CPAP therapy improves quality of life for patients with mild sleep apnea
Three months of CPAP treatment improved the quality of life of patients with mild obstructive sleep apnea, according to results of the MERGE randomized controlled trial.
The findings suggest a need to consider treatment for mild OSA, the researchers concluded.
“Patients with moderate to severe OSA get good benefit from CPAP treatment,” Julia L. Kelly, PhD, clinical research physiotherapist in the clinical and academic unit of sleep and breathing at the National Heart and Lung Institute, Royal Brompton Hospital, London, told Healio. “However, some patients can have debilitating symptoms of OSA, including daytime sleepiness and fatigue, but their disease is only classified as ‘mild’ when tested by a sleep monitor and standard diagnosis criteria. Prior to our study, there was little evidence to support the treatment of these mild patients.”
The MERGE trial was conducted at 11 secondary care sleep centers in the United Kingdom. The researchers’ goal was to evaluate the effect of CPAP on the SF-36 vitality scale in patients with mild OSA (apnea-hypopnea index 5 to 15). Kelly and colleagues scored polygraphy data (ApneaLink Air, ResMed) from patients with mild OSA, based on the American Academy of Sleep Medicine (AASM) 2007 and 2012 definitions.
The researchers randomly assigned 301 patients between November 2016 and February 2019. Of those, 233 patients were diagnosed with mild OSA based on the AASM 2012 definition. The mild OSA group was then allocated to CPAP plus standard care (n = 115) or standard care only (n = 118). Standard care involved sleep hygiene counseling.
At 3 months, change in SF-36 vitality scale was improved in the CPAP group by 7.5 points (95% CI, 5.3-9.6) compared with standard care only (P < .0001), according to the abstract.
The researchers also reported improvement in sleepiness, with a 3-point reduction in Epworth Sleepiness Scale (95% CI, –3.8 to –2.1; P < .0001), according to the results.
When the researchers analyzed change in SF-36 vitality scale in patients with mild OSA using the AASM 2007 criteria (n = 205), there was a similar improvement in quality of life in the CPAP group. Among 95 patients at the mildest end of the OSA spectrum — or those diagnosed with OSA using the AASM 2012 criteria but labeled as “normal” under the 2007 criteria — quality of life was similarly improved, according to the abstract.
“We were indeed surprised by our results — specifically, that even those patients at the very mildest end of the disease spectrum gained benefit from CPAP treatment,” Kelly told Healio. “These were patients who would not have been diagnosed with OSA using the standard diagnosis criteria.”
“Our results highlight the need for health care professionals and providers to consider treatment for mild OSA, specifically for those with symptoms,” MERGE trial chief investigator Mary Morrell, PhD, professor of sleep and respiratory medicine at the National Heart and Lung Institute, Imperial College London, said in a press release.