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

[billbolton]

they will likely be present in significant numbers in the dataset no matter how hard you try to educate newly enrolled patients and how rigorously you monitor compliance during the study.

So it actually was a faithful "real world" study then

[archangle]

This part is interesting:

"Patients were excluded from the study if they reported severe daytime sleepiness (Epworth Sleepiness Scale score >15; scores
range from 0 to 24, with higher scores indicating greater severity) or were considered to have an increased risk of an accident from falling
asleep, if they had very severe hypoxemia (oxygen saturation <80% for >10% of recording time),"

So, they excluded people who were showing the more important signs of sleep apnea?

[Julie]

Actually, why is everyone still hung up on this travesty, fiasco, whatever? It was a farce of a study and one of probably hundreds published every day somewhere that should be forgotten immediately - why go on and on here feeling righteous about it when we've all agreed it's a mess? Wouldn't it be better to write the authors and give them hell? To ask the publishers why their standards are so low?

[Eddie Fasolino]

Actually, why is everyone still hung up on this travesty, fiasco, whatever?

Why are you bumping it to the top of the page, Ms. 13,000 Posts.

Wouldn't it be better to write the authors and give them hell? To ask the publishers why their standards are so low?

Please post copies of the letters you have written.

[49er]

Posted this earlier in the thread but happy to repeat it.

Website for lead researcher Dr. Craig Anderson:

http://www.georgeinstitute.org.au/people/craig-anderson

Unfortunately, only phone number is provided. Did find this general email address that perhaps might get forwarded to Dr. Anderson if someone wanted to write to write to this address and comment on the study.

info@georgeinstitute.org.au

49er

PS - And of course, one could use snail mail

[jnk...]

Actually, why is everyone still hung up on this travesty, fiasco, whatever? It was a farce of a study and one of probably hundreds published every day somewhere that should be forgotten immediately - why go on and on here feeling righteous about it when we've all agreed it's a mess? Wouldn't it be better to write the authors and give them hell? To ask the publishers why their standards are so low?

I would respectfully request that more people get "hung up on" it, examine it, and post comments on it. This is, after all, a forum. It's what we do.

And although many of us here may see it for what it is--a perhaps noble-minded but not-very-bright attempt to prove something elusive--some in the medical community can be very quick to give credence to such studies to the extent of being influenced by them in subtle ways for OSA patients overall. That is worth fighting against with all hands on deck, IMO. This is not the sort of study that will go away if ignored. It will become part of the literature on the subject for years to come, unfortunately.

I would NOT try to give the authors heck. Reason being related to the old adage: "Never try to teach a pig to sing; it wastes your time and irritates the pig." Feel sorry for the authors. But, hey, maybe they did the very best they could. Most of the damage done in this world is done by people who are simply trying to be helpful as best they can.

And publishers publish. It's what they do. As for "standards," they have to print the studies by the dumber researchers too, not just the smarter ones, in order to be balanced with their coverage. The less-smart researchers need to make a living too, after all.

[jnk...]

This part is interesting:

"Patients were excluded from the study if they reported severe daytime sleepiness (Epworth Sleepiness Scale score >15; scores
range from 0 to 24, with higher scores indicating greater severity) or were considered to have an increased risk of an accident from falling
asleep, if they had very severe hypoxemia (oxygen saturation <80% for >10% of recording time),"

So, they excluded people who were showing the more important signs of sleep apnea?

Exactly. They excluded the very people who would have been most likely to benefit and who are most motivated to use PAP because of feeling Epworth-related improvements day-to-day.

BRILLIANT!

Problem is, that was likely the only ethical and legally responsible thing to do. After all, you don't put a morbidly sleepy guy on sham PAP unless you are trying to find the best subtle way to kill him and to get sued for it.

[Hosehead4ever]

So basically, they're saying CPAP doesn't work....

In fact they said that xPAP does work.

