The Positive and Negative about Positive Airway Pressure Therapy

Abstract

answered in this single-center retrospective and speak to the study limitations. As previously mentioned, Tikkanen's group has a different protocol on the basis of pretransplant sensitization risk groups (8). Each group, on the basis of sensitization, receives different immunosuppression. They did account for these differences in their multivariate analysis; nonetheless, it still makes generalizability to other centers less applicable. Another limitation that Tikkanen and colleagues reveal is that during the study term there was no accepted definition of antibody-mediated rejection (AMR) in lung transplantation (8). Thus, there were only few cases of definitive AMR and no ability to associate dnDSA, AMR, and CLAD. Last, the follow-up time was relatively short (median of 764 d). Thus, there was no ability to gauge the rate of decline of lung function and allograft survival.Tikkanen and colleagues have furthered our knowledge of HLA antibodies and their link to CLAD (8). Their data may alter the way some allocate their organs, particularly paying attention to DQ mismatching. However, further studies are needed to validate the results of Tikkanen and colleagues (8) and focus on how therapy alters dnDSA and if such manipulations alter the trajectory of CLAD. Future research should be directed toward prospective randomized trials that incorporate HLA testing, standardized surveillance of the allograft, and treatment protocols for CLAD. n

Sleep Disturbances as a Risk Factor for Stroke

“…Both the large (SAVE) and the small scale (RICCADSA) RCTs failed to demonstrate efficacy of CPAP therapy. Negative findings in such high-profile trials underscore the need for future trials, and are vital contributors to recognizing and addressing the key factors to be considered in the design of future studies [ 136 , 137 ]. Several important aspects should be discussed in this context.…”

CPAP Treatment and Cardiovascular Prevention

“…Finally, to overcome concerns about leaving patients with severe OSA untreated, the control group may receive alternative treatments for OSA, for example, mandibular devices, positional therapy, or supplemental oxygen. 1,52,53 However, this approach has drawbacks; the alternative therapy increases the cost and sample size, 54 and may have a beneficial effect on CV end points, making it difficult to detect a beneficial CPAP effect. However, sequential analysis techniques could counter some concerns.…”

Update in Sleep-disordered Breathing 2016

“…There are important messages to be understood from these two studies (35,36). First, the findings may not be extrapolated to symptomatic patients.…”