Extract
The recently published technology assessment of continuous positive airway pressure (CPAP), prepared for the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services and entitled Long-Term Health Outcomes in Obstructive Sleep Apnea, has created considerable angst within the sleep medicine community with its conclusion that randomised trials “do not provide evidence that CPAP prescription affects long-term, clinically important outcomes” [1]. As an invited peer reviewer of this report, I was highly critical of the report's exclusion of excessive sleepiness and other symptoms from consideration as “clinically important outcomes”. Sleepiness and fatigue are the most common reasons that patients seek evaluation for obstructive sleep apnoea (OSA), being present in over 80% of sleep clinic patients [2]. By excluding sleepiness from consideration as an outcome of OSA, the AHRQ failed to address a question of fundamental importance in assessing the benefits of CPAP therapy.
Tweetable abstract
The AHRQ assessment of the impact of CPAP on long-term health outcomes in sleep apnoea is flawed in its failure to consider the impact of CPAP on sleepiness, but correctly identifies a lack of clinic trial evidence of cardiovascular benefits from CPAP https://bit.ly/3D5Ekf3
Footnotes
Conflict of interest: Outside the submitted work, D.J. Gottlieb reports consulting fees from Powell Mansfield, Inc. (key opinion leader roundtable discussion on sleep apnoea diagnostic technology, personal payment), scientific advisory board participation with Signifier Medical, Inc. and Wesper, Inc., and provision of sleep apnoea testing devices at below market rates for a research study from ResMed, Inc., through Brigham and Women's Hospital as primary grantee.
- Received April 3, 2023.
- Accepted June 19, 2023.
- Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org