Health Outcomes And Continuous Positive Airway Pressure

Over the past decade, there have been a number of RCTs that have demonstrated the effectiveness of CPAP in improving neurobehavioral outcomes such as daytime sleepiness and blood pressure, in patients with moderate-to-severe OSA (99,105,106). Benefits have also been demonstrated in OSA subgroups such as those patients with coincident Alzheimer's disease and OSA (107). Different parameters of sleep patterns improve over a defined time scale but mostly within one month of establishing CPAP in severe OSA patients (33). Depression symptoms associated with untreated OSA may ameliorate with successful institution of CPAP therapy (108). However, the evidence for benefits is less clear in patients with more severe disease without significant sleepiness (98) or in patients with mild disease (109).

Researchers have employed either an oral placebo or sham/sub-therapeutic CPAP as control arms in RCTs examining the effects of CPAP. There is no "perfect placebo" for CPAP and each approach has limitations and obvious difficulties in blinding. Even a patient on sham CPAP may be made aware of persisting snoring or observed apneas by a bed partner. However, existing studies have clearly defined a role for CPAP in moderate-to-severe symptomatic OSA. The treatment of the asymptomatic patient with milder disease remains controversial (109). One study compared (humidified) CPAP to sham CPAP in mild OSA and showed improvement in subjective sleepiness and a trend toward improved objective wakefulness in the treatment group along with improvement in PSG indices of OSA, but other outcomes (mood, quality of life, psychomotor vigilance task reaction times) were similar in the two groups as were adherence and treatment preference (110). A meta-analysis of RCTs in mild-moderate OSA suggests quite modest benefit from CPAP treatment on both subjective and objective measures of daytime sleepiness (111).

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