title: Effects of short-term CPAP withdrawal on neurobehavioral performance in patients with obstructive sleep apnea.
abstract: OBJECTIVE
  Changes in sleep parameters and neurobehavioral functioning were systematically investigated after an acute (1 night) and short-term (7 nights) period of withdrawal from continuous positive airway pressure (CPAP) treatment and 1 subsequent night of CPAP reintroduction in patients with obstructive sleep apnea.
  
  
  METHODS
  Repeated-measurement within-subject design.
  
  
  METHODS
  Sleep laboratory, university teaching hospital.
  
  
  METHODS
  Twenty participants receiving optimal CPAP therapy for > or = 12 months.
  
  
  METHODS
  CPAP withdrawal.
  
  
  RESULTS
  Polysomnograms were performed on Night 0 (with CPAP), Night 1 and Night 7 (without CPAP) and Night 8_R (with CPAP). Acute CPAP withdrawal resulted in the recurrence of sleep-disordered breathing with sleep disruption, hypoxemia, and increased subjective sleepiness. Short-term CPAP withdrawal exacerbated hypoxemia, increased subjective and objective sleepiness and poor mood ratings. Neurobehavioral functioning assessed using the Psychomotor Vigilance Task was impaired following Night 7 and associated with hypoxemia and changes in morning levels of tumor necrosis factor-alpha. However, other neurobehavioral measures were not affected. Autonomic arousals measured via respiratory-related reductions in finger blood volume by peripheral arterial tonometry decreased from Night 1 to Night 7. On Night 8_R, reintroduction of CPAP treatment eliminated most airway obstruction, maintained oxygenation, and reversed daytime sleepiness and some vigilance decrements.
  
  
  CONCLUSIONS
  Despite recurrence of sleep-disordered breathing with increased sleepiness and impaired vigilance, most neurobehavioral variables were unaffected by CPAP withdrawal. The reduction in vigilance appeared to be associated with worsened hypoxemia and changed levels of tumor necrosis factor-alpha. Resumption of CPAP treatment had immediate benefits on sleep consolidation and subjective sleepiness.
authors: Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney Australia, Sydney, Australia.
authors: Qiao
authors: Q
authors: Yang
authors: Craig L
authors: CL
authors: Phillips
authors: Kerri L
authors: KL
authors: Melehan
authors: Naomi L
authors: NL
authors: Rogers
authors: J Paul
authors: JP
authors: Seale
authors: Ronald R
authors: RR
authors: Grunstein