Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA,Sleep and Breathing

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Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-08-10 , DOI: 10.1007/s11325-022-02694-z
Gabriela Pontes Luz ₁ , Luciana Badke ₁ , Luiz Eduardo Nery ₁ , Luciana Oe Silva ₂ , Thais Moura Guimarães ₂ , Glaury Coelho ₂ , Aline Millani ₂ , Rodrigo Gomes Alves ₂ , Camila Kase ₂ , Sergio Tufik ₂ , Lia Bittencourt ₂

Affiliation

Objective

This study’s objective was to compare the best long-term treatment, mandibular advancement device (MAD) or continuous positive airway pressure (CPAP), for patients with mild obstructive sleep apnea (OSA) in improving excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life.

Methods

This study was a single-blind, parallel, randomized clinical trial with controls. The sample was composed of individuals between 18 and 65 years of age with a body mass index of < 35 kg/m² and apnea/hypopnea index above five and less than 15. Participants were submitted to physical examination, polysomnography, and the following questionnaires: Pittsburgh Sleep Quality Index, Berlin Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, Karolinska Sleepiness Scale, Modified Fatigue Impact Scale, Functional Outcomes of Sleep Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory. They were also presented with the following tests: maintenance of wakefulness test and psychomotor vigilance task.

Results

Of 79 patients, 25 were in the MAD group, 31 in the CPAP group, and 23 in the control group. Polysomnographic parameters were best normalized with CPAP compared with MAD. Fatigue was improved in the MAD and CPAP groups, with no difference between these treatments. Quality of life was also improved with both treatments, but CPAP was superior to MAD. Daytime sleepiness, mood, and sustained attention showed no difference with the interventions. Greater adherence was obtained with MAD patients than with CPAP measured by hours of use.

Conclusions

Treatment with CPAP was better at normalizing polysomnographic parameters and improving quality of life in patients with mild OSA. Both treatments improved fatigue with no difference between the two treatments. Neither treatment improved daytime sleepiness, mood or sustained attention.

Clinical Trials Database

NTC01461486.

中文翻译：

CPAP 与下颌前移装置对轻度 OSA 患者白天过度嗜睡、疲劳、情绪、持续注意力和生活质量的影响

客观的

本研究的目的是比较最佳的长期治疗方法，即下颌前移装置 (MAD) 或持续气道正压通气 (CPAP)，对轻度阻塞性睡眠呼吸暂停 (OSA) 患者改善白天过度嗜睡、疲劳、情绪、持续注意力的效果和生活质量。

方法

这项研究是一项单盲、平行、随机的临床试验，有对照。样本由年龄在 18 至 65 岁之间、体重指数 < 35 kg/m ²和呼吸暂停/呼吸不足指数高于 5 且低于 15 的个体组成。参与者接受了体格检查、多导睡眠监测和以下问卷调查：匹兹堡睡眠质量指数、柏林问卷、Epworth 嗜睡量表、斯坦福嗜睡量表、卡罗林斯卡嗜睡量表、改良疲劳影响量表、睡眠问卷的功能结果、贝克焦虑量表和贝克抑郁量表。他们还接受了以下测试：保持清醒测试和精神运动警惕性任务。

结果

79例患者中，MAD组25例，CPAP组31例，对照组23例。与 MAD 相比，CPAP 对多导睡眠图参数进行了最佳标准化。MAD 和 CPAP 组的疲劳得到改善，这些治疗之间没有差异。两种治疗也改善了生活质量，但 CPAP 优于 MAD。白天嗜睡、情绪和持续注意力与干预措施没有差异。MAD 患者的依从性高于 CPAP（按使用小时数衡量）。