Original articleCPAP treatment of a population-based sample—what are the benefits and the treatment compliance?
Introduction
In the middle-aged population approximately one-quarter of men and one-tenth of women suffer from obstructive sleep apnea (OSA), defined as at least five respiratory pauses per hour of sleep [1]. Only about one out of five sufferers also report daytime sleepiness, thereby fulfilling the present criteria for obstructive sleep apnea syndrome (OSAS).
There have been a number of recent reports suggesting an association between sleep apnea and cardiovascular disease [2] and impaired glucose metabolism [3] also in populations without reported daytime sleepiness. This raises the question whether also asymptomatic individuals with OSA should be offered treatment [4]. Continuous positive airway pressure (CPAP) is currently the most widely used treatment for severe OSAS. The success of the treatment is, however, highly dependent on compliance with the prescribed treatment [5].
The discussion about whether individuals who have not sought medical advice should be screened for OSA raises two important questions: (1) Do such populations benefit from the treatment in terms of improved quality of life, improved glucose metabolism and reduced cardiovascular morbidity? and (2) Do such individuals tolerate the available treatment?
The effects of treatment on blood pressure are under debate. In one study, CPAP treatment did not reduce blood pressure in patients attending a sleep clinic, who had an apnea-hypopnea index (AHI) >30 with little or no daytime sleepiness [6]. This is in contrast to patients fulfilling the diagnosis of OSAS, including daytime sleepiness, where CPAP treatment was followed by significant decrease in blood pressure [7]. In patients with severe, symptomatic OSAS, CPAP treatment led to significantly increased insulin sensitivity [8]. However, there is still no intervention study published which addresses the effects of CPAP treatment on glucose metabolism in subjects with OSA but little or no symptoms. There is, in addition, still a lack of knowledge about CPAP compliance in a population-based sample.
The aim of this study was to evaluate treatment effects on the metabolic profile, general symptom load and quality of life in a population-based sample of men with an AHI of ≥10. Another purpose was to investigate the compliance to CPAP treatment in this population.
Section snippets
Study population
In 1984, a random sample of 4021 men aged 30–69 years was selected from the population registry of the city of Uppsala, Sweden. Of those, 3201 (79.6%) men responded to a questionnaire evaluating snoring and sleep disturbances [9] and a total of 2668 (89.7% of the survivors) participated in a ten-year follow-up in 1994 by answering a new questionnaire [10]. An age-stratified sample of 232 men from the responders at the follow-up underwent a single night of sleep recording during March 1996 to
Results
Of the 232 men who were investigated with a whole-night registration, 72 had an AHI of ≥10. One subject was already receiving CPAP treatment and was therefore excluded. Of the remaining subjects, 42 (59.1%) agreed to participate. In the repeated sleep study preceding the treatment period, four subjects had an AHI of <10 and were excluded. Of the 38 men who started CPAP treatment, a total of 28 subjects completed the three-week protocol, and, hence, 28 matched controls were recruited.
The
Discussion
To our knowledge, this is the first study were the metabolic effects and compliance of CPAP treatment have been assessed in a population-based sample where study subjects were sampled solely on the basis of the results from sleep recordings, disregarding subjective symptoms. The main finding is that CPAP treatment of a population-based sample of men with AHI ≥10 have beneficial effects on symptom load and quality of life, as well as on certain metabolic indices. However, compliance with
Acknowledgements
This study was supported financially by the Swedish Heart Lung Foundation and the Uppsala County Association against Heart and Lung Diseases. The authors thank Ulrike Spetz-Nyström, RN, for her excellent assistance.
References (38)
- et al.
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial
Lancet
(2002) - et al.
A 10-year follow-up of snoring in men
Chest
(1998) - et al.
Measurements of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device
Chest
(1991) - et al.
Sleep-disordered breathing, glucose intolerance, and insulin resistance
Respir Physiol Neurobiol
(2003) - et al.
Circulating concentrations of insulin-like growth factor-1 and development of glucose intolerance: a prospective observational study
Lancet
(2002) - et al.
Quality of life in patients with obstructive sleep apnea. Effect of nasal continuous positive airway pressure—a prospective study
Chest
(1999) - et al.
The occurence of sleep-disordered breathing among middle-aged adults
N Engl J Med
(1993) - et al.
Prospective study of the association between sleep-disordered breathing and hypertension
N Engl J Med
(2000) - et al.
Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study
J Int Med
(2001) - et al.
The link between sleep apnea and cardiovascular disease: time to target the nonsleepy sleep apneics?
Am J Respir Crit Care Med
(2001)
Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea
Am Rev Respir Dis
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
Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome
Am J Respir Crit Care Med
Somatic diseases and sleep complaints. An epidemiological study of 3,201 Swedish men
Acta Med Scand
Prevalence of sleep apnoea and snoring in hypertensive men: a population based study
Thorax
Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man
Diabetologia
A new method for measuring daytime sleepiness: the epworth sleepiness scale
Sleep
SF-36 Hälsoenkät: Svensk manual och tolkningsguide (Swedish manual and interpretation guide)
Cited by (133)
Healthcare-seeking behaviour and utilization of treatment in a community-based screening study for obstructive sleep apnoea in Busselton, Western Australia
2019, Sleep HealthCitation Excerpt :Despite its demonstrated effectiveness, up to 50% of patients who are recommended CPAP either reject this treatment option or discontinue within the first week.23 In those that continue therapy, adherence rates range from 29-88%.24–26 Documented adherence rates with oral appliances range from 48-84%.27
Independent relationships between cardinal features of obstructive sleep apnea and glycometabolism: a cross-sectional study
2018, Metabolism: Clinical and ExperimentalCitation Excerpt :Previous rodent studies have suggested that IH can impair pancreatic islet beta cell function, subsequently increasing fasting glucose levels and generating insulin resistance [21,22], thereby further exacerbating the development of diabetes [23,24]. Although there is strong evidence that OSA is a significant risk factor for abnormal glucose metabolism according to clinical studies [15,16,23,24], and although continuous positive airway pressure (CPAP) treatment can decrease glucose and insulin levels and improve glucose homeostasis [25,26], the studies were limited by small sample sizes [15,16], a lack of objective polysomnography (PSG) data [23,24], or no consideration of the effect of both SF and IH on glycometabolism in OSA [15,16,23,24]. In addition, the commutative confounding effects and interaction between IH and SF on the association with glycometabolism have not been evaluated.
Effect of portable non-invasive ventilation & environmental conditions on everyday activities
2017, Respiratory Physiology and NeurobiologyPay attention to treating a subgroup of positional obstructive sleep apnea patients
2017, Journal of the Formosan Medical Association