All India Institute of Medical Sciences New Delhi, India
Correspondence to: Somnath Bose, MD, Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi 110029, India; e-mail: email@example.com
No part of this work has been presented/published or sent for publication to any forum/journal in any form, and the authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
We thank Hwang et al1 for their work that correlates sleep-disordered breathing with postoperative complications; however, we would like to raise a few issues in this respect:
The authors have opined that screening modalities of obstructive sleep apnea (OSA) have largely been based on expert opinion with lack of clinical evidence. Such is clearly not the case: questionnaires like Berlin,2 STOP (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure), and STOP-Bang (Body mass index, Age, Neck size, Gender)3 are available and have been clinically validated. The STOP and STOP-Bang questionnaires are particularly concise, easy to administer, and particularly validated in surgical patients and show high sensitivity for moderate-to-severe OSA.3 Clearly, use of such validated simple methods would be less cumbersome than the use of nocturnal oximetry as used here, and these could be used for future studies.
It has been established that OSA4 is associated with increased perioperative morbidities more so with general anesthesia and perioperative use of opioids. A sizable proportion of patients (62 of 172) underwent surgeries (gynecologic, urologic, and orthopedic), which, depending on site and type of surgery, could either have been done under regional or general anesthesia. The authors have not clarified the type of anesthetic administered in these; nor have they clarified the protocol of general anesthesia, whether it was standardized for all patients, the analgesic modality followed in the various surgeries. These missing factors have a bearing on the perioperative outcome. In the absence of such information, it becomes difficult to interpret the contextuality of the data.
The inclusion of complications (GI bleed and intraperitoneal bleed) completely unrelated to the topic under investigation should have been left out from evaluation of complications because it could be a potential confounding factor.
We would like to add that the key to successful perioperative management of such patients lies in maintaining a high index of suspicion and tailoring the anesthetic technique and perioperative care in accordance with the patients' clinical condition.
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