0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users

Introduction

Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment.

Methods

A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests.

Results

1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p<.001), likely to be employed (p=.013), more likely to snore loudly (p<.001) and to have breathing pauses while asleep (p<.001). They also had higher ISI (p<.001), were more like to report RLS (p<.001) nightmares (p=.027), and had higher PHQ-4 (p<.001) and PC-PTSD (p<.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p<.001) and those with observed breathing pauses were more likely to use PAP (p<.001).

Conclusion

One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans.

Support

Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).

1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation

Introduction

Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia.

Report of Case

This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask.

Conclusion

This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.

Montelukast improves regional air-trapping due to small airways obstruction in asthma

Quantitative image analysis of high-resolution computed tomography (HRCT) performed at residual volume, before and after methacholine, is a sensitive method of detecting small airways involvement in asthma and response to therapy targeted to the small airways. Since an oral anti-leukotriene reaches the small airways via the circulation, the present authors hypothesised that treatment with montelukast would lead to improved small airway patency. A double-blind crossover study compared the effect of montelukast versus placebo for 4 weeks in 16 mild-to-moderate steroid-naïve asthmatics. Small airways function was evaluated by HRCT at residual volume before and after methacholine to assess regional air-trapping and airways hyperresponsiveness, as well as by physiological studies of small airways. Montelukast treatment resulted in significantly less regional air-trapping on HRCT on the pre-methacholine images when compared with placebo, as well as improvement in total quality of life scores and symptom sub-scores. However, montelukast treatment had no effect on increases in regional air-trapping on HRCT in response to methacholine. No differences were noted in global measures of small airways physiology between placebo and montelukast. In conclusion, distal airways disease improves in asthmatic subjects treated with montelukast. This improvement can be detected with high-resolution computed tomography, but not with conventional physiological studies.