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Evidence summaries

Cpap for Obstructive Sleep Apnoea

Continuous positive airways pressure (CPAP) is effective in reducing symptoms of sleepiness and improving quality of life measures in people with moderate and severe obstructive sleep apnoea and appears to be superior compared with positional therapy. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 36 studies with a total of 1 718 subjects. Study quality was mixed. Compared with control, CPAP showed significant improvements in certain objective and subjective measures of sleepiness, quality of life and cognitive function (parallel-group studies: Epworth sleepiness scale (ESS) -3.83 units, 95% CI -4.57 to -3.09; crossover studies: ESS -1.84 units, 95% CI -2.57 to -1.11). Twenty-four hour systolic and diastolic blood pressures were lower with CPAP compared with control (parallel-group trials). Compared with oral appliances, CPAP significantly reduced the apnoea and hypopnoea index (crossover studies: -7.97 events/hr, 95% CI -9.56 to -6.38) and improved sleep efficiency (crossover studies: 2.31%, 95% CI 0.02 to 4.6) and minimum oxygen saturation (4.14%, 95% CI 3.25 to 5.03). Responders to both treatments expressed a strong preference for the oral appliance. However, participants were more likely to withdraw on OA than on CPAP therapy.

In a meta-analysis of randomized trials 2, three trials with a total of 71 patients comparing positional therapy versus CPAP in patients with positional OSA (obstructive sleep apnea) were included. Apnea-hypopnea index (AHI), mean oxygen saturation level, arousal index, sleep efficiency, and sleep time were the outcomes of this meta-analysis. Positional therapy showed higher AHI (MD 4.28, 95% CI 0.72 to 7.83) and lower oxygen saturation level (MD -1.04, 95% CI -1.63 to -0.46) than CPAP. It showed no distinct advantage over CPAP in terms of arousal index, sleep efficiency, and total sleep time, but CPAP reduced sleep time in the supine position.

    References

    • Giles TL, Lasserson TJ, Smith BH et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;(3):CD001106. [PubMed]
    • Ha SC, Hirai HW, Tsoi KK. Comparison of positional therapy versus continuous positive airway pressure in patients with positional obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Med Rev 2014;18(1):19-24. [PubMed]

Primary/Secondary Keywords