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BMJ No 7104 Volume 315 Letters Saturday 9 August 1997 Obstructive sleep apnoeaTreatment prevents road accidents, injury, and death caused by daytime sleepinessEditor,In stating that the results of their meta-analysis 'do not ... provide sufficiently robust evidence for the effectiveness of continuous positive airways pressure,' John Wright and colleagues ignore their own conclusion that sleep apnoea causes sleepiness and possibly road accidents, and thereby injury and death.(1) They also reach the opposite conclusion to that reached by other reports, including one from the Royal College of Physicians(2) and one from the Australian National Health and Medical Research Council and the New Zealand Ministry of Health.(3) Two randomised controlled trials, one published since Wright and colleagues' analysis was completed, found that patients benefited from continuous positive airways pressure.(4,5) Neither the Royal College of Physicians nor the Australian National Health and Medical Research Council finds the authors' criticisms of the randomised controlled trial by Engleman et al convincing. Indeed, the Australian National Health and Medical Research Council, which included not only specialists in sleep medicine but other clinicians on their steering committee, found that this study produced 'the most compelling evidence of the impact of [continuous positive airways pressure] and that there were no major methodological threats to its validity.'(3) The danger of Wright and colleagues' study is that purchasers of health care within the NHS will give credence to it and cite it as a reason for not providing the appropriate services. To deny this treatment to patients would fly in the face of evidence presented in other reviews and lead to an increase in otherwise avoidable road accidents. S J G Semple
Royal College of Physicians, References 1 Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 1997;314:851-60. (22 March.) 2 Royal College of Physicians. Sleep apnoea and related conditions. A report of a working party. London: RCP, 1993. 3 Australian Health Technology Advisory Committee. The effectiveness and cost-effectiveness of nasal continuous positive airway pressure (nCPAP) in treatment of obstructive sleep apnoea in adults. Canberra: Government Public Service, 1996. 4 Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994;343:572-5. 5 Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 1997;52:114-9.
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