Obstructive sleep apnoea/hypopnoea syndrome not to OSA/H. These cost estimations, however, did not take into account the possible medical (OSA/H) has a high prevalence. According to most epidemiological studies (despite some limitations consequences of apnoea-related road traffic accidents. due to non-standard definition criteria), OSA/H involves 1–4% of the middle-aged symptomatic Numerous studies have reported on the relationship between sleepiness, as a consequence of population, even more if we consider non-symptomatic people or patients above 60 years, although sleep disruption due to OSA/H, and automobile acccidents or near-missed accidents. The relative in this population the clinical symptoms and consequences are less clear [1]. In addition, high blood risk to have an accident lies between 2.3 and 7.3, but here, unlike what is seen in the studies on pressure and coronary heart disease, with their high burden of morbidity and mortality are definitively cardiovascular complications of OSA/H, there is generally no close correlation between this risk and recognized as major complications of OSA/H independently of associated obesity, alcohol intake, the severity of OSA/H. The sleep medical community has taken this sex and age [2–4]. Obstructive sleep apnoea/ hypopnoea affects mainly middle-aged, prodisease seriously, and has developed a number of therapeutic modalities such as weight loss, befessionally active patients, which implies high health care costs and loss of working days. havioural modifications, tracheostomy, naso-pharyngeal tube, uvulopalatopharyngoplasty (UPPP), The medical cost of undiagnosed sleep apnoea has been evaluated in a case–control study group nasal surgery, nasal dilators, electric stimulation of pharyngeal muscles, continuous positive airway of 358 US obese patients with moderate OSA/H (mean apnoea–hypopnoea index 37) [5]. In the year pressure (CPAP), oral appliances (OAs) and maxillofacial surgery. Continuous positive airway presprior to the diagnosis, mean annual medical costs were US$2720 for cases, compared with US$1384 sure and OAs are the most studied and used modalities. for controls. The difference was statistically significant (P<0.01). The severity of sleep-disordered This year, we celebrate the 20th anniversay of the publication by Sullivan et al. [6] on the efficacy breathing was correlated to the magnitude of medical costs. The additional cost estimation for the of CPAP for OSA/H. Since that time, CPAP remains a well-proven treatment. Nevertheless until recently entire USA was calculated at $3.4 billion each year. It should be mentioned that there was no matching there remained a need to demonstrate its efficacy in the improvement of morbidity, mortality and between cases and controls for body weight, so that the cost differences could be due to obesity and quality of life with randomized placebo-controlled studies as noted in the disturbing paper of Wright et al. in 1997 [7]. In this issue of Sleep Medicine Reviews, Drs William Beninati and Mark Sanders Correspondence should be addressed to: Daniel Rodenstein, give us a summary of the efficacy studies published Cliniques Saint-Luc, Av. Hippocrate 10, 1200 Brussels, Belgium. Fax: 32 2 764 28 31; E-mail:rodenstein@pneu.ucl.ac.be in the last 3 years [8]. With them we can clearly
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