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a Respiratory
Medicine Unit, b Department of
Psychology, c University of Edinburgh, UK
Correspondence to: Professor N J Douglas, Department of Medicine, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, UK.
Received 9 January 1998; Returned to authors 14 January 1998; Revised version received 9 February 1998; Accepted for publication 10 February 1998
BACKGROUND
Patients with the sleep
apnoea/hypopnoea syndrome (SAHS) report improved sleepiness, cognitive
function, and psychological well being after continuous positive airway
pressure (CPAP) therapy, and it is for these daytime features that CPAP
is usually given. However, few randomised or controlled studies exist
on the effects of CPAP on daytime function.
METHODSA prospective, randomised, single blind,
placebo controlled, crossover trial of daytime function after CPAP was
conducted in 23 patients with SAHS, all with 
15
apnoeas+hypopnoeas/hour and 2 symptoms of SAHS. All patients spent
four weeks on CPAP therapy and four weeks on oral placebo treatment,
following randomisation to treatment order. With ethics committee
approval, patients were told the placebo tablet might improve upper
airway function. Average effective CPAP use was monitored using hidden
time clocks. Assessments of objective and subjective sleepiness,
symptoms, cognitive performance, and psychological well being were
performed on the last day of each treatment and compared.
RESULTSObjective sleepiness measured by sleep
onset latency on the multiple sleep latency test improved with CPAP
(mean difference from placebo +2.4 min, 95% CI 0.8 to 4.0; p<0.001)
as did subjective sleepiness on the Epworth scale (mean difference -6,
95% CI -3 to -9; p = 0.001). Symptom total score also fell with CPAP
(mean difference -1.6, 95% CI -2.2 to -1.0; p<0.001). No
determinants of these changes with active treatment were identified,
and no significant enhancements to cognitive function or psychosocial well being were found in this small sample.
CONCLUSIONSThese findings provide further
evidence for clinically significant benefits to daytime function from CPAP.
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