Share This Article:

Does Positive Airway Pressure Therapy Result in Improved Sleep Quality?

Abstract Full-Text HTML XML Download Download as PDF (Size:2718KB) PP. 2416-2424
DOI: 10.4236/health.2014.618278    4,890 Downloads   5,621 Views   Citations

ABSTRACT

Introduction: Positive airway pressure (PAP) therapy is the gold-standard for obstructive sleep apnea (OSA) management. While it is known that PAP is efficacious for controlling breathing events during sleep when it is worn at the right pressure for the amount of time prescribed, there is less clear data on how well it improves sleep quality. There are few studies that have examined the effectiveness of PAP therapy on sleep quality. Methods: OSA participants (n = 241) from a larger trial examining a PAP adherence were included. Participants were provided with PAP instruction and followed at 2 months and 4 months. PAP adherence was measured as the number of hours per night at prescribed pressure, an objective measure of treatment adherence. The Pittsburgh Sleep Quality Index (PSQI) was used as the primary measure of sleep quality. Results: The PSQI was significantly correlated with PAP adherence at both the 2-month and 4-month time points, such that lower sleep quality was associated with lower PAP use. This finding held for the sleep disturbance subscale of the PSQI. Over 55% of those using PAP therapy at the 4-month time point continued to report significantly disturbed sleep. Discussion: This study shows that PAP therapy does not appear to improve sleep quality to a degree that would be expected. Over half of those patients using PAP therapy still experienced disturbed sleep. Whether the disturbed sleep is directly attributable to the PAP device itself or to disturbed sleep secondary to uncontrolled OSA when PAP is not worn is worthy of further investigation.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Stepnowsky, C. , Zamora, T. and Edwards, C. (2014) Does Positive Airway Pressure Therapy Result in Improved Sleep Quality?. Health, 6, 2416-2424. doi: 10.4236/health.2014.618278.

