Potential Weaknesses in Major Trial Explored in Reevaluating CPAP Benefits
Significant Benefit to Be Gained
The rewards of CPAP in patients who become comfortable with this therapy can be significant. The impairments in quality of sleep in patients with obstructive sleep apnea are often the impetus to seek care. “It is very important that patients get that subjective experience of feeling better the next day, and I would say about one-third of my patients get that next-day eureka feeling from initiating CPAP after sleeping so poorly for many years,” Dr. Segal reported.
These quality-of-life benefits were reflected in the SAVE study. For those in the CPAP arm, relative to those receiving usual care alone, there were highly significant improvements in objective anxiety and depression scales, as well as the physical and mental components of the 36-item Short Form (SF-36) quality of life tool. A reduction in daytime symptoms of sleep deprivation was also significant for CPAP on the Epworth Sleepiness Scale.
Relative to other tools to treat obstructive sleep apnea, CPAP is typically the most attractive option, according to Dr. Segal. For example, he is not an advocate of oral devices that advance the mandible, which he said have never been shown to be effective in moderate-to-severe apnea. He also suggested that surgery, which can be painful, does not uniformly provide benefit. However, he acknowledged that engaging patients in CPAP who do not experience a symptomatic benefit may now be more difficult after the results of the SAVE study. Although “the jury is still out” in regard to the ability of CPAP to reduce cardiovascular events in adherent patients, the evidence has now raised doubts for those already prescribed CPAP for the goal of reducing cardiovascular risk.“Those patients who are dedicated CPAP users will keep using this, but those who are perhaps looking for an excuse not to use CPAP may look at this data in a different way,” Dr. Segal said.
—Theodore Bosworth
Suggested Reading
McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919-931.
