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Meng F, Ang GY, Chang RRY, Lee CP, Tan KB, Abisheganaden JA. Cost-effectiveness analysis of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. J Sleep Res 2024:e14326. [PMID: 39228120 DOI: 10.1111/jsr.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
This study assessed the cost-effectiveness of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. The analysis evaluated a 5-year care pathway using a Markov model, considering per-patient costs of treatment, health system cost savings of obstructive sleep apnea and attributed conditions, the effectiveness measured in disability-adjusted life years with a discount rate of 3% and a weighted 5-year continuous positive airway pressure adherence of 74.1% from Singapore studies. Per-patient costs of treatment were from a large public hospital in Singapore. Efficacy of continuous positive airway pressure treatment, health system costs and disability-adjusted life years were obtained from literature; costs are in US dollars. We conducted probabilistic sensitivity analysis, one-way sensitivity analysis and what-if analysis. Based on a willingness-to-pay threshold of US $50,000 per disability-adjusted life year in USA, continuous positive airway pressure therapy was highly cost-effective, with an incremental cost-effectiveness ratio of $13,822 per disability-adjusted life year averted. Compared with the annual total costs of $856 for patients with continuous positive airway pressure treatment diagnosed by an inpatient sleep study, the total costs for those diagnosed by a home sleep test were $625, resulting in a remarkable 27% reduction per patient per year. One-way sensitivity analysis indicated that costs of treatment, effectiveness of continuous positive airway pressure treatment and adherence had a higher impact on the cost-effectiveness of continuous positive airway pressure therapy. The what-if analysis suggested that for continuous positive airway pressure treatment to be cost-effective, adherence rate should be at least 16.1%. These findings provide valuable insights for policymakers in making informed decisions on funding diagnosis and continuous positive airway pressure therapy within Singapore's healthcare system.
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Affiliation(s)
- Fanwen Meng
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Gary Yee Ang
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | | | - Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Bryan Tan
- Chief Health Economist Office, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Centre of Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Arputhan Abisheganaden
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Harding CD, Fuentes AL, Malhotra A. Tackling obstructive sleep apnea with pharmacotherapeutics: expert guidance. Expert Opin Pharmacother 2024; 25:1019-1026. [PMID: 38913403 PMCID: PMC11227253 DOI: 10.1080/14656566.2024.2365329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The efficacy of non-pharmacotherapeutic treatment of obstructive sleep apnea, a highly prevalent condition with serious cardiometabolic and neurocognitive health consequences, is well established. Supplementing traditional treatment strategies with medications can improve symptoms and reduce side effects. Efforts to identify medications that target the causes of sleep apnea have met with mixed success. However, this remains a worthwhile objective for researchers to pursue, given the potential benefit pharmacotherapy could bring to those patients who reject or struggle to adhere to existing treatments. AREAS COVERED This article presents the case for obstructive sleep apnea pharmacotherapy including drugs that reduce the occurrence of apnea events, such as weight loss agents, ventilation activators and muscle and nervous system stimulants, drugs that alleviate symptoms, such as wake-promoting agents for excessive daytime sleepiness, and drugs that improve adherence to existing treatments, such as hypnotics. Literature was accessed from PubMed between 1 March 2024 and 18 April 2024. EXPERT OPINION Exciting recent advances in both our understanding of obstructive sleep apnea pathology and in the techniques used to identify therapeutic agents and their targets combine to embolden a positive outlook for the expanded use of drugs in tackling this consequential disease.
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Affiliation(s)
- Christian D. Harding
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Ana Lucia Fuentes
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
- Pulmonary and Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
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Ssegonja R, Ljunggren M, Sampaio F, Tegelmo T, Theorell-Haglöw J. Economic evaluation of telemonitoring as a follow-up approach for patients with obstructive sleep apnea syndrome starting treatment with continuous positive airway pressure. J Sleep Res 2024; 33:e13968. [PMID: 37337981 DOI: 10.1111/jsr.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Telemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost-effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost-effective strategy compared with the standard follow-up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow-up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow-up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow-up, there was no significant difference in treatment compliance, and the mean residual apnea-hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72-1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04-13.84), and about 73% fewer physical healthcare visits 0.27 (0.20-0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow-up, -192 USD (-346 to -41). The form of follow-up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment.
