Papers

Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence

^a Bradford Royal Infirmary Bradford West Yorkshire BD9 6RJ, ^b North Yorkshire Health Authority York YO3 4XF, ^c NHS Centre for Reviews and Dissemination University of York York YOU DD

Correspondence to: Dr Wright j.wright@leeds.ac.uk

Additional data from this article are available on the http://www.bmj.com/
Objective: To examine the research evidence for the health consequences of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure.
Design: A systematic review of published research, studies being identified by searching Medline (1966-96), Embase (1974-96), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1982-95); scanning citations; and consulting experts. Studies in all languages were considered which either investigated the association between obstructive sleep apnoea in adults and key health outcomes or evaluated the effectiveness of treatment of obstructive sleep apnoea with continuous positive airways pressure in adults.
Main outcome measures: Mortality, systematic hypertension, cardiac arrhythmias, ischaemic heart disease, left ventricular hypertrophy, pulmonary hypertension, stroke, vehicle accidents, measures of daytime sleepiness, and quality of life.
Results: 54 epidemiological studies examined the association between sleep apnoea and health related outcomes. Most were poorly designed and only weak or contradictory evidence was found of an association with cardiac arrhythmias, ischaemic heart disease, cardiac failure, systemic or pulmonary hypertension, and stroke. Evidence of a link with sleepiness and road traffic accidents was stronger but inconclusive. Only one small randomised controlled trial evaluated continuous positive airways pressure. Five non-randomised controlled trials and 38 uncontrolled trials were identified. Small changes in objectively measured daytime sleepiness were consistently found, but improvements in morbidity, mortality, and quality of life indicators were not adequately assessed.
Conclusions: The relevance of sleep apnoea to public health has been exaggerated. The effectiveness of continuous positive airways pressure in improving health outcomes has been poorly evaluated. There is enough evidence suggesting benefit in reducing daytime sleepiness in some patients to warrant large randomised placebo controlled trials of continuous positive airways pressure versus an effective weight reduction programme and other interventions.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Sanders, M. H., Montserrat, J. M., Farre, R., Givelber, R. J. (2008). Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application. Proc Am Thorac Soc 5: 161-172 [Abstract] [Full text]  
• Buchner, N. J., Sanner, B. M., Borgel, J., Rump, L. C. (2007). Continuous Positive Airway Pressure Treatment of Mild to Moderate Obstructive Sleep Apnea Reduces Cardiovascular Risk. Am. J. Respir. Crit. Care Med. 176: 1274-1280 [Abstract] [Full text]  
• Pevernagie, D., Masa, J. F., Meurice, J. C., Farre, R., Marrone, O., Rodenstein, D. (2007). Treatment of obstructive sleep-disordered breathing with positive airway pressure systems. ERR 16: 125-131 [Abstract] [Full text]  
• Ferreira, S., Winck, J., Bettencourt, P., Rocha-Goncalves, F. (2006). Heart failure and sleep apnoea: To sleep perchance to dream. Eur J Heart Fail 8: 227-236 [Abstract] [Full text]  
