Dose-response relationship between positive airway pressure therapy and excessive daytime sleepiness: the HomePAP study
| Autor: | Maeve Pascoe, James Bena, Noah D. Andrews, Dennis Auckley, Ruth Benca, Martha E. Billings, Vishesh K. Kapur, Conrad Iber, Phyllis C. Zee, Susan Redline, Carol L. Rosen, Nancy Foldvary-Schaefer |
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| Rok vydání: | 2022 |
| Předmět: |
HomePAP trial
Adult Male Pulmonary and Respiratory Medicine Sleep Apnea Adolescent Clinical Sciences Disorders of Excessive Somnolence Medicare Clinical Research Psychology Humans adherence Wakefulness Lung Aged Sleep Apnea Obstructive Other Medical and Health Sciences Neurology & Neurosurgery Continuous Positive Airway Pressure Obstructive excessive daytime sleepiness Evaluation of treatments and therapeutic interventions Middle Aged Epworth Sleepiness Scale Scientific Investigations United States Good Health and Well Being Neurology PAP therapy 6.1 Pharmaceuticals Commentary Patient Compliance Female Neurology (clinical) Sleep Research |
| Zdroj: | J Clin Sleep Med Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, vol 18, iss 4 |
| ISSN: | 1550-9397 1550-9389 |
| DOI: | 10.5664/jcsm.9792 |
| Popis: | Study objectivesThe clinical benefits of positive airway pressure (PAP) therapy for obstructive sleep apnea are assumed to require adherent PAP usage, defined by the Centers for Medicare & Medicaid Services as ≥ 4 hours of use ≥ 70% of nights. However, this definition is based on early data and does not necessarily capture improvements at subthreshold adherence. We explored dose-response relationships between PAP adherence measures and excessive daytime sleepiness from the HomePAP randomized controlled trial.MethodsParticipants aged ≥ 18 years with an apnea-hypopnea index ≥ 15 events/h and baseline sleepiness (Epworth Sleepiness Scale [ESS] ≥ 12) received PAP therapy. Data were collected at baseline, 1-month follow-up, and 3-months follow-up. Regression models and receiver operating characteristic curves evaluated PAP measures as predictors of ESS change and normalization (ESS < 10).ResultsIn 119 participants (aged 49.4 ± 12.6 years, 66.4% male, 72.3% White), > 50% were PAP nonadherent per Centers for Medicare & Medicaid Services criteria at 3 months. The percentage of nights with PAP use ≥ 4 hours predicted ESS change (P = .023), but not when controlling for the apnea-hypopnea index. The percentage of nights with ≥ 4 hours and average PAP use provided the best discrimination for predicting ESS normalization; each 10% increase in PAP use ≥ 4 hours increased the odds of ESS normalization by 22% (P = .007); those using PAP ≥ 4 hours had a nearly 3-fold greater odds of ESS normalization (P = .025). PAP use for at least 4 hours and on 70% of nights provided the best balance between specificity (0.50) and sensitivity (0.73).ConclusionsAlthough subadherent PAP usage may still confer some benefit for patients with obstructive sleep apnea, adherence to current criteria confers the highest likelihood for ESS change and normalization.Clinical trial registrationRegistry: ClinicalTrials.gov; Name: Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP); URL: https://clinicaltrials.gov/ct2/show/NCT00642486; Identifier: NCT00642486.CitationPascoe M, Bena J, Andrews ND, etal. Dose-response relationship between positive airway pressure therapy and excessive daytime sleepiness: the HomePAP study. J Clin Sleep Med. 2022;18(4):1027-1034. |
| Databáze: | OpenAIRE |
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