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Yoshiro Toyama, MD; Kazuo Chin, PhD, MD
Author and Funding Information

From the Kyoto University Graduate School of Medicine.

Correspondence to: Kazuo Chin, MD, PhD, Shogoin 54, Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan; Email: chink@kuhp.kyoto-u.ac.jp.


Financial/nonfinancial disclosures: The authors 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(4):1188-1189. doi:10.1378/chest.12-2758
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To the Editor:

We were honored to receive the thoughtful letter from Mr Polesel and colleagues regarding our article.1 Although we believe that our results support the effects on dyslipidemia of CPAP treatment of obstructive sleep apnea, which have been reported,2 they pointed out the remaining issues. Our opinions concerning their suggestions are as follows.

First, we collected some data on the lifestyle of the patients, such as alcohol consumption, sleeping pill use, and types of duties, by asking the participants.3 However, few data that enabled estimating the daily calorie balance or dietary habits were provided. Manual laborers made up a small percentage of the participants because the surveyed company was in a service industry, and we did not take the job type into consideration. It may require great efforts to collect such data in detail in an epidemiologic survey, but it would be important in a further study. Second, we used the blood sample data from the health examination to evaluate the metabolic states biochemically. Inflammation markers and adipokines are generally not measured in routine blood examination, so we could not investigate the associations of these markers with lipid metabolism in this study design. Finally, there is no doubt that polysomnography is the best method to assess sleep efficiency and sleep architecture. However, we wanted to assess sleep under usual lifestyle conditions. It is considered that actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations,4 and the unattended type 3 monitoring was reported to be reliable under the specific conditions in which our study was conducted.5 In addition, as we previously reported, interscorer and night-to-night reliability of respiratory disturbance index were excellent3 (interclass correlation coefficient of 0.98 and 0.95, respectively). It remains unsolved whether polysomnography in the laboratory or a portable system in the usual lifestyle conditions is better.

Mr Polesel and colleagues have shown clearly what should be investigated in the future, and we quite agree with them. Indeed, the relationships among lipid metabolism, obesity, and daily life, including quantity or quality of sleep, are very complicated, and it seems to be difficult to unravel them. Further studies are required to solve these issues.

References

Toyama Y, Chin K, Chihara Y, et al. Association between sleep apnea, sleep duration, and serum lipid profile in an urban, male, working population in Japan. Chest. 2013;143(3):720-728. [CrossRef] [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;365(24):2277-2286. [CrossRef] [PubMed]
 
Nakayama-Ashida Y, Takegami M, Chin K, et al. Sleep-disordered breathing in the usual lifestyle setting as detected with home monitoring in a population of working men in Japan. Sleep. 2008;31(3):419-425. [PubMed]
 
Morgenthaler T, Alessi C, Friedman L, et al; Standards of Practice Committee. American Academy of Sleep Medicine. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007;30(4):519-529. [PubMed]
 
Collop NA, Anderson WM, Boehlecke B, et al; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3(7):737-747. [PubMed]
 

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Tables

References

Toyama Y, Chin K, Chihara Y, et al. Association between sleep apnea, sleep duration, and serum lipid profile in an urban, male, working population in Japan. Chest. 2013;143(3):720-728. [CrossRef] [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;365(24):2277-2286. [CrossRef] [PubMed]
 
Nakayama-Ashida Y, Takegami M, Chin K, et al. Sleep-disordered breathing in the usual lifestyle setting as detected with home monitoring in a population of working men in Japan. Sleep. 2008;31(3):419-425. [PubMed]
 
Morgenthaler T, Alessi C, Friedman L, et al; Standards of Practice Committee. American Academy of Sleep Medicine. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007;30(4):519-529. [PubMed]
 
Collop NA, Anderson WM, Boehlecke B, et al; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3(7):737-747. [PubMed]
 
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