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OBJECTIVES The aim of this study was to compare the relative efficacy of continuous positive airway pressure ( CPAP ) and positional treatment in the management of positional obstructive sleep apnea ( OSA ) , using objective outcome measures . DESIGN A prospect i ve , r and omized , single blind crossover comparison of CPAP and positional treatment for 2 weeks each . SETTING A university teaching hospital . PATIENTS Thirteen patients with positional OSA , aged ( mean+/-SD ) 51+/-9 years , with an apnea-hypopnea index ( AHI ) of 17+/-8 . MEASUREMENTS ( 1 ) Daily Epworth Sleepiness Scale scores ; ( 2 ) overnight polysomnography , an objective assessment of sleep quality and AHI ; ( 3 ) maintenance of wakefulness testing ; ( 4 ) psychometric test battery ; ( 5 ) mood scales ; ( 6 ) quality -of-life question naires ; and ( 7 ) individual patient 's treatment preference . RESULTS Positional treatment was highly effective in reducing time spent supine ( median , 0 ; range , 0 to 32 min ) . The AHI was lower ( mean difference , 6.1 ; 95 % confidence interval [ CI ] , 2 to 10.2 ; p = 0.007 ) , and the minimum oxygen saturation was higher ( 4 % ; 95 % CI , 1 % to 8 % ; p = 0.02 ) on CPAP as compared with positional treatment . There was no significant difference , however , in sleep architecture , Epworth Sleepiness Scale scores , maintenance of wakefulness testing sleep latency , psychometric test performance , mood scales , or quality -of-life measures . CONCLUSION Positional treatment and CPAP have similar efficacy in the treatment of patients with positional OSA Background —There is increasing evidence that obstructive sleep apnea ( OSA ) is an independent risk factor for arterial hypertension . Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure ( nCPAP ) therapy on hypertension in OSA , the impact of treatment on cardiovascular sequelae has been question ed altogether . Therefore , we studied the effect of nCPAP on arterial hypertension in patients with OSA . Methods and Results —Sixty consecutive patients with moderate to severe OSA were r and omly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average . Nocturnal polysomnography and continuous noninvasive blood pressure recording  for 19 hours was performed before and with treatment . Thirty two patients , 16 in each group , completed the study . Apneas and hypopneas were reduced by ≈95 % and 50 % in the therapeutic and subtherapeutic groups , respectively . Mean arterial blood pressure decreased by 9.9±11.4 mm Hg with effective nCPAP treatment , whereas no relevant change occurred with subtherapeutic nCPAP ( P = 0.01 ) . Mean , diastolic , and systolic blood pressures all decreased significantly by ≈10 mm Hg , both at night and during the day . Conclusions —Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure . The fact that a 50 % reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment . The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37 % and stroke risk by 56 % OBJECTIVES : Radiofrequency volume reduction ( RFTVR ) is a minor procedure directed at reducing the tongue base volume to treat obstructive sleep apnea . Subjective and objective treatment effectiveness was evaluated . STUDY DESIGN AND SETTING : Two separate prospect i ve , matched , nonr and omized , open enrollment treatment groups ( RFTVR , n = 73 and nasal continuous positive airway pressure ( CPAP , n = 99 ) were concurrently enrolled in a multicenter study . RESULTS : Fifty-six ( 76.7 % ) RFTVR  completed PSG with a mean 5.4 ± 1.8 treatments ( 13,394 ± 5459 joules ) . Perioperatively , acute pain was mild to moderate ; edema , mucosal erosion , paresthesia , tinnitus were infrequent ; and speech , swallowing taste , or throat irritation were unchanged . Self-reported outcomes did not differ between RFTVR and CPAP groups . Mean apnea/hypopnea index decreased ( 40.5 ± 21.5 to 32.8 ± 22.6 events/hr , P < 0.01 ) . Electrolyte solution injected predicted results ( r = 0.43 , P < 0.001 ) . The most severe complication was abscess ( 1.1 % ) . CONCLUSION : RFTVR  improves apnea/hypopnea index . Improvement may be related to solution injected with treatment . RFTVR and CPAP clinical outcomes improvement were similar . CLINICAL SIGNIFICANCE : In mild obstructive sleep apnea , treatment of symptomatic outcomes with RFTVR may be an alternative to CPAP Obstructive sleep apnea and hypertension are common conditions that frequently coexist . Continuous positive airway pressure ( CPAP ) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension . However , the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension , conditions associated with increased cardiovascular risk , is unknown . Thirty-six male patients ( age , 43±7 years ; body mass index , 28.8±3.0 kg/m2 ) with untreated severe obstructive sleep apnea ( apnea – hypopnea index , 56±22 events/hr on polysomnography ) with diagnostic criteria for prehypertension and /or masked hypertension , based on office and 24-hour ambulatory blood pressure monitoring , respectively , were studied . The patients r and omized to no treatment ( control ; n=18 ) or CPAP ( n=18 ) for 3 months had similar frequency of prehypertension and masked hypertension at study entry . There were no significant changes in blood pressure in patients r and omized to the control group . In contrast , patients r and omized to CPAP presented significant reduction in office systolic ( from 126±5 to 121±7 mm Hg ; P=0.001 ) and a trend for diastolic blood pressure ( from 75±7 to 73±8 mm Hg ; P=0.08 ) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure ( P<0.05 for each comparison ) . There was a significant reduction in the frequency of prehypertension ( from 94 % to 55 % ; P=0.02 ) and masked hypertension ( from 39 % to 5 % ; P=0.04 ) only in the CPAP group . In conclusion , effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea BACKGROUND Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure . We hypothesized that treatment of obstructive sleep apnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function . METHODS Twenty-four patients with a depressed left ventricular ejection fraction ( 45 percent or less ) and obstructive sleep apnea who were receiving optimal medical treatment for heart failure underwent polysomnography .  On the following morning , their blood pressure and heart rate were measured by digital photoplethysmography , and left ventricular dimensions and left ventricular ejection fraction were assessed by echocardiography . The subjects were then r and omly assigned to receive medical therapy either alone ( 12 patients ) or with the addition of continuous positive airway pressure ( 12 patients ) for one month . The assessment protocol was then repeated . RESULTS In the control group of patients who received only medical therapy , there were no significant changes in the severity of obstructive sleep apnea , daytime blood pressure , heart rate , left ventricular end-systolic dimension , or left ventricular ejection fraction during the study . In contrast , continuous positive airway pressure markedly reduced obstructive sleep apnea , reduced the daytime systolic blood pressure from a mean ( + /-SE ) of 126+/-6 mm Hg to 116+/-5 mm Hg ( P=0.02 ) , reduced the heart rate from 68+/-3 to 64+/-3 beats per minute ( P=0.007 ) , reduced the left ventricular end-systolic dimension from 54.5+/-1.8 to 51.7+/-1.2 mm ( P=0.009 ) , and improved the left ventricular ejection fraction from 25.0+/-2.8 to 33.8+/-2.4 percent ( P<0.001 ) . CONCLUSION In medically treated patients with heart failure , treatment of coexisting obstructive sleep apnea by continuous positive airway pressure reduces systolic blood pressure and improves left ventricular systolic function . Obstructive sleep apnea may thus have an adverse effect in heart failure that can be addressed by targeted therapy Background : The effects of continuous positive airway pressure ( CPAP ) for obstructive sleep apnoea ( OSA ) on insulin resistance are not clear . Trials have found conflicting results and no appropriate control groups have been used . Methods : Forty-two men with known type 2 diabetes and newly diagnosed OSA ( > 10 dips/h in oxygen saturation of > 4 % ) were r and omised to receive therapeutic ( n = 20 ) or placebo CPAP ( n = 22 ) for 3 months . Baseline tests were performed and repeated after 3 months . The study was double blind . Results : Results are expressed as mean ( SD ) . CPAP  improved the Epworth sleepiness score significantly more in the therapeutic group than in the placebo group ( −6.6 ( 4.5 ) vs −2.6 ( 4.9 ) , p = 0.01 ) . The maintenance of wakefulness test improved significantly in the therapeutic group but not in the placebo group ( + 10.6 ( 13.9 ) vs −4.7 ( 11.8 ) min , p = 0.001 ) . Glycaemic control and insulin resistance did not significantly change in either the therapeutic or placebo groups : HbA1c ( −0.02 ( 1.5 ) vs + 0.1 ( 0.7 ) , p = 0.7 , 95 % CI −0.6 % to + 0.9 % ) , euglycaemic clamp ( M/I : + 1.7 ( 14.1 ) vs −5.7 ( 14.8 ) , p = 0.2 , 95 % CI −1.8 to + 0.3 l/kg/min1000 ) , HOMA-%S ( −1.5 ( 2.3 ) vs −1.1 ( 1.8 ) , p = 0.2 , 95 % CI −0.3 % to + 0.08 % ) and adiponectin ( −1.1 ( 1.2 ) vs −1.1 ( 1.3 ) , p = 0.2 , 95 % CI −0.7 to + 0.6 & mgr;g/ml ) . Body mass index , bioimpedance and anthropometric measurements were unchanged . Hours of CPAP use per night were 3.6 ( 2.8 ) in the treatment group and 3.3 ( 3.0 ) in the placebo group ( p = 0.8 ) . There was no correlation between CPAP use and the measures of glycaemic control or insulin resistance . Conclusion : Therapeutic CPAP does not significantly improve measures of glycaemic control or insulin resistance in men with type 2 diabetes and OSA STUDY OBJECTIVE To compare the lateral pharyngoplasty procedure with uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnea hypopnea syndrome ( OSAHS ) . DESIGN Prospect i ve r and omized study . SETTING Academic tertiary center . PATIENTS Twenty-seven adults with OSAHS originally selected for treatment with UPPP .  INTERVENTIONS Patients were r and omly assigned to 2 groups : in one group , we performed the lateral pharyngoplasty ( 15 cases ) , and in the other , we did the UPPP ( 12 cases ) . MEASUREMENTS AND RESULTS We compared treatment outcomes through the evaluation of OSAHS-related symptoms and the analysis of polysomnographic tests and computed tomography measurements of pharyngeal airway . The lateral pharyngoplasty group achieved a statistically greater reduction in body weight , excessive daytime sleepiness , and apnea-hypopnea index . In addition , only in this group did we observe a statistically significant increase in the amount of deep sleep stages and improvement in morning headaches . Patients from the UPPP group did not present significant changes in the polysomnographic parameters . Pharyngeal airway measurement outcomes were similar in both groups and did not reflect the clinical and polysomnographic differences we observed . CONCLUSIONS Lateral pharyngoplasty produces better clinical and polysomnographic outcomes in the treatment of OSAHS than does UPPP , without result ant differences in the cross-sectional measurements of the pharyngeal airway between these treatments OBJECTIVE To determine the efficacy of the laser-assisted uvulopalatoplasty ( LAUP ) procedure on snoring and Apnea-Hypopnea-Index ( AHI ) improvement in patients with snoring and mild obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN Prospect i ve , nonr and omized , nonblinded assessment of outcomes after LAUP in patients suffering from benign habitual snoring and /or mild OSAS . METHODS Fifty-nine patients with habitual snoring and 25 patients with mild OSAS underwent LAUP ( 6 of them underwent simultaneous classic tonsillectomy and 20 carbon-dioxide laser tonsillotomy ) . All patients and their bed partners completed pre- and post-treatment question naires ranking snoring , whereas the patients with mild OSAS underwent postoperative polysomnography ( PSG ) . RESULTS During a 6-month to 5-year follow-up ( mean 40 months ) , 91.5 % of the patients with habitual snoring reported significant short-term improvement based on post-treatment question naires , whereas 79.7 % reported long-term subjective improvement . Nineteen of 25 patients ( 76 % ) with mild OSAS reported significant improvement of snoring based on posttreatment question naires . According to the postoperative PSG , only 2 % showed a worse AHI , whereas 60 % showed reduction of the AHI to < or = 5 . Eight patients ( 32 % ) showed little or no improvement of AHI . CONCLUSIONS LAUP , in combination with carbon-dioxide laser tonsillotomy in some cases , is a safe , cost-effective , outpatient procedure for the treatment of many cases of habitual snoring and mild OSAS when preceded by careful selection of the c and i date PURPOSE The purpose of this study was to compare the subjective findings of the Epworth Sleepiness Scale ( ESS ) to the objective findings of the overnight sleep study ( OSS ) in 57 patients who underwent phase I and phase II surgery for the correction of obstructive sleep apnea ( OSA ) . PATIENTS AND METHODS Forty-two patients in phase I category ( hyoid suspension , palatal surgery , and /or genioglossus advancement ) and 15 patients in phase II category ( maxillom and ibular advancement ) were examined . All patients had an OSS and completion of an ESS preoperatively and at a minimum of 8 weeks postoperatively . The results of each test were evaluated to examine any relationship between the improvements of the findings of the OSS to the changes in the ESS . RESULTS Using accepted criteria , phase I surgery produced an 80 % success rate and phase II surgery produced a greater than 95 % success rate in both the respiratory disturbance index and the ESS . CONCLUSIONS 1 ) Both phase I and phase II procedures are effective in treating OSA . 2 ) Phase II appears to be more effective in treating OSA using both objective and subjective evaluations . 3 ) Improvement in ESS scores and excessive daytime sleepiness seems to parallel the improvement in OSS scores in patients undergoing surgical correction of OSA Objective To assess the effect of continuous positive airway pressure ( CPAP ) on 24 hour ambulatory blood pressure monitoring values in a large number of patients with untreated systemic hypertension of new onset and obstructive sleep apnoea . Design Multicentre , double blind , r and omised , placebo controlled trial . Setting Eleven general hospitals in Spain between 2004 and 2007 . Participants 340 patients recently diagnosed as having systemic hypertension by a general practitioner ( systolic blood pressure ≥140 mm Hg , diastolic blood pressure ≥90 mm Hg , or both ) and an apnoea-hypopnoea index per hour of sleep of > 15 events/hour . Intervention Patients were assigned to CPAP ( n=169 ) or sham CPAP ( n=171 ) for three months . Main outcome measurements Net changes in the different 24 hour ambulatory blood pressure monitoring values from baseline to three months of optimal or sham CPAP . Results 277 ( 81 % ) of the 340 patients r and omised were men ; the patients had a mean age of 52.4 ( SD 10.5 ) years , a body mass index of 31.9 ( 5.7 ) , an Epworth sleepiness scale score of 10.1 ( 4.3 ) , an apnoea-hypopnoea index of 43.5 ( 24.5 ) . No differences between groups were seen at baseline . Compared with placebo and analysed by intention to treat , the mean 24 hour ambulatory blood pressure of the CPAP group decreased by 1.5 ( 95 % confidence interval : 0.4 to 2.7 ) mm Hg ( P=0.01 ) . The mean 24 hour ambulatory blood pressure monitoring measures decreased by 2.1 mm Hg ( 0.4 to 3.7 ) mm Hg ( P=0.01 ) for systolic pressure and 1.3 ( 0.2 to 2.3 ) mm Hg ( P=0.02 ) for diastolic blood pressure . Mean nocturnal blood pressure decreased by 2.1 ( 0.5 to 3.6 ) mm Hg ( P=0.01 ) . Conclusions CPAP produced a statistically significant reduction in blood pressure in patients with systemic hypertension and obstructive sleep apnoea . This reduction is small and did not achieve the 3 mm Hg drop in mean 24 hour ambulatory blood pressure that the trial was powered to detect . Consequently , these results may have uncertain clinical relevance . However , taking into account the prevalence of hypertension and the likelihood of comorbidities , the decrease in blood pressure , although minimal , may be beneficial . Trial registration Clinical trials NCT00202527 BACKGROUND The increase in peripheral chemoreflex sensitivity in patients with obstructive sleep apnea ( OSA ) is associated with activation of autonomic nervous system and hemodynamic responses . Nasal CPAP ( nCPAP ) is an effective treatment for OSA , but little is known on its effect on chemoreflex sensitivity . OBJECTIVES To assess the effect of nCPAP treatment or placebo ( sham nCPAP ) on ventilatory control in patients with OSA . SETTING Sleep laboratory of Azienda Ospedaliera Garibaldi . PATIENTS Twenty-five patients with moderate-to-severe OSA . DESIGN AND MEASUREMENTS Patients were r and omly assigned to either therapeutic nCPAP ( use of optimal pressure , n = 15 ) or sham nCPAP ( suboptimal pressure of 1 to 2 cm H2O , n = 10 ) in a double-blind fashion and treated for 1 month . A rebreathing test to assess ventilatory response to normocapnic hypoxia and normoxic hypercapnia was performed at basal condition and after 1 month of treatment . RESULTS The use of therapeutic nCPAP or sham nCPAP did not affect daytime percentage of arterial oxygen saturation ( SaO2 % ) or end-tidal P(CO2 ) . The normocapnic hypoxic ventilatory response was reduced after 1 month of treatment with nCPAP ( the slope was 1.08 + /- 0.02 L/min/SaO2 % at basal condition and 0.53 + /- 0.07 L/min/SaO2 % after 1 month of treatment , p = 0.008 ) [ mean + /- SD ] , but not in patients treated with sham nCPAP ( slope , 0.83 + /- 0.09 L/min/SaO2 % and 0.85 + /- 0.19 L/min/SaO2 % at basal condition and after 1 month , respectively ) . The normoxic hypercapnic ventilatory response remained unchanged after 1 month in both groups . No changes in ventilatory response to either hypoxia or hypercapnia were observed after a single night of nCPAP treatment . CONCLUSION The ventilatory response to hypoxia is reduced during regular treatment , but not after short-term treatment , with nCPAP . Readjusted peripheral oxygen chemosensitivity during nCPAP treatment may be a side effect of both reduced sympathetic activity and increased baroreflex activity , or a possible continuous positive airway pressure-related mechanism leading to a reduced activation of autonomic nervous system per se Background : The obstructive sleep apnoea/hypopnoea syndrome ( OSAHS ) is associated with hypertension and increased cardiovascular risk , particularly when accompanied by marked nocturnal hypoxaemia . The mechanisms of these associations are unclear . We hypothesised that OSAHS combined with severe nocturnal hypoxaemia causes impaired vascular function that can be reversed by continuous positive airways pressure ( CPAP ) therapy . Methods : We compared vascular function in two groups of patients with OSAHS : 27 with more than 20 4 % desaturations/h ( desaturator group ) and 19 with no 4 % and less than five 3 % desaturations/h ( non-desaturator group ) . In a r and omised , double blind , placebo controlled , crossover trial , the effect of 6 weeks of CPAP therapy on vascular function was determined in the desaturator group . In all studies , vascular function was assessed invasively by forearm venous occlusion plethysmography during intra-arterial infusion of endothelium dependent ( acetylcholine 5–20 μg/min and substance P 2–8 pmol/min ) and independent ( sodium nitroprusside 2–8 μg/min ) vasodilators . Results : Compared with the non-desaturator group , patients with OSAHS and desaturations had reduced vasodilatation to all agonists ( p = 0.007 for all ) . The apnoea/hypopnoea index and desaturation frequency were inversely related to peak vasodilatation with acetylcholine ( r = −0.44 , p = 0.002 and r = −0.43 , p = 0.003 ) and sodium nitroprusside ( r = −0.42 , p = 0.009 and r = −0.37 , p = 0.02 ) . In comparison with placebo , CPAP  therapy improved forearm blood flow to all vasodilators ( p = 0.01 ) . Conclusions : Patients with OSAHS and frequent nocturnal desaturations have impaired endothelial dependent and endothelial independent vasodilatation that is proportional to hypoxaemia and is improved by CPAP therapy . Impaired vascular function establishes an underlying mechanism for the adverse cardiovascular consequences of OSAHS Background : Previous r and omized controlled trials have addressed the efficacy of m and ibular advancement devices ( MADs ) in the treatment of obstructive sleep apnea ( OSA ) . Their common control condition , nasal continuous positive airway pressure ( nCPAP ) , was frequently found to be superior to MAD therapy . However , in most of these studies , only nCPAP was titrated objective ly but not MAD . To enable an unbiased comparison between both treatment modalities , the MAD should be titrated objective ly as well . Objective : The aim of the present study was to compare the treatment effects of a titrated MAD with those of nCPAP and an intra-oral placebo device . Methods : Sixty-four mild/moderate patients with obstructive sleep apnea ( OSA ; 52.0 ± 9.6 years ) were r and omly assigned to three parallel groups : MAD , nCPAP and placebo device . From all patients , two polysomnographic recordings were obtained at the hospital : one before treatment and one after approximately 6 months of treatment . Results : The change in the apnea-hypopnea index ( ΔAHI ) between baseline and therapy evaluation differed significantly between the three therapy groups ( ANCOVA ; p = 0.000 ) . No differences in the ΔAHI were found between the MAD and nCPAP therapy ( p = 0.092 ) , whereas the changes in AHI in these groups were significantly larger than those in the placebo group ( p = 0.000 and 0.002 , respectively ) . Conclusion : There is no clinical ly relevant difference between MAD and nCPAP in the treatment of mild/moderate OSA when both treatment modalities are titrated objective ly OBJECTIVE : To evaluate the short-term safety and efficacy of palatal implants in patients with mild and moderate obstructive sleep apnea ( OSA ) . STUDY DESIGN AND SETTING : A prospect i ve , non-r and omized study conducted at 5 clinical sites . Three polyester implants were placed in the soft palate under local anesthesia during a single-stage office procedure . Polysomnography was conducted at baseline and 90 days post-procedure . Subjective quality of life data were collected . RESULTS : Fifty-three patients were evaluated ;  the apnea hypopnea index ( AHI ) decreased from 25.0 ± 13.9 to 22.0 ± 14.8 events/hour ( P = 0.05 ) . The Epworth Sleepiness Scale ( ESS ) decreased from 11.0 ± 5.1 to 6.9 ± 4.5 ( P < 0.001 ) , and the snore score decreased from 7.9 ± 2.1 to 4.0 ± 3.0 ( P < 0.001 ) . No serious complications occurred during the study . CONCLUSION : Palatal implants can be an effective initial low morbidity treatment option for patients diagnosed