Introduction
Obstructive sleep apnoea (OSA) is a common sleep disorder, which has been linked to many adverse health outcomes including excessive sleepiness, impaired quality of life including daytime alertness, cognitive function, mood, motor vehicle crashes and cardiovascular events. Positive airways pressure (PAP) is the primary treatment modality.
Intervention
Continuous Positive Airway Pressure (CPAP)
Indication
Use of CPAP in people with OSA to improve daytime sleepiness, sleep-related quality of life and modest lowering of blood pressure, particularly nocturnal systolic blood pressure.1
Precautions
Ensure that prior to treatment of OSA with CPAP, a diagnosis of OSA has been established using objective sleep apnoea testing.
Adverse effects
Side effects that have been reported with CPAP include nasal dryness/irritation, dry mouth, sore throat and sinus infection.1
Availability
Public funding of CPAP varies by state and territory in Australia. The cost of the CPAP, mask and other accessories has been estimated to be over $1500. Access to CPAP is via a home or laboratory-based sleep study. The pathway to having a sleep study can be through referral to a sleep or respiratory specialist or via direct referral from the GP, when the following Medicare criteria are met: A high pre-test probability of symptomatic, moderate-severe OSA is confirmed by a Epworth Sleepiness Scale (ESS) score ≥ 8, and OSA50 score ≥5 or STOP-Bang score ≥3.
Description
A 2019 systematic review commissioned by the American Academy of Sleep Medicine found that CPAP resulted in a reduction in sleepiness, blood pressure, and motor vehicle accidents, compared with no treatment in people with OSA. CPAP also improved sleep-related quality of life. The effectiveness of CPAP in reducing cardiovascular events and all-cause mortality in OSA was inconclusive.1
Tips and Challenges
- Poor adherence (usually defined as less than of 4 hours in a 24-hour period) with CPAP limits its effectiveness. Technological advances have improved the fit and comfort of the masks but regular follow-up and troubleshooting are needed.1, 2
- Mandibular advancement devices may be an alternative to CPAP.2
Grading
High for reducing OSA severity and for improving self-reported sleepiness; moderate to high for improving sleep-related quality of life and for reducing blood pressure; inconclusive for reducing cardiovascular events and all-cause mortality.