CHEST Guidelines-Rebuttal-From-Drs-Collop-and-Berry

Rebuttal-From-Drs-Collop-and-Berry_chest

Pdf Summary

The document discusses the complexities in diagnosing and treating Obstructive Sleep Apnea Syndrome (OSAS) versus plain Obstructive Sleep Apnea (OSA). Recent updates in diagnostic criteria have broadened the spectrum of symptoms and comorbidities used to diagnose OSAS, yet many of these indicators, such as daytime sleepiness, are common and not specific to OSAS. This has made distinguishing between OSA and OSAS challenging, potentially leading to over-treatment. Experts emphasize that treatment should focus on those with OSAS rather than everyone diagnosed with OSA through a polysomnogram, particularly for non-sleep specialists.<br /><br />Drs. Collop and Berry share their insights, linking existing studies that incorporate arousal criteria with diagnosing hypopneas instead of using only oxygen desaturation. Incorporating arousals might increase the prevalence of OSA diagnosis to include mild cases, which makes it harder to correlate mild-to-moderate OSA with cardiovascular events directly. Most of the newly identified patients through arousal criteria suffer from mild OSA, for which treatment benefits remain unproven.<br /><br />They argue for a consistent definition for the Apnea-Hypopnea Index (AHI) to guide diagnosis and treatment since different scoring methods (arousal vs. desaturation) influence prevalence and can skew treatment considerations. <br /><br />From the opposing viewpoint, Drs. Holley and Phillips express concern about the overdiagnosis and treatment of OSA due to the inclusion of arousal criteria, arguing for a rigorous approach that focuses on treating symptomatic patients. The paper also acknowledges the AHI metric's limitations and advocates for exploring additional diagnostic variables, beyond AHI, to improve patient outcome predictions, such as oxygen desaturation depth and heart rate variability.<br /><br />In conclusion, the ongoing debate reflects the need for standardized, evidence-based criteria in diagnosing and treating sleep apnea to minimize overdiagnosis and ensure treatment efficiency.

Keywords

Obstructive Sleep Apnea Syndrome

OSAS

Obstructive Sleep Apnea

OSA

diagnostic criteria

polysomnogram

Apnea-Hypopnea Index

arousal criteria

overdiagnosis

treatment efficiency