Extract
A recently published report prepared for the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services concluded that the published evidence from randomised controlled trials (RCTs) mostly does not support a benefit from continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) in outcomes that include cardiometabolic comorbidity, cognitive function, quality of life and driving accident risk [1]. While some conclusions are valid, especially the lack of RCT evidence for benefits of CPAP therapy in the secondary prevention of pre-existing cardiovascular disease, and the inconsistent definitions of OSA regarding measures of sleep disordered breathing and the clinical syndrome, this group of European experts strongly question the validity of many conclusions contained in this report.
Tweetable abstract
A government-sponsored US report that CPAP therapy for sleep apnoea did not benefit clinical outcomes is compromised by reliance on RCTs with inappropriate patient selection and failure to include evidence of benefit of CPAP on excessive daytime sleepiness https://bit.ly/3G3drdu
Footnotes
Conflict of interest: W.T. McNicholas reports support for the current manuscript from the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), and reports a leadership role as board member of the European Sleep Research Society, outside the submitted work. E.S. Arnardottir reports support for the current manuscript from the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), and NordForsk (NordSleep) via the Icelandic Research Fund, and reports lecture honoraria from Nox Medical, Philips, ResMed, Jazz Pharmaceuticals, Linde Healthcare, Alcoa – Fjardaral, Wink Sleep, Vistor (NovoNordisk) and Apnimed, participation on the Philips Sleep Medicine and Innovation medical advisory board, and has a leadership role as secretary of the board of the European Sleep Research Society, outside the submitted work. T. Leppänen reports support for the current manuscript from the European Union's Horizon 2020 Research and Innovation Programme (grant 965417), NordForsk (NordSleep project 90458) via Business Finland (5133/31/2018), and Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (5041794), and reports lecture honoraria from Turku University Hospital, Turku, outside the submitted work. S. Schiza has nothing to disclose. W. Randerath reports lecture honoraria from Heinen & Löwenstein, Jazz Pharmaceuticals, Philips Respironics, Bioprojet, Westfalen Medical and Habel Medizintechnik, travel support from Heinen & Löwenstein, Jazz Pharmaceuticals, Philips Respironics and Bioprojet, advisory board participation with Bioprojet, Jazz Pharmaceuticals, Procter & Gamble and Desitin, and leadership roles with the European Respiratory Society (Head Assembly 4, Sleep Disordered Breathing) and the German Respiratory Society (Secretary General).
Support statement: This work was supported by H2020 Health (grant: 965417). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received February 1, 2023.
- Accepted March 27, 2023.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org