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Volume 10 No. 06
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Accepted Papers

Letters to the Editor

The Lumpers and Splitters Paradox

Anthony M. Masi, M.D., F.A.A.S.M.
Lung and Sleep Medicine, St. Louis, MO

The recent issue of Journal of Clinical Sleep Medicine (Vol. 10, No. 2, 2014) could be renamed the Paradox issue. It honestly left my head spinning. With no disrespect to the esteemed authors, the “splitters” in the Editorial1 and Commentary2 professed the clinical importance of recognizing, counting, and treating subtle reductions in airflow associated with arousals (RERA's), whereas the juxtaposed “lumpers” in the Review Article3 stated that the clinical success of oral appliance therapy does not depend on fine-tuned elimination of all subtle or even blatant respiratory events. Which group is correct? Based on these articles, it should be no surprise that CMS is waiting for the dust storm in sleep medicine to clear before changing its national coverage determinations on the diagnosis and treatment of obstructive sleep apnea.


Dr. Masi has indicated no financial conflicts of interest.


Masi AM. The lumpers and splitters paradox. J Clin Sleep Med 2014;10(6):701.



Krakow B, Krakow J, Ulibarri VA, et al., authors. Frequency and accuracy of “RERA” and “RDI” terms in the Journal of Clinical Sleep Medicine from 2006 through 2012. J Clin Sleep Med. 2014;10:121–4. [PubMed]


Collop N, author. Breathing related arousals: call them what you want, but please count them. J Clin Sleep Med. 2014;10:125–6. [PubMed]


Sutherland K, Vanderveken OM, Tsuda H, et al., authors. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10:215–27. [PubMed]