The New England Journal of Medicine has offered tough news for sleep experts lately. First the SERVE-HF trial ruined ASV, now the SAVE trial put a hurt on an even bigger part of their practices, finding that CPAP didn't reduce cardiovascular events in patients with obstructive sleep apnea and pre-existing cardiovascular disease. But based on a panel discussion yesterday, the experts aren't so willing to go along with this one.
They raised a host of objections with the trial--from the population being too old, too male, too undertreated for cardiovascular disease, to not having as many patients as originally intended. Some of the experts eventually conceded that the results do suggest that CPAP doesn't work for the specific population in the trial, one of the important characteristics of which was that they were not sleepy, even before they tried CPAP. Although even on that point, one of the speakers pointed out that people often don't know that they are sleepy, and that quality of life was better in the patients on CPAP.
If I sound suspicious about all this, it might be because the session started with the moderator apparently trying to take down ACP's CPAP guidelines. Of course, after reviewing the evidence, he was forced to concede that "actually maybe the ACP recommendations are correct." Well, duh.