CHEST Guidelines-Could-Sleep-Apnea-Paradoxically-Protect-Myocardium

Could-Sleep-Apnea-Paradoxically-Protect-Myocardium

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The text includes a letter to the editor and a subsequent response related to a study by Sánchez-de-la-Torre and colleagues, published in CHEST in 2018. The letter, authored by Marinos Fysekidis, Régis Cohen, and Abdallah Al-Salameh, congratulates the authors for their work on the paradoxical relationship between obstructive sleep apnea (OSA) and cardiovascular outcomes in patients with acute coronary syndrome (ACS). The letter raises questions about study methodology, specifically concerning the diagnosis of OSA, the potential influence of morphine on sleep study results, and the lack of detailed analysis on time to revascularization after ACS symptom onset. The letter critiques the exclusion criteria that might have led to a selection bias, suggesting that further research is needed to better understand the impact of OSA-related preconditioning on ACS outcomes.<br /><br />The response from the study authors acknowledges the issues raised, emphasizing the need for more research in this area. They state that while polysomnography is the standard for diagnosing OSA, in their study, respiratory polygraphy was used effectively. They address the concerns about morphine use by explaining its metabolism time relative to the sleep studies. They concede that determining the exact duration from symptom onset to revascularization was challenging due to variability in patients' symptom reporting. The authors also clarify that their study's selection criteria were linked to a larger study design, acknowledging that certain limitations were already discussed in their original paper. The ongoing need for research on how OSA might affect ACS through mechanisms like ischemic preconditioning is underscored.

Keywords

obstructive sleep apnea

cardiovascular outcomes

acute coronary syndrome

study methodology

polysomnography

respiratory polygraphy

morphine influence

revascularization timing

selection bias

ischemic preconditioning