Abstract
Introduction:Positive airway pressure (PAP) therapy is the gold-standard for obstructive sleep apnea (OSA) management. While it is known that PAP is efficacious for controlling breathing events during sleep when it is worn at the right pressure for the amount of time prescribed, there is less clear data on how well it improves sleep quality. There are few studies that have examined the effectiveness of PAP therapy on sleep quality.Methods:OSA participants (n = 241) from a larger trial examining a PAP adherence were included. Participants were provided with PAP instruction and followed at 2 months and 4 months. PAP adherence was measured as the number of hours per night at prescribed pressure, an objective measure of treatment adherence. The Pittsburgh Sleep Quality Index (PSQI) was used as the primary measure of sleep quality.Results:The PSQI was significantly correlated with PAP adherence at both the 2-month and 4-month time points, such that lower sleep quality was associated with lower PAP use. This finding held for the sleep disturbance subscale of the PSQI. Over 55% of those using PAP therapy at the 4-month time point continued to report significantly disturbed sleep.Discussion:This study shows that PAP therapy does not appear to improve sleep quality to a degree that would be expected. Over half of those patients using PAP therapy still experienced disturbed sleep. Whether the disturbed sleep is directly attributable to the PAP device itself or to disturbed sleep secondary to uncontrolled OSA when PAP is not worn is worthy of further investigation.
Highlights
Positive airway pressure (PAP) therapy is the gold-standard for obstructive sleep apnea (OSA) management
OSA generally results in poor sleep quality, characterized by short sleep latency, increased Stage 1 sleep, decreased rapid-eye movement (REM) and slow-wave sleep (SWS), poor sleep efficiency, and frequent sleep fragmentation caused by transient arousals [1] [2]
There is an evolving school of thought that the level of sleep disturbance in OSA patients who have been prescribed and regularly use PAP therapy may be underappreciated. This idea is supported by the result of the current study, which found that a large sample of OSA patients who were using PAP therapy with an overall acceptable level of use continued to report disturbed sleep 2 months and 4 months after starting therapy
Summary
Positive airway pressure (PAP) therapy is the gold-standard for obstructive sleep apnea (OSA) management. Results: The PSQI was significantly correlated with PAP adherence at both the 2-month and 4-month time points, such that lower sleep quality was associated with lower PAP use. This finding held for the sleep disturbance subscale of the PSQI. Discussion: This study shows that PAP therapy does not appear to improve sleep quality to a degree that would be expected. Positive airway pressure (PAP) therapy [9] is the gold-standard treatment for OSA [10], with meta-analytic reports showing improvement in daytime sleepiness [11] and HRQOL [12]. Despite PAP being the most efficacious treatment available to OSA patients, adherence is substandard (3 to 5 hours per night) [13]
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