CPAPtalk.com

Goofproof wrote:

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

Still too high of a price.

lol

What do these results mean for clinical practice?

What they mean is that they should study the people who are able to be 100% compliant with CPAP treatment to see if it reduces their cardiovascular risk. If so, then the focus of treatment should be on acceptance and optimization.

Janknitz wrote:they should study the people who are able to be 100% compliant with CPAP treatment to see if it reduces their cardiovascular risk

Here's an idea that is easier, quicker and cheaper: Just ask us.

Cpap probably does not reduce or stop heart stroke for sure. It won't cure your heart problem. What it does is it won't stress out your already weaken heart. Every min you lost your oxygen will jump start your heart to grasp for more air. Cpap helps to minimize the occurrence.

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Chevie wrote:

Janknitz wrote:they should study the people who are able to be 100% compliant with CPAP treatment to see if it reduces their cardiovascular risk

Here's an idea that is easier, quicker and cheaper: Just ask us.

Yeah, but their objective is to MAKE MONEY.....from research grants. There's an abundance of information free for the taking, but it's like some of the "climate scientists"......they're looking to suck up to the sources of their income. They'll say anything to make money.......even if it's wrong. And, they've been caught lying.


Den

.

The researchers need to be studying how to get the average usage up to a point to where it is helpful.
Like it is among forum members.

Here's a real humdinger from the Discussion section (paragraph 3):

"One important potential limitation of our trial is that, for several of the participating countries, the diagnosis and treatment of sleep apnea were not well established in clinical practice when the trial began. However, before trial recruitment, we expended substantial time and effort in conducting training workshops for investigators and study coordinators. In addition, extensive site monitoring was conducted throughout the trial to ensue a high standard of study conduct."

Really, this is unbelievable. If you have to conduct "training workshops for investigators and study coordinators" YOU SHOULD NOT BE WOKING WITH THESE INCOMPETENTS IN THE FIRST PLACE.

These authors need to "expend substantial time and effort" learning how to conduct a decent clinical trial. I'm trying to imagine doing such a thing in a large, multicenter, international cancer trial and then trying to get it published in any halfway decent oncology journal. I can't think of one that would find it acceptable - the manuscript would be sent back by return of post.

Actually, this sounds like SOP for many studies; we mistakenly assume the objective for a study is to gain knowledge.
Unfortunately, many "studies" are conducted to support a pre-conceived conclusion--not to get at the truth.

Maybe some countries just have what and who they have to work with, and maybe it would be decent to understand that rather than name call.

Pneumophile wrote: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 of the Stanford V regimen in Hodgkin's disease when the various drugs 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?

I confess to showing deference to NEJM. I grade med journals on the curve. I hope they would show me the same professional courtesy if they ever got bored enough to read any of my posts here. I'm sure they hit the mark much more often than I do.

Heart docs don't always view PAP therapies strictly in the context of OSA treatment, either. They sometimes tend to come at it from other specialized angles that are way over my head.

I won't, uh, lose any sleep over it. The AASM, and certainly the ASAA, are big boys who can do just fine getting rebuttals formulated without requiring any help from me, should they see the need to do so.

Julie wrote:Maybe some countries just have what and who they have to work with, and maybe it would be decent to understand that rather than name call.

To be generous, it is very unwise to conduct serious clinical research with institutions or countries or individuals who are not competent to do the work. Actually it is highly irresponsible because 1) large amounts of time and money are wasted, when both could have been much better spent elsewhere; 2) the resulting deeply flawed work may end up in a scientific journal that the unwary might actually read and find credible; 3) the body of scientific literature becomes contaminated, which can take a lot more time and money to correct.

I very rarely comment so negatively about a paper in public or in private and I've reviewed manuscripts for a variety of journals for a long time - decades in fact. As a reviewer I've seen my share of submitted manuscripts that were very poor, all of which did not get published in the journal involved. I cannot recall a paper as poor as this being published in a journal of the caliber of the New England Journal but that's just me.

Julie wrote:Maybe some countries just have what and who they have to work with, and maybe it would be decent to understand that rather than name call.

such admirable sensitivity doesn't make it scientifically valid.

Some people have halo's on their avatars, others show sensitivity in their comments. I do neither.

I have discovered that it is possible to leave comments after articles on the NEJM website. I will probably do so, but only after very carefully rereading, then rerereading, this paper and giving it a lot more thought. I will be much more polite than I have been here but I will make my points and I will question the wisdom of the NEJM in publishing the article. I suppose that I can see their rationale but IMO it is very weak and I agree with the many criticisms made in the accompanying editorial. Which begs the question: why did they go ahead and publish it, rather than leave it to some second- or third-rate operation?

Nope, doesn't make it valid, but the way Pneumo. expressed his feelings just struck me a bit sideways... comes from working with researchers for years and hearing what some have had to deal with before getting to most western or northern countries... never mind.

Wow! There are over 311 comments to that story at the moment. Lots of pro and con. It has certainly generated a lot of discussion.