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Introduction The incidence of obstructive sleep apnea in military personnel has increased over 500% since the early 2000s. Adherence to continuous positive airway pressure (PAP), an efficacious treatment, has been suboptimal. This article presents a behavioral intervention model for enhancing PAP therapy adherence and describes how the model was received by military personnel. Materials and Methods The study population comprised 254 out of 280 military personnel (93% men, mean age 39 years) who attended a 90-minute behavioral intervention class within the first 8 weeks of PAP use. They were coached on the Knowledge, Skills, Attitudes (KSA) model of PAP therapy success: Knowledge about obstructive sleep apnea and PAP treatment; Skills to develop a habitual loop for nightly PAP use; and Attitudes that address readiness, barriers, and solutions for sustaining PAP use. Participants completed a voluntary, anonymous postclass survey that inquired of their perception of various elements of the class. Data were analyzed using descriptive statistics and a paired sample t-test. Results In participants’ self-rating of how much they know about PAP treatment before and after the class, their ratings indicated that they experienced a significant increase in knowledge (P < 0.0001). On the postclass survey, 77% of the participants (N = 195/254) “agree a lot” or “strongly agree” that the class gave them tools to have a successful treatment and 78% (N = 198/254) noted that it was a valuable educational experience. The Knowledge portion was rated by 79% (N = 201/254) of the participants as “quite a lot” or “extremely” beneficial. The Skills segment was rated as “quite a lot” or “extremely” beneficial by 72% (N = 183/254) of the participants. The Attitudes discussion was perceived as “quite a lot” or “extremely” beneficial by 70% (N = 178/254) of the participants. Participants’ free-text responses to “what was most helpful” were generally positive. Conclusions A KSA model of behavioral intervention for enhancing PAP therapy adherence was well received by participants. Future research will assess the impact of this intervention on adherence as measured by objective indicators.

Accordingly, we aimed to 1) identify characteristics associated with and 2) assess the impact of low ArTH on CPAP use among U.S. Veterans with OSA. Methods: Demographics, comorbidities, polysomnographic measures and CPAP use were assessed in U.S. Veterans (n=975) enrolled in a multi-site observational cohort with mean follow-up of 5.5 years. In patients with OSA (apnea hypopnea index, AHI≥5/hour and recommended treatment) presence of low or high ArTH was estimated using previously validated polysomnographic predictors (AHI, nadir nocturnal oxygen saturation and fraction of hypopneas). Associations between low ArTH, demographics, comorbidities and polysomnographic measures were evaluated using univariate, and predictors of regular CPAP use were evaluated by multivariate logistic regression. Results: Thirty eight percent of OSA patients exhibited a low ArTH. In bivariate analyses, the odds of exhibiting a low ArTH increased with advancing age and periodic leg movement index (PLMI), while odds of a high ArTH increased with obesity (body mass index, BMI≥30kg/m 2 ), non-white race/ethnicity and hypertension (p-value < 0.05). Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH Introduction: Drowsy driving related accidents in Sleep Disordered Breathing (SDB) represent an important public health issue with a paucity of large clinic-based cohort data demonstrating impact of SDB treatment. We hypothesize that Positive Airway Pressure (PAP) will reduce self-reported near-accidents/accidents in well-phenotype patients in a large clinical cohort with SDB. Methods: Questionnaire-based self-reported near-motor vehicle accidents/accidents scores of 1,995 patients with SDB who initiated PAP (1/1/2010-12/31/2014) were retrospectively analyzed. We examined changes in the proportion of near-accidents/accidents before and after PAP, stratified by adherence (usage ≥ 4 hours nightly ≥ 70% of the time). A multi-variable logistic regression model was used to examine the association of self-reported near-accidents/accidents after PAP initiation and ESS changes (and separately Patient Health Questionnaire-9 (PHQ-9))adjusted for age, gender, race, socioeconomic status, smoking, BMI, sleep duration, anti-depressants, co-morbidities (cardiac risk factors, cardiac disease, cancer, chronic renal failure, depression and stroke).Results: Mean age 56.21 ± 3.2 years, 45.7% female, and 76.0% Caucasian. In the entire cohort, PAP reduced near-accidents/accidents from 13.9% to 6.6% (p < 0.0001). In subgroups, self-reported near-accidents/accidents reduced from (14% to 5.3%, p < 0.001) in adherent patients versus 16.0% to 13.1% in non-adherent patients (p < 0.001). For each one-point improvement in ESS, the odds of self-reported near-accidents/accidents decreased by 8.0% (OR=0.92, 95% CI=0.88-0.96, p < 0.001). For each one-point increase in the baseline PHQ-9 score, the odds of reporting near-accidents/accidents increased by 6.0% (OR=1.06, 95% CI=1.03-1.10, p < 0.001). Conclusion: Overall, PAP improved self-reported drowsy driv...

