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Fluid Shift in Obstructive Sleep ApneaFluid Shift and Sleep Apnea Pathogenesis: Does It Really Have No Role in the Pathogenesis? FREE TO VIEW

Aibek E. Mirrakhimov, MD
Author and Funding Information

From Kyrgyz State Medical Academy and National Centre of Cardiology and Internal Medicine.

Correspondence to: Aibek E. Mirrakhimov, MD, Kyrgyz State Medical Academy, Ahunbaeva St, 92 Bishkek, 720040, Kyrgyzstan; e-mail: amirrakhimov1@gmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):830. doi:10.1378/chest.11-2650
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To the Editor:

The study by Jafari and Mohsenin1 published in a recent issue of CHEST (October 2011) tested the effect of nighttime rostral fluid shift on the development of obstructive sleep apnea (OSA) and its severity. The strengths of their study were stringent methodology and statistical processing of the received data. In contrast to some prior works, they did not find any effect of fluid shift on sleep disordered breathing severity. The studied population was likely free of clinically significant excessive fluid, evidenced by the absence of limb edema. Only three individuals received a diagnosis of heart failure (HF), which was mild and likely clinically compensated. However, most patients with OSA were obese and had thicker necks, which is known to be an OSA risk factor. The authors concluded that fluid shift unlikely has any role in the pathogenesis of OSA.

Some issues are noteworthy. First, it is well known that OSA is a risk factor for arterial hypertension (AH), kidney disease, and HF. That, in turn, may result in fluid retention. Second, several studies have shown a detrimental effect of fluid shift on OSA severity in comorbid conditions like HF,2 AH,3 and kidney disease.4 Recently a research group from France confirmed that fluid shift does, in fact, play a role in that setting. They enrolled subjects with chronic venous insufficiency and managed them with daytime compression stockings, which resulted in improved OSA severity.5

It is likely that in the early course of OSA rostral shift may not play a major role, but with the time needed for OSA complications to develop (eg, AH and HF), it may further worsen apnea-hypopnea index and, in turn, complicate the course of comorbid disorders, making a vicious cycle. Therefore, it seems that rostral fluid shift likely plays a role in the pathogenesis of OSA and its severity.

Jafari B, Mohsenin V. Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing? Chest. 2011;1404:991-997. [PubMed] [CrossRef]
 
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;12114:1598-1605. [PubMed]
 
Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension. 2010;566:1077-1082. [PubMed]
 
Tang SC, Lam B, Ku PP, et al. Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol. 2006;179:2607-2616. [PubMed]
 
Redolfi S, Arnulf I, Pottier M, et al. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med. 2011;184:1062-1066. [PubMed]
 

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References

Jafari B, Mohsenin V. Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing? Chest. 2011;1404:991-997. [PubMed] [CrossRef]
 
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;12114:1598-1605. [PubMed]
 
Friedman O, Bradley TD, Chan CT, Parkes R, Logan AG. Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension. Hypertension. 2010;566:1077-1082. [PubMed]
 
Tang SC, Lam B, Ku PP, et al. Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis. J Am Soc Nephrol. 2006;179:2607-2616. [PubMed]
 
Redolfi S, Arnulf I, Pottier M, et al. Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency. Am J Respir Crit Care Med. 2011;184:1062-1066. [PubMed]
 
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