To the Editor Dr Yu and colleagues concluded that PAP use in patients with sleep apnea was not associated with reduced risk of cardiovascular outcomes or death.1
The meta-analysis included randomized clinical trials (RCTs) with different phenotypes of sleep apnea (2 with central sleep apnea [CSA] and 8 with obstructive sleep apnea [OSA]), populations, sample sizes, therapies, and outcomes. The CSA trials enrolled patients with heart failure, who have very different features from patients with OSA without heart failure. The pitfalls of these trials have been extensively reviewed.2,3 The 8 OSA trials used different techniques and criteria for OSA diagnosis, and analyzed composite cardiovascular outcomes instead of specific and selected outcomes. Most trials included nonsleepy patients with moderate OSA, whereas sleepy patients with severe OSA are at most risk of cardiovascular consequences.2 The heterogeneity of the included studies precludes firm conclusions.
Javaheri S, Campos-Rodriguez F. Outcomes of Positive Airway Pressure for Sleep Apnea. JAMA. 2017;318(20):2042–2043. doi:10.1001/jama.2017.16291
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