Jordanna M. Hostler, MD; David C. Hostler, MD, MPH; Aaron B. Holley, MD
Disclaimer: The views represented in this letter are those of the authors and do not reflect the policies of the U.S. Department of Defense or the U.S. Army.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0593.
Hostler J., Hostler D., Holley A.; Diagnosis of Obstructive Sleep Apnea in Adults. Ann Intern Med. 2015;162:455-456. doi: 10.7326/L15-5062-2
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Published: Ann Intern Med. 2015;162(6):455-456.
TO THE EDITOR:
We read with concern the ACP clinical guideline about the diagnosis of OSA (1). This guideline offers PSG as a solitary tool for sleep-related symptoms; the guideline's broad application could result in unnecessary testing and treatment.
Polysomnography performed with current technologies and scored using the criteria recommended by the AASM in 2012 will yield an average apnea–hypopnea index that is 3-fold higher than that obtained with the equipment and scoring criteria available at the time of most of the studies cited to support this guideline. Flow changes are currently graded using a pressure-transduced air flow monitor—which is far more sensitive than the thermistor used in prior studies—and the new AASM guideline does not require oxygen desaturation to be present for a breathing event to be scored (2). In fact, a recent trial showed that the prevalence of an apnea–hypopnea index of 5 or more events per hour using the current criteria was 94.6% in a population with a “mild-moderate” pretest probability of OSA (3). This condition exists on a spectrum, and apnea–hypopnea index cutoffs are largely arbitrary. Given the changes in diagnosis, are we measuring clinically meaningful disease? What are the costs of overdiagnosis?
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