• Elwood, P., Hack, M., Pickering, J., Hughes, J., Gallacher, J. (2006). Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort. J. Epidemiol. Community Health 60: 69-73 [Abstract] [Full text]  
• Pack, A. I. (2006). Advances in Sleep-disordered Breathing. Am. J. Respir. Crit. Care Med. 173: 7-15 [Abstract] [Full text]  
• Leung, R. S. T., Bowman, M. E., Diep, T. M., Lorenzi-Filho, G., Floras, J. S., Bradley, T. D. (2005). Influence of Cheyne-Stokes respiration on ventricular response to atrial fibrillation in heart failure. J. Appl. Physiol. 99: 1689-1696 [Abstract] [Full text]  
• Tarasiuk, A., Greenberg-Dotan, S., Brin, Y. S., Simon, T., Tal, A., Reuveni, H. (2005). Determinants Affecting Health-Care Utilization in Obstructive Sleep Apnea Syndrome Patients. Chest 128: 1310-1314 [Abstract] [Full text]  
• Doherty, L. S., Kiely, J. L., Swan, V., McNicholas, W. T. (2005). Long-term Effects of Nasal Continuous Positive Airway Pressure Therapy on Cardiovascular Outcomes in Sleep Apnea Syndrome. Chest 127: 2076-2084 [Abstract] [Full text]  
• Gibson, G.J. (2005). Obstructive sleep apnoea syndrome: underestimated and undertreated. Br Med Bull 72: 49-65 [Abstract] [Full text]  
• Parra, O., Arboix, A., Montserrat, J.M., Quinto, L., Bechich, S., Garcia-Eroles, L. (2004). Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J 24: 267-272 [Abstract] [Full text]  
• Udwadia, Z. F., Doshi, A. V., Lonkar, S. G., Singh, C. I. (2004). Prevalence of Sleep-disordered Breathing and Sleep Apnea in Middle-aged Urban Indian Men. Am. J. Respir. Crit. Care Med. 169: 168-173 [Abstract] [Full text]  
• Fleetham, J (2004). Sleep disordered breathing awoken. Thorax 59: 5-6 [Full text]  
• Stradling, J R, Davies, R J O (2004). Sleep {middle dot} 1: Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history. Thorax 59: 73-78 [Abstract] [Full text]  
• Kirk, V. G., Bohn, S. G., Flemons, W. W., Remmers, J. E. (2003). Comparison of Home Oximetry Monitoring With Laboratory Polysomnography in Children. Chest 124: 1702-1708 [Abstract] [Full text]  
• Rees, P J. (2003). Review: continuous positive airway pressure therapy improves subjective and objective sleepiness in obstructive sleep apnoea. Evid. Based Med. 8: 112-112 [Full text]  
• Babar, S. I., Quan, S. F. (2003). Continuous Positive Airway Pressure: Placebo Power, or Does It Really Work?. Arch Intern Med 163: 519-520 [Full text]  
• Patel, S. R., White, D. P., Malhotra, A., Stanchina, M. L., Ayas, N. T. (2003). Continuous Positive Airway Pressure Therapy for Treating gess in a Diverse Population With Obstructive Sleep Apnea: Results of a Meta-analysis. Arch Intern Med 163: 565-571 [Abstract] [Full text]  
• Mar, J., Rueda, J.R., Duran-Cantolla, J., Schechter, C., Chilcott, J. (2003). The cost-effectiveness of nCPAP treatment in patients with moderate-to-severe obstructive sleep apnoea. Eur Respir J 21: 515-522 [Abstract] [Full text]  
• Becker, H. F., Jerrentrup, A., Ploch, T., Grote, L., Penzel, T., Sullivan, C. E., Peter, J. H. (2003). Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea. Circulation 107: 68-73 [Abstract] [Full text]  
• Blankfield, R. P., Sajkov, D., McEvoy, R. D. (2003). Continuous positive airway pressure normalizes pulmonary artery pressures in subjects with obstructive sleep apnea and pulmonary hypertension. Am. J. Respir. Crit. Care Med. 167: 94-94 [Full text]  
• Thys, F., Roeseler, J., Reynaert, M., Liistro, G., Rodenstein, D.O. (2002). Noninvasive ventilation for acute respiratory failure: a prospective randomised placebo-controlled trial. Eur Respir J 20: 545-555 [Abstract] [Full text]  
