CHEST Guidelines-Meta-analysis-Does-Not-Establish-Effectiveness-of- (1)

Meta-analysis-Does-Not-Establish-Effectiveness-of- (1)

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Dr. Mahadevappa Hunasikatti provided a critique of a 2017 article by Kuhn et al. on the effectiveness of CPAP (Continuous Positive Airway Pressure) and Mandibular Advancement Devices (MADs) on the quality of life in patients with Obstructive Sleep Apnea (OSA). Dr. Hunasikatti challenges the claim that MADs may be as effective as CPAP, arguing that the meta-analysis reviewed in the original article fails to establish such effectiveness due to a lack of high-quality randomized controlled trials. He emphasizes the importance of internal validity in network meta-analyses, which depends on correctly identifying studies, assessing the quality of these studies, and accounting for potential biases.<br /><br />Dr. Hunasikatti also touches upon the broader context of OSA treatment, noting the US Preventive Services Task Force's position that there is insufficient evidence to recommend routine screening for OSA in asymptomatic adults. He points out that the treatment of mild OSA typically focuses on symptomatic patients.<br /><br />He argues that, while oral appliances (OA) may serve as an alternative for patients who cannot tolerate CPAP, CPAP remains more effective in reducing obstructive breathing events during sleep, especially in moderate to severe cases. Efficacy in these treatments is measured by the Apnea-Hypopnea Index (AHI)—a lower AHI during treatment implies greater effectiveness.<br /><br />The Kuhn et al. study authors responded by addressing these concerns, reinforcing their findings while acknowledging the limitations raised. They maintain that their network meta-analysis offers valuable insights though agree additional high-quality trials could further substantiate treatment comparisons. This exchange exemplifies the ongoing discourse surrounding treatment efficacy for OSA and the necessity for more definitive evidence to guide clinical decisions.

Keywords

Dr. Mahadevappa Hunasikatti

CPAP

Mandibular Advancement Devices

Obstructive Sleep Apnea

meta-analysis

randomized controlled trials

internal validity

US Preventive Services Task Force

Apnea-Hypopnea Index

treatment efficacy