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Philip A. Ades, MD
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From the Department of Medicine, Division of Cardiology, Cardiac Rehabilitation and Preventive Cardiology, University of Vermont College of Medicine.

Correspondence to: Philip A. Ades, MD, Cardiac Rehabilitation and Prevention, 62 Tilley Dr, South Burlington, VT 05403; e-mail: Philip.Ades@vtmednet.org


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. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1640. doi:10.1378/chest.12-0517
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To the Editor:

I thank Dr Damiani and colleagues from the University of Bari for their perceptive comments about the effect of obstructive sleep apnea (OSA), CPAP, and weight loss on endothelial function. Their comments are quite relevant to our study of weight loss in overweight patients with coronary heart disease and the effects of weight loss on endothelial function.1

In our study, we did not screen patients for sleep-disordered breathing or for OSA. Neither did we exclude subjects for the presence of these conditions. In a cardiac rehabilitation population similar to ours, Sharma and Parker2 recently found a preexisting formal diagnosis of OSA in 17% of subjects, but when a predictive questionnaire was added, a prevalence of OSA of >50% was estimated. In that our study population was exclusively overweight, with all subjects having a BMI of ≥ 27 kg/m2 and an elevated waist circumference, the prevalence of OSA may have been even higher.

We found that weight loss resulted in an improvement in endothelial-dependent vasodilator capacity in a dose-dependent fashion. We also noted that greater weight loss was associated with a greater improvement in insulin sensitivity. There are well-established interactions among obesity, insulin resistance, and OSA,3,4 with weight loss expected to improve both insulin sensitivity and OSA and each, in turn, expected to favorably affect endothelial function. However, it may be difficult to sort out the independent effects of each given that weight loss will improve both insulin sensitivity and sleep-disordered breathing in tandem.

In conclusion, I accept the assertion by Dr Damiani and colleagues that further study of the interactions among sleep-disordered breathing, weight loss, CPAP, and endothelial function and of the role each plays in patients with coronary heart disease is warranted. I thank them for their astute observations.

Ades PA, Savage PD, Lischke S, et al. The effect of weight loss and exercise training on flow-mediated dilatation in coronary heart disease: a randomized trial. Chest. 2011;1406:1420-1427. [CrossRef] [PubMed]
 
Sharma S, Parker AT. Prevalence of obstructive sleep apnea in a patient population undergoing cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2011;313:188-192. [PubMed]
 
Sharma SK, Agrawal S, Damodaran D, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;36524:2277-2286. [CrossRef] [PubMed]
 
Theorell-Haglöw J, Berne C, Janson C, Lindberg E. The role of obstructive sleep apnea in metabolic syndrome: a population-based study in women. Sleep Med. 2011;124:329-334. [CrossRef] [PubMed]
 

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References

Ades PA, Savage PD, Lischke S, et al. The effect of weight loss and exercise training on flow-mediated dilatation in coronary heart disease: a randomized trial. Chest. 2011;1406:1420-1427. [CrossRef] [PubMed]
 
Sharma S, Parker AT. Prevalence of obstructive sleep apnea in a patient population undergoing cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2011;313:188-192. [PubMed]
 
Sharma SK, Agrawal S, Damodaran D, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;36524:2277-2286. [CrossRef] [PubMed]
 
Theorell-Haglöw J, Berne C, Janson C, Lindberg E. The role of obstructive sleep apnea in metabolic syndrome: a population-based study in women. Sleep Med. 2011;124:329-334. [CrossRef] [PubMed]
 
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