The Agency for Healthcare Research and Quality (AHRQ) is preparing to publish a technology assessment of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA ).^[1]Agency for Healthcare Research and Quality: Evidence-based Practice Center Systematic Review Protocol; Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea in Medicare Eligible … Continue reading A draft is available and the final report is expected to be published within the next several months. The purpose of the assessment, requested by CMS, is to provide a critical evaluation of the literature supporting the impact of CPAP on health outcomes in those being treated for OSA.

OSA is a common condition with an estimated prevalence of up to 30% in adult males. An entire industry has sprung up in the wake of studies linking effective therapy with improvements in health outcomes such as cardiovascular disease and stroke. CPAP, long regarded as the only effective non-invasive treatment for OSA, is notoriously difficult for patients to tolerate, and poor compliance has added to the challenge of accurately assessing therapeutic outcomes. Payers and providers have struggled to negotiate this complicated landscape, prompting a need to better understand the true benefits of treatment.
Key among the findings reported in the AHRQ assessment was a lack of evidence linking a decrease in the apnea/hypopnea index (AHI), a widely used marker of severity in OSA, with improvement in outcomes such as cardiovascular disease, stroke, and all-cause mortality. The strength of the evidence directly linking CPAP treatment with these, and other health outcomes, was also found to be low, but the authors note their assessment was limited by a high degree of inconsistency in key reporting measures across studies. The lack of a standard definition for OSA and variability in reporting sleep studies were cited as examples. The authors point to the lack of quality evidence as a barrier to an accurate assessment of benefit and recommend that additional studies be undertaken.
Carelon will be keeping a close eye on further developments as they unfold. Quality measures are key to an accurate interpretation of the literature, and organizations such as AHRQ provide an additional layer of assurance that the tests and procedures that impact people’s lives are grounded in solid evidence.