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1 From the Division of Respiratory Medicine, University of Saskatchewan, Saskatoon
2 From the Regina Health District, Regina, Saskatchewan, Canada
Michael F. Fitzpatrick, MD, Division of Respiratory and Critical Care Medicine, Richardson House, Queen's University, Kingston, Ontario, Canada, K7L 3N6; email: mf19{at}post.queensu.ca
Objectives: (1) To compare the continuous positive airway pressure (CPAP) requirement at the time of diagnosis (T0), after 2 weeks (T2), and after 4 weeks (T4) of CPAP treatment, in patients with severe obstructive sleep apnea (OSA); and (2) to assess whether any alteration in CPAP requirement over the first 4 weeks of CPAP treatment would influence daytime alertness, subjective sleepiness, or mood.
Design: A prospective, controlled, single-blind crossover study.
Setting: University teaching hospital.
Patients: Ten patients with newly diagnosed and previously untreated severe OSA (aged 52±9 years, apnea hypopnea index [AHI] of 99±31) and subsequently 10 control patients (aged 52±11 years, AHI 85±17).
Measurements: Overnight polysomnography with CPAP titration to determine the CPAP requirement, which was standardized for body position and sleep stage, on all three occasions (T0, T2, T4). Objective sleep quality, daytime alertness, subjective sleepiness (Epworth Sleepiness Scale), and mood (Hospital Anxiety and Depression Scale).
Results: CPAP requirement decreased from T0 to T2 (median difference, 1.5 cm H2O, 95% confidence interval [CI], 1.1 to 2.7 cm H2O, p=0.0004) and did not differ between T2 and T4. Use of the lower CPAP pressure during T2 to T4 was associated with a decrease in Epworth scale (mean difference, 2.6, 95% CI, 1.2 to 4; p=0.01) and anxiety (median change, 2; 95% CI, 0.5 to 2.9, p=0.03) scores, as compared with the first 2 weeks. Daytime alertness did not differ between T0 to T2 and T2 to T4.
Conclusion: CPAP requirement falls within 2 weeks of starting CPAP treatment. A change to the lower required CPAP was not associated with any deterioration in daytime alertness but was associated with small subjective improvements in sleepiness and mood.
Key Words: CPAP • sleep apnea • treatment
Submitted on December 2, 1997
Accepted on April 1, 1998
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