Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details
“…The timing and duration of the CPAP-off periods as well as the subjects' sleep should be documented to define and interpret the effectiveness of intervention. The residual apnea burden, including REM OSA, is directly influenced by the proportion and timing of CPAP-on and -off periods [ 148 - 150 ]. In future trials, a predefined secondary analysis of REM OSA should be performed, considering its significant cardiovascular effects and prevalence [ 158 ].…”
Section: Obstructive Sleep Apneamentioning
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“…The timing and duration of the CPAP-off periods as well as the subjects' sleep should be documented to define and interpret the effectiveness of intervention. The residual apnea burden, including REM OSA, is directly influenced by the proportion and timing of CPAP-on and -off periods [ 148 - 150 ]. In future trials, a predefined secondary analysis of REM OSA should be performed, considering its significant cardiovascular effects and prevalence [ 158 ].…”
Section: Obstructive Sleep Apneamentioning
“…To summarize, we caution against discarding the benefit of CPAP therapy for the prevention of stroke and other cardiovascular events in OSA on the basis of results from the currently available RCTs. The overall findings suggest what really matters is the therapeutic effectiveness, which is determined by CPAP adherence, CPAP efficacy, apnea burden [ 148 - 150 ], and possibly disease phenotype [ 165 - 167 ]. Apnea burden is driven by residual or emergent sleep apnea during CPAP-on and-off periods along with the duration of CPAP-off periods [ 150 - 152 , 170 ].…”
Section: Obstructive Sleep Apneamentioning
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“…real versus device-provided measures). For CPAP, it was underlined that AHI flow was not always correlated or concordant with PG/PSG measures, especially when a 3% versus a 4% threshold of oxygen desaturation is used (results were worse when a PSG was used because of the additive impact of arousals (which cannot be diagnosed by the device) on the scoring) [18, 25–27]. Equivalent, exhaustive data are lacking for ASV therapy, whereas preliminary [28] or final data [8, 29, 30] are in favour of a similar discrepancy between AHI flow and AHI PSG .…”
Section: Discussionmentioning
“…In the Silveira study, the Bland and Altman plot of the difference between PSG-AHI and ASV-AHI flow against the mean of both measurements, reports a mean difference of 11.9 ± 9.6 (95% limits of agreement − 6.90, 30.71) [30]. In a recent editorial, Thomas and Bianchi have underlined the existing concern that the efficacy of CPAP and ASV therapies can be overestimated by the reported AHI flow [27]. Future randomized ASV-studies must take into account these considerations by including several PSG controls for ASV quality in the study design.…”
Section: Discussionmentioning