References

[1] Loredo, J.S., Ancoli-Israel, S., Kim, E.J., Lim, W.J. and Dimsdale, J.E. (2006) Effect of Continuous Positive Airway Pressure versus Supplemental Oxygen on Sleep Quality in Obstructive Sleep Apnea: A Placebo-CPAP-Controlled Study. Sleep, 29, 564-571.
[2] McArdle, N. and Douglas, N.J. (2001) Effect of Continuous Positive Airway Pressure on Sleep Architecture in the Sleep Apnea-Hypopnea Syndrome: A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine, 164, 1459-1463.
http://dx.doi.org/10.1164/ajrccm.164.8.2008146
[3] Stepnowsky, C., Johnson, S., Dimsdale, J. and Ancoli-Israel, S. (2000) Sleep Apnea and Health-Related Quality of Life in African-American Elderly. Annals of Behavioral Medicine, 22, 116-120.
http://dx.doi.org/10.1007/BF02895774
[4] Beebe, D.W., Groesz, L., Wells, C., Nichols, A. and McGee, K. (2003) The Neuropsychological Effects of Obstructive Sleep Apnea: A Meta-Analysis of Norm-Referenced and Case-Controlled Data. Sleep, 26, 298-307.
[5] Findley, L.J., Suratt, P.M. and Dinges, D.F. (1999) Time-on-Task Decrements in “Steer Clear” Performance of Patients with Sleep Apnea and Narcolepsy. Sleep, 22, 804-809.
[6] Aikens, J.E., Caruana-Montaldo, B., Vanable, P.A., Tadimeti, L. and Mendelson, W.B. (1999) MMPI Correlates of Sleep and Respiratory Disturbance in Obstructive Sleep Apnea. Sleep, 22, 362-369.
[7] Grunstein, R.R., Stenlof, K., Hedner, J.A. and Sjostrom, L. (1995) Impact of Self-Reported Sleep-Breathing Disturbances on Psychosocial Performance in the Swedish Obese Subjects (SOS) Study. Sleep, 18, 635-643.
[8] Parish, J.M. and Lyng, P.J. (2003) Quality of Life in Bed Partners of Patients with Obstructive Sleep Apnea or Hypopnea after Treatment with Continuous Positive Airway Pressure. Chest, 124, 942-947.
http://dx.doi.org/10.1378/chest.124.3.942
[9] Sullivan, C.E., Issa, F.G., Berthon-Jones, M. and Eves, L. (1981) Reversal of Obstructive Sleep Apnoea by Continuous Positive Airway Pressure Applied through the Nares. Lancet, 1, 862-865.
http://dx.doi.org/10.1016/S0140-6736(81)92140-1
[10] Loube, D.I., et al. (1999) Indications for Positive Airway Pressure Treatment of Adult Obstructive Sleep Apnea Patients: A Consensus Statement. Chest, 115, 863-866.
http://dx.doi.org/10.1378/chest.115.3.863
[11] Patel, S.R., White, D.P., Malhotra, A., Stanchina, M.L. and Ayas, N.T. (2003) Continuous Positive Airway Pressure Therapy for Treating Sleepiness in a Diverse Population with Obstructive Sleep Apnea. Archives of Internal Medicine, 163, 565-571.
http://dx.doi.org/10.1001/archinte.163.5.565
[12] Wright, J., Johns, R., Watt, I., Melville, A. and Sheldon, T. (1997) Health Effects of Obstructive Sleep Apnoea and the Effectiveness of CPAP: A Systematic Review of the Research Evidence. British Medical Journal, 314, 851-860.
http://dx.doi.org/10.1136/bmj.314.7084.851
[13] Stepnowsky Jr., C.J. and Moore, P.J. (2003) Improving CPAP Use by Patients with the Sleep Apnoea/Hypopnoea Syndrome (SAHS). Sleep Medicine Reviews, 7, 445-446.
http://dx.doi.org/10.1053/smrv.2002.0289
[14] Barker, R., Zamora, T. and Stepnowsky, C. (2011) Accuracy of CPAP-Measured Apnea and Hypopneas. Sleep, 34, A327.
[15] Berry, R.B., Kushida, C.A., Kryger, M.H., Soto-Calderon, H., Staley, B. and Kuna, S.T. (2012) Respiratory Event Detection by a Positive Airway Pressure Device. Sleep, 35, 361-367.
[16] Cilli, A., Uzun, R. and Bilge, U. (2013) The Accuracy of Autotitrating CPAP-Determined Residual Apnea-Hypopnea Index. Sleep Breath, 17, 189-193.
http://dx.doi.org/10.1007/s11325-012-0670-x
[17] Veasey, S.C. (2006) Obstructive Sleep Apnea: Re-Evaluating Our Index of Severity. Sleep Medicine, 7, 5-6.
http://dx.doi.org/10.1016/j.sleep.2005.08.012
[18] Nieto, F.J., Young, T.B., Lind, B.K., Shahar, E., Samet, J.M., Redline, S., et al. (2000) Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study. Sleep Heart Health Study. JAMA, 283, 1829-1836.
http://dx.doi.org/10.1001/jama.283.14.1829
[19] Hers, V., Liistro, G., Dury, M., Collard, P., Aubert, G. and Rodenstein, D.O. (1997) Residual Effect of nCPAP Applied for Part of the Night in Patients with Obstructive Sleep Apnoea. European Respiratory Journal, 10, 973-976.
http://dx.doi.org/10.1183/09031936.97.10050973
[20] Sforza, E. and Lugaresi, E. (1995) Daytime Sleepiness and Nasal Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnea Syndrome Patients: Effects of Chronic Treatment and 1-Night Therapy Withdrawal. Sleep, 18, 195-201.