with mild to moderate OSA OBJECTIVES Uvulopalatopharyngoplasty ( UPPP ) is the most common surgical treatment for obstructive sleep apnea ( OSA ) . Anatomic and physiologic abnormalities associated with OSA can make perioperative management difficult . Only single-site case series provide current estimates of the incidence of perioperative complications , with a pooled crude serious complication rate of 3.5 % and a crude mortality rate of 0.4 % . The primary objective of this study was to calculate the incidence of perioperative morbidity and mortality in a large , multisite cohort of UPPP patients . STUDY DESIGN Prospect i ve cohort study of adults undergoing inpatient UPPP with or without other concurrent procedures METHODS The serious complication and 30-day mortality rates were calculated from the Department of Veterans Affairs ( VA ) National Surgical Quality Improvement Program data base of prospect ively collected outcomes of all VA inpatient surgeries nationally 1991 to 2001 . Serious complications were defined by 15 specific life-threatening complications . Deaths were captured whether the patient was in the hospital or discharged . RESULTS Veteran patients ( n = 3130 ) had a mean age of 50 years and were predominantly male ( 97 % ) . The serious nonfatal complication rate was 1.5 % ( 47/3,130 ) ( 95 % confidence interval [ CI ] 1.1 % , 1.9 % ) . The 30-day mortality rate was 0.2 % ( 7/3130 ) ( 95 % CI 0.1 % , 0.4 % ) . There was no significant effect of year of surgery or patient age on the risk of serious complication or death . CONCLUSION The incidence of serious nonfatal complications and 30-day mortality after UPPP are 1.5 % and 0.2 % , respectively , in a large cohort of UPPP patients at veteran hospitals OBJECTIVES /HYPOTHESIS To evaluate the effect of surgical intervention for obstructive sleep apnea ( OSA ) on patients ' level of excessive daytime sleepiness as determined by the Epworth Sleepiness Scale ( ESS ) . The ESS question naire is a vali date d measure of subjective daytime sleepiness . There have been several studies that have shown that continuous positive airway pressure ( CPAP ) improves excessive daytime sleepiness in OSA patients as measured by the ESS . STUDY DESIGN Retrospective case series . METHODS This is a study of patients who had uvulopalatopharyngoplasty ( UPPP ) ; UPPP and tonsillectomy ; or UPPP , tonsillectomy , and radiofrequency ablation of the base of the tongue for OSA between January 2007 and December 2009 . Forty patients were identified who met the criteria of having had an ESS evaluation and polysomnography prior to surgery for OSA . RESULTS Across all of the patients there was a mean reduction of their ESS by 5.6 ± 4.1 ; t = 8.82 , P < .001 . Only three of the patients did not improve in their ESS scores after surgical treatment for OSA . CONCLUSIONS Surgical intervention for OSA significantly improves sleepiness in OSA patients as measured by the ESS . Two meta-analyses of multiple , r and omized , controlled studies showed patients with mild to moderate OSA treated with CPAP demonstrated an improvement in the ESS score of 1.2 points ( 95 % confidence interval , 0.05 - 1.9 , P = .001 ) and 2.94 points for patients with mild to severe OSA treated with CPAP . The results of this study show an improvement in ESS after surgery that is substantially higher than previously reported with CPAP for all categories of OSA M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS Application of continuous positive airway pressure ( CPAP ) as the st and ard treatment for  sleep apnea/hypopnea syndrome ( SAHS )  is a moot point . Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo . The recent description of a true placebo ( sham CPAP ) prompted us to conduct a r and omized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS . Forty-eight patients , stratified in four groups according to severity , were r and omly allocated into two treatment groups ( optimal and sham CPAP ) for a 6-wk period . Of these , 45 completed follow-up ( 91 % males ; age : 54 + /- 10 yr ; body mass index [ BMI ] : 32 + /- 6 kg/m(2 ) ; apnea-hypopnea index [ AHI ] : 54 + /- 19 events/h ; and Epworth Sleepiness Scale [ ESS ] : 16 + /- 5 ) . The ESS , a question naire on SAHS-related symptoms , Functional Outcomes Sleep Question naire ( FOSQ ) , and the Short Form Health Survey ( SF-36 ) were completed at inclusion and after treatment . After 10 d of washout , the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP . The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness ( -9.5 versus -2.3 , p < 0.001 ) , other SAHS-related symptoms ( -18.5 versus -4.5 , p < 0.001 ) , vigilance ( + 8.5 versus + 3.4 , p = 0.009 ) , and general productivity ( + 4.0 versus + 0.5 , p = 0.04 ) FOSQ scales . Both groups used a similar number of hours for the optimal and the sham CPAP ( 4.3 versus 4.5 , ( p = NS ) . The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS ( -2.3 versus -6.7 , p < 0.001 ) and other sleep apnea syndrome (SAS)-related symptoms ( -4.5 versus -11.2 , p = 0.02 ) . Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS OBJECTIVE The role of the lateral pharyngeal muscular walls in the pathogenesis of obstructive sleep apnea hypopnea syndrome ( OSAHS ) is crucial . My objective is to describe a surgical procedure for splinting the lateral pharyngeal walls in patients with OSAHS and report the initial results . STUDY DESIGN Prospect i ve r and omized pilot study performed in an academic tertiary center as part of a doctoral thesis . PATIENTS AND METHODS Ten adults with OSAHS , originally selected for treatment with uvulopalatopharyngoplasty  , underwent the lateral pharyngoplasty procedure , which consists of a microdissection of the superior pharyngeal constrictor muscle within the tonsillar fossa , sectioning of this muscle , and suturing of the created laterally based flap of that muscle to the same-side palatoglossus muscle . In addition , a palatopharyngeal Z-plasty is performed to prevent retropalatal collapse . RESULTS Lateral pharyngoplasty  improved sleep and daytime symptoms related to OSAHS . After at least 6 months of follow-up , the median apnea-hypopnea index decreased from 41.2 to 9.5 ( P = .009 ) and the median total sleep time spent in rapid eye movement ( REM ) sleep and in stages 3 plus 4 non-REM sleep increased from 14.1 % to 22.1 % ( P = .059 ) and from 5.3 % to 16.3 % ( P = .037 ) , respectively . Also , there was statistically significant improvement in snoring , daytime sleepiness , and overall impact of the disease on quality of life . Swallowing disturbances lasted a median of 14.5 days after the surgeries , and all patients returned to normal subjective swallowing function in the follow-up . CONCLUSIONS Lateral pharyngoplasty is a safe and straightforward approach to lateral pharyngeal muscles and has produced appreciable benefits for OSAHS patients Obstructive sleep apnea ( OSA ) is associated with recurrent episodes of nocturnal hypoxia and increased risk for development of systemic hypertension . Prior studies have been limited , however , in their ability to show reduction in blood pressure after continuous positive airway pressure ( CPAP ) therapy , and the effect of supplemental oxygen alone on blood pressure in OSA has not been evaluated . We performed a r and omized , double-blind , placebo-controlled study comparing the effects of 2 weeks of CPAP versus sham-CPAP versus supplemental nocturnal oxygen on 24-hour ambulatory blood pressure in 46 patients with moderate-severe OSA . We found that 2 weeks of CPAP therapy result ed in a significant reduction in daytime mean arterial and diastolic blood pressure and nighttime systolic , mean , and diastolic blood pressure ( all Ps < 0.05 ) . Although nocturnal supplemental oxygen therapy improved oxyhemoglobin saturation , it did not affect blood pressure . We conclude that CPAP therapy reduces both daytime and nighttime blood pressure in patients with OSA , perhaps through mechanisms other than improvement of nocturnal oxyhemoglobin saturation BACKGROUND Patients with the sleep apnoea/hypopnoea syndrome ( SAHS ) report improved sleepiness , cognitive function , and psychological well being after continuous positive airway pressure ( CPAP ) therapy , and it is for these daytime features that CPAP is usually given . However , few r and omised or controlled studies exist on the effects of CPAP on daytime function . METHODS A prospect i ve , r and omised , single blind , placebo controlled , crossover trial of daytime function after CPAP was conducted in 23 patients with SAHS , all with ⩾15 apnoeas+hypopnoeas/hour and ⩾2 symptoms of SAHS . All patients spent four weeks on CPAP therapy and four weeks on oral placebo treatment , following r and omisation to treatment order . With ethics committee approval , patients were told the placebo tablet might improve upper airway function . Average effective CPAP use was monitored using hidden time clocks . Assessment s of objective and subjective sleepiness , symptoms , cognitive performance , and psychological well being were performed on the last day of each treatment and compared . RESULTS Objective sleepiness measured by sleep onset latency on the multiple sleep latency test improved with CPAP ( mean difference from placebo + 2.4 min , 95 % CI 0.8 to 4.0 ; p<0.001 ) as did subjective sleepiness on the Epworth scale ( mean difference –6 , 95 % CI –3 to –9 ; p = 0.001 ) . Symptom total score also fell with CPAP ( mean difference –1.6 , 95 % CI –2.2 to –1.0 ; p<0.001 ) . No determinants of these changes with active treatment were identified , and no significant enhancements to cognitive function or psychosocial well being were found in this small sample . CONCLUSIONS These findings provide further evidence for clinical ly significant benefits to daytime function  from CPAP Background : Patients with mild to moderate obstructive sleep apnoea ( OSA ) may be managed with different treatment options . This study compared the effectiveness of three commonly used non-surgical treatment modalities . Methods : Subjects with mild to moderate OSA were r and omised to one of three treatment groups for 10 weeks : conservative measures ( sleep hygiene ) only , continuous positive airways pressure ( CPAP ) in addition to conservative measures or an oral appliance in addition to conservative measures .  All overweight subjects were referred to a weight-reduction class . OSA  was assessed by polysomnography .  Blood pressure was recorded in the morning and evening in the sleep laboratory . Daytime sleepiness was assessed with the Epworth Sleepiness Scale . Health-related quality of life ( HRQOL ) was assessed with the 36-Item Short-Form Health Survey ( SF-36 ) and Sleep Apnoea Quality of Life Index ( SAQLI ) . Results : 101 subjects with a mean ( SEM ) apnoea – hypopnoea index ( AHI ) of 21.4 ( 1.1 ) were r and omised to one of the three groups . The severity of sleep-disordered breathing was decreased in the CPAP and oral appliance groups compared with the conservative measures group , and the CPAP group was significantly better than the oral appliance group . Relief from sleepiness was significantly better in the CPAP group . CPAP was also better than the oral appliance or conservative measures in improving the “ bodily pain ” domain , and better than conservative measures in improving the “ physical function ” domain of SF-36 . Both CPAP and the oral appliance were more effective than conservative measures in improving the SAQLI , although no difference was detected between the CPAP and oral appliance groups . CPAP and the oral appliance significantly lowered the morning diastolic blood pressure compared with baseline values , but there was no difference in the changes in blood pressure between the groups . There was also a linear relationship between the changes in AHI and body weight . Conclusion : CPAP produced the best improvement in terms of physiological , symptomatic and HRQOL measures , while the oral appliance was slightly less effective . Weight loss , if achieved , result ed in an improvement in sleep parameters , but weight control alone was not uniformly effective STUDY OBJECTIVE To assess separately the effectiveness and safety of nasal-continuous positive airway pressure ( N-CPAP ) and that of surgery in comparison to conservative management in patients with obstructive sleep apnea syndrome ( OSAS ) . DESIGN . A r and omized study with 1-year follow-up . SETTING A university hospital acting as a referral center for OSAS . PATIENTS Symptomatic patients with OSAS ( 72 male and 4 female patients aged 18 to 65 years ) , who had oxygen desaturations in the overnight recording . INTERVENTIONS After the initial diagnostic workup , patients were considered to be c and i date s for either N-CPAP ( 44 patients ) or surgical treatment ( uvulopalatopharyngoplasty [ UPPP ] with or without m and ibular osteotomy ) ( 32 patients ) . Within the groups , the patients were then r and omized to either the assigned treatment or conservative management . MAIN OUTCOME MEASURES The number of nocturnal oxygen desaturation events of 4 % or more per hour in bed ( ODI4 ) ; daytime somnolence ; side effects . RESULTS N-CPAP Group : Compliance with N-CPAP therapy at 1 year was 13 of 21 . The most common reason for noncompliance was general intolerance of CPAP . All compliant patients had a normal ODI4 ( < 10 ) , whereas 1 of 20 of their control subjects had a normal finding . Patients receiving active treatment were significantly less somnolent than their control subjects at 1 year ( p < 0.05 ) . SURGERY GROUP : At 1 year , 7 of 18 of the surgically treated and 1 of 14 of the conservatively treated patients had a normal ODI4 ( p < 0.001 ) . Daytime somnolence was significantly less severe in the surgically treated patients compared with their control subjects ( p < 0.001 ) both at 3 and 12 months . The overall postoperative complication rate was 22 % . CONCLUSIONS N-CPAP is an effective therapy for OSAS , but compliance is a problem . Surgical therapy ( UPPP with or without m and ibular osteotomy ) needs further evaluation The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA OBJECTIVE : To assess a new method ( modified cautery-assisted palatal stiffening operation [ CAPSO ] ) to treat snoring and mild obstructive sleep apnea ( OSA ) . DESIGN : A prospect i ve , nonr and omized trial . METHODS : Thirteen patients with simple snoring and mild OSA underwent the modified CAPSO under local anaesthesia . All patients had preoperative polysomnography and at 3 months postoperatively . RESULTS : All patients were Friedman stage II and III , with tonsil size 0 , 1 , or 2 . All patients had improvement in their snoring . Eighty-four percent of the patients had improvement in the Epworth Sleepiness Scale , from 12.2 to 8.9 . Objective success on the polysomnogram was noted in six out of the eight patients ( 75 % ) with mild OSA . The AHI improved from 12.3 % to 5.2 % ( P < 0.05 ) , and the LSAT improved from 88.3 % to 92.5 % ( P < 0.05 ) . CONCLUSION : The modified CAPSO is a simple , low-cost , and effective office-based method to treat snoring and mild obstructive sleep apnea OBJECTIVE : R and omized , double-blinded , placebo-controlled , clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome ( OSAHS ) . STUDY DESIGN AND SETTING : Sixty-two non-obese adults with history of snoring , daytime sleepiness , and mild/moderate OSAHS , were r and omized to receive palatal implants ( n = 31 ) or placebo procedure ( n = 31 ) . Complete follow-up including quality of life ( QOL , SF-36 ) , snoring visual analog scale ( VAS ) , and Epworth Sleepiness Scale ( ESS ) data were obtained in 62 patients . Seven patients refused follow-up polysomnography for a total of 55 patients ( 29 implant and 26 placebo ) . RESULTS : The treatment group ( change in score of −7.9 ± 7.7 ) was significantly improved compared with the placebo group ( change in score of 0.9 ± 4.3 ) for apnea/hypopnea index ( AHI ) ( P < 0.0001 ) , QOL , SF-36 ( P < 0.0001 ) , snoring VAS ( P < 0.0001 ) , and ESS ( P = 0.0002 ) . CONCLUSIONS : Palatal implants improve AHI , QOL , snoring intensity , and daytime sleepiness for selected patients with mild/moderate OSAHS Formulating a rational health policy necessitates the ability to compare between different healthcare interventions and disease scenarios . Continuous positive airway pressure ( CPAP ) therapy with a conservative lifestyle strategy in sleep apnoea/hypopnoea syndrome ( SAHS ) was evaluated using health utility and quality -adjusted life years ( QALYs ) as outcome measures . A total 71 SAHS ( apnoea/hypopnoea index ≥15 h−1 ) patients completed a r and omised , parallel group study over 3 months using utilities derived by the st and ard gamble approach ( Usg ) and European quality of life question naire ( Euroqol ) ( Ueq ) . The severely impaired health status at baseline improved by 23 % ( Usg 0.32 to 0.55 ) adding 8 QALYs in the CPAP group , compared to a 4 % improvement with 4.7 QALYs added in the lifestyle group ( Usg 0.31 to 0.35 ) . The Ueq showed a marginal change with CPAP ( 0.73 to 0.77 ) but did not demonstrate any improvement with lifestyle intervention . The health status impairment in sleep apnoea/hypopnoea syndrome patients is markedly improved by continuous positive airway pressure compared to a modest improvement with conservative lifestyle strategies using the st and ard gamble utility , which may be incorporated in effectiveness and economic analyses . The European quality of life question naire did not reflect a similar degree of impact and is probably not useful in this population OBJECTIVES /HYPOTHESIS Recent guidelines from the American Society of Anesthesiologists recommended postoperative monitoring for most patients undergoing surgery for obstructive sleep apnea ( OSA ) . These guidelines , however , are largely based on retrospective literature and expert opinion . The appropriate level of postoperative monitoring remains controversial . Our objective was to prospect ively document the early postoperative course of patients undergoing OSA surgery . STUDY DESIGN Prospect i ve cohort study . METHODS One hundred twenty-one patients ( age 43.9 + or - 13.5 years , 79.8 % male ) with sleep- study proven OSA ( apnea-hypopnea index 31.9 + or - 22.7 ) who were undergoing surgery for OSA at our tertiary care center were recruited from 2007 to 2009 . Outcome measures were : 1 ) incidence of respiratory complications requiring nursing intervention , 2 ) level of postoperative blood oxygen saturation divided into three groups : mean oxygen saturation in recovery room ( SpO2(recovery ) ) , mean oxygen saturation in step-up unit ( SpO2(step-up ) ) , and lowest oxygen saturation over the 24 hour period ( SpO2(minimum ) ) . These results were then compared to the benchmark literature . RESULTS The overall incidence of nursing intervention  in response to a respiratory complication ( 3.4 % ) was significantly less than expected ( P < .002 ) . Mean SpO2(recovery ) was 92.9 + or - 3.2 % , SpO2(step-up ) was 95.9 + or - 1.6 % , and SpO2(minimum ) was 92.8 + or - 3.1 % . No variables were identified as being predictive of any of the outcome measures . CONCLUSIONS The incidence of respiratory events requiring intervention in the early postoperative course of OSA patients was low ( 3.4 % ) . Routine postoperative inpatient monitoring may not be required in many cases CONTEXT Continuous positive airway pressure ( CPAP ) is the first-line treatment for patients with symptomatic obstructive sleep apnea ( OSA ) . However , its indication for all patients with sleep-disordered breathing , regardless of daytime symptoms , is unclear . OBJECTIVE To evaluate the effect of CPAP treatment on the incidence of hypertension or cardiovascular events in a cohort of nonsleepy patients with OSA . DESIGN , SETTING , AND PATIENTS Multicenter , parallel-group , r and omized controlled trial in 14 teaching hospitals in Spain . Between May 2004 and May 2006 , 725 consecutive patients were enrolled who had an apnea-hypopnea index of 20 h(-1 ) or greater and an Epworth Sleepiness Scale score of 10 or less ( scores range from 0 - 24 , with values < 10 suggesting no daytime sleepiness ) . Exclusion criteria were previous cardiovascular event , physical or psychological incapacity , chronic disease , or drug or alcohol addiction . Follow-up ended in May 2009 . INTERVENTION Patients were allocated to receive CPAP treatment or no active intervention . All participants received dietary counseling and sleep hygiene advice . MAIN OUTCOME MEASURES Incidence of either systemic hypertension ( taking antihypertensive medication or blood pressure greater than 140/90 mm Hg ) or cardiovascular event ( nonfatal myocardial infa rct ion , nonfatal stroke , transient ischemic attack , hospitalization for unstable angina or arrhythmia , heart failure , or cardiovascular death ) . RESULTS Seven hundred twenty-three patients underwent follow-up for a median of 4 ( interquartile range , 2.7 - 4.4 ) years ( 1 patient from each group did not receive allocated treatment ) ; 357 in the CPAP group and 366 in the control group were included in the analysis . In the CPAP group there were 68 patients with new hypertension  and 28 cardiovascular events ( 17 unstable angina or arrhythmia , 3 nonfatal stroke , 3 heart failure , 2 nonfatal myocardial infa rct ion , 2 transient ischemic attack , 1 cardiovascular death ) . In the control group there were 79 patients with new hypertension and 31 cardiovascular events ( 11 unstable angina or arrhythmia , 8 nonfatal myocardial infa rct ion , 5 transient ischemic attack , 5 heart failure , 2 nonfatal stroke ) . The hypertension or cardiovascular event incidence density rate was 9.20 per 100 person-years ( 95 % CI , 7.36 - 11.04 ) in the CPAP group and 11.02 per 100 person-years ( 95 % CI , 8.96 - 13.08 ) in the control group . The incidence density ratio was 0.83 ( 95 % CI , 0.63 - 1.1 ; P = .20 ) . CONCLUSIONS In patients with OSA without daytime sleepiness , the prescription of CPAP compared with usual care did not result in a statistically significant reduction in the incidence of hypertension or cardiovascular events . However , the study may have had limited power to detect a significant difference . