P371 Audit of a long-term population of patients on

nCPAP within a tertiary referral centre

C.A. Beckwith *

Stone Patricia A, Sleep Service, North West Lung

Centre, South Manchester Universities Hospitals Trust,

Wythenshawe Hospital Manchester, M23 9LT

Objectives: To gather information about the patientswho attended the service over a 12-month period.The aim was to examine the compliance betweentwo groups of patients, those patients who had acontinuous problem of obstructive sleep apnoea(OSA) and those who had a periodic/positional prob-lem of OSA.Material and methods: Data was collected over a 12-month period on 839 patients, all attending on theirannual appointment with the nurse specialist.Gender, age, length of time on treatment, compliance atfirst visit after commencing CPAP and compliance atcurrent visit, Epworth Sleepiness score before nCPAPand current score at this visit were noted.Results: Five hundred and eighty-six patients had a con-tinuous problem, 299 had a periodic/positional problem,and 24 had obesity hypoventilation. Epworth Sleepinessscore using paired t-test gave statistical analysis of a high-ly significant reduction in ESS in both groups (p < 0.001)90% compliance of 4 h or more usage was seen in the con-tinuous group which compares well with other publisheddata in the UK. In the periodic/positional group compli-ance was 74%. Indications are that those with a continu-ous problem of OSA are more likely to use nCPAP longterm and gain the best symptomatic response.Conclusions: The majority of patients attending our ser-vice are compliant with nCPAP treatment, and treatmentis effective. This compares well with other studies thathave been published with similar cohorts of patients. Thisgives us valuable insight into our long-term population ofpatients using n CPAP.

doi:10.1016/j.sleep.2006.07.180

P372 Upper airway obstruction may affect nasal contin-

uous positive airway pressure level

Kwon Hyo Bok, Hyo Yeol Kim *, Jin-Young Min, Seung

Kyu Chung, Hun-Jong Dhong, Young-Jun Chung

Samsung Medical Center, Sungkyunkwan University

School of Medicine, Department of Otorhinolaryngolo-

gy-Head, Republic of Korea

Objectives: Nasal continuous positive airway pressure(CPAP) is a useful and efficient treatment modality,but the patient’s compliance depends on several factorssuch as nasal CPAP level. The aim of this study was toevaluate the relationship between upper airway obstruc-

tion and nasal CPAP level in obstructive sleep apneasyndrome (OSAS).Subjects and methods: This retrospective study (fromAugust 1995 through May 2005) included 50 patientssuffering from OSAS with a mean apnea–hypopneaindex of 43.78/h, who underwent overnight polysom-nography, laboratory nasal CPAP, and acoustic rhi-nometry(AR) for the measurement of minimal cross-sectional area (MCA) of the nasal cavity. We comparedthe nasal CPAP level with the degree of anatomic upperairway obstruction including tonsil and palate grade,MCA, subjective symptoms, or body mass index(BMI).A single linear regression analysis was performed tocompare between the variables.Results: The mean nasal CPAP level was 6.32 ± 2.17cmH2O. We found a significant correlation betweennasal CPAP level and BMI (p < 0.01) and degree of ton-sil grade (p = 0.02). Furthermore, AR measurementscorrelated with nasal CPAP level(p = 0.025) in patientswith BMI < 25. The other variables such as subjectivesymptoms, palate grade, and anatomic nasal obstructionin obese patients (BMI > 25) revealed no correlationwith nasal CPAP level.Conclusions: Upper airway obstruction including nasalobstruction and tonsillar hypertrophy may increasenasal CPAP level. Correction of nasal obstruction andtonsillectomy may reduce the nasal CPAP level andincrease the patient’s compliance of nasal CPAP.

doi:10.1016/j.sleep.2006.07.181

P373 The clinical efficacy and comfort of modifiedAutoSetTM compared with standard AutoSetTM

Justin Chan 1,*, Colan Chan 1, Alison Hansford 2,

Jocelyn Yen 1, Chit Shu Chan 1,*

1 Sleep and Chest Disorders Centre, Sydney, Australia2 ResMed Ltd., North Ryde, Australia

Objectives: Modified AutoSet delivers bi-level pressure,with the pressure support level set for user comfort, andthe mean pressure determined by a modified AutoSet al-gorithm. This may increase patient comfort but may alsocause break through residual respiratory events. A studywas conducted to investigate the clinical efficacy and sub-jective comparison of comfort and satisfaction of modi-fied AutoSet compared to standard AutoSet.Materials and methods: Subjects diagnosed withobstructive sleep apnoea, established on AutoSet thera-py, were recruited to this randomized single blindedstudy. Subjects gave written informed consent. Subjectswere all previously using S7 AutoSet (ResMed Ltd)devices and ResMed masks. Subjects trialed the modi-fied AutoSet in standard AutoSet mode and in modifiedAutoSet mode, in a randomized order, for 7 nights in

