What data do we need to diagnose and treat obstructive sleep apnoea syndrome?

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All recent reviews of the epidemiology of sleepelsewhere [20–22], are not truly debates at all: disordered breathing [1] have shown that oboften the debaters agree more than disagree. Even structive sleep apnoea syndrome is a common conMontserrat et al. in an article on the con-side of dition affecting (by conservative estimates) about whether all sleep apnoea should be treated conclude 2% of the female adult population and 4% of the that: “ . . . the available evidence shows that nCPAP adult male population [2]. Rigorous epidemiologic is suitable in symptomatic patients and in this group studies have shown that sleep apnoea is an inof patients CPAP treatment is adequately and rodependent risk factor for the development of arbustly supported.” Thus, most experts agree that terial hypertension [3–6]. Animal studies have what should be treated is the sleep apnoea synshown that apnoea causes arterial hypertension drome, not a single number derived in a sleep test which is reversible with treatment of the apnoea in a possibly asymptomatic individual. What people [7]. Studies have shown that patients with sleep are arguing about is not the sleepy, overweight apnoea have cognitive impairment [8, 9], impaired patient with an apnoea index of 60. Unfortunately, ability to operate a motor vehicle [10], an increased policy makers are confused because of our inautomobile accident rate [10, 11] and a reduced consistent use of the term sleep apnoea to describe quality of life [12–17]. Prospective randomised clina syndrome and a laboratory finding. In their rebuttal ical trials using placebo (subtherapeutic CPAP) have Montserrat et al. state: “In asymptomatic patients shown that CPAP treatment has positive effects on with OSAS, no subjective gain becomes apparent the following outcomes: sleepiness [18], ability to after a long enough period of good compliance with steer a motor vehicle [19] and self-reported health sham (or active!) CPAP treatment” [24]. Is the status [18]. Why then, is there still a vigorous expression “asymptomatic patients with OSAS” not debate about whether sleep apnoea should be an oxymoron? treated [20–24], and why are sleep diagnostic serIn Canada, a country which has universal access to vices and CPAP therapy not universally available healthcare, some provinces offer diagnostic services even in jurisdictions that have “universal” healthfor sleep apnoea but do not pay for nasal CPAP, care? while some provinces offer diagnostic services but The debates about whether sleep apnoea synonly pay for a portion of the CPAP treatment, while drome should be treated, in this issue [23, 24] and some parts of the country that offer diagnostic services and CPAP treatment have waiting lists that are in the order of 1 year or more. Within the United States, given the many types of health serCorrespondence should be addressed to: M. Kryger, MD, vices and plans, there is a broad spectrum of covDirector, Sleep Disorders Centre, St. Boniface Hospital erage for diagnostic services and treatment options Research Centre, 351 Tache Avenue, Winnipeg, MB, Canada. Fax: (204) 235 0021; E-mail: kryger@sleep.umanitoba.ca and in some instances there may be payment for