Header

UZH-Logo

Maintenance Infos

Effects of suboptimal adherence of CPAP-therapy on symptoms of obstructive sleep apnea: a randomised, double-blind, controlled trial


Gaisl, Thomas; Rejmer, Protazy; Thiel, Sira; Haile, Sarah R; Osswald, Martin; Roos, Malgorzata; Bloch, Konrad E; Stradling, John R; Kohler, Malcolm (2020). Effects of suboptimal adherence of CPAP-therapy on symptoms of obstructive sleep apnea: a randomised, double-blind, controlled trial. European Respiratory Journal:1901526.

Abstract

NTRODUCTION:
Continuous positive airway pressure (CPAP) is currently the treatment of choice for sleepiness in patients with obstructive sleep apnea (OSA), however, adherence is often thought to be suboptimal. We investigated the effects of suboptimal CPAP-usage on objective and subjective sleepiness parameters in patients with OSA.
MATERIAL AND METHODS:
In this 2-week, parallel, double-blind, randomised controlled trial we enrolled moderate-to-severe OSA patients with excessive pre-treatment daytime sleepiness (Epworth-Sleepiness-Scale [ESS] score >10 points) who had suboptimal CPAP adherence over at least 12 months (mean nightly usage time 3-4 h). Patients were allocated through minimisation to either subtherapeutic CPAP ("sham-CPAP") or continuation of CPAP (therapeutic-CPAP). A Bayesian analysis with historical priors calculated the posterior probability of superiority.
RESULTS:
Between May, 2016 and November, 2018, 57 patients (60±8 years, 79% men, 93% Caucasian) were allocated in total, and 52 who completed the study (50% in each arm) were included in the final analysis. The unadjusted ESS-score increase was +2.4 points (95% CI +0.6 to +4.2; p=0.01) in the sham-CPAP-group when compared to continuing therapeutic CPAP. The probability of superiority of therapeutic CPAP over sham CPAP was 90.4% for ESS, 90.1% for systolic, and 80.3% for diastolic blood pressure.
CONCLUSIONS:
Patients with moderate-to-severe OSA and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence, albeit not as much as they might get if they adhered more. Whether a similar statement can be made for even lower adherence levels remains to be established in future trials.

Abstract

NTRODUCTION:
Continuous positive airway pressure (CPAP) is currently the treatment of choice for sleepiness in patients with obstructive sleep apnea (OSA), however, adherence is often thought to be suboptimal. We investigated the effects of suboptimal CPAP-usage on objective and subjective sleepiness parameters in patients with OSA.
MATERIAL AND METHODS:
In this 2-week, parallel, double-blind, randomised controlled trial we enrolled moderate-to-severe OSA patients with excessive pre-treatment daytime sleepiness (Epworth-Sleepiness-Scale [ESS] score >10 points) who had suboptimal CPAP adherence over at least 12 months (mean nightly usage time 3-4 h). Patients were allocated through minimisation to either subtherapeutic CPAP ("sham-CPAP") or continuation of CPAP (therapeutic-CPAP). A Bayesian analysis with historical priors calculated the posterior probability of superiority.
RESULTS:
Between May, 2016 and November, 2018, 57 patients (60±8 years, 79% men, 93% Caucasian) were allocated in total, and 52 who completed the study (50% in each arm) were included in the final analysis. The unadjusted ESS-score increase was +2.4 points (95% CI +0.6 to +4.2; p=0.01) in the sham-CPAP-group when compared to continuing therapeutic CPAP. The probability of superiority of therapeutic CPAP over sham CPAP was 90.4% for ESS, 90.1% for systolic, and 80.3% for diastolic blood pressure.
CONCLUSIONS:
Patients with moderate-to-severe OSA and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence, albeit not as much as they might get if they adhered more. Whether a similar statement can be made for even lower adherence levels remains to be established in future trials.

Statistics

Citations

Dimensions.ai Metrics
3 citations in Web of Science®
4 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

19 downloads since deposited on 09 Jan 2020
19 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Pulmonary and Respiratory Medicine
Uncontrolled Keywords:Pulmonary and Respiratory Medicine
Language:English
Date:2020
Deposited On:09 Jan 2020 16:14
Last Modified:21 Mar 2021 01:00
Publisher:European Respiratory Society
ISSN:0903-1936
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1183/13993003.01526-2019
PubMed ID:31862764
Project Information:
  • : FunderSNSF
  • : Grant ID32003B_162534
  • : Project TitleEffects of suboptimal use of CPAP therapy on symptoms of obstructive sleep apnoea

Download

Green Open Access

Download PDF  'Effects of suboptimal adherence of CPAP-therapy on symptoms of obstructive sleep apnea: a randomised, double-blind, controlled trial'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 993kB
View at publisher