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Affiliation(s)
- Richard Ssegonja
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Tegelmo
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
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Pachito DV, Eckeli AL, Drager LF. Cost-Utility Analysis of Continuous Positive Airway Pressure Therapy Compared With Usual Care for Obstructive Sleep Apnea in the Public Health System in Brazil. Value Health Reg Issues 2024; 40:81-88. [PMID: 38056224 DOI: 10.1016/j.vhri.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 08/16/2023] [Accepted: 10/17/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES This study aimed to conduct a cost-utility analysis of continuous positive airway pressure (CPAP) therapy compared with usual care as treatment of moderate to severe cases of obstructive sleep apnea (OSA) in Brazil, where decentralized policies of CPAP provision are in place. METHODS Markov cohort model comparing CPAP therapy with usual care, that is, no specific treatment for OSA, for moderate to severe cases was used. The payer perspective from the Unified Health System, Brazil, was adopted. Effectiveness parameters and costs related to health states were informed by literature review. Resource use related to CPAP therapy was defined by specialists and costs informed by recent purchase and leasing contracts. Incremental cost-effectiveness ratios were generated for purchase and leasing contracts to reflect current practices. A conservative willingness-to-pay threshold was set at 1 gross domestic product per capita per quality-adjusted life-year (QALY) (Brazilian reais [BRL] 40 712/QALY). Uncertainties were explored in deterministic and probabilistic sensitivity analyses. RESULTS Incremental cost-effectiveness ratio for the purchase modality was 8303 BRL/QALY and for leasing 45 192 BRL/QALY. Considering the adopted willingness-to-pay threshold, provision of CPAP by the purchase modality was considered cost-effective but not the leasing modality. The parameter related to the greatest uncertainty was the reduction in the risk of having a stroke attributable to CPAP. Probabilistic analysis confirmed the robustness of results. CONCLUSIONS CPAP therapy is a cost-effective alternative compared with usual care for moderate to severe OSA for the purchase modality. These results should help underpinning the decision making related to a uniform policy of CPAP provision across the country.
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Affiliation(s)
- Daniela V Pachito
- Prossono Centro de Diagnóstico e Medicina do Sono, Ribeirão Preto, Sao Paulo, Brazil.
| | - Alan L Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Sao Paulo, Brazil
| | - Luciano F Drager
- Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil; Unidade de Hipertensão, Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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Ortiz JL, Rosselli D. Adherence to Positive Airway Pressure Therapy in a Cohort of Colombian Patients with Obstructive Sleep Apnea Syndrome. Sleep Sci 2023; 16:227-230. [PMID: 37425975 PMCID: PMC10325836 DOI: 10.1055/s-0043-1770799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Objective To describe the adherence to the use of positive air pressure (PAP) devices in a cohort of patients with sleep apnea syndrome in Colombia. Material and Methods Descriptive cross-sectional study of adult patients treated between January 2018 and December 2019 in the sleep clinic of a private insurer in Colombia. Results The analysis included 12,538 patients (51.3% women) with a mean age of 61.3 years; 10,220 patients (81.5%) use CPAP and 1,550 (12.4%) BIPAP. Only 37% are adherent (> 70% of use for 4 hours or more), adherence rates were highest in the >65 years age groups. 2,305 patients (18.5%) were hospitalized, on average 3.2 times; 515 of these (21.3%) had one or more cardiovascular comorbidities. Conclusion Adherence rates in this sample are lower than those reported elsewhere. They are similar in males and females and tend to improve with age.
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Affiliation(s)
- Judith L. Ortiz
- Faculty of Economic and Administrative Sciences, Pontificia Universidad Javeriana, Bogota, DC, Colombia
| | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogota, DC, Colombia
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Sawunyavisuth B, Sopapol N, Tseng CH, Sawanyawisuth K. Marketing factors associated with a continuous positive airway pressure machine purchasing in patients with obstructive sleep apnea. Future Sci OA 2023; 9:FSO844. [PMID: 37026026 PMCID: PMC10072120 DOI: 10.2144/fsoa-2022-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Aim: Obstructive sleep apnea (OSA) is related with several cardiovascular diseases. It should be treated with a continuous positive airway pressure (CPAP) machine. There is limited data on marketing factors on a decision of CPAP machine purchasing in OSA patients. Materials & methods: We enrolled adult patients aged over 18 years with OSA who tried a CPAP. Marketing factors were evaluated for a decision of CPAP machine purchasing. Results: There were 95 OSA patients participated in the study. Nice color CPAP machine and good knowledge and informative salesperson had adjusted odds ratio (aOR) of 4.480 and 9.478, the other two factors had aOR at 0.102 and 0.217. Conclusion: Marketing factors related to CPAP machine purchasing in patients with OSA.
