Obstructive Sleep Apnea
Stroke Study Flaws with Regard to CPAP
November 12th 2005
Previous studies have indicated the CPAP (Constant Positive Air
Pressure) treatment for Obstructive Sleep Apnea (OSA) has benefited
patients with heart failure, high blood pressure and more. It is
proven treatment for OSA.
A recent study published in the New England Journal of Medicine
concerning sleep apnea is not conclusive but makes claims concerning the
ineffectiveness of the treatment. This article will examine the curious
claims made by the Yale Study.
The study said “Nonetheless, our study demonstrated an increased risk of
stroke or death from any cause among patients with the obstructive sleep
apnea syndrome despite the administration of various therapies”. What
do various therapies mean? Was CPAP lumped in with other therapies?
Even more troubling is this statement made by the researchers “58
percent were using airway pressurization for at least four hours per
night for five nights or more per week”. Five times a week is not
enough. Treatment should be done every night and even when napping.
The study administrators admit the study was not designed to compare
CPAP use with those that did not use CPAP. According to the study “The
present study was not designed or powered to address adherence with
treatment or the effect of treatment on outcomes.”
This could lead to skewed data concerning their CPAP findings. For
instance according to the study “ it is likely that many of our patients
had had untreated obstructive sleep apnea for years before seeking
treatment, resulting in a prolonged exposure to cardiovascular risk.”
It is important to start therapy as soon as possible if you are
diagnosed with obstructive sleep apnea.
Compliance with the treatment is a major issue. Many that start the
treatment find it too burdensome and stop. According to the study
“reduced compliance with continuous positive airway pressure and limited
efficacy of other treatments may have played a role in the failure of
therapy to reduce the risk to baseline levels.”
Finally, the study compares their participants with patients from the
previous studies. “In contrast to the patients in a recent study that
suggested a beneficial effect of treatment on outcomes, 25 our
population was older and had a higher prevalence of cardiovascular risk
What is needed is a study comparing patients with OSA who use CPAP
(nightly) and those that do not use CPAP at all. It appears the study
lumped all the treatments together including surgery and oral devices.
Many of the patients received “some type” of treatment.
This does not eliminate the value of CPAP treatment. The study admits
“thirty-one percent achieved a weight reduction of 10 percent or more”.
It has been shown that weight reduction reduces the severity of OSA.
Also, previous studies have shown CPAP therapy “can reverse
hypercoagulability and hemodynamic changes and even reduce the risk of
According to WebMD 1 in 5 men have OSA and 1 in 10 women have the
syndrome. It is important that patients with moderate and severe OSA can
possibly lower their blood pressure, reducing the risk of complications
associated with that.
By Dan Wilson
Best Syndication Staff Writer
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