Response to letter entitled 'CPAP adherence and cardiovascular disease: beware of the healthy adherer effect'

摘要

To the Editor: We thank Dr. Kunisaki [1] for his thoughtful comments on our study regarding the occurrence of cardiovascular disease (CVD) events in continuous positive airway pressure (CPAP) treated and control patients [2]. In amendment to the letter of Dr. Kunisaki, the pairwise matched control patients had used CPAP for a median of 4.0 months and discontinued the treatment prior to the commencement of the 6.2-year study follow-up. We agree that "healthy adherer" effect is an important issue and should be acknowledged during the evaluation of the effectiveness of any treatment. As noted in our paper, due to the retrospective study design, there can be underlying patient characteristics including different personality types causing bias between CPAP-treated and control patients.