BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) affects an estimated 2-4% of the middle aged population. Meta-analyses of randomised controlled trials have shown that the severe presentation of the syndrome (apnoea hypopnoea index (AHI) >30/hour) is effectively treated with continuous positive airway pressure (CPAP). Until recently there have been insufficient data to determine whether CPAP improves sleepiness in the larger subgroup with mild to moderate OSAS (AHI 5-30/hour). METHODS: A systematic search of Medline and a hand search identified seven randomised controlled trials where CPAP was compared with either a placebo or with conservative management in the treatment of mild to moderate OSAS (AHI 5-30/hour). All trials used the Epworth Sleepiness Scale (ESS), four used the Multiple Sleep Latency Test (MSLT), and three used the Maintenance of Wakefulness Test (MWT) to measure sleepiness. RESULTS: Meta-analyses indicated that CPAP significantly reduced subjective daytime sleepiness (ESS) by 1.2 points (95% CI 0.5 to 1.9, p = 0.001), improved objective daytime wakefulness (MWT) by 2.1 minutes (95% CI 0.5 to 3.7, p = 0.011), but did not affect objective daytime sleepiness (MSLT, mean benefit -0.2 minutes, 95% CI -1.0 to 0.6, p = 0.6). The two significant effects were small (effect size <0.30). CONCLUSIONS: CPAP elicits small improvements in subjective sleepiness and objective wakefulness in people with mild to moderate OSAS. However, the effects on sleepiness are of limited clinical significance.
BACKGROUND:Obstructive sleep apnoea syndrome (OSAS) affects an estimated 2-4% of the middle aged population. Meta-analyses of randomised controlled trials have shown that the severe presentation of the syndrome (apnoea hypopnoea index (AHI) >30/hour) is effectively treated with continuous positive airway pressure (CPAP). Until recently there have been insufficient data to determine whether CPAP improves sleepiness in the larger subgroup with mild to moderate OSAS (AHI 5-30/hour). METHODS: A systematic search of Medline and a hand search identified seven randomised controlled trials where CPAP was compared with either a placebo or with conservative management in the treatment of mild to moderate OSAS (AHI 5-30/hour). All trials used the Epworth Sleepiness Scale (ESS), four used the Multiple Sleep Latency Test (MSLT), and three used the Maintenance of Wakefulness Test (MWT) to measure sleepiness. RESULTS: Meta-analyses indicated that CPAP significantly reduced subjective daytime sleepiness (ESS) by 1.2 points (95% CI 0.5 to 1.9, p = 0.001), improved objective daytime wakefulness (MWT) by 2.1 minutes (95% CI 0.5 to 3.7, p = 0.011), but did not affect objective daytime sleepiness (MSLT, mean benefit -0.2 minutes, 95% CI -1.0 to 0.6, p = 0.6). The two significant effects were small (effect size <0.30). CONCLUSIONS: CPAP elicits small improvements in subjective sleepiness and objective wakefulness in people with mild to moderate OSAS. However, the effects on sleepiness are of limited clinical significance.
Authors: H M Engleman; R N Kingshott; P K Wraith; T W Mackay; I J Deary; N J Douglas Journal: Am J Respir Crit Care Med Date: 1999-02 Impact factor: 21.405
Authors: Richard J Schwab; Safwan M Badr; Lawrence J Epstein; Peter C Gay; David Gozal; Malcolm Kohler; Patrick Lévy; Atul Malhotra; Barbara A Phillips; Ilene M Rosen; Kingman P Strohl; Patrick J Strollo; Edward M Weaver; Terri E Weaver Journal: Am J Respir Crit Care Med Date: 2013-09-01 Impact factor: 21.405
Authors: Girolamo A Ortolano; Jeffrey Schaffer; Morven B McAlister; Ilia Stanchfield; Elizabeth Hill; Liliana Vandenburgh; Michelle Lewis; Shirnett John; Francis P Canonica; Joseph S Cervia Journal: J Clin Sleep Med Date: 2007-12-15 Impact factor: 4.062
Authors: V Tsara; A Amfilochiou; M J Papagrigorakis; D Georgopoulos; E Liolios; C Alexopoulou; C Maniou; P Kithreotis; G Trakada; F Synodinos; G Vilos; P Steiropoulos Journal: Hippokratia Date: 2009-10 Impact factor: 0.471
Authors: Richard J Castriotta; Strahil Atanasov; Mark C Wilde; Brent E Masel; Jenny M Lai; Samuel T Kuna Journal: J Clin Sleep Med Date: 2009-04-15 Impact factor: 4.062