Weigh the Options before Starting CPAP

Phillips, Barbara; Dhaon, Nitin A.

doi:10.5664/jcsm.3066

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Age effects would not be expected to manifest over the relatively short periods that trials run [41,42]. The evidence for CPAP use being associated with weight gain remains unclear but even when demonstrated the degree of increase seems too small to impact significantly on treated OSAH [43]. In any case, the range of trial durations in this meta-analysis was narrow, and there were too few trials (and patients) to examine this observation in detail.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea

Sharples

Clutterbuck-James

Glover

et al. 2016

Sleep Medicine Reviews

167

109

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SummaryObstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness, impairs quality-of-life, and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment and mandibular advancement devices (MAD) have been shown to be effective in individual trials but their effectiveness particularly relative to disease severity is unclear.A MEDLINE, Embase and Science Citation Index search updating two systematic reviews to August 2013 identified 77 RCTs in adult OSAH patients comparing: MAD with conservative management (CM); MAD with CPAP; or CPAP with CM. Overall MAD and CPAP significantly improved apnoea-hypopnoea index (AHI) (MAD −9.3/hr (p < 0.001), CPAP −25.4 (p < 0.001)). In direct comparisons mean AHI and Epworth sleepiness scale score were lower (7.0/hr (p < 0.001) and 0.67 (p = 0.093) respectively) for CPAP. There were no CPAP vs. MAD trials in mild OSAH but in comparisons with CM, MAD and CPAP reduced ESS similarly (MAD 2.01 (p < 0.001); CPAP 1.23 (p = 0.012).Both MAD and CPAP are clinically effective in the treatment of OSAH. Although CPAP has a greater treatment effect, MAD is an appropriate treatment for patients who are intolerant of CPAP and may be comparable to CPAP in mild disease.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea

Sharples

Clutterbuck-James

Glover

et al. 2016

Sleep Medicine Reviews

167

109

View full text Add to dashboard Cite

show abstract

“…La PPC améliorant significativement la vigilance, on pourrait s'attendre à ce que la perte de poids des patients obèses en soit facilitée. Malheureusement, les études ayant exploré cette hypothèse ont donné des résultats décevants (12,(18)(19)(20). L'étude la plus large dans ce domaine, Apnea Positive Pressure Long-Term Efficacity Study (APPLES) est une étude prospective (6 mois) randomisée, en double aveugle ayant comparé l'effet d'une PPC efficace à celui d'une PPC « fantôme » c'est-à-dire éta-blie à un niveau de pression inefficace (12).…”

Section: Ventilation En Pression Positive Continueunclassified

Syndrome d’Apnées Obstructives du Sommeil et Obésité : quels traitements ?

Gabe

Nguyen-Plantin

Fleury

2015

Obes

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“…Modifications in leptin levels, inflammatory cytokines, and growth hormone axis and decreased energy expenditure have been suggested as possible mechanisms for the reported weight gain. 8 CPAP may reduce the resting metabolic rate without an appreciable impact on physical activity levels. 9 One study found that increase in weight after CPAP therapy correlated with insulin resistance.…”

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confidence: 99%