CPAP therapy for excessive daytime sleepiness and accident risk in obstructive sleep apnoea

A 2022 report for the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Service concluded that most of the published evidence does not suggest that continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea improves long-term, clinically important outcomes. 1 Balk EM Adam GP Cao W et al. Long-term health outcomes in obstructive sleep apnea: a systematic review of comparative studies evaluating positive airway pressure and validity of breathing measures as surrogate outcomes. https://www.ahrq.gov/research/findings/ta/index.htmlDate accessed: July 12, 2022 Google Scholar The report especially focused on the paucity of evidence that CPAP improves morbidity and mortality, but also indicated a paucity of evidence for benefit to driving accident risk, cognitive function, or quality of life among treated patients with obstructive sleep apnoea. The report further criticised the inconsistent definitions of sleep-disordered breathing and obstructive sleep apnoea. Although many criticisms raised in the AHRQ report are valid, especially the very limited evidence for CPAP therapy in the secondary prevention of cardiometabolic disease, we strongly question the authors’ conclusion that CPAP does not improve cognition function, especially daytime sleepiness and associated accident risk (figure), particularly as the conclusions on accident risk were largely based on two reports that were not designed to assess this aspect. 2 McEvoy RD Antic NA Heeley E et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016; 375: 919-931 Crossref PubMed Scopus (1258) Google Scholar , 3 McMillan A Bratton DJ Faria R et al. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med. 2014; 2: 804-812 Summary Full Text Full Text PDF PubMed Scopus (158) Google Scholar