The Agency for Healthcare Research and Quality (AHRQ) was charged on producing an evidence-based report on long-term benefits of CPAP therapy for obstructive sleep apnea. They produced a 155-page report. It came to the overall conclusion that there was no evidence of long-term benefit of CPAP for any outcome.
Unfortunately, the authors of the draft report did not look at the totality of the evidence. Moreover, the draft report had several major flaws.
We were given only 2 weeks to comment on the draft report. AHRQ agreed to accept a lengthy written response. To achieve this, a coalition of 20 sleep societies and other societies with a major interest in sleep apnea, patients’ groups, technologists’ organizations came together. A writing group was established under the chairmanship of Susheel Patil (AASM representative). Other members of the writing group came from AAN, ATS, ACCP (Chest), SRS, A comprehensive 20-page response was submitted before the deadline which can be viewed here.
Key issues raised in the response were: a) treating sleepiness as an intermediate variable not a primary outcome; b) not assessing changes in blood pressure, but only reduction in incident hypertension and normalization of blood pressure; c) failure to recognize the challenges to RCTs in this area and an inadequate description of needs and opportunities for future studies.
This report should be seen as a wakeup call to our field. There is a major need for us to do better research to determine the impact long-term use of CPAP treatments for OSA. Hopefully, the coalition that got a very detailed response together in a short time can work to establish a research agenda.
Allan I. Pack, MBChB, PhD
John Miclot Professor of Medicine
Division of Sleep Medicine/Department of Medicine
University of Pennsylvania Perelman School of Medicine