[21] Yang, Q., Phillips, C.L., Melehan, K.L., Rogers, N.L., Seale, J.P. and Grunstein, R.R. (2006) Effects of Short-Term CPAP Withdrawal on Neurobehavioral Performance in Patients with Obstructive Sleep Apnea. Sleep, 29, 545-552.
[22] Wickwire, E.M., Smith, M.T., Birnbaum, S. and Collop, N.A. (2010) Sleep Maintenance Insomnia Complaints Predict Poor CPAP Adherence: A Clinical Case Series. Sleep Medicine, 11, 772-776.
http://dx.doi.org/10.1016/j.sleep.2010.03.012
[23] Nguyen, X.L., Chaskalovic, J., Rakotonanahary, D. and Fleury, B. (2010) Insomnia Symptoms and CPAP Compliance in OSAS Patients: A Descriptive Study Using Data Mining Methods. Sleep Medicine, 11, 777-784.
http://dx.doi.org/10.1016/j.sleep.2010.04.008
[24] Pieh, C., Bach, M., Popp, R., Jara, C., Cronlein, T., Hajak, G., et al. (2013) Insomnia Symptoms Influence CPAP Compliance. Sleep & Breath, 17, 99-104.
http://dx.doi.org/10.1007/s11325-012-0655-9
[25] Tunis, S.R., Stryer, D.B. and Clancy, C.M. (2003) Practical Clinical Trials: Increasing the Value of Clinical Research for Decision Making in Clinical and Health Policy. JAMA, 290, 1624-1632.
http://dx.doi.org/10.1001/jama.290.12.1624
[26] Stepnowsky, C., Edwards, E., Zamora, T., Barker, R. and Agha, Z. (2013) Patient Perspective on Use of an Interactive Website for Sleep Apnea. International Journal of Telemedicine and Applications, 2013, Article ID: 239382.
http://dx.doi.org/10.1155/2013/239382
[27] AASM (1999) Sleep-Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. The Report of an American Academy of Sleep Medicine Task Force. Sleep, 22, 667-689.
[28] Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213.
http://dx.doi.org/10.1016/0165-1781(89)90047-4
[29] Buysse, D.J., Reynolds, C.F., Monk, T.H., Hoch, C.C., Yeager, A.L. and Kupfer, D.J. (1991) Quantification of Subjective Sleep Quality in Healthy Elderly Men and Women Using the Pittsburgh Sleep Quality Index (PSQI). Sleep, 14, 331-338.
[30] Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) Pittsburgh Sleep Quality Index (PSQI).
http://www.sleep.pitt.edu/content.asp?id=1484&subid=2316
[31] Johns, M.W. (1991) A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545.
[32] Radloff, L.S. (1977) The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1, 385-401.
http://dx.doi.org/10.1177/014662167700100306
[33] Andresen, E.M., Malmgren, J.A., Carter, W.B. and Patrick, D.L. (1994) Screening for Depression in Well Older Adults: Evaluation of a Short Form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77-84.
[34] Bardwell, W.A., Ancoli-Israel, S. and Dimsdale, J.E. (2007) Comparison of the Effects of Depressive Symptoms and Apnea Severity on Fatigue in Patients with Obstructive Sleep Apnea: A Replication Study. Journal of Affective Disorders, 97, 181-186.
http://dx.doi.org/10.1016/j.jad.2006.06.013
[35] Jackson, M.L., Stough, C., Howard, M.E., Spong, J., Downey, L.A. and Thompson, B. (2010) The Contribution of Fatigue and Sleepiness to Depression in Patients Attending the Sleep Laboratory for Evaluation of Obstructive Sleep Apnea. Sleep Breath, 15, 439-445.
http://dx.doi.org/10.1007/s11325-010-0355-2
[36] Wells, R.D., Day, R.C., Carney, R.M., Freedland, K.E. and Duntley, S.P. (2004) Depression Predicts Self-Reported Sleep Quality in Patients with Obstructive Sleep Apnea. Psychosomatic Medicine, 66, 692-697.
http://dx.doi.org/10.1097/01.psy.0000140002.84288.e1
[37] Rush, A.J., Armitage, R., Gillin, J.C., Yonkers, K.A., Winokur, A., Moldofsky, H., et al. (1998) Comparative Effects of Nefazodone and Fluoxetine on Sleep in Outpatients with Major Depressive Disorder. Biological Psychiatry, 44, 3-14.
http://dx.doi.org/10.1016/S0006-3223(98)00092-4
[38] Gillin, J.C., Rapaport, M., Erman, M.K., Winokur, A. and Albala, B.J. (1997) A Comparison of Nefazodone and Fluoxetine on Mood and on Objective, Subjective, and Clinician-Rated Measures of Sleep in Depressed Patients: A Double-Blind, 8-Week Clinical Trial. Journal of Clinical Psychiatry, 58, 185-192.
http://dx.doi.org/10.4088/JCP.v58n0502
[39] Stepnowsky, C.J., Palau, J.J., Zamora, T., Ancoli-Israel, S. and Loredo, J.S. (2011) Fatigue in Sleep Apnea: The Role of Depressive Symptoms and Self-Reported Sleep Quality. Sleep Medicine, 12, 832-837.
http://dx.doi.org/10.1016/j.sleep.2011.07.004

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.