CPAP treatment of a population-based sample--what are the benefits and the treatment compliance?
OBJECTIVE
Continuous positive airway pressure (CPAP) treatment has positive effects, including improved insulin sensitivity in sleep-laboratory cohorts with obstructive sleep apnea syndrome. There is still a lack of data on benefits obtained and possibilities to treat less symptomatic individuals. The aim of this study was to evaluate the effect of CPAP treatment on metabolic profile and quality of life (QoL) in a population-based sample of men with sleep apnea. Another purpose was to investigate the compliance to CPAP in this population.


METHODS
A population-based sample of 38 men with an AHI>or=10 were treated with CPAP regardless of symptom profile. The controls included men with AHI <10 matched for age and hypertension. The effects were evaluated after 3 weeks and 6 months. Insulin resistance was quantified using the homeostasis model assessment (HOMA). Daytime sleepiness, QoL and subjective symptom load was assessed using the Epworth Sleepiness Scale (ESS), the Medical Outcomes Study Short Form Health Survey (SF-36) and the Minor Symptoms Evaluation-Profile (MSE-P) questionnaires, respectively.


RESULTS
Complete three-week data were obtained from 28 treated men and 28 controls. Compared with controls, the CPAP group displayed a greater reduction of fasting serum insulin (P=0.02), decrease in insulin resistance (P=0.01) and an increase in IGF-1 (P=0.005). The CPAP group further showed an improvement in the SF-36 domains of mental health (P=0.03) and vitality (P=0.06) and a reduction in symptom load in the sleep dimension of the MSE-P. Only 11 (29%) of subjects starting CPAP were still on treatment after 6 months. Those who still used CPAP had a higher score on ESS at baseline (11.3 (4.4) vs. 5.9 (3.4), P<0.0001).


CONCLUSIONS
Benefits of short-term treatment included signs of reduced insulin resistance and improved QoL. However, in this population-based sample compliance with CPAP was very low. More severe sleepiness was a positive predictive factor for treatment compliance.
Lindberg
Eva
E
Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, Uppsala, and Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. eva.lindberg@akademiska.se
Berne
Christian
C
Elmasry
Ahmed
A
Hedner
Jan
J
Janson
Christer
C
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects; D006970:Disorders of Excessive Somnolence / Q000503:physiopathology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D017286:Polysomnography; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D014280:Triglycerides; D007334:Insulin-Like Growth Factor I; D002784:Cholesterol