Elsevier

Sleep Medicine

Volume 7, Issue 7, October 2006, Pages 553-560
Sleep Medicine

Original article
CPAP treatment of a population-based sample—what are the benefits and the treatment compliance?

https://doi.org/10.1016/j.sleep.2005.12.010Get rights and content

Abstract

Background & purpose

Continuous positive airway pressure (CPAP) treatment has positive effects, including improved insulin sensitivity in sleep-laboratory cohorts with obstructive sleep apnea syndrome. There is still a lack of data on benefits obtained and possibilities to treat less symptomatic individuals. The aim of this study was to evaluate the effect of CPAP treatment on metabolic profile and quality of life (QoL) in a population-based sample of men with sleep apnea. Another purpose was to investigate the compliance to CPAP in this population.

Patients and methods

A population-based sample of 38 men with an AHI ≥10 were treated with CPAP regardless of symptom profile. The controls included men with AHI <10 matched for age and hypertension. The effects were evaluated after 3 weeks and 6 months. Insulin resistance was quantified using the homeostasis model assessment (HOMA). Daytime sleepiness, QoL and subjective symptom load was assessed using the Epworth Sleepiness Scale (ESS), the Medical Outcomes Study Short Form Health Survey (SF-36) and the Minor Symptoms Evaluation-Profile (MSE-P) questionnaires, respectively.

Results

Complete three-week data were obtained from 28 treated men and 28 controls. Compared with controls, the CPAP group displayed a greater reduction of fasting serum insulin (P=0.02), decrease in insulin resistance (P=0.01) and an increase in IGF-1 (P=0.005). The CPAP group further showed an improvement in the SF-36 domains of mental health (P=0.03) and vitality (P=0.06) and a reduction in symptom load in the sleep dimension of the MSE-P. Only 11 (29%) of subjects starting CPAP were still on treatment after 6 months. Those who still used CPAP had a higher score on ESS at baseline (11.3 (4.4) vs. 5.9 (3.4), P<0.0001).

Conclusions

Benefits of short-term treatment included signs of reduced insulin resistance and improved QoL. However, in this population-based sample compliance with CPAP was very low. More severe sleepiness was a positive predictive factor for 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.

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