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Why Radiofrequency Ablation (RFA)? The CPAP Success Myth

Posted On April 1, 2014
Why RFA? The CPAP Success Myth
April 01, 2014

CPAP’s actual compliance or success rate is about 33%…

You will not hear that number at any conference, read it in any journal or see it mentioned by any practicing sleep physician. One-third success rates do not sell CPAP machines or supplies or convince patients of its position as the “Gold Standard”. Most physicians, companies and Individuals involved with the non-surgical aspects of sleep apnea therapy will mention compliance or success rates of 80-90%.

However… the 33% compliance or success rate is in the literature if you will simply do the math.

When looking first at the success rates, patients who are started on CPAP but stop using it are excluded from the denominator. It’s as if they never existed. Results are calculated based on “Compliant Patients”, those still using their CPAP machine at least 4 hours per night, 70% of the nights.

Several points need to be made to understand this point:

The First Major Point is that a Compliant Patient actually only has to use their CPAP 35% of the Sleeping Hours (4 of 8 sleep hours is 50% x 70% of nights = 35%)*

If 90% of patients are “Compliant” but only use their machines 35% of the sleeping hours, they are actually only using the CPAP 31.5% of the time. Statistics is an amazing area of mathematics. As has been mentioned a million times, statistics allow one to manipulate data to measure and support almost anything you want to achieve. It’s all about presentation, almost like “fine dining”, where average food can seem special when presented in the correct manner.

If CPAP is only being worn 31.5% of the sleeping hours, how effective can that be in decreasing morbidity and mortality. Would you allow a hypertensive or diabetic patients to take their medication every third day and consider this successful therapy?

The Second Major Point is that 25-40% of patients who start CPAP discontinue use at one year

Now we have to calculate the 31.5% usage by 60% and we find that CPAP Compliance is really around 20%. If 100 patients with OSA are started on CPAP, 40% will quit and 60% will continue. Of those 60%, the average hours of usage in a meta-analysis of studies confirms only 5 of 8 hours. This means that CPAP is worn only 62.5% of sleep hours in 60% of patients. This results in about 37.5% usage out of the original 100 patients started on CPAP. 31.5% vs. 37.5%. Either way you use the actual statistics, success is far from the 80-90% quoted number.

The Third Major Point  is that CPAP Success is Based on Non-Curative Therapy while “Surgery is Based Only On Curative Results”

Sleep Journals will point to the dismal success of surgical procedures, quoting rates between 30-50%, while conveniently comparing to 80-90% success rates with CPAP. Simple math has shown that the 80-90% really equates to 31.5-37.5% success. But again, this is “not a cure”. We are comparing the proverbial “Apple to an Orange”. If we gauge CPAP success as achieving an AHI of <5-10 and an 02 Sat > 89%, but requires continued CPAP usage every night of the patients remaining life, how is this equivalent to a Surgical Procedure achieving an AHI <5-10 and an 02 Sat > 89% which eliminates the need for any further intervention?

CPAP Success has an ongoing cost and the CPAP’s negative impact secondary to wearing it every night, travel requirements, etc… on the patients quality of life where the Surgical Success eliminates the ongoing cost and eliminates the CPAP’s impact on the patients quality of life.

Evidence has shown that there is a cost savings associated with curing a sleep apnea patient. Including sleep monitoring procedures in the detection of sleep-disordered breathing, cost analysis demonstrates a savings of $9,200 to $13,400 per quality-adjusted life year gained**. With an average age of diagnosis between 45 and 55 and an average life expectancy of a male somewhere in the range 75 to 80 years, there is a savings of $276,000 to $402,000 when sleep apnea is adequately treated or cured.

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*Weaver TE, Kribbs NB, Pack AI, et al. Night-to-night variability in CPAP use over the first three months of treatment. Sleep. 1997;20:278–83

**Position Statement of the American Academy of Sleep Medicine – “Cost Justification for Diagnosis and Treatment of Obstructive Sleep Apnea. 1017-1018. SLEEP, Vol. 23, No. 8, 2000 



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