(12-02-2012, 11:14 AM)IDRIck Wrote: My apologies, as I scientist I like to see the data behind various viewpoints.
So do I, which is why I didn't take the meta analysis conclusions at face value, but rather began to look at the underlying studies that made up the entire picture, plus the methods and data that were used in those individual studies. So, if you did as you said you like to do ("see the data"), you should have come to a similar conclusion: that the studies were biased because they used very old APAP machines and because they used the APAPs in a wide pressure range mode, which is NOT the way APAPs should be used.
Quote:I'm not trained in a medical field but I do have an understanding of clinical trials and frequently do searches on topics relative to my particular health issues.
That's good. Part of the problem here is two-fold, I think:
APAP technology has improved dramatically in the past 2-3 years. The scientific community just hasn't caught up yet, therefore there is a lack of quality studies to show that APAP is a better solution for many patients.
We also must open our eyes to the fact that the sleep apnea industry is a lucrative one for many stakeholders. The truth is that DMEs have a vested interest in providing you with a low-end CPAP machine over a higher-end APAP, because they make more profit with a low-cost machine (they are usually reimbursed around $1400-1500 for distributing a CPAP to a patient, no matter what make or model, and therefore make more profit by giving you a low-end machine). In addition, doctors have a vested interest in wanting you to "come back for more" so-to-speak, so they can charge you continuing fees for office visits, more sleep tests, etc. You're likely to need more "adjustments" and "changes" to your therapy if the doctor puts you on straight CPAP than if he were to properly instruct you on how to use an APAP.
Here's the bottom line: Data-capable APAP machines hand the "keys to treatment" over to the patient
. If you can take control of your own therapy, you'll need less professional health care services, not more. Not all patients are able to use those "keys", but many increasingly are. Biased meta studies like this only serve to give ammunition to those health care professionals who want to keep patients "in the dark" with regard to how to best treat their condition, so that they can guarantee a steady cash-flow stream, as uninformed patients are forced to pay for "expert advice". We've had health care professionals on Apnea Board in the past who have haughty attitudes saying things like "I'm the professional here and I know better than you; so quit trying to 'play doctor' with your CPAP treatment - that's my job
". The Sleep Apnea Patient Empowerment Movement is threatening their profit margins, quite simply. But, it's a snowballing movement that is starting to move exponentially - these doctors need to change their mindset and realize that increasingly, patients want more
control over their own healthcare decisions, not less
Quote:In the medical discussions that I've found, initial recommended therapy is a CPAP with APAPs reserved for a subset of sleep apnea patients. Perhaps we're merely in the transition period and soon all will be started on an APAP.
Yes, I think you're correct here. It's important for doctors to remember that an APAP can be set in straight CPAP mode if need be, and that it's really the gold-standard for treatment, since it offers the most options
for future treatment, at little cost. If straight CPAP is prescribed and there is a future need to change fixed pressures, the only way to do that properly is with an expensive sleep study in a lab; with a data-capable APAP, that expensive necessity many times can be avoided.
It's probably going to take a year or two more yet before the medical community catches up with the reality of what's going on in the Sleep Apnea Patient Empowerment Movement. As I do communicate with many doctors, RTs, sleep center owners, etc, I see a few of them have already started to make this transitional mindset. It's slow progress, but it is occurring out there. This move essentially changes the primary focus of a sleep lab's goals - in the past, it was used to diagnose OSA and titrate
a proper fixed pressure.
Now, with the advent of improved data-capable APAPs, along with PC software, many patients see no need for regular overnight sleep studies at all (other than their initial diagnostic study).... the old standard of "get a sleep study every 5 years" (for mainly titration purposes) is being taken over by patients armed with an APAP and PC software who can manage their own titration with these useful tools. I'm sure you can see how that is a financial threat to some sleep labs who will lose revenue as follow-up sleep studies become unnecessary. This is primarily where resistance to our movement is coming from, I think.
Quote:Prevailing opinion by many on this board would support this change but I don't know what would need to change for the medical community to indeed transistion to an all APAP approach.
No one is demanding a transition to an "all APAP approach". Instead, we simply want health care professionals to quit blindly attacking those who prefer APAPs over CPAP, or using biased studies like this as "proof" that APAPs are no better (or worse) than CPAPs. We do think it's wise to consider prescribing APAP over CPAP, if only for the additional treatment options
that such a decision allows.
Quote:Again my apologies for asking for data. I will cease and desist.
There's nothing wrong with asking for data. But, when you present a biased meta study to support your opinions, you can't expect that folks around here will just "let that stand" without challenges.
This is the the beauty of Apnea Board and the Sleep Apnea Patient Empowerment Movement: we realize that the training, education and experience health care professionals have is very useful to us and many times is worth paying for. We also realize that training, education and experience can be obtained by anyone - including us lowly patients, and that at times, we can save money and obtain better treatment if we take a more active role in our own therapy.