The following three articles in this issue ofThorax 1-3 summarise the contributions to a lively symposium on public health aspects of obstructive sleep apnoea (OSA) which I had the pleasure of chairing at the meeting of the British Thoracic Society in December 1997. The symposium followed the publication in the BMJ of a systematic review by Wright and colleagues on the health effects of obstructive sleep apnoea and the effectiveness of continuous positive airway pressure.4Their main conclusions were that the relevance of sleep apnoea to public health had been exaggerated and the effectiveness of treatment with continuous positive airway pressure (CPAP) had been poorly evaluated. The authors questioned whether sleep apnoea was “a separate disease entity or a marker or a symptom of obesity and ageing” and they suggested that the morbidity associated with sleep apnoea was due to confounding factors, particularly obesity. In relation to CPAP treatment, they concluded that the quality of controlled trials was “poor” and that no studies had included “an adequate placebo”. Anecdotal evidence from several centres suggests that the final sentence of their paper: “Calls for widespread investment in health service provision in this topic may be premature” has been taken to heart in considerable measure by purchasing authorities throughout the UK and further afield.

The juxtaposition in the paper by Wright et al 4 of reviews of the cardiovascular morbidity and mortality possibly associated with sleep apnoea and the efficacy of treatment with CPAP could easily lead the clinically naive purchaser to infer that CPAP treatment is used to prevent such long term vascular consequences. As Davies2 points out, this is not the case—the aim of treatment is to control the morbidity associated with disabling sleepiness. As it happens, a similar review of CPAP treatment was carried out almost …