ADVERTISEMENT
CURRENT ISSUE
AUGUST 2014
KINDLE EDITION



SEARCH JOURNAL ARCHIVES


SEARCH PUBMED


MANUSCRIPT SUBMISSIONS


SUBSCRIBE TO SLEEP

CONTINUING MEDICAL EDUCATION


ADVERTISE WITH US


ABOUT SLEEP

ABSTRACT SUPPLEMENTS


ACCEPTED PAPERS
Bookmark and Share         RSS Feed

VOLUME 34, ISSUE 01

EFFECTS OF CPAP ON DAYTIME FUNCTIONS
The Effect of CPAP in Normalizing Daytime Sleepiness, Quality of Life, and Neurocognitive Function in Patients with Moderate to Severe OSA

Nick A. Antic, MBBS, PhD1,2; Peter Catcheside, PhD1,2; Catherine Buchan, RN3; Michael Hensley, PhD4; Matthew T. Naughton, MD3; Sharn Rowland, RN1; Bernadette Williamson, RN4; Samantha Windler, Psych (Hons)1; R. Doug McEvoy, MD1,2

1Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; 2Department of Medicine, Flinders University, Bedford Park, South Australia, Australia; 3Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia; 4Department of Respiratory and Sleep Medicine, John Hunter Hospital and School of Medicine and Public Health, the University of Newcastle, Newcastle, New South Wales, Australia



  Expand  Table of Contents    
Text size:  

Study Objectives:

The study aimed to document the neurobehavioral outcomes of patients referred to and treated by a sleep medicine service for moderate to severe obstructive sleep apnea (OSA). In particular, we aimed to establish the proportion of patients who, while appearing to have optimal continuous positive airway pressure (CPAP) adherence, did not normalize their daytime sleepiness or neurocognitive function after 3 months of CPAP therapy despite effective control of OSA.

Design:

Multicenter clinical-effectiveness study.

Setting:

Three academic sleep centers in Australia.

Participants:

Patients referred to a sleep medicine service with moderate to severe OSA (n = 174).

Intervention:

CPAP.

Measurements and Results:

Participants were assessed pretreatment and again after 3 months of CPAP therapy. At the beginning and at the conclusion of the trial, participants completed a day of testing that included measures of objective and subjective daytime sleepiness, neurocognitive function, and quality of life. In patients with symptomatic moderate to severe OSA (i.e., apnea-hypopnea index > 30/h), we found a treatment dose-response effect for CPAP in terms of Epworth Sleepiness Scale scores (P < 0.001). Several key indexes of neurobehavior (e.g., Functional Outcomes of Sleep Questionnaire, Epworth Sleepiness Scale) currently used to assess treatment response failed to normalize in a substantial group of patients after 3 months of CPAP treatment, even in those who were maximally compliant with treatment. Forty percent of patients in this trial had an abnormal Epworth Sleepiness Scale score at the conclusion of the trial. In addition, we showed no dose-response effect with the Maintenance of Wakefulness Test, raising doubts as to the clinical utility of the Maintenance of Wakefulness Test in assessing treatment response to CPAP in patients with OSA.

Conclusions:

Our study suggests that a greater percentage of patients achieve normal functioning with longer nightly CPAP duration of use, but a substantial proportion of patients will not normalize neurobehavioral responses despite seemingly adequate CPAP use. It is thus crucial to adequately assess patients after CPAP therapy and seek alternate etiologies and treatments for any residual abnormalities.

Citation:

Antic NA; Catcheside P; Buchan C; Hensley M; Naughton MT; Rowland S; Williamson B; Windler S; McEvoy RD. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. SLEEP 2011;34(1):111-119.

Related Article

Identifying Moderators of CPAP Efficacy
Expand  Table of Contents
ADVERTISEMENT
Classifieds View SLEEP 2011 Poster Presentations Online