Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome
Open accessAbstract
BACKGROUND: Patients with the sleep apnoea/hypopnoea syndrome (SAHS) report improved sleepiness, cognitive function, and psychological well being after continuous positive airway pressure (CPAP) therapy, and it is for these daytime features that CPAP is usually given. However, few randomised or controlled studies exist on the effects of CPAP on daytime function. METHODS: A prospective, randomised, single blind, placebo controlled, crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS, all with > or = 15 apnoeas + hypopnoeas/hour and > or = 2 symptoms of SAHS. All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment, following randomisation to treatment order. With ethics committee approval, patients were told the placebo tablet might improve upper airway function. Average effective CPAP use was monitored using hidden time clocks. Assessments of objective and subjective sleepiness, symptoms, cognitive performance, and psychological well being were performed on the last day of each treatment and compared. RESULTS: Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP (mean difference from placebo +2.4 min, 95% CI 0.8 to 4.0; p < 0.001) as did subjective sleepiness on the Epworth scale (mean difference -6, 95% CI -3 to -9; p = 0.001). Symptom total score also fell with CPAP (mean difference -1.6, 95% CI -2.2 to -1.0; p < 0.001). No determinants of these changes with active treatment were identified, and no significant enhancements to cognitive function or psychosocial well being were found in this small sample. CONCLUSIONS: These findings provide further evidence for clinically significant benefits to daytime function from CPAP.
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Cites
Reliability and factor analysis of the Epworth Sleepiness Scale.
Johns, M. (1992) · Sleep · doi:10.1093/sleep/15.4.376 · Cited by 2,193 · see citing works
The two‐period cross‐over clinical trial.
Hills, M., & Armitage, P. (1979) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1979.tb05903.x · Cited by 1,403 · see citing works
Engleman, H. M., Martin, S. E., Douglas, N. J., & Deary, I. J. (1994) · The Lancet · doi:10.1016/s0140-6736(94)91522-9 · Cited by 592 · see citing works
Self-citationGould, G. A., Whyte, K., Rhind, G. B., Airlie, M. A. A., Catterall, J. R., Shapiro, C. M., & Douglas, N. J. (1988) · American Review of Respiratory Disease · doi:10.1164/ajrccm/137.4.895 · Cited by 481 · see citing works
Self-citationWright, J., Johns, R., Watt, I., Melville, A., & Sheldon, T. (1997) · BMJ · doi:10.1136/bmj.314.7084.851 · Cited by 410 · see citing works
Kribbs, N. B., Pack, A. I., Kline, L. R., Getsy, J. E., Schuett, J. S., Henry, J. N., Maislin, G., & Dinges, D. F. (1993) · American Review of Respiratory Disease · doi:10.1164/ajrccm/147.5.1162 · Cited by 395 · see citing works
Nasal CPAP: An Objective Evaluation of Patient Compliance
Reeves-Hoché, M. K., Meck, R., & Zwillich, C. W. (1994) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.149.1.8111574 · Cited by 358 · see citing works
Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome
Engleman, H. M., Martin, S. E., Deary, I. J., & Douglas, N. J. (1997) · Thorax · doi:10.1136/thx.52.2.114 · Cited by 340 · see citing works
Self-citationFactors Impairing Daytime Performance in Patients With Sleep Apnea/Hypopnea Syndrome
Cheshire, K. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400150068012 · Cited by 334 · see citing works
Self-Reported Use of CPAP and Benefits of CPAP Therapy
Engleman, H. M., Asgari‐Jirhandeh, N., McLeod, A. L., Ramsay, C. F., Deary, I. J., & Douglas, N. J. (1996) · CHEST Journal · doi:10.1378/chest.109.6.1470 · Cited by 288 · see citing works
Self-citationThe Clinical Use of the Multiple Sleep Latency Test
Thorpy, M. J. (1992) · SLEEP · doi:10.1093/sleep/15.3.268 · Cited by 272 · see citing works
Bédard, M., Montplaisir, J. Y., Malo, J., Richer, F., & Rouleau, I. (1993) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639308402567 · Cited by 255 · see citing works
The Two-Period Crossover Trial
Armitage, P., & Hills, M. (1982) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2987883 · Cited by 179 · see citing works
Clinicians and patients with hypertension: Unsettled issues about compliance
Rudd, P. (1995) · American Heart Journal · doi:10.1016/0002-8703(95)90368-2 · Cited by 165 · see citing works
Compliance in clinical trials of two nonbronchodilator, antiasthma medications.
