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Factors associated with improvements in subjective symptoms of obstructive sleep apnea syndrome after continuous positive airway pressure therapy

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Continuous positive airway pressure (CPAP) therapy improves subjective symptoms in obstructive sleep apnea syndrome (OSAS) patients; however, factors predicting symptom improvement post-CPAP therapy and the CPAP duration necessary for improving subjective symptoms are unclear. This study aimed to identify these factors and the appropriate nightly CPAP duration for improving subjective symptoms.

Methods

We recruited 359 subjects who completed both overnight polysomnography and subjective symptom assessments using the Epworth Sleepiness Scale (ESS), Zung Self-Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). Firstly, we analyzed subject characteristics, and the associations between each assessment score and the Apnea-Hypopnea Index. These assessments were then repeated for 138 subjects who could continue for 3 months after starting CPAP. Secondly, associations between changes in self-reported outcome measures and nightly CPAP duration were analyzed. We identified subjects with abnormal initial ESS, PSQI, and SDS scores and divided them into “improvement” and “non-improvement” groups to examine factors associated with a positive outcome after CPAP therapy.

Results

Subjective symptom scores and proportions of subjects exceeding the cutoff values of each symptom score were not significantly related to OSAS severity. ESS, SDS, and PSQI scores improved 3 months after CPAP treatment, and factors involved in each improvement were found. Remarkably, longer CPAP nightly duration resulted in improvements in all subjective symptom scores. Furthermore, minimum durations between 4.75 and 5.40 h were necessary for improvements in subjective symptoms based on ROC curve analysis.

Conclusions

Longer nightly CPAP use significantly improved OSAS subjective symptoms.

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Abbreviations

AHI:

Apnea-Hypopnea Index

CPAP:

Continuous Positive Airway Pressure

ESS:

Epworth Sleepiness Scale

EDS:

Excessive Daytime Sleepiness

OSAS:

Obstructive Sleep Apnea Syndrome

PSG:

Polysomnography

PSQI:

Pittsburgh Sleep Quality Index

SDS:

Zung Self-Depression Scale

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Authors and Affiliations

  1. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Kengo Otsuka, Koichi Fukunaga, Mizuha Haraguchi, Tetsuo Tani & Tomoko Betsuyaku

  2. Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan

    WakakoYamasawa

  3. RESM Shin Yokohama Sleep & Respiratory Medical Care Clinic, Kanagawa, Japan

    Ryutaro Shirahama

Authors
  1. Kengo Otsuka
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  2. Koichi Fukunaga
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  3. WakakoYamasawa
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  4. Mizuha Haraguchi
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  5. Tetsuo Tani
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  6. Ryutaro Shirahama
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  7. Tomoko Betsuyaku
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Corresponding author

Correspondence to Koichi Fukunaga.

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Conflict of interest

KO, KF, MH, TT, and TB were supported by funds donated by Teijin Home Healthcare Limited (Japan), Fukuda Denshi (Japan), and Philips Respironics (Japan). However, these companies had no role in the study design, data collection and analysis, or preparation of the manuscript. The other authors declare that that there is no conflict of interest regarding the publication of this paper.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study protocol (No. 2015043) was approved by the institutional review board of each participating institution.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comments:

The symptoms of OSA, which includes Excessive daytime sleepiness, can be associated with increase in cardiovascular mortality 1, although it does not Correlate to the severity of OSA2.

Factors which improve this and other subjective symptoms of OSA with CPAP use are important and examined in this study by Dr Otsuka et al. The study found sufficient nightly CPAP duration as an important factor which improved numerous subjective symptoms like EDS, depression scores and sleep quality. The study also defined what an effective CPAP duration was to achieve these improvements.

Duration of CPAP therapy has been subject of debate. Prior studies have shown duration that are effective but this study helps answer the relevant question for the patient - how much do I have to use CPAP nightly so that I start to feel a difference.

Toshita Kumar

Conneticut, USA

1. Jiang Xie, MD, PhD, 1 , 2 Fatima H. Sert Kuniyoshi, PhD, 1 Naima Covassin, PhD, 1 Prachi Singh, PhD, 1Apoor S. Gami, MD, 1 C. Anwar A. Chahal, MD, 1 and Virend K. Somers, MD, PhD Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction J Am Heart Assoc. 2018 Jan; 7(2): e007221. Published online 2018 Jan 19. doi: 10.1161/JAHA.117.007221

2. By Douglas Kirsch Daytime sleepiness and obstructive sleep apnea severity: where symptoms and metrics do not converge. Publisher: Cambridge University Press. https://doi.org/10.1017/CBO9781139583848.011 pp 41-47

3. Terri E. Weaver, PhD, RN, FAAN,1,2,3 Greg Maislin, MS, MA,1,2,3 David F. Dinges, PhD,3,4 Thomas Bloxham, MD,5Charles F. P. George, MD,6 Harly Greenberg, MD,7 Gihan Kader, MD,8 Mark Mahowald, MD,9 Joel Younger, MD,10and Allan I. Pack, MD, PhD2,3 Relationship Between Hours of CPAP Use and Achieving Normal Levels of Sleepiness and Daily Functioning Sleep. 2007 Jun 1; 30(6): 711-719.

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Tomoko Betsuyaku died before the publication of this work.

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Otsuka, K., Fukunaga, K., WakakoYamasawa et al. Factors associated with improvements in subjective symptoms of obstructive sleep apnea syndrome after continuous positive airway pressure therapy. Sleep Breath 24, 491–498 (2020). https://doi.org/10.1007/s11325-019-01877-5

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  • DOI: https://doi.org/10.1007/s11325-019-01877-5

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