From the Guidelines
Obstructive sleep apnea syndrome (OSAS) should be treated with continuous positive airway pressure (CPAP) as the gold-standard therapy to reduce cardiovascular mortality and events. This is based on the evidence from the 2016 European guidelines on cardiovascular disease prevention in clinical practice, which highlights the positive relationship between OSAS and hypertension, CAD, atrial fibrillation, stroke, and HF 1. The guidelines also note that OSAS affects an estimated 9% of adult women and 24% of adult men, and has been associated with an increased risk of CV morbidity and mortality.
Some key points to consider in the management of OSAS include:
- Screening for OSAS can be performed using the Berlin Questionnaire and daytime sleepiness can be assessed by the Epworth Sleepiness Scale and overnight oximetry 1
- Definitive diagnosis often requires polysomnography, usually during a night in a sleep laboratory during which multiple physiological variables are continuously recorded 1
- Treatment options include behavioural changes, such as avoiding alcohol, caffeine or other stimulants of wakefulness before sleep, increased physical activity, discontinuation of sedating drugs and obesity control 1
- CPAP therapy has been shown to reduce CV mortality and events, and is therefore the recommended treatment for OSAS 1
It is essential to prioritize the treatment of OSAS to reduce the risk of cardiovascular problems, stroke, and accidents due to daytime sleepiness. By using CPAP therapy and making lifestyle modifications, patients with OSAS can significantly improve their symptoms and overall health.
From the Research
Overview of OHS/OSA
- Obesity hypoventilation syndrome (OHS) is a condition characterized by obesity and poor breathing, often accompanied by obstructive sleep apnea (OSA) 2, 3.
- The treatment of OHS typically involves positive airway pressure (PAP) therapy, which can be delivered through continuous PAP (CPAP) or noninvasive ventilation (NIV) 2, 3, 4.
Comparison of CPAP and NIV
- Studies have compared the effectiveness of CPAP and NIV in patients with OHS and concomitant severe OSA, with some finding similar outcomes between the two treatments 3, 5, 4.
- A systematic review and meta-analysis found that PAP therapy, including both CPAP and NIV, was associated with improved outcomes in patients with OHS, including increased resolution of OHS and improvements in mortality, gas exchange, and quality of life 2.
- Another study found that CPAP and NIV had similar effectiveness in improving awake hypercapnia in ambulatory patients with OHS and concomitant severe OSA, regardless of the severity of baseline hypercapnia 5.
Adherence to PAP Therapy
- Adherence to PAP therapy is an important factor in the treatment of OHS, with studies suggesting that adherence to CPAP and NIV can be similar in patients with OHS 6.
- A study comparing adherence between CPAP and NIV in OHS found that nearly half of patients experienced trivial adverse effects related to PAP therapy, but that adherence to both treatments was generally good 2.
Treatment Recommendations
- Based on the available evidence, the American Thoracic Society has made a conditional recommendation that PAP therapy, including CPAP, be offered to patients with OHS to improve outcomes 2, 3.
- The choice between CPAP and NIV may depend on individual patient factors, such as the severity of OHS and the presence of concomitant severe OSA 3, 5, 4.