Patients With OSA Are Perceived as Younger Following Treatment With CPAP

  • Fabiana Yagihara
    Faculdade de Medicina FMUSP, Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo/SP, Brazil
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  • Geraldo Lorenzi-Filho
    Faculdade de Medicina FMUSP, Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo/SP, Brazil

    Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo/SP, Brazil
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  • Rogerio Santos-Silva
    Correspondence to: Rogerio Santos-Silva, PhD, Avenida Rebouças, 411, CEP 05401-000, São Paulo, SP, Brazil
    Faculdade de Medicina FMUSP, Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, Sleep Laboratory, São Paulo/SP, Brazil

    Núcleo Interdisciplinar da Ciência do Sono (NICS), São Paulo/SP, Brazil
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      The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA.


      Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1 month. The sequence was interposed by 15 days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients’ conditions.


      Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7 h per night on 94% of the nights and the placebo intervention on 98% of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) ( P < .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation < 90% were predictors of a decreased age rating following CPAP treatment.


      Patients with severe OSA had a younger appearance following 1 month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management.

      Trial registry; No.: NCT02117271; URL:

      Key Words


      ESS ( Epworth Sleepiness Scale), FOSQ ( Functional Outcomes of Sleep Questionnaire), PSG ( polysomnography), Spo2 ( oxyhemoglobin saturation), TST ( total sleep time)
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        • Tufik S.
        • Santos-Silva R.
        • Taddei J.A.
        • Bittencourt L.R.
        Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study.
        Sleep Med. 2010; 11: 441-446
        • Badran M.
        • Yassin B.A.
        • Fox N.
        • Laher I.
        • Ayas N.
        Epidemiology of sleep disturbances and cardiovascular consequences.
        Can J Cardiol. 2015; 31: 873-879
        • Nowak M.
        • Kornhuber J.
        • Meyrer R.
        Daytime impairment and neurodegeneration in OSAS.
        Sleep. 2006; 29: 1521-1530
        • Morrell M.J.
        • Jackson M.L.
        • Twigg G.L.
        • et al.
        Changes in brain morphology in patients with obstructive sleep apnoea.
        Thorax. 2010; 65: 908-914
        • Marshall N.S.
        • Wong K.K.
        • Phillips C.L.
        • Liu P.Y.
        • Knuiman M.W.
        • Grunstein R.R.
        Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study?.
        J Clin Sleep Med. 2009; 5: 15-20
        • Yaggi H.K.
        • Concato J.
        • Kernan W.N.
        • Lichtman J.H.
        • Brass L.M.
        • Mohsenin V.
        Obstructive sleep apnea as a risk factor for stroke and death.
        N Engl J Med. 2005; 353: 2034-2041
        • Budhiraja R.
        • Budhiraja P.
        • Quan S.F.
        Sleep-disordered breathing and cardiovascular disorders.
        Respir Care. 2010; 55: 1322-1332
        • Kakkar R.K.
        • Berry R.B.
        Positive airway pressure treatment for obstructive sleep apnea.
        Chest. 2007; 132: 1057-1072
        • Marshall N.S.
        • Barnes M.
        • Travier N.
        • et al.
        Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis.
        Thorax. 2006; 61: 430-434
        • Epstein L.J.
        • Kristo D.
        • Strollo Jr., P.J.
        • et al.
        Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540-545
      1. NCT02117271.
        (The Treatment of Obstructive Sleep Apnea With Continuous Positive Airway Pressure on Appearance and Age. Recruitment Status: Completed First Posted: April 17, 2014 Last Update Posted: March 29, 2017) (Accessed April 17, 2019)
        • Berry R.B.
        • Brooks R.
        • Gamaldo C.E.
        • et al.
        The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0.
        American Academy of Sleep Medicine, Darien, IL2012
        • Kushida C.A.
        • Chediak A.
        • Berry R.B.
        • et al.
        Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea.
        J Clin Sleep Med. 2008; 4: 157-171
        • Weaver T.E.
        • Laizner A.M.
        • Evans L.K.
        • et al.
        An instrument to measure functional status outcomes for disorders of excessive sleepiness.
        Sleep. 1997; 20: 835-843
        • Beck A.T.
        • Epstein N.
        • Brown G.
        • Steer R.A.
        An inventory for measuring clinical anxiety: psychometric properties.
        J Consult Clin Psychol. 1988; 56: 893-897
        • Yagihara F.
        • Lorenzi-Filho G.
        • Santos-Silva R.
        Nasal dilator strip is an effective placebo intervention for severe obstructive sleep apnea.
        J Clin Sleep Med. 2017; 13: 215-221
        • Sawyer A.M.
        • Gooneratne N.S.
        • Marcus C.L.
        • Ofer D.
        • Richards K.C.
        • Weaver T.E.
        A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions.
        Sleep Med Rev. 2011; 15: 343-356
        • Antic N.A.
        • Catcheside P.
        • Buchan C.
        • et al.
        The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA.
        Sleep. 2011; 34: 111-119
        • Weaver T.E.
        • Maislin G.
        • Dinges D.F.
        • et al.
        Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning.
        Sleep. 2007; 30: 711-719
        • Punjabi N.M.
        • Caffo B.S.
        • Goodwin J.L.
        • et al.
        Sleep-disordered breathing and mortality: a prospective cohort study.
        PLoS Med. 2009; 6e1000132
        • Marin J.M.
        • Carrizo S.J.
        • Vicente E.
        • Agusti A.G.
        Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.
        Lancet. 2005; 365: 1046-1053
        • Christensen K.
        • Thinggaard M.
        • McGue M.
        • et al.
        Perceived age as clinically useful biomarker of ageing: cohort study.
        BMJ. 2009; 339: b5262
        • Gunn D.A.
        • Larsen L.A.
        • Lall J.S.
        • Rexbye H.
        • Christensen K.
        Mortality is written on the face.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 72-77
        • Huang P.
        • Zhou J.
        • Chen S.
        • Zou C.
        • Zhao X.
        • Li J.
        The association between obstructive sleep apnea and shortened telomere length: a systematic review and meta-analysis.
        Sleep Med. 2017; 48: 107-112
        • Oyetakin-White P.
        • Suggs A.
        • Koo B.
        • Matsui M.S.
        • Yarosh D.
        • Cooper K.D.
        • Baron E.D.
        Does poor sleep quality affect skin ageing?.
        Clin Exp Dermatol. 2015; 40: 17-22
        • Benedetti F.
        Placebo and the new physiology of the doctor-patient relationship.
        Physiol Rev. 2013; 93: 1207-1246
        • Petrovic P.
        • Kalso E.
        • Petersson K.M.
        • Ingvar M.
        Placebo and opioid analgesia imaging a shared neuronal network.
        Science. 2002; 295: 1737-1740
        • Diederich N.J.
        • Goetz C.G.
        The placebo treatments in neurosciences: new insights from clinical and neuroimaging studies.
        Neurology. 2008; 71: 677-684
        • Colloca L.
        • Miller F.G.
        Role of expectations in health.
        Curr Opin Psychiatry. 2011; 24: 149-155
        • Piedimonte A.
        • Benedetti F.
        • Carlino E.
        Placebo-induced decrease in fatigue: evidence for a central action on the preparatory phase of movement.
        Eur J Neurosci. 2015; 41: 492-497
        • Chervin R.D.
        • Ruzicka D.L.
        • Vahabzadeh A.
        • Burns M.C.
        • Burns J.W.
        • Buchman S.R.
        The face of sleepiness: improvement in appearance after treatment of sleep apnea.
        J Clin Sleep Med. 2013; 9: 845-852