CPAP and heart disease -- must read!

[meister]

http://heart.healthcentersonline.com/ne ... k.cfm?nl=1

[ozij]

SOURCE: New England Journal of Medicine, November 10, 2005.
Publish Date: November 10, 2005

Please, not again.... the studies in this issue of the NEMJ have has been discussed in previous threads, and this link is to one more site abusing the study results with misleading headlines.

:sigh

O.

[neversleeps]

Please, not again....

I had the same initial reaction, Ozij! Meister, you must have missed the thread: IMPORTANT New Apnea Study

The problem arose when the authors of the study published this paper in the NEJM:
Link to New England Journal of Medicine paper on risk factors with OSA

In the above referenced paper, the researchers acknowledged: "The present study was not designed or powered to address adherence with treatment or the effect of treatment on outcomes." But they didn't stop there. They also wrote, "Nonetheless, our study demonstrated an increased risk of stroke or death from any cause among patients with the obstructive sleep apnea syndrome despite the administration of various therapies." It is unfortunate this particular sentence seems to be what many publications and readers have found to be noteworthy.

For the benefit of anyone out there who thinks this study determined cpap therapy to be ineffective, the researchers clearly stated it was never their intention to address adherence with treatment or the effect of treatment on outcomes. Thus, the continued use of CPAP therapy throughout the course of the study was never monitored or verified. Some (58%) of the participants were prescribed cpap therapy at the beginning of the study. They told the researchers they used it at least 4 hrs per night, 5 nights per week when the study began. (That, alone, sends up a red flag. Would you reach a conclusion: "Nonetheless, our study demonstrated an increased risk of stroke or death from any cause among patients with the obstructive sleep apnea syndrome despite the administration of various therapies," regarding the efficacy of cpap therapy based on participants who only used it half of their sleeping hours? Would you reach that conclusion regarding the efficacy of cpap therapy based on what someone SAID they did? Even this initial "compliance" was not verified by machine/software data; they just went by what these people told them regarding hours of use AT THE BEGINNING OF THE STUDY.)

There was NO verification or any attempt to verify or monitor continued CPAP use by any of the participants throughout the approximately 3.4 year study. How many kept using it? The researchers don't know. They never checked. If any of the participants kept up with the therapy for the duration of the study, how many of their sleeping hours did they use it? The researchers don't know. They never checked.

It is also important to note, that following their "Nonetheless" statement, they wrote, "Several explanations may account for this finding. First, it is likely that many of our patients had had untreated obstructive sleep apnea for years before seeking treatment, resulting in a prolonged exposure to cardiovascular risk. The median 3.4 years of follow-up may not have been a sufficient length of time to derive the potential cardiovascular therapeutic benefits. Second, reduced compliance with continuous positive airway pressure and limited efficacy of other treatments may have played a role in the failure of therapy to reduce the risk to baseline levels. Third, in contrast to thein a recent study that suggested a beneficial effect of treatment on outcomes, our population was older and had a higher prevalence of cardiovascular risk factors."

So, Ozij's advice regarding this paper is excellent. She wrote that anyone worried by it should either disregard it, or look for studies done about the effects of CPAP or Automatic PAP (APAP) on people who use it consistently all night, and for each nap. See her thread: IMPORTANT APNEA STUDIES

[meister]

I was in a hurry and saw the headline in the news. I should have
taken more time to actually read the article. Sorry that I missed
the previous discussion thread. It is threads like these which I
wish we had a way to delete from the forum!