Thorax 1998;53:341-345 ( May )

Rapid communication

Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome Heather M Engleman,^a Sascha E Martin,^a Ruth N Kingshott,^a Thomas W Mackay,^a Ian J Deary,^b Neil J Douglas^a

^a Respiratory Medicine Unit, ^b Department of Psychology, ^c University of Edinburgh, UK

Correspondence to: Professor N J Douglas, Department of Medicine, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, UK.

Received 9 January 1998; Returned to authors 14 January 1998; Revised version received 9 February 1998; Accepted for publication 10 February 1998

BACKGROUNDPatients with the sleep apnoea/hypopnoea syndrome (SAHS) report improved sleepiness, cognitive function, and psychological well being after continuous positive airway pressure (CPAP) therapy, and it is for these daytime features that CPAP is usually given. However, few randomised or controlled studies exist on the effects of CPAP on daytime function.
METHODSA prospective, randomised, single blind, placebo controlled, crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS, all with 15 apnoeas+hypopnoeas/hour and 2 symptoms of SAHS. All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment, following randomisation to treatment order. With ethics committee approval, patients were told the placebo tablet might improve upper airway function. Average effective CPAP use was monitored using hidden time clocks. Assessments of objective and subjective sleepiness, symptoms, cognitive performance, and psychological well being were performed on the last day of each treatment and compared.
RESULTSObjective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP (mean difference from placebo +2.4 min, 95% CI 0.8 to 4.0; p<0.001) as did subjective sleepiness on the Epworth scale (mean difference -6, 95% CI -3 to -9; p = 0.001). Symptom total score also fell with CPAP (mean difference -1.6, 95% CI -2.2 to -1.0; p<0.001). No determinants of these changes with active treatment were identified, and no significant enhancements to cognitive function or psychosocial well being were found in this small sample.
CONCLUSIONSThese findings provide further evidence for clinically significant benefits to daytime function from CPAP.

Keywords: sleep apnoea/hypopnoea syndrome; continuous positive airway pressure; sleepiness; psychomotor performance; affective disorders

