The article on obstructive sleep apnoea may mislead the unwary reader as it appears to give equal prominence to claims supported by substantial evidence and those made on the basis of much weaker evidence.1 It states that obstructive sleep apnoea can probably increase the risk of strokes and heart disease. In fact the evidence suggests there is an association with stroke but failed to find an association with heart disease.2 It is of course harder to prove that obstructive sleep apnoea causes stroke as the presence of sleep apnoea is associated with other cardiovascular risk factors that could equally explain an association with cardiovascular disease.
The assertion that continuous positive airway pressure (CPAP) during sleep is effective is supported by a large number of randomised controlled trials, which were included in a systematic review for the National Institute for Health and Care Excellence.3 CPAP reduced daytime sleepiness, it also reduced blood pressure by 2 mmHg.
By contrast there is not a single randomised controlled trial of tonsillectomy for obstructive sleep apnoea. The statement that in children with obstructive sleep apnoea ‘tonsillectomy is usually curative’ is not supported by evidence. Unfortunately this statement is repeated (‘removal of large tonsils in children is usually effective’) and the claim is repeated in relation to adults (‘tonsillectomy may occasionally be effective in the less obese adult’).
GPs may like to consider the weight of evidence when considering whether to refer patients for surgical treatments.
REFERENCES
- 1.Stradling J. Obstructive sleep apnoea: is it moving into primary care. Br J Gen Pract. 2016 doi: 10.3399/bjgp16X683785. http://bjgp.org/content/66/643/e149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Loke YK, Brown JW, Kwok CS, et al. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(5):720–728. doi: 10.1161/CIRCOUTCOMES.111.964783. [DOI] [PubMed] [Google Scholar]
- 3.National Institute for Health and Care Excellence . Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. London: NICE; 2008. p. TA139. https://www.nice.org.uk/Guidance/TA139 (accessed 7 Mar 2016). [Google Scholar]