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00127348 OBJECTIVES /HYPOTHESIS Radiofrequency ( RF ) surgery of the soft palate ( SP ) is an established treatment option for the treatment of snoring . Due to its minimally invasive character , it has received attention in the management of mild obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN The aim of this study was to assess the efficacy and the occurrence of adverse events after single-stage SP RF surgery in patients with mild OSAS in a r and omized single-blinded placebo-controlled trial in an outpatient department at a tertiary care center , academic teaching hospital . METHODS Thirty-two patients with mild OSAS ( apnea-hypopnea index [ AHI ] 5 - 15 , body mass index < 35 ) were r and omized to receive a single session of RF surgery or placebo ( insertion of applicator without energy delivery ) with local anesthesia . The primary outcome measures were ( AHI ) , Epworth Sleepiness Scale , and a 36-item short-form health survey quality -of-life question naire . The secondary measures were the soft tissue airway parameters in cephalometric radiographs , snoring scores , and rates of adverse events . RESULTS Neither objective ly measured significance s ( active AHI 11.0 [ 5.0 - 9.0 ] to 13.0 [ 2.0 - 26.0 ] and placebo AHI 12.0 [ 5.0 - 8.0 ] to 11.0 [ 1.0 - 29.0 ] , P = .628 ) , nor were trends of a diminishing effect on symptoms of mild OSAS found in the treatment arms . No significant changes in the soft tissue airway parameters occurred . One patient ( 5.9 % ) in the active treatment group was cured . CONCLUSIONS RF surgery of SP is not recommended as a single-stage approach in mild OSAS RATIONALE  Obstructive sleep apnea ( OSA ) is associated with adverse cardiovascular outcomes , including myocardial infa rct ion and stroke . Atherosclerosis is a key mechanism for these cardiovascular events . Recent cross-sectional studies showed the presence of early signs of atherosclerosis in patients with OSA who were free of comorbidities . OBJECTIVES To determine the impact of treatment with continuous positive airway pressure ( CPAP ) on atherosclerosis . METHODS We r and omly assigned 24 patients with severe OSA ( age , 46 + /- 6 yr ) who were free of comorbidities to receive no treatment ( control , n = 12 ) or CPAP ( n = 12 ) for 4 months . Carotid intima-media thickness , arterial stiffness ( evaluated by pulse-wave velocity ) , carotid diameter , 24-hour blood pressure monitoring , C-reactive protein , and catecholamines were determined at baseline and after 4 months . MEASUREMENTS AND MAIN RESULTS At baseline , all measurements were similar in both groups and did not change in the control group after 4 months . In contrast , a significant decrease occurred in carotid intima-media thickness ( 707 + /- 105 vs. 645 + /- 95 microm , P = 0.04 ) , pulse-wave velocity ( 10.4 + /- 1.0 vs. 9.3 + /- 0.9 m/s , P < 0.001 ) , C-reactive protein ( 3.7 + /- 1.8 vs. 2.0 + /- 1.2 mg/L , P = 0.001 ) , and catecholamines ( 365 + /- 125 vs. 205 + /- 51 ng/ml , P < 0.001 ) after 4 months of CPAP . Carotid diameter did not change significantly . Regarding the whole group , changes in carotid intima-media thickness were correlated with changes in catecholamines ( r = 0.41 , P < 0.05 ) . Changes in pulse-wave velocity were correlated with changes in C-reactive protein ( r = 0.58 , P < 0.01 ) and catecholamines ( r = 0.54 , P < 0.01 ) . CONCLUSIONS The treatment of OSA significantly improves early signs of atherosclerosis , supporting the concept that OSA is an independent risk factor for atherosclerosis . Clinical trial registered with www . clinical trials.gov ( NCT 00400543 ) OBJECTIVE : To evaluate the initial short-term effectiveness of palatal implants in treating patients with mild to moderate obstructive sleep apnea ( OSA ) . Previous published studies have focused on snoring without OSA . STUDY DESIGN : A prospect i ve , nonr and omized study of 25 previously untreated patients with an apnea-hypopnea index ( AHI ) of 10 to 30 and a body mass index ( BMI ) of ≤30 .  Three permanent implants ( Pillar ; Restore Medical , St Paul , MN ) were placed in the soft palate of each patient with a specially design ed delivery tool in an office setting under local anesthesia after a formal polysomnography . A repeat polysomnography was obtained after 90 days . RESULTS : The AHI was reduced from a mean of 16.2 to a mean of 12.1 ( P < 0.05 ) for the study group . Twenty of 25 patients ( 80 % ) experienced a decrease in the AHI . Twelve of 25 patients ( 48 % ) showed a post-90-day implant AHI of 10 or less , a benchmark for the possible cessation of continuous positive airway pressure therapy . The Epworth Sleepiness Score decreased from 9.7 to 5.5 ( P < 0.001 ) and the visual analog Scale of snoring intensity reported by bed partners decreased from 8.4 to 4.3 ( P < 0.001 ) . CONCLUSION : The palatal implant method can significantly improve AHI and other sleep-related parameters in patients with mild to moderate OSA and a BMI of ≤30 . Short-term results are comparative to those reported for uvulopalatopharyngoplasty but achieved in a low-cost , single-stage , outpatient office setting with low morbidity BACKGROUND Nasal continuous positive airway pressure ( NCPAP ) is widely used as a treatment for obstructive sleep apnoea . However , to date there are no r and omised controlled trials of this therapy against a well-matched control . We undertook a r and omised prospect i ve parallel trial of therapeutic NCPAP for obstructive sleep apnoea compared with a control group on subtherapeutic NCPAP . METHODS Men with obstructive sleep apnoea , defined as an Epworth sleepiness score of 10 or more and ten or more dips per h of more than 4 % SaO2 caused by obstructive sleep apnoea on overnight sleep study , were r and omly assigned therapeutic NCPAP or subtherapeutic NCPAP ( about 1 cm H2O ) for 1 month . Primary outcomes were subjective sleepiness ( Epworth sleepiness score ) , objective sleepiness ( maintenance of wakefulness test ) , and SF-36 question naire measurements of self-reported functioning and well-being . FINDINGS 107 men entered the study : 53 received subtherapeutic NCPAP and 54 therapeutic NCPAP . Use of NCPAP by the two treatment groups was similar : 5.4 h ( therapeutic ) and 4.6 h ( subtherapeutic ) per night . Subtherapeutic NCPAP did not alter the overnight number of SaO2 dips per h compared with baseline , and thus acted as a control . Therapeutic NCPAP was superior to subtherapeutic NCPAP in all primary outcome measures . The Epworth score was decreased from a median of 15.5 to 7.0 on therapeutic NCPAP , and from 15.0 to 13.0 on subtherapeutic NCPAP ( between treatments , p<0.0001 ) . Mean maintenance-of-wakefulness time increased from 22.5 to 32.9 min on therapeutic NCPAP and , not significantly , from 20.0 to 23.5 min on subtherapeutic NCPAP ( between treatments p<0.005 ) . Effect sizes for SF-36 measures of energy and vitality were 1.68 ( therapeutic ) and 0.97 ( subtherapeutic ) NCPAP ( between treatments p<0.0001 ) . For mental summary score , the corresponding values were 1.02 and 0.4 ( between treatments p=0.002 ) . INTERPRETATION Therapeutic NCPAP reduces excessive daytime sleepiness and improves self-reported health status compared with a subtherapeutic control . Compared with controls , the effects of therapeutic NCPAP are large and confirm previous uncontrolled clinical observations and the results of controlled trials that used an oral placebo OBJECTIVE The study goal was to determine the effectiveness of ( 1 ) multilevel temperature-controlled radiofrequency tissue ablation ( TCRFTA ) or ( 2 ) continuous positive airway pressure ( CPAP ) for the treatment of mild to moderate obstructive sleep apnea syndrome ( OSAS ) . STUDY DESIGN AND METHODS We conducted a r and omized , placebo-controlled , 2-site trial , comparing TCRFTA ( n = 30 ) and CPAP ( n = 30 ) with sham-placebo ( n = 30 ) using intention-to-treat analysis . RESULTS Compared with pretreatment baseline , TCRFTA improved reaction time , OSAS-specific quality of life ( QOL ) , and subjective sleepiness ( all P < 0.05 ) . Compared with sham-placebo , TCRFTA improved QOL , airway volume , apnea index , and respiratory arousal index ( all P < 0.05 ) . TCRFTA  side effects and complications were mild , temporary , and similar to sham-placebo . CPAP improved QOL and sleepiness compared with baseline and QOL when compared with sham-placebo ( all P < 0.05 ) . Significant differences were not seen between TCRFTA and CPAP outcomes . CONCLUSION TCRFTA and CPAP each improve QOL for mild-moderate OSAS patients .  TCRFTA improvements may result from changes in airway volume , apnea index , and respiratory arousal index Arterial blood pressure rises at apnea termination , and there is increasing evidence that the sleep apnea-hypopnea syndrome ( SAHS ) is associated with daytime hypertension but no r and omized controlled trial evidence of whether SAHS treatment reduces blood pressure exists . We , therefore , conducted a r and omized placebo-controlled cross-over study of the effects of 4 wk of continuous positive airway pressure ( CPAP ) or oral placebo on 24-h blood pressure in 68 patients ( 55 males , 13 females ; median apnea-hypopnea index [ AHI ] , 35 ) not receiving hypotensive medication .  Ambulatory blood pressure was recorded for the last 48 h of each treatment . Epworth Sleepiness Score ( ESS ) and Functional Outcomes of Sleep Question naire ( FOSQ ) were also recorded . All patients were normotensive . There was a small decrease in 24-h diastolic blood pressure ( placebo , 79.2 [ SE 0.9 ] mm Hg ; CPAP , 77.8 [ SE 1.0 ] mm Hg ; p = 0.04 ) with the greatest fall occurring between 2:00 A.M. and 9:59 A.M. The observed decrease in 24-h diastolic blood pressure was greater in two a priori groups , CPAP use > or = 3.5 h per night ( 81.5 [ SE 1.2 ] mm Hg ; 79.6 [ SE 1.2 ] mm Hg ; p = 0.03 ) and those with more than twenty 4 % desaturations per hour ( 82.4 [ SE 2.1 ] mm Hg ; 77.4 [ SE 2.1 ] mm Hg ; p = 0.002 ) . Systolic pressure also fell in the latter group ( 133.1 [ SE 2.8 ] mm Hg ; 129.1 [ SE 2.1 ] mm Hg ; p = 0.009 ) . Desaturation frequency was the best predictor of diastolic blood pressure fall with CPAP ( r = 0.38 ; p = 0.002 ) . Both ESS and FOSQ domains improved . Thus , CPAP can reduce blood pressure in patients with SAHS , particularly in those with nocturnal oxygen desaturation , but the decrease is small Background : A r and omised controlled study was undertaken to examine the effect of nasal continuous positive airway pressure ( CPAP ) on 24 hour systemic blood pressure ( BP ) in patients with obstructive sleep apnoea ( OSA ) . Methods : Patients were fitted with an ambulatory BP measuring device as out patients during normal activities and recorded for 24 hours before starting therapeutic or subtherapeutic ( 4 cm H2O ) CPAP treatment . BP monitoring was repeated before completion of 12 weeks of treatment . The primary end point was the change in 24 hour mean BP . Results : Twenty three of 28 participants in each treatment arm completed the study . There was no significant difference between the two groups in age , body mass index , Epworth Sleepiness Score , apnoea-hypopnoea index , arousal index , and minimum Sao2 . Twenty four patients were hypertensive . The pressure in the therapeutic CPAP group was 10.7 ( 0.4 ) cm H2O . CPAP usage was 5.1 ( 0.4 ) and 2.6 ( 0.4 ) hours/night for the therapeutic and subtherapeutic CPAP groups , respectively ( p<0.001 ) . After 12 weeks of treatment there were significant differences between the two CPAP groups in mean ( SE ) changes in 24 hour diastolic BP ( −2.4 ( 1.2 ) v 1.1 ( 1.0 ) mm Hg ( 95 % CI −6.6 to −0.5 ) , p = 0.025 ) ; 24 hour mean BP ( −2.5 ( 1.3 ) v 1.3 ( 1.1 ) mm Hg ( 95 % CI −7.2 to −0.2 ) , p = 0.037 ) ; sleep time systolic BP ( −4.1 ( 2.1 ) v 2.2 ( 1.8 ) mm Hg ( 95 % CI −11.8 to −0.7 ) , p = 0.028 ) ; and sleep time mean BP ( −3.6 ( 1.7 ) v 1.3 ( 1.4 ) mm Hg ( 95 % CI −9.2 to −0.4 ) , p = 0.033 ) . Conclusions : Compared with subtherapeutic CPAP , 12 weeks of treatment with therapeutic CPAP leads to reductions in 24 hour mean and diastolic BP by 3.8 mm Hg and 3.5 mm Hg , respectively , in mildly sleepy patients with OSA Obstructive sleep apnoea ( OSA ) is associated with high cardiovascular morbidity and mortality . Several r and omised controlled trials have shown that continuous positive airway pressure ( CPAP ) treatment of OSA reduces blood pressure ( BP ) . This r and omised , sham-placebo controlled crossover trial assesses whether CPAP produces a similar clinical ly significant fall in BP in hypertensive OSA patients , but without hypersomnolence . Thirty-five , nonsleepy , hypertensive patients with OSA were treated with CPAP for 1 month , r and omised first to either therapeutic or sham-placebo ( subtherapeutic CPAP , about 1 cmH2O pressure ) . The second months ' alternative treatment followed a 2-week washout period .  BP was measured over 24 h , before and at the end of the two treatment periods : mean 24-h BP was the primary outcome variable . There was no overall significant difference in mean 24-h BP : the change in mean 24-h BP on therapeutic CPAP was -2.1 mmHg ( sd 8.1 ) , and -1.1 mmHg ( sd 8.1 ) on subtherapeutic CPAP , with a difference of 0.7 mmHg ( 95 % confidence interval ( CI ) + 2.9– -4.4 ) . There was a small significant fall in Epworth Sleepiness Score , therapeutic ( -1.4 ) versus sham ( -0.3 ) , and difference -1.2 ( 95 % CI -2.0– -0.4 ) , but no change in objective sleepiness . In nonhypersomnolent hypertensive patients with obstructive sleep apnoea , there is no significant fall in mean 24-h blood pressure with continuous positive airway pressure , in contrast to the fall seen in hypersomnolent patients with obstructive sleep apnoea BACKGROUND Although oral appliances are effective in some patients with obstructive sleep apnoea ( OSA ) , they are not universally effective . A novel anterior m and ibular positioner ( AMP ) has been developed with an adjustable hinge that allows progressive advancement of the m and ible . The objective of this prospect i ve crossover study was to compare efficacy , side effects , patient compliance , and preference between AMP and nasal continuous positive airway pressure ( nCPAP ) in patients with symptomatic mild to moderate OSA . METHODS Twenty four patients of mean ( SD ) age 44.0 ( 10.6 ) years were recruited with a mean ( SD ) body mass index of 32.0 ( 8.2 ) kg/m2 , Epworth sleepiness score 10.7 ( 3.4 ) , and apnoea/hypopnoea index 26.8 (11.9)/hour . There was a two week wash-in and a two week wash-out period and two treatment periods ( AMP and nCPAP ) each of four months . Efficacy , side effects , compliance , and preference were evaluated by a question naire and home sleep monitoring . RESULTS One patient dropped out early in the study and three refused to cross over so treatment results are presented on the remaining 20 patients . The apnoea/hypopnoea index ( AHI ) was lower with nasal CPAP 4.2 (2.2)/hour than with the AMP 13.6 (14.5)/hour ( p < 0.01 ) . Eleven of the 20 patients ( 55 % ) who used the AMP were treatment successes ( reduction of AHI to < 10/hour and relief of symptoms ) , one ( 5 % ) was a compliance failure ( unable or unwilling to use the treatment ) , and eight ( 40 % ) were treatment failures ( failure to reduce AHI to < 10/hour and /or failure to relieve symptoms ) . Fourteen of the 20 patients ( 70 % ) who used nCPAP were treatment successes , six ( 30 % ) were compliance failures , and there were no treatment failures . There was greater patient satisfaction with the AMP ( p < 0.01 ) than with nCPAP but no difference in reported side effects or compliance . CONCLUSIONS AMP is an effective treatment in some patients with mild to moderate OSA and is associated with greater patient satisfaction than nCPAP OBJECTIVE : To determine the efficacy of a new multilevel surgical protocol for  obstructive sleep apnea ( OSA ) .  STUDY DESIGN AND SETTING : Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospect i ve , controlled clinical trial after clinical examination , endoscopy , and polysomnography . Surgery included uvulaflap , tonsillectomy , hyoid suspension , and radiofrequency treatment of the tongue base ( group A ) . A second group did not receive hyoid suspension ( group B ) . In both groups , nasal surgery was performed if necessary . Polysomnography and Epworth Sleepines Scale ( ESS ) were recorded at baseline and 2 to 15 months after surgery . RESULTS : In group A , the mean apnea-hypopnea index ( AHI ) decreased significantly after surgery ( 38.9 ± 20.0 vs 20.7 ± 20.6 , P < 0.0001 ) , whereas in group B the AHI did not . All secondary variables ( minimal oxygen saturation , mean oxygen saturation , arousal index ) , and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION : The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA , whereas surgery without hyoid suspension was less successful Laser-assisted uvulopalatoplasty ( LAUP ) can reduce snoring by sequentially removing excessive vibratory tissue of the velopharynx . The procedure can be performed under local anesthesia in an office setting . Since the appearance of the soft palate is similar after both LAUP and uvulopalatopharyngoplasty , LAUP may also be efficacious in the management of  obstructive sleep apnea syndrome ( OSAS ) .  LAUP was performed in 34 consecutive prospect ively evaluated patients with OSAS . Of the 34 patients , 28 ( 82 % ) were male ; the mean age was 53 years , and the mean body mass index was 31.1 . In the study population of 13 patients who completed preoperative and postoperative sleep studies , the apnea index decreased from 19.4 to 4.2 ( P = .006 ) , the respiratory disturbance index ( RDI ) decreased from 31.2 to 15.7 ( P = .092 ) , and mean lowest oxyhemoglobin saturation increased from 82.3 % to 85.0 % ( P = .581 ) . The RDI fell to 10 or lower in 38.5 % of patients and was reduced by at least 50 % in 53.8 % of the study group . Snoring was significantly reduced in 92.3 % of patients ( P < .001 ) . These early results suggest that LAUP may be efficacious in the management of OSAS Doubt has been expressed about the efficacy of nasal continuous positive airways pressure ( NCPAP ) therapy for  sleep apnoea .  Recent evidence from a r and omized controlled trial of 1 month duration , suggested that NCPAP therapy can have a substantial impact on subjective and clinical outcomes in the short term , but data was not available to determine whether these effects were sustained over the long term . This study , an extension of the original trial , examined whether the beneficial impacts of NCPAP continued over the longer term . Patients were followed-up 1 month after being placed on  active or sub-therapeutic NCPAP . They completed health status measures and a clinical test of sleepiness . After this period , all patients were placed on NCPAP and followed up 5 months later . The beneficial impact of NCPAP on sleep apnoea was sustained on all measures at follow-up . Furthermore , those who had initially been in the sub-therapeutic arm gained scores after 5 months of NCPAP similar to those of the active group . The impact of NCPAP appears sustained in the longer term . Subjective health status instruments have been advocated as important outcome points in r and omized trials . This study would support such a use , and shows the important role of patient report in the evaluation of health care OBJECTIVE To assess medium- to long-term subjective and objective results of laser-assisted uvulopalatoplasty ( LAUP ) for patients with obstructive sleep apnea . DESIGN A nonr and omized prospect i ve before-after trial . SUBJECTS AND INTERVENTIONS Twenty-six patients underwent LAUP  by means of vertical trenches along either side of the uvula and reduction of the uvula . MAIN OUTCOME MEASURES Subjective analysis included a preoperative and 2 postoperative evaluations of the state of snoring : 4 weeks and a mean + /- SD of 12.3 + /- 9.1 months after completion of treatment . In addition , a score on 5 other sleep-related symptoms was recorded before treatment and after 12.3 + /- 9.1 months ; at that time , patients also estimated their overall satisfaction with the procedure . Objective analysis included preoperative polysomnographic studies that were repeated postoperatively . RESULTS A significant decline in snoring improvement from 88 % ( 23/26 ) to 65 % ( 17/26 ) was recorded ; furthermore , the state of snoring worsened from 4 % ( 1/26 ) to 12 % ( 3/26 ) . Reevaluation of 5 other sleep-related symptoms after completion of LAUP uncovered a 50 % improvement rate ( 13/26 ) , and a 15 % ( 4/26 ) worsening rate . Overall satisfaction from the procedure was 58 % ( 15/26 ) . Postoperative objective studies revealed that only 31 % ( 8/26 ) of the procedures were successful , while 31 % were associated with worsening of respiratory disturbance index . Fifty-four percent ( 14/26 ) of the patients had a sensation of pharyngeal dryness . In addition , 1 patient developed velopharyngeal stenosis . CONCLUSIONS The favorable subjective short-term results of LAUP deteriorated in time . Postoperative polysomnography revealed that LAUP might lead to deterioration of existing apnea . These findings are probably related to velopharyngeal narrowing and progressive palatal fibrosis inflicted by the laser beam A placebo-controlled , partial cross-over , double-blind , r and omized study was performed with 46 adults with sleep apnea-hypopnea syndrome ( SAHS ) to determine the effect of therapeutic and subtherapeutic ( 0 - 1  cm H(2)O ) nasal continuous positive airway pressure ( CPAP ) treatment on polysomnographic and neuropsychological testing . The following neuropsychological tests were administered : Geriatric Depression Scale , Trail Making A and B , Digit Span Test Forward and Backward , Epworth Sleepiness Scale , SteerClear , Digit Symbol , Controlled Oral Word Association , and Complex Figure Recall . Compared with results without CPAP , subtherapeutic CPAP did not affect any measured polysomnographic parameter . Comparison of neuropsychological test results obtained between the initial periods of effective treatment ( Group 1 , 16.1 d ; Group 2 , 19.6 d ; p = NS ) in all subjects showed significant improvements in Digit Symbol , Digit Span Backward , and Complex Figure tests . However , there were no group differences in changes in test results during the period when one group was on effective CPAP and the other on ineffective CPAP ( Group 1 , 16.1 d ; Group 2 , 13.9 d ; p = NS ) . The results indicate the feasibility and importance of using ineffective CPAP as a placebo treatment and the importance of including a placebo control in studies evaluating the effect of treatment on neuropsychological function in SAHS Background : It is unclear whether continuous positive airway pressure ( CPAP ) , the treatment of choice for severe obstructive sleep apnoea ( OSA ) , is effective at improving outcomes in mild OSA . Methods : To help define the role of humidified CPAP in mild OSA , a r and omised crossover study was undertaken of patients with an apnoea hypopnoea index ( AHI ) of 5–30/hour .  Subjective sleepiness , objective wakefulness , mood , reaction time , and quality of life were measured at baseline , after 3 weeks treatment with humidified CPAP and 3 weeks sham CPAP ( 2 week washout ) . Results : Twenty nine of 31 enrolled patients ( age 25–67 years , seven women , mean ( SD ) body mass index 31.5 ( 6 ) kg/m2 ) completed the protocol .  