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Sleep Medicine

(109) Comprehensive Sleep Apnea Care: Can the Otolaryngologist Do It All?

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Annie E. Moroco, MD

    Resident Physician
    Thomas Jefferson University
    Philadelphia, PA, United States

    • Co-Author(s)

  • Michele A. Fiorella, MS

    Medical Student
    Thomas Jefferson University
    Phila, Pennsylvania, USA

  • Maurits S. Boon, MD

    Professor
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • Colin T. Huntley, MD

    Associate Professor
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Annie E. Moroco, MD: No relevant relationships to disclose.
Maurits S. Boon, MD: No relevant relationships to disclose.


Introduction: Continuous positive airway pressure (CPAP) is the initial treatment modality for obstructive sleep apnea (OSA). However, patient adherence with this modality is poor, as low as 30-60%. Historically, CPAP has been managed by sleep medicine and primary care providers, with referral to an Otolaryngologist only after failure of CPAP treatment. Here, we present our institutional experience with patients newly diagnosed with OSA and the ability of the Otolaryngologist to provide comprehensive sleep care.

Methods: A retrospective chart review was performed to identify patients seen by a single sleep surgeon at our tertiary care center. Identified patients included in the analysis were prescribed CPAP between December 2021 and October 2022. Patients without available CPAP compliance data were excluded. The medical record was reviewed for patient demographics, sleep study and CPAP compliance data, clinical visit information, and alternative OSA therapies. Mean disease alleviation was calculated by multiplying the percentage apnea-hypopnea index (AHI) reduction with nightly duration of CPAP use relative to total sleep time.

Results: Thirty-six patients met inclusion criteria. The mean patient age was 53.8 years, with 50% of patients having severe OSA. Sixty-seven percent of patients were compliant with CPAP. The mean 30-day compliance rate was 71.4% and mean AHI when using device was 2.1 events/hour. Mean disease alleviation was 58.8%. Nine patients (25.0%) pursued alternative or additional therapy, including upper airway stimulation, expansion sphincter pharyngoplasty, oral appliance therapy, or nasal surgery to improve CPAP tolerability. Of note, 33% (4/12) of patients who were non-adherent to CPAP therapy opted to pursue alternative treatment options.

Conclusions: Among patients prescribed CPAP therapy in the sleep surgery clinic, 67% were compliant. Twenty-five percent of total patients, and one-third of non-compliant patients, pursued subsequent alternative therapy. CPAP prescription by the Otolaryngologist is a feasible and effective treatment approach with high rates of compliance.