1031 A Multicenter Study Examining Two Scoring Algorithms for Diagnosis of Obstructive Sleep Apnea (OSA) in an Acute Neurorehabilitation Population with Traumatic Brain Injury (TBI). (27th April 2018) - Ricketti, P
Abstract: Introduction: Sleep disturbances including sleep apnea are prevalent in the acute stage of TBI and associated with worse neurologic outcome. Eligibility for treatment of OSA with continuous positive airway pressure (CPAP) depends on the apnea-hypopnea index (AHI) severity. There is divergence in scoring rules for hypopneas between the American Academy of Sleep Medicine (AASM) and Center for Medicare and Medicaid Services (CMS), the latter being more restrictive. A previous study comparing this divergence approximates 22%, with largest discrepancy in subjects <65 years old (28%). To date, no study has compared the scoring rules in a TBI sample during a stage of critical neural repair. Methods: This is a secondary analysis from a six-center, prospective, observational cohort study from the TBI Model System Lifetime Study where overnight, fully attended polysomnographies were conducted on TBI subjects in acute rehabilitation hospital units as part of a PCORI-funded clinical trial. De-identified data were transferred to the lead site (Tampa VA) and scored by a single blinded registered polysomnographer using CMS criteria and then re-scored using AASM criteria. Results were reviewed and interpreted by a board-certified sleep medicine specialist. Obstructive AHI was used to define presence and severity of OSA. Results: The initial participants (N=58) were primarily male (88%), white (77%), with moderate to severe TBI. Using AASM criteria, 74% of the sample met OSA criteria (AHI >/= 5 events/hour) whereas only 34% met criteria using CMS criteria. Contrast of OSA severity levels revealed 55% disagreement among severity classifications between the two scoring systems. Conclusion: Under CMS criteria, 40% of TBI survivors with OSA might not qualify for treatment during a time of critical neural impair. Untreated hypoxemia and sleep disruption from OSA may negatively influence TBI outcome. Support (If Any): Patient Centered Outcomes Research Institute (CER-1511–33005), General Dynamics Health Solutions (W91YTZ-13-C-0015) for the Defense and Veterans Brain Injury Center, Department of Veterans Affairs Health Services Research and Development (1I50 HX001233), National Institute on Disability, Independent Living and Rehabilitation Research (90DP0045-01-0).