LAUSR

Dear Editor, Obstructive sleep apnea syndrome (OSAS) is an underdiagnosed chronic disease with a very high prevalence in adults. Patients with untreatedOSAS are at significantly increased risk of comorbidities as well motor vehicle accidents and work accidents. In order to counteract the impact of OSAS on public health in Italy, the Italian Minister of Health has approved a new approach that is aimed at preventing and making an early diagnosis of OSAS in adults and children. To our knowledge, this is the first example of a holistic model planned by a national institution. OSAS is a chronic disease with an estimated prevalence of 23.4% in women and 49.7% in men over 40 years of age [1]. Patients with untreated OSAS are at significantly increased risk of cerebro-cardiovascular, metabolic and neurocognitive disease, motor vehicle accidents [2], and work accidents [3]. For these reasons, OSAS has an adverse impact on quality of life and life expectancy, with a substantial adverse impact on economic systems. Awareness of OSAS as being a health issue of great relevance is rising [4]. In order to prevent motor vehicles accidents and related injuries, countries with developed economies have either proposed or adopted protocols or mandatory testing for the screening and early diagnosis of OSAS in commercial and/or private vehicle drivers [5]. In order to counteract the impact of OSAS on public health in Italy, the Italian Minister of Health has approved a new approach that is aimed at preventing and making an early diagnosis of OSAS in adults and children. To our knowledge, this is the first example of a holistic model planned by a national institution that is aimed at improving the health of OSAS patients. There is a very significant gap between the estimated number of patients with OSAS (approximately 80% of them are undiagnosed) and the ability of the Italian health system to diagnose and care patients. This gap is likely to increase further for twomain reasons: (i) although normal-weight subjects may be affected by OSAS, the increase in the prevalence of OSAS is associated with increased obesity, with obesity being the highest risk factor for OSAS; (ii) according to the European Commission Directive 2014/85/EU, testing is mandatory for moderate or severe OSAS, both when associated with excessive daytime sleepiness (EDS) and before a driver’s license is granted or renewed, and applicants or drivers with moderate or severe OSAS who are undergoing treatment shall be subject to periodic medical review at intervals not exceeding 3 years for drivers of Group 1 and 1 year for drivers of Group 2 driving license [5]. As a result of the Commission Directive 2014/85/EU, adherence to treatment must be evaluated in an objective manner [5]. International statements on OSAS are as follows that: (i) the clinical suspicion should be confirmed by objective testing; (ii) home sleep testing (HST) is validated for the diagnosis of OSAS, titration of positive airway pressure (PAP), and oral appliance devices and is used * Desiderio Passali [email protected]