We were also surprised by the treatment prescribed by authors. We think that there are insufficient data related to left ventricular diastolic dysfunction, which is commonly associated with severe obstructive sleep apnea, and can represent a contraindication for using these new vasodilators. In fact, by using bosentan, mean pulmonary artery pressure got worse initially up to 53 mm Hg.3,4 In addition, portal hypertension, renal failure, and thyroid disorders should be ruled out to apply the term of idiopathic PAH in this case. Finally, it seems that there are no clear criteria in terms of using combination therapy. We do not understand why a second or a third drug are added because the results obtained compared to monotherapy are probably very similar. It would be also interesting to have more data about the dosages used and decision making in the future.5 We think there are doubts enough to consider adequate the management of the patient and the treatment prescribed by authors.