Continuous Positive Airway Pressure Treatment of Sleepy Patients with Milder Obstructive Sleep Apnea

Abstract

Rationale: Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness, which interferes with daily functioning. It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients. Objectives: To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea. Methods: Patients with self-reported daytime sleepiness (Epworth Sleepiness Scale score .10) and an apnea-hypopnea index with 3% desaturation and from 5 to 30 events per hour were randomized to 8 weeks of active or sham continuous positive airway pressure treatment. After the 8-week intervention, participants in the sham arm received 8 weeks of active continuous positive airway pressure treatment. Measurements and Main Results: The Total score on the Functional Outcomes of Sleep Questionnaire was the primary outcome measure.The adjusted mean change in the Total score after the first 8-week intervention was 0.89 for the active group (n ¼ 113) and 20.06 for the placebo group (n ¼ 110) (P ¼ 0.006). The group difference in mean change corresponded to an effect size of 0.41 (95% confidence interval, 0.14-0.67). The mean (SD) improvement in Functional Outcomes of Sleep Questionnaire Total score from the beginning to the end of the crossover phase (n ¼ 91) was 1.73 6 2.50 (t Author Contributions: T.E.W. was responsible for the study design, conduct of the study, data collection and interpretation, and writing of the manuscript. C.M. served as Project Manager, and was responsible for execution of study procedures, study quality control, and data collection. G.M. was the blinded biostatistician on the study, collaborated on the study, conducted the primary data analysis, provided interpretation of the results, and contributed to the writing of the manuscript. J.C. served as the unblinded biostatistician on the study and conducted required data analysis for the DSMB before unblinding. B.S. was responsible for study design and data collection and interpretation. J.R.L. contributed to study design and served for a period of time as Executive Secretary of the Data Safety Monitoring Board. K.A.F., C.F.P.G., D.A.S., H.G., D.M.R., J.A.W., and T.L.-C. contributed to study design, supervised data collection, interpreted the data, and edited and reviewed the manuscript. I.G. provided interpretation and quality control for the blood pressure obtained from the 48-hour ambulatory monitoring data. S.T.K. was responsible for study design, data collection, interpretation of the data, and writing of the manuscript.Correspondence and requests for reprints should be addressed to Terri E. Weaver, Ph.D., R.N., University of Illinois at Chicago College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL 60612. E-mail: teweaver@uic.edu This article has an online supplement, which is accessible from this issue's table of contents at www.atsjournals.org What This Study Adds to the Fi...

Half of the family members of critically ill patients experience excessive daytime sleepiness

“…The domain which was most notably affected was general productivity, which includes concentration, completing daily tasks and chores, remembering, working on hobbies, completing financial affairs and paperwork, employment tasks, and maintaining telephone conversations. Contextually, these scores were similar to those in individuals with mild sleep apnea [21] and worse than in patients suffering excessive daytime sleepiness due to congestive heart failure [23], chronic obstructive pulmonary disease with nocturnal hypoxemia [24], traumatic brain injury [22], and geriatric patients with self-reported sleepiness [25]. Additionally, the low FOSQ-10 scores may reflect the impact of sleepiness on daytime activities, including interactions with the ICU medical team, which is further evidenced by the association we found between perceived poor physician communication and cognitive blunting.…”

“…We found that excessive daytime sleepiness is common among family members of the critically ill. Over half of our subjects reported significant daytime sleepiness [9], demonstrating sleepiness similar to patients with obstructive sleep apnea [11, 21]. Thus, the proportion of significant daytime sleepiness (50.2 %) in these subjects is striking and considerably greater than in the general population (10–20 %) [8].…”

Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches

“…This provided a ready target for treatment with CPAP and mandibular advancement devices which improve EDS [35]. Compared to those without sleepiness, treatment of patients with EDS has also been shown to reduce blood pressure, vascular risk [5, 10, 11], and improve quality of life [36]. Thus it has been proposed that OSA with EDS is a unique phenotype [37].…”

Stimulating therapy for obstructive sleep apnoea

“…Among patients who tolerate PAP, results are excellent; however, effectiveness is limited by variable adherence. 34 Improvements in our understanding of OSA pathogenesis have led to a concept that the mechanism (endotype) underlying OSA is highly variable across individuals such that some patients have primarily an upper airway anatomical problem, whereas others have dysfunction in upper airway dilator muscles, some have unstable control of breathing and some may have combinations of abnormalities. 1 This realisation has led to the concept of personalised medicine in OSA such that therapies could theoretically be targeted to the mechanism underlying apnoea rather than using a ‘one-size-fits-all’ approach.…”