This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (93)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Sleep Apnea  • Evidence-Based Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Results of a Meta-analysis

Sanjay R. Patel, MD; David P. White, MD; Atul Malhotra, MD; Michael L. Stanchina, MD; Najib T. Ayas, MD

Arch Intern Med. 2003;163:565-571.

Background  Although continuous positive airway pressure (CPAP) has become the standard of care in the treatment of obstructive sleep apnea (OSA), 2 systematic reviews have questioned its utility. Since the publication of these reviews, several randomized controlled trials have been reported. We, therefore, performed a meta-analysis to assess the effect of CPAP on subjective and objective sleepiness.

Methods  We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSA. Meta-analyses were performed using a random-effects model. Statistical heterogeneity was assessed using the Q statistic.

Results  Twelve trials of CPAP in patients with OSA meeting our inclusion criteria were found. The Epworth Sleepiness Scale score was reported in 11 studies (706 patients). A meta-analysis found that CPAP reduced the Epworth Sleepiness Scale score an average of 2.94 points more than placebo (P<.001). The heterogeneity (Q₁₀ = 57.7, P<.001) between studies could not be explained by differences in sex composition, mean age, mean body mass index, or country of study. Trials recruiting subjects with severe OSA plus sleepiness (mean apnea-hypopnea index, 30 events per hour; and mean Epworth Sleepiness Scale score, 11) had a greater decrease in the Epworth Sleepiness Scale score than the other studies (4.75 vs 1.10; P<.001). Objective measures of sleepiness were reported in 8 trials (482 subjects). Continuous positive airway pressure increased sleep onset latency by 0.93 minute (P = .04) more than placebo.

Conclusions  Continuous positive airway pressure therapy significantly improves subjective and objective measures of sleepiness in patients with OSA across a diverse range of populations. Patients with more severe apnea and sleepiness seem to benefit the most.

From the Division of Sleep Medicine, Brigham and Women's Hospital (Drs Patel, White, Malhotra, Stanchina, and Ayas), the Pulmonary and Critical Care Unit, Massachusetts General Hospital (Drs Patel, Malhotra, and Stanchina), and Harvard Medical School (Drs Patel, White, Malhotra, Stanchina, and Ayas), Boston, Mass. Dr Ayas is now with the Division of Pulmonary Medicine, Vancouver General Hospital, Vancouver, British Columbia. Dr White serves as a consultant and has received research grant support from Respironics, Inc, Murrysville, Pa (a manufacturer of continuous positive airway pressure devices).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sleep Apnea and Psychological Functioning in Chronic Fatigue Syndrome
Libman et al.
J Health Psychol 2009;14:1251-1267.
ABSTRACT  

Armodafinil for Treatment of Excessive Sleepiness Associated With Shift Work Disorder: A Randomized Controlled Study
Czeisler et al.
Mayo Clin Proc. 2009;84:958-972.
ABSTRACT | FULL TEXT  

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients
Koutsourelakis et al.
Eur Respir J 2009;34:687-693.
ABSTRACT | FULL TEXT  

Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study
Pepin et al.
Eur Respir J 2009;33:1062-1067.
ABSTRACT | FULL TEXT  

Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing
Jennum and Riha
Eur Respir J 2009;33:907-914.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea and Central Sleep Apnea: Epidemiology, Pathophysiology, and Risk Factors
Malhotra
ACCP Sleep Med Brd Rev 2009;4:193-200.
FULL TEXT  

Positive Airway Pressure Therapy for Obstructive Sleep Apnea Syndrome: The Boards and Beyond
Freedman
ACCP Sleep Med Brd Rev 2009;4:293-312.
FULL TEXT  

Review: Pharmacotherapy of obstructive sleep apnea
Jayaraman et al.
Ther Adv Respir Dis 2008;2:375-386.
ABSTRACT  

Impact of Upper Airway Surgery on CPAP Compliance in Difficult-to-Manage Obstructive Sleep Apnea
Chandrashekariah et al.
Arch Otolaryngol Head Neck Surg 2008;134:926-930.
ABSTRACT | FULL TEXT  

Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea
Mulgrew et al.
Thorax 2008;63:536-541.
ABSTRACT | FULL TEXT  

Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application
Sanders et al.
Proc Am Thorac Soc 2008;5:161-172.
ABSTRACT | FULL TEXT  

Treatment effects of sleep apnoea: where are we now?
Buyse and the participants of working group 2
ERR 2007;16:146-168.
ABSTRACT | FULL TEXT  

