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Thomas E. Vanhecke, MD; Barry A. Franklin, PhD; Peter A. McCullough, MD, MPH
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William Beaumont Hospital Royal Oak, MI

Correspondence to: Thomas E. Vanhecke, MD, Divisions of Cardiology, Nutrition and Preventive Medicine, Department of Internal Medicine, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073; e-mail: tvanhecke@gmail.com


The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):584-585. doi:10.1378/chest.08-2498
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To the Editor:

We are grateful for the insightful comments by Dr. Maeder and colleagues regarding our article in CHEST (September 2008).1 We agree that adipose tissue is metabolically inert; however, in those individuals with larger body habitus, higher absolute values of maximum oxygen consumption (milliliters per minute) are obtained based solely on having larger muscle mass. As reported earlier,2 correction for body mass allows comparisons to standards previously reported for healthy individuals and for those with heart failure. Regardless, when using absolute values of maximum oxygen uptake (milliliters per minute), there remained a significant decrease in cardiorespiratory fitness in the cohort with obstructive sleep apnea syndrome (OSAS) compared to the cohort without this disorder (Table).

Table Graphic Jump Location
Table 1 Baseline Characteristics of Subjects With and Without OSAS*

*Data are presented as mean ± SD.

Although, we regret our description of the study by Maeder et al as having a small sample size, we do not believe that this study of natriuretic peptides in patients with obstructive sleep apnea is contradictory to our study results, as they excluded patients without OSAS and did not have a control group. Furthermore, there were major differences in obesity between these two populations (body mass index was 48.6 kg/m2 in the present study and 30.2 kg/m2 in the previous study.) We are very pleased to see that cardiorespiratory fitness in individuals with OSAS is improved following treatment with continuous positive airway pressure because this answers a key question posed by our study results.3

We acknowledge that heart rate response was not novel to our study but consistent with recent data published by Maeder et al.4 Together, these data demonstrate the effects of OSAS on heart rate response and other key markers of autonomic dysfunction elucidate the pathophysiology of OSAS and may explain the favorable effects of treating sleep-related breathing disorders.5

Vanhecke TE, Franklin BA, Zalesin KC, et al. Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest. 2008;134:539-545. [PubMed] [CrossRef]
 
Barker D, Artis N, Tan LB, et al. Correcting data for body size may confound results. Chest. 2006;129:493-494. [PubMed]
 
Maeder MT, Ammann P, Rickli H, et al. N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea. Sleep Breath. 2008;12:7-16. [PubMed]
 
Maeder MT, Münzer T, Rickli H, et al. Association between heart rate recovery and severity of obstructive sleep apnea syndrome. Sleep Med. 2008; 109:753-761. [PubMed]
 
Grote L, Hedner J, Peter JH. The heart rate response to exercise is blunted in patients with sleep-related breathing disorder. Cardiology. 2004;102:93-99. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 Baseline Characteristics of Subjects With and Without OSAS*

*Data are presented as mean ± SD.

References

Vanhecke TE, Franklin BA, Zalesin KC, et al. Cardiorespiratory fitness and obstructive sleep apnea syndrome in morbidly obese patients. Chest. 2008;134:539-545. [PubMed] [CrossRef]
 
Barker D, Artis N, Tan LB, et al. Correcting data for body size may confound results. Chest. 2006;129:493-494. [PubMed]
 
Maeder MT, Ammann P, Rickli H, et al. N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea. Sleep Breath. 2008;12:7-16. [PubMed]
 
Maeder MT, Münzer T, Rickli H, et al. Association between heart rate recovery and severity of obstructive sleep apnea syndrome. Sleep Med. 2008; 109:753-761. [PubMed]
 
Grote L, Hedner J, Peter JH. The heart rate response to exercise is blunted in patients with sleep-related breathing disorder. Cardiology. 2004;102:93-99. [PubMed]
 
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