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Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial
Open accessAbstract
BACKGROUND: Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. METHODS: This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. RESULTS: Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS -2.0 (95% CI -2.6 to -1.4), p<0.0001), objectively measured sleepiness and self-assessed health status. CPAP did not improve the 5-year calculated vascular risk or any of its components. CONCLUSIONS: In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.
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Metadata
- Authors
- Craig, S. E., Kohler, M., Nicoll, D., Bratton, D. J., Nunn, A., Davies, R., & Stradling, J.
- Affiliations
- Churchill Hospital (GB)
- University Hospital Zurich (CH)
- MRC Clinical Trials Unit at UCL (GB)
- Corresponding author
- Craig, Sonya Elizabeth
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2012-10-30
- Volume
- 67
- Issue
- 12
- Pages
- 1090-1096
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- OpenAlex
- W2108496675
- Cited by
- 228
- References
- 39
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 7 · 2023: 15 · 2022: 13 · 2021: 15 · 2020: 15 · 2019: 17 · 2018: 31 · 2017: 21 · 2016: 17 · 2015: 21 · 2014: 25 · 2013: 17 · 2012: 2
- FWCI
- 13.87
- Type
- journal article
- Language
- en
- Update notices
- correction (2012-12-01)
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- ResMed
- National Institute for Health and Care Research
- British Heart Foundation (PG/05/068/19057)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- continuous positive airway pressure, obstructive sleep apnea, daytime sleepiness, Epworth Sleepiness Scale, cardiovascular risk, medication adherence, self-rated health, oxygen desaturation index
- MeSH terms
- Canada, Cardiovascular Diseases, Female, United Kingdom, Health Status Indicators, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Treatment Outcome, Risk Assessment, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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