MedicalResearch.com Interview with:
Prof. Mary J Morrell
Faculty of Medicine, National Heart & Lung Institute
Professor of Sleep & Respiratory Physiology
Imperial College, London
Medical Research: What are the main findings of the study?
Prof. Morrell: Our results showed that when older patients with obstructive sleep apnea were treated with continuous positive airway pressure (CPAP) they had significantly less daytime sleepiness than those not treated with CPAP. A comparison of the costs and benefits of treatment suggested that CPAP would meet the usual criteria for being funded by the NHS.
Medical Research: Were any of the findings unexpected?
Prof. Morrell: 278 older patients with obstructive sleep apnea were included in the trial. Of the 140 patients randomized to CPAP treatment 120 (86%) reported they were still using CPAP 3 months, and 99 (71%) at 12 months but the number of hours they used the CPAP treatment per night was unexpectedly low. This is likely to have diluted any treatment effect between the groups. Indeed, exploratory analyses revealed that the treatment effect was larger in patients with greater CPAP usage.
Medical Research: What should clinicians and patients take away from your report?
Prof. Morrell: Our study supports the use of CPAP in older people with obstructive sleep apnea and shows that it would be good value for money in the NHS.
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Morrell: Based on the results of this study we suggest a number of research priorities:
- To focus on how best to optimise CPAP treatment to improve adherence, especially in the older patient.
- To stratify older patients with obstructive sleep apnoea according to co-morbidities and assess the effectiveness of CPAP treatment.
- Define outcomes for treatment of in women, and ethnic groups with obstructive sleep apnea that are currently underrepresented in clinical trials.
Obstructive sleep apnea in different groups may have different anatomical and physiological causes with different consequences – this hypothesis remains to be explored and may be fundamental to the understanding of the disorder.
Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial
Alison McMillan MBBS,Daniel J Bratton MSc,Rita Faria MSc,Magda Laskawiec-Szkonter MA,Susan Griffin MSc,Prof Robert J Davies MD,Prof Andrew J Nunn MSc,Prof John R Stradling MD,Renata L Riha MD,Prof Mary J Morrell PhD,on behalf of the PREDICT Investigators
The Lancet Respiratory Medicine – 27 August 2014