Humidified CPAP  improved polysomnographic indices of OSA and Epworth Sleepiness Scale ( 2.4 points ( 95 % CI 0.6 to 4.2 ) ) . Objective wakefulness ( modified maintenance of wakefulness test ) showed a trend towards improvement ( 5.2 minutes ( 95 % CI −0.6 to 11 ) ) . Mood ( Hospital Anxiety and Depression Scale ) , quality of life ( SF 36 , Functional Outcomes of Sleep Question naire ) , and reaction times ( Psychomotor Vigilance Task ) were not improved more than sham CPAP . Compliance with humidified and sham CPAP both averaged 4.9 hours/night . Placebo effects were evident in many outcomes and there was no clear treatment preference . Conclusions : Humidified CPAP  improves subjective sleepiness and possibly objective wakefulness but not reaction times , quality of life , or mood . These results do not support the routine use of CPAP in all patients with mild OSA , but offers some support for the trialling of CPAP in those with severe sleepiness A common clinical dilemma faced by sleep physicians is in deciding the level of severity at which patients with obstructive sleep apnea ( OSA ) should be treated . There is particular uncertainty about the need for , and the effectiveness of , treatment in mild cases . To help define the role of nasal continuous positive airway pressure ( CPAP ) treatment in mild OSA we undertook a r and omized controlled cross-over trial of CPAP in patients with an apnea- hypopnea index ( AHI ) of 5 - 30 ( mean , 12.9 + /- 6.3 SD ) . Twenty-four-hour blood pressure and neurobehavioral function were measured at baseline , after 8 wk of treatment with CPAP , and after 8 wk of treatment with an oral placebo tablet .  Twenty-eight of 42 patients enrolled in the study completed both treatment arms . Baseline characteristics were not different between those who completed the study and those who did not complete the study . Patients used CPAP  for a mean ( SD ) of 3.53 ( 2.13 ) h per night and the mean AHI on the night of CPAP implementation was 4.24 ( 2.9 ) . Nasal CPAP improved self-reported symptoms of OSA , including snoring , restless sleep , daytime sleepiness , and irritability ( in-house question naire ) , more than did placebo , but did not improve objective ( Multiple Sleep Latency Test ) or subjective ( Epworth Sleepiness Scale ) measures of daytime sleepiness . We found no benefit of CPAP over placebo in any tests of neurobehavioral function , generic SF-36 ( 36-item Short Form Medical Outcomes Survey ) or sleep-specific ( Functional Outcomes of Sleep Question naire ) quality of life question naires , mood score ( Profile of Moods States and Beck Depression Index ) , or 24-h blood pressure . However , the placebo tablet result ed in a significant improvement in a wide range of functional variables compared with baseline . This placebo effect may account for some of the treatment responses to CPAP observed previously in patients with mild OSA Ambulatory blood pressure ( BP ) monitoring was performed in 13 patients with the sleep apnea/ hypopnea syndrome ( SAHS ) during a r and omized , placebo controlled crossover trial of the effects of continuous positive airway pressure ( CPAP ) therapy .  BP was monitored at half-hourly intervals for a 24-hour period both on CPAP and on an oral placebo , each given for a minimum of 3 weeks . Objective effective CPAP use averaged 4.3 hours per night . Weight and anti-hypertensive medications remained stable over the study period . Systolic , diastolic and mean arterial BP for 24-hour , daytime and nighttime periods were not significantly different on placebo compared to CPAP . Those patients with no significant overnight fall in BP on placebo ( " non-dippers " ) showed a significant improvement in daytime mean arterial BP on CPAP ( 98 + /- 4 mm Hg ) compared to placebo ( 102 + /- 4 mm Hg ; p = 0.01 ) . These findings , in a well-controlled trial , suggest that BP is not reduced by CPAP in a heterogeneous group of SAHS patients , but it may be selectively improved in those patients most at risk for cardiovascular morbidity and mortality The sleep apneahypopnea syndrome is currently defined by the presence of a pathologic number of episodes of cessation ( apnea ) or reduction ( hypopnea ) of respiratory flow during sleep ( the apneahypopnea index , defined as the number of apnea and hypopnea episodes per hour ) . This syndrome is normally associated with arterial desaturation , sleep disruption ( arousals ) , severe snoring , and excessive daytime sleepiness ( 1 ) . Nasal continuous positive airway pressure ( CPAP ) is the treatment of choice for the sleep apneahypopnea syndrome ( 2 , 3 ) . Several r and omized , placebo-controlled studies have shown that CPAP improves subjective and objective daytime sleepiness , quality of life , cognitive performance , and psychological well-being in patients with this syndrome ( 4 - 9 ) . The effects of CPAP on other clinical ly relevant variables , such as prognosis and incidence of cardiovascular events or traffic accidents , are unclear ( 10 ) . The available evidence therefore supports the notion that CPAP is an effective symptomatic treatment for patients with the sleep apneahypopnea syndrome . Epidemiologic studies report that many persons with an apneahypopnea index of at least 5 do not experience daytime sleepiness ( 11 ) . In clinical practice , these patients are commonly referred to consultation by their partner ( who observed apneas during sleep ) or by an otorhinolaryngologist ( who ordered a polysomnographic study before surgery for snoring ) . Whether these nonsleepy patients with a pathologic apneahypopnea index require treatment with CPAP is unclear ( 12 , 13 ) . On the one h and , it may be argued that they do not need treatment because they do not have symptoms ; moreover , the available evidence relates only to the efficacy of CPAP treatment on such symptoms . On the other h and , because the sleep apneahypopnea syndrome is a chronic , slowly progressing disease , patients with this syndrome may perceive their symptoms poorly . If this is the case , treatment with CPAP may substantially improve their well-being and quality of life . In addition , CPAP treatment of nonsleepy patients may have other potentially relevant biological effects , such as control of arterial hypertension , which is common in the sleep apneahypopnea syndrome ( 14 ) but often goes unnoticed . We design ed a multicenter r and omized , placebo-controlled , parallel-group study to evaluate the short-term ( 6 weeks ) effects of CPAP on quality of life , objective sleepiness , cognitive function , and arterial blood pressure in nonsleepy patients with a pathologic apneahypopnea index . Methods Patients Participants were recruited prospect ively from patients attending the sleep units of six teaching hospitals in Spain from August 1999 to March 2000 . All participants had an apneahypopnea index of 30 or greater , as determined during a full , supervised , st and ard polysomnographic study ; had Epworth Sleepiness Scale scores of 10 or less ( 15 ) ; and had no or mild daytime sleepiness , according to the International Classification of Sleep Disorders ( 16 ) . Patients were excluded if they had cognitive deterioration of any cause , a chronic underlying disease that may affect their quality of life , or severe cardiac disease ; had less than 8 years of formal education ; or used illicit drugs or drank excessive alcohol . The ethics committee of all participating institutions approved the study protocol , and all participants gave written consent after they were informed of the characteristics of the investigation . However , participants remained blinded to the hypothesis of the study . Design We design ed a multicenter r and omized , placebo-controlled , parallel-group study . A computer-generated r and om-number list generated with SPSS software [ SPSS , Inc. , Chicago , Illinois ] was used to assign patients to receive CPAP or sham CPAP . In all participants , we measured the following variables at baseline and after 6 weeks of treatment with CPAP or sham CPAP : 1 ) quality of life ; 2 ) degree of sleepiness ; 3 ) different psychological variables , such as attention , vigilance , visual memory , coordination , and mental control ; 4 ) arterial blood pressure on ambulatory monitoring ; and 5 ) drug intake and alcohol consumption , as potential confounding variables . Patients assigned to the CPAP group received treatment with optimal nasal CPAP at home for 6 weeks ( Respironics , Inc. , Murrisville , Pennsylvania ) . The optimal nasal CPAP pressure was determined during a full-night polysomnographic study as the pressure necessary to abolish all respiratory events and snoring , secondary arousals , and episodes of oxyhemoglobin desaturation during rapid eye movement sleep and in the supine position . Patients assigned to sham CPAP received this treatment at home during 6 weeks , using the method described by Farr and colleagues ( 17 ) . These patients also underwent a sham titration polysomnographic study in which no pressure was added . According to the r and omization schedule , the morning after the CPAP trial , patients were sent home with a CPAP or sham CPAP device . During the study , all participants had telephone access to research ers for advice if required . Measurements Polysomnographic studies included recording of oronasal flow and thoracoabdominal movements , electrocardiography , submental and pretibial  electromyography  , electroculography , electroencephalography ( C4A1 and C3A2 ) , and transcutaneous measurement of arterial oxygen saturation . A polysomnographic study was considered valid for scoring if the total sleep time was longer than 240 minutes . Sleep scoring was st and ardized according to international criteria ( 18 ) . Respiratory events ( apneas and hypopneas ) were scored according to criteria proposed by the Spanish Respiratory Society ( 19 ) , which defined apneas as cessation of respiratory flow for more than 10 seconds and hypopneas as a significant reduction in respiratory flow followed by an arousal ( as defined by Collard and associates [ 20 ] ) or an episode of arterial oxygen desaturation greater than 4 % . The apneahypopnea index was defined as the sum of the number of apneas plus hypopneas per hour of sleep . The arousal index indicates the number of arousals per hour of sleep . Quality of life was quantified by using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) ( 21 ) and the Functional Outcomes of Sleep Question naire ( FOSQ ) ( 22 ) . The degree of sleepiness was assessed by using the  Multiple Sleep Latency Test ( 1 ) ( MSLT ) and the Epworth Sleepiness Scale ( 15 ) . The technicians who scored the MSLT were blinded to the patients ' treatment assignments . Patients filled out the Epworth Sleepiness Scale themselves , without input from family or friends . Attention , vigilance , visual memory , and coordination were assessed by using the following psychological tests : digit span , block design , and digit symbols from the Wechsler Adult Intelligence Scale ( 23 ) ; mental control and verbal paired associates from the Wechsler Memory Scale ( 24 ) ; the Paced Auditory Serial Addition Test ( PASAT ) ; and the trail making test ( 25 ) . A psychologist administered or supervised ( in the case of the SF-36 , the FOSQ , and the Epworth Sleepiness Scale ) these tests between 9 a.m. and noon and in the absence of family or friends . Psychologists were aware of the study hypothesis but were blinded to patient treatment assignments . Ambulatory blood pressure ( Spacelabs Medical , Redmond , Washington ) was recorded 3 days before the MSLT was administered . Systolic and diastolic blood pressure values were measured for 24 hours . At least 60 data points were recorded in each patient . The average daytime ( 8:00 to 22:00 ) and nighttime ( 22:00 to 8:00 ) values were calculated . Patients were classified as nondippers if the systolic or diastolic blood pressure at night did not decrease by more than 10 % of diurnal values ( 26 ) . Adherence  to CPAP or sham CPAP was assessed by using the timer built into each CPAP device . At the end of the study period , we recorded the presence or absence of several potential side effects of therapy , such as claustrophobia , morning headache , insomnia , nose or ear pain , skin lesions , bleeding , and dryness of the oropharyngeal mucosa . Statistical Analysis The study was powered according to the findings of Jenkinson and colleagues ( 8) . In brief , quality of life ( assessed by the SF-36 question naire ) was the main outcome variable . We expected a mean difference of 9 in the change in the SF-36 question naire score after treatment between the CPAP and the sham CPAP group . Accordingly , we calculated that for a two-sided test , 25 patients in each group had to complete the study if a st and ard deviation of 9.5 , an error of 0.5 , and a error of 0.1 were assumed . Results are given as the mean ( SE ) . For the main outcome variables , the 95 % CI is also given . A two-tailed t-test for independent sample s or a chi-square test was used to compare anthropometric and clinical variables at baseline in the two groups . The effects of treatment were analyzed on an intention-to-treat basis by using a two-sided t-test for independent sample s to compare the change over time in different variables between the two groups . A P value less than 0.05 was considered significant . Results Baseline Data Figure 1 shows the trial design . During the study , 69 patients who fulfilled all inclusion criteria were recruited from the six participating institutions . Fourteen patients declined to participate in the study . The remaining 55 patients underwent r and omization . One patient initially assigned to the sham CPAP group was lost to follow-up after his first evaluation owing to a change in residence ( Figure 1 ) . Thus , the final study sample comprised 54 patients ( 29 in the CPAP group and 25 in the sham CPAP group ) . Figure 1 . Trial design . Table 1 shows the patients ' main anthropometric and clinical characteristics at the start of the study . The  CPAP  and  sham CPAP  groups did not differ significantly for any variable ( Table 1 ) . By design , all patients had an apneahypopnea index of 30 or greater ( ranging from 30 to 91 ) STUDY OBJECTIVES We hypothesized that positional therapy would be equivalent to continuous positive airway pressure ( CPAP ) at normalizing the apnea-hypopnea index ( AHI ) in patients with positional obstructive sleep apnea ( OSA ) . METHODS Thirty-eight patients ( 25 men , 49 + /- 12 years of age , body mass index 31 + /- 5 kg/m2 ) with positional OSA ( nonsupine AHI < 5 events/h ) identified on a baseline polysomnogram were studied . Patients were r and omly assigned to a night with a positional device ( PD ) and a night on CPAP ( 10 + /- 3 cm H2O ) . RESULTS Positional therapy was equivalent to CPAP at normalizing the AHI to less than 5 events per hour ( 92 % and 97 % , respectively [ p = 0.16 ] ) . The AHI decreased from a median of 11 events per hour ( interquartile range 9 - 15 , range 6 - 26 ) to 2 ( 1 - 4 , 0 - 8 ) and 0 events per hour ( 0 - 2 , 0 - 7 ) with the PD and CPAP , respectively ; the difference between treatments was significant ( p < 0.001 ) . The percentage of total sleep time in the supine position decreased from 40 % ( 23%-67 % , 7%-82 % ) to 0 % ( 0%-0 % , 0%-27 % ) with the PD ( p < 0.001 ) but was unchanged with CPAP ( 51 % [ 36%-69 % , 0%-100 % ] ) . The lowest SaO2 increased with the PD and CPAP therapy , from 85 % ( 83%-89 % , 76%-93 % ) to 89 % ( 86%-9%1 , 78%-95 % ) and 89 % ( 87%-91 % , 81%-95 % ) , respectively ( p < 0.001 ) . The total sleep time was unchanged with the PD , but decreased with CPAP , from 338 ( 303 - 374 , 159 - 449 ) minutes to 334 ( 287 - 366 , 194 - 397 ) and 319 ( 266 - 343 , 170 - 386 ) minutes , respectively ( p = 0.02 ) . Sleep efficiency , spontaneous arousal index , and sleep architecture were unchanged with both therapies . CONCLUSION Positional therapy is equivalent to CPAP at normalizing the AHI in patients with positional OSA , with similar effects on sleep quality and nocturnal oxygenation We compared radiofrequency techniques used in the treatment of snoring and obstructive sleep apnea [ radiofrequency assisted uvulopalatoplasty ( RAUP ) and channeling ] as regard the efficacy and morbidity . A pilot , prospect i ve r and omized single blinded study was conducted on 40 patients in the ENT Department , Kasr Al-Aini Hospital , Cairo University during the period from April to December 2003 . Patients were r and omized into two groups each consisting of 20 patients . The first group was treated by submucosal channeling of the palate , while the second group was treated by radiofrequency assisted uvulopalatoplasty ( RAUP ) . Patients were followed for 4 months , filling a question naire in a st and ard visual analogue score pattern . Assessment was done prior to the surgery and was repeated 3 , 10 days and 3 weeks postoperatively . Visual analogue scores were done for the following parameters : pain , speech deficits , dysphagia , and snoring ( by the bed partner ) . Polysomnography was done pre to intervention and was repeated 4 months postoperatively . This work confirms the favorable effects of radiofrequency in the treatment of patients with snoring and mild to moderate obstructive sleep apnea ( OSA ) particularly on snoring  , confirming the results of the previous studies and highlighting the more rapid relief of snoring and apnea in RAUP group compared to channeling group but with more postoperative pain and morbidity BACKGROUND Nasal side effects are common in patients with obstructive sleep apnea syndrome ( OSAS ) starting on nasal continuous positive airway pressure ( CPAP ) therapy . We tested the hypothesis that heated humidification or nasal topical steroids improve compliance , nasal side effects and quality of life in this patient group . METHODS 125 patients with the established diagnosis of OSAS ( apnea/hypopnea index > or = 10/h ) , who tolerated CPAP via a nasal mask , and who had a successful CPAP titration were r and omized to 4 weeks of dry CPAP , humidified CPAP or CPAP with additional topical nasal steroid application ( fluticasone , GlaxoWellcome ) . Groups were similar in all demographic variables and in frequency of nasal symptoms at baseline . Outcome measures were objective compliance , quality of life ( short form 36 ) , subjective sleepiness ( Epworth Sleepiness Scale score ) and nasal symptoms such as runny , dry or blocked nose , sneezing and headaches ; all variables assessed using a vali date d question naire and by direct interview . RESULTS There was no difference in compliance between groups after 4 weeks ( dry : 5.21 + /- 1.66 h/night , fluticasone : 5.66 + /- 1.68 , humidifier : 5.21 + /- 1.84 ; p = 0.444 ) . Quality of life and subjective sleepiness improved in all groups , but there were no differences in the extent of improvement . Nasal Symptoms were less frequently reported in the humidifier group ( 28 % ) than in the remaining groups ( dry : 70 % , fluticasone : 53 % , p = 0.002 ) . However , the addition of fluticasone result ed in increased frequency of sneezing . CONCLUSION The addition of a humidifier , but not nasal steroids decreases the frequency of nasal symptoms in unselected OSAS patients initiating CPAP therapy ; however compliance and quality of life remain unaltered OBJECTIVE To evaluate the usefulness of uvulopalatopharyngoplasty plus m and ibular osteotomy with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea syndrome ( OSAS ) . DESIGN Prospect i ve study of 20 consecutive patients with OSAS . SETTING University medical center . PATIENTS AND INTERVENTIONS Twenty OSAS patients with multilevel upper airway obstruction who refused continuous positive airway pressure treatment . All patients were evaluated before and 6 months after surgery by clinical history , the Epworth Sleepiness Scale , physical examination , fiberoptic nasopharyngoscopy combined with the Müller maneuver , cephalometric analysis , nocturnal polysomnography  , and a  second-night polysomnography with upper airway pressure recording during sleep . Surgery procedures were uvulopalatopharyngoplasty plus m and ibular osteotomy with genioglossus and hyoid advancement . Surgical successful outcome was defined as an apnea-hypopnea index ( AHI ) lower than 20 plus subjective resolution of daytime symptoms . MAIN OUTCOME MEASURE Surgical success rate . RESULTS Mean + /- SD AHI decreased from 60.5 + /- 16.5 to 44.6 + /- 27(P = .007 ) , and CT90 ( percentage of time with oxyhemoglobin saturation below 90 % ) decreased from 39.5 % + /- 26 % to 25.1 % + /- 26.4 % ( P = .002 ) . The overall surgical success rate was 35 % but increased to 57 % in patients with moderate OSAS ( AHI , 41 - 60 ) and to 100 % in mild OSAS ( AHI , 21 - 40 ) . In the group of severe OSAS , the success rate was 9 % . Predictors of surgical outcome success were the AHI , CT90 , stages 2 and 3 - 4 sleep percentages , and the cephalometric ANB angle ( angle formed from the deepest point on the maxillary outer contour to the nasion to the deepest point on the outer m and ibular contour ) . CONCLUSION Patients with mild and moderate OSAS and multilevel obstruction in the upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus and hyoid advancement OBJECTIVE : A tongue suture is postulated to prevent tongue base collapse in obstructive sleep apnea ( OSA ) and snoring . This procedure uses a permanent tongue base suture to support the pharynx and lessen collapse . This study evaluates 2-month results in 28 OSA and snoring patients . STUDY DESIGN AND SETTING S : Forty-three patients have been enrolled in a multi-institutional prospect i ve open enrollment study using the “ Repose ” bone screw system . Subjects were evaluated using polysomnography measures of general health ( SF-36 ) , snoring , and sleep ( Epworth Sleepiness Scale and Functional Outcomes of Sleep ) performed before and again 2 months after treatment . RESULTS : In 14 OSA patients ( Apnea + Hypopnea ( AHI ) > 15 ) and 14 snorers ( AHI < 15 ) , no change was noted in sleep architecture or lowest oxygen saturation . AHI decreased in OSA ( 35.4 + 13.7 to 24.5 + 14.5 , P < 0.00 ) , but not in snorers . AHI decreased in the lateral ( 16.5 + 16.5 to 3.8 + 6.4 , P < 0.01 ) but not the supine position . Epworth Sleepiness Scale , Functional Outcomes of Sleep , and snoring scales improved . Snoring decreased but remained bothersome to the bed partner . CONCLUSIONS : A tongue suspension suture partially reduces the respiratory severity of OSA . Small changes are noted in symptoms of sleepiness , snoring , and functional outcomes . Demonstration of efficacy of the technique and device will require further controlled trials Background : Long-term trials are needed to capture information regarding the persistence of efficacy and loss to follow-up of both m and ibular advancement device ( MAD ) therapy and continuous positive airway pressure ( CPAP ) therapy . Objectives : The aim of the study was to compare these treatment aspects between MAD and nasal CPAP ( nCPAP ) in a 1-year follow-up . Methods : Forty-three mild/moderate obstructive sleep apnea patients ( 52.2 ± 9.6 years ) with a mean apnea-hypopnea index ( AHI ) of 20.8 ± 9.9 events/h were r and omly assigned to two parallel groups : MAD ( n = 21 ) and nCPAP ( n = 22 ) . Four polysomnographic recordings were obtained : one before treatment , one for the short-term evaluation , and two recordings 6 and 12 months after the short-term evaluation . Excessive daytime sleepiness ( EDS ) was also evaluated at the polysomnographic recordings . Results : The initially achieved improvements in the AHI remained stable over time within both groups ( p = 0.650 ) . In the nCPAP group , the AHI improved 4.1 events/h more than in the MAD group ( p = 0.000 ) . The EDS values showed a gradual improvement over time ( p = 0.000 ) , and these improvements were similar for both groups ( p = 0.367 ) . In the nCPAP group , more patients withdrew from treatment due to side effects than in the MAD group . Conclusions : The absence of significant long-term differences in EDS improvements between the MAD and the nCPAP groups with mild/moderate obstructive sleep apnea may indicate that the larger improvements in AHI values in the nCPAP group are not clinical ly relevant . Moreover , nCPAP patients may show more problems in accepting their treatment modality than MAD patients This prospect i ve , r and omized , cross-over trial was design ed to compare the efficacy of a m and ibular advancement splint ( MAS ) with that of nasal continuous positive airway pressure ( nCPAP ) in patients with obstructive sleep apnoea ( OSA ) . Twenty-four patients ( 20 males and four females ) with mild to moderate OSA ( AHI between 10 and 49 events per hour ) were enrolled in the study . Each patient used both MAS and nCPAP , with the initial therapy being allocated at r and om . Treatment periods lasted for two months with a two-week wash-out interval between .  