Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial
Background Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. Methods This multicentre, randomised controlled, parallel, hosp...
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| Veröffentlicht in: | Thorax 2012-12, Vol.67 (12), p.1090-1096 |
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| description | Background Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. Methods This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. Results Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS −2.0 (95% CI −2.6 to −1.4), p |
| doi_str_mv | 10.1136/thoraxjnl-2012-202178 |
| format | Article |
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Methods This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. Results Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS −2.0 (95% CI −2.6 to −1.4), p<0.0001), objectively measured sleepiness and self-assessed health status. CPAP did not improve the 5-year calculated vascular risk or any of its components. Conclusions In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thoraxjnl-2012-202178</identifier><identifier>PMID: 23111478</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group</publisher><subject>Biological and medical sciences ; Canada - epidemiology ; Cardiology. Vascular system ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - prevention & control ; Continuous Positive Airway Pressure ; Female ; Health Status Indicators ; Humans ; Hypertension ; Hypoxia ; Male ; Medical sciences ; Middle Aged ; Patients ; Pneumology ; Respiratory system : syndromes and miscellaneous diseases ; Risk Assessment ; Risk Factors ; Sleep apnea ; Sleep Apnea, Obstructive - physiopathology ; Sleep Apnea, Obstructive - therapy ; Surveys and Questionnaires ; Treatment Outcome ; United Kingdom - epidemiology</subject><ispartof>Thorax, 2012-12, Vol.67 (12), p.1090-1096</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2014 INIST-CNRS</rights><rights>Copyright: 2012 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b488t-af5a6c14774d4a5853b6e7441962182d9c8bc5332962aea4d1ad8fee36ddec593</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://thorax.bmj.com/content/67/12/1090.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://thorax.bmj.com/content/67/12/1090.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,315,781,785,3197,23573,27926,27927,77602,77633</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26635406$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23111478$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Craig, Sonya Elizabeth</creatorcontrib><creatorcontrib>Kohler, Malcolm</creatorcontrib><creatorcontrib>Nicoll, Debby</creatorcontrib><creatorcontrib>Bratton, Daniel J</creatorcontrib><creatorcontrib>Nunn, Andrew</creatorcontrib><creatorcontrib>Davies, Robert</creatorcontrib><creatorcontrib>Stradling, John</creatorcontrib><title>Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial</title><title>Thorax</title><addtitle>Thorax</addtitle><description>Background Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. Methods This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. Results Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS −2.0 (95% CI −2.6 to −1.4), p<0.0001), objectively measured sleepiness and self-assessed health status. CPAP did not improve the 5-year calculated vascular risk or any of its components. Conclusions In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.</description><subject>Biological and medical sciences</subject><subject>Canada - epidemiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Continuous Positive Airway Pressure</subject><subject>Female</subject><subject>Health Status Indicators</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypoxia</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pneumology</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - physiopathology</subject><subject>Sleep Apnea, Obstructive - therapy</subject><subject>Surveys and Questionnaires</subject><subject>Treatment Outcome</subject><subject>United Kingdom - epidemiology</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc9u1DAQxiMEotvCI4AsIaReAnbiOF5u1Yo_lYp6AM7RxJnVenHsYDtb9u14NGa7S5E4cbEt-zczn7-vKF4I_kaIWr3NmxDh59a7suKioqUSrX5ULIRUuqyrpXpcLDiXvFR1q86K85S2nHMtRPu0OKtqIYRs9aL4tQo-Wz-HObEpJJvtDhnYeAd7NkVMaY7I7DjFsMPEkkOcrKdr1s-Z-ZCZAWdmBxkHtoN0OEYWbfrOrGcTZIs-J3Zn84aN1tsRnNuztB-nHEZ6NSz0KcfZ3M-9b89g8gHhHcsbZJ9vv1xdr1gEP4TRJhpiSG8MztExRwvuWfFkDS7h89N-UXz78P7r6lN5c_vxenV1U_ZS61zCugFl6M-tHCQ0uql7ha2UYqkqoathaXRvmvpgXAUIchAw6DVirYYBTbOsL4rLY1-y4seMKXekx6Bz4JHM68hYoRvJZUPoq3_QbZijJ3UdZSS0UEvOiWqOlIkhpYjrborkT9x3gneHiLuHiLtDxN0xYqp7eeo-9yMOD1V_MiXg9QmgPMCtyTxj019OqZp0KuL4kevH7X_O_g0LPMdD</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Craig, Sonya