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CPAP Treatment for Adults with Obstructive Sleep Apnea: Review of the Clinical and Cost-Effectiveness and Guidelines

Last updated: November 18, 2013
Project Number: RC0502-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Obstructive sleep apnea (OSA) is a common disorder in which the upper airway is partially or fully obstructed by soft tissue during sleep. OSA interferes with breathing, resulting in disrupted sleep. It affects 3% of adult Canadians, and is more prevalent in men and in people over the age of 45.

Technology
Treatment options for OSA include weight loss, dental devices or oral appliance therapy, surgical procedures, and continuous positive airway pressure (CPAP).CPAP is the mainstay of OSA treatment and involves wearing a mask that pumps air into the nose or mouth during sleep. The airflow generates positive pressure, which opens the airway and prevents the soft tissue from collapsing.There are several tests available for scoring the effectiveness of OSA treatments.

Issue
OSA has substantial patient health and economic implications. If left untreated, OSA can lead to fatigue, daytime drowsiness, headaches, cardiovascular disease, decreased quality of life, lowered occupational productivity, and increased risk of motor vehicle accidents. Studies evaluating the effect of CPAP on medical costs are limited and findings are inconsistent; a review of the clinical and cost-effectiveness evidence will therefore help inform decision-making.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 757 citations, and 3 additional reports were retrieved from grey literature searching. Of these, 8 articles met the criteria for inclusion in this review: 1 systematic review, 4 non-randomized studies, 2 economic evaluations, and 1 guideline.

Key Messages
For patients with moderate or severe OSA:

  • CPAP is effective at improving sleep.
  • CPAP is cost-effective.
  • The American College of Physicians guideline on CPAP recommends CPAP treatment as initial therapy.

Question

  1. What is the evidence for the clinical effectiveness and safety of CPAP treatment for adults with moderate to severe obstructive sleep apnea?
  2. What is the evidence for the cost-effectiveness of CPAP treatment for adults with moderate to severe obstructive sleep apnea?
  3. What are the evidence-based guidelines regarding CPAP treatment for adults with moderate to severe obstructive sleep apnea?

Key Message

CPAP treatment was found to be effective at improving sleep outcomes in patients with moderate to severe obstructive sleep apnea (OSA), as determined by improvements in Epworth Sleepiness Scale scores. CPAP treatment was found to be more costly than dental devices and lifestyle advice, but lower than commonly accepted cost-effectiveness thresholds. One evidence-based guideline recommends CPAP treatment as initial therapy for patients diagnosed with OSA, with all supporting evidence from trials of patients with moderate to severe OSA.