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The principal author, Dr. Yuksel Peker, e-mailed me a response to my summary and discussion of his article that made some points I have now incorporated in those items to correct them, specifically: (1) that they used the Respiratory Distress Index (RDI) for diagnosis of OSA, but the Oxygen Desaturation Index (ODI) for titration of CPAP pressure levels; (2) that the lack of an objective measure of CPAP compliance really applied only to the first six patients during their first two years on CPAP, so did not represent as major a problem as I had misunderstood it to be; (3) that although the initial Body Mass Indices (BMI) of non-users was a bit higher before CPAP prescription, it later declined significantly in the ensuing two years; most significantly, BMI did not differentiate the users and nonusers in the subgroup of patients with cardiovascular and respiratory disease who were hospitalized during follow-up.
Finally, they acknowledged the importance of measuring other parameters of sleep disruption, such as arousals related to respiratory events, for correlation with medical consequences, but was impossible in an epidemiological study such as this due to practical constraints.

It is very helpful to get author feedback on summaries such as these because it is very easy to miss important points when one attempts a critique. Their counterpoints have obviously added to the strength of their study, a gratifying result since I believe it has considerable importance for social, political, and financial decision-making about treatment of sleep apnea. By prejudice as much as knowledge, I am of the opinion that oxygen desaturation has been overemphasized and disruption of sleep continuity underemphasized as a basic cause of many of the symptoms and complications of sleep-disordered breathing, but I am sure there are many who would hold the opposite view, that hypoxia is the most significant event to tissue damage at least.

Do you have your own comments to add? E-mail me at

kerrinwh@ix.netcom.com

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