[Conservative treatment in mild obstructive sleep apnea: comparison of theophylline and nasal continous positive airway pressure ventilation].

BACKGROUND

Comparison of theophylline and nasal continous positive airway pressure-ventilation (nCPAP) in patients non eligible for surgical treatment with obstructive sleep apnea.

PATIENTS AND MATERIALS

In a prospective non-randomized study 60 patients with mild obstructive sleep apnea were investigated. All individuals were not eligible for surgery under general anaesthesia or refused surgical treatment. The efficacy of a daily single dose oral theophylline (5 - 7 mg/kg body weight, n = 30) and nCPAP ventilation (n = 30) was evaluated by apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS). Statistical data analysis was performed using the Wilcoxon-Test.

RESULTS

In the theophylline group 4/26 patients (15 %) showed a mean AHI reduction of 42 %. The ESS-Score improved from 10.0 to 8.0. Therapy compliance was 86 %. The non-responder (22/26 patients, 85 %) group showed a mean AHI increase of 11 % (from 24.6 to 27.3). This difference was not of statistical significance (p < or = 0.878). In the CPAP group the AHI decreased from 23.3 to 2.9 (p < or = 0,0001). Mean ventilation pressure was 6.4 mbar. The ESS-Score improved from 10 to 8. Compliance was 50 %. Six of thirty patients (20 %) did not use the CPAP device regularly. During the first four weeks another nine of thirty (30.7 %) patients turned back the device. Main reasons were discomfort (61 %), noise (38 %), rhinitis, conjunctivitis and discomfort of the partner (10 %).

CONCLUSIONS

None of the treatments investigated can be considered as a substantial alternative for the majority of patients non eligible for surgery. Theophylline has a high compliance but little therapeutic effect. CPAP-ventilation is more effective but has a compliance problem in the patients investigated. Both modalities may have benefit but have to be individually indicated. A multimodal approach may ease the problem.