title: Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome.
abstract: BACKGROUND
  Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), even those generally compliant with CPAP therapy, often intermittently discontinue CPAP.
  
  
  OBJECTIVE
  Examine the impact of CPAP withdrawal on sleep, sleep disordered breathing (SDB), and daytime function in subjects with varying severity of OSAHS.
  
  
  METHODS
  Forty-two subjects (26M/16 F) with OSAHS (AHI4% = 45.2 ± 35.5/h pretreatment) on CPAP for 4 months were evaluated on the second night of CPAP withdrawal. Sleep architecture, SDB indices, and subjective/objective daytime function were assessed pretreatment, on CPAP therapy, and after CPAP withdrawal. Comparisons were made between pretreatment and CPAP withdrawal for the entire group, and for subgroups of mild/moderate (AHI4% < 30/h, n = 22) and severe (AHI4% > 30/h, n = 20) SDB.
  
  
  RESULTS
  Overall, and for mild/moderate subjects, SDB indices returned to pretreatment values on CPAP withdrawal but with fewer apneas and more hypopneas/RERAs. For severe SDB, the event frequency (AI, AHI4%, and RDI) was lower and O2 desaturation was improved on CPAP withdrawal. Across SDB severity, sleep architecture showed lower %REM (15.6% vs 12.9%, P = 0.009) on the CPAP withdrawal compared to pretreatment. Stanford Sleepiness Score, MSLT, and PVT measures were not significantly different between pretreatment and CPAP withdrawal.
  
  
  CONCLUSIONS
  Over a wide range of SDB severity CPAP withdrawal results in recurrence of SDB, albeit with less severe O2 desaturation. Subjective/objective daytime function returned to pretreatment levels. Sleep architecture changes on CPAP withdrawal (acute SDB) may reflect reduced sleep pressure compared to pretreatment chronic SDB. Our data suggest detrimental effects of even brief withdrawal of CPAP in subjects with both mild and severe OSAHS.
  
  
  BACKGROUND
  Young LR; Taxin ZH; Norman RG; Walsleben JA; Rapoport DM; Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. SLEEP 2013;36(3):405-412.
authors: NYU School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York, NY, USA.
authors: Laura R
authors: LR
authors: Young
authors: Zachary H
authors: ZH
authors: Taxin
authors: Robert G
authors: RG
authors: Norman
authors: Joyce A
authors: JA
authors: Walsleben
authors: David M
authors: DM
authors: Rapoport
authors: Indu
authors: I
authors: Ayappa
mesh_terms: D000203:Activities of Daily Living; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000379:methods; D012008:Recurrence; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*
keywords: CPAP withdrawal; daytime sleepiness; sleep disordered breathing