Author response to editorial on routine screening for sleep apnea

摘要

I would like to thank the editor for the opportunity to reply to Dr. Salord and Dr. Monasterio, and I would like to thank them for their interest in our manuscript. I think it is an important issue that deserves a thorough discussion. Several of the critiques that Salord and Monasterio bring up are well-known problems with retrospective analyses of databases and are addressed in the discussion section of our manuscript. In addition, we would like to respond to some specific comments. First, I would like to reply to the possibility of inaccurate detection of complications in a retrospective study. We feel that our accuracy to detect cardiopulmonary complications during the postoperative course was quite high because we have an electronic medical record and each chart was reviewed by a trained reviewer. Our definitions of complications are unambiguous and we are very confident that our reported incidence of cardiopulmonary complications is accurate. Second, the question of which group to compare is an important one but again one that we chose carefully. Since we are trying to compare the clinical efficacy of universal sleep apnea screening, we need to look at patients that do not have a known diagnosis of sleep apnea. Those patients come from an orthopedic no sleep apnea group (un-screened). Comparing the entire group of orthopedic patients (and including the 17.3 % with known OSA) would not make sense since we are not screening patients with known diagnoses of sleep apnea. In addition, I would again like to highlight the point from our study that supports minimal chance of selection bias.