Multisociety Commentary Critiques AHRQ Report on Long-term Health Outcomes in Obstructive Sleep Apnea

Innovations in Pulmonology, Critical Care & Sleep Medicine | Winter 2024

NEWS BRIEF

Journal of Clinical Sleep Medicine, Feb. 20, 2024

Susheel P. Patil, MD, PhD

A multisociety committee of sleep medicine specialists, including lead authors Susheel P. Patil, MD, PhD, Director of Sleep Medicine at University Hospitals Cleveland Medical Center, Clinical Associate Professor at Case Western Reserve University School of Medicine and colleague Martha E. Billings, MD, MSC, published a unified letter critiquing the Agency for Healthcare Research and Quality’s (AHRQ) draft report on the long-term health outcomes of therapy for Obstructive Sleep Apnea (OSA).

The AHRQ analyzed 52 qualifying clinical trials conducted between January 2010 and March 2021. The Centers for Medicare & Medicaid Services requested this systematic review in service of developing national coverage determinations.

The authors raise concerns that, taken out of context, the conclusions presented in the AHRQ’s report discount or minimize demonstrated short- and long-term benefits of Continuous Positive Airway Pressure (CPAP), the most common therapy for patients with OSA. CPAP has been shown to improve OSA-related sleepiness and sleep-related quality life.

The AHRQ report focused on long-term, patient-centered outcomes of CPAP, while inadequately acknowledging the benefits of CPAP that sleep medicine professionals deem important, such as “sleepiness or other symptoms.” In fact, the authors state, excessive daytime sleepiness is one of the most common patient-reported symptoms but was excluded as an outcome in the AHRQ report. The report also did not address long-term benefits on measures such as cardiovascular outcomes.

Ultimately, the AHRQ concluded there is clinical equipoise regarding CPAP on long-term outcomes, and while it recommended additional high-quality studies, it didn’t address challenges inherent in conducting research with OSA patients.

The sleep medicine community acknowledges limitations of randomized control trials in studying OSA, but would like to see the AHRQ recommend study designs that balance patient safety and the need for long-term, evidence-based studies. The review committee also suggests journals require standardizing how OSA metrics are reported to improve comparison between studies and expressed concern that payers may develop policies to reduce coverage for OSA treatment while not considering the full scope of available evidence or before additional studies provide critical missing data.