Obstructive Sleep Apnea: CPAP and AHI vs. outcomes

Project Summary Title and Description

Title
Obstructive Sleep Apnea: CPAP and AHI vs. outcomes
Description
Purpose of the Review: The Centers for Medicare and Medicaid Services (CMS) nominated the topic to the Agency for Healthcare Research and Quality for a Technology Assessment. The scope of the report’s protocol was developed to inform CMS’s coverage decisions. The report will address contextual questions (CQs) and conduct a systematic review (SR). The CQs cover background material to help to understand the findings of the SR, including information on currently-used treatment modalities for OSA, the postulated rationales for use of CPAP, currently-used measures of AHI and related measures in contemporary research and clinical settings, validated sleep questionnaires. The CQs also cover discussion of the ideal study designs for establishing validity of surrogate or intermediate measures. The CQs will be addressed using a, best-evidence, but nonsystematic approach. The SR will (1) summarize evidence on the validity of measures of sleep and breathing as surrogates (or intermediate outcomes) for clinically significant outcomes in patients with OSA, effectively assessing the linkage between the former and the latter, and (2) synthesize evidence on the (comparative) efficacy, effectiveness and safety of CPAP to prevent clinically important outcomes. The SR will attempt to describe heterogeneity of treatment effects in terms of diversity of patient populations, devices and treatment protocols, outcome definitions and study design characteristics. For included randomized controlled trials (RCT), we will examine the concordance among AHI (and similar measures), validated sleep questionnaires, and clinical outcomes. The intended audience includes CMS and non-CMS stakeholders including guideline developers, clinicians and other providers of care for patients with OSA, healthcare policy makers, and patients.
Attribution
N/A
Authors of Report
N/A
Methodology description
Systematic Review
PROSPERO
CRD42020192725
DOI
N/A
Notes
"zzz_" before an author's name indicates an extraction that was excluded.
Funding Source
AHRQ Contract No. 290-2015-00002-I Task Order No. 75Q80119F32017

Key Questions

1. KQ 2: What is the evidence that apnea and hypopnea-based measures of sleep-disordered breathing (e.g., apneic indices, hypopnea indices, and apnea-hypopnea indices) used in current practice and research are valid surrogate or intermediate measures for long-term health outcomes?
2. KQ 2: What is the evidence that apnea and hypopnea-based measures of sleep-disordered breathing (e.g., apneic indices, hypopnea indices, and apnea-hypopnea indices) used in current practice and research are valid surrogate or intermediate measures for long-term health outcomes?
3. KQ 1: What is the efficacy, effectiveness, comparative effectiveness, and harms of CPAP devices to improve long-term health outcomes?
4. KQ 1: What is the efficacy, effectiveness, comparative effectiveness, and harms of CPAP devices to improve long-term health outcomes?

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