Although the results of this study are encouraging, the study design comparing CPAP adherent to CPAP nonadherent groups may be problematic. Prior studies10,11 have revealed that adherent patients have better outcomes than nonadherent ones (regardless of the intervention), presumably because adherence is a marker of a more educated, more motivated patient who may be more likely to follow diet, exercise, medication instructions. For example, minor dietary changes may underlie some of the improvements in lipids observed in the present study. Further, we can see that the CPAP-nonadherent group has a higher body mass index, which may play a role in the differences noted between the two groups. One also wonders if there is a difference the pathogenesis of OSA. Whether these underlying differences affected the outcomes is unclear. It is also discouraging to see that despite intensive counseling and monitoring by Dorkova et al3 that 50% of the participants were nonadherent to CPAP, despite their being motivated to participate in a clinical trial. We are reminded that despite having an effective treatment for OSA, CPAP is difficult to use for many patients and new therapeutic targets are needed.