Key Point

Most patients do not prefer CPAP as treatment for obstructive sleep apnea, despite the fact that AASM guidelines recommend the use of this therapy.

STANFORD, CALIF—New practice guidelines issued by the American Academy of Sleep Medicine (AASM) support the use of continuous positive airway pressure (CPAP) treatment for patients with sleep-related breathing disorders such as obstructive sleep apnea¹; however, two meta-analysis reports suggest that patients with obstructive sleep apnea tend not to prefer this treatment.^2,3

Both meta-analyses assessed the effectiveness of CPAP versus other therapies for the treatment of obstructive sleep apnea. The first study, by Tammie Giles and colleagues, examined 36 randomized trials—involving a total of 1,718 patients—comparing CPAP with oral appliances or an inactive control therapy. The second study, by Jerome Lim and colleagues, assessed 16 randomized trials—comprising 745 patients—comparing oral appliances with an inactive control therapy or other treatments.

According to the AASM guidelines, CPAP is a safe and effective treatment for obstructive sleep apnea, and findings from both studies concur. Also, 24-hour systolic and diastolic blood pressure appeared to be lower in patients who received CPAP, compared with those who received control therapy. However, although evidence suggests that some functional outcomes, such as subjective sleepiness and quality of life, improve with positive pressure treatment, patients tend not to prefer this treatment.

"[CPAP] is more effective than oral appliances in reducing respiratory disturbances in these people but subjective outcomes are more equivocal. Certain people tend to prefer oral appliances to CPAP where both are effective. This could be because they offer a more convenient way of controlling obstructive sleep apnea," Dr. Giles’ team reported.

"Until there is more definitive evidence on the effectiveness of oral appliances in relation to CPAP, with regard to symptoms and long-term complications, it would appear to be appropriate to recommend oral appliance therapy to patients with mild, symptomatic obstructive sleep apnea-hypopnea, and those patients who are unwilling or unable to tolerate CPAP therapy," commented Dr. Lim and colleagues.

They concluded, "Future research should recruit patients with more severe symptoms of sleepiness, to establish whether the response to therapy differs between subgroups in terms of quality of life, symptoms, and persistence with usage."

—Karen L. Spittler

References
1. Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29:375-380.
2. Giles T, Lasserson T, Smith B, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;(1):CD001106.
3. Lim J, Lasserson T, Fleetham J, Wright J. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev. 2006;(1):CD004435.

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