brief survey before receiving their CPAP devices. 72 of 94 participants repeated the survey after they used their CPAP devices for 30 -90 days. 94 data of CPAP adherence were downloaded from each participant's CPAP device. Results: Using the enter method of multiple regression analysis, we found from: (1) the survey of pre-CPAP therapy, the level of PSH-BI explained a significant amount of the variance in CPAP adherence, R 2 = .066, R 2 adjusted = .046, F(2, 91) = 3.27, ρ < .05. Although the level of PSB did not significantly predicted CPAP adherence (β = -.071, t(91) = -.688, ns), the level of BI significantly predicted CPAP adherence (β = .249, t(91) = 2.456, ρ < .05); (2) the survey of post-CPAP therapy, the level of PSH-BI explained a significant amount of the variance in CPAP adherence, R 2 = .213, R 2 adjusted = .190, F(2, 69) = 9.34, ρ < .01. Both levels of PSB and BI significantly predicted CPAP adherence (β = -.262, t(69) = -2.268, ρ < .05; β = .381, t(69) = 3.561, ρ < .01, respectively). Introduction:The pathophysiology of apneas is distinct from that of hypopneas. Apneas reflect static obstruction with absent flow, while hypopneas reflect dynamic obstruction with decreased flow. We propose that hypopneas and respiratory-effort related arousals (RERAs) are eliminated with lower positive airway pressure (PAP) than apneas, and both higher HAR and higher RAR (RERA+hypopnea/apnea ratio) are associated with lower optimum PAP due to a lower critical closing pressure (Pcrit). Methods: We performed a retrospective chart review in a sample of 150 consecutive adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS), defined by a total Respiratory Disturbance Index (tRDI) of ≥ 5 apneas, hypopneas, and RERAs per hour of sleep. Polysomnography was scored using AASM 2016 Version 2.3 guidelines using both option 1a (tRDI) and 1b (apnea hypopnea index [AHI]) criteria. Polysomnographic data were collected; HAR and RAR were calculated. The primary outcome was a correlation between HAR and RAR and optimum PAP, where HAR and RAR were the main independent variables, and the level of optimum PAP was the main outcome variable. Data were analyzed using a 2-tailed Student's t-test for continuous variables. The level of statistical significance was defined as p < 0.05. Results: Among 76 men and 74 women aged 54.7 ± 14.2 years with a mean body mass index (BMI) of 37.6 ± 11.5 kg/m 2 and a mean AHI of 30.2 ± 31.3, optimum PAP was significantly lower with higher HAR (p = 0.037) and higher RAR (p = 0.00002). In addition, hypopnea index, AHI, tRDI, and BMI also had a significant direct association with PAP (p < 0.001), while the oxygen saturation nadir had a significant inverse association (p < 0.001). Apnea index and optimum PAP were not significantly related. We also observed a significant association between BMI and both HAR (p < 0.0001) and RAR (p < 0.001). Conclusion: OSAHS with a preponderance of hypopneas and paucity of apneas requires a lower level of PAP, suggesting a distinct pathophysiology of hypopnea-predom...