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Comment & Response
August 8, 2019

Defining Exposure and Nonexposure in Observational Studies of Sleep Apnea Treatment

Author Affiliations
  • 1Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
  • 2Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  • 3Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Philadelphia
JAMA Otolaryngol Head Neck Surg. Published online August 8, 2019. doi:10.1001/jamaoto.2019.1880

To the Editor We read with interest the article by Lisan et al,1 published online on April 11, 2019. The authors analyzed publicly available data from the Sleep Heart Health Study (SHHS)2 to answer an important question: does prescription of positive airway pressure (PAP) treatment save lives? The authors observed substantially lower mortality risk among those with severe obstructive sleep apnea (OSA) who were prescribed PAP relative to matched controls who were not prescribed PAP (hazard ratio [HR], 0.38-0.58). However, we are concerned that the methods used to define PAP exposure led to substantial heterogeneity in these groups—limiting our interpretation.