Polysomnography  was performed prior to the study and after each clinical intervention . Patient and partner question naires were used to assess changes in general health and daytime somnolence . The AHI decreased from 22.2 to 3.1 using nCPAP , and to 8.0 using the MAS ( P < 0.001 for both devices ) and there was no statistically significant difference between the two treatments . The Epworth Sleepiness Score ( ESS ) fell from 13.4 to 8.1 with nCPAP , and to 9.2 with MAS ( P < 0.001 ) , again with no differences between the use of MAS or nCPAP . The question naire data showed an improvement in general health scores ( P < 0.001 ) after both treatments , but daytime sleepiness only improved significantly using nCPAP ( P < 0.001 ) . Despite this , 17 out of the 21 subjects who completed both arms of the study preferred the MAS . The splints were well tolerated and their efficacy suggests that the MAS may be a suitable alternative to nCPAP in the management of patients with mild or moderate OSA BACKGROUND Obstructive sleep apnoea is associated with raised blood pressure . If blood pressure can be reduced by nasal continuous positive airway pressure ( nCPAP ) , such treatment could reduce risk of cardiovascular disease in patients with obstructive sleep apnoea . Our aim was to see whether nCPAP for sleep apnoea reduces blood pressure compared with the most robust control intervention subtherapeutic nCPAP . METHODS We did a r and omised parallel trial to compare change in blood pressure in 118 men with obstructive sleep apnoea ( Epworth score > 9 , and a > 4 % oxygen desaturation index of > 10 per h ) who were assigned to either therapeutic ( n=59 ) or subtherapeutic ( 59 ) nCPAP ( about 1 cm H(2)O pressure ) for 1 month . The primary outcome was the change in 24-h mean blood pressure . Secondary outcomes were changes in systolic , diastolic , sleep , and wake blood pressure , and relations between blood pressure changes , baseline blood pressure , and severity of sleep apnoea . FINDINGS Therapeutic nCPAP reduced mean arterial ambulatory blood pressure by 2.5 mm Hg ( SE 0.8 ) , whereas subtherapeutic nCPAP increased blood pressure by 0.8 mm Hg ( 0.7 ) ( difference -3.3 [ 95 % CI -5.3 to -1.3 ] ; p=0.0013 , unpaired t test ) . This benefit was seen in both systolic and diastolic blood pressure , and during both sleep and wake . The benefit was larger in patients with more severe sleep apnoea than those who had less severe apnoea , but was independent of the baseline blood pressure . The benefit was especially large in patients taking drug treatment for blood pressure .  INTERPRETATION In patients with most severe sleep apnoea , nCPAP reduces blood pressure , providing significant vascular risk benefits , and substantially improving excessive daytime sleepiness and quality of life There is r and omized controlled evidence that patients with sleep apnea-hypopnea syndrome ( SAHS ) treated with continuous positive airway pressure ( CPAP )  have improved daytime function and quality of life . " Before- and -after " data indicate that CPAP improves sleep quality , but there is no r and omized controlled evidence of this . We tested the hypothesis that CPAP improved sleep quality in patients with SAHS . We also sought correlations between polysomnographic ( PSG ) indices and benefit from use of CPAP .  Twenty-two patients with SAHS ( median , [ interquartile range ] apnea-hypopnea index , 40 [ 25 - 65 ] events/h ) spent 1 mo receiving CPAP and 1 mo receiving placebo capsules , in r and om order , and home sleep studies were performed at the end of each month . CPAP result ed in a lower arousal index , less Stage 1 , and more Stage 3 + 4 sleep , but there was no increase in Stage REM ( rapid eye movement ) sleep . Improvement in Epworth score after 6 - 12 mo of treatment correlated significantly with PSG indices on CPAP :  sleep efficiency index ( r = 0.78 , p < 0.001 ) , Stage REM ( r = 0.55 , p = 0.001 ) , Stage 3 + 4 ( r = 0.5 , p = 0.02 ) , and arousal index ( r = -0.43 , p = 0.05 ) . This study provides r and omized controlled trial evidence that patients with SAHS  sleep better when receiving CPAP . Patients with good sleep quality on CPAP at 1 mo are likely to gain later benefit in subjective daytime sleepiness OBJECTIVES To examine whether treatment of obstructive sleep apnea ( OSA ) with continuous positive airway pressure ( CPAP ) in patients with Alzheimer 's disease ( AD ) results in better cognitive function . DESIGN R and omized double-blind placebo-controlled trial . Participants were r and omized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks . SETTING General clinical research center . PARTICIPANTS Fifty-two men and women with mild to moderate AD and OSA . INTERVENTION CPAP . MEASUREMENTS A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks . RESULTS A comparison of subjects r and omized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition . A comparison of pre- and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition . The study was underpowered to make definitive statements about improvements within specific cognitive constructs , although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed . CONCLUSION OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD . OSA treatment seems to improve some cognitive functioning . Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present OBJECTIVE : Review long-term results of the modified cautery-assisted palatoplasty ( mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea ( OSA ) . STUDY DESIGN : Prospect i ve series of 77 patients . All patients were > 18 years old , type I Fujita , body mass index ( BMI ) < 33 , Friedman clinical stage II , with apnea-hypopnea index ( AHI ) from 1.0 to 30.0 . The mean follow-up time was 33.5 months . The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils . The procedure was done under general or local anesthesia . RESULTS : There were 69 men and eight women ; the mean age was 39.3 years old ; and mean BMI was 24.9 ( range 20.7–26.8 ) . There were 38 snorers and 39 OSA patients .  The AHI improved in patients with OSA , 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05 ) . The overall success rate for this OSA group was 71.8 percent ( at mean 33.5 months ) . The mean snore scores ( visual analog score ) improved from 8.4 to 2.5 ( for all 77 patients ) . Lowest oxygen saturation also improved in all OSA patients . Subjectively , all patients felt less tired . CONCLUSION : This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA AIMS We tested the hypothesis that : ( i ) obstructive sleep apnoea ( OSA ) by itself originates pulmonary hypertension ( PH ) ; and ( ii ) the application of continuous positive airway pressure ( CPAP ) can reduce pulmonary pressure . METHODS AND RESULTS In this r and omized and cross-over trial , 23 middle-aged OSA ( apnoea-hypopnoea index , 44.1 + /- 29.3 h(-1 ) ) and otherwise healthy patients and 10 control subjects were included . OSA patients r and omly received either sham or effective CPAP for 12 weeks . Echocardiographic parameters , blood pressure recordings , and urinary catecholamine levels were obtained at baseline and after both treatment modalities . At baseline , OSA patients had higher pulmonary artery systolic pressure than control subjects ( 29.8 + /- 8.8 vs. 23.4 + /- 4.1 mmHg , respectively , P = 0.036 ) . Ten out of 23 patients [ 43 % , ( 95 % CI : 23 - 64 % ) ] and none of the control subjects had PH at baseline ( P = 0.012 ) . Two patients were removed from the study because of inadequate CPAP compliance . Effective CPAP induced a significant reduction in the values for pulmonary systolic pressure ( from 28.9 + /- 8.6 to 24.0 + /- 5.8 mmHg , P < 0.0001 ) . The reduction was greatest in patients with either PH or left ventricular diastolic dysfunction at baseline . CONCLUSION Severe OSA is independently associated with PH in direct relationship with disease severity and presence of diastolic dysfunction . Application of CPAP reduces pulmonary systolic pressure levels Abstract Conclusion : Flow-mediated dilatation ( FMD ) is decreased in patients with moderate or severe obstructive sleep apnea syndrome ( OSAS ) , and Han-uvulopalatopharyngoplasty ( H-UPPP ) can improve FMD . Objective : To evaluate FMD in patients with moderate or severe OSAS and observe the effect of H-UPPP on FMD in these patients . Methods : Forty-nine patients who were first diagnosed with moderate or severe OSAS by polysomnography ( PSG ) and had no other diseases served as the experimental group , and 35 individuals with normal PSG as the control group .  FMD was measured with high-resolution B-mode ultrasonography in the two groups . PSG and FMD were again performed in the experimental group 6 months after H-UPPP . Results : FMD was significantly lower in the experimental group than in the control group ( 6.5 ± 2.1 % vs 11.2 ± 2.9 % , p < 0.01 ) . FMD was significantly improved 6 months after H-UPPP compared with preoperative FMD ( 9.7 ± 2.7 % vs 6.5 ± 2.1 % , p < 0.01 ) OBJECTIVE To compare the efficacy of single-stage , multilevel , temperature-controlled radiofrequency tissue volume reduction ( TCRFTVR ) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure ( CPAP ) in primary treatment of mild to moderate obstructive sleep apnea . DESIGN A prospect i ve nonr and omized clinical study . SETTING Tertiary care referral center . PATIENTS Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1 , 2003 , and October 31 , 2006 , were review ed . INTERVENTIONS Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality . MAIN OUTCOME MEASURES Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared . RESULTS The baseline characteristics of the groups were not significantly different . Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements . The results were not significantly different in the posttreatment intergroup comparisons . Treatment success rates were 52.4 % for nasal CPAP and 53.8 % for TCRFTVR ( P = .92 ) . CONCLUSION Similar comparison results with nasal CPAP in objective and subjective variables make single-stage , multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea The minimal disease severity at which patients with the sleep apnea/hypopnea syndrome ( SAHS ) gain benefit from treatment is not well characterized , although a pilot study of continuous positive airway pressure ( CPAP ) therapy showed daytime improvements in patients with 5 to 15 apneas + hypopneas per hour slept ( AHI ) . We have thus performed a second , larger , r and omized , placebo- controlled study in a prospect i ve series of 34 patients ( 13 female ) with mild SAHS ( AHI 5 to 15 ) and daytime sleepiness . Patients spent 4 wk on CPAP treatment and 4 wk on an oral placebo , with r and omization of treatment order , and daytime assessment s on the last day of each treatment . Effective  CPAP  use averaged 2.8 + /- 2.1 h ( mean + /- SD ) per night . Compared with placebo , CPAP improved symptom score ( p < 0.01 ) , subjective ( Epworth ; p < 0.01 ) but not objective ( maintenance of wakefulness test ; p > 0.2 ) sleepiness , performances on 2 of 7 cognitive tasks ( p < 0.02 ) , depression score ( p < 0.01 ) , and five subscales of the SF-36 health/functional status question naire ( p < /= 0.03 ) . Fourteen of 34 patients preferred CPAP . In 14 patients with AHI in the range 5 to 10 , symptoms , cognitive function , psychological well-being and quality of life were improved . These results confirm benefits for daytime function after CPAP treatment for mild SAHS , but highlight unacceptability of CPAP in many such patients This study aim ed to evaluate the effectiveness of elevated posture in the management of obstructive sleep apnea ( OSA ) . Fourteen subjects presenting with mild-moderate OSA , ( apnea-hypopnea index [ AHI ] 10 to 60/h ) , were included in a r and omized crossover investigation . A shoulder-head elevation pillow ( SHEP ) was compared with nasal continuous positive airway pressure ( nCPAP ) therapy . Treatment success was defined as AHI ≤ 10/h and partial success as AHI > 10 < 16/h . Four subjects achieved treatment success with the SHEP and three achieved partial success . The remaining seven subjects were treatment failures . In contrast , success was achieved with nCPAP in 12 subjects . One subject achieved partial success and one was a treatment failure . With the SHEP , the mean AHI decreased from 27 ± 12/h to 21 ± 17/h . With nCPAP , the mean AHI was 5 ± 3/h ; ( p= 0.008 for the difference between treatments ) . Although somewhat variable , these data provide evidence that elevated posture during sleep is helpful in the management of OSA in some individuals . Results support the use of elevated posture as second-line therapy in the management of OSA . However , no relationships could be identified between baseline data , including the identification of positional OSA , and objective outcomes that might predict patients who are likely to benefit from treatment in an elevated position This study aim ed to investigate the value of the surgery of revised uvulopalatopharyngoplasty ( UPPP ) on ambulatory blood pressure ( BP ) in obstructive sleep apnea/hypopnea syndrome ( OSAHS ) patients with hypertension and oropharyngeal obstruction . A retrospective cohort study was performed in 29 patients with OSAHS and hypertension , who received treatment with revised UPPP surgery .  After surgery 1 month , the Apnea-hypopna index ( AHI ) and body mass index ( BMI ) significantly decreased ( P < 0.05 ) , and mini SpO2 and mean SpO2 increased than before ( P < 0 . 05 ) , but the heart rate showed no significant difference ( P > 0.05 ) . In the meantime , compared to pretreatment , nighttime systolic SBP , nighttime diastolic DBP , morning systolic SBP , morning diastolic DBP , 24-h DBP , and 24-h SBP , decreased significantly ( P < 0.05 ) , but daytime SBP and daytime DBP showed no significant difference ( P > 0.05 ) . The results of this study indicated that the BP in the sleep apnea patients with hypertension might gradually decrease by revised UPPP surgery OBJECTIVES Endothelial dysfunction has been proposed as a potential mechanism implicated in the pathogenesis of cardiovascular complications of obstructive sleep apnea syndrome ( OSAS ) . This study aim ed to evaluate the microvascular endothelial function ( MVEV ) in OSAS and the impact on MVEF of 2 months of treatment with continuous positive airway pressure ( CPAP ) and m and ibular advancement device ( MAD ) . METHODS Microvascular reactivity was assessed using laser Doppler flowmetry combined with acetylcholine ( Ach ) and sodium nitroprusside ( SNP ) iontophoresis in 24 OSAS patients and 9 control patients . In 12 of the 24 OSAS patients , microvascular reactivity was reassessed after 2 months of CPAP and MAD using a r and omized cross-over design . RESULTS Ach-induced vasodilation was significantly lower in OSAS patients than in matched controls and correlated negatively with apnea hypopnea index ( r=-0.49 , p<0.025 ) and nocturnal oxygen desaturations ( r=-0.63 , p<0.002 ) . Ach-induced vasodilation increased significantly with both CPAP and MAD . The increase in Ach-induced vasodilation under OSAS treatment correlated with the decrease in nocturnal oxygen desaturations ( r=0.48 , p=0.016 ) . CONCLUSION Our study shows an impairment of MVEF in OSAS related to OSAS severity . Both CPAP and MAD treatments were associated with an improvement in MVEF that could contribute to improve cardiovascular outcome in OSAS patients Laser-assisted uvulopalatoplasty ( LAUP ) is an outpatient surgical treatment for snoring and obstructive sleep apnea ( OSA ) , but to date , no controlled trials have been published . Forty-five subjects with mild OSA ( apnea/hypopnea index [ AHI ] , 10 - 27 per hour ) were r and omized to LAUP or to no treatment ( control group ) . The AHI post-LAUP was reduced by 21 % overall and to 10 or less per hour in 5 of 21 subjects ( 24 % ) . Four of 24 subjects in the control group ( 16.7 % ) had an AHI of 10 or less per hour at outcome . The AHI decreased with the LAUP compared with no change with the control group at outcome . Ten subjects ( 48 % ) reported significantly improved snoring after the LAUP . There was no improvement in excessive daytime sleepiness , but there was a small improvement in quality of life ( unless side effects were included in the quality of life score ) . Side effects were common , but serious complications did not occur . LAUP surgery is effective in some subjects with mild OSA for the treatment of snoring , but the reduction in AHI and the level of symptomatic improvement were minor overall The aim of the study was to evaluate the effects of successful laser-assisted uvulopalatoplasty ( LAUP ) on oral airway resistance ( ROA ) during wakefulness in patients with OSAS . Fifteen healthy subjects ( group I ) and 25 subjects ( group II ) with moderately severe or severe obstructive sleep apnea syndrome ( OSAS ) proven by an overnight sleep study and who desired LAUP were enrolled . All underwent an overnight sleep study , pulmonary function testing and measurement of oral airway resistance [ ROA ( including impedance ( Zrs ) , resistance ( R ) and reactance ( X ) ] measurement by Impulse Oscillometry ( IOS ) ( MasterScreen IOS , VIASYS Healthcare GmbH , Germany ) in the upright ( seated ) position and then in the supine position while awake . Group II subjects had these measurements twice , both before and 3 months after LAUP . Based on the assessment of their sleep study after LAUP , they were divided into two groups : responders ( group IIa ) and nonresponders ( group IIb ) . Zrs was normal in the sitting position both before and after LAUP in both groups IIa and IIb and comparable to that of group I controls . There was an increase in Zrs in the supine position in both groups IIa and IIb subjects before LAUP . After LAUP , the Zrs in group IIb subjects remained elevated , while that in group IIa subjects returned to levels comparable to those in the normal controls . OSAS patients before LAUP have abnormal ROA in the supine position as reflected by a high Zrs . The Zrs is improved after LAUP that successfully ameliorates OSAS STUDY OBJECTIVES The effect of therapy using a cervicom and ibular support collar ( CMSC ) to manage obstructive sleep apnea ( OSA ) was compared with st and ard therapy , nasal continuous positive airway pressure ( nCPAP ) . DESIGN Subjects received treatment with CMSC or nCPAP each for 1 month in r and om order . The study was analyzed on an intention-to-treat basis . SETTING Tom McKendrick Sleep Laboratory , Dunedin Hospital . PARTICIPANTS Ten adult subjects with mild-to-moderate OSA ( apnea-hypopnea index [ AHI ] , 24 + /- 13/h slept [ mean + /- SD ] ) completed the study . INTERVENTIONS The CMSC was design ed to prevent m and ibular movement and hold the head in slight extension , thus preventing the postural changes that might contribute to OSA . Positioning of the CMSC was confirmed by an externally applied cervical range of motion ( CROM ) instrument and by cephalometry . Subjects were carefully instructed in the use of each device and completed a symptom diary . After 1 month , subjects underwent  polysomnography  with each of the allocated devices in situ , and symptom question naires were administered . MEASUREMENTS AND RESULTS Treatment success ( AHI < /= 10/h slept ) with CMSC was achieved in only 2 of 10 subjects , partial success ( AHI > 10/h to < /= 15/h slept ) was achieved in 2 subjects , and in 6 of 10 subjects there was no benefit . In contrast , treatment success was achieved in 7 of 10 subjects receiving nCPAP .  Mean AHI was 29.4 + /- 13.4/h at baseline , 26.9 + /- 17.2/h slept with CMSC , and 9.9 + /- 8.0/h slept with nCPAP ( p = 0.001 ) . No significant differences in sleep architecture or sleep efficiency were achieved using nCPAP compared to CMSC . The efficacy of the CMSC in maintaining the desired head position was confirmed by cephalometry and the CROM instrument . CONCLUSIONS Our results , although negative , provide important evidence that control of head and neck posture , perhaps adopted as a second-line treatment , is not helpful in the management of OSA . It appears that other anatomic and physiologic factors have a dynamic overriding influence on upper airway closure compared to simple skeletal relationships The aim of this r and omized controlled trial was to assess the effects of treatment with continuous positive airway pressure versus conservative therapy ( CT ) on well-being , mood , and functional status in subjects with mild sleep-disordered breathing ( SDB ) . One hundred and eleven subjects , aged 25 to 65 yr , with a respiratory disturbance index ( RDI ) of 5 to 30 and without subjective pathologic sleepiness , were r and omized to nasal CPAP or to CT . Ninety-seven subjects were followed-up after 8 wk . Treatment response was assessed from changes between baseline and follow-up measures of mood , energy/fatigue , and functional status/general health . Of the 51 subjects r and omized to CPAP , 25 ( 49 % ) experienced an improved outcome , as compared with 12 of 46 of subjects ( 26 % ) r and omized to CT ( p < 0.05 ) . The odds of experiencing a treatment response in the CPAP as compared with the CT group were 2.72 ( OR : 1.18 to 6.58 , 95 % CI ) . A beneficial effect of CPAP over CT was most evident among individuals without sinus problems and among subjects with hypertension or diabetes . Differential treatment responses were not related to degree of baseline sleepiness or SDB . This suggests that middle-aged snorers with relatively low levels of SDB ( RDI < 30 ) may benefit more from nasal CPAP than from less specific therapy directed at improving breathing during sleep .  