Scandinavian cardiovascular journal : SCJ
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Scand. Cardiovasc. J. · Feb 2009
Randomized Controlled Trial Multicenter StudyRationale and design of the Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea--RICCADSA trial.
Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). ⋯ The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.
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We present a short discussion of the literature concerning institutional volume and outcomes for congenital heart surgery. Although there are limitations to some of the studies discussed, all published studies conclude that higher volumes are associated with better outcomes. We then reflect on some of the arguments that can be made in favour of greater centralisation of this practice and some of the arguments that can be made against centralisation.