Introduction Continuous positive airway pressure (CPAP) is currently the treatment of choice for sleepiness in patients with obstructive sleep apnoea (OSA); however, adherence is often thought to be suboptimal. We investigated the effects of suboptimal CPAP usage on objective and subjective sleepiness parameters in patients with OSA. Material and methods In this 2-week, parallel, double-blind, randomised controlled trial we enrolled moderate-to-severe OSA patients with excessive pre-treatment daytime sleepiness (Epworth sleepiness scale (ESS) score >10 points) who had suboptimal CPAP adherence over ≥12 months (mean nightly usage time 3–4 h). Patients were allocated through minimisation to either subtherapeutic CPAP (“sham CPAP”) or continuation of CPAP (“therapeutic CPAP”). A Bayesian analysis with historical priors calculated the posterior probability of superiority. Results Between May, 2016 and November, 2018, 57 patients (aged 60±8 years, 79% male, 93% Caucasian) were allocated in total, and 52 who completed the study (50% in each arm) were included in the final analysis. The unadjusted ESS score increase was 2.4 points (95% CI 0.6–4.2, p=0.01) in the sham-CPAP group when compared to continuing therapeutic CPAP. The probability of superiority of therapeutic CPAP over sham CPAP was 90.4% for ESS, 90.1% for systolic blood pressure and 80.3% for diastolic blood pressure. Conclusions Patients with moderate-to-severe OSA and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence, albeit not as much as they might get if they adhered more. Whether a similar statement can be made for even lower adherence levels remains to be established in future trials. Patients with obstructive sleep apnoea and daytime sleepiness are still getting a substantial benefit from suboptimal CPAP adherence (i.e. 3–4 h per night), albeit not as much as they might get if they adhered more http://bit.ly/2Phgeo2

中文翻译：

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CPAP 治疗依从性不佳对阻塞性睡眠呼吸暂停症状的影响：一项随机、双盲、对照试验

简介 持续气道正压通气 (CPAP) 是目前阻塞性睡眠呼吸暂停 (OSA) 患者嗜睡的首选治疗方法；然而，依从性通常被认为是次优的。我们调查了次优 CPAP 使用对 OSA 患者客观和主观嗜睡参数的影响。材料和方法 在这项为期 2 周的平行、双盲、随机对照试验中，我们招募了治疗前白天过度嗜睡（Epworth 嗜睡量表 (ESS) 评分 >10 分）且 CPAP 欠佳的中度至重度 OSA 患者坚持 ≥ 12 个月（平均每晚使用时间 3-4 小时）。通过最小化将患者分配到亚治疗性 CPAP（“假 CPAP”）或继续 CPAP（“治疗性 CPAP”）。使用历史先验的贝叶斯分析计算了优势的后验概率。结果 2016 年 5 月至 2018 年 11 月，共分配 57 名患者（年龄 60±8 岁，79% 男性，93% 白种人），完成研究的 52 名患者（每组 50%）进入最终分析。与持续治疗性 CPAP 相比，假 CPAP 组未调整的 ESS 评分增加了 2.4 分（95% CI 0.6-4.2，p=0.01）。ESS 治疗性 CPAP 优于假 CPAP 的可能性为 90.4%，收缩压为 90.1%，舒张压为 80.3%。结论 中度至重度 OSA 和白天嗜睡的患者仍然从次优的 CPAP 依从性中获得了实质性的好处，尽管不如如果他们坚持得更多。是否可以对更低的依从性做出类似的声明，仍有待在未来的试验中确定。阻塞性睡眠呼吸暂停和白天嗜睡的患者仍然从次优的 CPAP 依从性（即每晚 3-4 小时）中获得实质性益处，尽管可能不如如果他们坚持更多 http://bit.ly/2Phgeo2