• Schafer, H., Pauleit, D., Sudhop, T., Gouni-Berthold, I., Ewig, S., Berthold, H. K. (2002). Body Fat Distribution, Serum Leptin, and Cardiovascular Risk Factors in Men With Obstructive Sleep Apnea*. Chest 122: 829-839 [Abstract] [Full text]  
• Gotsopoulos, H., Chen, C., Qian, J., Cistulli, P. A. (2002). Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea: A Randomized, Controlled Trial. Am. J. Respir. Crit. Care Med. 166: 743-748 [Abstract] [Full text]  
• Flemons, W. W. (2002). Obstructive Sleep Apnea. NEJM 347: 498-504 [Full text]  
• Blankfield, R. P. (2002). Clinical Correlates of Pulmonary Artery Systolic Pressure. Circulation 106 : e34-e34 [Full text]  
• Turkington, P.M., Bamford, J., Wanklyn, P., Elliott, M.W. (2002). Prevalence and Predictors of Upper Airway Obstruction in the First 24 Hours After Acute Stroke. Stroke 33: 2037-2042 [Abstract] [Full text]  
• Peker, Y., Hedner, J., Norum, J., Kraiczi, H., Carlson, J. (2002). Increased Incidence of Cardiovascular Disease in Middle-aged Men with Obstructive Sleep Apnea: A 7-Year Follow-up. Am. J. Respir. Crit. Care Med. 166: 159-165 [Abstract] [Full text]  
• Sjostrom, C, Lindberg, E, Elmasry, A, Hagg, A, Svardsudd, K, Janson, C (2002). Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. Thorax 57: 602-607 [Abstract] [Full text]  
• Silvestrini, M., Rizzato, B., Placidi, F., Baruffaldi, R., Bianconi, A., Diomedi, M. (2002). Carotid Artery Wall Thickness in Patients With Obstructive Sleep Apnea Syndrome. Stroke 33: 1782-1785 [Abstract] [Full text]  
• Lacasse, Y, Godbout, C, Series, F (2002). Independent validation of the Sleep Apnoea Quality of Life Index. Thorax 57: 483-488 [Abstract] [Full text]  
• Young, T., Peppard, P. E., Gottlieb, D. J. (2002). Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective. Am. J. Respir. Crit. Care Med. 165: 1217-1239 [Abstract] [Full text]  
• Prabhakar, N. R. (2002). Sleep Apneas . An Oxidative Stress?. Am. J. Respir. Crit. Care Med. 165: 859-860 [Full text]  
• Smith, R., Ronald, J., Delaive, K., Walld, R., Manfreda, J., Kryger, M. H. (2002). What Are Obstructive Sleep Apnea Patients Being Treated for Prior to This Diagnosis?. Chest 121: 164-172 [Abstract] [Full text]  
• Douglas, N. J., Engleman, H. M., Faccenda, J. F., McArdle, N. (2002). THE SCIENCE OF DESIGNING ETHICAL CPAP TRIALS. Am. J. Respir. Crit. Care Med. 165: 132a-134 [Full text]  
• MOOE, T., FRANKLIN, K. A., HOLMSTROM, K., RABBEN, T., WIKLUND, U. (2001). Sleep-disordered Breathing and Coronary Artery Disease . Long-term Prognosis. Am. J. Respir. Crit. Care Med. 164: 1910-1913 [Abstract] [Full text]  
• Walker, R. P. (2001). Long-term Health Consequences of Mild to Moderate Obstructive Sleep Apnea. Arch Otolaryngol Head Neck Surg 127: 1397-1400 [Full text]  
• Piccirillo, J. F. (2001). More Information Needed About the Long-term Health Consequences of Mild to Moderate Obstructive Sleep Apnea. Arch Otolaryngol Head Neck Surg 127: 1400-1401 [Full text]  
• MCARDLE, N., DOUGLAS, N. J. (2001). Effect of Continuous Positive Airway Pressure on Sleep Architecture in the Sleep Apnea-Hypopnea Syndrome . A Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 164: 1459-1463 [Abstract] [Full text]  
