CPAP improves quality of life in mild OSA
When compared with sleep hygiene counseling, CPAP in addition to sleep counseling improved symptoms among patients with mild obstructive sleep apnea, according to data published in The Lancet Respiratory Medicine.
The researchers included patients aged 18 to 80 years with mild OSA, defined by an apnea-hypopnea index of five to 15 events per hour, using American Academy of Sleep Medicine (AASM) 2007 or 2012 scoring criteria, from 11 sleep centers in the United Kingdom in the multicenter, parallel, randomized controlled MERGE trial. They then randomly assigned patients to 3 months of CPAP plus standard care sleep hygiene counseling or standard care alone.
The primary outcome was change in the vitality scale of the SF-36 questionnaire among patients with mild OSA diagnosed by the AASM 2012 criteria in the intention-to-treat population. Patient eligibility was assessed using respiratory polygraphy.
After 3 months of treatment, the adjusted mean change in SF-36 vitality score was 9.2 points (95% CI, 6.8-11.6) with CPAP vs. –0.8 points (95% CI, –3.2 to 1.5) with standard care, yielding a mean treatment effect of 10 points (95% CI, 7.2-12.8). Similarly, results from a more conservative analysis of covariance (ANCOVA) last-observation-carried-forward analysis also demonstrated a difference in the adjusted mean change in the vitality score with CPAP vs. standard care, with a treatment effect of 7.5 points (P < .0001).
Additionally, the researchers found improvements in most secondary outcomes with CPAP vs. standard care, including subjective sleepiness, fatigue, anxiety and depression, insomnia and functionality, as measured by various scales. Improvements in other areas of the SF-36, including the mental component and social functioning, role-emotional and mental health scales, were also noted.
Comparable improvements in quality of life measures were also observed among patients with mild OSA diagnosed using the AASM 2007 scoring criteria. Further, in a subgroup analysis of patients with the mildest disease, such as patients diagnosed with mild OSA using the 2012 criteria but considered normal with the 2007 criteria, results showed significant improvement in vitality score and other quality of life measures with CPAP vs. standard care.
Overall, three serious adverse events occurred during the trial, including one on the CPAP group, but none were deemed related to the interventions.
A total of 233 patients among 301 who underwent randomization from 2016 to 2019 were diagnosed with mild OSA using the AASM 2012 criteria and were included in the intention-to-treat population. Of these, 115 were randomly assigned CPAP plus standard care and 118 were assigned standard care alone. Ninety percent completed the trial.
In a linked comment, Walter T. McNicholas, MD, from the department of respiratory and sleep medicine at the School of Medicine, University College Dublin and St. Vincent’s Hospital Group in Ireland and the First Affiliated Hospital of Guangzhou Medical University in China, noted that data from the MERGE trial “support an active management approach” in patients with mild OSA.
“The management of patients with obstructive sleep apnea is likely to evolve from the generalized approach of CPAP use or not, to a more personalized approach based on clinical and pathophysiological phenotype, which is especially likely to apply in mild obstructive sleep apnea,” he wrote. “Thus, the management of patients with obstructive sleep apnea will probably require a more considered approach in future, especially in mild cases, which emphasizes the need for specialized knowledge and expertise among clinicians responsible for selecting the most appropriate management option for individual patients.” – by Melissa Foster
Disclosures: This study was funded by ResMed. Wimms reports she received personal fees from ResMed. Please see the study for all other authors’ relevant financial disclosures. McNicholas reports no relevant financial disclosures.