SLEEP DISORDERED BREATHING

Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea

Bing Lam², Kim Sam¹, Wendy YW Mok², Man Tat Cheung⁴, Daniel YT Fong³, Jamie CM Lam², David CL Lam², Loretta YC Yam⁴, Mary SM lp¹

¹ Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
² Department of Medicine, The University of Hong Kong, Hong Kong SAR, China;
³ Department of Nursing, The University of Hong Kong, Hong Kong SAR, China
⁴ Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China

Correspondence to:
Professor M S M Ip
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China; msmip{at}hkucc.hku.hk

Background: Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non-surgical treatment modalities.

Methods: Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10 weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight-reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health-related quality of life (HRQOL) was assessed with the 36-Item Short-Form Health Survey (SF-36) and Sleep Apnoea Quality of Life Index (SAQLI).

Results: 101 subjects with a mean (SEM) apnoea–hypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the "bodily pain" domain, and better than conservative measures in improving the "physical function" domain of SF-36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight.

Conclusion: CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.

Abbreviations: AHI, apnoea–hypopnoea index; CPAP, continuous positive airways pressure; ESS, Epworth Sleepiness Scale; HRQOL, health-related quality of life; ITT, intention-to-treat; OSA, obstructive sleep apnoea; PSG, polysomnography; SAQLI, Sleep Apnoea Quality of Life Index

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