- Design
- Clinical practice guideline with systematic review and GRADE
- Population
- Adults with obstructive sleep apnoea, by subgroup
- Primary outcome
- Patient-centred and prognostic outcomes of CPAP vs no or sham treatment
- Effect
- Strong recommendation for CPAP with excessive daytime sleepiness; conditional elsewhere
The European Respiratory Society and European Sleep Research Society convened a task force of sleep, respiratory and cardiology experts, patient representatives and methodologists, and graded the evidence comparing CPAP with no or sham treatment across subgroups of obstructive sleep apnoea.
CPAP is strongly recommended for adults with excessive daytime sleepiness. It is conditionally suggested for sleep apnoea in general, for its effects on sleepiness, patient-reported outcomes and blood pressure, with further conditional recommendations for moderate-to-severe disease, older adults and those with hypertension, including resistant hypertension. For patients without sleepiness, for atrial fibrillation with the aim of reducing recurrence, and for impaired glucose metabolism with the aim of improving glycaemic control, the guideline suggests either CPAP or no treatment — taking other symptoms into account.
The practical effect is to tie CPAP to symptoms and blood pressure rather than to the apnoea index alone, and to make the decision a shared one where benefit is uncertain.
- Offer CPAP to adults with sleep apnoea and excessive daytime sleepiness — the recommendation is strong.
- Consider CPAP in moderate-to-severe sleep apnoea, older adults and resistant hypertension.
- Without sleepiness, CPAP or no treatment are both reasonable; decide with the patient.
- Do not rely on CPAP alone to prevent atrial fibrillation recurrence or to improve glycaemic control.
- Measure blood pressure before and after starting CPAP; it is one of the benefits supported.
Why it matters
It moves the decision away from the apnoea-hypopnoea index alone and towards symptoms and blood pressure.
Don't overread it
Most recommendations are conditional, reflecting moderate or low certainty evidence.
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