Sleep apnoea and the misuse of evidence-based medicine

Abstract

1and sleep clinics in the UK began to treat substantial numbers of patients in the early to mid 1980s. The advent of a simple but effective treatment, nasal continuous positive-airway pressure (CPAP), 2 made investigation of the symptoms of sleep apnoea worthwhile. The success of nasal CPAP therapy has led to financial difficulties in most hospitals that provide this service, and several health authorities in the UK have refused to fund nasal CPAP therapy. The concept of CPAP treatment is simple. Gentle pressurisation of the upper airway during sleep prevents the collapse of the pharynx and hence obstruction. However, it is a difficult therapy to learn to use and to cope with night after night, year after year. New developments by manufacturers of CPAP systems have improved the comfort, but patients still have to wear unaesthetic and sometimes uncomfortable masks strapped onto the face and supplied by a wide-bore tube from an electrically driven pump. Thousands of patients choose to do this night after night because without such treatment they relapse, often within 24 h, to their pretreatment state. 3 The symptoms of sleep apnoea are the predictable consequences of years of severe sleep fragmentation and deprivation—more than 400 brief awakenings from sleep can occur every night. Many studies have documented the debilitating effects of sleep deprivation in these patients: sleepiness, poor vigilance, cognition, and quality of life, and, perhaps most worrying of all, a seven-fold increase in driving accidents. 4‐8