CPAP therapy may be beneficial to a broader group of subjects than previously appreciated Background : Sleep-disordered breathing ( SDB ) is common after stroke , but it is unclear whether it should be treated . Objective : To conduct a r and omised controlled trial of continuous positive airway pressure ( CPAP ) after stroke . Methods : Patients with stroke with ⩾30 apnoeas and hypopnoeas per hour ( (A+H)/h ) with predominant obstructive sleep apnoea or hypopnoea were r and omised to either CPAP treatment or conservative treatment for 8 weeks . Outcomes were measured blind to treatment allocation at 8 weeks and 6 months after the stroke . The primary outcome was physical function on the Nottingham Extended Activities of Daily Living Scale . Results : Of 658 patients with stroke screened , only 71 ( 10.7 % ) were eligible and consented to a sleep study 14–19 days after stroke . 66 patients completed the sleep study ( 21 women ; mean age 72 years ) , 33 ( 50 % ) had ⩾30 (A+H)/h that were predominantly obstructive . 15 were r and omised to CPAP treatment and 15 to conventional treatment . Despite intensive efforts , objective use of CPAP was poor , averaging 1.4 h a night . CPAP treatment result ed in no significant improvements ( p>0.1 ) in the primary outcome or in neurological function or sleepiness , and in poorer health status on some measures . Conclusions : This trial showed no benefit from CPAP treatment , the relevance of the observed detrimental effects is question able . Even in our highly selected patients with stroke , use of CPAP was poor . At present , CPAP treatment should be advocated for patients with stroke only if they have symptoms of SDB STUDY OBJECTIVE We investigated the short-term effectiveness of continuous positive airway pressure ( CPAP ) and oxygen in improving sleep quality in patients with obstructive sleep apnea ( OSA ) . DESIGN R and omized , double-blind , placebo-controlled , parallel study . SETTING General Clinical Research Center at a university hospital . PATIENTS Seventy-six patients with untreated OSA . INTERVENTIONS Patients were r and omly assigned to 1 of 3 treatments ( CPAP , placebo-CPAP , or nocturnal oxygen at 3 L per minute ) for 2 weeks . Sleep quality was assessed at baseline and after 1 and 14 days of therapy . Repeated- measures analysis of variance was used to evaluate treatment and time effects , and their interaction . MEASUREMENTS AND RESULTS Sixty-three patients completed the protocol . When compared with placebo-CPAP and nocturnal oxygen , CPAP increased rapid eye movement ( REM ) sleep and significantly reduced stage 1 sleep and the number of stage shifts ( p < or = .003 ) . CPAP improved , to within normal limits , the apnea-hypopnea index , total arousal index , and mean oxyhemoglobin saturation ( p < or = .001 ) . The effects of CPAP were apparent during the first night of therapy . Oxygen improved only mean nocturnal saturation ( p = .009 ) . CPAP had no significant effect on stage 2 sleep or slow-wave sleep . CONCLUSIONS CPAP was associated with an improvement in sleep quality in patients with OSA by consolidating sleep , reducing stage 1 sleep , and improving REM sleep .  CPAP was effective in correcting the respiratory and arousal abnormalities of OSA . The effectiveness of supplemental oxygen was limited to oxyhemoglobin desaturation Purpose To determine the effect of a controlled heated breathing tube humidifier ( cHH ) on the quality of life ( QOL ) , compliance and nasopharyngeal side effects during continuous positive airway pressure ( CPAP ) therapy in patients with obstructive sleep apnea syndrome ( OSAS ) in comparison with conventional CPAP . Methods In this prospect i ve r and omised cross-over study , 44 patients with OSAS were investigated . During the first two consecutive treatment nights monitored by polysomnography , patients were r and omly assigned to receive CPAP with or without cHH . Patients were then r and omised to receive one of the treatment modalities at home for 4 weeks . Compliance was recorded and question naires assessing side effects and QOL were administered . Results Sleep parameters measured during the nights in the sleep laboratory did not change . The same result applied to QOL and compliance measured after 4 weeks . During the first two nights we found significant differences between CPAP with and without cHH for dryness of mouth ( 2.0 ± 1.4 vs. 1.4 ± 1.6 ) in favour of cHH ( p < 0.05 ) . Evaluation of coldness of the face showed improvement whereas waking up due to wetness on the face ( 0.3 ± 0.6 vs. 0.6 ± 0.8 ; p < 0.05 ) was slightly increased . Data after 4 weeks confirmed these findings with further subjective improvement in the reduction of side effects . Conclusions By the using of the technology of cHH QOL and compliance did not improve . The side effects of CPAP therapy without humidification with respect to nasopharyngeal dryness , however , was reduced immediately as well as during the first weeks of treatment The aim of this trial was to evaluate the effectiveness of continuous positive airway pressure ( CPAP ) in patients with mild sleep apnea- hypopnea syndrome ( SAHS ) . One hundred forty-two consecutive patients with mild SAHS ( apnea-hypopnea index 10 - 30 , without severe sleepiness ) were r and omly assigned to receive conservative treatment (CT)-sleep hygiene and weight loss-(65 patients ) or CT plus CPAP ( 77 patients ) , and 125 patients ( 86 % males , age : 54 + /- 9 yr , BMI : 29 + /- 4 kg/m(2 ) , AHI : 20 + /- 6 , ESS : 12 + /- 4 ) completed the follow-up . The following outcomes were assessed at inclusion and after 3 and 6 mo of treatment : sleepiness ( Epworth scale , multiple sleep latency test [ MSLT ] ) , other symptoms related to SAHS , cognitive function , and perceived health status ( Functional Outcomes of Sleep Question naire [ FOSQ ] , Nottingham Health profile ) . The relief of SAHS-related clinical symptoms was significantly greater in the CPAP group than in the CT group ; the Epworth scale and FOSQ also showed more improvement in the CPAP group but did not reach significance . There were no significant differences in the other tests performed probably because the baseline values were normal . CPAP compliance was 4.8 + /- 2.2 h and treatment continuation was accepted by 62 % of the patients at the end of the study . These results suggest that CPAP can be considered in treating patients with mild SAHS  on the basis of an improvement in symptoms BACKGROUND The sleep apnoea/hypopnoea syndrome ( SAHS ) causes snoring , apnoeas , and restlessness during sleep which partners frequently complain about . A study was undertaken to determine the impact on partners of SAHS and of treatment of the patient with continuous positive airway pressure ( CPAP ) . METHODS Forty nine partners and patients with SAHS booked for CPAP treatment  completed in house and vali date d question naires ( Pittsburgh sleep quality index , Short Form 36 self-reported health status ) before the patient started treatment . Twenty three couples in whom the index SAHS patient had no driving problems were recruited to a r and omised crossover trial with 1 month limbs of CPAP and placebo capsule . At the end of each limb the partners ' sleep was monitored by  home polysomnography ( PSG ) and question naires were completed . RESULTS Before treatment partners frequently reported moderate to severe disturbance from patient snoring/apnoeas/restlessness and had poor sleep quality and self-reported health status . In the crossover study ( 22 completed ) the partners ' objective sleep quality did not differ between CPAP and placebo , but they reported benefit from treatment of the patients with CPAP in subjective sleep quality ( p=0.05 ) and disturbance to sleep ( p=0.03 ) . The reported change in partners ' sleep quality between pre- study and following CPAP treatment correlated positively with CPAP use ( r=0.5 , p=0.01 ) . CONCLUSIONS Partners of patients with SAHS have poor sleep quality and self-reported health status but only subjective sleep quality benefits from treatment of the patient with CPAP STUDY OBJECTIVES Previous studies have shown that CPAP has a substantial impact on daytime symptoms and quality of life ( QOL ) . It remains unclear which outcome measures best identify real CPAP effects and carry independent information . METHODS One hundred-two men with moderate-severe obstructive sleep apnea were r and omized to either " real " or " sham " CPAP for one month . Outcome measures were subjective sleepiness ( Epworth Sleepiness Scale [ ESS ] ) and QOL measures includiig SF-36/SF-12 and Calgary Sleep Apnea Quality of Life Index ( SAQLI ) . The bed partner 's  QOL and rating of patient 's response to CPAP were assessed with the Dublin question naire . All data were st and ardized using effect sizes and expressed as real minus sham to remove the nonspecific effects of placebo . RESULTS Real CPAP was superior to sham CPAP in almost all outcome measures . ESS , patient 's component from Dublin , and social interactions from SAQLI showed the largest differences in effect sizes between real and sham ( 1.33 , 0.98 , and 0.92 respectively ) . ESS carried the highest predictive power of real CPAP response ( P < 0.0001 , r2 = 0.21 ) . Question number 5 from Dublin ( partner assessed patient 's sleep quality ) and question 6 from ESS ( dozing while talking ) were the best single item predictors of real CPAP response . CONCLUSIONS Real CPAP reduces subjective sleepiness and improves  QOL  of both patients and bed partners . ESS is the best score ; question number 5 from Dublin and question number 6 from ESS are the best single item predictors of real CPAP response . This information should allow the selection of appropriate questions in clinical practice and research protocol OBJECTIVES This study compares the efficacy of 2 tongue-base surgical procedures in the treatment of patients with moderate to severe sleep-disordered breathing . STUDY DESIGN AND SETTING We conducted a prospect i ve , r and omized crossover surgical trial at a university hospital . METHODS Seventeen patients with moderate to severe sleep-disordered breathing and Fujita type II upper airway collapse for whom conservative treatment failed were enrolled into an institutional review board-approved surgical protocol . They were r and omly assigned to undergo palatopharyngoplasty combined with either tongue advancement ( m and ibular osteotomy ) or tongue suspension . Parameters assessed included severity of sleep-disordered breathing ( polysomnography ) , sleepiness ( Epworth Sleepiness Scale ) , and anatomic changes ( upper airway endoscopy ) , as well as demographic factors . Patients not achieving satisfactory improvement in their condition were offered nonsurgical management or additional surgical treatment that varied based on the postoperative assessment but included crossing over to the other tongue surgical procedure . RESULTS Nine of the 17 patients were r and omized to the tongue suspension group , and 8 to the tongue advancement group . In the 9 tongue suspension patients , Epworth Sleepiness Scale scores fell from 12.1 to 4.1 ( P = 0.007 ) . Airway collapse for all 9 patients measured on Müller maneuver improved , by a mean of 64 % ( P = 0.0006 ) at the palate and 83 % ( P = 0.0003 ) at the base of the tongue . In the 8 tongue advancement patients , Epworth Sleepiness Scale scores fell from a mean of 13.3 to 5.4 ( P = 0.004 ) . Airway collapse for 5 of 8 patients measured on Müller maneuver improved by a mean of 31 % ( P = 0.1 ) at the palate and 75 % ( P = 0.03 ) at the base of the tongue . CONCLUSION Prospect i ve , r and omized trials of tongue-base surgery for sleep-disordered breathing are possible . Preliminary findings from the current protocol reveal a slight advantage of tongue suspension over tongue advancement STUDY OBJECTIVES Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure ( CPAP ) in treating patients with obstructive sleep apnea syndrome ( OSAS ) . In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS . DESIGN Cohort study of a previously conducted r and omized clinical trial . SETTING University Medical Center , Groningen , The Netherl and s. PATIENTS OR PARTICIPANTS One hundred three patients with OSAS . INTERVENTIONS CPAP and oral appliance therapy ( Thornton Adjustable Positioner type-1 , Airway Management , Inc. , Dallas , TX , USA ) . MEASUREMENTS AND RESULTS Objective ( polysomnography ) and subjective ( Epworth Sleepiness Scale , Functional Outcomes of Sleep Question naire , Medical Outcomes Study 36-item Short Form Health Survey [ SF-36 ] ) parameters were assessed after 1 and 2 years of treatment . Treatment was considered successful when the apnea-hypopnea index ( AHI ) was < 5 or showed substantial reduction , defined as reduction in the index of at least 50 % from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy . Regarding the proportions of successful treatments , no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up . More patients ( not significant ) dropped out under oral appliance therapy ( 47 % ) compared with CPAP ( 33 % ) . Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes . However , CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy ( P < 0.05 ) . CONCLUSIONS Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure ( CPAP ) in patients with mild to moderate obstructive sleep apnea syndrome ( OSAS ) . In patients with severe OSAS , CPAP remains the treatment of first choice . CLINICAL TRIAL INFORMATION The original r and omized clinical trial , of which this study is a 2-year follow-up , is registered at IS RCT N.org ; identifier : IS RCT N18174167 ; trial name : Management of the obstructive sleep apnea-hypopnea syndrome : oral appliance versus continuous positive airway pressure therapy ; URL : http://www.controlled-trials.com/IS RCT N18174167 OBJECTIVES Temperature-controlled radiofrequency volumetric reduction ( TCRF ) , a minimally invasive procedure , has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome ( OSAS ) . An adjunctive method was objective ly evaluated . METHOD A prospect i ve , nonr and omized clinical study was undertaken on 20 consecutive OSAS patients with isolated tongue base obstruction .  Under local anesthesia , multiple lesions of the ventral tongue ( genioglossus insertion ) and dorsal tongue were given at each treatment session . A visual analog scale was used to assess changes in speech and swallowing . Polysomnography and Epworth Sleepiness Scale ( ESS ) were used to assess outcome . Patients were maintained on nasal continuous positive airway pressure after each treatment . RESULTS Patients received a mean 4.6 + /- 0.6 treatments for a mean total of 7915 + /- 1152 joules . There was no significant change in speech or swallowing at 3 months after completion of treatment . Patients reported a significant decrease in sleepiness with a mean change in ESS from 12.4 + /- 2.9 to 7.3 + /- 3.0 ( P < 0.001 ) . Mean apnea/hypopnea index decreased from 35.1 + /- 18.1 to 15.1 + /- 17.4 ( P < 0.001 ) . Transient mild to moderate pain and swelling occurred after each treatment . There were no significant complications ( ulceration , paresthesia , infection ) . CONCLUSION TCRF can successfully treat the OSAS patient with tongue base obstruction . Combined treatment of the ventral ( genioglossus insertion ) and dorsal tongue appears safe and may improve outcome with less total energy when compared with traditional dorsal-only applications Objective Evaluate long-term safety and outcomes of palatal implants for patients with mild to moderate obstructive sleep apnea ( OSA ) . Study Design and Setting Continuation of a prospect i ve case series of patients with palatal implants .  Polysomnography , daytime sleepiness , and snoring intensity were measured at baseline , 90 days , and extended follow-up . Results Twenty-two ( 42 % ) patients from the previous study were followed for a median of 435.5 days . Thirteen were classified as responders , based on their 90-day evaluation . 76.9 % of initial responders maintained improvements in apnea-hypopnea index ( AHI ) , daytime sleepiness , and snoring at extended follow-up . Nine patients were initial nonresponders for AHI and daytime sleepiness and remained unchanged at extended follow-up . However , snoring for these nine patients initially improved , and the improvement continued through extended follow-up . Conclusion Initial response or nonresponse to palatal implants remains stable over an extended period . The generalizability of these results is unknown because of significant loss to follow-up . Significance Study results report safety and beneficial long-term outcomes of palatal implants for mild to moderate OSA treatment in selected patients RATIONALE Continuous positive airway pressure ( CPAP ) is the current treatment for patients with symptomatic obstructive sleep apnea ( OSA ) . Its use for all subjects with sleep-disordered breathing , regardless of daytime symptoms , is unclear . OBJECTIVES This multicenter controlled trial assesses the effects of 1 year of CPAP treatment on blood pressure ( BP ) in nonsymptomatic , hypertensive patients with OSA . METHODS We evaluated 359 patients with OSA . Inclusion criteria consisted of an apnea-hypopnea index ( AHI ) greater than 19 hour(-1 ) , an Epworth Sleepiness Scale score less than 11 , and one of the following : under antihypertensive treatment or systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 mm Hg . Patients were r and omized to CPAP ( n = 178 ) or to conservative treatment  ( n = 181 ) . BP was evaluated at baseline and at 3 , 6 , and 12 months of follow-up . MEASUREMENTS AND MAIN RESULTS Mean ( SD ) values were as follows : age , 56 + /- 10 years ; body mass index ( BMI ) , 32 + /- 5 kg x m(-2 ) ; AHI , 45 + /- 20 hour(-1 ) ; and Epworth Sleepiness Scale score , 7 + /- 3 . After adjusting for follow-up time , baseline blood pressure values , AHI , time with arterial oxygen saturation less than 90 % , and BMI , together with the change in BMI at follow-up , CPAP treatment decreased systolic blood pressure by 1.89 mm Hg ( 95 % confidence interval : -3.90 , 0.11 mm Hg ; P = 0.0654 ) , and diastolic blood pressure by 2.19 mm Hg ( 95 % confidence interval : -3.46 , -0.93 mm Hg ; P = 0.0008 ) . The most significant reduction in BP was in patients who used CPAP for more than 5.6 hours per night . CPAP compliance was related to AHI and the decrease in Epworth Sleepiness Scale score . CONCLUSIONS In nonsleepy hypertensive patients with OSA , CPAP treatment for 1 year is associated with a small decrease in BP . This effect is evident only in patients who use CPAP for more than 5.6 hours per night . Clinical trial registered with www . clinical trials.gov ( NCT00127348 ) In the current study , we evaluated the effectiveness of uvulopalatopharyngoplasty ( UPPP ) in treatment of patients with obstructive sleep apnea ( OSA ) syndrome .  All patients were previously received medical treatment but their symptoms did not resolve . A prospect i ve study was conducted in Shahid Sadoughi Hospital in Yazd , Iran . Several sleep indices were evaluated using polysomnography ( PSG ) in all patients before performing UPPP and tonsillectomy . All patients were visited 6 months after surgery and PSG was repeated to assess the efficacy of surgical intervention . A total of 48 patients were enrolled and underwent UPPP and tonsillectomy .  Six months after surgery , significant improvements were observed in all indices of sleep ( apnea – hypopnea index , respiratory distress index , arterial oxygen saturation , and snoring index ) . The score of daytime sleepiness ( assessed by Epworth score ) was also improved . According to the result of this study , using UPPP surgery in patients with OSA  can cause symptoms improvement in 64 % of cases . It seems that Muller ’s maneuver test has assisted in briefly increasing success rate after surgery , though to prove this cl aim ; other studies should be design ed and performed in a r and omized clinical trial STUDY OBJECTIVE To compare efficacy , side effects , patient compliance , and preference between oral appliance ( OA ) therapy and nasal-continuous positive airway pressure ( N-CPAP ) therapy . DESIGN R and omized , prospect i ve , crossover study . SETTING University hospital and tertiary sleep referral center . PATIENTS Twenty-seven unselected patients with mild-moderate obstructive sleep apnea ( OSA ) . INTERVENTIONS There was a 2-week wash-in and a 2-week wash-out period , and 2 x 4-month treatment periods ( OA and N-CPAP ) . Efficacy , side effects , compliance , and preference were evaluated by a question naire and home sleep monitoring . MEASUREMENTS AND RESULTS Two patients dropped out early in the study and treatment results are presented on the remaining 25 patients . The apnea/hypopnea index was lower with N-CPAP ( 3.5 + /- 1.6 ) ( mean + /- SD ) than with the OA ( 9.7 + /- 7.3 ) ( p < 0.05 ) . Twelve of the 25 patients who used the OA ( 48 % ) were treatment successes ( reduction of apnea/hypopnea to < 10/h and relief of symptoms ) , 6 ( 24 % ) were compliance failures ( unable or unwilling to use the treatment ) , and 7 ( 28 % ) were treatment failures ( failure to reduce apnea/hypopnea index to < 10/h and /or failure to relieve symptoms ) . Four people refused to use N-CPAP after using the OA . Thirteen of the 21 patients who used N-CPAP were overall treatment successes ( 62 % ) , 8 were compliance failures ( 38 % ) , and there were no treatment failures . Side effects were more common and the patients were less satisfied with N-CPAP ( p < 0.005 ) . Seven patients were treatment successes with both treatments , six of these patients preferred OA , and one preferred N-CPAP as a long-term treatment . CONCLUSIONS We conclude that OA is an effective treatment in some patients with mild-moderate OSA and is associated with fewer side effects and greater patient satisfaction than N-CPAP STUDY OBJECTIVES Evaluate the long-term durability of treatment response and safety of a nasal expiratory positive airway pressure ( EPAP ) device used to treat obstructive sleep apnea ( OSA ) . DESIGN A prospect i ve , multicenter , single-arm , open-label extension to a 3-month EPAP vs sham r and omized clinical trial SETTING 13 sites including both academic and private sleep disorder centers PATIENTS OSA patients in the EPAP arm of the EPAP vs sham r and omized study who used the EPAP device ≥ 4 h per night , ≥ 5 nights per week on average during months 1 and 2 of the 3-month trial and had ≥ 50 % reduction in AHI or AHI reduction to < 10 documented by polysomnography , comparing the 3-month device-on PSG to the week-one device-off PSG . INTERVENTIONS Treatment with a nasal EPAP device  ( N = 41 ) for 12 months . Polysomnography ( PSG ) on the patients wearing the device was performed after 12 months of treatment . The month 12 device-on PSG data from the analyzable subject cohort ( N = 34 ) was compared to the week 1 device-off PSG from the EPAP vs sham trial . MEASUREMENTS AND RESULTS Of the 51 patients eligible , 34 were still using the EPAP device at the end of 12 months . Median AHI was reduced from 15.7 to 4.7 events/h ( week 1 device-off versus month 12 device-on ) . The decrease in the AHI ( median ) was 71.3 % ( p < 0.001 ) . The median proportion of sleep time with snoring was reduced by 74.4 % ( p < 0.001 ) . Over 12 months of EPAP  treatment , the Epworth Sleepiness Scale decreased ( 11.1 ± 4.2 to 6.0 ± 3.2 , p < 0.001 ) , and the median percentage of reported nights used ( entire night ) was 89.3 % . CONCLUSIONS Nasal EPAP  significantly reduced the AHI , improved subjective daytime sleepiness and reduced snoring after 12 months of treatment . Long-term adherence to EPAP was excellent in those who had a positive clinical response at month 3 of the EPAP vs sham study . CLINICAL TRIAL REGISTRATION Clinical Trials.gov TRIAL NAME : Extension Study of Original Protocol AERO C009 for Obstructive Sleep Apnea-hypopnea ( AERO C009E ) . URL : http:// clinical trials.gov/ct2/show/NCT00849043?term=Ventus+Medical&rank=2 . REGISTRATION NUMBER NCT00849043 STUDY OBJECTIVES To evaluate the effects of treatment with a dental appliance or uvulopalatopharyngoplasty ( UPPP ) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea ( OSA ) followed up for 4 years , and compliance and complementary treatment . DESIGN R and omized study . SETTING Central Hospital , Västerås , Uppsala University , Sweden . PATIENTS Ninety-five male patients with confirmed mild-to-moderate OSA ( apnea index [ AI ] > 5 and < 25 ) were r and omized to treatment with a dental appliance or UPPP .  