ERS/ESRS clinical practice guideline for continuous positive airway pressure for the treatment of adult obstructive sleep apnoea

Abstract

Background Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnoea (OSA), although its effectiveness may vary across OSA subtypes. This joint European Respiratory Society (ERS)/European Sleep Research Society (ESRS) clinical practice guideline evaluates CPAP's impact on patient-centred and prognostically relevant outcomes, comparing it to no or sham treatment in different OSA subgroups. Methods The joint ERS/ESRS Task Force consisted of experts in pulmonology, cardiology and respiratory sleep medicine, patient representatives and methodologists. Questions were formulated using the PICO (Population, Intervention, Comparator, Outcomes) framework. A systematic review assessing the effects of CPAP on critical outcomes was performed. The certainty of evidence for all outcomes was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus on the direction and strength of the recommendation was informed by Evidence-to-Decision frameworks and achieved through discussions and voting. Recommendations The Task Force generally suggests CPAP treatment for OSA because of its beneficial effects on sleepiness, other patient-reported outcomes and blood pressure (conditional recommendations). CPAP is recommended in patients with excessive daytime sleepiness (EDS) (strong recommendation). Additional specific conditional recommendations are given for patients with moderate-to severe OSA, the elderly, and patients with arterial and treatment-resistant hypertension. The Task Force suggests either CPAP or no treatment in patients without EDS (but taking into account other OSA-related symptoms), in patients with atrial fibrillation with the aim of reducing its recurrence and in patients with impaired glucose metabolism to improve glycaemic control. Conclusion CPAP is an effective treatment for adults with OSA. However, recommendations for its use vary across different patient subgroups.