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Am. J. Respir. Crit. Care Med., Volume 159, Number 2, February 1999, 461-467

Randomized Placebo-controlled Crossover Trial of Continuous Positive Airway Pressure for Mild Sleep Apnea/Hypopnea Syndrome

HEATHER M. ENGLEMAN, RUTH N. KINGSHOTT, PETER K. WRAITH, THOMAS W. MACKAY, IAN J. DEARY, and NEIL J. DOUGLAS

Departments of Respiratory Medicine and Psychology, University of Edinburgh, United Kingdom

The minimal disease severity at which patients with the sleep apnea/hypopnea syndrome (SAHS) gain benefit from treatment is not well characterized, although a pilot study of continuous positive airway pressure (CPAP) therapy showed daytime improvements in patients with 5 to 15 apneas + hypopneas per hour slept (AHI). We have thus performed a second, larger, randomized, placebo- controlled study in a prospective series of 34 patients (13 female) with mild SAHS (AHI 5 to 15) and daytime sleepiness. Patients spent 4 wk on CPAP treatment and 4 wk on an oral placebo, with randomization of treatment order, and daytime assessments on the last day of each treatment. Effective CPAP use averaged 2.8 ± 2.1 h (mean ± SD) per night. Compared with placebo, CPAP improved symptom score (p < 0.01), subjective (Epworth; p < 0.01) but not objective (maintenance of wakefulness test; p > 0.2) sleepiness, performances on 2 of 7 cognitive tasks (p < 0.02), depression score (p < 0.01), and five subscales of the SF-36 health/functional status questionnaire (p =< 0.03). Fourteen of 34 patients preferred CPAP. In 14 patients with AHI in the range 5 to 10, symptoms, cognitive function, psychological well-being and quality of life were improved. These results confirm benefits for daytime function after CPAP treatment for mild SAHS, but highlight unacceptability of CPAP in many such patients.




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R. N. KINGSHOTT, M. VENNELLE, E. L. COLEMAN, H. M. ENGLEMAN, T. W. MACKAY, and N. J. DOUGLAS
Randomized, Double-blind, Placebo-controlled Crossover Trial of Modafinil in the Treatment of Residual Excessive Daytime Sleepiness in the Sleep Apnea/Hypopnea Syndrome
Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 918 - 923.
[Abstract] [Full Text]

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 QJMHome page
C. Jenkinson, R.J.O. Davies, R. Mullins, and J.R. Stradling
Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea
QJM, February 1, 2001; 94(2): 95 - 99.
[Abstract] [Full Text] [PDF]

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 ChestHome page
D. Rakotonanahary, N. Pelletier-Fleury, F. Gagnadoux, and B. Fleury
Predictive Factors for the Need for Additional Humidification During Nasal Continuous Positive Airway Pressure Therapy
Chest, February 1, 2001; 119(2): 460 - 465.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
J. F. FACCENDA, T. W. MACKAY, N. A. BOON, and N. J. DOUGLAS
Randomized Placebo-controlled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep Apnea-Hypopnea Syndrome
Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 344 - 348.
[Abstract] [Full Text]

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 ChestHome page
F. Morisson, A. Decary, D. Petit, G. Lavigne, J. Malo, and J. Montplaisir
Daytime Sleepiness and EEG Spectral Analysis in Apneic Patients Before and After Treatment With Continuous Positive Airway Pressure
Chest, January 1, 2001; 119(1): 45 - 52.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
D. J. GOTTLIEB, Q. YAO, S. REDLINE, T. ALI, and M. W. MAHOWALD
Does Snoring Predict Sleepiness Independently of Apnea and Hypopnea Frequency?
Am. J. Respir. Crit. Care Med., October 1, 2000; 162(4): 1512 - 1517.
[Abstract] [Full Text] [PDF]

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 ChestHome page
M. Littner
Polysomnography in the Diagnosis of the Obstructive Sleep Apnea-Hypopnea Syndrome : Where Do We Draw the Line?
Chest, August 1, 2000; 118(2): 286 - 288.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
Y. PEKER, J. HEDNER, H. KRAICZI, and S. LÖTH
Respiratory Disturbance Index . An Independent Predictor of Mortality in Coronary Artery Disease
Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 81 - 86.
[Abstract] [Full Text]

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 Am. J. Respir. Crit. Care Med.Home page
K. E. BLOCH, A. ISELI, J. N. ZHANG, X. XIE, V. KAPLAN, P. W. STOECKLI, and E. W. RUSSI
A Randomized, Controlled Crossover Trial of Two Oral Appliances for Sleep Apnea Treatment
Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 246 - 251.
[Abstract] [Full Text]

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 Am. J. Respir. Crit. Care Med.Home page
J. Wright and T. Sheldon
The Efficacy of Nasal Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea Syndrome Is Not Proven
Am. J. Respir. Crit. Care Med., June 1, 2000; 161(6): 1776 - 1778.
[Full Text]

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 ChestHome page
D. S. C. Hui, J. K. W. Chan, D. K. L. Choy, F. W. S. Ko, T. S. T. Li, R. C. C. Leung, and C. K. W. Lai
Effects of Augmented Continuous Positive Airway Pressure Education and Support on Compliance and Outcome in a Chinese Population
Chest, May 1, 2000; 117(5): 1410 - 1416.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
N. J. Douglas
Upper Airway Resistance Syndrome Is Not a Distinct Syndrome
Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1413 - 1415.
[Full Text]

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 Evid. Based Med.Home page
N. Douglas
Review: screening tests are not as accurate as overnight polysomnography for the diagnosis of adult sleep apnoea
Evid. Based Med., March 1, 2000; 5(2): 61 - 61.
[Full Text]

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 Am. J. Respir. Crit. Care Med.Home page
R. N. KINGSHOTT, M. VENNELLE, C. J. HOY, H. M. ENGLEMAN, I. J. DEARY, and N. J. DOUGLAS
Predictors of Improvements in Daytime Function Outcomes with CPAP Therapy
Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 866 - 871.
[Abstract] [Full Text] [PDF]

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 ChestHome page
D. I. Loube
Technologic Advances in the Treatment of Obstructive Sleep Apnea Syndrome
Chest, November 1, 1999; 116(5): 1426 - 1433.
[Abstract] [Full Text] [PDF]

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 JWatch PsychiatryHome page
More Data on CPAP for Obstructive Sleep Apnea
Journal Watch Psychiatry, May 1, 1999; 1999(501): 16 - 16.
[Full Text]

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 JWatch GeneralHome page
More Data on CPAP for Obstructive Sleep Apnea
Journal Watch (General), March 12, 1999; 1999(312): 4 - 4.
[Full Text]


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