0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Treatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime Sleepiness: A Randomized, Controlled Trial

Ferran Barbé, MD; Lola R. Mayoralas, PhD; Joaquin Duran, MD; Juan F. Masa, MD; Andreu Maimó, MD; Josep M. Montserrat, MD; Carmen Monasterio, MD; Margalida Bosch, RN; Antoni Ladaria, MD; Manuela Rubio, MD; Ramon Rubio, MD; Magdalena Medinas, PhD; Lourdes Hernandez, MD; Silvia Vidal, MD; Neil J. Douglas, MD; and Alvar G.N. Agustí, MD
[+] Article and Author Information

From Hospital Universitari Son Dureta, Palma de Mallorca, Hospital San Pedro de Alcantara, Caceres, Hospital Txagorritxu, Vitoria-Gasteiz, Hospital Joan March, Bunyola, Hospital Clinic, Barcelona, and Hospital Bellvitge, L'Hospitalet de Llobregat, Spain; and Royal Infirmary, Edinburgh, United Kingdom.


Acknowledgments: The authors thank the participating patients; Jordi Forteza-Rey, MD (Hospital Universitari Son Dureta, de Palma de Mallorca, Spain), for help with the ambulatory blood pressure monitoring system; and A. De la Peña, MD (Unidad de Apoyo a la Investigación, Hospital Universitari Son Dureta), and Gemma Vilagut, PhD (Institut Municipal de Investigació Médica, Barcelona), for advice on statistical analysis.

Grant Support: In part by Fondo Investigacion Sanitaria grant 99-0032, the Spanish Respiratory Society (1998), and Associacio Balear per l'estudi de les malaties respiratories.

Requests for Single Reprints: Alvar G.N. Agustí, MD, Servei de Pneumologia, Hospital Universitari Son Dureta, Andrea Doria, 55, 07014 Palma de Mallorca, Spain; e-mail, aagusti@hsd.es.

Current Author Addresses: Dr. Barbé, Dr. Mayoralas, Ms. Bosch, Dr. Ladaria, and Dr. Agustí: Servei de Pneumologia, Hospital Universitari Son Dureta, Andrea Doria, 55, 07014 Palma de Mallorca, Spain.

Drs. Duran and R. Rubio: Servicio de Neumologia, Hospital Txagorritxu, 01009 Vitoria-Gasteiz, Spain.

Drs. Masa and M. Rubio: Servicio de Neumologia, Hospital San Pedro de Alcantara, 10003 Caceres, Spain.

Drs. Maimó and Medinas: Hospital Joan March, Servei de Pneumologia, Carretera de Soller, 15, 07193 Bunyola. Spain.

Drs. Montserrat and Hernandez: Servei de Pneumologia, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain.

Drs. Monasterio and Vidal: Servei de Pneumologia, Hospital de Bellvitge, 08970 L'Hospitalet de Llobregat, Spain.

Dr. Douglas: Respiratory Medicine Unit, Department of Medicine, The University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW, United Kingdom.

Author Contributions: Conception and design: F. Barbé, L.R. Mayoralas, J. Duran, J.F. Masa, A. Maimó, J.M. Montserrat, C. Monasterio, R. Rubio, L. Hernandez, S. Vidal, N.J. Douglas, A.G.N. Agustí.

Analysis and interpretation of the data: F. Barbé, L.R. Mayoralas, J. Duran, J.M. Montserrat, M. Bosch, R. Rubio, L. Hernandez, N.J. Douglas, A.G.N. Agustí.

Drafting of the article: F. Barbé, L.R. Mayoralas, M. Bosch, A.G.N. Agustí.

Critical revision of the article for important intellectual content: J. Duran, J.F. Masa, A. Maimó, J.M. Montserrat, C. Monasterio, M. Rubio, L. Hernandez, S. Vidal, N.J. Douglas.

Final approval of the article: F. Barbé, L.R. Mayoralas, J. Duran, J.F. Masa, A. Maimó, J.M. Montserrat, C. Monasterio, M. Bosch, A. Ladaria, M. Rubio, R. Rubio, M. Medinas, L. Hernandez, S. Vidal, N.J. Douglas, A.G.N. Agustí.

Provision of study materials or patients: F. Barbé, L.R. Mayoralas, J. Duran, J.F. Masa, A. Maimó, J.M. Montserrat, C. Monasterio, M. Bosch, A. Ladaria, M. Rubio, R. Rubio, M. Medinas, L. Hernandez, S. Vidal.

Statistical expertise: A.G.N. Agustí.

Obtaining of funding: F. Barbé, J. Duran, J.F. Masa, A. Maimó, J.M. Montserrat, M. Rubio, R. Rubio, A.G.N. Agustí.

Administrative, technical, or logistic support: L.R. Mayoralas, A. Maimó, J.M. Montserrat, C. Monasterio, M. Bosch, A. Ladaria, M. Rubio, M. Medinas, L. Hernandez, S. Vidal.

Collection and assembly of data: L.R. Mayoralas, M. Bosch, A. Ladaria, M. Rubio.


Ann Intern Med. 2001;134(11):1015-1023. doi:10.7326/0003-4819-134-11-200106050-00007
Text Size: A A A

The sleep apnea–hypopnea syndrome is currently defined by the presence of a pathologic number of episodes of cessation (apnea) or reduction (hypopnea) of respiratory flow during sleep (the apnea–hypopnea index, defined as the number of apnea and hypopnea episodes per hour). This syndrome is normally associated with arterial desaturation, sleep disruption (arousals), severe snoring, and excessive daytime sleepiness (1). Nasal continuous positive airway pressure (CPAP) is the treatment of choice for the sleep apnea–hypopnea syndrome (23). Several randomized, placebo-controlled studies have shown that CPAP improves subjective and objective daytime sleepiness, quality of life, cognitive performance, and psychological well-being in patients with this syndrome (49). The effects of CPAP on other clinically relevant variables, such as prognosis and incidence of cardiovascular events or traffic accidents, are unclear (10). The available evidence therefore supports the notion that CPAP is an effective symptomatic treatment for patients with the sleep apnea–hypopnea syndrome.

First Page Preview

View Large
First page PDF preview

Figures

Grahic Jump Location
Figure 1.
Trial design.

CPAP = continuous positive airway pressure.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Lack of relationship between daytime sleepiness according to Epworth Sleepiness Scale score (a subjective measure) or Multiple Sleep Latency Test score (an objective measure) before treatment with actual or sham continuous positive airway pressure.
Grahic Jump Location
Grahic Jump Location
Figure 3.
Mean scores on the Epworth Sleepiness Scale, Multiple Sleep Latency Test, the Steer-Clear test, and Functional Outcomes of Sleep Questionnaire (a quality-of-life measure) before (white bars) and after (gray bars) actual or sham continuous positive airway pressure (CPAP).

Error bars represent SEs.

Grahic Jump Location
Grahic Jump Location
Figure 4.
Mean blood pressure measurements before (white bars) and after (gray bars) actual or sham continuous positive airway pressure (CPAP).

Error bars represent SEs.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Treatment for Sleep Apnea in People without Symptoms

The summary below is from the full report titled “Treatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime Sleepiness. A Randomized, Controlled Trial.” It is in the 5 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1015-1023). The authors are F Barbé, LR Mayoralas, J Duran, JF Masa, A Maimó, JM Montserrat, C Monasterio, M Bosch, A Ladaria, M Rubio, R Rubio, M Medinas, L Hernandez, S Vidal, NJ Douglas, and AGN Agustí.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)