Abstracts / Sleep Medicine 7 (2006) S1–S127 S75

each mode, in their own home. Subjects returned to thesleep center for each mode change and at that time: (1)had the modified AutoSet downloaded [apnoea–hypop-noea index (AHI), apnoea index (AI), hypopnoea index(HI), leak, pressures and usage data] and (2) completedsubjective questionnaires relating to comfort and satis-faction for that mode. Statistical analysis was performedusing a 2-sided paired T-test, p < 0.05 modified AutoSetvs standard AutoSet.Results: Nineteen subjects completed the study [16M:3F,mean age: 57 yr (37–85), mean Body Mass Index: 36.1 kg/m2 (25.9–45.3), mean initial Respiratory DisturbanceIndex: 59.6 events/h (24.3–100.9)]. There was no differ-ence between modified AutoSet and standard AutoSetwith respect to Average Usage, AHI, AI, HI, MaximumPressure and Median Leak. The majority of subjects ratedmodified AutoSet to be as, or more, comfortable and sat-isfying than standard AutoSet.Conclusion: Modified AutoSet was equivalent to stan-dard AutoSet in the efficacy of treatment. The majorityof subjects rated modified AutoSet to be as, or more,comfortable and satisfying than standard AutoSet.

doi:10.1016/j.sleep.2006.07.182

P374 3-Month CPAP treatment in a young male patient

with severe obstructive sleep apnoea syndrome – a quali-

tative case study from the couple’s perspective

Anders Brostrom 1,2,*, Peter Johansson 1,2,4, Jan Albers 5,

Jan Wiberg 5, Eva Svanborg 3, Bengt Fridlund 6

1 Department of Neurophysiology, University Hospital,

S-581 85 Linkoping, Sweden2 Department of Medicine and Care, Linkoping Univer-

sity, Faculty of Health Sciences, Linkoping, Sweden3 Department of Neuroscience and Locomotion, Faculty of

Health Sciences, Linkoping University, Linkoping, Sweden4 Department of Cardiology, Linkoping University Hos-

pital, Linkoping, Sweden5 Department of Internal Medicine, County Hospital

Ryhov, Jonkoping, Sweden6 School of Health Sciences and Social Work, Vaxjo

University, Vaxjo, Sweden

Objective: To explore and describe the experiences ofCPAP treatment in a young male patient with severeobstructive sleep apnoea syndrome and hypertensionduring a 3-month period from the couple’s perspective.Design and method description: An intrinsic single casestudy based on an embedded design with a phenomeno-graphic approach was employed. Conceptions were col-lected during a 3-month period by means of six semi-structured interviews with a 33-year-old male patientsuffering from hypertension and severe obstructive sleepapnoea syndrome, and his girlfriend. A one night sleep

respiratory recording was performed before treatmentwith an Auto-CPAP machine with humidifier and anasal mask was initiated.Results: Before CPAP treatment medical examinationsshowed AHI: 92; ODI: 64; BP: 155/110; BMI: 39. Fearfor apneas, load snoring, disrupted sleep, nocturia,excessive sleepiness, cognitive impairment, initial infor-mation about diagnosis, and a fear of death were stress-ors for both patient and spouse. Social relations werenegatively affected related to the patients’ tiredness, list-lessness and passivity to perform social activities and anunequal load of housework. It led to a strained relation-ship with risk for separation as described by the spouse.The couple described help from a friend to gainincreased awareness, initiation of diagnostic proceduresand information about OSAS, risk factors and treat-ment by a physician and CPAP-nurse as types of sup-port. After 2 weeks CPAP treatment with an initialcompliance rate of 4 h use/night fear of using the mask,a perceived lack of control over the breathing, physio-logical side effects of CPAP and a need to talk aboutCPAP treatment with strangers were perceived as stress-ors by the patient. Frustration over practical problemswas perceived as a stressor by the spouse. The patientfelt that social relations had improved related toincreased power of initiative, but the spouse describedthat decreased sexual lust and affection at bedtimecaused a hesitation about the future relationship.Tailoring of side effects, information about OSAS, riskfactors, motivation and compliance given by theCPAP-nurse, as well as acceptance of initial side effectsand an open attitude from spouse and others weredescribed as types of support. After 3-month CPAP

treatment compliance rates improved to almost 8 huse/night and earlier practical, psychosocial and physio-logical stressors became less important. To talk aboutCPAP with relatives and to travel and sleep in unfamil-iar environments were still described as stressors by thepatient, but a need for weight loss and a fear for cardio-vascular disease by both. The relationship had improvedwith increased participation in social activities and amore equal load of housework that led to increasedaffection and sexual lust as described by the spouse.Encouragement given by the spouse to increase physicaltraining, carry through dietary changes, as well as toadhere to treatment for hypertension were described astypes of support.Conclusions: An increased knowledge about experiencedstressors, effects on social relations, and types ofsupport, as described in this young couple, can helphealthcare personal to better understand causes for anon-compliant behaviour during different time framesof CPAP treatment.

doi:10.1016/j.sleep.2006.07.183

S76 Abstracts / Sleep Medicine 7 (2006) S1–S127