Studies have shown that positive pressure therapy, if successfully implemented, can have significant impact on a variety of parameters of health and daily living. A number of studies have shown that PAP therapy significantly improves subjective and objective measures of daytime sleepiness (16,17), improves quality of life (18-20), and has a positive impact on neurocognitive function in patients with OSA (18,19).
Further studies have shown that significant reductions in adverse cardiovascular disease outcomes may be obtained with successful treatment of OSA (5,10). CPAP reduces blood pressure in hypertensive patients (21,22), reverses hemodynamic changes in the cerebral circulation (23), and may reduce pulmonary pressures in OSA patients (24). Moreover, CPAP has been shown to prevent OSA-associated bradyarrhythmias (25,26), decrease recurrence of atrial fibrillation after cardioversion (27), and abolish ventricular arrhythmias (28,29). Furthermore, patients with congestive heart failure (CHF) and OSA have shown a marked improvement in left ventricular ejection fraction and functional class after initiation of CPAP therapy (30,31).
In addition, CPAP produces many other sustained benefits that may have significant impact on long-term health outcomes, in particular, those processes that appear to contribute to the pathogenesis of cardiovascular disease. These benefits include decreased platelet activity and aggregation during sleep in OSA patients (32), a decrease in factor VII coagulant activity (VII:C) (32,33), decreased fibrinogen levels (34), increased levels of circulating nitric oxide (35,36), decreased overall sympathetic nervous system output (37,38), improved insulin sensitivity and glucose intolerance (39), reduced C-reactive protein (CRP) and interleukin-6 levels (40), and reduced serum leptin levels (41,42).
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