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Nocturnal Home Oximetry in Detecting the Sleep Apnea-Hypopnea Syndrome and in Working Up Hypersomnolence
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Both the article by Series and colleagues [1] and the editorial by Pack [2] failed to address an important issue when evaluating sleepy patients who have been presumptively diagnosed as having obstructive sleep apnea. Excessive daytime sleepiness does not equate to a diagnosis of obstructive sleep apnea. Many other nonapneic respiratory and nonrespiratory sleep disorders require a comprehensive polysomnogram for diagnosis [3]. Specifically, high resistance during breathing—without apneas, hypopneas, or desaturations—can lead to frequent arousals from sleep and reversible daytime sleepiness [4]. Periodic limb movements of sleep would also be missed if oximetry alone were used.
Hypersomnolent patients do not seek medical expertise to rule out obstructive sleep apnea but rather to accurately diagnose the cause of their daytime sleepiness and have it corrected. Finally, because obstructive sleep apnea is not the most common cause of excessive daytime sleepiness [5], strategies aimed at evaluating only obstructive sleep apnea are likely to be ineffective.
Alejandro D. Chediak, MD
Mount Sinai Medical Center; Miami Beach, FL 33140
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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