0738 Advance Taper of Antidepressants Prior to Multiple Sleep Latency Testing Increases the Number of Sleep-Onset Rapid Eye Movement Periods and Reduces Mean Sleep Latency

Introduction

Patients presenting with excessive sleepiness are frequently on antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited.

Methods

Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014-2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement suppressing antidepressants (REMS-AD) at assessment and during testing, actigraphy and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMS), proportion with ≥2 SOREMS and mean sleep latency (MSL) in patients who were on REMS-AD and discontinued prior to testing versus those who remained on REMS-AD were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT wherever feasible; fluoxetine is stopped 4 weeks prior. Regression analyses accounting for demographic, clinical and other medication-related confounders were performed.

Results

A total of 502 patients (age=38.18±15.90 years; 67% female) underwent MSLT; 178 (35%) were on REMS-AD at the time of assessment. REMS-AD were discontinued prior to testing in 121/178 (70%) patients. Patients tapered off REMS-AD were more likely to have ≥2 SOREMS (OR-12.20; 95%CI=1.60-92.94) compared to patients who remained on REMS-AD at the time of the MSLT. They also had shorter MSL (8.77±0.46 vs 10.21±0.28; p>0.009) and higher odds of having ≥2 SOREMS (OR=2.22; 95%CI=1.23-3.98) compared to patients not on REMS-AD at initial assessment. These differences persisted after regression analyses accounting for confounders.

Conclusion

Patients who taper off REMS-AD prior to MSLT are more likely to demonstrate ≥2SOREMs and have a shorter MSL. Pending further prospective investigations, clinicians should preferably withdraw REMs-AD before an MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results.

Support

None

0719 The Association of Sleep Apnea and Cardiorespiratory Fitness with Long-Term Major Cardiovascular Events

Introduction

Sleep disordered breathing (SDB) is associated with adverse cardiovascular outcomes and decreased cardiorespiratory fitness (CRF). The risk of long-term major adverse cardiovascular events (MACE) when SDB and decreased CRF co-occur has not been determined.

Methods

We included consecutive patients that underwent a symptom-limited cardiopulmonary exercise test followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-severe SDB (apnea/hypopnea index ≥15/hour) and decreased CRF defined as <70% predicted peak oxygen consumption (VO2). MACE was a composite outcome of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), stroke/transient ischemic attack (TIA) and death. Cox-proportional hazard models adjusting for factors known to influence CRF and MACE were constructed.

Results

Of 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5-10.3 years). After adjusting for age, sex, beta-blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking and positive airway pressure (PAP) usage, decreased CRF alone (HR=1.91, 95%CI=1.15-3.18, p=0.012), but not SDB alone (HR=1.26, 95%CI=0.75-2.13, p=0.389) was associated with increased risk of MACE. Those with SDB and decreased CRF had increased risk of MACE compared to patients with decreased CRF alone (HR=1.85, 95%CI=1.21-2.84, p<0.005) after accounting for these confounders; the risk was attenuated after additionally adjusting for adequate adherence to PAP (HR=1.85, 95%CI=0.99-3.05, p=0.05).

Conclusion

The incidence of MACE, including mortality, was high in this sample. Moderate-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of including CRF in the risk assessment of patients with SDB, and conversely, that of screening for SDB in patients with low peak VO2.

Support

None.

0173 Spring Forward, Fall Back: Increased Patient Safety-Related Adverse Events Following the Spring Time Change

Introduction

“Spring forward,” the start of daylight savings time (DST) reduces sleep opportunity by an hour. The resulting sleep deprivation in healthcare workers can increase the potential for medical errors. We examined the change in patient safety-related adverse events (AEs) following the time change in both spring and fall.

Methods

Self-reported AEs that occurred 7 days prior to and following the spring and fall time changes for years 2010–2017 in a large healthcare organization were ascertained. AEs likely resulting from human errors were identified. The change in the number of AEs (all AEs or restricted to those resulting from human error) following the spring and fall time change were modeled using negative binomial mixed models using a random effect to correct for non-independent observations in consecutive.

Results

Over the 8 year period, there were more AEs (all and human) in the 7 days following the change in time both in spring (All: 2812 V. 2699; Human: 1902 V. 1625) and fall (All: 3207 V. 3007; Human: 2189 V. 2087). However, the only statistically significant increase was for the estimated 18% increase in human errors following time change in spring (95% CI: 6% to 34%; p = 0.004). The 18% AE increase in spring was also significantly greater than the 5% increase in AE in fall (p = 0.018).

Conclusion

There is a significant increase in human error related AEs following the “spring forward” clock change which can jeopardize patient safety. Based on safety considerations, DST might best be eliminated; alternatively, policy makers and healthcare organizations should evaluate measures to mitigate the increased risk during this period.

Support

NA