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 factors.”

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 cardiovascular events.”

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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