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 (OSA) poses significant health risks, warranting effective treatment strategies. While Continuous Positive Airway Pressure (CPAP) therapy is widely utilized, assessing treatment effectiveness remains complex. This study aimed to establish reference values for mean disease alleviation (MDA) in a large CPAP-treated cohort.

Methods: Data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES) were analyzed. A total of 352 participants underwent 6 months of CPAP 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 61.1% (±34.2%), with a significant positive correlation between MDA and adherence (R=0.81, P<0.001). Older participants demonstrated higher adherence and MDA compared to younger participants (58.2% ± 27.8% vs. 51.1% ± 27.4%, P=0.047). Despite higher efficacy, females demonstrated lower adherence, yielding comparable MDA levels to males. Participants achieving MDA ≥40% had significantly lower odds of sleepiness (OR=0.40, 95% CI: 0.23-0.70, P=0.001).

Conclusions: MDA serves as a valuable metric for evaluating OSA therapy outcomes, integrating both adherence and treatment efficacy. MDA ≥40% was associated with clinically meaningful improvements in sleepiness. Embracing MDA as a benchmark for OSA therapy evaluation holds promise for optimizing personalized and effective OSA management and improving patient outcomes. Future research should focus on optimizing MDA and exploring its impact on long-term outcomes.