Efficacy of Continuous Positive Airway Pressure (CPAP) in Patients with Obstructive Sleep Apnea (OSA): A Real-World Study
Keywords:
Continuous positive airway pressure, obstructive sleep apnea, CPAP, OSA, real-world
Abstract
Background: Sleep being an essential biological function, has a significant role. The basic structure of sleep consists of non-rapid eye movement (NREM) and rapid eye movement (REM). Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the commonest of sleep-related breathing disorders, which is a chronic disorder characterized by the presence of partial or complete blockage of the upper airway causing reduced (hypopnea) or absent (apnea) airflow during sleep. Continuous positive airway pressure (CPAP) therapy reduces OSA severity, improves both daytime and nocturnal symptoms in particular excessive daytime sleepiness and fatigue.
Objective: Assessment of AHI, Arousal Index, and sleep pattern improvement (N1, N2, N3, and R duration), blood pressure pre and post CPAP therapy and compliance of patients to CPAP therapy over a period of ≥6 months
Methodology: A total 107 polysomnography (PSG) reports of patients who visited the sleep centre from March 2019 to March 2020 were included for the analysis.
Results: Our study reported a significant decrease (p<0.0001) in AHI, Arousal Index, and blood pressure post CPAP therapy in the overall population, both the genders and in all age groups. There was a significant increase in N3, and R (p<0.05) post CPAP therapy in most of the patients, whereas there was a marginal decrease in N1 and N2 post CPAP therapy.
Conclusion: Our results from the real-life clinical setting confirms that CPAP is effective at decreasing AHI, Arousal Index, blood pressure, and adherence to treatment with CPAP reported increased sleep efficiency and improvement in both nocturnal and diurnal symptoms in Indian patients with moderate to severe OSA.
Source(s) of Support: No funding was provided.
Conflicting Interest: Nil.
References
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26. Holley AB, Lettieri CJ, Shah AA. Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest. 2011 Dec 1;140(6):1511-6.
27. Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath. 2018 Sep 1;22(3):555-68.
28. Li W, Xiao L, Hu J. The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care. 2013 Jul 1;58(7):1184-95.
29. Liu T, Li W, Zhou H, Wang Z. Verifying the relative efficacy between continuous positive airway pressure therapy and its alternatives for obstructive sleep apnea: a network metaanalysis. Front Neurol. 2017 Jun 28;8:289.
30. Tachikawa R, Minami T, Matsumoto T, Murase K, Tanizawa K, Inouchi M, et al. Changes in habitual sleep duration after continuous positive airway pressure for obstructive sleep apnea. Ann Am Thorac Soc. 2017 Jun;14(6):986-93.
31. Zhang C, Lv J, Zhou J, Su L, Feng L, Ma J, et al. The effect of CPAP treatment on EEG of OSAS patients. Sleep Breath. 2015
Dec 1;19(4):1121-4.
32. Lei Q, Lv Y, Li K, Ma L, Du G, Xiang Y, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials. J Bras Pneumol. 2017 Sep;43(5):373-9.
33. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea: a systematic review and metaanalysis. Chest. 2014 Apr 1;145(4):762-71.
34. Durán J, Esnaola S, Rubio R, Iztueta Á. Obstructive sleep apnea– hypopnea and related clinical features in a populationbased sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001 Mar 1;163(3):685-9.
35. Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middleaged urban Indian men. Am J Respir Crit Care Med. 2004 Jan 15;169(2):168-73.
36. McMillan A, Bratton DJ, Faria R, Laskawiec-Szkonter M, Griffin S, Davies RJ, et al, PREDICT Investigators. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med. 2014 Oct 1;2(10):804-12.
2. Colten HR, Altevogt BM. Sleep physiology. In: Sleep disorders and sleep deprivation: An unmet public health problem 2006. Washington DC; 2006. p. 34-35.
3. Carley DW, Farabi SS. Physiology of sleep. Diabetes Spectr. 2016 Feb 1;29(1):5-9.
4. Sateia MJ. International classification of sleep disorders. Chest. 2014 Nov 1;146(5):1387-94.
5. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteenyear follow-up of the Wisconsin sleep cohort. Sleep. 2008 Aug 1;31(8):1071-8.
6. Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis. 2015 Sep;6(5):273-85.
7. Joshi JM. Obstructive sleep apnea and its prevalence in India. RespiMirror. 2015 Apr 1;5(1):1-2.
8. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014 Feb 22;383(9918):736-47.
9. Guilleminault C, Quo SD. Sleep-disordered breathing. A view at the beginning of the new Millennium. Dent Clin North Am. 2001 Oct;45(4):643-56.