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Affiliation(s)
- Bundit Sawunyavisuth
- Department of Marketing, Faculty of Business Administration & Accountancy, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Nattaporn Sopapol
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chi-Hsing Tseng
- Department of Marketing & Distribution Management, National Pingtung University, Pingtung, Taiwan, 900391, Republic of China
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Pachito DV, Finkelstein B, Albertini C, Gaspar A, Pereira C, Vaz P, Eckeli AL, Drager LF. Legal action for access to resources inefficiently made available in health care systems in Brazil: a case study on obstructive sleep apnea. J Bras Pneumol 2023; 49:e20220092. [PMID: 36820743 PMCID: PMC9970612 DOI: 10.36416/1806-3756/e20220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 12/06/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, associated with morbidity and mortality. Although effective treatment for OSA is commercially available, their provision is not guaranteed by lines of care throughout Brazil, making legal action necessary. This study aimed at presenting data related to the volume of legal proceedings regarding the access to diagnosis and treatment of OSA in Brazil. METHODS This was a descriptive study of national scope, evaluating the period between January of 2016 and December of 2020. The number of lawsuits was analyzed according to the object of the demand (diagnosis or treatment). Projections of total expenses were carried out according to the number of lawsuits. RESULTS We identified 1,462 legal proceedings (17.6% and 82.4% related to diagnosis and treatment, respectively). The projection of expenditure for OSA diagnosis in the public and private spheres were R$575,227 and R$188,002, respectively. The projection of expenditure for OSA treatment in the public and private spheres were R$2,656,696 and R$253,050, respectively. There was a reduction in the number of lawsuits between 2017 and 2019. CONCLUSIONS Legal action as a strategy for accessing diagnostic and therapeutic resources related to OSA is a recurrent practice, resulting in inefficiency and inequity. The reduction in the number of lawsuits between 2017 and 2019 might be explained by the expansion of local health care policies or by barriers in the journey of patients with OSA, such as difficulties in being referred to specialized health care and low availability of diagnostic resources.
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Affiliation(s)
- Daniela V Pachito
- . Prossono - Centro de Diagnóstico e Medicina do Sono, Ribeirão Preto (SP) Brasil
| | | | | | | | | | - Paulo Vaz
- . Heads in Health, São Paulo (SP) Brasil
| | - Alan Luiz Eckeli
- . Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Luciano F Drager
- . Unidades de Hipertensão, Instituto do Coração - InCor - e Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Centro de Cardiologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
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Abdelwahab M, Marques S, Huang A, De Moraes TP, Previdelli I, Cruz JAW, Al-Sayed AA, Capasso R. Value of Surgical and Nonsurgical Treatment for Sleep Apnea: A Closer Look at Healthcare Utilization. Otolaryngol Head Neck Surg 2023; 168:1228-1237. [PMID: 36794772 DOI: 10.1002/ohn.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact healthcare utilization in patients who have obstructive sleep apnea (OSA). STUDY DESIGN This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time. SETTING A population-based study using real-world data and insurance databases. METHODS A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient-specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions. RESULTS When the cost of the intervention was eliminated in the 2-year follow-up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p < .001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups. CONCLUSION Treating OSA with surgery can lessen overall healthcare utilization compared to no treatment and CPAP.
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Affiliation(s)
- Mohamed Abdelwahab
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA.,Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sandro Marques
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Allen Huang
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Thyago P De Moraes
- Graduate Program in Life Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Isolde Previdelli
- Department of Biostatistics, Universidade Estadual de Maringá, Maringá, Brazil
| | - June Alisson Westarb Cruz
- Department of Postgraduate Program in Adminstration, School of Business, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ahmed A Al-Sayed
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA.,Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, California, USA
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Baillieul S, Shah NM, Dharmasena R, Schiza S, Testelmans D, Pataka A. CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars. Breathe (Sheff) 2022; 18:220148. [PMID: 36865657 PMCID: PMC9973521 DOI: 10.1183/20734735.0148-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.
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Affiliation(s)
- Sébastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, Grenoble, France,Corresponding author: Sébastien Baillieul ()
| | - Neeraj M. Shah
- Lane Fox Respiratory Research Centre, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - Sophia Schiza
- Sleep Disorders Centre, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Dries Testelmans
- KU Leuven – University of Leuven, University Hospitals Leuven, Department of Respiratory diseases, Leuven, Belgium
| | - Athanasia Pataka
- Aristotle University Thessaloniki and Respiratory Failure Unit, Aristotle University Thessaloniki, G. Papanikolaou Hospital Exohi, Thessaloniki, Greece
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