Sleep studies were performed before and 1 year and 4 years after intervention . Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up . RESULTS The success rate ( percentage of patients with at least 50 % reduction in AI ) in the dental-appliance group was 81 % , which was significantly higher than in the UPPP group , 53 % ( p < 0.05 ) . Normalization ( AI < 5 or apnea/hypopnea index < 10 ) was observed in 63 % of the dental-appliance group and 33 % of the UPPP group after 4 years . The difference between the groups was significant ( p < 0.05 ) . The compliance to use of the dental appliance was 62 % at the 4-year follow-up . Thirty patients ( 75 % ) in the UPPP group continued without complementary treatment . The dental appliances had few adverse effects on the stomatognathic system , and the number of adjustments and repairs of the appliances over time was moderate . Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty with swallowing after UPPP were reported by 8 % and 10 % , respectively . CONCLUSIONS The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group , but the effectiveness of the dental appliance was partly invali date d by the compliance of 62 % at the 4-year follow-up . However , the appliances had few adverse effects on the stomatognathic system and required only moderate adjustments . Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA OBJECTIVES /HYPOTHESIS Healthcare remunerating agencies in North America require patients with obstructive sleep apnea ( OSA ) to undergo a continuous positive airway pressure ( CPAP ) trial before funding surgical therapy . The adherence rate of CPAP is problematic . This study 's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy , and to explore consideration of surgical therapy as first-line treatment in this specific OSA sub population . STUDY DESIGN This was a prospect i ve cohort study . METHODS Patients with moderate-severe OSA who had failed a minimum 6-month trial of CPAP were recruited . All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty ± septoplasty .  Outcome measures included apnea-hypopnea index ( AHI ) , Epworth Sleepiness Scale ( ESS ) , and Sleep Apnea Quality of Life Index ( SAQLI-E ) , and blood pressure . Patients were followed for 1 year . RESULTS By AHI measurement , 85.7 % of patients in the entire cohort were successfully treated by surgery . ESS while on CPAP was 13.7 ± 2.9 , improving to 4.1 ± 2.5 after surgery . SAQLI-E scores on CPAP were 25.7 ± 5.8 , improving to 10.2 ± 3.2 after surgery . Blood pressure remained elevated during CPAP but normalized after surgery . All changes were significant at P < .001 . CONCLUSIONS Surgical intervention improved OSA severity as measured by the ESS , SAQLI-E , and blood pressure . These measures had not improved on CPAP . AHI improved as well . Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP , without confounding issues of treatment adherence and with only minor surgical risk . LEVEL OF EVIDENCE 2 Laryngoscope 124:S1-S9 , 2014 Continuous positive airway pressure ( CPAP ) is the treatment of choice for the sleep apnoea/hypopnoea syndrome ( SAHS ) ; it is usually given with the aim of improving daytime cognitive function , mood , and sleepiness . However , its efficacy has not been vali date d by controlled trials . We have carried out a r and omised , placebo-controlled , crossover study of objective daytime sleepiness , symptoms , cognitive function , and mood in a consecutive series of 32 SAHS patients with a median apnoea plus hypopnoea frequency of 28 ( range 7 - 129 ) per hour slept . Patients were treated with 4 weeks each of CPAP and an oral placebo , which they were told might improve upper airway muscle function during sleep . Assessment s on the last day of each treatment included a multiple sleep latency test and tests of symptom scores , mood profiles , and cognitive performance . The patients had significantly less daytime sleepiness on CPAP than during the placebo period ( mean sleep latency 7.2 [ SE 0.7 ] vs 6.1 [ 0.7 ] min , p = 0.03 ) . There were also improvements with CPAP in symptom ratings ( 2.1 [ 0.2 ] vs 4.3 [ 0.3 ] , p < 0.001 ) , mood ( p < 0.05 for several measures ) , and cognitive performance , which showed improved vigilance ( obstacles hit in Steer Clear " driving " test 76 [ 5 ] vs 81 [ 6 ] , p < 0.01 ) , mental flexibility ( trail-making B time 66 [ 5 ] vs 75 [ 5 ] s , p < 0.05 ) , and attention ( p < 0.05 ) . Objective ly monitored CPAP use averaged only 3.4 ( 0.4 ) hours per night , but this study provides evidence of improved cognitive performance even at this low level of CPAP compliance RATIONALE To establish a new approach to investigate the physiological effects of obstructive sleep apnea ( OSA ) , and to evaluate novel treatments , during a period of continuous positive airway pressure ( CPAP ) withdrawal . OBJECTIVES To determine the effects of CPAP withdrawal . METHODS Forty-one patients with OSA and receiving CPAP were r and omized to either CPAP withdrawal ( subtherapeutic CPAP ) , or continued CPAP , for 2 weeks . Polysomnography , sleepiness , psychomotor performance , endothelial function , blood pressure ( BP ) , heart rate ( HR ) , urinary catecholamines , blood markers of systemic inflammation , and metabolism were assessed . MEASUREMENTS AND MAIN RESULTS CPAP withdrawal led to a recurrence of OSA within a few days and a return of subjective sleepiness , but was not associated with significant deterioration of psychomotor performance within 2 weeks . Endothelial function , assessed by flow-mediated dilatation , decreased significantly in the CPAP withdrawal group compared with therapeutic CPAP ( mean difference in change , -3.2 % ; 95 % confidence interval [ CI ] , -4.5 , -1.9 % ; P < 0.001 ) . Compared with continuing CPAP , 2 weeks of CPAP withdrawal was associated with a significant increase in morning systolic BP ( mean difference in change , + 8.5 mm Hg ; 95 % CI , + 1.7 , + 15.3 mm Hg ; P = 0.016 ) , morning diastolic BP ( mean difference in change , + 6.9 mm Hg ; 95 % CI , + 1.9 , + 11.9 mm Hg ; P = 0.008 ) , and morning HR ( mean difference in change , + 6.3 bpm , 95 % CI , + 0.4 , + 12.2 bpm ; P = 0.035 ) . CPAP withdrawal was associated with an increase in urinary catecholamines but did not lead to an increase in markers of systemic inflammation , insulin resistance , or blood lipids . CONCLUSIONS CPAP withdrawal usually leads to a rapid recurrence of OSA , a return of subjective sleepiness , and is associated with impaired endothelial function , increased urinary catecholamines , blood pressure , and heart rate . Thus the proposed study model appears to be suitable to evaluate physiological and therapeutic effects in OSA . Clinical trial registered with www.controlled-trials.com ( IS RCT N93153804 ) The place of surgical treatment in obstructive sleep apnea syndrome ( OSAS ) remains unclear . Uvulopalatopharyngoplasty ( UPPP ) has a response rate of 41 % overall and only 5 % when retrolingual narrowing is present . Thus , in cases with suspected hypopharyngeal collapse  maxillofacial surgery has been proposed with improved results . The Stanford group has design ed a step-by-step surgical procedure tailored to the specific anatomical abnormalities encountered in each patient . The goal is to avoid a full maxillom and ibular advancement osteotomy ( MMO ) , at least in a subgroup of patients , beginning with a limited m and ibular osteotomy ( with or without hyoid myotomy and hyothyroidopexy and with or without UPPP ) ( phase 1 surgery ) . In this procedure MMO is performed as the second or third step ( phase 2 surgery ) . The present study reports on our prospect i ve experience with 51 consecutive patients ( 64 surgical procedures ) treated by the step-by-step maxillofacial surgery previously described by the Stanford team . Only 2 of the 53 patients initially treated were lost for follow-up . Surgery was considered a success if the postoperative apnea and hypopnea index ( AHI ) was less than 15/h with at least a 50 % reduction . Forty-four patients had phase 1 surgery . The success rate was 22.7 % ( 10 of 44 ) . The mean AHI was unchanged with a trend for reduction in the apnea index . Twenty patients had maxillom and ibular advancement surgery ( phase 2 ) ( 13 failures of phase 1 , 7 patients primarily because of facioskeletal deformities ) . The AHI decreased from 59 + /- 29/h to 11 + /- 9/h after phase 2 . Of the patients 75 % ( 15 of 20 ) were considered to have had a successful outcome . In conclusion , phase 1 does not seem effective in most patients with OSAS . The results of phase 2 surgery are successful in young patients with severe OSAS even if the surgical technique is more aggressive BACKGROUND Continuous positive airway pressure ( CPAP ) is an effective treatment in patients with moderate and severe sleep apnoea/hypopnoea syndrome ( SAHS ) , but the minimum illness severity at which patients obtain benefit from CPAP is unclear . A study was therefore undertaken to investigate whether CPAP improves symptoms and daytime function in patients with mild SAHS . METHODS Sixteen consecutively recruited patients with mild SAHS ( 5.0 - 14.9 apnoeas + hypopnoeas per hour slept and two or more symptoms of SAHS ) participated in a prospect i ve placebo controlled r and omised crossover trial to assess the effects of CPAP on symptoms and daytime function . Patients spent four weeks on placebo and four weeks on CPAP , undergoing assessment s of sleepiness , symptoms , cognitive performance , and well being on the last day of each treatment . Data from the placebo and CPAP assessment s were compared . RESULTS The mean ( SE ) objective effective use of CPAP was 2.8 ( 0.7 ) hours per night . Significant improvements in symptom score ( -1.7 ( 0.5 ) , p < 0.01 ) , mental flexibility ( -14 ( 5 ) seconds , p = 0.02 ) , and depression rating ( -1.6 ( 0.8 ) , p = 0.03 ) on CPAP were observed . However , no significant differences in subjective or objective sleepiness were found . Ten of the 16 patients preferred CPAP and opted to continue with this treatment , although this proportion was non-significant ( p > 0.4 ) . The eight patients with best CPAP use showed an additional CPAP related improvement in quality of life ( -4.4 ( 1.8 ) , p = 0.03 ) . Those who complied better with CPAP therapy also had a higher average microarousal frequency ( p < 0.01 ) and apnoea+hypopnoea index ( p = 0.02 ) than the poorer compliers . CONCLUSIONS The results of this study provide evidence for improvements in symptoms and daytime function for patients with mild SAHS treated with CPAP Objective . To test the hypothesis that uvulopalatopharyngoplasty ( UPPP )  improves sleep apnea – related quality of life ( measured on the Functional Outcomes of Sleep Question naire [ FOSQ ] ) at 3-month follow-up . Secondary objectives were to test ( 1 ) the stability of the outcomes at 6 months , ( 2 ) the effect on global sleep apnea quality -of-life change , and ( 3 ) the effect on sleep apnea symptoms . Study Design . Multicenter , prospect i ve , longitudinal case series . Setting . Diverse university- and community-based otolaryngology practice s. Subjects and Methods . The cohort included 68 patients from 17 practice s , with a mean ± st and ard deviation age of 44 ± 12 years and mean apnea-hypopnea index of 35 ± 32 events/hour . All patients underwent UPPP  , defined as an open procedure modifying the shape and size of the palate , pharynx , and uvula , with or without tonsillectomy . Baseline data were collected on site before surgery , and outcome data were collected by mail 3 and 6 months after surgery , with follow-up rates of 51 % and 50 % , respectively . Results . FOSQ scores improved from 14.3 ± 3.4 ( scale 5 - 20 , normal ≥17.9 ) at baseline to 17.2 ± 2.7 at 3 months ( mean improvement 2.9 ; 95 % confidence interval , 1.8 - 4.0 ; P < .001 ) and 17.5 ± 2.5 at 6 months ( mean improvement 3.1 ; 95 % confidence interval , 2.0 - 4.2 ; P < .001 ) . All quality -of-life and symptom measures improved significantly at 3 and 6 months ( all P < .05 ) . Conclusion . This prospect i ve , multicenter , university- and community-based study provides evidence that UPPP significantly improves disease-specific quality of life and sleep apnea symptoms in patients with sleep apnea . Validity may be limited by significant loss to follow-up and absence of an unoperated control group OBJECTIVE AND HYPOTHESIS Obstructive sleep apnea ( OSA ) is a relatively common and serious problem with many medical and social consequences . Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia , but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes . In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term . STUDY DESIGN A total of 150 patients with apnoea hypopnoea index ( AHI ) between 5 and 30 events per hour , no morbid obesity and retropalatal site of obstruction were included in this prospect i ve study . METHODS Patients were r and omly and equally divided into two groups , each comprising 75 patients . The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate ( BRVTR ) and the second group was treated with laser-assisted uvulopalatoplasty ( LAUP ) . Each group was further subdivided into five subgroups each consisting of 15 patients . The first group received one treatment session , the second received two sessions , the third received three sessions , the fourth received four sessions and the fifth group received five treatment sessions . Evaluation of efficiency of both techniques in treating OSA was assessed objective ly by polysomnography . RESULTS In those treated with BRVTR ; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term . In those treated with LAUP , a single treatment session was enough to achieve a favourable outcome on OSA in the short term , while two sessions were needed to achieve the same long-term outcome . DISCUSSION In OSA , fewer treatment sessions are needed with LAUP ( one session ) than with BRVTR ( three sessions ) to achieve a favourable outcome . In LAUP more treatment sessions ( two ) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable outcome ( one session ) , which is not the case with BRVTR ( three sessions are needed to achieve both short- and long-term favourable results ) BACKGROUND Obstructive sleep apnea syndrome ( OSAS ) is an independent risk factor for arterial hypertension . Several controlled trials have investigated the effect of continuous positive airway pressure ( CPAP ) on BP in patients with OSAS , but its effect on hypertensive patients has not been analyzed specifically . OBJECTIVE To analyze the effect of CPAP on ambulatory BP in patients with OSAS and hypertension who were undergoing antihypertensive treatment . DESIGN AND PATIENTS We conducted a parallel , r and omized , placebo-controlled trial in 68 patients with OSAS and hypertension , who were receiving treatment with antihypertensive medication .  Patients were r and omly allocated to either therapeutic or subtherapeutic CPAP for 4 weeks . Ambulatory BP was registered at baseline and after treatment . Antihypertensive treatment was not changed during the study . Changes in BP were assessed on an intention-to-treat basis . RESULTS There were no baseline differences in the apnea-hypopnea index , comorbidities , or ambulatory BP between groups . Objective compliance with CPAP was similar in both the therapeutic and subtherapeutic groups ( 5.0 + /- 1.4 h/d vs 4.4 + /- 1.9 h/d , respectively ; p = 0.13 [ mean + /- SD ] ) . There was a small and statistically nonsignificant decrease ( - 0.3 + /- 6.3 mm Hg vs - 1.1 + /- 7.9 mm Hg ; difference , - 0.8 mm Hg [ 95 % confidence interval , - 2.7 to 4.3 ] ; p = 0.65 ) in 24-h mean BP ( 24hMBP ) in both subtherapeutic and therapeutic groups after 4 weeks of treatment . No significant changes in systolic , diastolic , daytime , or nighttime BP were observed . The normal circadian dipper pattern was restored in a higher proportion of patients in the therapeutic group compared to the subtherapeutic CPAP group , although differences were not significant ( 11 of 32 patients vs 3 of 25 patients ; odds ratio , 3.84 ; 95 % confidence interval , 0.82 to 20.30 ; p = 0.10 ) . There was no correlation between the magnitude of change in 24hMBP and CPAP compliance , OSAS severity , or number of antihypertensive drugs used . CONCLUSION Four weeks of CPAP did not reduce BP in patients with OSAS and hypertension who were treated with antihypertensive medication , compared to placebo group OBJECTIVES /HYPOTHESIS An outpatient surgical procedure for snoring and obstructive sleep apnea syndrome ( OSAS ) should not only stiffen the soft palate , but also widen the opening of retropalatal space . This study presents a concurrent palatal implants ( PI ) and uvulopalatal flap ( UPF ) in the outpatient setting under local anesthesia for OSAS patients . STUDY DESIGN Prospect i ve study . METHODS Patients with snoring and more than or an equivalent of 5 events hourly but less than 20 hourly on the apnea-hypopnea index ( AHI ) were enrolled . Three office-based procedures were performed , that is , PI , UPF , and PI concurrent with UPF ( PI-UPF ) . Postoperative pain was evaluated using a visual analog scale . Before surgery and after surgery , subjective outcomes were assessed using the snoring scale , and objective outcomes were assessed using overnight polysomnography . RESULTS Sixty-three patients underwent office-based procedures for OSAS . Among them , 21 underwent PI , 20 underwent UPF , and 22 underwent PI-UPF . PI attained the lowest postoperative pain scores . At 6 months after surgery , the mean snoring scale in PI , UPF , and PI-UPF group were 3.7 ± 0.7 , 3.2 ± 0.8 , and 1.8 ± 0.6 , respectively ( P < .05 ) . The mean AHI scores in group PI , UPF , and PI-UPF were 9.0 ± 4.6 , 8.8 ± 4.0 , and 6.1 ± 2.5 events per hour , respectively ( P < .05 ) . The mean snoring index in group PI , UPF , and PI-UPF were 120.6 ± 79.5 , 115.7 ± 86.3 , and 71.8 ± 41.7 events per hour , respectively ( P < .05 ) . CONCLUSIONS Concurrent PI and UPF is a safe and effective office-based procedure for selected patients with OSAS and snoring Obstructive sleep apnea ( OSA ) is highly prevalent among patients with congestive heart failure ( CHF ) and may contribute to progression of cardiac dysfunction via hypoxia , elevated sympathetic nervous system activity , and systemic hypertension . Our aim was to assess the long-term effect of OSA treatment with nocturnal continuous positive airway pressure ( CPAP ) on systolic heart function , sympathetic activity , blood pressure , and quality of life in patients with CHF . Fifty-five patients with CHF and OSA were r and omized to 3 months of CPAP or control groups . End points were changes in left ventricular ejection fraction , overnight urinary norepinephrine excretion , blood pressure , and quality of life .  Nineteen patients in the CPAP group and 21 control subjects completed the study . Compared with the control group , CPAP treatment was associated with significant improvements in left ventricular ejection fraction ( delta 1.5 + /- 1.4 % vs. 5.0 + /- 1.0 % , respectively , p = 0.04 ) , reductions in overnight urinary norepinephrine excretion ( delta 1.6 + /- 3.7 vs. -9.9 + /- 3.6 nmol/mmol creatinine , p = 0.036 ) , and improvements in quality of life . There were no significant changes in systemic blood pressure . In conclusion , treatment of OSA among patients with CHF leads to improvement in cardiac function , sympathetic activity , and quality of life Continuous positive airway pressure ( CPAP ) is worldwide considered as the st and ard treatment of sleep apnea/hypopnea syndrome ( SAHS ) although studies on the effectiveness of this treatment are limited . The aim of our study was to evaluate the effectiveness of CPAP in improving SAHS-related symptoms , daytime function , perceived health status , and quality of life in patients with moderate to severe SAHS . The effect of conservative treatment ( CT ) measures -sleep hygiene and weight loss- was compared with CT + CPAP . We included 105 consecutive patients ( 13 females , age 53 + /- 10 yr , body mass index [ BMI ] = 32 + /- 6 kg/m2 , apnea/hypopnea index [ AHI ] = 56 + /- 20 , Epworth sleepiness scale [ ESS ] = 12 + /- 5 ) who met our criteria for CPAP treatment . Patients were r and omly allocated in two groups of similar characteristics . Group 1 ( n = 37 ) was asked to improve sleep hygiene and started a weight loss program . Group 2 ( n = 68 ) received , in addition , treatment with CPAP . Both groups were followed through weekly telephone calls and appointments . Sleepiness , other symptoms related to SAHS , daytime function , perceived health status , and quality of life were assessed through question naires at inclusion and after 3 mo of treatment . The relief of sleepiness and other SAHS-related clinical symptoms and improvement in perceived health status was much greater in Group 2 receiving CT + CPAP compared with Group 1 , only receiving CT . The odds of experiencing a treatment response with CPAP + CT compared with CT alone was 6.52 ( odds ratio [ OR ] = 2.51 to 17.6 , 95 % confidence interval [ 95 % CI ] ) . CPAP is currently the treatment of choice . At this time , the indication of CPAP treatment in moderate to severe SAHS is adequately supported The objectives of this study were : to evaluate the change in the three quality of life ( QOL ) dimensions of vitality , contentment and sleep before intervention and 1 year after treatment with a dental appliance or uvulopalatopharyngoplasty ( UPPP ) ; to compare the effect of treatment between these two treatment groups on these three dimensions ; and to determine the relation between the QOL scores and somnographic values . Ninety-five patients with mild to moderate obstructive sleep apnoea ( OSA ) ( AI > 5 ) were r and omly allocated to either a dental appliance or UPPP treatment group . Seven patients withdrew after r and omization but before treatment , leaving 88 patients eligible for treatment . The patients were examined using somnography and administered the Minor Symptoms Evaluation-Profile ( MSE-P ) , a QOL question naire , before and 1 year after intervention . