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

They can add this to their study, (But Won't), In 2005 I had what turned out to be a second heart attack, first one wasn't treated, just ignored. went thru 2 stents and a month later a quad by-pass.

I was put of XPAP because my airway was so closed it took them 20 minutes to tube me for the OP.

My heart is almost gone, 35% infraction rate. Without XPAP I wouldn't be here, not that here is the best, it beats the alternative. If we could unfund all the junk (science ) and put these so called learned experts in the trash where they belong, the internet could be much better.

Educations job nowadays isn't to educate, it's to milk money to feed itself, like the government. It takes those that can't do, and allows them to make the next generation of experts, that can't do. Jim

I've been thinking about doing a study on how ignorance does not reduce heart attack or strokes but haven't been able to find any in the corporate health industry to fund the study. Seems like unless I'm able to help them sell more of their bullcrap, they don't want in invest in such studies.

My concern about this so-called study is that insurers will use it as an excuse to stop paying for CPAP. They don't want to pay for "quality of life" enhancers.

Forget about insurance. The whole health system is collapsing .... especially the insurance portion.





Red line is average premium increase.

So, DS, are you predicting 2017 the year of the American Spring?

jnk... wrote:So, DS, are you predicting 2017 the year of the American Spring?

I've been expecting the American Spring since 2012.

I don't know "when" it will happen --- only that it is inevitable at some point before I die of natural causes.

Comments on the above study written by Babak Mokhlesi, M.D., and Najib T. Ayas, M.D., M.P.H, from the Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago (B.M.); and the Sleep Disorders Program, Respiratory and Critical Care Divisions, Department of Medicine, University of British Columbia, Vancouver, Canada. (N.T.A.)…
August 28, 2016DOI: 10.1056/NEJMe1609704


EXCERPTS:


The Sleep Apnea Cardiovascular Endpoints (SAVE) trial, the results of which are now reported in the Journal by McEvoy et al., is an important and welcome addition to the field. Patients with a history of coronary artery disease or cerebrovascular disease and moderate-to-severe obstructive sleep apnea were randomly assigned to receive CPAP plus usual care (CPAP group) or usual care alone (usual-care group).

Despite the negative result for the primary end point, CPAP had a significant beneficial effect on quality of life, mood, daytime sleepiness, and work productivity.

This trial raises several issues. One major issue is whether the results were negative because obstructive sleep apnea does not have clinically significant adverse cardiovascular effects — and thus any treatment would be ineffective in reducing cardiovascular events — or because the patients did not use CPAP for a long enough duration each night to derive cardiovascular benefits. Given the substantial human and animal data that have consistently documented links between obstructive sleep apnea and cardiovascular health, we suspect that it may be the latter. In the SAVE trial, the mean duration of CPAP adherence was only 3.3 hours per night, which is probably less than half the time the patient was asleep. This dose of CPAP may not be adequate to prevent cardiovascular events. In a prespecified propensity-score–matched analysis, 561 patients who used CPAP for more than 4 hours per night were compared with a control group of patients who received usual care alone.

Another related issue may be the timing of CPAP; when used in the beginning of the night, CPAP may be less effective than when used later in the night. In many of the trial patients, CPAP may not have been in use during rapid-eye-movement (REM) sleep, the sleep stage that predominates in the early morning hours. This is a concern because apneic or hypopneic events that occur during REM sleep are longer, with greater oxygen desaturation, than those that occur during non-REM sleep; moreover, events that occur during REM sleep have a significantly stronger association with hypertension.

To maximize enrollment, the investigators recruited participants from a variety of geographic locations that had limited resources. They took a pragmatic approach and performed a diagnostic test for obstructive sleep apnea (using a home sleep-study screening device [ApneaLink; ResMed]) that is much simpler to perform than polysomnography. However, it is possible that the limited resources at certain participating sites may have affected adherence to CPAP therapy and the trial results, given that the mean duration of adherence was lower than in other studies.

What do these results mean for clinical practice? We believe that for symptomatic patients with obstructive sleep apnea, a trial of CPAP should be offered. It would also be prudent to offer CPAP to patients with obstructive sleep apnea and severe hypoxemia during sleep regardless of symptoms — these patients were excluded from the SAVE trial.

What do these results mean for clinical practice?

