Daytime Sleepiness Treatable with CPAP

Sleep apnea and daytime sleepiness improved with CPAP treatment

(RxWiki News) The most common treatment for severe obstructive sleep apnea is continuous positive airway pressure (CPAP). But what about those with mild sleep apnea or excessive daytime sleepiness?

A recent study has found that CPAP is just as effective for those with mild and moderate sleep apnea and daytime sleepiness as it is for severe obstructive sleep apnea.

"Use CPAP to treat mild and moderate sleep apnea."

The study, led by Terri E. Weaver, PhD, RN, dean of the University of Illinois at Chicago College of Nursing, involved a randomized trial that managed to test CPAP use against a "placebo" CPAP - a fake version of the treatment. True CPAP involves wearing a mask that forces air into a person's nostrils to ensure they are continuously getting fresh air while asleep.

The 239 patients involved in the trial were assigned to receive either real, active CPAP or the fake version for eight weeks of treatment. All the patients had been recently diagnosed with mild obstructive sleep apnea or else had reported extreme daytime sleepiness.

After those eight weeks of the trial, the patients who had been receiving the fake CPAP treatment were then switched over to eight weeks of real treatment with active CPAP.

The researchers compared the start-of-study and end-of-study scores of all the patients on an assessment tool called the Functional Outcomes of Sleep Questionnaire, which measures how daytime sleepiness affects a person's everyday activities.

They found that those using real CPAP improved considerably after eight weeks of treatment while those using the fake CPAP had virtually no change at all in their symptoms; in fact, they worsened a tiny bit.

Yet when those who had been assigned initially to the fake CPAP then used the real CPAP for eight additional weeks, their symptoms and reported sleepiness improved even more than the original group who spent eight weeks on the real treatment from the start.

The patients in both groups who received active CPAP also reported better scores on a psychological mood scale.

"The improvements we saw were highly significant and clinically relevant," said Dr. Weaver. "In addition, our study was conducted at both large and smaller clinical practice sites, making our results highly generalizable."

According to William Kohler, MD, medical director of the Florida Sleep Institute in Spring Hill, Florida, most sleep doctors likely already prescribe CPAP for patients with mild to moderate sleep apnea if they show other symptoms.

Those symptoms can include high blood pressure, irritability, trouble focusing, daytime sleepiness and depression, for example.

He said he has seen significant improvement in his own patients after they begin using CPAP for mild and moderate sleep apnea.

"I've had patients in their 70s and 80s tell me that they feel like teenagers again after they use CPAP," Dr. Kohler said. "Even with the mild to moderate sleep apnea, CPAP can cause you to have a lot of functional improvement and alertness."

He said mild to moderate apnea is generally defined as having 5 to 15 events per hour in which a person stops breathing for at least 10 seconds. Unless a person has the other symptoms, however, he said it's not always necessary to give someone CPAP.

"If you have 5 to 15 with symptoms, go ahead and treat it," he said. 

The study was limited by how short the CPAP usage (real and fake) was in the groups. Those using the active treatment received CPAP for an average four hours a day and up to six hours total at a time.

Those using the sham treatment received it one to five hours a day (an average of three hours daily). Appropriate use of CPAP involves a person using it any time they are asleep for the full duration of sleep.

"Given the high prevalence of obstructive sleep apnea, our study suggests that there is significant value in treating sleepy patients with mild to moderate disease," concluded Dr. Weaver. "CPAP therapy, the primary treatment for obstructive sleep apnea, is highly effective and confers significant health benefits in these patients."

Sleep apnea has been linked to a number of other health conditions, including cardiovascular risks and mental health conditions.

CPAP masks can cost between approximately $30 and $200, and CPAP machines range from about $150 to over $5,500. Most insurance plans will cover some or all of CPAP therapy hardware.

The study was published July 20 in the American Journal of Respiratory and Critical Care Medicine. The research was funded by the National Heart, Lung and Blood Institute, Respironics Sleep and Respiratory Research Foundation and Cephalon Inc.

The CPAP equipment used in the study was provided by Philips Respironics, Inc., ProTech Services, Inc. and Embla.

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Review Date: 
July 20, 2012