• MONASTERIO, C., VIDAL, S., DURAN, J., FERRER, M., CARMONA, C., BARBE, F., MAYOS, M., GONZALEZ-MANGADO, N., JUNCADELLA, M., NAVARRO, A., BARREIRA, R., CAPOTE, F., MAYORALAS, L. R., PECES-BARBA, G., ALONSO, J., MONTSERRAT, J. M. (2001). Effectiveness of Continuous Positive Airway Pressure in Mild Sleep Apnea-Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 164: 939-943 [Abstract] [Full text]  
• Ziegler, M. G., Mills, P. J., Loredo, J. S., Ancoli-Israel, S., Dimsdale, J. E. (2001). Effect of Continuous Positive Airway Pressure and Placebo Treatment on Sympathetic Nervous Activity in Patients With Obstructive Sleep Apnea. Chest 120: 887-893 [Abstract] [Full text]  
• Stradling, J R, Pepperell, J C T, Davies, R J O (2001). Sleep apnoea and hypertension: proof at last?. Thorax 56: ii45-49 [Full text]  
• MONTSERRAT, J. M., FERRER, M., HERNANDEZ, L., FARRE, R., VILAGUT, G., NAVAJAS, D., BADIA, J. R., CARRASCO, E., DE PABLO, J., BALLESTER, E. (2001). Effectiveness of CPAP Treatment in Daytime Function in Sleep Apnea Syndrome . A Randomized Controlled Study with an Optimized Placebo. Am. J. Respir. Crit. Care Med. 164: 608-613 [Abstract] [Full text]  
• Barbe, F., Mayoralas, L. R., Duran, J., Masa, J. F., Maimo, A., Montserrat, J. M., Monasterio, C., Bosch, M., Ladaria, A., Rubio, M., Rubio, R., Medinas, M., Hernandez, L., Vidal, S., Douglas, N. J., Agusti, A. G.N. (2001). Treatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime Sleepiness: A Randomized, Controlled Trial. ANN INTERN MED 134: 1015-1023 [Abstract] [Full text]  
• Guilleminault, C., Do Kim, Y., Chowdhuri, S., Horita, M., Ohayon, M., Kushida, C. (2001). Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnoea syndrome. Eur Respir J 17: 838-847 [Abstract] [Full text]  
• Ferguson, K. (2001). Oral Appliance Therapy for Obstructive Sleep Apnea . Finally Evidence You Can Sink Your Teeth Into. Am. J. Respir. Crit. Care Med. 163: 1294-1295 [Full text]  
• Karlawish, J. H. T., Pack, A. I. (2001). Addressing the Ethical Problems of Randomized and Placebo-Controlled Trials of CPAP. Am. J. Respir. Crit. Care Med. 163: 809-810 [Full text]  
• DURAN, J., ESNAOLA, S., RUBIO, R., IZTUETA, A. (2001). Obstructive Sleep Apnea-Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr. Am. J. Respir. Crit. Care Med. 163: 685-689 [Abstract] [Full text]  
• Jenkinson, C., Davies, R.J.O., Mullins, R., Stradling, J.R. (2001). Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea. QJM 94: 95-99 [Abstract] [Full text]  
• FACCENDA, J. F., MACKAY, T. W., BOON, N. A., DOUGLAS, N. J. (2001). Randomized Placebo-controlled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep Apnea-Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 163: 344-348 [Abstract] [Full text]  
• Schulz, R, Schmidt, D, Blum, A, Lopes-Ribeiro, X, Lücke, C, Mayer, K, Olschewski, H, Seeger, W, Grimminger, F (2000). Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea: response to CPAP therapy. Thorax 55: 1046-1051 [Abstract] [Full text]  
• d'Ortho, M.-P., Grillier-Lanoir, V., Levy, P., Goldenberg, F., Corriger, E., Harf, A., Lofaso, F. (2000). Constant vs Automatic Continuous Positive Airway Pressure Therapy : Home Evaluation. Chest 118: 1010-1017 [Abstract] [Full text]  
• Harbison, J., O'Reilly, P., McNicholas, W. T. (2000). Cardiac Rhythm Disturbances in the Obstructive Sleep Apnea Syndrome : Effects of Nasal Continuous Positive Airway Pressure Therapy. Chest 118: 591-595 [Abstract] [Full text]  
