0893 Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Comorbid Chronic Obstructive

Abstract Introduction Cognitive impairment in older Veterans is an independent predictor of subsequent mortality and disability. Pilot data indicate that patients with OSA-COPD Overlap Syndrome (OVS) have reduced sleep quality and quality of life (QoL). However, there are no prior systematic studies evaluating treatment paradigms in patients with OVS. Our ongoing clinical trial is investigating whether, compared with usual care, positive airway pressure (PAP) therapy alleviates sleep disturbances, sleepiness, and improves cognitive function and QoL in older adults with OVS. Methods The design is a prospective parallel group randomized controlled trial in Veterans 60 years and older, with moderate-to-severe OSA with concomitant COPD (OVS). 225 eligible participants will be randomized to two treatment groups (PAP and conservative care) in 2:1 ratio for a duration of 6 months. Participants on the conservative care arm are required to follow good sleep habits and sleep hygiene, and on the PAP arm, in addition, are required to be adherent to PAP treatment (CPAP or Bilevel PAP, as required). Sleep questionnaires are administered to evaluate sleepiness, sleep quality, and general and disease specific QoL. Cognitive function is evaluated using Trail Making Test Part A and B, Paced Auditory Serial Addition Test, Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R, Weschler Abbreviated Scale Intelligence II, Weschler Memory Scale IV, and Psychomotor Vigilance Test, respectively. All tests are administered at baseline visit, 3 months, and 6 months. Results We have enrolled 222 participants between Detroit and Ann Arbor VAMC locations, randomized 50 participants (48 males, 5 females; age: 70.5±6.5 years, BMI: 29.2±6.3kg/m2, AHI: 44.4±20.9events/hr, spirometry FEV1: 61.6±14.9% predicted, arterial blood gas (n=37) PaCO2:41.3±3.7 mmHg, ESS: 7.6±4.3, Six Minute Walk Test Total Distance Walked: 389.6±105.7 meters, FOSQ Total Score: 17.0±3.5, SGRQ Total Score: 45.6±22.6;30 participants have completed the study per the protocol. Group analysis will be available at the end of the trial. COVID pandemic has negatively impacted enrollment targets. Conclusion Final results from our study will determine the effects of treating a novel target (OVS) to maximize daytime function and QoL, while also providing a framework for early treatment of mild cognitive impairment in vulnerable older Veterans. Support (if any) VHA RR&D # 1I01RX003124-01