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Improving Use of Continuous Positive Airway Pressure for Obstructive Sleep Apnea FREE

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The summary below is from the full report titled “Effects of a Short Course of Eszopiclone on Continuous Positive Airway Pressure Adherence. A Randomized Trial.” It is in the 17 November 2009 issue of Annals of Internal Medicine (volume 151, pages 676-702). The authors are C.J. Lettieri, A.A. Shah, A.B. Holley, W.F. Kelly, A.S. Chang, and S.A Roop.

Ann Intern Med. 2009;151(10):I-38. doi:10.7326/0003-4819-151-10-200911170-00001
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What is the problem and what is known about it so far?

During sleep, some people stop breathing for short periods because of blockage of air passages in the upper respiratory tract. This condition, called obstructive sleep apnea, prevents restful sleep. People with sleep apnea sometimes feel bad, have difficulty thinking clearly, or report daytime sleepiness. The usual treatment involves wearing a special mask during sleep. The mask is part of a device that uses air pressure to keep the air passages open (continuous positive airway pressure, or CPAP). People who either find CPAP uncomfortable or do not feel immediate benefit from it often discontinue therapy. Doctors who treat sleep apnea need approaches that help these people tolerate and continue CPAP. One idea is short-term use of a mild sedative that helps promote sleep when people are first trying CPAP.

Why did the researchers do this particular study?

To see whether a short course of a nonbenzodiazepine sedative (eszopiclone) when starting therapy improves long-term CPAP adherence more than placebo in adults with obstructive sleep apnea.

Who was studied?

160 adults with severe obstructive sleep apnea.

How was the study done?

Researchers recruited patients with newly diagnosed obstructive sleep apnea. They randomly assigned the patients to take eszopiclone, 3 mg, or a matching placebo (pill without any active ingredient) every night for the first 2 weeks of CPAP therapy. Neither the patients nor their doctors knew who received which pill. At the end of the 2 weeks, patients were asked whether they had side effects, such as headaches or dizziness. The researchers then followed patients for 6 months. They measured use of CPAP with an electronic “smart card” embedded in the device and asked patients about such symptoms as daytime sleepiness.

What did the researchers find?

Patients receiving eszopiclone discontinued CPAP therapy less often and reported improved symptoms more often than patients receiving placebo. They also used CPAP more often (more nights) and for more hours per night than did patients given placebo. Reported side effects of pills were uncommon and did not differ from those with placebo.

What were the limitations of the study?

The study was small and some patients did not complete it. It was conducted at a specialized sleep center. Patients' reasons for discontinuing CPAP were not assessed.

What are the implications of the study?

Eszopiclone given during the first 2 weeks of therapy may help improve long-term use of CPAP in some patients with severe obstructive sleep apnea.





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