They're saying it doesn't fix non-OSA related pre-existing conditions - there's no surprise at all there

Why do you consider pre-existing CV conditions to be non-OSA related when pretty much all of the evidence I have seen prior to this study says that OSA *is* directly related to CV disease/events. Just because the CVD was diagnosed first doesn't mean the OSA didn't predate it. Most of us aren't even diagnosed until our health is suffering but we can trace our symptoms back to long before that. Read correctly, this study only says that xPAP therapy doesn't help when it isn't used correctly. That's literally the *only* factual statement I can take away from the study. It can't say it doesn't help when used correctly because the patients they studied didn't use xPAP correctly.

[Pneumophile]

they will likely be present in significant numbers in the dataset no matter how hard you try to educate newly enrolled patients and how rigorously you monitor compliance during the study.

So it actually was a faithful "real world" study then

It is what is described in the art as an "observational study" (of sorts ...) - in this case one that has yielded little useful information except that poorly motivated subjects like those people did not benefit in terms of CV events. There were some minor benefits in other respects, it is true. Read the paper (and the Supplement) and you'll learn about them.

There is nothing wrong with observational studies in principle - I've helped to design one myself (somatic mutations as affecting tumor response in GIST, large American and European dataset,retrospective) but if they aren't designed properly and run effectively they can be next to useless.
Cheers.

[Pneumophile]

Julie, jnk is quite right and clearly understands the situation mich better than you - imho of course.

What exactly is your problem? If you have lost interest in this thread then, most respectively, why not just buzz off? Posts like that one of yours that won't be missed.

Perhaps this is a bit harsh but really, your post contributes precisely nothing to a useful and interesting debate. but yes, I may well contact the authors - none of your business though. That would be a communication between scientists - are you a scientist?

[Pneumophile]

Archangel, jnk: I have also wondered why those patients (daytime sleepiness) were excluded from the study. I may communicate with the lead author to find out. No rationale is given in the paper iirc but maybe it's buried somewhere in the 80 pages of Supplementary Appendix. Frankly I can't think of one, at least one that makes sense but they're the experts ....

[jnk...]

Julie has been here a good while. She posts what she thinks and feels. She doesn't expect everyone to agree with her takes and doesn't seem to mind being contradicted with other viewpoints. I have learned from her, even those times when I have disagreed with her. If we all agreed and felt the exact same way on every subject, we wouldn't have much to talk about around here. Her way of expressing frustration with the study may differ from some.

This forum welcomes scientists, doctors, lecturers, CPAP-evangelists, CPAP-detractors, dentists, deniers, and especially confused users looking for help. But we don't generally worship any of them.

I am not a scientist, though. I am an Internet-OSA-forum-rabble-rouser, which on the scale of things, sometimes puts me just barely this side of "troll."

Just my take.

And even though I have derided and demeaned the study and the studiers, my heart does genuinely go out to them on a deeper level. The only thing worse than never being published is having your career ended by having your name attached to a study that somehow managed to suck more information out of the universe than to add anything to it.

[Pneumophile]

Perhaps I was unduly harsh but my patience was exercised. I have enjoyed some of her other posts. I am not a Saint ..
You may not be a scientist but so what .... you write well and you THINK.

[jnk...]

Mostly, as seen by my verbiage, I apparently just like to THINK that I write well.

Thank-yous are allowed here, so I thank you for your kind words.

Full apologies are allowed here too. Just sayin'.

One thing this forum will do is exercise your patience. But man, seems to me there is no place else quite like it.

[Pneumophile]

Agree with your last comment particularly.

You don't just think you write well, trust me you do write well. But enough of this flattery.

The trouble with not writing well is, no matter how smart and knowledgeable you are you will have trouble getting involved usefully in debates.m Never underestimate the importance of literacy, as I'mmsure you agree.

Julie also writes well and I was too harsh, I sort of knew it at the time. I was annoyed because some of the ongoing posts in this have been very good, from people who have clearly read and thought about this unfortunate paper (eg the patient exclusion issue (that as a reviewer I would have highlighted). I have been guilty of similar forum transgressions. My canonization is on hold while my forum interactions are being reviewed at the Vatican ...