Article: Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea

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TitleRandomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea
AuthorsLam, B1
Sam, K1
Mok, WYW1
Cheung, MT2
Fong, DYT1
Lam, JCM1
Lam, DCL1
Yam, LYC2
Ip, MSM1
Issue Date2007
PublisherB M J Publishing Group. The Journal's web site is located at http://thorax.bmjjournals.com/
CitationThorax, 2007, v. 62 n. 4, p. 354-359 [How to Cite?]
DOI: http://dx.doi.org/10.1136/thx.2006.063644
AbstractBackground: Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non-surgical treatment modalities. Methods: Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10 weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight-reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health-related quality of life (HRQOL) was assessed with the 36-Item Short-Form Health Survey (SF-36) and Sleep Apnoea Quality of Life Index (SAQLI). Results: 101 subjects with a mean (SEM) apnoea-hypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the "bodily pain" domain, and better than conservative measures in improving the "physical function" domain of SF-36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight. Conclusion: CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.
ISSN0040-6376
2011 Impact Factor: 6.84
2011 SCImago Journal Rankings: 0.429
DOIhttp://dx.doi.org/10.1136/thx.2006.063644
ISI Accession Number IDWOS:000245212500015
PubMed Central IDPMC2092459
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorLam, B
dc.contributor.authorSam, K
dc.contributor.authorMok, WYW
dc.contributor.authorCheung, MT
dc.contributor.authorFong, DYT
dc.contributor.authorLam, JCM
dc.contributor.authorLam, DCL
dc.contributor.authorYam, LYC
dc.contributor.authorIp, MSM
dc.date.accessioned2010-04-12T01:38:58Z
dc.date.available2010-04-12T01:38:58Z
dc.date.issued2007
dc.description.abstractBackground: Patients with mild to moderate obstructive sleep apnoea (OSA) may be managed with different treatment options. This study compared the effectiveness of three commonly used non-surgical treatment modalities. Methods: Subjects with mild to moderate OSA were randomised to one of three treatment groups for 10 weeks: conservative measures (sleep hygiene) only, continuous positive airways pressure (CPAP) in addition to conservative measures or an oral appliance in addition to conservative measures. All overweight subjects were referred to a weight-reduction class. OSA was assessed by polysomnography. Blood pressure was recorded in the morning and evening in the sleep laboratory. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Health-related quality of life (HRQOL) was assessed with the 36-Item Short-Form Health Survey (SF-36) and Sleep Apnoea Quality of Life Index (SAQLI). Results: 101 subjects with a mean (SEM) apnoea-hypopnoea index (AHI) of 21.4 (1.1) were randomised to one of the three groups. The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group, and the CPAP group was significantly better than the oral appliance group. Relief from sleepiness was significantly better in the CPAP group. CPAP was also better than the oral appliance or conservative measures in improving the "bodily pain" domain, and better than conservative measures in improving the "physical function" domain of SF-36. Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI, although no difference was detected between the CPAP and oral appliance groups. CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values, but there was no difference in the changes in blood pressure between the groups. There was also a linear relationship between the changes in AHI and body weight. Conclusion: CPAP produced the best improvement in terms of physiological, symptomatic and HRQOL measures, while the oral appliance was slightly less effective. Weight loss, if achieved, resulted in an improvement in sleep parameters, but weight control alone was not uniformly effective.
dc.description.naturepublished_or_final_version
dc.identifier.citationThorax, 2007, v. 62 n. 4, p. 354-359 [How to Cite?]
DOI: http://dx.doi.org/10.1136/thx.2006.063644
dc.identifier.citeulike1214936
dc.identifier.doihttp://dx.doi.org/10.1136/thx.2006.063644
dc.identifier.epage359
dc.identifier.hkuros134677
dc.identifier.isiWOS:000245212500015
dc.identifier.issn0040-6376
2011 Impact Factor: 6.84
2011 SCImago Journal Rankings: 0.429
dc.identifier.issue4
dc.identifier.openurl
dc.identifier.pmcidPMC2092459
dc.identifier.pmid17121868
dc.identifier.scopuseid_2-s2.0-34147222635
dc.identifier.spage354
dc.identifier.urihttp://hdl.handle.net/10722/57517
dc.identifier.volume62
dc.languageeng
dc.publisherB M J Publishing Group. The Journal's web site is located at http://thorax.bmjjournals.com/
dc.publisher.placeUnited Kingdom
dc.relation.ispartofThorax
dc.relation.referencesReferences in Scopus
dc.rightsThorax. Copyright © B M J Publishing Group.
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
dc.subject.meshSleep Apnea, Obstructive - therapy
dc.subject.meshBlood Pressure
dc.subject.meshContinuous Positive Airway Pressure
dc.subject.meshPatient Education as Topic
dc.subject.meshPlethysmography
dc.titleRandomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. Pamela Youde Nethersole Eastern Hospital