The multicenter study is significant because it discusses residual sleepiness in CPAP compliant patients. Numerous studies have shown that only 23-45% of CP_AP patients are compliant. This study shows that even among CPAP compliant patients residual sleepiness occurs frequently.
Even though CPAP is considered the Gold Standard for Sleep Apnea Treatment poor compliance has always plagued this therapy. Dental Sleep Medicine offers patients comfortable oral appliance alternatives to CPAP. Studies have shown that most patients prefer oral appliances to CPAP when offered a choice of therapies. Patients wanting to learn more about treatment of sleep apnea with oral appliances can find it @ http://www.ihatecpap.com/
The study covered 502 patients from 37 French sleep centers. It is important to note that the study included patients using CPAP as little as 3 hours per night. Recent studies have shown that even among patients who actually use their CPAP most patients only wear their CPAP 4-5 hours not the 7 1/2-8 hours that is considered ideal.
Sixty patients (12%) remained sleepy after CPAP use as measured by a score of 11 or more on the Epworth Sleepiness Scale.
It is vitally important that patients with Sleep Apnea receive treatment with CPAP, Oral Appliances or other therapies. This study highlights why all patients should be offered multiple treatment options especially if they are not successful with CPAP.
The Pub Med abstract follows for your convenience.
1: Eur Respir J. 2009 May;33(5):1062-
Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study.
Pépin JL, Viot-Blanc V, Escourrou P, Racineux JL, Sapene M, Lévy P, Dervaux B, Lenne X, Mallart A.
HP2 Laboratory (Hypoxia Pathophysiology)
The percentage of compliant continuous positive airway pressure (CPAP)-treated apnoeic patients that continue to experience residual excessive sleepiness (RES) is unknown. RES was defined by an Epworth Sleepiness Scale (ESS) score of >or=11. In total, 502 patients from 37 French sleep centres using CPAP >3 h night(-1) attending their 1-yr follow-up visit were eligible. ESS and polysomnographic data as well as symptoms, quality of life, depression scores and objective CPAP compliance at 1 yr were collected. Overall, 60 patients remained sleepy on CPAP (ESS 14.3+/-2.5) leading to a prevalence rate of RES of 12.0% (95% confidence interval (CI) 9.1-14.8). After having excluded associated restless leg syndrome, major depressive disorder and narcolepsy as confounding causes, the final prevalence rate of RES was 6.0% (95% CI 3.9-8.01). Patients with RES were younger and more sleepy at diagnosis. The relative risk of having RES was 5.3 (95% CI 1.6-22.1), when ESS before treatment was >or=11. Scores of emotional and energy Nottingham Health Profile domains were two times worse in patients with RES. As 230,000 obstructive sleep apnoea patients are currently treated in France by continuous positive airway pressure, more than 13,800 of them might suffer from residual excessive sleepiness.
