CPAP versus Oxygen in Obstructive Sleep Apnea

Daniel J. Gottlieb, Naresh M. Punjabi, Reena Mehra, Sanjay R. Patel, Stuart F Quan, Denise C. Babineau, Russell P. Tracy, Michael Rueschman, Roger S. Blumenthal, Eldrin F. Lewis, Deepak L. Bhatt, Susan Redline

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

BACKGROUND: Obstructive sleep apnea is associated with hypertension, inflammation, and increased cardiovascular risk. Continuous positive airway pressure (CPAP) reduces blood pressure, but adherence is often suboptimal, and the benefit beyond management of conventional risk factors is uncertain. Since intermittent hypoxemia may underlie cardiovascular sequelae of sleep apnea, we evaluated the effects of nocturnal supplemental oxygen and CPAP on markers of cardiovascular risk. METHODS: We conducted a randomized, controlled trial in which patients with cardiovascular disease or multiple cardiovascular risk factors were recruited from cardiology practices. Patients were screened for obstructive sleep apnea with the use of the Berlin questionnaire, and home sleep testing was used to establish the diagnosis. Participants with an apnea-hypopnea index of 15 to 50 events per hour were randomly assigned to receive education on sleep hygiene and healthy lifestyle alone (the control group) or, in addition to education, either CPAP or nocturnal supplemental oxygen. Cardiovascular risk was assessed at baseline and after 12 weeks of the study treatment. The primary outcome was 24-hour mean arterial pressure. RESULTS: Of 318 patients who underwent randomization, 281 (88%) could be evaluated for ambulatory blood pressure at both baseline and follow-up. On average, the 24-hour mean arterial pressure at 12 weeks was lower in the group receiving CPAP than in the control group (-2.4 mm Hg; 95% confidence interval [CI], -4.7 to -0.1; P = 0.04) or the group receiving supplemental oxygen (-2.8 mm Hg; 95% CI, -5.1 to -0.5; P = 0.02). There was no significant difference in the 24-hour mean arterial pressure between the control group and the group receiving oxygen. A sensitivity analysis performed with the use of multiple imputation approaches to assess the effect of missing data did not change the results of the primary analysis. CONCLUSIONS: In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure.

Original languageEnglish (US)
Pages (from-to)2276-2285
Number of pages10
JournalNew England Journal of Medicine
Volume370
Issue number24
DOIs
StatePublished - 2014
Externally publishedYes

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Continuous Positive Airway Pressure
Obstructive Sleep Apnea
Oxygen
Arterial Pressure
Blood Pressure
Control Groups
Cardiovascular Diseases
Confidence Intervals
Education
Sleep Apnea Syndromes
Berlin
Apnea
Random Allocation
Cardiology
Sleep
Randomized Controlled Trials
Hypertension
Inflammation
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gottlieb, D. J., Punjabi, N. M., Mehra, R., Patel, S. R., Quan, S. F., Babineau, D. C., ... Redline, S. (2014). CPAP versus Oxygen in Obstructive Sleep Apnea. New England Journal of Medicine, 370(24), 2276-2285. https://doi.org/10.1056/NEJMoa1306766

CPAP versus Oxygen in Obstructive Sleep Apnea. / Gottlieb, Daniel J.; Punjabi, Naresh M.; Mehra, Reena; Patel, Sanjay R.; Quan, Stuart F; Babineau, Denise C.; Tracy, Russell P.; Rueschman, Michael; Blumenthal, Roger S.; Lewis, Eldrin F.; Bhatt, Deepak L.; Redline, Susan.

In: New England Journal of Medicine, Vol. 370, No. 24, 2014, p. 2276-2285.

Research output: Contribution to journalArticle

Gottlieb, DJ, Punjabi, NM, Mehra, R, Patel, SR, Quan, SF, Babineau, DC, Tracy, RP, Rueschman, M, Blumenthal, RS, Lewis, EF, Bhatt, DL & Redline, S 2014, 'CPAP versus Oxygen in Obstructive Sleep Apnea', New England Journal of Medicine, vol. 370, no. 24, pp. 2276-2285. https://doi.org/10.1056/NEJMoa1306766
Gottlieb DJ, Punjabi NM, Mehra R, Patel SR, Quan SF, Babineau DC et al. CPAP versus Oxygen in Obstructive Sleep Apnea. New England Journal of Medicine. 2014;370(24):2276-2285. https://doi.org/10.1056/NEJMoa1306766
Gottlieb, Daniel J. ; Punjabi, Naresh M. ; Mehra, Reena ; Patel, Sanjay R. ; Quan, Stuart F ; Babineau, Denise C. ; Tracy, Russell P. ; Rueschman, Michael ; Blumenthal, Roger S. ; Lewis, Eldrin F. ; Bhatt, Deepak L. ; Redline, Susan. / CPAP versus Oxygen in Obstructive Sleep Apnea. In: New England Journal of Medicine. 2014 ; Vol. 370, No. 24. pp. 2276-2285.
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AU - Quan, Stuart F

AU - Babineau, Denise C.

AU - Tracy, Russell P.

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