TABLE VIII.B. 1.

Evidence for improvement in sleepiness with PAP

	Year	LOE	Study design	Study groups	Clinical end-point	Conclusion
Marshal et al.1199	2006	1a	SR	7 RCTs comparing CPAP to placebo or conservative management in subjects with mild to moderate OSA	Objective and subjective daytime sleepiness and objective wakefulness	Meta-analyses demonstrated a significant reduction in subjective sleepiness (ESS) by 1.2 points (95% CI: 0.5, 1.9), improved objective daytime wakefulness (MWT) by 2.1 min (95% CI 0.5, 3.7), and no significant change in MSLT.
McDaid et al.1200	2009	1a	SR	48 studies comparing CPAP vs. alternatives (oral placebo, sham CPAP, dental device, and usual care)	Objective and subjective daytime sleepiness and sleepiness and wakefulness	CPAP significantly reduced ESS score compared to control by 2.7 points (95% CI: −3.5, −2.0). CPAP improved daytime wakefulness (MWT) by 3.3 min (95% CI: 1.3, 5.3). CPAP did not significantly change MSLT values for all participants, but there was a benefit (mean difference 2.3 min, 95% CI: 9, 3.7, I2 0%) for those with severe disease (as measured by AHI).
Patil et al.39	2019	1a	SR	Up to 38 RCTs comparing PAP vs. alternatives (predominantly sham PAP or no PAP, but also nasal dilator strips, sleep hygiene and counselling, and usual care)	Objective and subjective daytime sleepiness and objective wakefulness	Meta-analyses of 38 RCTs demonstrated a clinically significant decrease in ESS score by 2.4 points with the use of PAP compared with controls (95% CI: −2.8, −1.9). A meta-analysis of seven RCTs showed a reduction in MWT or OSLER sleep latency by 0.5 min in subjects treated with PAP (95% CI: 0.2, 0.8). A meta-analysis of seven RCTs found no significant difference in mean sleep latency in subjects treated with PAP compared to controls.