Mawhinney, H., Spector, S. L., Ra, K., Siegel, S. C., Rachelefsky, G. S., Katz, R. M., & As, R. (1991) · PubMed · Cited by 134 · see citing works
Clinical Features of the Sleep Apnoea/Hypopnoea Syndrome
Whyte, K., Allen, M. B., Jeffrey, A. A., Gould, G. A., & Douglas, N. J. (1989) · QJM · doi:10.1093/oxfordjournals.qjmed.a068358 · Cited by 92 · see citing works
Self-citationIs the SF 36 sensitive to sleep disruption? A study in subjects with sleep apnoea
SMITH, I. E., & Shneerson, J. M. (1995) · Journal of Sleep Research · doi:10.1111/j.1365-2869.1995.tb00167.x · Cited by 73 · see citing works
The Two Period Cross Over Trial
Barker, N., Hews, R. J., Huitson, A., & Poloniecki, J. D. (1982) · Journal of Applied Statistics · doi:10.1080/02664768200000009 · Cited by 71 · see citing works
Krieger, J., Weitzenblum, E., Monassier, J., et al. (1983) · The Lancet · doi:10.1016/s0140-6736(83)90966-2 · Cited by 63 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [13]13. US Modafinil in Narcolepsy Multicenter Study Group. Modafinil for the treatment of pathological somnolence in narcolepsy. Neurology 1998 (in press).
- [14]14. Australian Health Technology Advisory Committee. The eVectiveness and cost-eVectiveness of nasal continuous positive airway pressure (nCPAP) in the treatment of obstructive sleep apnea in adults. Canberra: Australian Government Publish- ing Services, 1996. on July 17, 2023 by guest. Protected by copyright. http://thorax.bmj.com/ Thorax: first published as 10.1136/thx.53.5.341 on 1 May 1998. Downloaded from
Cited by
Sorted by citations
Peker, Y., Glantz, H., Eulenburg, C., Wegscheider, K., Herlitz, J., & Thunström, E. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201601-0088oc · Cited by 756 · see citing works
Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., & Harrod, C. G. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7638 · Cited by 721 · see citing works
Evaluation of Positive Airway Pressure Treatment for Sleep Related Breathing Disorders in Adults
Gay, P., Weaver, T., Loube, D., & Iber, C. (2006) · Sleep · doi:10.1093/sleep/29.3.381 · Cited by 614 · see citing works
Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea
Barnes, M., McEvoy, R. D., Banks, S., Tarquinio, N., Murray, C. G., Vowles, N., & Pierce, R. J. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200311-1571oc · Cited by 597 · see citing works
Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea
Chervin, R. D. (2000) · Chest · doi:10.1378/chest.118.2.372 · Cited by 571 · see citing works
ENGLEMAN, H. M., KINGSHOTT, R. N., WRAITH, P. K., MACKAY, T. W., DEARY, I. J., & DOUGLAS, N. J. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.2.9803121 · Cited by 558 · see citing works
Self-citationBarbé, F., Mayoralas, L. R., Duran, J., Masa, J. F., Maimó, A., Montserrat, J. M., Monasterio, C., Bosch, M., Ladaria, A., Rubio, M., et al. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-134-11-200106050-00007 · Cited by 534 · see citing works
Self-citationNeuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review
ALOIA, M. S., ARNEDT, J. T., DAVIS, J. D., RIGGS, R. L., & BYRD, D. (2004) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617704105134 · Cited by 391 · see citing works
HOY, C. J., VENNELLE, M., KINGSHOTT, R. N., ENGLEMAN, H. M., & DOUGLAS, N. J. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.4.9808008 · Cited by 379 · see citing works
