Impact of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-04-01 DOI:10.1007/s11325-025-03309-z

Siraj Omar Wali, Ghadah Batawi, Omar Kanbr, Nadeem Shafique Butt, Murad A Yasawy, Dalyah Alqaidi, Faris Alhejaili, Ranya Alshumrani, David Gozal

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引用次数: 0

Abstract

Purpose: Continuous positive airway pressure (CPAP) is the gold standard for managing moderate-to-severe obstructive sleep apnea (OSA). However, adherence to CPAP usage remains problematic with many patients either intermittently or permanently discontinuing CPAP use. However, the impact of CPAP therapy discontinuation remains unclear. This study aimed to evaluate the effects of complete and intermittent CPAP withdrawal on clinical and objective relapse of OSA.

Patients and methods: This randomized study involved patients with moderate-to-severe OSA who were compliant with CPAP therapy. All subjects underwent a CPAP efficacy assessment (CPAP check), followed by 1 month of closely monitored CPAP usage. Subjects were then randomized into two groups: (1) complete CPAP withdrawal (NO-CPAP); (2) intermittent CPAP use (INT-CPAP) (using the device every other day). Clinical relapse was assessed daily and defined as reemergence of any of the OSA symptoms. Weekly home sleep testing was performed to assess OSA relapse objectively, defined as an apnea-hypopnea index (AHI) of > 5.

Results: A total of 22 patients were included, with 12 subjects assigned to NO-CPAP group and 10 to the INT-CPAP group. Both groups exhibited a rapid recurrence of OSA within 1 week of CPAP discontinuation, with significant increases in AHI, oxygen desaturation index, and time spent with O₂ saturation < 90% compared to baseline CPAP-check parameters (p < 0.05). In addition, clinical relapse occurred earlier in ⁓70% of the INT-CPAP group (Median 2.9 days) and 33% in the NO-CPAP group (Median, 3.5 days) (p < 0.05). Age and neck circumference were identified as significant predictors of OSA relapse (p < 0.05).

Conclusion: Discontinuation of CPAP therapy, whether completely or intermittently, leads to rapid OSA relapse, with age and neck circumference being key predictors of OSA relapse. These findings underscore the impact of CPAP withdrawal and the need for continuous CPAP adherence to effectively manage OSA.

Clinical trial registration: A full trial protocol can be accessed through: https://clinicaltrials.gov/study/NCT05471765 .

查看原文本刊更多论文

持续气道正压治疗对阻塞性睡眠呼吸暂停患者的影响：一项随机对照试验。

目的：持续气道正压通气（CPAP）是治疗中重度阻塞性睡眠呼吸暂停（OSA）的金标准。然而，坚持使用CPAP仍然是一个问题，许多患者间歇性或永久停止使用CPAP。然而，停止CPAP治疗的影响仍不清楚。本研究旨在评价完全停药和间歇停药对OSA临床和客观复发的影响。患者和方法：这项随机研究纳入了接受CPAP治疗的中重度OSA患者。所有受试者接受CPAP疗效评估（CPAP检查），随后1个月密切监测CPAP使用情况。然后将受试者随机分为两组：(1)完全停用CPAP (NO-CPAP)；(2)间歇CPAP使用（INT-CPAP）（每隔一天使用一次）。每日评估临床复发，定义为任何OSA症状的再次出现。每周进行家庭睡眠测试，客观评估OSA复发，定义为呼吸暂停-低通气指数（AHI）为bb0.5。结果：共纳入22例患者，其中12例为NO-CPAP组，10例为INT-CPAP组。两组患者在停服CPAP后1周内均出现OSA快速复发，AHI、氧去饱和指数、O2饱和时间均显著升高。结论：完全或间歇性停服CPAP均可导致OSA快速复发，年龄和颈围是OSA复发的关键预测因素。这些发现强调了停用CPAP的影响以及持续坚持CPAP以有效管理OSA的必要性。临床试验注册：完整的试验方案可通过https://clinicaltrials.gov/study/NCT05471765访问。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.