期刊
ANNALS OF THE AMERICAN THORACIC SOCIETY
卷 19, 期 9, 页码 1570-1580出版社
AMER THORACIC SOC
DOI: 10.1513/AnnalsATS.202109-1036OC
关键词
causal inference; inverse probability weight; daytime sleepiness; sleep apnea
资金
- French National Research Agency in the framework of the Investissements d'avenir program [ANR-15-IDEX-02]
- Grenoble Alpes University Foundation
- United Kingdom Medical Research Council (MRC Skills Development Fellowship) [MR/T032448/1]
- MIAI University Grenoble Alpes [ANR-19-P3IA-0003]
This study demonstrates how two causal inference methods can be used to assess the impact of CPAP adherence on daytime sleepiness in patients with OSA. The results indicate a causal effect of CPAP adherence on daytime sleepiness, with differences observed between lower and higher adherence groups, while no significant differences were found when considering higher levels of adherence.
Rationale: Continuous positive airway pressure (CPAP), the first line therapy for obstructive sleep apnea (OSA), is considered effective in reducing daytime sleepiness. Its efficacy relies on adequate adherence, often defined as >4 hours per night. However, this binary threshold may limit our understanding of the causal effect of CPAP adherence and daytime sleepiness, and a multilevel approach for CPAP adherence can be more appropriate. Objectives: In this study, we show how two causal inference methods can be applied on observational data for the estimation of the effect of different ranges of CPAP adherence on daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS). Methods: Data were collected from a large prospective observational French cohort for patients with OSA. Four groups of CPAP adherence were considered (0-4, 4-6, 6-7, and 7-10 h per night). Multivariable regression, inverse-probability-of treatment weighting (IPTW), and inverse propensity weighting with regression adjustment (IPW-RA) were used to assess the impact of CPAP adherence level on daytime sleepiness. Results: In this study, 9,244 patients with OSA treated by CPAP were included. The mean initial ESS score was 11 (+/- 5.2), with a mean reduction of 4 points (+/- 5.1). Overall, there was evidence of the causal effect of CPAP adherence on daytime sleepiness which was mainly observed between the lower CPAP adherence group (0-4 h) compared with the higher CPAP adherence group (7-10 h). There are no differences by considering higher level of CPAP adherence (>4 h). Conclusions: We showed that IPTW and IPW-RA can be easily implemented to answer questions regarding causal effects using observational data when randomized trials cannot be conducted. Both methods give a direct causal interpretation at the population level and allow the assessment of the appropriate consideration of measured confounders.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据