---

© 1998 by Thorax
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Antic, N. A., Buchan, C., Esterman, A., Hensley, M., Naughton, M. T., Rowland, S., Williamson, B., Windler, S., Eckermann, S., McEvoy, R. D. (2009). A Randomized Controlled Trial of Nurse-led Care for Symptomatic Moderate-Severe Obstructive Sleep Apnea. Am. J. Respir. Crit. Care Med. 179: 501-508 [Abstract] [Full Text]  
• Freedman, N. S. (2009). Positive Airway Pressure Therapy for Obstructive Sleep Apnea Syndrome: The Boards and Beyond. ACCP Sleep Med Brd Rev 4: 293-312 [Full Text]  
• Robinson, G V, Langford, B A, Smith, D M, Stradling, J R (2008). Predictors of blood pressure fall with continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea (OSA). Thorax 63: 855-859 [Abstract] [Full Text]  
• Campos-Rodriguez, F., Perez-Ronchel, J., Grilo-Reina, A., Lima-Alvarez, J., Benitez, M. A., Almeida-Gonzalez, C. (2007). Long-term Effect of Continuous Positive Airway Pressure on BP in Patients With Hypertension and Sleep Apnea. Chest 132: 1847-1852 [Abstract] [Full Text]  
• Bradshaw, D. A., Ruff, G. A., Murphy, D. P. (2006). An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea.. Chest 130: 1369-1376 [Abstract] [Full Text]  
• West, S D, Nicoll, D J, Stradling, J R (2006). Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61: 945-950 [Abstract] [Full Text]  
• Robinson, G. V., Smith, D. M., Langford, B. A., Davies, R. J. O., Stradling, J. R. (2006). Continuous positive airway pressure does not reduce blood pressure in nonsleepy hypertensive OSA patients. Eur Respir J 27: 1229-1235 [Abstract] [Full Text]  
• West, S D, Jones, D R, Stradling, J R (2006). Comparison of three ways to determine and deliver pressure during nasal CPAP therapy for obstructive sleep apnoea. Thorax 61: 226-231 [Abstract] [Full Text]  
• Aloia, M. S., Stanchina, M., Arnedt, J. T., Malhotra, A., Millman, R. P. (2005). Treatment Adherence and Outcomes in Flexible vs Standard Continuous Positive Airway Pressure Therapy. Chest 127: 2085-2093 [Abstract] [Full Text]  
• Chervin, R. D., Burns, J. W., Ruzicka, D. L. (2005). Electroencephalographic Changes during Respiratory Cycles Predict Sleepiness in Sleep Apnea. Am. J. Respir. Crit. Care Med. 171: 652-658 [Abstract] [Full Text]  
• Whitelaw, W. A., Brant, R. F., Flemons, W. W. (2005). Clinical Usefulness of Home Oximetry Compared with Polysomnography for Assessment of Sleep Apnea. Am. J. Respir. Crit. Care Med. 171: 188-193 [Abstract] [Full Text]  
• Skinner, M. A., Choudhury, M. S., Homan, S. D.R., Cowan, J. O., Wilkins, G. T., Taylor, D. R. (2005). Accuracy of Monitoring for Sleep-Related Breathing Disorders in the Coronary Care Unit. Chest 127: 66-71 [Abstract] [Full Text]  
• Gordon, P, Sanders, M H (2005). Sleep {middle dot} 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome. Thorax 60: 68-75 [Abstract] [Full Text]  
• Barnes, M., McEvoy, R. D., Banks, S., Tarquinio, N., Murray, C. G., Vowles, N., Pierce, R. J. (2004). Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea. Am. J. Respir. Crit. Care Med. 170: 656-664 [Abstract] [Full Text]  
• Johnson, M K, Carter, R, Nicol, A, Paton, R, Banham, S W (2004). Long-term continuous positive airway pressure (CPAP) outcomes from a sleep service using limited sleep studies and daycase CPAP titration in the management of obstructive sleep apnoea/hypopnoea syndrome. Chronic Respiratory Disease 1: 83-88 [Abstract]  
• Flemons, W. W., Douglas, N. J., Kuna, S. T., Rodenstein, D. O., Wheatley, J. (2004). Access to Diagnosis and Treatment of Patients with Suspected Sleep Apnea. Am. J. Respir. Crit. Care Med. 169: 668-672 [Full Text]  
• Pelletier-Fleury, N., Meslier, N., Gagnadoux, F., Person, C., Rakotonanahary, D., Ouksel, H., Fleury, B., Racineux, J-L. (2004). Economic arguments for the immediate management of moderate-to-severe obstructive sleep apnoea syndrome. Eur Respir J 23: 53-60 [Abstract] [Full Text]  
• Schwartz, J. R. L., Hirshkowitz, M., Erman, M. K., Schmidt-Nowara, W. (2003). Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea: A 12-Week, Open-Label Study. Chest 124: 2192-2199 [Abstract] [Full Text]  
• Parish, J. M., Lyng, P. J. (2003). Quality of Life in Bed Partners of Patients With Obstructive Sleep Apnea or Hypopnea After Treatment With Continuous Positive Airway Pressure. Chest 124: 942-947 [Abstract] [Full Text]  
• Patel, S. R., White, D. P., Malhotra, A., Stanchina, M. L., Ayas, N. T. (2003). Continuous Positive Airway Pressure Therapy for Treating gess in a Diverse Population With Obstructive Sleep Apnea: Results of a Meta-analysis. Arch Intern Med 163: 565-571 [Abstract] [Full Text]  
• Fitzpatrick, M. F., Alloway, C. E. D., Wakeford, T. M., MacLean, A. W., Munt, P. W., Day, A. G. (2003). Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?. Am. J. Respir. Crit. Care Med. 167: 716-722 [Abstract] [Full Text]  
• Dingli, K., Coleman, E.L., Vennelle, M., Finch, S.P., Wraith, P.K., Mackay, T.W., Douglas, N.J. (2003). Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome. Eur Respir J 21: 253-259 [Abstract] [Full Text]  
