I love it. I think it's an important teaching point and yeah, I think it's an important teaching point and I think it is non-obvious and so like I think there's plenty of people who are going to think CPAP is the wrong answer. Just a comment or two on the commentary. In the beginning part, if you could go back to the commentary please, thank you. In that first part, in that first paragraph, in the second sentence, maybe instead of saying what it's supported by, just say the diagnostic criteria for OHS are blah. So people don't have to like connect those dots. And then I wonder if in the end, in the last paragraph, it's worth some discussion of although BPAP and VAPS are not the appropriate initial therapy, there's plenty of people that we end up putting on those things. I have a lot of thoughts on that point. Yeah, like how do we, when is CPAP not the right thing to stick with? Because you know if Peter Gay and Lisa Wolfer here, we would be having an hour because they and I tend to side at the same, on the same side and have some issues with the Spanish study just because they don't talk about the second phenotype, right? There's the one phenotype where it's really all obstruction and when you clear the obstruction, the ventilation improves. And then the other phenotype where it's really a dampened drive. Can you scroll up because we might be able to, so I think number one, adding that in that while this is true, a follow-up should be done and if, you know, after three months continued oxygenation improves, but if it doesn't, blah, blah, blah. I would feel better if they weren't super hypoxic, oh, wait, that's on the diagnostic. Okay. Yeah. Yeah. Or at least giving an example, yeah, yeah, I guess it's fine. And you do put initially and I agree with all of that. I don't disagree with any of it. You know, like you have to follow them up. Well, we can do, I mean, you can talk a little bit about it. You know, the point is to, you know, one, obviously there's new clinical guidelines and this is new data, which, you know, to some is controversial, but, you know, you lead with data, not with what our experiences are, but to your point, right? I mean, the point is right that 90% of OHS is OSA and it's severe OSA typically, but you make a great point, you know, which is that, you know, that 10% who are the ones that typically present hospitalized are the ones that most likely require an IV. So, you know, we can make a short comment to that point, you know, just indicating sort of that distribution and sort of say, I was trying, I was kind of, sort of getting at it towards the end of the commentary, but it doesn't quite come out, I think, you know, and you're bringing that out. Could you scroll that down just real quick and show, yeah, just, you know, how to sort of, and you don't have to say it that way, actually, but you know what I mean? There's sort of two phenotypes in there. It's, you know, it's the third paragraph, right? This is the rare, you know, we had a lot of debate about this on the guideline committee when we wrote the guideline and exactly this issue of the phenotypes and not trying to lose that fact that there is this subgroup. And the guidelines did a nice job about not precluding you from being able to make that choice. Yeah, I was really happy to see that. Patience is spelled incorrectly in that paragraph, by the way. Yeah, no, I've got a bunch of grammatical issues here. Yeah, maybe just add another sentence after that, right? Close follow up in the first few months of the patients that are prescribed CPAP and then add another statement or two. Random editorial stuff. So I just pulled up all the approved abbreviations. OSA is approved. CPAP is approved. And I have a major issue with this list. So if you could raise it for me. OK, BiPAP B lowercase I PAP is approved, which is a brand name. So there's no way I stay away from it. I would never write BiPAP. I like I and way too many people don't know that it's a brand name, which is like horrifying to me. So the way that she did it is 100 percent correct and should be swapped out for our approved abbreviation. We should not be approving a brand name. Right. Is it ST? Is that what you're saying? So BiPAP or Bi-level, either one. But BiPAP is fine. OK, it's fine. BiPAP. And so what you might want to do here is put BiPAP in spontaneous timed modes because I don't know that the ST is approved. Does that make sense? So you could put BiPAP up and VAPS is not. So I would write volume assured pressure support. Can you scroll up so we can see that? And ASV is not so adaptive surfa ventilation. So CPAP and BiPAP in spontaneous timed would be fine. I think I. Yeah, but we spell those out. Yeah. OK, but but to our team, BiPAP shouldn't be on there. Oh, my gosh. Yeah. See that. And OHS down below, I think, needs to be spelled out. I don't see that that was. It should the first time you say, oh, yeah, you did. Never mind. OK, that's awesome. This is a great question and it's important that we address this. So. I specifically think I didn't write it because it hurts me to like it's too hard to. Yeah, you did a great job.

obesity-hypoventilation syndrome

diagnostic criteria

CPAP

follow-up

clinical guidelines