Seckin, Z.I.

Abstract Introduction The World Health Organization (WHO) has categorized pulmonary hypertension (PH) in five groups. Obstructive sleep apnea (OSA) is an independent cause of group 3 PH. The prevalence of OSA in PH patients is approximately 20% and untreated OSA may contribute to pulmonary vascular remodeling, exacerbating PH. Regular use of positive airway pressure (PAP) can improve pulmonary artery pressures. We hypothesized that untreated OSA is associated with mortality in all five groups of PH, and that mortality is reduced with PAP therapy. Methods We performed a retrospective chart review of the PH patient registry at Mayo Clinic Jacksonville, comprised of 696 patients classified per WHO classification of PH. Mortality in each WHO group of PH was abstracted as well as the presence of OSA as a comorbidity. Compliance with positive airway pressure therapy (PAP) was assessed across all patients with OSA. Results Patients in the registry were followed for a mean of 101.2 months. The mortality across all groups was 36.8%, ranging from 22.6% in group 4 to 64.3% in group 5. OSA was present in 46.9% patients, and it ranged from 33% in group 5 to 58% in group 2. Mortality did not vary significantly in the patients with OSA versus those without OSA (p=0.56). Of patients with OSA, 45.9% was deemed compliant with PAP therapy. Overall, the compliant patients had reduced mortality compared to the noncompliant ones (p=0.045), however this significance was due to pronounced effect in group 1 patients only. Conclusion Almost half of PH patients from our registry had OSA. Compliance with PAP therapy was associated with lesser mortality, primarily due to the effect seen in Group 1 PH patients. Support (if any)

Abstract Introduction Obstructive sleep apnea (OSA) is effectively treated with continuous positive airway pressure (CPAP), but access remains a challenge. The COVID-19 pandemic accelerated telehealth, offering a convenient alternative to in-person visits for OSA evaluation and treatment initiation. This study compares patients managed entirely via video telehealth to those managed entirely in person. We hypothesize that virtual are as effective as in-person evaluations in managing most OSA patients. Methods The study is approved by the Mayo Clinic IRB. We retrospectively studied adult patients diagnosed with OSA requiring CPAP initiation between June 2020–2023. Data collected included baseline demographics, home sleep apnea testing (HSAT) results, polysomnography (PSG) results, Epworth Sleepiness Scale (ESS) scores, OSA severity, compliance results, other relevant comorbidities (i.e. cardiovascular diseases). Visit type categorized as “in-person” for patients who had both initial and follow-up appointments in-person, while “telehealth” group included patients who had both appointments virtually. Results Of 59 patients, 33 had telehealth (56%). The groups had similar medians in age (66 vs 62), sex (73% vs 67% male), and BMI (30 vs 32). There was no significant difference in median ESS scores (8 vs 7, p=0.7). However, the severity of OSA (moderate to severe) was higher in the in-person group (73% vs 45%, p=0.03). When baseline sleep study data was investigated, there were no differences in AHI and average SpO2 values measured by HSAT or PSG between the two groups (p>0.05 for all). CPAP compliance was significantly higher in the telehealth group compared to in-person (78% vs 40%, OR: 5.5, 95% CI: 1.7-17.1, p=0.003). Virtual visit type was the only independent predictor of compliance (p=0.006), after adjusting for age, BMI, comorbidities and OSA severity in multivariate analysis. However, there was no difference in average daily CPAP usage (6:39 vs 7:18, p=0.5) and percentage of days with usage >4 hours (91% vs 95, p=0.5). Median AHI after treatment improved in both groups, with no significant difference between groups (1.7 vs 2.4, p=0.8). Conclusion Telehealth offers a successful alternative to in-person visits for OSA evaluation, with similar outcomes and significantly better compliance, enhancing OSA management. Support (if any)

Abstract Background: Intravenous fluid resuscitation is fundamental for sepsis-induced hypoperfusion. The 2021 Surviving Sepsis Campaign recommends 30 mL/kg of intravenous crystalloid within the first three hours. Fluid management in patients with sepsis is challenging due to risk for volume overload hence edema in the lungs and other organs. Conflicting literature debates over whether liberal or restricted fluid administration is optimal in this population. We hypothesized that, despite X-ray findings suggesting volume overload, liberal fluid resuscitation in patients with severe sepsis or septic shock does not increase in-hospital mortality or ventilation requirements. Methods: The study is approved by the Mayo Clinic IRB. We retrospectively studied adult patients admitted to the medical ICU with severe sepsis or septic shock from 2014-2018. Data collected included admission weight, chest Xray (CXR) fluid status (“wet” vs. “dry”), fluid resuscitation volumes at 3 and 24 hours (liberal [≥30 mL/kg] vs. restricted), in-hospital mortality, ventilation need, ICU/hospital length of stay (LOS), admission lactate, baseline NT-proBNP, home oxygen use, and history of heart failure or chronic pulmonary disease. For accuracy, an independent pulmonologist reviewed CXRs, and patients with radiologist-pulmonologist discrepancies were excluded. Results: Of 346 patients, 68% had “wet” CXRs. Patients with “dry” CXRs received greater median fluid resuscitation at both 3 hours (3913 mL vs. 3126 mL, p=0.001) and 24 hours (6085 mL vs. 5435 mL, p=0.0005). Liberal fluid resuscitation was more frequent in patients with “dry” CXR than those with “wet” CXR (72% vs. 57%, p=0.006). In-hospital mortality was lower among patients receiving liberal resuscitation compared to restricted (13% vs. 21%; OR 0.573, 95% CI 0.32-1.02, p=0.04), although in patients with “wet” CXRs, liberal resuscitation did not significantly impact mortality (p=0.17). Need for invasive or noninvasive ventilation tended to be higher in the restricted group compared to the liberal group, though this was not statistically significant (45% vs. 29%; OR 0.48, 95% CI 0.21-1.12, p=0.07). There was no significant difference in ICU or hospital LOS between patients receiving liberal and restricted resuscitation (p=0.14 and p=0.9, respectively). In multivariate analysis, in-hospital mortality was significantly associated with chronic pulmonary disease (p=0.04) and admission lactate (p=0.007) but not with CXR findings (p=0.72) or fluid resuscitation volume (p=0.38). Additionally, neither CXR findings (p=1) nor liberal fluid resuscitation (p=0.07) significantly increased the need for ventilation. Conclusion: Liberal fluid resuscitation in patients with severe sepsis or septic shock appears safe and does not increase mortality or ventilation needs, even in those with radiographic volume overload.