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?

Associated Extraction Forms

Type
Standard

Associated Studies (each link opens a new tab)

Title Authors Year
Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial.
Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial.
Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients.
Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients.
Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients.
Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial.
Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients.
Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients. 2019
Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial. 2016
Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women. 2014
Association of Positive Airway Pressure Prescription With Mortality in Patients With Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study. 2019
Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study. 2013
Continuous Positive Airway Pressure (CPAP) Treatment Reduces Mortality at the Population Level 2018
Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. 2012
Stroke and other cardiovascular events in patients with obstructive sleep apnea and the effect of continuous positive airway pressure. 2017
All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment: a registry study with 10 years of follow-up. 2015
Continuous positive airway pressure and survival of very elderly persons with moderate to severe obstructive sleep apnea. 2016
A retrospective analysis of 4000 patients with obstructive sleep apnea in Okinawa, Japan 2009
Incident Type 2 Diabetes in OSA and Effect of CPAP Treatment: A Retrospective Clinic Cohort Study. 2019
Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure. 2015
Association of Continuous Positive Airway Pressure Treatment With Sexual Quality of Life in Patients With Sleep Apnea: Follow-up Study of a Randomized Clinical Trial. 2018
Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. 2012
Long-term effects of continuous positive airway pressure on blood pressure and prognosis in hypertensive patients with coronary heart disease and obstructive sleep apnea: a randomized controlled trial. 2015
Effect of CPAP therapy on C-reactive protein and cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome. 2016
CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. 2016
Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised controlled trial. 2012
Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. 2014
Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial on psychological distress. 2017
Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). 2012
Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial. 2017
Continuous Positive Airway Pressure Treatment Reduces Mortality in Elderly Patients with Moderate to Severe Obstructive Severe Sleep Apnea: A Cohort Study. 2015
Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. 2012
The Effect of Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes. 2016
Evaluation of autoCPAP devices in home treatment of sleep apnea/hypopnea syndrome. 2007
Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea. 2019
Positive airway pressure initiation: a randomized controlled trial to assess the impact of therapy mode and titration process on efficacy, adherence, and outcomes. 2011
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. 2005
Long-term survival in veterans with sleep apnea 2018
Obstructive sleep apnea as a risk factor for type 2 diabetes. 2009
Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study. 2015
Predictors for Progression of Sleep Disordered Breathing among Public Transport Drivers: A 3-Year Follow-Up Study. 2015
Association of incident cardiovascular disease with progression of sleep-disordered breathing. 2011
The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea. 2013
Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial. 2017
Treatment of OSA reduces the risk of repeat revascularization after percutaneous coronary intervention. 2015
Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea. 2017
Survival benefit of CPAP favors hypercapnic patients with the overlap syndrome. 2014
Impact of an oral appliance on obstructive sleep apnea severity, quality of life, and biomarkers. 2018
Longitudinal assessment of sleep disordered breathing in Vietnam veterans with post-traumatic stress disorder. 2014
Patient-reported outcome: results of the multicenter German post-market study. 2018
Improved cognitive functions after treatment with an oral appliance in obstructive sleep apnea. 2012
A comparison of the long-term outcome and effects of surgery or continuous positive airway pressure on patients with obstructive sleep apnea syndrome. 2006
A 7-year follow-up study of obstructive sleep apnoea in healthy elderly: The PROOF cohort study. 2017
OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study. 2017
Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. 2018
Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: outcomes and practicability. 2014
Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. 2013
Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. 2018
Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients. 2017
Prospective study of the association between sleep-disordered breathing and hypertension. 2000
Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. 2001
Sleep Apnea, Cognitive Profile, and Vascular Changes: An Intriguing Relationship. 2017
CPAP therapy improves erectile function in patients with severe obstructive sleep apnea. 2019
Autoadjusted versus fixed CPAP for obstructive sleep apnoea: a multicentre, randomised equivalence trial. 2018
Sleep apnea and glucose metabolism: a long-term follow-up in a community-based sample. 2012
Predictors of improvements in daytime function outcomes with CPAP therapy. 2000
Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study. 2021
Association of continuous positive airway pressure compliance with complications in patients with type 2 diabetes and obstructive sleep apnea. 2021
Continuous positive pressure therapy usage and incident stroke in patients with obstructive sleep apnea: A nationwide population-based cohort study. 2020
Health-Related Quality of Life and Sleep Quality after 12 Months of Treatment in Nonsevere Obstructive Sleep Apnea: A Randomized Clinical Trial with Continuous Positive Airway Pressure and Mandibular Advancement Splints. 2020
Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial. 2020
Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. 2005
Economic arguments for the immediate management of moderate-to-severe obstructive sleep apnoea syndrome. 2004

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