Adherence to Quantify Effective AHI Reduction at Home in Older Adults

Abstract Introduction Any consequence of OSA treatment with PAP is likely to depend on baseline OSA severity and adherence to PAP in relation to habitual sleep duration. These variables can be combined to evaluate 1) the degree of effective residual AHI and 2) the degree of effective reduction in the AHI. We sought to characterize both of these outcomes in older adults newly diagnosed with OSA. Methods We recruited 19 patients (ages 55-85) from the Mount Sinai Integrative Sleep Center with a diagnostic PSG or WatchPAT showing AHI4% > 15/hour and willing to initiate PAP therapy. PAP adherence was obtained via remote monitoring after 3 months of use, and habitual sleep duration was obtained with 3-19 days of wrist actigraphy (ActiGraph). To account for differences between the AHI4% and the PAP-generated residual AHI, the AHI4% on PAP was considered 0/hour when the PAP-generated AHI was ≤5/hour or 5 units below the PAP-generated AHI when >5/hour. The effective residual AHI was defined as: ([AHI4% on PAP x usage hours] + [diagnostic AHI4% x (habitual sleep duration – usage hours)]) / (habitual sleep duration). Effective AHI4% reduction = diagnostic AHI4% - effective residual AHI4%. Wilcoxon signed rank tests were used to compare diagnostic AHI4% to the effective residual AHI4%. Results Mean age was 63±1.4 years, 37% were female, with mean BMI 33±1.7 and mean Epworth Sleepiness Score 6.5±0.7. Average habitual sleep duration was 5.8±0.3 hrs and average PAP use duration was 3.4±0.6 hrs. The median effective residual AHI4% was 9±20/hour, which was significantly lower than the diagnostic AHI4% (27±20/hour, p=0.002). The median effective AHI4% reduction was 15±23/hour, reflecting a mean 54±9% reduction from the baseline diagnostic AHI4%. Patients using PAP ≥ 6hrs (n=4) had an effective residual AHI4% of 1±2/hour (median diagnostic AHI4%: 29±24/hour), whereas patients using PAP < 2hrs (n=7) had an effective residual AHI4% of 24±17/hour (median diagnostic AHI4%: 24±37/hour). Conclusion This pilot study presents a characterization of the effective residual AHI and degree of effective AHI reduction in older sleep clinic patients prescribed PAP therapy. These values may be useful when considering health-related consequences of OSA treatment. Support (if any) R01AG066870, RF1AG083975, R01AG080609, R01AG082278, R01AG056682