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

[DreamStalker]

. . . That's bloody all!

Julie said a dirty word! Julie said a dirty word! Oh, wait, Canada isn't in the UK anymore, is it? I forgot. Never mind.

If I had a dollar for every time I said "bloody this" or "bloody that" when I returned to the US from England after 25 years .....

Seriously: I've never understood what is so bad about saying that particular 'b' word here in the US? Enlighten me please. I have learned to almost completely eliminate it, but only at great personal cost

The 'b' word has more than one definition:

verb informal
verb: bitch; 3rd person present: bitches; past tense: bitched; past participle: bitched; gerund or present participle: bitching

1.
express displeasure; grumble.
"they bitch about everything"
synonyms: complain, whine, grumble, grouse; informal whinge, moan, grouch, gripe
"they bitched about the bitching"

Origin
Old English bicce, of Germanic origin.



noun
noun: bitch; plural noun: bitches; noun: a bitch

1. a female dog, wolf, fox, or otter.
2. informal
a difficult or unpleasant situation or thing.
"this thread is a bitch to bitch about"
synonyms: nightmare; informal bastard, bummer, —— from hell, stinker
"a bitch of a forum"
3.
informal
a complaint.
"my big bitch is that there's nothing to bitch about here"

[palerider]

Seriously: I've never understood what is so bad about saying that particular 'b' word here in the US? Enlighten me please. I have learned to almost completely eliminate it, but only at great personal cost

I'm not aware that there's actually any badness about it in the US. more confusion than anything else.

[jnk...]

Most of the sensitivity about the word is in Britain moreso than the rest of the Commonwealth, from what I understand.

http://news.bbc.co.uk/2/hi/asia-pacific/4789650.stm

[Pneumophile]

Very interesting link jnk but sadly not so surprising. The piece refers to the regulators, not to British public opinion - two very different things of course. Political correctness has advanced in Britain almost as much there as over here - in this respect maybe more. At any rate I don't like to needlessly confuse or upset people so I avoid 'bloody'' here on in the Land of the Free.. Actually "bally" (as in "bally hell, I've cocked it up again!") serves me just as well. It leaves most Americans somewhat confused and they don't know whether they should be outraged or not

[Pneumophile]

I'm not aware that there's actually any badness about it in the US. more confusion than anything else.

I have been made to feel a tad boorish for using it; eyebrows are often raised. So I demur. But it's a great swear word: it provides the needed catharsis to the swearer but gives no real offense imo.

Do I have your permission to start using it again .....

[palerider]

I'm not aware that there's actually any badness about it in the US. more confusion than anything else.

I have been made to feel a tad boorish for using it; eyebrows are often raised. So I demur. But it's a great swear word: it provides the needed catharsis to the swearer but gives no real offense imo.

Do I have your permission to start using it again .....

I use it at times... and I'm not even from over there, just watch a lot of brit tv

perhaps they were raising their eyebrows because "it sounds like he's swearing, but I don't understand" sort of thoughts

I'm fine with you bloodying, or even buggering (which seems to be a favorite down undah)

[Pneumophile]

OK, back to the paper:

A chunk of the Supplementary Appendix is taken up with baseline characteristics in the "High CPAP Adherent" (>40%!), "Low CPAP Adherent (< 40%)" and "Usual Care" groups. The numbers don't seem out of line so that's OK - no evidence that results were skewed somehow by non-random group assignments at the get-go.

There is an enormous table of SAE's (Serious Adverse Events) that occurred during the study by treatment group (CPAP and Usual Care) which doesn't raise any red flags. Modest CPAP use did not make people sicker than non-use.

A pretty Forest plot (I like Forest plots) showing pre-specified subgroups for the primary (CV) outcome shows nothing significantly different from 1.0 (random or "null"). This is as expected from the main paper - no amount of slicing and dicing reveals any significant association between CPAP "usage" and cardiovascular disease progression.

Figure S3 shows cumulative event curves (primary CV outcome) for good and poor CPAP adherence and for usual care patients. To my eye there is a somewhat worse (but apparently not significantly ..) event curve for Poor Adherence CPAP patients than the event curves for either Good Adherence or Usual Care patients. To me this suggests - but only suggests - that if a decent number of subjects had truly had good adherence (>80% CPAP use, say), then the Good Adherence curve might have separated significantly from "poor adherence". But this does not explain why the Usual Care curve is so close to the Good Adherence curve and not to the Poor Adherence curve. Any ideas?

[Arlene1963]

I can't come up with any ideas re your question, Pneumophile, but I find this all very interesting and hope it can be thrashed out here! I copied Figure S3 and am going to paste it here so that maybe more folks can comment and see what you are talking about.



And here's Figure S4 showing outcomes and adherence. As one can see in this study the composite outcome for cerebral events favors CPAP use.

[So Well]

[So Well]

Hi good folks, I don't get here often anymore, but when I do, you all are still carrying on. Best regards from the Left Coast and keep on.

[So Well]

(I need to get a new avatar. Don't look so young anymore.)

[jnk...]

. . . permission . . .

According to Rule 4.2 of the International Scientific Dudes' Association Manual, public cursing is "strictly verboten, with the possible exception of when one is reviewing the work of one's peers."

I make it a rule not to pay attention to the finer details of studies that are based on overall flawed designs and definitions and misunderstandings from the get-go, for three primary reasons:

1. I am inherently lazy and do not find junk science entertaining. It would, to me, in this case, be the equivalent of hoping to stumble upon elegant, subtle, insightful, edifying literary genius in a back issue of Mad magazine because of not recognizing that the premise of the issue was a parody and a bad joke from the beginning.

2. The only thing worse than sham CPAP (which, in my opinion, according to my personal definition, is what ALL the study participants were using) is sham science, and I am simply not science-geek enough to admire the nuances of silly ideas couched in pseudo-scientific terms--in much the same way that I am not Hollywood-geek enough to admire any occasionally well-chosen camera angles in the new Ben-Hur bomb.

3. I do not wish to dignify the details of a study that, in my opinion, could easily result in loss of life if its sloppy conclusions were irresponsibly applied to real-world clinical practice for average OSA sufferers. Enough knucklehead primary docs have fallen for that sort of thing already.

But hey just me.

If someone wants to print 100 pages to back up his proof that he was unable to find a way to formulate the tools to prove anything whatsoever to anyone, good for him. But I ain't readin' it. On principle. I regret skimming the silly thing. Let alone parse it.

That said, everyone else knock yourself out sifting through the rubble of that study, if you find the exercise useful to you. I see nothing worth saving. Julie and I will read the thread from a distance so we don't get in your way or get dirty breathing in any of the dust that you raise.

I have already concluded for myself what caused that plane to crash: pilot error. I don't have the stomach to pick through the smoldering ashes in hopes of verifying that all the mechanical and electrical systems were fully functional as the clueless pilot steered the craft toward the ground.

[chunkyfrog]

Mad magazine---now that is literature!
Satire with no holy places. Nothing in our culture is safe.
The emperor is indeed naked as a jaybird!

[jnk...]

Mad magazine---now that is literature!
Satire with no holy places. . . .

But it's only funny when you know it's a joke.

[Pneumophile]

Thanks for posting figures S3 and S4 Arlene.