A systematic review of continuous positive airway pressure for obstructive sleep apnoea–hypopnoea syndrome

Centre for Reviews and Dissemination, University of York, York, UK.
Sleep Medicine Reviews (Impact Factor: 8.51). 05/2009; 13(6):427-36. DOI: 10.1016/j.smrv.2009.02.004
Source: PubMed


We conducted a systematic review of current evidence on the effectiveness of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnoea-hypopnoea syndrome (OSAHS). The primary outcomes were subjective sleepiness, using Epworth Sleepiness Scale (ESS) and objective sleepiness using Maintenance of Wakefulness Test (MWT) and Multiple Sleep Latency Test (MSLT). Mean difference (MD) in endpoints was used to compare CPAP to usual care, placebo and dental devices. The analysis was stratified by symptom and disease severity at baseline. CPAP significantly reduced ESS score compared to control (MD -2.7, 95% CI -3.45, -1.96). The benefit was greatest in patients whose symptoms were severe at baseline: severely symptomatic population (MD -5.0, -6.5, -3.5); moderate (MD -2.3, -3.0, -1.6); mild (MD -1.1, -1.8, -0.3). CPAP significantly improved MWT score compared to control (MD 3.3, 1.3, 5.3) but not on the MSLT. There was no statistically significant difference between CPAP and dental devices on the ESS, MWT or MSLT, in a population with moderate symptoms. There was some evidence of benefit for blood pressure with CPAP compared to control. CPAP is an effective treatment for OSAHS in moderate to severe symptomatic patients and there may be benefits for mild symptoms. Dental devices may be a treatment option for moderate symptoms.

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    • "Clinical practice has shown that Continuous Positive Airway Pressure (CPAP) is a far more effective therapy for Obstructive Sleep Apnea Syndrome (OSAS) than traditional surgery Since the devices used in CPAP therapy inevitably creates noise, evaluating the impact of noise on sleeping was given a fair amount of attention in the past decades (Mcdaid et al., 2009; Katrien and Bauters, 2010). It is known from previous research that major sources of noise from a ventilator are vibration, the centrifugal fan and aerodynamic noise caused by air turbulence (Pavić, 2003; Park et al., 2010). "

    Preview · Article · Jun 2014 · Scientific research and essays
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    • "And Wickwire and colleagues found that those OSA patients with the complaint of insomnia had lower rates of CPAP use [43]. While placebo controlled trials of CPAP indicate that CPAP is highly efficacious at controlling apneas and hypopneas during sleep [44], it is becoming increasingly clear that this does not necessarily translate into the reduction of OSA symptoms to normal levels. Future studies will need to examine this issue in more depth, especially using new remote data capture methods that allow for more frequent assessments of OSA symptoms when using CPAP. "
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    ABSTRACT: Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4 ± 2.4 and 4.1 ± 2.3 hrs/nt; P = 0.02; mean ± SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies.
    Full-text · Article · Mar 2013 · International Journal of Telemedicine and Applications
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    • "Untreated OSA adds at least 3.4 billion dollars to annual medical costs in the United States (Kapur et al., 1999) and has negative health consequences, such as excessive daytime sleepiness (Gottlieb et al., 1999), diminished quality of life (Baldwin et al., 2001), hypertension (OÕConnor et al., 2009; Peppard, 2009), ischemic stroke (Redline et al., 2010) and increased all-cause mortality (Marshall et al., 2008). Effective treatment for OSA can be achieved through the use of CPAP, which is the primary and most effective treatment option for OSA (Mcdaid et al., 2009). "
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    ABSTRACT: This study aimed to identify pre-treatment and immediate early treatment factors predicting continuous positive airway pressure (CPAP) use during the first week of therapy, when the pattern of non-adherence is established. Four domains of potential predictors were examined: pre-treatment demographic and clinical factors, patients' perceived self-efficacy, treatment delivery (mask leak and bothering side effects) and immediate disease reduction (residual respiratory events and flow limitation). The Autoset™ Clinical System objectively documented daily CPAP use, mask leak, residual respiratory events and flow limitation. Ninety-one CPAP-naive patients with newly diagnosed obstructive sleep apnea were followed for 1week after treatment initiation. Mean CPAP daily use during the first week was 3.4±2.7h, with significantly lower use observed in black than non-black participants (2.7 versus 4.4h, respectively, P=0.002). Less intimacy with partners caused by CPAP was the only treatment side effect correlated with CPAP use (r=-0.300, P=0.025). Reduced CPAP use during the first week was associated simultaneously with being black, higher residual apnea-hypopnea index and the treatment side effect of less intimacy with partners. The three factors together accounted for 25.4% of the variance in the CPAP use (R(2) =0.254, P<0.01). These data suggest the need to assess the impact of CPAP on intimacy and troubleshooting aspects of the treatment that interfere with sexual relationships. Assessing the presence of residual respiratory events may be important in promoting CPAP adherence. The association of race and CPAP use needs to be explored further by including more socioeconomic information.
    Full-text · Article · Oct 2011 · Journal of Sleep Research
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