• Davies, C. W H, Crosby, J. H, Mullins, R. L, Barbour, C., Davies, R. J O, Stradling, J. R (2000). Case-control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax 55: 736-740 [Abstract] [Full text]  
• SCHULZ, R., MAHMOUDI, S., HATTAR, K., SIBELIUS, U., OLSCHEWSKI, H., MAYER, K., SEEGER, W., GRIMMINGER, F. (2000). Enhanced Release of Superoxide from Polymorphonuclear Neutrophils in Obstructive Sleep Apnea . Impact of Continuous Positive Airway Pressure Therapy. Am. J. Respir. Crit. Care Med. 162: 566-570 [Abstract] [Full text]  
• Davies, R. J. O., Stradling, J. R. (2000). The Efficacy of Nasal Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea Syndrome Is Proven. Am. J. Respir. Crit. Care Med. 161: 1775-1776 [Full text]  
• Wright, J., Sheldon, T. (2000). The Efficacy of Nasal Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea Syndrome Is Not Proven. Am. J. Respir. Crit. Care Med. 161: 1776-1778 [Full text]  
• Peppard, P. E., Young, T., Palta, M., Skatrud, J. (2000). Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension. NEJM 342: 1378-1384 [Abstract] [Full text]  
• Douglas, N. J. (2000). Upper Airway Resistance Syndrome Is Not a Distinct Syndrome. Am. J. Respir. Crit. Care Med. 161: 1413-1415 [Full text]  
• Nieto, F. J., Young, T. B., Lind, B. K., Shahar, E., Samet, J. M., Redline, S., D'Agostino, R. B., Newman, A. B., Lebowitz, M. D., Pickering, T. G., for the Sleep Heart Health Study, (2000). Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study. JAMA 283: 1829-1836 [Abstract] [Full text]  
• Hack, M., Davies, R. J O, Mullins, R., Choi, S. J., Ramdassingh-Dow, S., Jenkinson, C., Stradling, J. R (2000). Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax 55: 224-231 [Abstract] [Full text]  
• Lavie, P., Herer, P., Hoffstein, V. (2000). Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ 320: 479-482 [Abstract] [Full text]  
• GROTE, L., PLOCH, T., HEITMANN, J., KNAACK, L., PENZEL, T., PETER, J. H. (1999). Sleep-related Breathing Disorder Is an Independent Risk Factor for Systemic Hypertension. Am. J. Respir. Crit. Care Med. 160: 1875-1882 [Abstract] [Full text]  
• Chin, K., Shimizu, K., Nakamura, T., Narai, N., Masuzaki, H., Ogawa, Y., Mishima, M., Nakamura, T., Nakao, K., Ohi, M. (1999). Changes in Intra-Abdominal Visceral Fat and Serum Leptin Levels in Patients With Obstructive Sleep Apnea Syndrome Following Nasal Continuous Positive Airway Pressure Therapy. Circulation 100: 706-712 [Abstract] [Full text]  
• Arabi, Y., Morgan, B. J., Goodman, B., Puleo, D. S., Xie, A., Skatrud, J. B. (1999). Daytime blood pressure elevation after nocturnal hypoxia. J. Appl. Physiol. 87: 689-698 [Abstract] [Full text]  
• van Houwelingen, K.G., van Uffelen, R., van Vliet, A.C.M. (1999). The sleep apnoea syndromes. Eur Heart J 20: 858-866  
• Loube, D. I., Andrada, T. F. (1999). Comparison of Respiratory Polysomnographic Parameters in Matched Cohorts of Upper Airway Resistance and Obstructive Sleep Apnea Syndrome Patients. Chest 115: 1519-1524 [Abstract] [Full text]  
• Chervin, R. D., Murman, D. L., Malow, B. A., Totten, V. (1999). Cost-Utility of Three Approaches to the Diagnosis of Sleep Apnea: Polysomnography, Home Testing, and Empirical Therapy. ANN INTERN MED 130: 496-505 [Abstract] [Full text]  
• Pack, A. I., Gurubhagavatula, I. (1999). Economic Implications of the Diagnosis of Obstructive Sleep Apnea. ANN INTERN MED 130: 533-534 [Full text]  