Adherence to Nasal Positive Airway Pressure Therapy Among School-aged Children and Adolescents With Obstructive Sleep Apnea Syndrome
Uong et al.
Pediatrics 2007;120:e1203-e1211.
ABSTRACT | FULL TEXT  

Selective Loss of Catecholaminergic Wake Active Neurons in a Murine Sleep Apnea Model
Zhu et al.
J. Neurosci. 2007;27:10060-10071.
ABSTRACT | FULL TEXT  

Effect of Continuous Positive Airway Pressure Treatment on Serum Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome
Steiropoulos et al.
Chest 2007;132:843-851.
ABSTRACT | FULL TEXT  

Adherence, Reports of Benefits, and Depression Among Patients Treated With Continuous Positive Airway Pressure
Wells et al.
Psychosom. Med. 2007;69:449-454.
ABSTRACT | FULL TEXT  

Continuous Positive Airway Pressure for Obstructive Sleep Apnea
Basner
NEJM 2007;356:1751-1758.
FULL TEXT  

An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea.
Bradshaw et al.
Chest 2006;130:1369-1376.
ABSTRACT | FULL TEXT  

Does CPAP delay the development of cardiovascular disease in patients with obstructive sleep apnoea hypopnoea?
Ayas et al.
Thorax 2006;61:459-460.
FULL TEXT  

Cost-effectiveness of Continuous Positive Airway Pressure Therapy for Moderate to Severe Obstructive Sleep Apnea/Hypopnea.
Ayas et al.
Arch Intern Med 2006;166:977-984.
ABSTRACT | FULL TEXT  

Heart failure and sleep apnoea: To sleep perchance to dream
Ferreira et al.
Eur J Heart Fail 2006;8:227-236.
ABSTRACT | FULL TEXT  

Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis
Marshall et al.
Thorax 2006;61:430-434.
ABSTRACT | FULL TEXT  

Advances in Sleep-disordered Breathing
Pack
Am. J. Respir. Crit. Care Med. 2006;173:7-15.
ABSTRACT | FULL TEXT  

NADPH Oxidase Mediates Hypersomnolence and Brain Oxidative Injury in a Murine Model of Sleep Apnea
Zhan et al.
Am. J. Respir. Crit. Care Med. 2005;172:921-929.
ABSTRACT | FULL TEXT  

Excessive Daytime Sleepiness in a General Population Sample: The Role of Sleep Apnea, Age, Obesity, Diabetes, and Depression
Bixler et al.
J. Clin. Endocrinol. Metab. 2005;90:4510-4515.
ABSTRACT | FULL TEXT  

Inducible Nitric Oxide Synthase in Long-term Intermittent Hypoxia: Hypersomnolence and Brain Injury
Zhan et al.
Am. J. Respir. Crit. Care Med. 2005;171:1414-1420.
ABSTRACT | FULL TEXT  

Treatment Adherence and Outcomes in Flexible vs Standard Continuous Positive Airway Pressure Therapy
Aloia et al.
Chest 2005;127:2085-2093.
ABSTRACT | FULL TEXT  

Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea
Marshall et al.
Thorax 2005;60:427-432.
ABSTRACT | FULL TEXT  

Clinical Usefulness of Home Oximetry Compared with Polysomnography for Assessment of Sleep Apnea
Whitelaw et al.
Am. J. Respir. Crit. Care Med. 2005;171:188-193.
ABSTRACT | FULL TEXT  

Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea
Barnes et al.
Am. J. Respir. Crit. Care Med. 2004;170:656-664.
ABSTRACT | FULL TEXT  

Marked Decrease in Sleepiness in Patients with Sleep Apnea by Etanercept, a Tumor Necrosis Factor-{alpha} Antagonist
Vgontzas et al.
J. Clin. Endocrinol. Metab. 2004;89:4409-4413.
ABSTRACT | FULL TEXT  

Managing excessive daytime sleepiness in adults
DTB 2004;42:52-56.
ABSTRACT | FULL TEXT  

Sleep disordered breathing awoken
Fleetham
Thorax 2004;59:5-6.
FULL TEXT  

OTHER ARTICLES NOTED (25 Apr 2003 to 18 Jul 2003)
Evid. Based Nurs. 2003;6:e1-12.
FULL TEXT  

Review: continuous positive airway pressure therapy improves subjective and objective sleepiness in obstructive sleep apnoea
Rees
Evid. Based Med. 2003;8:112-112.
FULL TEXT  

Continuous Positive Airway Pressure: Placebo Power, or Does It Really Work?
Babar and Quan
Arch Intern Med 2003;163:519-520.
FULL TEXT