Browsing by Subject "TSI"
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Item APPLICATION OF TREATMENT SUCCESS INDEX ON MULTIPLE VARIABLES IMPLICATED IN SLEEP APNEA(2014-03) Welch, Lindsey; Bentkowski, Olivia; Jouett, Noah; Raven, Ph.D., PeterThe NIH states that Positive Airway Pressure (PAP) is the optimal treatment for obstructive sleep apnea (OSA), with successful treatment benefits ranging from an increased quality of sleep to decreasing or preventing high blood pressure. Previous research has explored the positive effects of PAP use on various health indicators, however this data is based on subjective PAP use data from patients. The goal of this study was to evaluate the relationship between various health indicators and the success of using PAP with a Treatment Success Index (TSI), a measured value of treatment success based on PAP compliance and treatment efficacy. The TSI assumes that usage and effectiveness are equally important, and that decrements in either impose multiplicative impact on treatment quality. Purpose (a): The goal of this study was to evaluate the relationship between various health indicators and the success of using PAP with a Treatment Success Index (TSI), a measured value of treatment success based on PAP compliance and treatment efficacy. The literature demonstrates quite clearly that untreated OSA issues in a wide array of physical malady, ranging from obesity to cardiovascular disease. Therefore, we hypothesize that Obstructive Sleep Apnea (OSA) patients treated with Positive Airway Pressure (PAP) will demonstrate more favorable values of health indicators as compared to untreated patients (classified by Treatment Success Index). Methods (b): Data collection was performed at an office visit for each subject. PAP machines were brought from home to provide at-home data. Health indicators collected included Epworth score, heart rate, systolic and diastolic blood pressure and BMI. Subjects were assigned a Treatment Success Index (TSI) percentage based on compliance and at-home effectiveness data. Analysis was completed to determine the relationship between TSI score and the health indicators collected. Subjects with a TSI greater than or equal to 85 were considered treated, while subjects with a TSI less than 85 were considered untreated. Analysis was run on these groups to compare health indicators to their treated or untreated status. Results (c): The Epworth score was found to be decreased in the treated group, determined by the Mann-Whitney U Test results of a median value of 5 in the treated group and 7 in the untreated group (p<0.001). Systolic blood pressure was increased in the treated group, with a Mann-Whitney U Test demonstrating a median of 130 for the treated group and 124 for the untreated group (p <0.001). BMI was also increased in the treated group at 33.6, compared to 31.7 in the untreated group (p=0.002, Mann-Whitney U). There were no significant findings related to changes in heart rate of diastolic blood pressure. Conclusions (d): While Epworth score showed a favorable response to PAP treatment as determined by TSI values, systolic blood pressure and BMI were found to be higher in the treated groups. This does not indicate a negative effect of PAP use on these variables, but rather suggests other underlying mechanisms.Item EVALUATION OF HEART RATE VARIABILITY IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA(2014-03) Bentkowski, Olivia; Welch, Lindsey; Jouett, Noah; Smith, Michael L.Heart Rate Variability (HRV) is a non-invasive assessment of the activity of the autonomic nervous system (Xhyheri et al). Previous studies have shown a correlation between higher low/high frequency (LF/HF) values and poor cardiovascular health; however, there is question on how to effectively incorporate these findings into clinical practice and treatment. The aim of this study is to determine a relationship between HRV values and the success of using Positive airway pressure (PAP) (measured by Treatment Success Index) for the treatment of Obstructive Sleep Apnea (OSA). Purpose (a): Obstructive Sleep Apnea (OSA) patients treated with Positive Airway Pressure (PAP) (classified by a Treatment Success Index) will have a lower LF/HF ratio as compared to the untreated group. Methods (b): Subjects were instrumented for 30-45 minutes with a 3-lead ECG, which exported raw data into our data acquisition software. Using WinCPRS, we performed spectral analysis on the calculated R-R intervals, which were derived from raw data. LF/HF Heart Rate Variability (HRV) ratios were then calculated and reported for each subject group. Subjects were stratified into treated and untreated groups depending on their Treatment Success Index (TSI) scores. Subjects with TSI's greater than or equal to 85 were considered treated, while subjects with TSIs less than 85 were considered untreated. Results (c): There was no statistical difference in the low frequency to high frequency ratio (LF/HF) between the treated and untreated subjects (Mann Whitney U, p = 0.175). SDNN was determined to show no statistical difference between the treated and untreated subjects (Student’s t-test, p = 0.273). There was no statistical difference in pNN50 between the treated and untreated subjects (Mann Whitney U, p = 0.254). RMSSD demonstrated no statistical difference between the treated and untreated subjects (Mann Whitney U, p = 0.205). Conclusions (d): RMSSD and pNN50 were not found to be significantly higher in the treated subjects. LF/HF ratio and SDNN were not significantly lower in the treated subjects. However, this does not suggest ineffectiveness of PAP treatment in OSA, but rather inadequate sample size.