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In response to Redefining successful therapy in obstructive sleep apnea: A call to arms
Author(s) -
Pang Kenny P.,
Rotenberg Brian W.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24790
Subject(s) - obstructive sleep apnea , medicine , otorhinolaryngology , family medicine , pediatrics , library science , psychiatry , computer science
With reference to the letter by Certal et al., we are delighted to know that there are sleep specialists who concur that the definitions of success in the treatment of obstructive sleep apnea must move beyond that of the apnea-hypopnea index (AHI) being the only parameter. It is well accepted that there are variations in the AHI due to a multitude of reasons including the definition of hypopnea and its scoring, the first-night effect, night-to-night variability, and differences in the diagnostic devices used. It is also appreciated that obstructive sleep apnea is a multisystemic disease, with its effects seen not only in the cardiovascular and respiratory systems but the central neurological system as well. The net “disease load” caused by the repetitive nocturnal airway obstruction during sleep has a deleterious effect on the entire body. Therefore, it is increasingly evident that it is insufficient to only rely on one parameter as the overall marker of treatment success. We concur that the oxygen desaturation index and time below 90% oxygen saturation (among other sleep indices available) are useful sleep parameters that may be well utilized when assessing for response to therapy. However, we would like to also stress that non– sleep-related parameters like blood pressure, body mass index, quality of life scores, performance vigilance testing, and blood parameters like nitric oxide level, arginase activity, and C-reactive protein may be useful. The world of sleep medicine is at an inflection point in regard to evidence-based medicine, and the modern evidence is suggesting that we as practitioners should move to more inclusive definitions of disease state and treatment effect. We feel the time has come to have a discussion with colleagues worldwide on this topic, and to develop both major and minor criteria as are frequently done for other prevalent diseases (e.g., chronic sinusitis). We invite further comments and/or recommendations in this regard, and hope to engage with our colleagues personally at a consensus meeting in the near future.