Comment on a draft report by Agency for Healthcare Research and Quality (AHRQ) before the public comment period closes on April 23, 2021.
A draft report by AHRQ states:
Studies are highly inconsistent as to how they define breathing measures during sleep studies and OSA itself. Insufficient evidence exists to assess the validity of AHI as a surrogate or intermediate outcome for long-term clinical outcomes. Until such validation has been conducted, it cannot be assumed that changes (e.g., improvements) in intermediate or surrogate outcomes are correlated with long-term clinical outcomes.
The published evidence mostly does not support that CPAP prescription affects long-term, clinically important outcomes. Specifically, with low SoE RCTs do not demonstrate that CPAP affects all-cause mortality, various CV outcomes, clinically important changes in psychosocial measures, or other clinically important outcomes. When NRCSs are combined with the RCTs there is the suggestion that CPAP reduces the risks of all-cause mortality (low SoE); other conclusions are not changed. The low SoE for these outcomes suggests that we have limited confidence that the summary estimates are close to the true effect.
Studies did not adequately address whether effects of CPAP vary based on disease severity (e.g., as assessed by AHI), symptoms (e.g., as assessed by sleepiness scales), other patient characteristics, different features or modes or CPAP, or different criteria or definitions of sleep measures or OSA diagnosis.
Additional studies are needed before we have a clear understanding of the potential effects of CPAP on long-term outcomes for patients with OSA, whether any particular group of patients may benefit to a greater or lesser degree from CPAP treatment or whether of AHI (and/or other breathing measures) are valid intermediate or surrogate measures of clinical outcomes.Comment on the draft report here
I find this report unsettling. As a retired physician, I resisted an overnight sleep study for seven years before being convinced that one was indicated. That study revealed an AHI of 124. I was aware that the attrition rate of those placed on CPAP approached 50% within 6 months of introduction. Being stubborn, I was determined to be a “poster boy” for CPAP. Upon institution of CPAP for my OSA, all parameters of measurement became normal and, after more than five years on this intervention, remain so. Perhaps my renewed energy, activity, and improved outlook are all psychological. Yes, I am “a numbers guy”, watching my progress on a daily basis. But a report such as this… acknowledging that future studies are desperately needed… runs the high risk of eliminating funding for CPAP and its variants through insurance programs of all types until those studies are completed and verifiable. For the multitudes who have benefitted by the therapeutic intervention and who suspect that our improvement and well-being is in large part due to the physical effects of CPAP intervention, interruption of funding could have tragic consequences.
I agree, doc! When I put that CPAP on, my brain took to it like a duck to water! That was years ago, and I believe it has helped me stay healthy going on 82.
Thank you Jim and Thomas for your testimonials.
Are you gonna share your comments using the review process from the AHRQ?
I greatly appreciate Dr. Davis response. I do not think the editor of Sleep Review is a physician. I could be wrong. I would appreciate the editor explaining the relationship between upper airway obstruction, hypoxemia, pulmonary vasoconstriction, pulmonary hypertension, cardiac remodeling and arrhythmias. PAP saves lives and health care dollars.
You are correct that I am not a physician. I did not write or contribute to the draft report. I am encouraging healthcare professionals to leave their comments on the report-creator’s website before the comment period closes so that the final report will be accurate. Click on the “comment on the draft report here” link to submit comments to the agency that created the report. Thanks!
My doctor took me off CPAP after 17 years. My daytime sleepiness has increased. I cannot sit for a minute without falling asleep.
It has been 5 months now and I see him in May. I know my oxygen desaturation reaches a nadir of 83 while I am not using the CPAP.
I had only 1 apnea and 68 hypopneas during my latest sleep test without CPAP. The study using CPAP therapy recomended use at 9cm
H20 with heated humidification. I am perplexed.