This news release from the American Academy of Sleep Medicine describes a large retrospective study that shows that positive airway pressure (PAP) therapy improves quality of life in patients with obstructive sleep apnea. PAP therapy is often given via CPAP (continuous positive airway pressure) machines, and has been a standard treatment for sleep apnea for several decades. The release does a good job describing the study itself, and how the authors broke down patients into subgroups that compared age and socio-economic status.
But the release also left much to be desired: it didn’t describe the limitations of retrospective studies or adequately discuss the harms or costs of these machines, which can be prohibitively expensive for some patients. Most importantly, the news release did not do a good job of establishing the novelty of this study. While there was a large sample size and various measures of quality of life, it is still unclear how this study is new since the benefits of CPAP are already well known.
Obstructive sleep apnea is a common condition in the United States (and the world). It affects about 20 million adult Americans each year, and significantly decreases quality of life due to poor sleep. Sufferers of sleep apnea report daytime symptoms as well, which can include drowsiness, moodiness, headaches, and lack of energy. However sleep apnea is also a well-studied condition, and it is already known that there are several interventions, including use of a CPAP machine, that can help improve symptoms and quality of life. It would be more newsworthy if the researchers had learned something different or new about CPAP treatment or sleep apnea, instead of re-establishing what has already been known for years. The most interesting thing from this news release was that those in lower socio-economic subgroups seemed to benefit less from PAP therapy–perhaps this is a region worth further study.
Despite touting the benefits of CPAP, the news release made no mention of the costs of CPAP home machines. These machines aren’t cheap–a quick internet search shows that they can run anywhere from $500 to over $1,000, not including other necessary equipment such as face masks and cleaning supplies. While the National Sleep Foundation says that most insurance policies cover CPAP machines, it is likely that someone buying a machine will still have to pay a hefty out-of-pocket sum. This could prove to be an obstacle to many seeking treatment, especially people from lower socio-economic backgrounds.
The news release was vague about how much patients benefited, and didn’t provide any numbers from the study itself to put the findings in context. While the release said that “results show that there were significant and clinically meaningful improvements,” for patients using CPAP, the reader has no idea what that ultimately means. It would have been helpful if the news release provided some numerical indicators that demonstrated exactly how much the intervention helped.
While CPAP therapy is relatively safe, there are still common side effects that were not mentioned in the news release. According to the National Sleep Foundation, most CPAP users will experience some mild side effects including congestion, runny nose, or stomach bloating. Though the harms are only mildly irritating, it would have been helpful if they were included in the release.
The release mentioned that there were over 2,000 people in the study, that it was conducted over a period of four years, and that scores on two different questionnaires were used to measure benefits. The study itself mentioned some additional limitations, including the fact that it was a retrospective study and there was no control arm. These limitations should have been included in the news release as well.
No disease mongering in this news release.
The news release did include a section at the bottom describing the funding sources for the study. However, it neglected to note that the first author has ties to two industry companies (Phillips Respironics and ResMed), both of which make money on the sale and upkeep of CPAP machines and supplies. This is an important financial conflict of interest to include.
While CPAP is a widely used and effective treatment for sleep apnea, it is not the only solution. Other treatments include dental appliances, surgery, and nerve stimulation. The news release did not make any mentions of these alternate treatments.
The news release made no mention of the availability of CPAP machines, even though they are easy to find. As mentioned above, however, their cost can often be prohibitive. It would have been helpful if the news release discussed low-cost options, especially since they mentioned that the intervention seemed to have less effect for lower socio-economic subgroups.
This is the main problem with the news release: how is the fact that PAP helps sleep apnea news? CPAP machines were first used in the early 1970s, and since then there has been a large body of evidence that PAP is helpful for sleep apnea patients. In the study discussion, the authors include one sentence that attempts to establish the novelty of their research: “Our study differs from the existing clinical studies because it includes a robustly large number of patients and utilizes both sleep-related and global QoL instruments.”
They seem to be saying that their study is novel on two accounts: the large sample size, and the fact that they use two different questionnaires as measurements. But is this enough to warrant a news release on a treatment that has already been studied extensively? Including this information would have helped readers to draw their own conclusions on this question.
No unjustifiable or sensational language here.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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