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TREATING OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH COMPLEX CONGENITAL HEART DISEASE FOLLOWING THE FONTAN REPAIR Watson NF, 1 Stout K, 2, 3 Bushnell T, 1 Schlater ME, 2 Gurvitz M, 2, 3 Jones TK2 1 ; Neurology, University of Washington, Seattle, WA, USA, 2 ; Medicine, University of Washington, Seattle, WA, USA, 3 ; Pediatrics, University of Washington, Seattle, WA, USA Introduction : Ten percent of congenital heart disease patients have single ventricle physiology. The Fontan procedure treats this by directing systemic venous return to the pulmonary arteries. Absent right ventricular ejection, pulmonary blood flow depends on low pulmonary vascular resistance and effective systemic ventricular function. Normal inspiration with negative intrathoracic pressure enhances this flow, increasing systemic venous return. Obstructive sleep apnea OSA ; has detrimental effects on cardiac physiology. Treating OSA is challenging in Fontan patients as continuous positive airway pressure CPAP ; can interfere with systemic venous return reducing cardiac index CI ; . We describe our experience establishing safe CPAP levels in 3 Fontan patients with OSA. Methods : Three Fontan patients diagnosed with severe OSA via polysomnography were evaluated in the cardiac catheterization lab with electroencephalographic monitoring. CPAP pressures were increased stepwise every 10 minutes while monitoring pulmonary and systemic pressures and saturations. CI and vascular resistance were calculated at each CPAP level. CPAP was increased until CI declined. Results : Patient 1 had a CPAP threshold of 9 cm H2O with higher pressures decreasing CI by 0.4 L min M2 and increasing pulmonary capillary wedge pressure PCWP ; by 4 mmHg. Patient 2 had a CPAP threshold of 12 cm H2O with higher pressures decreasing CI by 0.5-0.8 L min M2 and increasing PCWP by 2 mmHg. Patient 3 had a CPAP threshold of 5 cm H2O with higher pressures decreasing CI by 0.5 L min M2 and increasing PCWP by 3 mmHg. Subsequent CPAP titrations revealed subthreshold pressure requirements of 6 and 8 cm H2O for patients 1 and 2. Patient 3's OSA was not controlled at 5 cm H2O and required supplemental oxygen to maintain nocturnal saturations above 88%. Conclusion : This pilot study demonstrates the safety and importance of establishing CPAP thresholds in Fontan patients with OSA ensuring maximal therapeutic benefit while avoiding potentially dangerous reductions in CI. Support optional.
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