Mean disease alleviation as a comprehensive metric for evaluating continuous positive airway pressure therapy in obstructive sleep apnea: establishing reference values and clinical significance.

Abstract

Study objectives: Obstructive sleep apnea poses significant health risks, warranting effective treatment strategies. Continuous positive airway pressure therapy is widely used, but assessing treatment effectiveness remains complex. This study aimed to establish reference values for mean disease alleviation (MDA) in a large cohort treated with continuous positive airway pressure.

Methods: Data from the Apnea Positive Pressure Long-term Efficacy Study were analyzed. A total of 352 participants underwent 6 months of continuous positive airway pressure therapy, with adherence and efficacy monitored objectively. MDA, calculated as the product of treatment efficacy and percentage adherence, was assessed. Age and sex differences in MDA and its association with sleepiness (Epworth Sleepiness Scale scores > 10) were evaluated using logistic regression and linear regression models.

Results: The mean MDA in the 352 participants at 6 months was 53.85% ± 27.22%. Older participants demonstrated higher adherence and MDA compared to younger participants (58.2% ± 27.8% vs 51.1% ± 27.4%, P = .047). Despite higher efficacy, females demonstrated lower adherence, yielding MDA levels comparable to those of males. Participants achieving MDA ≥ 40% had significantly lower odds of sleepiness (odds ratio = 0.40; 95% confidence interval: 0.23-0.70; P = .001). In linear regression models, MDA was significantly associated with a reduction in Epworth Sleepiness Scale scores from baseline to 6 months (β = 0.146, P = .006), further supporting MDA as a robust predictor of treatment success.

Conclusions: MDA serves as a valuable metric for evaluating obstructive sleep apnea therapy outcomes, integrating both adherence and treatment efficacy. MDA ≥ 40% was associated with clinically meaningful improvements in sleepiness. Embracing MDA as a benchmark for obstructive sleep apnea therapy evaluation holds promise for optimizing personalized and effective obstructive sleep apnea management.

Citation: Budhiraja R, Batool-Anwar S, Quan SF. Mean disease alleviation as a comprehensive metric for evaluating continuous positive airway pressure therapy in obstructive sleep apnea: establishing reference values and clinical significance. J Clin Sleep Med. 2025;21(6):973-982.