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.
Donovan LM, Bertisch SM, Patel SR. Defining Exposure and Nonexposure in Observational Studies of Sleep Apnea Treatment. JAMA Otolaryngol Head Neck Surg. Published online August 08, 2019. doi:10.1001/jamaoto.2019.1880
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