Sleep apnea syndrome 1999-2022: From randomized trials to cohort studies

Sleep Breathing Disorders in their various forms represent a major public health problem, owing to their prevalence and their associated consequences, in particular Excessive Daytime Sleepiness (EDS), impairment of vigilance, cardiovascular and metabolic morbidities. Although the large scale use of Positive Airway Pressure and Non-Invasive Ventilation dates back to the eighties, the scientific evidence has been built progressively. Since 2000, randomi-zed controlled trials (RCTs) have been designed in order to evaluate the treatment effects in Obstructive Sleep Apnea (OSA), then Sleep Apnea and Heart Failure and Obesity-Hypoventilation Syndrome. However, the effects on cardiovascular morbidity and mortality remain limited, in primary as well as secondary prevention. It remains a conflicting issue and there are pending questions on study designs and specific sub-groups responsiveness to apneas and Intermittent Hypoxia. There is some evidence that OSA patients presenting with severe EDS may also exhibit greater cardiovascular consequences. Thus, they could represent one of the target groups that should be specifically tested. Also, large RCTs including repeated diurnal and nocturnal tests remain difficult to implement. An alternative could be using "real life" comparative cohort studies.(c) 2023 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.