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ObjectiveThe main aim of this meta-analysis was to evaluate the predictors of the efficacy of continuous positive airway pressure (CPAP) in ameliorating excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA).MethodsRandomized controlled trials (RCTs) published between January 1994 and October 2021 were searched in the PubMed, EMBASE, and Cochrane Library databases. The weighted mean differences (WMDs) for the Epworth Sleepiness Scale (ESS) scores, the Multiple Sleep Latency Test (MSLT), and the Maintenance of Wakefulness Test (MWT) were pooled in STATA.ResultsA total of 41 RCTs involving 7,332 patients were included. CPAP therapy was found to be significantly associated with changes in ESS (WMD = −2.14, P < 0.001), MSLT (WMD = 1.23, P < 0.001), and MWT (WMD = 1.6, P < 0.001). Meta-regression analysis and subgroup analysis indicated that in mild OSA, the efficacy of CPAP therapy for subjective EDS was limited to patients <50 years of age, with a baseline body mass index (BMI) of ≥30 kg/m2, baseline ESS score of ≥11, therapy adherence for ≥3 h/night, and treatment duration of ≥2 months. In moderate OSA, significant differences were observed in the changes in ESS among groups stratified by baseline ESS score (P = 0.005), adherence (P < 0.001), treatment duration (P = 0.009), and trial design type (P = 0.001). In severe OSA, this difference was observed among groups stratified by baseline BMI (P = 0.028), baseline ESS score (P = 0.001), and adherence (P = 0.047). Patients with moderate-severe OSA but not mild OSA showed significant improvements in MSLT. Patients with the age <50 years or BMI ≥33 kg/m2 had a more significant increase in MWT.ConclusionContinuous positive airway pressure therapy improved subjective and objective sleepiness in patients with OSA. Age, baseline BMI, baseline ESS score, adherence, and duration of treatment may predict the effects of CPAP on EDS in patients with OSA. Notably, the baseline ESS scores and adherence were stable predictors regardless of OSA severity.

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Background Transcranial magnetic stimulation (TMS) is a noninvasive tool to improve cognition. Relevant clinical studies are mainly focused on neurological and psychiatric diseases. However, cognition decline and psychiatric disorders are popular in obstructive sleep apnea (OSA) patients. We aimed to investigate the effect of TMS over the left dorsolateral prefrontal cortex (DLPFC) on cognition test performance and to compare the changes in quantitative electroencephalogram (EEG) before and after stimulation for OSA. Methods This study recruited 42 OSA patients diagnosed with polysomnography according to American Academy of Sleep Medicine guidelines. TMS (intermittent theta‐burst stimulation paradigm; 2 s on, 8 s off, 600 pulses*3, intermittent 15 min) was performed on the DLPFC. Cambridge Automated Neuropsychological Test Battery was used to assess cognitive performance. EEG oscillations were computed via power spectral density with MATLAB software. Results Real‐TMS group displayed a significant improvement in visual memory, sustain attention performance, as well as the outcome of working memory. However, the executive function of latency was changed in both groups. Furthermore, TMS resulted in a significant increase in the relative power spectral density of the theta band and beta band in the parietal, temporal, and anterior regions, respectively. Conclusions In summary, our findings indicate that TMS can safely modulate cortical oscillations and improve cognition in OSA patients. In the future, TMS can be utilized as an alternative treatment option to improve cognition in OSA patients.