Long-term health outcomes for patients with obstructive sleep apnea: placing the Agency for Healthcare Research and Quality report in context-a multisociety commentary

被引:5
作者
Patil, Susheel P. [1 ,2 ,11 ]
Billings, Martha E. [3 ]
Bourjeily, Ghada [4 ]
Collop, Nancy A. [5 ]
Gottlieb, Daniel J. [6 ,7 ]
Johnson, Karin G. [8 ]
Kimoff, R. John [9 ]
Pack, Allan I. [10 ]
机构
[1] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
[2] Univ Hosp Cleveland, Cleveland, OH USA
[3] Univ Washington, Sch Med, Seattle, WA USA
[4] Brown Univ, Warren Alpert Med Sch, Providence, RI USA
[5] Emory Univ, Atlanta, GA USA
[6] VA Boston Healthcare Syst, Boston, MA USA
[7] Brigham & Womens Hosp, Boston, MA USA
[8] Univ Massachusetts, Chan Sch Med Baystate, Springfield, MA USA
[9] McGill Univ Hlth Ctr, Montreal, PQ, Canada
[10] Univ Penn, Philadelphia, PA USA
[11] Univ Hosp Cleveland, Bolwell Bldg 6th Floor,11100 Euclid Ave, Cleveland, OH 44106 USA
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2024年 / 20卷 / 01期
基金
加拿大健康研究院;
关键词
obstructive sleep apnea; OSA; continuous positive airway pressure; CPAP; health outcomes; POSITIVE AIRWAY PRESSURE; EXCESSIVE DAYTIME SLEEPINESS; MOTOR-VEHICLE CRASH; BLOOD-PRESSURE; MOTIVATIONAL ENHANCEMENT; CARDIOVASCULAR EVENTS; IMPORTANT DIFFERENCE; SYMPTOM SUBTYPES; AMERICAN ACADEMY; CPAP WITHDRAWAL;
D O I
10.5664/jcsm.10832
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
This multisociety commentary critically examines the Agency for Healthcare Research and Quality (AHRQ) final report and systematic review on long-term health outcomes in obstructive sleep apnea. The AHRQ report was commissioned by the Centers for Medicare & Medicaid Services and particularly focused on the term patient -centered outcomes of continuous positive airway pressure, the variability of sleep -disordered breathing metrics, and the validity of these metrics surrogate outcomes. This commentary raises concerns regarding the AHRQ report conclusions and their potential implications for policy decisions. A major concern expressed in this commentary is that the AHRQ report inadequately acknowledges the benefits of continuous positive airway pressure for several established, long-term clinically important outcomes including excessive sleepiness, motor vehicle accidents, and blood pressure. While acknowledging the limited evidence for the long-term benefits of continuous positive airway pressure treatment, especially cardiovascular outcomes, as summarized by the AHRQ report, this commentary reviews the limitations of recent randomized controlled trials and nonrandomized controlled studies and the challenges of conducting future randomized controlled trials. A research agenda to address these challenges is proposed including study designs that may include both high quality randomized controlled trials and nonrandomized controlled studies. This commentary concludes by highlighting implications for the safety and quality of life for millions of people living with obstructive sleep apnea if the AHRQ report alone was used by payers to limit coverage for the treatment of obstructive sleep apnea while not considering the totality of available evidence.
引用
收藏
页码:135 / 149
页数:15
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