Effect of CPAP Treatment on Life Quality in Patients with Obstructive SleepApnea-hypopnea Syndrome Results of a Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YE Hong ,  LI Taoping , FENG Yuan , SHEN Haiyan , LIU Aihua

Department of Sleep Disorder Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;

Corresponding author：

LI Taoping, Email: ltpnet@126.com

Keywords：

Continuous positive airway pressure; Obstructive sleep apnea; Life quality; Meta-analysis

DOI：

10.7507/1672-2531.20090189

Video：

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Objective 　To assess the effect of continuous positive airway pressure treatment (CPAP) on subjective and objective sleepiness in patients with obstructive sleep apnea-hypopnea syndrom (OSAHS).
Methods 　We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSAHS. We use computer to search Pubmed (1990-2008.5), CNKI (1994-2008.5), google (1995-2008.5), Springer Link (1997-2008)、 and many meeting articals. We chose the literatures that divided patients randomly into two groups as CPAP group and subtheraputic CPAP or drug group. Meta-analysis were performed to access the effect and bias.
Results 　A total of 15 trials involving 1 052 patients were included. A Meta-analysis showed that (1) The total effect was that compared with the control group, CPAP treatment group significantly depressed the degree of sleepiness in ESS [WMD= – 2.61, 95%CI (– 3.92, – 1.29)] and in MWT/ MSLT [WMD= 1.42, 95%CI (– 0.01, 2.85)]. (2) Results of subgroups on ESS were that: 1. CPAP vs CT: there was a significant effect on CPAP therapy [WMD= – 3.15, 95%CI (– 4.84, – 1.47)]. 2. CPAP vs sham CPAP: there was no significant difference between the two groups. 3. CPAP vs drugs: CPAP was more efficient than drugs. CPAP may be more efficient in improving patients’ life quality.
Conclusion 　CPAP is a valuable treatment for OSAHS no matter in subjective or objective sleepiness .But more attention should be paid to the lone-time treatment of CPAP.

Citation： YE Hong,LI Taoping,FENG Yuan,SHEN Haiyan,LIU Aihua. Effect of CPAP Treatment on Life Quality in Patients with Obstructive SleepApnea-hypopnea Syndrome Results of a Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(10): 1067-1073. doi: 10.7507/1672-2531.20090189 Copy

1.	中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 2002, (04).
2.	Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med, 2001, 134(11): 1015-1023.
3.	Marshall NS, Neill AM, Campbell AJ, et al. Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax, 2005, 60(5): 427-432.
4.	Smith LA, Vennelle M, Gardner RS, et al. Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebocontrolled trial. Eur Heart J, 2007, 28(10): 1221-1227.
5.	Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 461-467.
6.	Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebocontrolled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 163(2): 344-348.
7.	Henke KG, Grady JJ, Kuna ST. Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apneahypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med, 2001, 163(4): 911-917.
8.	Monasterio C, Vidal S, Duran J, et al. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 164(6): 939-943.
9.	Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10.	Mansfield DR, Gollogly NC, Kaye DM, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med, 2004, 169(3): 361-366.
11.	Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6): 1229-1235.
12.	Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest,2006, 129(6): 1459-1467.
13.	Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 495-501.
14.	Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med, 2001, 164(4): 608-613.
15.	Lam B, Sam K, Mok WY, et al. Randomised study of three nonsurgical treatments in mild to moderate obstructive sleep apnoea. Thorax, 2007, 62(4): 354-359.
16.	Redline S, Adams N, Strauss ME, et al. Improvement of mild sleepdisordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med, 1998, 157(3 Pt 1): 858-865.
17.	Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest, 1996, 110(1): 114-119.
18.	Lojander J, Kajaste S, Maasilta P, et al. Cognitive function and treatment of obstructive sleep apnea syndrome. J Sleep Res, 1999, 8(1): 71-76.
19.	Yu BH, Ancoli-Israel S, Dimsdale JE. Effect of CPAP treatment on mood states in patients with sleep apnea. J Psychiatr Res, 1999, 33(5): 427-432.
20.	Phillips BA, Schmitt FA, Berry DT, et al. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest, 1990, 98(2): 325-330.
21.	Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension, 2006, 47(5): 840-845.
22.	Kawahara S, Akashiba T, Akahoshi T, et al. Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Intern Med, 2005, 44(5): 422-427.
23.	Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J, 2006, 28(5): 1020-1028.
24.	Antczak J, Popp R, Hajak G, et al. Positron emission tomography findings in obstructive sleep apnea patients with residual sleepiness treated with continuous positive airway pressure. J Physiol Pharmacol, 2007, 58 Suppl 5(Pt 1): 25-35.
25.	Neill AM, Wai HS, Bannan SP, et al. Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J, 2003, 22(2): 258-262.
26.	Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep, 2007, 30(6): 711-719.
27.	章志丹, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, (03).

