First night positive airway pressure therapy does not impair sleep quality in obstructive sleep apnea

Positive airway pressure (PAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), yet patients often express concern about its impact on sleep quality during the initial phase of treatment. This study investigated whether the first night of PAP therapy adversely affects objective sleep architecture.

In this retrospective study, polysomnographic data from N = 176 patients with OSA undergoing first-night PAP therapy (continuous, auto titrated, or bilevel) were compared with a healthy sleep control group (N = 73). Sleep efficiency (SE), proportions of sleep stages (N1, N2, N3, and R), number of arousals, residual apnea-hypopnea index (AHI), and amount of AHI reduction were assessed. Group differences were examined using multivariate analyses of variance, and associations between age, residual AHI, and AHI reduction with SE were evaluated using correlation analyses.

PAP therapy did not impair overall sleep architecture during the first night. N3 and R sleep were preserved across therapy modalities, with no significant differences compared to the healthy group. SE and stage N2 sleep were modestly reduced in the PAP groups. Across all groups, increasing age was associated with lower SE, indicating this effect was independent of PAP therapy. Residual AHI as well as AHI reduction were not associated with SE.

During the first night of PAP therapy, N3 and REM sleep were comparable to those of healthy sleepers, whereas SE and N2 sleep were lower. These findings provide clinically reassuring evidence that the first supervised night of PAP therapy is compatible with largely preserved restorative sleep architecture, despite modest reductions in SE and N2 sleep.