To the Editor.—
We read with interest the recent article by Scharf et al entitled "Nocturnal Oxygen Desaturation in Patients With Sickle Cell Anemia" (1983;249:1753). Certainly, patients with sickle cell disease experiencing significant nocturnal hypoxemia may be more likely to suffer from vaso-occlusive crises during sleep. However, the author's speculation that reductions in nocturnal oxygen saturation "may occur regularly in patients with sickle cell disease" implies that the hypoxemia documented in their patients was secondary to sickle cell anemia. We believe that this suggestion is unwarranted based on the case material provided.Scharf et al assert that hypoxemia occurred "without concomitant obstructive or central apnea" or significant degree of hypopnea. However, use of thermistors to monitor airflow does not allow reliable quantification of airflow. This is of particular importance for patient 1, since even mildly hypertrophic tonsils have been shown to obstruct the airway during sleep1 (although not always
Walsh JK, Corder JC, Kotagal S. Nocturnal Oxygen Desaturation in Sickle Cell Anemia. JAMA. 1983;250(20):2789–2790. doi:10.1001/jama.1983.03340200023013
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