Prescription sleep aids may do little to improve the use of continuous positive airway pressure (CPAP) among patients with obstructive sleep apnea (OSA). A new study published in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), finds that patients with OSA who were given prescription sleep aids were no more likely to use their CPAP machines than patients with OSA taking a placebo.
"CPAP treatment improves daytime alertness and quality of life for most patients with OSA and may prevent some of the long-term complications of this disorder, including heart attacks and strokes," said the study's lead author Capt. David A. Bradshaw, MD, FCCP, Naval Medical Center, San Diego, CA. "Yet, many people find CPAP difficult to use. People with a good initial experience are more likely to use CPAP regularly. Our hypothesis was that a sleeping pill might help new CPAP users adjust to sleeping with the equipment and promote long-term usage."
To determine the effect prescription sleep medications have on CPAP compliance, Capt. Bradshaw and colleagues compared CPAP use among 72 newly diagnosed male patients (mean age 38 ± 7 years) who were referred for CPAP treatment. All patients participated in standardized CPAP training and were randomized to receive the sleeping agent zolpidem (N=24), a placebo pill (N=24), or standard care (N=24) with no sleeping pill or placebo. Patients taking zolpidem or placebo were instructed to take one pill each night, 30 minutes prior to bedtime for the first 14 days of treatment. During the four-week trial, CPAP use was recorded by an internal data chip.
Compared with the placebo pill and standard care groups, the zolpidem group did not show greater CPAP usage in terms of total days used or average time used per night over the course of four weeks. When the initial 14 days of CPAP treatment were analyzed separately, there was also no difference in number of days used or average nightly use. Despite results, researchers believe prescription sleep medications, when used correctly, may prove helpful for a subset of patients with OSA.
"Studies have shown that almost half of patients with OSA have insomnia complaints," said Capt. Bradshaw. "Our study does not support prescription sleeping pills for all new CPAP users, but OSA patients with insomnia symptoms might benefit." Still, researchers remain cautious regarding the use of prescription sleep medications for patients with OSA.
"We are concerned, however, about the potential risk for worsening sleep apnea if patients intentionally or inadvertently remove the mask before the effects of the sleeping pill have worn off," said Capt. Bradshaw. "Also, sleeping pills sometimes have residual daytime effects, such as sleepiness, and can interfere with cognitive function - both of which are already problems for many patients with OSA, even after treatment with CPAP."
Upon completion of the trial, all patients showed significant symptom improvement on the Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ). Baseline demographics revealed no difference in age, body mass index, ESS, FOSQ, nadir oxygen saturation, or CPAP pressure setting among the three groups. Despite randomization, the standard care group had a higher apnea/hypopnea index than the other two groups.
"When used consistently, CPAP is a highly effective therapy for patients with obstructive sleep apnea," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "More research is needed to determine interventions that can help optimize the initial experience with CPAP and improve long-term usage."
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at www.chestnet.org.
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