Study: "CPAP machines do not reduce heart attack, strokes"

[palerider]

Avi - do you seriously think a research physician who likely publishes articles routinely would not know about copyright laws?

do you seriously think Avi thinks?

[Lucyhere]

do you seriously think Avi thinks?

Do you seriously think your retort benefits anyone, or just gives you additional post numbers?

[Wulfman...]

I wonder if the participants were using data-capable machines or were allowed to monitor and tweak their own therapy if they did have them......

Like so many other "studies", some enterprising individuals were looking to make some money showing predetermined biases.

Unfortunately, as we've seen by so many of the "drive-by" guest posters, there are many who believe this therapy is a hoax to make money, or they just don't take it seriously, or are in serious denial. Sad.

Use the therapy, tweak it to be the best it can be, monitor it with software.......and get LOTS of good, effective sleep.


Den

.

[Greendirt]

Whatever is found at a population level, given varying health and compliance profiles, usually means very little for an individual.

If an individual is complient with therapy and engaged in their health generally, their personal risk level might be lower than the study's sample.

This sort of study puts a big number of dissimilar cases together. That doesn't make 'junk science', it just gives somthing to think about beyond just the people interested enough in CPAP to visit forums.

[cancun]

As a cardiac patient, this article almost ruined my day until I got to the 3.3 hours of use part. What a disreputable misleading article. If I had read this before I started on CPAP, I probably wouldn't have started treatment because I was not aware of the oxygen desats I was having. Now my oxygen levels are in the 90's all night. This article/study is flawed and misleading. Morning rant over...have a nice day everyone

When I visited a friend in the cardiac unit with a heart attack, there was a large sign beside the door entering the unit. The sign listed the symptoms of sleep apnea and asked people to think whether they or any family members or friends had symptoms. It went on to say you can avoid a stay in the cardiac unit by treating your sleep apnea.

And, my friend was told to get a sleep study as soon as he recovered from surgery which placed two stents. He did, test was positive, and he now uses CPAP every night, all night.

Thanks ChicagoGranny for your post. I don't know if it was the result of 9 months of complete CPAP adherence or not, but on Friday I had my routine appointment with my cardiologist. Sleepyhead and odometer reports really impressed him. In addition, maybe no correlation, but my labs and Echo came back with improved results. So, I am not going to read these studies any more and go to the gym and do the treadmill like I do 3 times a week.

That is interesting CG, I have never seen anything like that in the cardiac unit before. When I had my heart attack and stent put in I was in the hospital for difficulty breathing and they did send me for a sleep study, I had a sleep study done the previous year and I did not have apnea but I did have it this time so I can definitely see the link between apnea and cardiac health.

[Arlene1963]

So who THE HELL financed this "study"?
The dental device makers?

The study was funded by the National Health and Medical Research Council of Australia, Philips Respironics and Fisher & Paykel Healthcare.

Additionally, Resmed and Philips Respironics donated the CPAP machines for the study.

This info is on the SAVE website here http://www.savetrial.org/partnerships which is linked to in the article referenced in the opening post.

[billbolton]

We already KNOW that xPAP is not a silver bullet that solves all the pre-existing medical problems that a patient brings to xPAP treatment...... it just treats Obstructive Sleep Apnea.

There are many, many, many threads here which amply illustrate this. The patients in the study specifically had pre-existing cardio and circulatory conditions which may well have been exacerbated by OSA (or some other SDB ailment) in the past so it should be no surprise that relieving their OSA symptoms did not have any significant causal impact on their pre-existing conditions, and the likelihood of adverse events arising from the pre-existing condition.

The study reported that they did see the normally expected benefits from xPAP treatment, which is great news. So, there really is nothing much to see here in terms of the realistic expectations of the outcomes for xPAP treatment.

[Arlene1963]

This morning I came across these interviews with cardiologists regarding this study.


http://www.medpagetoday.com/VideoConfer ... ideos/1854
http://www.medpagetoday.com/VideoConfer ... ideos/1886

[ChicagoGranny]

This morning I came across these interviews with cardiologists regarding this study.


http://www.medpagetoday.com/VideoConfer ... ideos/1854

http://www.medpagetoday.com/VideoConfer ... erESC2016/

Maybe you can post a brief summary of what they had to say?

[Arlene1963]

Hi ChicagoGranny, I will gladly do that later today.

If folks wish to click on the links though, these are simply short video clips of the doctors each discussing this study.

The doctors involved are Dr Kim A. Williams (President of the American College of Cardiology and chief of Cardiology at Rush University); Professor Doug McEvoy, MD principal investigator of the SAVE study; Dr Robert Harrington, cardiologist and Chair of the Dept of Medicine at Stanford University, and finally Dr E Magnus Ohman, a Professor of Medicine and cardiologist at Duke University.

[ChicagoGranny]

http://www.medpagetoday.com/VideoConfer ... ideos/1854

1. OSA patients with severe hypoxia were left out of the study.
2. The study followed patients for only 3.7 years - not enough time to fully evaluate cardiac risk.
3. Average compliance hours were a mere 3.3 hours per night.

A nonsense study!!

I would like to see your conclusions, Arlene.