Nothing. Meaningless. Clinical practice should never be influenced by one study. And especially not by one as stupid and misleading as this one. Clinicians should merely be entertained by reading such meandering, mindless, uninformed attempts at research--hoping that such an exercise in how NOT to conduct a useful study will make it obvious to fellow clinicians that no one should ever be distracted by the lunatics who have apparently, hopefully temporarily, taken over the research asylum. Anyone with his or her name attached to that study should start contemplating some form of plausible deniability ("musta been a misprint; I was nowhere near that study!") in order to have something left of their careers. I mean, there is "flawed," which can still be useful for opening up a dialog, and then there is 'absurdly flawed,' as in "don't waste time trying to make sense of whatever it was they thought they were trying to investigate."

The paper is available for free on the NEJM website - nejm.org

DreamStalker wrote:I've been thinking about doing a study on how ignorance does not reduce heart attack or strokes . . .

Well, now that depends. If ignorance is bliss, maybe the bliss itself could have some protective properties over time?

Personally, I think the study of ignorance could be brilliant! In fact, I think there is altogether too little information out there on the lack of information out there. I don't think we know enough about knowing as little as possible, so let's shed as much light as we can on this topic of the prevailing darkness!

Whaddya think you'll need for funding? Should I have my people call your people?

jnk... wrote:

What do these results mean for clinical practice?

Nothing. Meaningless. Clinical practice should never be influenced by one study. And especially not by one as stupid and misleading as this one. Clinicians should merely be entertained by reading such meandering, mindless, uninformed attempts at research--hoping that such an exercise in how NOT to conduct a useful study will make it obvious to fellow clinicians that no one should ever be distracted by the lunatics who have apparently, hopefully temporarily, taken over the research asylum. Anyone with his or her name attached to that study should start contemplating some form of plausible deniability ("musta been a misprint; I was nowhere near that study!") in order to have something left of their careers. I mean, there is "flawed," which can still be useful for opening up a dialog, and then there is 'absurdly flawed,' as in "don't waste time trying to make sense of whatever it was they thought they were trying to investigate."

Yes, I wouldn't argue. But it's even worse: the paper has the imprimatur of the NEJM, which I put in a league with the Nature series of journals (incl. Nature Medicine). Perhaps I should reconsider ......

Are you planning a detailed review in this thread? I will do it when I get the chance since I now have the full article. I see that the research findings were presented at a Cardio conference somewhere ..... I wonder how it went down.

Thanks for the excerpt avi. IMHO those two specialists (Chicago, Vancouver) were far too generous in their treatment of this paper. I agree with all of their concerns,which are major and SHOULD HAVE RESULTED IN ITS REJECTION by that esteemed journal. This seems to be one of those large, multicenter, international trials that suffer badly from quality control/process failures. They even had to terminate one site completely for that reason. Just pathetic.

Pneumophile wrote:Are you planning a detailed review in this thread? . . .

No, sir, I am not planning a detailed review. Have at it!

To balance out my earlier tirade, I would say that I think the NEJM are good people, as far as editorial staff go. Somehow, I do not hold them responsible. It is part of their job to garner attention by bringing occasional controversial work to bear. Sometimes printing cr*p, even laughable cr*p, helps a cause, in the sense of 'there is no such thing as bad publicity' and all that. I disagree with their decision, in this instance, to accept this particular study, because the subject matter is dear to my heart and deserves better. And misuse of it could cost lives. But I still respect, on principle, the NEJM decision to publish material they disagree with, even when it contains bad science. Sometimes medical journals, like newspapers, have to follow what people are talking about, or spark conversation on an important subject with whatever study happens to be out there. So I tend to aim my vinegar at the study people themselves, myself. And on a similar note, I tend to shy away from popular magazines that attribute the material that the NEJM prints to the NEJM itself. "According to the NEJM" makes me laugh; whereas, "according to an article in the NEJM" is a more accurate attribution, to my mind.

But hey, that's just me.

You are being unduly generous to NEJM, or rather to the relevant editor and reviewers (the latter are not staff, of course). But that's OK, one poor paper does not a bad journal make ..... No, the NEJM journal should not be publishing poorly designed studies. It would be like publishing a paper claiming to show lack of efficacy for the Stanford V regimen in Hodgkin's disease when the various drugs in the cocktail were given at 50% of the standard dose!

OK that's a bit strong but you get my point. Design and run a study that ENFORCES clinically respectable CPAP usage while CV events are being followed. Is that so hard?

Pneumophile wrote:The paper is available for free on the NEJM website - nejm.org

Still too high of a price.