THE EFFECT OF CPAP ON QUALITY OF LIFE IN FEMALES WITH MILD OSA: POST HOC ANALYSIS FROM THE MERGE RANDOMISED TRIAL

Abstract Introduction The MERGE trial was a multi-centre, randomised, parallel study that showed the beneficial effect of continuous positive airway pressure (CPAP) on quality-of-life in patients with mild obstructive sleep apnea (OSA) (Wimms et al. 2019); findings that have extended the new NICE guidance [Obstructive sleep apnoea/ hypopnoea syndrome and obesity hypoventilation syndrome in over 16s (NG202)].This post-hoc analysis aimed to determine whether differences between the sexes in symptoms and treatment response exist at the mild end of the OSA disease spectrum. Methods Patients were recruited (Nov 2016 - Feb 2019) to receive either CPAP plus standard care, or standard care alone. Mild OSA was defined as: apnea-hypopnea index (AHI) >5 to ≤15 events/hr. Symptoms and quality-of-life were measured by a range of generic and disease specific questionnaires at baseline and 3 months post CPAP commencement. Results 233 participants (30% female) were included in this analysis. Females were on average older (mean ± SD) (51.9±10.4 vs 49.8±12.2 years) with higher BMI (32.2±5.0 vs 29.4±3.7 kg/m2) and had a lower AHI than males (median(IQR)) (9.60(6.50 -12.40) vs 10.30(7.10-13.20) events/hour).Females were sleepier (Epworth Sleepiness Score (ESS) (mean ± SD) (11.0±4.2 vs 9.5±4.4)), more fatigued (Fatigue Severity Score (FSS) (42±12.8 vs. 34.4±13.5)) and reported higher levels of anxiety, depression and insomnia. Reported quality-of-life was lower in the SF- 36 mental (41.8±13 vs. 47.3±10.9) and physical components (43.0±11.2 vs. 49.7±9.1), as well as in all individual domains. Females also reported worse scores in the Euroqol 5 Dimensions (EQ-5D) and Functional Outcomes of Sleep Questionnaire (FOSQ), compared to males.All symptoms improved with CPAP use for both sexes, however female patients had larger improvements in the ESS (mean difference(95%CI)) (-5.2 (-6.7, -3.6) vs (-2.0 (-3.0, -1.0)) p=0.0035, and SF-36 vitality (11.7 (7.9, 15.5) vs 5.6 (3.1, 8.1)) p=0.0092. Conclusion In mild OSA, female patients were more symptomatic and reported worse quality-of-life than males, despite having lower AHIs; all were improved with CPAP treatment. Support (If Any) Funded by ResMed