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CPAP therapy: outcomes and patient use
  1. Neil J Douglas,
  2. Heather M Engleman
  1. Respiratory Medicine Unit, Department of Medicine, The University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW, UK
  1. Professor N J Douglas.

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Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with the sleep apnoea/hypopnoea syndrome. CPAP therapy is mainly used to improve daytime function but increasingly some centres are using CPAP to attempt to decrease cardiovascular risk. CPAP can be one of the most effective forms of therapy in modern medicine. However, not all patients find this therapy ideal and many do not use it as much as physicians would wish. This paper reviews the potential outcomes from CPAP therapy, the data on patient use of CPAP therapy, the factors which limit CPAP use, and whether CPAP use can be improved.

Outcome measures

The sleep apnoea/hypopnoea syndrome (SAHS) may be treated in order to improve patient survival, decrease hypertension and vascular risk factors, or to decrease symptoms and improve daytime function. The evidence that CPAP therapy improves survival is limited to one small study which was non-randomised and in which only 54% of the patients were followed up.1 Although these data suggest improved survival on CPAP, the study does not meet the levels of rigour required for present day evidence based medicine. There are no studies as yet addressing the issue of whether CPAP therapy prevents myocardial infarctions or cerebrovascular disease, and there is conflicting evidence about whether CPAP therapy does2 ,3 or does not4-6 reduce arterial blood pressure. Most of these studies suffer from either lack of a control limb,2-5small numbers,2-6 or lack of evidence of CPAP usage.2-5 There is thus a need for further well conducted large scale studies to address this issue.

Although the satisfactory clinical response of daytime sleepiness and impaired daytime function to CPAP therapy in patients with SAHS is well known, few controlled studies have addressed this issue. In a randomised placebo controlled trial …

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