CHEST Guidelines-OSA-and-Recurrent-VTE

OSA-and-Recurrent-VTE_chest

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The document contains two letters to the editor regarding studies published in the journal "Chest." In the first letter, Gerard A. Silvestri and Nicholas James Pastis from the Medical University of South Carolina address the benefits of transbronchial cryobiopsies, noting potential cost savings while emphasizing the need for well-designed studies and standardized guidelines. They suggest cryobiopsy could revolutionize bronchoscopy as endobronchial ultrasound did previously. <br /><br />The second letter, authored by Sibel Ocak Serin, Gulsah Karaoren, and Antonio M. Esquinas, responds to a study by Alonso-Fernández et al. about obstructive sleep apnea (OSA) as a risk factor for recurrent pulmonary embolism (PE). The authors question the choice of apnea-hypopnea index (AHI) cutoffs used in the study and suggest obesity and OSA's role in PE recurrence needs further exploration. They critique methods related to sample size and suggest results do not necessarily support the conclusions about continuous positive airway pressure (CPAP) treatment efficacy due to small sample size limitations. <br /><br />In Alonso-Fernández et al.'s response, they defend their methodology and findings, particularly the use of AHI as a risk factor and the study's limitations due to sample size. They also correct inaccuracies stated in the critique concerning referenced studies and clarify their risk model, which included nocturnal oxygen saturation and D-dimer levels as risk factors for PE recurrence, not baseline oxygen saturation or certain other parameters. They stress the need for large, randomized trials to fully assess CPAP's role in managing recurrent PE linked to OSA.

Keywords

transbronchial cryobiopsies

bronchoscopy

endobronchial ultrasound

obstructive sleep apnea

pulmonary embolism

apnea-hypopnea index

continuous positive airway pressure

nocturnal oxygen saturation

D-dimer levels

randomized trials