From the Guidelines
The APPLES trial demonstrated that CPAP therapy is effective in improving sleepiness, quality of life, and cognitive function in patients with obstructive sleep apnea (OSA), with optimal benefits seen in those using CPAP for at least 4 hours per night. The trial, which involved 1,105 participants with OSA, found that CPAP therapy significantly reduced Epworth Sleepiness Scale scores and improved vigilance and cognitive processing compared to sham CPAP treatment 1. The improvements in neurocognitive function were modest and primarily observed in participants with more severe OSA.
Key Highlights of the APPLES Trial
- The trial was a six-month multicenter study that evaluated the effectiveness of CPAP therapy for OSA
- CPAP therapy significantly improved objective measures of sleepiness, quality of life, and cognitive function compared to sham CPAP treatment
- CPAP adherence was crucial for achieving benefits, with greater improvements seen in patients who used CPAP for longer durations each night
- Blood pressure reductions were modest but statistically significant in the CPAP group
Clinical Implications
- The findings support CPAP as the first-line therapy for OSA, particularly in patients with daytime sleepiness and more severe disease
- Addressing adherence issues is crucial for optimal treatment outcomes
- The American Academy of Sleep Medicine clinical practice guideline suggests using positive airway pressure to treat OSA in adults with comorbid hypertension, with moderate-quality evidence showing clinically significant blood pressure reductions 1
Recommendations for Clinical Practice
- Clinicians should use CPAP therapy as the first-line treatment for OSA, particularly in patients with daytime sleepiness and more severe disease
- Clinicians should emphasize the importance of CPAP adherence and optimal use (at least 4 hours per night) to achieve benefits
- Clinicians should consider the potential benefits of CPAP therapy in reducing blood pressure in patients with comorbid hypertension, while also discussing the potential harms and burdens of treatment.
From the Research
Highlights of the APPLES Trial
- The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices 2
- The study aimed to determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA) 2
- The primary neurocognitive analyses showed a difference between groups for only the executive and frontal-lobe function variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the attention and psychomotor function or learning and memory variables at either the 2 or 6 month visits 2
- CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30) 2
- The study found that CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship 2
Key Findings
- The APPLES trial demonstrated the efficacy of CPAP therapy in improving sleepiness and neurocognitive function in patients with OSA 2
- The study highlighted the importance of considering the severity of OSA when evaluating the effects of CPAP therapy on neurocognitive function 2
- The trial's findings have implications for the treatment of OSA and the management of sleep-related disorders 2, 3
Study Design and Methods
- The APPLES trial was a randomized, double-blinded, 2-arm, sham-controlled, multicenter trial 2, 3
- The study included a battery of conventional and novel tests designed to evaluate neurocognitive function, mood, sleepiness, and quality of life 3
- The trial's design and methods were intended to provide a comprehensive and controlled evaluation of the effects of CPAP therapy on patients with OSA 3