Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial

Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnoea and acute coronary syndrome

“…In contrast, our non-sleepy patients were evaluated during an ACS but were not being evaluated for suspected OSA. Nevertheless, there are also studies describing poor compliance in clinical trials performed in non-sleepy patients recruited in sleep units (10). The adherence shown in our study is similar to the values reported by ChaiCoetzer et al (14) in the SAVE trial in which patients did not present to a sleep clinic and were mainly recruited in neurology or cardiology clinics, as in our study.…”

“…Although several studies have reported that excessive daytime sleepiness is absent in approximately 50% of all OSA patients (11), very few studies have focused on non-sleepy patients. The results of these studies are contradictory (10,(12)(13)(14), with some authors reporting similar CPAP adherence regardless of daytime sleepiness and others finding differences.…”

“…The effectiveness of CPAP therapy in improving clinical symptoms, quality of life and potential consequences associated with OSA is strongly related to compliance (7)(8)(9)(10); nevertheless, the predictors of adherence to this therapy are still not well known.…”

Lessons from randomised controlled trials of continuous positive airways pressure therapy in the prevention of cardiovascular morbidity and mortality

“…This implies that even partial treatment can be of symptomatic benefit in non-sleepy patients, mirroring the results of the MOSAIC study (15).…”

“…Second, patients in both SAVE and RICCADSA were not subjectively sleepy; it has been argued that non-sleepy patients may be at lower risk of cardiovascular disease than their sleepy counterparts (14). Supporting this theory, the MOSAIC study, which examined the impact of CPAP on minimally symptomatic OSA patients, did not show any improvement in daytime blood pressure following treatment (15), while other investigators have found OSA to be associated with metabolic disease only in sleepy cohorts (16). These findings are far from universal-no difference was seen in mortality in sleepy and non-sleepy patients in the Wisconsin sleep cohort (17)-and ethical concerns make it challenging to conduct long term controlled studies in sleepy OSA patients.…”