Self-citationInternational Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350 · see citing works
Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea: A Randomized, Controlled Trial
Gotsopoulos, H., Chen, C., Qian, J., & Cistulli, P. A. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200203-208oc · Cited by 331 · see citing works
A Randomized Controlled Trial of Continuous Positive Airway Pressure in Mild Obstructive Sleep Apnea
Barnes, M., Houston, D., Worsnop, C. J., Neill, A. M., Mykytyn, I. J., Kay, A., Trinder, J., Saunders, N. A., McEvoy, R. D., & Pierce, R. J. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.6.2003166 · Cited by 329 · see citing works
Robinson, G. V., Smith, D. M., Langford, B. A., Davies, R. J. O., & Stradling, J. R. (2006) · European Respiratory Journal · doi:10.1183/09031936.06.00062805 · Cited by 314 · see citing works
Jonas, D. E., Amick, H. R., Feltner, C., Weber, R. P., Arvanitis, M., Stine, A., Lux, L., & Harris, R. P. (2017) · JAMA · doi:10.1001/jama.2016.19635 · Cited by 267 · see citing works
Effectiveness of Continuous Positive Airway Pressure in Mild Sleep Apnea–Hypopnea Syndrome
MONASTERIO, C., VIDAL, S., DURAN, J., FERRER, M., CARMONA, C., BARBÉ, F., MAYOS, M., GONZALEZ-MANGADO, N., JUNCADELLA, M., NAVARRO, A., et al. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.164.6.2008010 · Cited by 260 · see citing works
Early Predictors of CPAP Use for the Treatment of Obstructive Sleep Apnea
Lewis, K. E., Seale, L., Bartle, I. E., Watkins, A. J., & Ebden, P. (2004) · Sleep · doi:10.1093/sleep/27.1.134 · Cited by 242 · see citing works
A Randomized, Controlled Crossover Trial of Two Oral Appliances for Sleep Apnea Treatment
BLOCH, K. E., ISELI, A., ZHANG, J. N., XIE, X., KAPLAN, V., STOECKLI, P. W., & RUSSI, E. W. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.1.9908112 · Cited by 223 · see citing works
Antic, N. A., Buchan, C., Esterman, A., Hensley, M., Naughton, M. T., Rowland, S., Williamson, B., Windler, S., Eckermann, S., & McEvoy, R. D. (2009) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200810-1558oc · Cited by 227 · see citing works
Tan, Y. K. (2002) · The European Journal of Orthodontics · doi:10.1093/ejo/24.3.239 · Cited by 206 · see citing works
Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial
Johnston, C. D. (2002) · The European Journal of Orthodontics · doi:10.1093/ejo/24.3.251 · Cited by 185 · see citing works
Pamidi, S., Wroblewski, K., Stepien, M., Sharif-Sidi, K., Kilkus, J., Whitmore, H., & Tasali, E. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201408-1564oc · Cited by 185 · see citing works
McDaid, C., Durée, K. H., Griffin, S. C., Weatherly, H. L. A., Stradling, J. R., Davies, R. J. O., Sculpher, M. J., & Westwood, M. E. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.02.004 · Cited by 180 · see citing works
Siccoli, M. M., Pepperell, J. C. T., Kohler, M., Craig, S. E., Davies, R. J. O., & Stradling, J. R. (2008) · Sleep · doi:10.1093/sleep/31.11.1551 · Cited by 161 · see citing works
Woodson, B. T., Steward, D. L., Weaver, E. M., & Javaheri, S. (2003) · Otolaryngology - Head and Neck Surgery · doi:10.1016/s0194-5998(03)00461-3 · Cited by 165 · see citing works
Smith, I., & Lasserson, T. J. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003531.pub3 · Cited by 151 · see citing works