Elizabeth</creator><creator>Kohler, Malcolm</creator><creator>Nicoll, Debby</creator><creator>Bratton, Daniel J</creator><creator>Nunn, Andrew</creator><creator>Davies, Robert</creator><creator>Stradling, John</creator><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20121201</creationdate><title>Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial</title><author>Craig, Sonya Elizabeth ; Kohler, Malcolm ; Nicoll, Debby ; Bratton, Daniel J ; Nunn, Andrew ; Davies, Robert ; Stradling, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b488t-af5a6c14774d4a5853b6e7441962182d9c8bc5332962aea4d1ad8fee36ddec593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Biological and medical sciences</topic><topic>Canada - epidemiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Continuous Positive Airway Pressure</topic><topic>Female</topic><topic>Health Status Indicators</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypoxia</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pneumology</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - physiopathology</topic><topic>Sleep Apnea, Obstructive - therapy</topic><topic>Surveys and Questionnaires</topic><topic>Treatment Outcome</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Craig, Sonya Elizabeth</creatorcontrib><creatorcontrib>Kohler, Malcolm</creatorcontrib><creatorcontrib>Nicoll, Debby</creatorcontrib><creatorcontrib>Bratton, Daniel J</creatorcontrib><creatorcontrib>Nunn, Andrew</creatorcontrib><creatorcontrib>Davies, Robert</creatorcontrib><creatorcontrib>Stradling, John</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Craig, Sonya Elizabeth</au><au>Kohler, Malcolm</au><au>Nicoll, Debby</au><au>Bratton, Daniel J</au><au>Nunn, Andrew</au><au>Davies, Robert</au><au>Stradling, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>67</volume><issue>12</issue><spage>1090</spage><epage>1096</epage><pages>1090-1096</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>Background Continuous positive airway pressure (CPAP) for symptomatic obstructive sleep apnoea (OSA) improves sleepiness and reduces vascular risk, but such treatment for the more prevalent, minimally symptomatic disease is contentious. Methods This multicentre, randomised controlled, parallel, hospital-based trial across the UK and Canada, recruited 391 patients with confirmed OSA (oxygen desaturation index >7.5/h) but insufficient symptoms to warrant CPAP therapy. Patients were randomised to 6 months of auto-adjusting CPAP therapy, or standard care. Coprimary endpoints were change in Epworth Sleepiness Score (ESS) and predicted 5-year mortality using a cardiovascular risk score (components: age, sex, height, systolic blood pressure, smoking, diabetes, cholesterol, creatinine, left ventricular hypertrophy, previous myocardial infarction or stroke). Secondary endpoints included some of the individual components of the vascular risk score, objectively measured sleepiness and self-assessed health status. Results Of 391 patients randomised, 14 withdrew, 347 attended for their follow-up visit at 6 months within the predefined time window, of which 341 had complete ESS data (baseline mean 8.0, SD 4.3) and 310 had complete risk score data. 22% of patients in the CPAP group reported stopping treatment and overall median CPAP use was 2 : 39 h per night. CPAP significantly improved subjective daytime sleepiness (adjusted treatment effect on ESS −2.0 (95% CI −2.6 to −1.4), p<0.0001), objectively measured sleepiness and self-assessed health status. CPAP did not improve the 5-year calculated vascular risk or any of its components. Conclusions In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.</abstract><cop>London</cop><pub>BMJ Publishing Group</pub><pmid>23111478</pmid><doi>10.1136/thoraxjnl-2012-202178</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Canada - epidemiology Cardiology. Vascular system Cardiovascular Diseases - epidemiology Cardiovascular Diseases - prevention & control Continuous Positive Airway Pressure Female Health Status Indicators Humans Hypertension Hypoxia Male Medical sciences Middle Aged Patients Pneumology Respiratory system : syndromes and miscellaneous diseases Risk Assessment Risk Factors Sleep apnea Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy Surveys and Questionnaires Treatment Outcome United Kingdom - epidemiology |
| title | Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial |
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