Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome.

Continuous positive airway pressure (CPAP) is worldwide considered as the standard treatment of sleep apnea/hypopnea syndrome (SAHS) although studies on the effectiveness of this treatment are limited. The aim of our study was to evaluate the effectiveness of CPAP in improving SAHS-related symptoms, daytime function, perceived health status, and quality of life in patients with moderate to severe SAHS. The effect of conservative treatment (CT) measures-sleep hygiene and weight loss- was compared with CT + CPAP. We included 105 consecutive patients (13 females, age 53 +/- 10 yr, body mass index [BMI] = 32 +/- 6 kg/m2, apnea/hypopnea index [AHI] = 56 +/- 20, Epworth sleepiness scale [ESS] = 12 +/- 5) who met our criteria for CPAP treatment. Patients were randomly allocated in two groups of similar characteristics. Group 1 (n = 37) was asked to improve sleep hygiene and started a weight loss program. Group 2 (n = 68) received, in addition, treatment with CPAP. Both groups were followed through weekly telephone calls and appointments. Sleepiness, other symptoms related to SAHS, daytime function, perceived health status, and quality of life were assessed through questionnaires at inclusion and after 3 mo of treatment. The relief of sleepiness and other SAHS-related clinical symptoms and improvement in perceived health status was much greater in Group 2 receiving CT + CPAP compared with Group 1, only receiving CT. The odds of experiencing a treatment response with CPAP + CT compared with CT alone was 6.52 (odds ratio [OR] = 2.51 to 17.6, 95% confidence interval [95% CI]). CPAP is currently the treatment of choice. At this time, the indication of CPAP treatment in moderate to severe SAHS is adequately supported.

[1]  S. Redline,et al.  Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. , 1998, American journal of respiratory and critical care medicine.

[2]  I. Deary,et al.  Obstructive sleep apnoea. Some criticisms of studies are unfounded. , 1997, BMJ.

[3]  T. Sheldon,et al.  Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence , 1997, BMJ.

[4]  I. Deary,et al.  Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. , 1997, Thorax.

[5]  J. Stradling.  Sleep apnoea and the misuse of evidence-based medicine , 1997, The Lancet.

[6]  R. Rodríguez-Roisín,et al.  Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome. , 1996, American journal of respiratory and critical care medicine.

[7]  F. Sériès.  Evaluation of treatment efficacy in sleep apnea hypopnea syndrome. , 1996, Sleep.

[8]  R. Rodríguez-Roisín,et al.  Comparison of partially attended night time respiratory recordings and full polysomnography in patients with suspected sleep apnoea/hypopnoea syndrome. , 1996, Thorax.

[9]  N J Douglas,et al.  Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. , 1996, Chest.

[10]  J. Stradling,et al.  Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airways pressure in patients with obstructive sleep apnoea. , 1995, Respiratory medicine.

[11]  D. Loube,et al.  Weight loss for obstructive sleep apnea: the optimal therapy for obese patients. , 1994, Journal of the American Dietetic Association.

[12]  I. Deary,et al.  Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome , 1994, The Lancet.

[13]  I. Deary,et al.  Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome. , 1993, Thorax.

[14]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[15]  J. Antó,et al.  Spanish version of the Nottingham Health Profile: translation and preliminary validity. , 1990, American journal of public health.

[16]  S P McKenna,et al.  The Nottingham Health Profile: subjective health status and medical consultations. , 1981, Social science & medicine. Part A, Medical sociology.

[17]  ColinE. Sullivan,et al.  REVERSAL OF OBSTRUCTIVE SLEEP APNOEA BY CONTINUOUS POSITIVE AIRWAY PRESSURE APPLIED THROUGH THE NARES , 1981, The Lancet.

[18]  P. Linkowski,et al.  Sleep apnea after 1 year domiciliary nasal-continuous positive airway pressure and attempted weight reduction. Potential for weaning from continuous positive airway pressure. , 1996, Chest.