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Editorials: Point and Counterpoint |

Rebuttal From Dr Rapoport

David M. Rapoport, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: D. M. R. receives patent royalties through New York University from Fisher & Paykel Healthcare Limited and Sefam Medical, Ltd for CPAP modifications; consulting fees and grant support from Fisher & Paykel Healthcare Limited; and consulting fees from BioMarin Pharmaceutical Inc, Morphy, Inc, and Jazz Pharmaceuticals plc.

CORRESPONDENCE TO: David M. Rapoport, MD, FCCP, Sleep Disorders Center, Bellevue Hospital, 462 First Ave, Room 7N2, New York, NY 10016


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):19-20. doi:10.1378/chest.15-1320
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Extract

In his counterpoint editorial, Dr Punjabi points out intrinsic limitations of the apnea-hypopnea index (AHI) concept. The cycle rate of events does not capture physiologic severity of each event (eg, quantitative flow reduction, event duration) or biologic impact (eg, degree of desaturation, sympathetic activation); the temporal distribution of events is not captured (eg, clusters of apneas and hypopneas are counted equally to widely separated individual events); and other essential aspects of sleep are ignored (eg, total duration of sleep determines overall exposure to sleep-disordered breathing). Thus, he argues that AHI is an overly simplistic representation of the complex physiology of a 7-h polysomnogram recording.

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