Povitz, M., Bolo, C. E., Heitman, S. J., Tsai, W. H., Wang, J., & James, M. T. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001762 · Cited by 147 · see citing works
Hui, D. S. C., Chan, J. K. W., Choy, D. K. L., Ko, F. W. S., Li, T. S. T., Leung, R. C. C., & Lai, C. K. W. (2000) · Chest · doi:10.1378/chest.117.5.1410 · Cited by 141 · see citing works
Drug therapy for obstructive sleep apnoea in adults
Smith, I., Lasserson, T. J., & Wright, J. J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003002.pub2 · Cited by 132 · see citing works
Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea
Schwartz, J. R. L., Hirshkowitz, M., Erman, M. K., & Schmidt-Nowara, W. (2003) · Chest · doi:10.1378/chest.124.6.2192 · Cited by 107 · see citing works
West, S. D., Kohler, M., Nicoll, D. J., & Stradling, J. R. (2009) · Sleep Medicine · doi:10.1016/j.sleep.2008.11.007 · Cited by 97 · see citing works
Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis
Anandam, A., Akinnusi, M., Kufel, T., Porhomayon, J., & El-Solh, A. A. (2013) · Sleep and Breathing · doi:10.1007/s11325-012-0677-3 · Cited by 95 · see citing works
West, S. D. (2006) · Thorax · doi:10.1136/thx.2005.046300 · Cited by 93 · see citing works
A Pilot Trial of a Telecommunications System in Sleep Apnea Management
DeMolles, D. A., Sparrow, D., Gottlieb, D. J., & Friedman, R. (2004) · Medical Care · doi:10.1097/01.mlr.0000132353.99209.fe · Cited by 88 · see citing works
Anderson, F. E., Kingshott, R. N., Taylor, D. R., Jones, D. R., Kline, L. R., & Whyte, K. F. (2003) · Sleep · doi:10.1093/sleep/26.6.721 · Cited by 60 · see citing works
Self-citationZhu, K., Roisman, G., Aouf, S., & Escourrou, P. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4844 · Cited by 46 · see citing works
Amaro, A. C. S., Duarte, F. H. G., Jallad, R. S., Bronstein, M. D., Redline, S., & Lorenzi-Filho, G. (2012) · Clinics · doi:10.6061/clinics/2012(05)11 · Cited by 35 · see citing works
Falcone, V. A., Damiani, M. F., Quaranta, V. N., Capozzolo, A., & Resta, O. (2014) · Respiratory Care · doi:10.4187/respcare.02491 · Cited by 33 · see citing works
Saraç, S., Afşar, G. Ç., Oruç, Ö., Topçuoğlu, Ö. B., Saltürk, C., & Peker, Y. (2017) · Medical Science Monitor · doi:10.12659/msm.902075 · Cited by 22 · see citing works
- Authors
- Engleman, H. M., Martin, S. E., Kingshott, R. N., Mackay, T. W., Deary, I. J., & Douglas, N. J.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Douglas, N. J
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 1998-05-01
- Volume
- 53
- Issue
- 5
- Pages
- 341-345
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC1745223
- OpenAlex
- W2123641217
- Cited by
- 308
- References
- 19
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 11 · 2019: 6 · 2018: 7 · 2017: 9 · 2016: 16 · 2015: 10 · 2014: 17 · 2013: 17 · 2012: 6
- FWCI
- 7.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › 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
- sleep apnea-hypopnea syndrome, continuous positive airway pressure, CPAP therapy, daytime functioning, daytime sleepiness, cognitive function, psychological well-being, multiple sleep latency test, Epworth scale, symptom scores, placebo therapy, upper airway function
- MeSH terms
- Adult, Cognition, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Prospective Studies, Quality of Life, Sleep Apnea Syndromes, Sleep Stages, Single-Blind Method, Cross-Over Studies
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