PURPOSE: Despite the high prevalence of obstructive sleep apnea (OSA) among Veterans, there is limited access to polysomnography (PSG) in VA hospitals, leading to treatment delays. Thus, we evaluated the efficacy of empiric treatment with autotitrating CPAP (APAP) in patients with high clinical suspicion of OSA.
METHODS: Hypothesis: Empiric treatment with APAP of patients clinically suspected to have moderate to severe OSA will improve the Epworth Sleepiness Scale (ESS), Functional Outcomes in Sleep Questionnaire (FOSQ score) and Health Related Quality of Life (SF36) for Physical and Mental Health (Physical component score (PCS) and mental component score (MCS) respectively). 36 subjects awaiting PSG, with clinical suspicion of moderate to severe OSA based on snoring,witnessed apneas, ESS > 12 and BMI > 30kg/m2, were randomized into APAP group and Sham CPAP (SPAP) group and treated for 3 months prior to PSG. Exclusion Criteria: CHF and moderate-severe COPD. Clinical measurements included age, BMI, AHI, pre- and post-treatment values for: ESS, FOSQ score, PCS and MCS. The statistical significance of the treatment effect on all variables (including pre-treatment measurements, post-treatment measurements and difference scores) was determined using independent sample t-tests. Pre- versus post-treatment differences, within groups, were evaluated, using paired t-tests.
RESULTS: 24 subjects completed the study with 12 in each group (except for SF36 with 11 and 12 in APAP and SPAP groups respectively) and OSA was confirmed by PSG (except in 2 sham group subjects awaiting PSG). APAP significantly reduced ESS (post-pre=-6.17 versus -1.25, for APAP and SPAP, respectively; P=0.0059), significantly increased MCS (post-pre=6.70 versus -1.37, P=0.0074), and FOSQ score approached significance (post-pre=18.34 versus 4.55, P=0.0758). Paired, within group, t-tests confirmed these findings, with significant changes in ESS, MCS, and FOSQ score in APAP group, but not in SPAP group (Table 2).
CONCLUSION: APAP significantly improves the sleepiness and quality of life in patients with high clinical suspicion of OSA.
CLINICAL IMPLICATIONS: Empiric therapy with APAP may be considered if there are diagnostic delays in patients with strong clinical suspicion of OSA.
DISCLOSURE: Naveen Akkina, No Financial Disclosure Information; No Product/Research Disclosure Information