No reduction in heart attacks for cpap users

[Crist]

It's not often I see something apnea related on the news here so this caught my attention tonight and I thought others might find it interesting. According to this study there is no reduction of heart attack or stroke but quality of life is improved for apnea sufferers who are using cpap.

http://mobile.abc.net.au/news/2016-08-28...ke/7792624

[DeepBreathing]

I must read up the actual report but based on the ABC article this is a disappointing outcome. For one thing it will make it harder to advocate for a better deal for apneacs from health funds in this country.

[somnus]

Not a good outcome. Goes beyond heart attacks, but not all negative results. The report is at
http://www.nejm.org/doi/full/10.1056/NEJ...#t=article

As I'm not allowed to provide links you will need to remove spaces to make the link work in a browser.

[OpalRose]

Not a good outcome. The report is at
htt p://ww w.nejm.org/doi/full/10.1056/NEJMoa1606599?af=R&rss=currentIssue&#t=article

As I'm not allowed to provide links you will need to remove spaces to make the link work in a browser.

Links are allowed to informational sites as long as there isn't a link to a commercial site where products are sold.

[DeepBreathing]

Thanks Somnus. As OpalRoase said, non-commercial links are allowed, though brand new members can't post clickable links until after they have four posts up. I've edited your post to make the link work properly.

[cands]

The wording from the ABC article:

"The Sleep Apnoea Cardiovascular Endpoints (SAVE) study monitored sleep apnoea patients with a pre-existing vascular disease over four years in 89 hospitals in Australia, New Zealand, India, the US, Spain and Brazil."

It is for patients with pre-existing vascular disease.

Does that mean the study does not examine the effect on CPAP users who do not have pre-existing cardiovascular morbidity?

[DeepBreathing]

Does that mean the study does not examine the effect on CPAP users who do not have pre-existing cardiovascular morbidity?

Yes, I believe that is the case.

I've just had a very quick skim through of the paper and a number of points jump out at me:

1. Only patients with pre-existing cardio- or cerebro-vascular disease were enrolled

2. All patients in the CPAP group were put on a constant pressure of 90% of that indicated by a week's trial on APAP. This is (to my way of thinking) a sub-optimal therapy

3. The mean outcomes were AHI=3.7 ("well controlled") and usage of 3.3 hrs/night. Again I don't believe either of these numbers indicates that the patients got good enough therapy to come to any sensible conclusion about the benefits of the therapy.

I need to go back and read it in detail, but I'm very disappointed that such a big study will get a lot of publicity on the basis of a very substandard therapeutic approach. The news media will latch onto a simple headline that "CPAP won't stop strokes or heart attacks" and a huge number of people who would potentially benefit will be turned off even trying PAP therapy.

[richb]

I am concerned as well about the median 3.3 hours of compliance. "Median" implies that half of the subjects had less than 3.3 hours of use per night. 3.3 hours of use is considered to be non-compliant and thus sub-therapeutical by insurance agencies including Medicare. What the study does suggest is that minimal use of CPAP does not improve cardiovascular risk for those who already have that risk. This study has a lot of flaws. What the headline should read is that "Non-compliance" does not improve outcomes for those with cardiovascular disease.

Rich

[0rangebear]

I just finished reading the entire article and report . This is not the first time I have run across clinical studies that conclude positive airway pressure does not have any effect on incidence of death from stroke or cardiac failure.

Typically these studies use severe cases and have very low compliance requirements.

In this study, they make the following statement in their conclusion.

Participants in the SAVE study who were assigned to CPAP adhered to the treatment for a mean of 3.3 hours per night over several years, which is similar to the mean adherence in other reports of CPAP use in patients who had no or minimal daytime sleepiness, and which is consistent with CPAP use in clinical practice. However, although this overall level of adherence to CPAP therapy exceeded the estimates in our power calculations, it may still have been insufficient to provide the level of effect on cardiovascular outcomes that had been hypothesized



I would chalk this one up to another clinical study on the effects of inadequate (noncompliant) therapy. All the clinical studies I have read ( I read them daily) indicate the 4 hour a night requirement is inadequate for effective therapy, most studies advocate the minimum of 5 to 6 hour per night for effective therapy.

[cate1898]

After reading that article, I'd like to know who funded this study.