Obstructive sleep apnea (OSA) is a condition in which the repetitive, partial, or complete closure of the upper airway results in repeated, reversible blood oxygen desaturation and sleep fragmentation. The prevalence of OSA, defined by an apnea-hypopnea index (AHI) ≥ 5 events/hour, was 9% in women and 24% in men in a random sample of Wisconsin state employees ages 30 to 60 years, and is increased with male gender, obesity, and age. When defined as a clinical syndrome (AHI ≥ 5 events/hour combined with significant sleepiness), OSA has a prevalence of 2% in women and 4% in men. A Canadian Community Health Survey in 2009 reported a 3% prevalence of OSA in Canadians adults. OSA is determined by a number of sleep parameter abnormalities measured by polysomnography such as AHI, arousal index, and minimum oxygen saturation (S_pO2). OSA is associated with neurobehavioral morbidities reflected by a reduction in the Epworth Sleepiness Score (ESS) and quality of life; increased cardiovascular diseases such as high blood pressure, heart failure; and metabolic morbidities such as oxidative stress. OSA is associated with substantial costs to society due to its morbidities, with costs of untreated OSA potentially doubling medical expenses, mainly because of cardiovascular diseases. OSA-related motor vehicle collisions in 2000 were estimated at US$15.9 billion in damages and health-related costs.

Treatment of OSA includes a wide range of options, such as changes in diet and lifestyle to reduce risk factors for OSA, pharmacotherapy, the use of continuous airway pressure (CPAP) and various oral devices to splint the airway open to facilitate airflow, to upper airway surgical treatment. In Ontario, patients waited a mean 11.6 months from the time being referred to a sleep clinic to the time of medical therapy initiation, and 16.2 months to surgical therapy initiation.

This Rapid Response report aims to review the clinical and cost-effectiveness of CPAP as compared to oral devices and lifestyle changes in the treatment of OSA.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• Appendix 1 Selection of Included Studies
• Appendix 2 Characteristics of Included Studies
• Appendix 3 Summary of Critical Appraisal of Included Study
• Appendix 4 Main Study Findings and Authors’ Conclusions

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.