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We investigated whether OSA patients experience nocturnal cerebral hypoxia that is prevented by continuous positive airway pressure (CPAP).<\/jats:p><jats:p>OSA patients using CPAP underwent sleep studies including pulse oximetry (arterial oxygen saturation (<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>)) and near-infrared spectroscopy to monitor cerebral tissue oxygenation (CTO) at baseline and after 2\u2005weeks on either subtherapeutic or therapeutic CPAP according to randomised allocation. Changes in oxygenation at end of the 2-week intervention were compared between groups.<\/jats:p><jats:p>Among 21 patients (mean apnoea\/hypopnoea index 50.3\u2005events\u00b7h<jats:sup>\u22121<\/jats:sup>), OSA recurred in all nine patients using subtherapeutic CPAP and in none of the patients using therapeutic CPAP: mean (95% CI) between-group differences in changes of oxygen desaturation index from baseline to 2\u2005weeks +40.7 (31.1\u201350.4)\u2005events\u00b7h<jats:sup>\u22121<\/jats:sup>for<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>and +37.0 (25.3\u201348.7) events\u00b7h<jats:sup>\u22121<\/jats:sup>for CTO (both p&lt;0.001). Mean nocturnal<jats:italic>S<\/jats:italic><jats:sub>pO<jats:sub>2<\/jats:sub><\/jats:sub>and CTO decreased more in patients using subtherapeutic<jats:italic>versus<\/jats:italic>therapeutic CPAP: \u22122.4 (\u22123.4\u2013\u22121.1)% and \u22123.8 (\u22127.4\u2013\u22120.1)%, respectively; both p&lt;0.03. Severe CTO drops \u226513% associated with cerebral dysfunction in\u00a0previous studies occurred in four out of nine patients using subtherapeutic CPAP, but in none out of 12 patients using therapeutic CPAP (p=0.01).<\/jats:p><jats:p>In patients with OSA, CPAP withdrawal resulted in nocturnal cerebral deoxygenation, suggesting a role of cerebral hypoxia in predisposing untreated OSA patients to cerebral damage.<\/jats:p>","DOI":"10.1183\/13993003.00032-2018","type":"journal-article","created":{"date-parts":[[2018,4,26]],"date-time":"2018-04-26T11:45:11Z","timestamp":1524743111000},"page":"1800032","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Nocturnal cerebral hypoxia in obstructive sleep apnoea: a randomised controlled trial"],"prefix":"10.1183","volume":"51","author":[{"given":"Esther 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