[raisedfist]

mask is supposed to be worn during ALL sleep periods, including naps or when you wake up multiple times in the night. i wonder how many people are actually compliant with this

[Arlene1963]

http://www.medpagetoday.com/VideoConfer ... ideos/1854

1. OSA patients with severe hypoxia were left out of the study.
2. The study followed patients for only 3.7 years - not enough time to fully evaluate cardiac risk.
3. Average compliance hours were a mere 3.3 hours per night.

ChicagoGranny, I completely agree with your summary of Dr Williams' comments.

Now for the others:

Doug McEvoy (Principal investigator of SAVE)

1. There was no demonstrable benefit from CPAP in CV events in this study among people who already have established CV disease.
2. Although no improvement in CV event outcomes, OSA should still be identified and CPAP should be used because QOL is vastly improved in various areas (depression, over all well being, reduction in sick days from work)
3. He emphasizes that this is one study only and benefit IS seen in terms of stroke prevention among those who use CPAP for longer each night. (I think this is a very positive outcome and not highlighted nearly enough)

Dr Harrington (Stanford University)

1. Patients with moderate OSA and existing CVD with symptoms of OSA such as tiredness, snoring, etc should be offered CPAP because it greatly improves QOL
2. Asymptomatic CV patients should not be offered CPAP to treat CV issues as this study shows no evidence of benefit on existing heart disease.
3. Basically his take on this study is that CPAP is indicated for alleviation of OSA symptoms and not to treat existing CVD.


Dr Ohman (Duke University)

1. Discusses the two latest large outcome trials done on patients with existing CVD and CPAP
2. Mentions that in HF patients the outcome study last year was very alarming and showed a definite trend to higher mortality which dramatically changed the way HF patients are treated (He is referring to the study on ASV and Heart failure patients)
3. Is concerned that these two latest studies show at best neutral outcomes
4. Still believes that CPAP is useful for patients with severe OSA in that it reduces BP, and is also indicated for heart rhythm control (I'm assuming Afib)


As someone who uses CPAP and is trying to prevent heart disease, I want to see better studies than this one. I understand that the relationship between CPAP and CVD might be more complicated than first realised, but studies like this simply muddy the waters.

What is really sad is that even among folks who were presumably motivated (ie existing heart disease) CPAP use on average was only 3.3 hours per night. What an indictment of the current standard of treatment of OSA.

[jnk...]

The larger problem is . . .

No insurance company is actually interested in paying cardiologists to maintain patient quality of life; it can't be effectively factored into their cute little evidence-basis formulas. So badly formulated studies such as this one can too easily be used as a reason to deny coverage, to the detriment of all. A bad study can do more damage than no study at all.

Prescribing a CPAP isn't all that is needed to help. Providing a CPAP isn't all that is needed. Having a CPAP isn't all that is needed. Improper and incomplete use of a CPAP may or may not help some or any a little or at all. It is only the constant use of customized-efficacy CPAP that has a chance in Hades of consistently helping people breathe and helping people sleep. Do the people who ran this study actually believe that have proven that humans don't need to sleep or to breathe to have a healthy heart?

To me, this is the equivalent of attempting to study the efficacy of a drug that the subjects, on AVERAGE, only used one-third of the time and at an unproven dosage for the time they did use it.

Part of the problem is that the people doing the study have confused the figures used for minimum usage of PAP for insurance coverage of a blower purchase with what is actually effective use of PAP therapy. If they blew it that bad on that vital detail, how can you trust one word of the stupid study?

Idiots.

If you don't know what you're talking about, please don't publish a study. Better to be thought a fool when it comes to PAP than to publish and remove all doubt.

In my humble opinion, of course.

[Pneumophile]

http://www.medpagetoday.com/VideoConfer ... ideos/1854

1. OSA patients with severe hypoxia were left out of the study.
2. The study followed patients for only 3.7 years - not enough time to fully evaluate cardiac risk.
3. Average compliance hours were a mere 3.3 hours per night.

A nonsense study!!

I would like to see your conclusions, Arlene.

I have not yet read the actual paper but trust me I will, if I have to get someone with access to the NEJM to send me the pdf. But if what I have read in the NEJM editorial (earlier post here) and in the Medscape piece is accurate, then this was a deeply flawed piece of work that should NEVER have been published in the New England Journal - some third rate journal in a scientific backwater perhaps but not any decent American or European journal.

Why? You have given some of the reasons here ChicagoGranny. Look, there is simply NO EXCUSE for NOT running a well powered analysis on a large subset of patients who are highly compliant - let's say a median of > 7 hours per night. Now maybe they did do that but I haven't read about it.' If they did, THAT should be the top line not some worthless comment on largely noncompliant individuals or pompous and erroneous conclusion about the non-efficacy of CPAP in cardiovascular disease.

An average of 3.3 hours means that many patients were on the blower for much less than that, obviously. If they had used medians instead of averages (which I always do in my own clinical research on patient biomarker and efficacy/toxicity data), we would be in a better position to interpret - averages are almost invariably skewed because clinical data are almost always non-Gaussian. Sorry to get technical but this stuff matters, and it tells you something about the sophistication or otherwise of the authors.

What the hell were these people thinking? I refer here not just to the authors of this study but to the relevant NEJM editorial staff. I will read that paper and report to this forum in some detail. Maybe I'm over-reacting to incorrect or incomplete information about this research or maybe this really is a rather disgraceful piece of work all around.