• ENGLEMAN, H. M., KINGSHOTT, R. N., WRAITH, P. K., MACKAY, T. W., DEARY, I. J., DOUGLAS, N. J. (1999). Randomized Placebo-controlled Crossover Trial of Continuous Positive Airway Pressure for Mild Sleep Apnea/Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 159: 461-467 [Abstract] [Full text]  
• BALLESTER, E., BADIA, J. R., HERNÁNDEZ, L., CARRASCO, E., de PABLO, J., FORNAS, C., RODRIGUEZ-ROISIN, R., MONTSERRAT, J. M. (1999). Evidence of the Effectiveness of Continuous Positive Airway Pressure in the Treatment of Sleep Apnea/Hypopnea Syndrome. Am. J. Respir. Crit. Care Med. 159: 495-501 [Abstract] [Full text]  
• D'Ambrosio, C., Bowman, T., Mohsenin, V. (1999). Quality of Life in Patients with Obstructive Sleep Apnea: Effect of Nasal Continuous Positive Airway PressureA Prospective Study. Chest 115: 123-129 [Abstract] [Full text]  
• FLEETHAM, J. A (1998). Is sleep disordered breathing associated with increased mortality?. Thorax 53: 627-628 [Full text]  
• Lindberg, E., Janson, C., Svärdsudd, K., Gislason, T., Hetta, J., Boman, G. (1998). Increased mortality among sleepy snorers: a prospective population based study. Thorax 53: 631-637 [Abstract] [Full text]  
• BARBE, F., PERICAS, J., MUNOZ, A., FINDLEY, L., ANTO, J. M., AGUSTI, A. G.N., de LLUC JOAN, M. (1998). Automobile Accidents in Patients with Sleep Apnea Syndrome . An Epidemiological and Mechanistic Study. Am. J. Respir. Crit. Care Med. 158: 18-22 [Abstract] [Full text]  
• Slyper, A. H. (1998). Childhood Obesity, Adipose Tissue Distribution, and the Pediatric Practitioner. Pediatrics 102: 4e-4 [Abstract] [Full text]  
• Engleman, H. M, Martin, S. E, Kingshott, R. N, Mackay, T. W, Deary, I. J, Douglas, N. J (1998). Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax 53: 341-345 [Abstract] [Full text]  
• Gibson, G J (1998). Public health aspects of obstructive sleep apnoea. Thorax 53: 408-409 [Full text]  
• Wright, J., Sheldon, T. (1998). Sleep apnoea and its impact on public health. Thorax 53: 410-413 [Full text]  
• Douglas, N. J (1998). Systematic review of the efficacy of nasal CPAP. Thorax 53: 414-415 [Full text]  
• Davies, R. J O (1998). Cardiovascular aspects of obstructive sleep apnoea and their relevance to the assessment of the efficacy of nasal continuous positive airway pressure therapy. Thorax 53: 416-418 [Full text]  
• REDLINE, S., ADAMS, N., STRAUSS, M. E., ROEBUCK, T., WINTERS, M., ROSENBERG, C. (1998). Improvement of Mild Sleep-disordered Breathing with CPAP Compared with Conservative Therapy. Am. J. Respir. Crit. Care Med. 157: 858-865 [Abstract] [Full text]  
• INNES, J A (1998). 1997 Winter Meeting of the British Thoracic Society. Thorax 53: 163-165 [Full text]  
• Shneerson, J., Smith, I., Pack, A. I, Young, T., Stradling, J R, Davies, R J O, Gibson, G J, Prowse, K, Semple, S J G, London, D R, Engleman, H M, Martin, S E, Deary, I J, Douglas, N J, Wright, J., Sheldon, T. (1997). Obstructive sleep apnoea. BMJ 315: 367-367 [Full text]  
• (1997). Sleep Apnea: Are Its Consequences Exaggerated?. JWatch Psychiatry 1997: 20-20 [Full text]  
• (1997). SLEEP APNEA: ARE ITS CONSEQUENCES EXAGGERATED?. JWatch General 1997: 1-1 [Full text]  
• Fleetham, J. A (1997). A wake up call for sleep disordered breathing. BMJ 314: 839-839 [Full text]  

Rapid Responses:

Read all Rapid Responses

Obstructive Sleep Apnea Syndrome and Depression

Mustafa S. Gozeler, et al.
bmj.com, 6 Apr 2005 [Full text]

Isolated UPPP has been shown to have limited success for treatment of OSA patients

Murat Enoz
bmj.com, 31 Oct 2005 [Full text]