CHEST Guidelines-Rebuttal-From-Dr-Freedman

Rebuttal-From-Dr-Freedman_chest

Pdf Summary

The document discusses various aspects of diagnosing and managing obstructive sleep apnea (OSA). It highlights three primary diagnostic strategies: (a) direct therapy using auto-adjust positive airway pressure (PAP), (b) home sleep studies with various non-standardized equipment, and (c) traditional, standardized in-laboratory polysomnography. The discussion addresses which approach is best-suited for different patient profiles. <br /><br />Once diagnosed, the initiation of therapy, the involvement of durable medical equipment (DME) companies, and the responsibility of managing patients are questioned, especially whether primary care physicians or specialized sleep medicine teams should take charge after receiving relevant training. Outcomes of care, chronic management, and integration of mobile health technologies and social media are also explored. The document stresses identifying when to shift from PAP to alternative therapies upon PAP failure. <br /><br />The complexity of achieving optimal outcomes for OSA patients through comprehensive, integrated strategies in screening, diagnosis, and therapy is examined. The overarching concern is transitioning towards a financially sustainable model in the U.S. that reduces dependency on in-laboratory polysomnography revenue and improves patient outcomes using home testing and remote technologies.<br /><br />In a rebuttal by Dr. Neil Freedman, the argument supports the role of home sleep testing (HST) in managing OSA for patients with high probability and low complexity. Freedman agrees that while HSTs are less sensitive than polysomnography, they can be suitable for the right patient demographics and situations. A balance is needed to avoid missing diagnoses while ensuring more at-risk patients receive testing, given the reduced cost and accessibility of HST. The importance of adequate management strategies that prioritize chronic care and improved patient outcomes is emphasized.

Keywords

obstructive sleep apnea

diagnostic strategies

auto-adjust PAP

home sleep studies

polysomnography

patient management

primary care

mobile health technologies

home sleep testing

chronic care