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Zarrin F. Shaikh, BMBS, PhD; Michael I. Polkey, PhD; Michael J. Mullen, MD; Mary J. Morrell, PhD
Author and Funding Information

From the National Institute of Health Research Respiratory Biomedical Research Unit (Drs Shaikh and Polkey), the Academic Unit of Sleep and Ventilation (Drs Shaikh and Morrell), National Heart and Lung Institute, Royal Brompton Hospital, Imperial College; and Department of Cardiology (Drs Shaikh and Mullen), Heart Hospital.

Correspondence to: Mary J. Morrell, PhD, Academic Unit of Sleep and Ventilation, 2nd Floor, Fulham Wing, Royal Brompton Hospital, London, SW3 6NP, England; e-mail: m.morrell@imperial.ac.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Morrell has received research grants from the National Institute of Health Research, British Heart Foundation, Wellcome Trust, and ResMed; none of these projects are related to the present study. Dr Mullen acts as a consultant and a proctor for Coherex Medical, Inc. Drs Shaikh and Polkey have 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.


Chest. 2013;143(2):582. doi:10.1378/chest.12-2501
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To the Editor:

We thank Dr Hoole and colleagues for their comments regarding our article1 reporting the outcome of patent foramen ovale closure in a small number of patients with obstructive sleep apnea. The first issue raised was the choice of closure device. However, in the absence of data, we are unable to comment on the use of other devices in obstructive sleep apnea.

Second, although we selected patients with a large physiologic shunt assessed during wakefulness, we accept that it may have been more logical to select on the basis of physiologic shunt during sleep. This could be conveniently assessed as the oxygen desaturation index/apnea-hypopnea index ratio, although in the future, more direct measurement during sleep may also be possible.

Last, we concluded that patent foramen ovale closure on clinical grounds was not justified. While we maintain this stance, we do accept that a trial using a different device, and powered on appropriate pilot data with different entry criteria, could yield a positive result. However, our data give no reason to believe so, and the variation that we observed leads us to suspect that the sample size required would be large. For this reason, we are not planning to do such a study ourselves. Of course, we agree with their final comment that additional data are needed.

References

Shaikh ZF, Jaye J, Ward N, et al. Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure. Chest. 2013;143(1):56-63.
 

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References

Shaikh ZF, Jaye J, Ward N, et al. Patent foramen ovale in severe obstructive sleep apnea: clinical features and effects of closure. Chest. 2013;143(1):56-63.
 
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