1. 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 2002, (04).
2. Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial. Ann Intern Med, 2001, 134(11): 1015-1023.
3. Marshall NS, Neill AM, Campbell AJ, et al. Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax, 2005, 60(5): 427-432.
4. Smith LA, Vennelle M, Gardner RS, et al. Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebocontrolled trial. Eur Heart J, 2007, 28(10): 1221-1227.
5. Engleman HM, Kingshott RN, Wraith PK, et al. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 461-467.
6. Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebocontrolled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 163(2): 344-348.
7. Henke KG, Grady JJ, Kuna ST. Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apneahypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med, 2001, 163(4): 911-917.
8. Monasterio C, Vidal S, Duran J, et al. Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med, 2001, 164(6): 939-943.
9. Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10. Mansfield DR, Gollogly NC, Kaye DM, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med, 2004, 169(3): 361-366.
11. Robinson GV, Smith DM, Langford BA, et al. Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J, 2006, 27(6): 1229-1235.
12. Campos-Rodriguez F, Grilo-Reina A, Perez-Ronchel J, et al. Effect of continuous positive airway pressure on ambulatory BP in patients with sleep apnea and hypertension: a placebo-controlled trial. Chest,2006, 129(6): 1459-1467.
13. Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med, 1999, 159(2): 495-501.
14. Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med, 2001, 164(4): 608-613.
15. Lam B, Sam K, Mok WY, et al. Randomised study of three nonsurgical treatments in mild to moderate obstructive sleep apnoea. Thorax, 2007, 62(4): 354-359.
16. Redline S, Adams N, Strauss ME, et al. Improvement of mild sleepdisordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med, 1998, 157(3 Pt 1): 858-865.
17. Lojander J, Maasilta P, Partinen M, et al. Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study. Chest, 1996, 110(1): 114-119.
18. Lojander J, Kajaste S, Maasilta P, et al. Cognitive function and treatment of obstructive sleep apnea syndrome. J Sleep Res, 1999, 8(1): 71-76.
19. Yu BH, Ancoli-Israel S, Dimsdale JE. Effect of CPAP treatment on mood states in patients with sleep apnea. J Psychiatr Res, 1999, 33(5): 427-432.
20. Phillips BA, Schmitt FA, Berry DT, et al. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest, 1990, 98(2): 325-330.
21. Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood pressure. Hypertension, 2006, 47(5): 840-845.
22. Kawahara S, Akashiba T, Akahoshi T, et al. Nasal CPAP improves the quality of life and lessens the depressive symptoms in patients with obstructive sleep apnea syndrome. Intern Med, 2005, 44(5): 422-427.
23. Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J, 2006, 28(5): 1020-1028.
24. Antczak J, Popp R, Hajak G, et al. Positron emission tomography findings in obstructive sleep apnea patients with residual sleepiness treated with continuous positive airway pressure. J Physiol Pharmacol, 2007, 58 Suppl 5(Pt 1): 25-35.
25. Neill AM, Wai HS, Bannan SP, et al. Humidified nasal continuous positive airway pressure in obstructive sleep apnoea. Eur Respir J, 2003, 22(2): 258-262.
26. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep, 2007, 30(6): 711-719.
27. 章志丹, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, (03).

Chinese Journal of Evidence-Based Medicine

Effect of CPAP Treatment on Life Quality in Patients with Obstructive SleepApnea-hypopnea Syndrome Results of a Meta-analysis

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