P107 Optimizing Obstructive Sleep Apnea Therapy in Patients with Acute Coronary Syndrome: A Pilot Randomised Controlled Trial

Continuous positive airway pressure (CPAP) therapy and oral appliance therapy (OAT) are recommended therapies for obstructive sleep apnoea (OSA). Recent clinical trials, limited by suboptimal implementation of OSA therapy, have demonstrated neutral cardiovascular benefit. It remains unclear if optimised OSA therapy will improve cardiovascular health. Thus, we have designed a pilot interventional study to inform a future RCT with the aim to evaluate the effectiveness of optimised and personalised OSA therapy in patients with acute coronary syndrome(ACS). Patients diagnosed with ACS and OSA (ODI4≥10 events/h) were randomised to personalised OSA treatment (CPAP and/or OAT) versus usual medical care (UC). Patients receiving OSA therapy were allowed to acclimatise to therapy for 1-2 months, with the aim of optimising therapy. Patients were followed up monthly for 6 months to assess treatment effectiveness. Polysomnography and cardiovascular measures were conducted at baseline and 6 months post-therapy or usual care. To date, 9 patients (CPAP=4, OAT=1, UC=4) have completed the study. OSA severity reduced in both treatment groups (CPAP: 53±14 vs. 17±18events/h, OAT: 22.4 vs. 14.7events/h). CPAP compliance was 6.8±0.9hours/day, 90±6%days >4h. OAT subjective compliance was 7 hours/day daily. At completion, 3 patients on CPAP therapy reported they were ‘extremely-comfortable’ using CPAP for OSA treatment. The patient on OAT reported OAT was ‘very effective in reducing OSA symptoms’ and will continue therapy. This preliminary data suggests that it is feasible to personalise and optimise OSA therapy in patients with ACS. Whether this positively impacts on cardiovascular risk remains to be determined.