Predictors of the Efficacy for Daytime Sleepiness in Patients With Obstructive Sleep Apnea With Continual Positive Airway Pressure Therapy: A Meta-Analysis of Randomized Controlled Trials

Abstract

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.

Effect of a digital patient motivation and support tool on CPAP/APAP adherence and daytime sleepiness: a randomized controlled trial

“…As Antic et al [ 30 ] already confirmed, indicators for subjective daytime sleepiness, functional status, and sleep-related quality of life, such as the ESS and FOSQ scores, are dose-dependent on CPAP treatment, with greater improvements in more-adherent patients. Regarding a presumable relation of (auto)CPAP adherence and ESS score, our results show an association of (auto)CPAP adherence with a reduction of ESS Score and are thereby in line with the meta-analysis of Li et al [ 35 ]. However, the impact of factors such as age, BMI, baseline ESS, etc.…”

Revisiting the maintenance of wakefulness test: from intra‐/inter‐scorer agreement to normative values in patients treated for obstructive sleep apnea

“…Third, the population in which normative values should be determined is not clear. Theoretically, this population should include healthy subjects who do not complain of sleepiness, and in whom the main causes of sleepiness (sleep deprivation, depression, obesity, sedative medications, sleep disorders including OSA) have been carefully ruled out, which is rarely the case in studies (Berger et al, 2021;Jaussent et al, 2020;Li et al, 2022). Interestingly, another study in 31 healthy individuals found a greater mean (SD) value of 36.9 (5.4) min, and suggested that even the method of recruitment of subjects (advertisement versus random selection) could influence the MWT results (Banks et al, 2004b;Krahn et al, 2021).…”

“…Four groups of patients were defined according to the presence of residual subjective sleepiness (as assessed by the ESS at the time of the MWT) and the efficacy of CPAP treatment (as measured by the residual AHI on pre‐MWT PSG). For residual AHI, we used the dichotomy <15 versus ≥15 events/h, with a residual AHI of ≥15 events/h defining a residual moderate OSA according to current AASM rules, keeping in mind that the acceptable residual AHI under CPAP treatment remains debated (Kapur et al, 2017; Li et al, 2022). Thus, the groups of patients were defined as follows: ENAN (ESS score <11, AHI <15 events/h); ENAX (ESS score <11, AHI ≥15 events/h); EXAN (ESS score ≥11, AHI <15 events/h), and EXAX (ESS score ≥11, AHI ≥15 events/h).…”