Effect on Quality of Life of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome: A Meta-analysis

Abstract

Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea syndrome (OSAS). However, the impact of CPAP on quality of life (QOL) is controversial. The aim of this study was to systematically review and determine whether CPAP improves QOL in patients with OSAS. We performed a comprehensive literature search to identify studies published between 1966 and 2007 comparing values of CPAP with control. Weighted mean difference (WMD) was used to analyze the data. The pooled WMD was calculated by using a fixed or random-effect model. The outcomes for 1,256 patients from 16 studies, of whom 656 patients underwent CPAP and 600 were controls, were included. CPAP led to significant improvements in the Nottingham health profile part 2 (WMD=1.657; 95% CI=3.005, -0.308; p=0.016), but there was no difference in other general QOL scores. Patients undergoing CPAP scored better in physical function (WMD=3.457; 95% CI=0.144, 6.771; p=0.041), body pain (WMD=4.017; 95% CI= -0.008, 8.042; p=0.05), energy vitality (WMD=6.984; 95% CI = 0.557, 13.411; p=0.033) and physical component summary (PCS) (WMD=2.040; 95% CI=0.045, 4.035; p=0.045) using the SF-36 tool. This meta-analysis shows that CPAP does not improve general QOL scores but does improve physical domains and vitality. Study design and QOL questionnaire tools are important to capture and evaluate information efficiently. However, generic QOL instruments may not be adequate in detecting important changes in quality of life in patients with OSAS.

Perioperative Complications in Obstructive Sleep Apnea Patients

“…However, a higher ODI (ODI 4 % > 28.5 events per hour) predicted patients at highest risk for postoperative complications in one study [36]. Questionnaires have generally labeled patients as high or low risk for OSA, though the STOP-Bang questionnaire may be useful for differentiating mild from moderate to severe OSA [32,33].…”

“…Screening for OSA in presurgery clinics can detect patients at high risk for OSA who might otherwise go undiagnosed. Data suggests that diagnosing and treating OSA improves a variety of outcomes, including quality of life and cardiovascular morbidity and mortality [36,37]. In support of this, a survey study of patients screening high risk for OSA preoperatively, who subsequently underwent confirmatory PSG and treatment, found that at 2 years the patients had improved quality of life and reduced use of medications for co-morbidities [38].…”

Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

“…However, validated OSA specific instruments may be more sensitive and germane to people with OSA. 46 Instruments such as the Calgary Sleep Apnea Quality of Life Inventory (SAQLI) or Functional Outcomes of Sleep Questionnaire (FOSQ) have been shown to be useful in identifying impaired QoL in persons with obstructive sleep apnea.…”

“…46 In randomized controlled trials, QoL improves after adequate treatment of OSA with positive airway pressure, 21,47 oral appliances, 48 and upper airway surgery. 49 All of these treatment modalities are commonly utilized for the treatment of OSA.…”

Factors Associated with Excessive Daytime Sleepiness in Obstructive Sleep Apnea Syndrome under CPAP Treatment

“…Recent metaanalyses demonstrated that CPAP elicited only small improvements in subjective sleepiness in mild to moderate OSAS, and the effects on objective sleepiness are of limited clinical significance [5]. Another meta-analysis showed that CPAP therapy does not improve general QOL scores associated with EDS, but does improve physical domains and vitality [6].…”