10. Yue HJ, Bardwell W, Ancoli-Israel S, Loredo JS, Dimsdale JE. Arousal frequency is associated with increased fatigue in obstructive sleep apnea. Sleep Breath. 2009 Nov 1;13(4):331-9.
11. Vaessen TJ, Overeem S, Sitskoorn MM. Cognitive complaints in obstructive sleep apnea. Sleep Med Rev. 2015 Feb 1;19:51-8.
12. Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J hypertens. 2012 Apr 1;30(4):633-46.
13. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003 May 21;289(19):2560-71.
14. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J hypertens. 2013 Jul;31(7):1281-357.
15. Modi M. The diagnosis of OSA. RespiMirror. 2015 Apr 1;5,(1):6-7.
16. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012 Oct 15;8(5):597-619.
17. Shevade M. Positive airway pressure in obstructive sleep apnea. RespiMirror. 2015 Apr 1;5,(1):11-12.
18. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019 Feb 15;15(2):335.
19. Weiss P, Kryger M. Positive airway pressure therapy for obstructive sleep apnea. Otolaryngol Clin North Am. 2016 Dec 1;49(6):1331-41.
20. Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, et al. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014. Lung India. 2015 Jul;32(4):422.
21. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2019 Feb 15;15(2):301.
22. Battan G, Kumar S, Panwar A, Atam V, Kumar P, Gangwar A, et al. Effect of CPAP therapy in improving daytime sleepiness in Indian patients with moderate and severe OSA. J Clin Diagn Res. 2016 Nov;10(11):OC14.
23. Guilleminault C, Lin CM, Goncalves MA, Ramos E. A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia. J Psychosom Res. 2004 May 1;56(5):511-5.
24. Miyauchi Y, Okazoe H, Okujyo M, Inada F, Kakehi T, Kikuchi H, et al. Effect of the continuous positive airway pressure on the nocturnal urine volume or night-time frequency in patients with obstructive sleep apnea syndrome. Urology. 2015 Feb 1;85(2):333-6.
25. Gupta A, Shukla G, Afsar M, Poornima S, Pandey RM, Goyal V, et al. Role of positive airway pressure therapy for obstructive sleep apnea in patients with stroke: a randomized controlled trial. J Clin Sleep Med. 2018 Apr 15;14(4):511-21.
26. Holley AB, Lettieri CJ, Shah AA. Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest. 2011 Dec 1;140(6):1511-6.
27. Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath. 2018 Sep 1;22(3):555-68.
28. Li W, Xiao L, Hu J. The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care. 2013 Jul 1;58(7):1184-95.
29. Liu T, Li W, Zhou H, Wang Z. Verifying the relative efficacy between continuous positive airway pressure therapy and its alternatives for obstructive sleep apnea: a network metaanalysis. Front Neurol. 2017 Jun 28;8:289.
30. Tachikawa R, Minami T, Matsumoto T, Murase K, Tanizawa K, Inouchi M, et al. Changes in habitual sleep duration after continuous positive airway pressure for obstructive sleep apnea. Ann Am Thorac Soc. 2017 Jun;14(6):986-93.
31. Zhang C, Lv J, Zhou J, Su L, Feng L, Ma J, et al. The effect of CPAP treatment on EEG of OSAS patients. Sleep Breath. 2015
Dec 1;19(4):1121-4.
32. Lei Q, Lv Y, Li K, Ma L, Du G, Xiang Y, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials. J Bras Pneumol. 2017 Sep;43(5):373-9.
33. Fava C, Dorigoni S, Dalle Vedove F, Danese E, Montagnana M, Guidi GC, et al. Effect of CPAP on blood pressure in patients with OSA/hypopnea: a systematic review and metaanalysis. Chest. 2014 Apr 1;145(4):762-71.
34. Durán J, Esnaola S, Rubio R, Iztueta Á. Obstructive sleep apnea– hypopnea and related clinical features in a populationbased sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001 Mar 1;163(3):685-9.
35. Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep-disordered breathing and sleep apnea in middleaged urban Indian men. Am J Respir Crit Care Med. 2004 Jan 15;169(2):168-73.
36. McMillan A, Bratton DJ, Faria R, Laskawiec-Szkonter M, Griffin S, Davies RJ, et al, PREDICT Investigators. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med. 2014 Oct 1;2(10):804-12.
Published
2020-12-24
How to Cite
Dr. Animesh Arya, Dr. Seema Arya , Dr. Radhika Arya. (2020). Efficacy of Continuous Positive Airway Pressure (CPAP) in Patients with Obstructive Sleep Apnea (OSA): A Real-World Study. The Indian Practitioner, 73(12), 22-29. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/1097
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Original Article
