Should mild obstructive sleep apnoea be treated? A systematic review from the standpoint of disease progression

Abstract

Objective This study was a systematic review to investigate the progression of untreated obstructive sleep apnoea in order to evaluate whether mild obstructive sleep apnoea should be treated from the standpoint of disease progression. Method The database search study outcomes that were collected included Apnea Hypopnea Index and Respiratory Disturbance Index. A meta-analysis of obstructive sleep apnoea severity over time intervals was performed. Results A total of 17 longitudinal studies and 1 randomised, controlled trial were included for review. For patients with mild obstructive sleep apnoea, mean pre-study and post-study Apnea Hypopnea Index was 5.21 and 8.03, respectively, over a median interval of 53.1 months. In patients with moderate to severe obstructive sleep apnoea, mean pre-study and post-study Apnea Hypopnea Index was 28.9 and 30.3, respectively, over a median interval of 57.8 months. Predictors for disease progression in mild obstructive sleep apnoea are patients aged less than 60 years and those with a baseline body mass index less than 25. Conclusion Mild obstructive sleep apnoea progression is observed, but it does not appear to reach any clinically significant progression to moderate or severe obstructive sleep apnoea.

Should we reconsider how we manage mild obstructive sleep apnoea?

“…3 Additionally, Fong et al . 2 found that predictors for disease progression in mild obstructive sleep apnoea are: age of less than 60 years and a baseline body mass index of less than 25 kg/m 2 .…”

“…The authors found that although untreated mild OSA does show a gradual increase in the Apnoea Hypopnea Index, or Respiratory Disturbance Index, over 53.1 months, this rate of increase slowly plateaus, and does not progress across categories into moderate, or severe, OSA. 2 The authors therefore conclude that it is difficult to justify the treatment of mild OSA from the standpoint of disease progression. A study published last year also confirmed at the molecular level less severe airway inflammation in mild OSA patients compared with moderate to severe OSA.…”

“…A study published last year also confirmed at the molecular level less severe airway inflammation in mild OSA patients compared with moderate to severe OSA. 3 Additionally, Fong et al 2 found that predictors for disease progression in mild obstructive sleep apnoea are: age of less than 60 years and a baseline body mass index of less than 25 kg/m 2 .…”

“…provide a systematic review of the current literature and analyse the critical question: does mild OSA progress significantly if left untreated? 2 Specifically, they aimed to examine the temporal pattern of OSA changes over time, and identify any predictors of progression.…”