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Randomized Controlled Trial
. 2025 Apr 1;29(2):146.
doi: 10.1007/s11325-025-03309-z.

Impact of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial

Siraj Omar Wali  1   2 , Ghadah Batawi  3 , Omar Kanbr  3   4 , Nadeem Shafique Butt  5 , Murad A Yasawy  6 , Dalyah Alqaidi  3 , Faris Alhejaili  7   3 , Ranya Alshumrani  3   8 , David Gozal  9
Affiliations
Randomized Controlled Trial

Impact of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial

Siraj Omar Wali et al. Sleep Breath. .

Abstract

Purpose: Continuous positive airway pressure (CPAP) is the gold standard for managing moderate-to-severe obstructive sleep apnea (OSA). However, adherence to CPAP usage remains problematic with many patients either intermittently or permanently discontinuing CPAP use. However, the impact of CPAP therapy discontinuation remains unclear. This study aimed to evaluate the effects of complete and intermittent CPAP withdrawal on clinical and objective relapse of OSA.

Patients and methods: This randomized study involved patients with moderate-to-severe OSA who were compliant with CPAP therapy. All subjects underwent a CPAP efficacy assessment (CPAP check), followed by 1 month of closely monitored CPAP usage. Subjects were then randomized into two groups: (1) complete CPAP withdrawal (NO-CPAP); (2) intermittent CPAP use (INT-CPAP) (using the device every other day). Clinical relapse was assessed daily and defined as reemergence of any of the OSA symptoms. Weekly home sleep testing was performed to assess OSA relapse objectively, defined as an apnea-hypopnea index (AHI) of > 5.

Results: A total of 22 patients were included, with 12 subjects assigned to NO-CPAP group and 10 to the INT-CPAP group. Both groups exhibited a rapid recurrence of OSA within 1 week of CPAP discontinuation, with significant increases in AHI, oxygen desaturation index, and time spent with O2 saturation < 90% compared to baseline CPAP-check parameters (p < 0.05). In addition, clinical relapse occurred earlier in ⁓70% of the INT-CPAP group (Median 2.9 days) and 33% in the NO-CPAP group (Median, 3.5 days) (p < 0.05). Age and neck circumference were identified as significant predictors of OSA relapse (p < 0.05).

Conclusion: Discontinuation of CPAP therapy, whether completely or intermittently, leads to rapid OSA relapse, with age and neck circumference being key predictors of OSA relapse. These findings underscore the impact of CPAP withdrawal and the need for continuous CPAP adherence to effectively manage OSA.

Clinical trial registration: A full trial protocol can be accessed through: https://clinicaltrials.gov/study/NCT05471765 .

Keywords: CPAP; Intermittent; Obstructive sleep apnea; Relapse; Withdrawal.

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Conflict of interest statement

Declarations. Ethical approval: was obtained from the Unit of Biomedical Ethics at King Abdulaziz university Hospital with reference no: 241 − 20. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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