1178 Predictors Of Being Seen By A Board-certified Sleep Medicine Provider

Introduction

Although several studies have evaluated the impact of board-certification in sleep medicine regarding obstructive sleep apnea treatment outcomes, no studies to date have identified predictive factors to determine which patients are evaluated by board-certified sleep medicine providers (BCSMP) in the clinical practice. Thus, the purpose of this study was to identify predictors of being seen by a BCSMP, relative to non-sleep specialist providers.

Methods

Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorder diagnoses such as insomnia, obstructive sleep apnea, restless legs syndrome, hypersomnias, and parasomnias, as well as medical comorbidities including cardiovascular, cerebrovascular, mood, pulmonary, and neurological disorders, were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographic data were obtained from the claims. BCSMP were identified using a novel cross-matching approach based on National Provider Identifier (NPI).

Results

A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013, but only 1,279 (2.2%) of these individuals were ever seen by a BCSMP. Within a multivariate logistic regression model, male gender, asthma, and heart failure were significantly associated with being seen by a BCSMP. Additionally, BCSMP were more likely to evaluate patients with two or more sleep diagnoses.

Conclusion

Complexity of sleep disorders and cardiovascular and lung comorbidities were predictive of being seen by a BCSMP. These results demonstrate the importance of BCSMPs in caring for complex sleep medicine patients.

Support

This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

0633 Volume Assured Pressure Support is an Effective Treatment in Patients with Central Sleep Apnea Syndrome

Introduction

Central sleep apnea syndrome (CSA) is commonly found in patients with congestive heart failure, brainstem disorders, and narcotic use. Various treatment modalities have been used with varied effectiveness in reducing the apnea-hypopnea index (AHI) and improving ventilation in patients with CSA. This study assessed whether Volume Assured Pressure Support (VAPS), a BiLevel mode of ventilation, is effective in treating CSA.

Methods

We performed a retrospective review of polysomnography (PSG) and VAPS titration studies on 11 patients at our institution: 7 patients had CSA with Cheyne-Stokes Respiration, 2 patients had CSA attributed to narcotic use, and 2 patients had primary CSA. CSA was diagnosed if more than 50% of the disordered breathing events were central. Five patients had failed a Continuous Positive Airway Pressure (CPAP) titration and then proceeded to VAPS while in 6 patients, VAPS was the initial treatment modality tried. We examined the effectiveness of VAPS in reducing AHI, improving oxygenation, and improving sleep architecture.

Results

Among the 11 patients, age was 63.0±12.1 yo, BMI was 33.7 ±4.5, 7 were males, Epworth sleepiness score was 9.3±4.9. The following significant changes from baseline PSG to VAPS titration were observed: AHI: 59.1± 8.0 to 27.2 ± 9.9 (p<.01); Time ≤ 88% O2 saturation (min): 48.1±14.5 to 15.4±6.1 (p<.05). Improvement in AHI was not related to gender, body mass index, narcotic use, or age. No significant changes in sleep architecture between the two studies were found. Ten (91%) patients had AHI > 30 on initial PSG. In 6 (55%) patients AHI was reduced to <15 with VAPS use. An additional patient had AHI reduced to 22.2, while 4 (36%) patients did not achieve an AHI < 30 with VAPS.

Conclusion

VAPS is an effective mode of treating CSA in the majority of patients.

Support

NA