CHEST Guidelines-Rebuttal-From-Drs-Holley-and-Phillips

Rebuttal-From-Drs-Holley-and-Phillips_chest

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The discussion revolves around the complexities of diagnosing Obstructive Sleep Apnea Syndrome (OSAS) versus Obstructive Sleep Apnea (OSA), particularly in the context of whether arousals should be included in the definition of hypopneas. The document highlights the differing opinions on the implications of including arousal-based scoring in diagnosing OSA and OSAS.<br /><br />Drs. Holley and Phillips argue that using arousal criteria to score hypopneas can lead to an overdiagnosis of OSA, suggesting that many patients may be labeled with OSA unnecessarily. They emphasize that only patients with true OSAS, characterized by specific symptoms and comorbidities, should be treated. They are concerned that the inclusion of arousals dramatically increases the reported prevalence of mild OSA without clear evidence of treatment benefit, particularly as it obscures the association between mild-to-moderate OSA and cardiovascular events.<br /><br />Drs. Collop and Berry, however, counter this by defending the inclusion of arousals in hypopnea scoring, stressing that it could lead to a more accurate assessment of sleep-disordered breathing, which benefits patient treatment. They suggest that omitting arousal-based scoring could miss diagnoses in patients who, while not showing significant desaturation, do experience frequent arousals that impair sleep quality.<br /><br />Both parties agree on the importance of a unified AHI (Apnea-Hypopnea Index) definition for consistency in diagnosis and treatment. This debate underscores the need for further research to determine the clinical significance of arousal-based scoring and its true impact on patient outcomes, with both sides agreeing that treatment decisions should be guided by controlled studies to ensure proper management of OSA and OSAS.

Keywords

Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea

hypopneas

arousals

overdiagnosis

sleep-disordered breathing

AHI definition

cardiovascular events

treatment benefit

controlled studies