Who Should Get Treated for Sleep Apnea?

Abstract

Editorials5 June 2001Who Should Get Treated for Sleep Apnea?Allan I. Pack, MB, ChB, PhD and Greg Maislin, MS, MAAllan I. Pack, MB, ChB, PhDDr. Pack and Mr. Maislin: Center for Sleep and Respiratory Neurobiology; University of Pennsylvania; Philadelphia, PA 19104-4286 and Greg Maislin, MS, MADr. Pack and Mr. Maislin: Center for Sleep and Respiratory Neurobiology; University of Pennsylvania; Philadelphia, PA 19104-4286Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-11-200106050-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This issue includes a report of a provocative randomized, placebo-controlled, parallel-group study by Barbé and colleagues (1), who found that nasal continuous positive airway pressure (CPAP) provided no benefit in patients with obstructive sleep apnea and a respiratory disturbance index greater than 30 episodes/h (currently regarded as severe sleep apnea [2]) but no self-reported sleepiness. This lack of benefit was demonstrated for self-reported and objectively measured sleepiness, as well as on generic and disease-specific quality-of-life instruments, neurocognitive tests, and 24-hour ambulatory blood pressure monitoring.The sample size in this study, derived according to data collected in a previous placebo-controlled parallel-group ...References1. Barbé F, Mayoralas LR, Duran J, Masa JF, Maimó A, Montserrat JM, et al . Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. A randomized, controlled trial. Ann Intern Med. 2001;134:1015-23. LinkGoogle Scholar2. . 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. 1999;22:667-89. [PMID: 10450601] CrossrefMedlineGoogle Scholar3. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999;353:2100-5. [PMID: 10382693] CrossrefMedlineGoogle Scholar4. Bonnet MH. Performance and sleepiness as a function of frequency and placement of sleep disruption. Psychophysiology. 1986;23:263-71. [PMID: 3749406] CrossrefMedlineGoogle Scholar5. Van Dongen HP, Doran SM, Dinges DF. Performance during sleep deprivation: evidence for state instability and trait vulnerability [Abstract]. Sleep. 2000;23 Suppl 2 A245-6. Google Scholar6. Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997;20:608-13. [PMID: 9351127] CrossrefMedlineGoogle Scholar7. Terán-Santos J, Jiménez-Gómez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999;340:847-51. [PMID: 10080847] CrossrefMedlineGoogle Scholar8. George CF, Smiley A. Sleep apnea & automobile crashes. Sleep. 1999;22:790-5. [PMID: 10505825] MedlineGoogle Scholar9. Hack M, Davies RJ, Mullins R, Choi SJ, Ramdassingh-Dow S, Jenkinson C, et al . Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax. 2000;55:224-31. [PMID: 10679542] CrossrefMedlineGoogle Scholar10. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al . Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147:887-95. [PMID: 8466125] CrossrefMedlineGoogle Scholar11. Rolfe I, Olson LG, Saunders NA. Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis. 1991;144:1130-3. [PMID: 1952444] CrossrefMedlineGoogle Scholar12. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al . Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829-36. [PMID: 10770144] CrossrefMedlineGoogle Scholar13. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-84. [PMID: 10805822] CrossrefMedlineGoogle Scholar14. Peker Y, Kraiczi H, Hedner J, Löth S, Johansson A, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J. 1999;14:179-84. [PMID: 10489848] CrossrefMedlineGoogle Scholar15. Shamsuzzaman AS, Somers VK. Fibrinogen, stroke, and obstructive sleep apnea: an evolving paradigm of cardiovascular risk [Editorial]. Am J Respir Crit Care Med. 2000;162:2018-20. [PMID: 11112100] CrossrefMedlineGoogle Scholar16. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al . Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep. 1997;20:267-7. [PMID: 9231952] MedlineGoogle Scholar17. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-5. [PMID: 1798888] CrossrefMedlineGoogle Scholar18. Bennett LS, Stradling JR, Davies RJ. A behavioural test to assess daytime sleepiness in obstructive sleep apnoea. J Sleep Res. 1997;6:142-5. [PMID: 9377534] CrossrefMedlineGoogle Scholar19. Dinges DF, Powell JW. Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations. Behavior Research Methods Instruments and Computers. 1985;17:652-5. CrossrefGoogle Scholar20. George CF, Boudreau AC, Smiley A. Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1996;154:175-81. [PMID: 8680676] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Allan I. Pack, MB, ChB, PhD; Greg Maislin, MS, MAAffiliations: Dr. Pack and Mr. Maislin: Center for Sleep and Respiratory Neurobiology; University of Pennsylvania; Philadelphia, PA 19104-4286Grant Support: Dr. Pack and Mr. Maislin are members of the Special Center of Research in Neurobiology of Sleep and Sleep Apnea (grant no. HL-60287).Corresponding Author: Allan I. Pack, MB, ChB, PhD, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104-4283.Current Author Addresses: Dr. Pack and Mr. Maislin: Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104-4283. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime Sleepiness Ferran Barbé , Lola R. Mayoralas , Joaquin Duran , Juan F. Masa , Andreu Maimó , Josep M. Montserrat , Carmen Monasterio , Margalida Bosch , Antoni Ladaria , Manuela Rubio , Ramon Rubio , Magdalena Medinas , Lourdes Hernandez , Silvia Vidal , Neil J. Douglas , and Alvar G.N. Agustí Metrics Cited byChapitre 3. Les pathologies respiratoires du sommeil et leurs conséquences neurocognitivesSleep and Sleep Disorders in Older AdultsSystemic and Pulmonary Hypertension in Obstructive Sleep ApneaQuality of Life in Obstructive Sleep Apnoea: A Role for Oxygen Desaturation Indices?Systemic and Pulmonary Hypertension in Obstructive Sleep ApneaAsymptomatic Sleep-disordered Breathing in Premenopausal Women Awaiting Bariatric SurgerySleep apnea in stroke patients: hard to diagnose, even harder to treatSleep in the Elderly: Normal Variations and Common Sleep DisordersDiagnosis and Treatment of Sleep Disorders in Older AdultsWhy a Polysomnogram Should Become Part of the Diagnostic Evaluation of Stroke and Transient Ischemic AttackPatient- and Bed Partner-Reported Symptoms, Smoking, and Nasal Resistance in Sleep-Disordered BreathingSystemic and Pulmonary Hypertension in Obstructive Sleep ApneaMicrosleep and sleepiness: a comparison of multiple sleep latency test and scoring of microsleep as a diagnostic test for excessive daytime sleepinessObstructive sleep apnoeaApneas, hypopneas, and respiratory effort-related arousals: moving closer to a standardCurrent medical management of sleep-related breathing disordersEpidemiology of Obstructive Sleep Apnea 5 June 2001Volume 134, Issue 11Page: 1065-1067KeywordsCardiovascular therapyContinuous positive airway pressureHypertensionMedical risk factorsMyocardial infarctionResearch laboratoriesSleepSleep apneaSleep deprivationTreatment guidelines ePublished: 5 June 2001 Issue Published: 5 June 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...