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Comparing the effects of supplemental oxygen therapy and continuous positive airway pressure on patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

  • Basic Science • Original Article
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Abstract

Background and objective

Obstructive sleep apnea (OSA) is associated with hypertension, psychological impairment, neurocognitive dysfunction, and poor quality of sleep. Continuous positive airway pressure (CPAP) has been confirmed to effectively improve OSA, while the effects of supplemental oxygen therapy on OSA have still remained controversial. This meta-analysis aimed to compare the effects of supplemental oxygen therapy and CPAP on patients with OSA.

Methods

PubMed, Cochrane library, EMBASE, and Web of Science databases were systematically searched from inception until April 2020. Randomized controlled trials (RCTs) that compared the effects of supplemental oxygen therapy and CPAP on patients with OSA were selected without language restriction.

Results

In this meta-analysis, 8 RCTs that involved 887 patients were found eligible for further analyses. Pooled data showed that there was no significant difference in improving nocturnal oxygen saturation (SpO2) level (95% confidence interval (CI) = − 1.17 to 1.53) or symptoms of depression (95%CI = − 0.69 to 1.19) between supplemental oxygen therapy and CPAP. Supplemental oxygen therapy was found less effective in reducing apnea-hypopnea index (AHI), time of SpO2 < 90%, blood pressure, and improving quality of sleep compared with CPAP. A subgroup analysis based on flow rate of oxygen indicated that the effects of supplemental oxygen therapy on blood pressure significantly differed. Furthermore, an improvement in overall time of SpO2 < 90% was correlated to duration of supplemental oxygen therapy.

Conclusions

CPAP is clinically effective for the treatment of patients with OSA. However, supplemental oxygen therapy can be cautiously used for improving nocturnal hypoxia and symptoms of depression when CPAP is not acceptable or not tolerated. Supplemental oxygen therapy is a promising option to alleviate partial disorders of OSA. Further studies need to focus on flow rate of oxygen and duration of supplemental oxygen therapy.

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Data availability

All data generated or analyzed in this study are included.

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Funding

This work was supported by grant no. 20170541026 from the Natural Science Foundation of Liaoning Province.

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Authors and Affiliations

  1. Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China

    Xia Sun & Yan Wang

  2. Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

    Jia Luo

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  1. Xia Sun
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  2. Jia Luo
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  3. Yan Wang
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All the authors actively participated in the study and read and approved the final version of the manuscript.

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Correspondence to Yan Wang.

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Comment

Although the meta analysis has demonstrated that supplemental oxygen may be considered where compliance with CPAP fails, the oxygen flow rate required may mean an individual’s tolerance of the delivery mode may be an issue in itself. Further studies are required to get a true picture of the effect of oxygen and to explain the physiology.

Margot Skinner

New Zealand

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Sun, X., Luo, J. & Wang, Y. Comparing the effects of supplemental oxygen therapy and continuous positive airway pressure on patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 25, 2231–2240 (2021). https://doi.org/10.1007/s11325-020-02245-4

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  • DOI: https://doi.org/10.1007/s11325-020-02245-4

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