학술논문
Mild obstructive sleep apnoea in females: post hoc analysis of the MERGE randomised controlled trial.
Document Type
Academic Journal
Author
Wimms AJ; University of Sydney, Sydney, Australia.; ResMed Science Center, ResMed Pty Ltd, Sydney, Australia.; These authors contributed equally.; Kelly JL; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK.; These authors contributed equally.; Turnbull CD; ResMed Science Center, ResMed Pty Ltd, Sydney, Australia.; McMillan A; Lister Hospital, Stevenage, UK.; Craig SE; Aintree University Hospital, Liverpool, UK.; O'Reilly JF; Aintree University Hospital, Liverpool, UK.; Nickol AH; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Decker MD; Willes Consulting Group, Inc., Encinitas, CA, USA.; Willes LA; Willes Consulting Group, Inc., Encinitas, CA, USA.; Calverley PMA; University of Liverpool, Liverpool, UK.; Benjafield AV; ResMed Science Center, ResMed Pty Ltd, Sydney, Australia.; Stradling JR; Oxford NIHR Biomedical Research Centre, Oxford, UK.; Morrell MJ; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK.
Source
Publisher: European Respiratory Society Country of Publication: England NLM ID: 101671641 Publication Model: eCollection Cited Medium: Print ISSN: 2312-0541 (Print) Linking ISSN: 23120541 NLM ISO Abbreviation: ERJ Open Res Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2312-0541
Abstract
Background: A post hoc analysis of the MERGE trial was conducted, to investigate whether sex differences are evident at the mildest end of the disease spectrum, for symptoms associated with obstructive sleep apnoea (OSA) and the response to continuous positive airway pressure (CPAP) treatment.
Methods: MERGE participants with mild OSA (apnoea-hypopnoea index 5-15 events·h-1 ; American Academy of Sleep Medicine 2012 criteria) were randomised to either CPAP plus standard care (sleep hygiene counselling) or standard care alone for 3 months. Quality of life (QoL) was measured by questionnaires completed before and after the 3 months. This post hoc analysis of participants of the MERGE trial compared the symptom presentation, and response to CPAP, between the sexes.
Results: 233 patients were included; 71 (30%) were female. Females were more symptomatic at baseline in all QoL questionnaires. Specifically, females had lower 36-item Short-Form Health Survey (SF-36) Vitality scores (mean±sd 39.1±10.1 versus 44.8±10.3) and higher Epworth Sleepiness Scale (ESS) scores (mean±sd 11.0±4.2 versus 9.5±4.4). Both sexes experienced snoring, but more females reported fatigue and more males reported witnessed apnoeas. All symptoms improved with CPAP for both sexes; however, females had larger improvements in SF-36 Vitality scores, which was the primary outcome of the MERGE trial (mean change 9.4 (95% CI 6.8-12.0) versus 6.0 (95% CI 4.3-7.7); p=0.034), and ESS (mean change -4.1 (95% CI -5.1- -3.0) versus -2.5 (95% CI -3.1- -1.8); p=0.015), after adjustment for baseline scores and CPAP usage.
Conclusions: Sex differences are apparent in patients with mild OSA. Females experience worse QoL symptoms than males at presentation to the sleep clinic; however, these improve significantly with CPAP treatment.
Competing Interests: Conflict of interest: A.J. Wimms is an employee of ResMed. Conflict of interest: J.L. Kelly has received personal fees from Sunrise, outside the scope of this work. Conflict of interest: C.D. Turnbull has received personal fees from Stowood, outside the scope of this work. Conflict of interest: A. McMillan has no conflict of interest. Conflict of interest: S.E. Craig has no conflict of interest. Conflict of interest: J.F. O'Reilly has no conflict of interest. Conflict of interest: A.H. Nickol has no conflict of interest. Conflict of interest: M.D. Decker confirms that they have no conflicts of interest (presence or absence) that might raise the question of bias in the work reported or the conclusions, implications or opinions stated in this manuscript, with the exception that they are working as an independent paid statistical consultant for ResMed Corporation. Conflict of interest: L.A. Willes confirms that they have no conflicts of interest (presence or absence) that might raise the question of bias in the work reported or the conclusions, implications or opinions stated in this manuscript, with the exception that they are working as an independent paid statistical consultant for ResMed Corporation. Conflict of interest: P.M.A. Calverley has no conflict of interest. Conflict of interest: A.V. Benjafield is an employee of ResMed. Conflict of interest: J.R. Stradling has received personal fees from ResMed UK, and a grant and personal fees from Bayer during the course of, but unrelated to, this study. Conflict of interest: M.J. Morrell has no conflict of interest.
(Copyright ©The authors 2024.)
Methods: MERGE participants with mild OSA (apnoea-hypopnoea index 5-15 events·h
Results: 233 patients were included; 71 (30%) were female. Females were more symptomatic at baseline in all QoL questionnaires. Specifically, females had lower 36-item Short-Form Health Survey (SF-36) Vitality scores (mean±sd 39.1±10.1 versus 44.8±10.3) and higher Epworth Sleepiness Scale (ESS) scores (mean±sd 11.0±4.2 versus 9.5±4.4). Both sexes experienced snoring, but more females reported fatigue and more males reported witnessed apnoeas. All symptoms improved with CPAP for both sexes; however, females had larger improvements in SF-36 Vitality scores, which was the primary outcome of the MERGE trial (mean change 9.4 (95% CI 6.8-12.0) versus 6.0 (95% CI 4.3-7.7); p=0.034), and ESS (mean change -4.1 (95% CI -5.1- -3.0) versus -2.5 (95% CI -3.1- -1.8); p=0.015), after adjustment for baseline scores and CPAP usage.
Conclusions: Sex differences are apparent in patients with mild OSA. Females experience worse QoL symptoms than males at presentation to the sleep clinic; however, these improve significantly with CPAP treatment.
Competing Interests: Conflict of interest: A.J. Wimms is an employee of ResMed. Conflict of interest: J.L. Kelly has received personal fees from Sunrise, outside the scope of this work. Conflict of interest: C.D. Turnbull has received personal fees from Stowood, outside the scope of this work. Conflict of interest: A. McMillan has no conflict of interest. Conflict of interest: S.E. Craig has no conflict of interest. Conflict of interest: J.F. O'Reilly has no conflict of interest. Conflict of interest: A.H. Nickol has no conflict of interest. Conflict of interest: M.D. Decker confirms that they have no conflicts of interest (presence or absence) that might raise the question of bias in the work reported or the conclusions, implications or opinions stated in this manuscript, with the exception that they are working as an independent paid statistical consultant for ResMed Corporation. Conflict of interest: L.A. Willes confirms that they have no conflicts of interest (presence or absence) that might raise the question of bias in the work reported or the conclusions, implications or opinions stated in this manuscript, with the exception that they are working as an independent paid statistical consultant for ResMed Corporation. Conflict of interest: P.M.A. Calverley has no conflict of interest. Conflict of interest: A.V. Benjafield is an employee of ResMed. Conflict of interest: J.R. Stradling has received personal fees from ResMed UK, and a grant and personal fees from Bayer during the course of, but unrelated to, this study. Conflict of interest: M.J. Morrell has no conflict of interest.
(Copyright ©The authors 2024.)