Read the fine print: updated sleep apnea guidelines and risk stratification.

To the Editor: The recent update of the report “Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea” by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea did not provide any new recommendations.1 Like its predecessor, the updated version includes “table 2,” a scoring system for perioperative risk for obstructive sleep apnea. This table allows the reader to assign a numerical score for severity of sleep apnea, invasiveness of surgery and anesthesia, and requirement for postoperative opioids. The overall score yields an estimate of perioperative risk. By its very design, the scoring system appears scientific and precise. A footnote to the table states: “This example, which has not been clinically validated, is meant only as a guide, and clinical judgment should be used to assess the risk of an individual Management of Patients with Obstructive Sleep Apnea.1 However, it is our belief that the document, although flawless from a methodological point of view, fails to convey the intended message to the reader. We found that all the recommendations listed in the document defer from the final decision to the clinicians, leaving “too much room” for individual maneuvers. As a matter of fact, as far as patient’s safety is concerned, the document falls short of the aim of a guideline, which should be able to indicate the best among all possible options. A few points seem more critical than the others: