Mild obstructive sleep apnea syndrome should be treated. Pro.

What little I remember from high school concerning debating technique consists of the Jesuit adage, “define your terms.” Consequently, I will begin by reviewing the possible criteria by which obstructive sleep apnea (OSA) could be considered “mild” in degree. The various attributes attached to OSA include the presence of symptoms (most frequently, hypersomnia), as well as various metrics obtained from the overnight polysomnogram. The latter include degree of oxyhemoglobin desaturation, which might encompass saturation nadir, total sleep time (TST) below a certain saturation, or mean saturation; respiratory-associated arousal index; or apnea-hypopnea index (AHI). Although the definition of “mild” OSA could be the subject of its own debate, the American Academy of Sleep Medicine has, in fact, taken a position on this issue.1 Two criteria are used: sleepiness, which must be either absent or mild in degree (only occurring in sedentary situations), and AHI, which must fall between 5 and 15 events per hour of sleep. Unfortunately, mild OSA in clinical research has almost universally been defined only in terms of AHI, usually that in the range of 5–15. This definition must then suffice for purposes of this debate.

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