ERS/ESRS clinical practice guideline for continuous positive airway pressure for the treatment of adult obstructive sleep apnoea
In brief
Sleep apnea guideline strongly recommends CPAP for patients with daytime sleepiness
A European guideline strongly recommends continuous positive airway pressure for adults with obstructive sleep apnea and excessive daytime sleepiness, and conditionally suggests it for several other groups, including people with moderate to severe apnea or hypertension. For patients without sleepiness, those with atrial fibrillation seeking to prevent recurrence, or those with impaired glucose metabolism, it suggests CPAP or no treatment; benefits differ by subgroup.
- Journal
- The European respiratory journal (Q1)
- Published
- 11 October 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Dries Testelmans, Esther Irene Schwarz, Ulla Anttalainen, Özen Kacmaz Basoglu, Matteo Bradicich, Sonja Craig, et al.
- PMID
- 42860272
- DOI
- 10.1183/13993003.01186-2026
Why clinicians should know about it
- Picked for Family Practice (paper of the day, 12 October 2026): ERS/ESRS CPAP guideline, relevant to OSA management in primary care
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 12 October 2026): CPAP guideline for adult OSA, directly relevant to sleep‑disordered breathing
Abstract
BACKGROUND: Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnoea (OSA), although its effectiveness may vary across OSA subtypes. This joint European Respiratory Society (ERS)/European Sleep Research Society (ESRS) clinical practice guideline evaluates CPAP's impact on patient-centred and prognostically relevant outcomes, comparing it to no or sham treatment in different OSA subgroups. METHODS: The joint ERS/ESRS Task Force consisted of experts in pulmonology, cardiology and respiratory sleep medicine, patient representatives and methodologists. Questions were formulated using the PICO (Population, Intervention, Comparator, Outcomes) framework. A systematic review assessing the effects of CPAP on critical outcomes was performed. The certainty of evidence for all outcomes was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus on the direction and strength of the recommendation was informed by Evidence-to-Decision frameworks and achieved through discussions and voting. RECOMMENDATIONS: The Task Force generally suggests CPAP treatment for OSA because of its beneficial effects on sleepiness, other patient-reported outcomes and blood pressure (conditional recommendations). CPAP is recommended in patients with excessive daytime sleepiness (EDS) (strong recommendation). Additional specific conditional recommendations are given for patients with moderate-to severe OSA, the elderly, and patients with arterial and treatment-resistant hypertension. The Task Force suggests either CPAP or no treatment in patients without EDS (but taking into account other OSA-related symptoms), in patients with atrial fibrillation with the aim of reducing its recurrence and in patients with impaired glucose metabolism to improve glycaemic control. CONCLUSION: CPAP is an effective treatment for adults with OSA. However, recommendations for its use vary across different patient subgroups.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.