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Future Research Needs for Treatment of Obstructive Sleep Apnea
Future Research Needs Papers, No. 12
Ethan M Balk, MD, MPH, Co-Project Lead, Mei Chung, PhD, MPH, Co-Project Lead, Jeffrey A Chan, BS, Research Associate, Denish Moorthy, MBBS, MS, Research Associate, Kamal Patel, MPH, MBA, Research Associate, Thomas W Concannon, PhD, Investigator, Sara J Ratichek, MA, Project Coordinator, and Lina Kong Win Chang, BS, Research Assistant.
Author Information and AffiliationsStructured Abstract
Background:
Obstructive sleep apnea (OSA) is an important public health issue, with challenges for diagnosis and treatment. A recent Comparative Effectiveness Review (CER) found numerous areas with insufficient or low strength of evidence.
Purpose:
With the assistance of a panel of representative stakeholders, to identify and prioritize future research needs topics for treatment of OSA.
Methods:
Twenty-two panel members represented six stakeholder categories: patients and the public; providers; purchasers of health care; payers; policymakers, and principal investigators. Building on future research needs topics derived from the CER, stakeholders nominated additional topics for discussion. Nominated topics were discussed by stakeholders (excluding product makers) on a secure Web site discussion board. At the close of the discussion period, stakeholders nominated their top 10 future research needs topics based on the Agency for Healthcare Research and Quality Effective Health Care Program selection criteria. From these nominations, the highest priority future research needs were determined and were elaborated upon to include possible study designs to address the topics.
Future Research Needs Topics:
The high-priority future needs topics included:
- What is the impact of treatment of sleep-disordered breathing on major long-term clinical outcomes, including mortality, cardiovascular disease, and diabetes?
- What are long-term outcomes of mandibular advancement device (MAD) treatment?
- Cost-effectiveness analysis of a management strategy (diagnosis of symptomatic or high-risk patients through treatments of patients diagnosed with OSA), specifically for patients with mild to moderate disease severity.
- Research on continuous positive airway pressure (CPAP) devices that are both economical as well as clinically effective.
- Comparative trials of different sleep apnea treatments based on patient characteristics
- Trials of CPAP stratified by disease severity.
- Trials of non-CPAP treatments stratified by disease severity.
- Comparison of alternative treatments for patients who do not tolerate CPAP.
- Trials to improve compliance with CPAP, MAD, and other treatments, particularly evaluating cognitive therapy approaches.
- What is the association between sleep apnea severity and long-term clinical outcomes?
Fourteen other future research needs topics were discussed.
Challenges:
Stakeholder participation in the online discussion board was low. Discussions were begun by only five stakeholders, and only 41 percent of stakeholders participated in the online discussion. The median number of comments across topics was only two. Topic nomination was done by 17 stakeholders (77 percent). Lessons learned from this Future Research Needs panel discussion can be applied to future panels.
Contents
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10055 I, Prepared by: Tufts Evidence-based Practice Center, Tufts Medical Center, Boston, MA
Suggested citation:
Balk EM, Chung M, Chan JA, Moorthy D, Patel K, Concannon TW, Ratichek SJ, Chang LKW. Future Research Needs for Treatment of Obstructive Sleep Apnea. Future Research Needs Paper No. 12. (Prepared by the Tufts Evidence-based Practice Center under Contract No. 290-2007-10055 I.) AHRQ Publication No. 12-EHC033-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2012. www.effectivehealthcare.gov/reports/final.cfm.
This report is based on research conducted by the Tufts Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10055 I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.
None of the investigators has any affiliation or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
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