• Snow, A., Gozal, E., Malhotra, A., Tiosano, D., Perlman, R., Vega, C., Shahar, E., Gozal, D., Hochberg, Z.'e., Pillar, G. (2002). Severe Hypersomnolence After Pituitary/Hypothalamic Surgery in Adolescents: Clinical Characteristics and Potential Mechanisms. Pediatrics 110: e74-74 [Abstract] [Full Text]  
• Gotsopoulos, H., Chen, C., Qian, J., Cistulli, P. A. (2002). Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea: A Randomized, Controlled Trial. Am. J. Respir. Crit. Care Med. 166: 743-748 [Abstract] [Full Text]  
• BARNES, M., HOUSTON, D., WORSNOP, C. J., NEILL, A. M., MYKYTYN, I. J., KAY, A., TRINDER, J., SAUNDERS, N. A., MCEVOY, R. D., PIERCE, R. J. (2002). A Randomized Controlled Trial of Continuous Positive Airway Pressure in Mild Obstructive Sleep Apnea. Am. J. Respir. Crit. Care Med. 165: 773-780 [Abstract] [Full Text]  
• Yan, A. T., Bradley, T. D., Liu, P. P. (2001). The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure. Chest 120: 1675-1685 [Abstract] [Full Text]  
• PACK, A. I., BLACK, J. E., SCHWARTZ, J. R. L., MATHESON, J. K. (2001). Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea. Am. J. Respir. Crit. Care Med. 164: 1675-1681 [Abstract] [Full Text]  
• MCARDLE, N., DOUGLAS, N. J. (2001). Effect of Continuous Positive Airway Pressure on Sleep Architecture in the Sleep Apnea-Hypopnea Syndrome . A Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 164: 1459-1463 [Abstract] [Full Text]  
• Parra, O. (2001). Sleep-disordered breathing and stroke: is there a rationale for treatment?. Eur Respir J 18: 619-622 [Full Text]  
• MONASTERIO, C., VIDAL, S., DURAN, J., FERRER, M., CARMONA, C., BARBE, F., MAYOS, M., GONZALEZ-MANGADO, N., JUNCADELLA, M., NAVARRO, A., BARREIRA, R., CAPOTE, F., MAYORALAS, L. R., PECES-BARBA, G., ALONSO, J., MONTSERRAT, J. M. (2001). Effectiveness of Continuous Positive Airway Pressure in Mild Sleep Apnea-Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 164: 939-943 [Abstract] [Full Text]  
• Popescu, G, Latham, M, Allgar, V, Elliott, M W (2001). Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use. Thorax 56: 727-733 [Abstract] [Full Text]  
• Hui, D. S. C, Choy, D. K. L., Li, T. S. T., Ko, F. W. S., Wong, K. K., Chan, J. K. W., Lai, C. K. W. (2001). Determinants of Continuous Positive Airway Pressure Compliance in a Group of Chinese Patients With Obstructive Sleep Apnea. Chest 120: 170-176 [Abstract] [Full Text]  
• Barbe, F., Mayoralas, L. R., Duran, J., Masa, J. F., Maimo, A., Montserrat, J. M., Monasterio, C., Bosch, M., Ladaria, A., Rubio, M., Rubio, R., Medinas, M., Hernandez, L., Vidal, S., Douglas, N. J., Agusti, A. G.N. (2001). 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 134: 1015-1023 [Abstract] [Full Text]  
• Jenkinson, C., Davies, R.J.O., Mullins, R., Stradling, J.R. (2001). Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea. QJM 94: 95-99 [Abstract] [Full Text]  
• Hedner, J., Grote, L. (2001). The Link between Sleep Apnea and Cardiovascular Disease . Time to Target the Nonsleepy Sleep Apneics?. Am. J. Respir. Crit. Care Med. 163: 5-6 [Full Text]  
• Chervin, R. D. (2000). Sleepiness, Fatigue, Tiredness, and Lack of Energy in Obstructive Sleep Apnea. Chest 118: 372-379 [Abstract] [Full Text]  
• BLOCH, K. E., ISELI, A., ZHANG, J. N., XIE, X., KAPLAN, V., STOECKLI, P. W., RUSSI, E. W. (2000). A Randomized, Controlled Crossover Trial of Two Oral Appliances for Sleep Apnea Treatment. Am. J. Respir. Crit. Care Med. 162: 246-251 [Abstract] [Full Text]  
• Chervin, R. D., Zallek, S. N., Lin, X., Hall, J. M., Sharma, N., Hedger, K. M. (2000). Sleep disordered breathing in patients with cluster headache. Neurology 54: 2302-2306 [Abstract] [Full Text]  
• Davies, R. J. O., Stradling, J. R. (2000). The Efficacy of Nasal Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea Syndrome Is Proven. Am. J. Respir. Crit. Care Med. 161: 1775-1776 [Full Text]  
• Wright, J., Sheldon, T. (2000). 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. 161: 1776-1778 [Full Text]  
• Hui, D. S. C., Chan, J. K. W., Choy, D. K. L., Ko, F. W. S., Li, T. S. T., Leung, R. C. C., Lai, C. K. W. (2000). Effects of Augmented Continuous Positive Airway Pressure Education and Support on Compliance and Outcome in a Chinese Population. Chest 117: 1410-1416 [Abstract] [Full Text]  
• Loredo, J. S., Ancoli-Israel, S., Dimsdale, J. E. (1999). Effect of Continuous Positive Airway Pressure vs Placebo Continuous Positive Airway Pressure on Sleep Quality in Obstructive Sleep Apnea*. Chest 116: 1545-1549 [Abstract] [Full Text]  
• HOY, C. J., VENNELLE, M., KINGSHOTT, R. N., ENGLEMAN, H. M., DOUGLAS, N. J. (1999). Can Intensive Support Improve Continuous Positive Airway Pressure Use in Patients with the Sleep Apnea/Hypopnea Syndrome?. Am. J. Respir. Crit. Care Med. 159: 1096-1100 [Abstract] [Full Text]  
• ENGLEMAN, H. M., KINGSHOTT, R. N., WRAITH, P. K., MACKAY, T. W., DEARY, I. J., DOUGLAS, N. J. (1999). Randomized Placebo-controlled Crossover Trial of Continuous Positive Airway Pressure for Mild Sleep Apnea/Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 159: 461-467 [Abstract] [Full Text]  
• Gibson, G J (1998). Public health aspects of obstructive sleep apnoea. Thorax 53: 408-409 [Full Text]  
• Douglas, N. J (1998). Systematic review of the efficacy of nasal CPAP. Thorax 53: 414-415 [Full Text]