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Future Research Needs - Methods Research Series



Research Review - Final – Feb. 9, 2012

Future Research Needs for Treatment of Obstructive Sleep Apnea

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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.

Structured 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:

  1. What is the impact of treatment of sleep-disordered breathing on major long-term clinical outcomes, including mortality, cardiovascular disease, and diabetes?
    1. What are long-term outcomes of mandibular advancement device (MAD) treatment?
  2. 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.
    1. Research on continuous positive airway pressure (CPAP) devices that are both economical as well as clinically effective.
  3. Comparative trials of different sleep apnea treatments based on patient characteristics
    1. Trials of CPAP stratified by disease severity.
    2. Trials of non-CPAP treatments stratified by disease severity.
    3. Comparison of alternative treatments for patients who do not tolerate CPAP.
  4. Trials to improve compliance with CPAP, MAD, and other treatments, particularly evaluating cognitive therapy approaches.
  5. 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.