CHEST Guidelines-Response_chest

Response_chest_10 (1)

Pdf Summary

This letter to the editor of the Journal of Clinical Sleep Medicine addresses comments made by Fysekidis and colleagues regarding a previous study on obstructive sleep apnea (OSA) and acute coronary syndrome (ACS). Dr. Xavier Soler, along with Alicia and Manuel Sánchez-de-la-Torre, responds, acknowledging the need for more research on the impact of OSA-related preconditioning on ACS due to limited existing literature. Although OSA is associated with greater cardiovascular risk, outcomes in ACS patients with and without sleep-disordered breathing do not show significant differences.<br /><br />The authors defend their methodology, stating that although polysomnography is ideal for diagnosing OSA, recent studies suggest respiratory polygraphy as an alternative. They note that opioids used in ACS treatment, like morphine and meperidine, should not significantly affect the sleep studies they conducted, as these drugs have short half-lives and most processing would have occurred within the timeframe of their study.<br /><br />Challenges in classifying symptom onset times were highlighted due to patients often providing vague accounts, especially those with atypical pain or without pain, such as diabetic patients. Consequently, this data wasn't analyzed. The initial analysis aimed to explore the relationship between OSA and peak troponin levels and included confounding variables, which were not statistically significant.<br /><br />Furthermore, the selection of patients was influenced by a prior study on Continuous Positive Airway Pressure (CPAP) treatment in ACS and OSA patients. The authors acknowledge limitations in their original paper and agree they should have been more clearly stated. Finally, the letter signifies the involvement of Drs. Soler and A. Sánchez-de-la-Torre as equal contributors, and information regarding potential conflicts of interest and contact details for correspondence is included.

Keywords

obstructive sleep apnea

acute coronary syndrome

OSA-related preconditioning

respiratory polygraphy

polysomnography

opioids

peak troponin levels

Continuous Positive Airway Pressure

confounding variables

conflicts of interest