P098 A case of successful adaptation to continual positive air pressure therapy (CPAP) with fixed pressure set at 4cmH2O in a patient with severe obstructive sleep apnea (OSA)

Abstract Introduction Noncompliance to continual positive air pressure (CPAP) therapy remains a major concern in the treatment for obstructive sleep apnea (OSA). Case description: 35-year-old female with a body mass index (BMI) 38.2 and Epworth Sleepiness Score (ESS) 8. Presented with snoring, excessive daytime sleepiness (EDS), poor concentration, nocturnal headaches and occasional dizziness. Diagnosed with severe OSA AHI 45.3, REM AHI 54.6, mean awake SpO2 96%, nadir SpO2 86%. Initial trial of automatic positive air pressure (APAP) over two-nights demonstrated usage of 8:08 hours, 95th percentile 11.2cm, AHI 0.4, nadir SpO2 89%. Fixed CPAP at 11cmH2O prescribed. Method Due to significant CPAP intolerance (side-effects including: light-headedness, and increased pressure behind the eyes), the treating Sleep Physician individulaised the CPAP therapy prescription prioritizing patient acclimatization in the short-term with a fixed pressure of 4cmH2O. Once acclimatized (usage exceeding >4hours) pressure would be gradually increased to control events. Close clinical follow up with early data download reviewed by Sleep Scientist weekly, with monthly Sleep Physician review. Results 4 week review: 100% compliance with CPAP 4cmH2O (avg. usage 8.5hours, 1.8/min leak, AHI 0.6). Significant subjective improvement to daytime symptoms reported. 10 month review: 99% compliance with CPAP 4cmH2O (avg.usage 8.5 hours, 0.6L/min leak, AHI 0.7). Successful adaptation to therapy with efficacious treatment. Discussion This case study highlights the importance of acknowledging the individuality of the patient, in this example CPAP pressure, for optimal care. Further analysis with a larger sample size would provide more insight into the future of pressure titration for patients who are reluctant to adhere to CPAP treatment.