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 1-year follow-up . The mean values for the three dimensions vitality , contentment and sleep improved significantly 1 year after intervention in the dental appliance and UPPP groups . No difference in the QOL scores at baseline was noted between the groups . One year after intervention the UPPP group showed significantly more contentment than the dental appliance group . In contrast , vitality and sleep dimensions did not differ between the two treatment groups . No significant correlations were observed between the QOL scores and somnographic values . In conclusion , quality of life improved significantly in the dental appliance and UPPP groups 1 year after intervention . However , the dental appliance group showed a lower level of contentment than the UPPP group , even though the somnographic values were superior in the former group The objective of this study was to investigate the effects on outcomes and morbidity of combining temperature-controlled radiofrequency ( TCRF ) tongue reduction with uvulopalatopharyngoplasty ( UPPP ) as an initial site-directed approach to the surgical treatment of obstructive sleep apnea syndrome ( OSAS ) . This investigation was a prospect i ve , nonr and omized , open-enrollment study of 20 consecutive eligible patients with OSAS . Seven patients had a single-level velopharyngeal obstruction ( Fujita type I or IIa ) , and they were assigned to undergo UPPP only ( group 1 ) . Thirteen patients had a multilevel velopharyngeal and retroglossal obstruction ( Fujita type IIb ) , and they were assigned to undergo TCRF tongue reduction in addition to UPPP ( group 2 ) . Patients who had only a retroglossal obstruction ( Fujita type III ) were not included in this study . Following their initial operation , nine patients in group 2 underwent two subsequent in-office TCRF tongue treatments under local anesthesia . Three patients in group 2 were lost to followup , and one patient underwent only one TCRF procedure at the initial operation ; data on the latter patient are included in some of the outcomes measures reported here where indicated , but no data are reported on the three who were lost to followup . The primary post-treatment outcomes measures were the results of comparative polysomnography and clinician and patient evaluations regarding morbidity and symptom improvement . Analysis of these data showed that there was no difference between the two groups in terms of postoperative pain or dysphagia following the initial operative session . The degree of symptom improvement in the two groups was similar . Overall success rates — as measured by the apnea/hypopnea index ( group 1 : 57.1 % success ; group 2 : 50.0 % ) and by the apnea index ( group 1 : 71.4 % success ; group 2 : 70.0%)—were statistically comparable , given the small size of the sample ( figures are based on 10 patients in group 2 ) . The author concludes that combining TCRT tongue reduction with UPPP in patients with multilevel obstruction improves response rates to a degree that is comparable to that seen with UPPP alone in patients with single-level velopharyngeal obstruction . Moreover , the combination treatment does not increase the risk of additional pain , morbidity , and complications compared with UPPP alone Objectives : We assessed the use of transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for the surgical management of tongue base obstruction in patients with obstructive sleep apnea . Methods : In a prospect i ve , nonr and omized trial using historical controls , patients underwent drug-induced sleep endoscopy , transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty , and preoperative and postoperative polysomnography .  Results : Twenty patients have completed the study to date . The rate of surgical success was 45 % , and the rate of surgical response was 65 % . The mean preoperative apnea-hypopnea index of 55.6 decreased by 56.7 % , to a mean postoperative value of 24.1 ( p < 0.001 ) , and the minimum arterial oxygen saturation increased from the mean preoperative value of 75.8 % to the mean postoperative value of 81.7 % ( p = 0.013 ) . The mean Epworth Sleepiness Scale score improved from 13.4 to 5.9 ( p = 0.003 ) . One patient had postoperative bleeding that required cauterization , result ing in a major complication rate of 4.2 % . Conclusions : Transoral robot-assisted lingual tonsillectomy with uvulopalatopharyngoplasty is a novel technique for the surgical management of obstructive sleep apnea that results in a significant decrease in the apnea-hypopnea index , a significant improvement in minimum arterial oxygen saturation , and a significant improvement in the Epworth Sleepiness Scale score and has an acceptable complication rate Objective To investigate the safety and efficacy of combined temperature-controlled radiofrequency volumetric tissue reduction of the tongue base and soft palate in obstructive sleep apnoea . Material and methods A total of 20 patients with obstructive sleep apnoea and combined palatal and retrolingual obstruction were included in a non-r and omized clinical trial and 51 combined treatments were performed  under local anaesthesia .  Postoperative pain was assessed using visual analogue scales . Functional parameters , daytime sleepiness and quality of life were assessed using question naires ( Epworth Sleepiness Scale , Short Form-36 ) before and 12 weeks after the last treatment session . Concurrently ,  polysomnography  was performed on two consecutive nights . Results The mean postoperative pain score dropped from 5.6 at Day 1 to 0.6 at Day 7 . Painkillers were taken for a mean of 3.3 days . There were no postoperative complications or changes in functional parameters . Daytime sleepiness improved significantly ( p<0.05 ) . The mean respiratory disturbance index was reduced from 25.3±11.4 to 16.7±15.3 ( p<0.05 ) . Six out of 18 ( 33 % ) patients were cured after a mean of 2.7 treatment sessions . Conclusion Combined radiofrequency volumetric tissue reduction of the tongue base and soft palate is a safe and effective treatment for obstructive sleep apnoea OBJECTIVE To study long-term results in patients undergoing uvulopalatal flap ( UPF ) for obstructive sleep apnea ( OSA ) . DESIGN Prospect i ve , clinical trial at tertiary referral center . MATERIAL AND METHODS A study was undertaken on 83 OSA patients with palatal obstruction based on radiography and physical findings .  UPF was conducted to increase the airway space and data were analyzed . RESULTS Patients had a mean age of 36.5 ± 12.3 years and a mean body mass index ( BMI ) of 29.4 ± 4.3 kg/m(2 ) . The mean follow-up was 54.2 ± 8.9 months , with a range of 48 to 62 months . The mean baseline apnea-hypopnea index ( AHI ) , short-term AHI , and long-term AHI were 45.6 ± 10.3 , 13.4 ± 5.2 , and 19.4 ± 5.1 , respectively . The mean baseline lowest oxygen saturation ( LSAT ) , short-term LSAT , and long-term LSAT were 82.6 ± 5.4 % , 89.2 ± 4.8 % , and 88.1 ± 3.2 % , respectively . Forty-three patients ( 51.8 % ) had long-term success , and 15 patients ( 25.8 % ) had an increase in the AHI over the follow-up period such that they were no longer considered success by traditional AHI criteria . Serious complications were not encountered . CONCLUSIONS UPF is a safe and effective procedure that results in long-term success for OSA . However , a regular follow-up is important because some patients will relapse in the long term STUDY OBJECTIVES ( 1 ) To determine the efficacy of automatically adjusted positive airway pressure ( APAP ) with a comfort feature ( A-Flex ) at reducing  apneas and hypopneas in participants with moderate to severe OSA . ( 2 ) To determine the relative difference between A-Flex , continuous positive airway pressure ( CPAP ) , and APAP-derived optimal pressure for CPAP ( CPAP(APAP ) ) on adherence to treatment . ( 3 ) To determine the relative difference between APAP with A-Flex , CPAP , and CPAP(APAP ) on long-term change in functional outcomes . DESIGN R and omized , double-blinded , 3-arm , multicenter trial . SETTING University and Veterans Affairs medical centers . PATIENTS OR PARTICIPANTS 168 participants were r and omized , and 140 completed the 180-day study . INTERVENTIONS ( 1 ) A-Flex ; ( 2 ) CPAP ; ( 3 ) APAP for 14 days and then switched to CPAP at a fixed pressure . MEASUREMENTS AND RESULTS Apnea-hypopnea indices , average and minimum oxygen saturation , time spent < 90 % were significantly poorer for A-Flex vs. CPAP at the initiation of study treatment ; with the exception of minimum oxygen saturation , these differences were absent at 180 days . A-Flex had lower average leak values at both 3 and 6 months . There were no significant differences between groups in major efficacy , adherence , and outcome ( subjective sleepiness , objective vigilance , blood pressure , quality of life ) measures . No differences between groups in attitudes toward use were observed at 3 or 6 months ; participant ratings for CPAP were significantly higher than A-Flex on treatment satisfaction and benefit , but not different for sleep quality and mask comfort . CONCLUSIONS We found that A-Flex shows equivalency , but non-superiority ( except for average leak values ) , in efficacy , adherence , and functional outcomes compared to CPAP after either 3 or 6 months . CLINICAL TRIAL REGISTRY Positive Pressure Treatment of Obstructive Sleep Apnea , http://www . clinical trials.gov , NCT00636181 STUDY OBJECTIVE To determine whether fixed-pressure or variable-pressure CPAP was preferred by patients and gave better outcomes in patients with the obstructive sleep apnea/hypopnea syndrome ( OSAHS ) . DESIGN R and omized blinded cross-over trial with 6 weeks of fixed and 6 weeks of variable-pressure CPAP . SETTING Sleep center . PATIENTS 200 consecutive consenting CPAP naïve patients with daytime sleepiness and > 15 apneas + hypopneas/h after an attended auto-CPAP titration night . INTERVENTIONS CPAP therapy using the same device ( Autoset Spirit ) set for 6 weeks in fixed pressure mode and for 6 weeks in variable pressure mode , the order of therapies being r and omized . MEASUREMENTS AND RESULTS All measurements were recorded at the end of each limb by a research er blind to treatment . These included symptoms , Epworth Score , CPAP usage , objective sleepiness by modified Osler test , vigilance and health related quality of life .  A total of 181 of 200 patients completed the study . At the end of the study , patients expressed no significant difference in the primary outcome , patient preference , 72 patients preferring fixed and 69 preferring variable-pressure CPAP .  Epworth score was lower on variable ( 9.5 , SEM 0.4 ) than fixed-pressure CPAP ( 10.0 , SEM 0.3 ; P = 0.031 ) . Mean CPAP use was higher on variable ( 4.2 , SEM 0.2 h/night ) than fixed-pressure CPAP ( 4.0 , SEM 0.2 h/night ; P = 0.047 ) . There were no other significant differences between treatments . CONCLUSIONS This study shows no difference in patient preference and only a marginal benefit of variable over fixed-pressure CPAP in OSAHS in terms of subjective sleepiness and CPAP use . The clinical value of this difference remains to be determined . CLINICAL TRIAL INFORMATION Variable-pressure versus fixed-pressure continuous positive airway pressure ( CPAP ) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome ( OSAHS ) ; Registration # IS RCT N43085025.http://www.controlled-trials.com//S RCT N43085025 STUDY OBJECTIVES To investigate the surgical outcomes and efficacy of modified uvulopalatopharyngoplasty ( mod UPPP ) and Coblation channelling of the tongue ( CCT ) as a treatment for  obstructive sleep apnea ( OSA ) .  METHODS Adult patients with simple snoring or obstructive sleep apnea were treated with combined modified UPPP , bilateral tonsillectomy , and CCT ( N = 48 ) .  Full polysomnography was performed preoperatively and 3 months postoperatively . Postoperative clinical assessment , sleep question naires , and patient demographics including body mass index were compared to preoperative data . All polysomnograms were re-scored to AASM recommended criteria by 2 sleep professionals . RESULTS The preoperative AHI ( median and interquartile range ) of 23.1 ( 10.4 to 36.6 ) was lowered to a postoperative AHI of 5.6 ( 1.9 to 10.4 ) ( p < 0.05 ) . The Epworth Sleepiness Scale score fell from 10.5 ( 5.5 to 13.5 ) to 5.0 ( 3.09 to 9.5 ) ( p < 0.05 ) . Morbidity of the surgery was low , with no long-term complications recorded . CONCLUSIONS Modified UPPP combined with CCT is a highly efficacious intervention for OSA with minimal morbidity . It should be considered for individuals who fail or are intolerant of CPAP or other medical devices BACKGROUND For the treatment of nonsevere obstructive sleep apnea syndrome ( OSAS ) , m and ibular advancement devices ( MADs ) are employed as an alternative to nasal continuous positive airway pressure ( CPAP ) therapy . However , very few specific data on the effectiveness of MADs in this group of patients are available . We therefore compared an individually adjustable intraoral sleep apnea device ( ISAD ) that permits movements of the lower jaw in three dimensions , with CPAP in the treatment of patients with an apnea/hypopnea index ( AHI ) < or = 30/h . METHODS In a r and omized crossover study , 16 men and 4 women ( mean + /- SD age , 56.5 + /- 10.2 years ; body mass index , 31.2 + /- 6.4 ; AHI , 17.5 + /- 7.7/h ) were treated for 6 weeks with each modality . RESULTS In the initial phase , a significant improvement in AHI ( baseline , 17.5 + /- 7.7/h ; ISAD , 10.5 + /- 7.5/h [ p < 0.05 ] ; CPAP , 3.5 + /- 2.9/h [ p < 0.01 ] ) and in breathing-related arousals ( baseline , 8.9 + /- 6.1/h ; ISAD , 3.7 + /- 3.3/h [ p < 0.01 ] ; CPAP , 1.4 + /- 1.6/h [ p < 0.01 ] ) was achieved with both modalities . Considering all 20 subjects , after 6 weeks of treatment , normalization of the respiratory parameters was seen only with CPAP . However , 30 % of the patients had a lasting reduction in AHI to < 10/h with the ISAD also . The patients considered the ISAD to be easier to use ( scale of 1 to 6 : ISAD , 1.8 + /- 1.1 ; CPAP , 3.1 + /- 1.5 [ p < 0.05 ] ) , and indicated greater utilization of the device in comparison with CPAP . CONCLUSION Even in patients with mild-to-moderate OSAS , CPAP is the more effective long-term treatment modality . In the individual case , the better compliance seen with the ISAD may be advantageous BACKGROUND AND PURPOSE Continuous positive airway pressure ( CPAP ) is an effective treatment for sleep apnea ( SA ) , although the evidence for improving chronic heart failure ( CHF ) is inconclusive . Our aim was to evaluate the effect of CPAP treatment on the left ventricle ejection fraction ( LVEF ) among other cardiological variables in a r and omized , multicenter , placebo (sham-CPAP)-controlled study . METHODS After the selection procedure , 60 patients with CHF with LVEF<45 % and SA with an apnea-hypopnea index (AHI)>10/h  were evaluated at baseline , and after 3 months of treatment with optimal CPAP or sham-CPAP . The assessment was based on the LVEF , hypertension , daytime sleepiness ( Epworth sleepiness scale [ ESS ] ) , quality of life ( SF-36 ) , New York Heart Scale ( NYHA score ) , dyspnea ( by using the Borg scale ) and exercise tolerance ( 6-min walk test ) . RESULTS The mean AHI was normalized in the optimal CPAP group but not in the sham-CPAP group . The LVEF showed a significant improvement in the group of patients treated with CPAP ( 2.5 ; 95 % CI : 0.6 to 4.3 ) , which was not observed in the sham-CPAP group ( 0.0 ; 95 % CI : -2.1 to 2.1 ) . However , the change in the LVEF from baseline to 3 months was not significantly greater in the whole group ( obstructive and Cheyne-Stokes events ) treated with CPAP than in the control group ( p : 0.07 ) . In patients with only obstructive sleep apnea ( OSA )  , who account for 83 % of the total population , there was a significant improvement in the LVEF in the group of patients treated with CPAP but no such improvement in the sham-CPAP group . In this OSA group , the change in the LVEF from baseline to 3 months was significantly greater in the group treated with CPAP than in the sham-CPAP group ( p : 0.03 ) . The other variables studied were not modified . When the patients were divided according to the severity of the LVEF ( a LVEF cut-off of 30 % ) , improvement was observed in those with a LVEF>30 . No changes were found in the other cardiological variables . CONCLUSIONS CPAP therapy proved to be useful in patients with associated sleep-disordered breathing and CHF . The improvement was more marked in patients with a LVEF>30 % . However , the increased LVEF in the CPAP group was not accompanied by changes in the other cardiological variables The efficacy of currently recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea ( apnea-hypopnea index [ AHI ] , 5 - 30 ) . A group of 114 sleep clinic patients with an AHI of 5 - 30 have participated in a r and omized controlled crossover trial of 3 months of treatment with each of nasal continuous positive airway pressure ( CPAP ) , a m and ibular advancement splint , and a placebo tablet . Outcomes were sleep fragmentation and hypoxemia , daytime sleepiness , quality of life , neurobehavioral function , and blood pressure . Both active treatments improved sleep outcomes , but positive airway pressure had a greater effect . The quality of life , symptoms , and subjective but not objective sleepiness improved to a similar degree with both treatments ; however , many of the improvements seen in neuropsychologic function and mood were not better than the placebo effect . Some aspects of nocturnal blood pressure were improved with the splint but not with CPAP . This study has shown that although both CPAP and m and ibular advancement splint effectively treated sleep-disordered breathing and sleepiness , the expected response in neurobehavioral function was incomplete . This may be due to the splint having a lesser therapeutic effect and CPAP being poorly tolerated and therefore used less in this patient group STUDY OBJECTIVES Positive airway pressure ( PAP ) treatment for obstructive sleep apnea ( OSA ) can be limited by suboptimal compliance . C-Flex technology ( Philips Respironics , PA , USA ) reduces pressure during expiration , aim ing to improve comfort and therefore compliance . This may be of particular relevance to patients requiring high pressures . Many studies thus far have suffered from design limitations and small sample sizes . This study aim ed to compare compliance with C-Flex and CPAP , as well as analyzing objective and subjective sleepiness and vigilance . DESIGN Three-month , double-blinded , parallel-arm r and omized controlled trial . SETTING A university-based sleep laboratory . PATIENTS 76 consecutive patients with severe OSA ( mean + /- SD AHI 60.2 + /- 32.9 events/hour , ESS 13.6 + /- 4.5/24 , BMI 35.6 + /- 7.8 kg/m2 ) , without significant cardiac , respiratory , psychiatric , or sleep comorbidities . INTERVENTIONS Patients were r and omized to C-Flex ( dip level 2 ) or CPAP . MEASUREMENTS AND RESULTS Patients underwent titration with C-Flex/CPAP ( mean pressure 11.6 cm H2O ) . Modified maintenance of wakefulness tests ( mod-MWT ) , psychomotor vigilance tasks ( PVT ) and question naires were administered at baseline and after one and 3 months . Median compliance was 5.51 and 5.89 h/night in the C-Flex and CPAP groups respectively ( P = 0.82 ) . There were no significant differences between groups in terms of PVT reaction time , subjective sleepiness , sleep quality , health-related quality of life , or treatment comfort . There was no significant difference between the groups regarding the change in mod-MWT sleep latency values . CONCLUSIONS In patients with severe OSA both CPAP and C-Flex result ed in substantial improvements in sleepiness , vigilance , and quality of life . The use of C-Flex did not result in greater compliance , and neither treatment appeared superior Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse , including tongue base obstruction . A new technique has recently been introduced that improves the nocturnal retro-lingual airway . This study was a prospect i ve , non-r and omized single-institution evaluation of a recently introduced surgical technique . Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty ( multilevel pharyngeal surgery ) . The patient demographics and treatment outcomes were prospect ively collected and retrospectively analysed . There were 16 men and three women , with a mean ( + /-SD ) age of 44.9 years ( + /- 14.2 ) and a mean pre-operative apnoea-hypopnoea index ( AHI ) of 42.8 + /- 24.8 . Twelve of the 19 patients ( 63.2 per cent ) have had post-operative polysomnography ;  eight of these 12 ( 67 per cent ) met the st and ard criteria for surgical response . Among these eight patients , the AHI improved from 32.4 to 14.4 ( p<0.01 ) ; the individual scores fell by a mean of 51.7 per cent . The apnoea index improved from 7.4 to 0.9 ( p<0.01 ) , with the individual scores falling by a mean of 81.4 per cent . There was anatomic and radiographic evidence of multilevel upper airway enlargement . Notably , the body mass index remained essentially unchanged ( 31.5 + /- 7.2 to 31.2 + /- 7.6 , p>0.5 ) . Subjectively , the mean Epworth sleepiness scale score fell from 11.0 + /- 5.4 to 5.4 + /- 3.8 ( p<0.005 ) . Four patients suffered transient velopharyngeal insufficiency , and two patients complained of limited anterior excursion of the tongue . There were no serious , long-term complications . The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea . It is easily performed by otolaryngologists , distinguishing it from other established techniques design ed to address tongue base obstruction
Background Continuous positive airway pressure ( CPAP ) is typically recommended as first line therapy for obstructive sleep apnea , but the adherence rate of CPAP is problematic .
This study ’s objective was to systematic ally review the literature relating to CPAP as first line therapy for OSA and compare it to surgical literature on the same topic .