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Wojciech Trzepizur, MD; Marc Le Vaillant, PhD; Nicole Meslier, MD; Thierry Pigeanne, MD; Philippe Masson, MD; Marie P. Humeau, MD; Acya Bizieux-Thaminy, MD; François Goupil, MD; Sylvaine Chollet, MD; Pierre H. Ducluzeau, MD, PhD; Frédéric Gagnadoux, MD, PhD; for the Institut de Recherche en Santé Respiratoire des Pays de la Loire (IRSR) Sleep Cohort Group
Author and Funding Information

From L’Université Nantes Angers le Mans University (Drs Trzepizur, Meslier, Ducluzeau, and Gagnadoux); Department of Respiratory Diseases (Drs Trzepizur, Meslier, Ducluzeau, and Gagnadoux) and Department of Endocrinology-Diabetology-Nutrition (Dr Ducluzeau), Angers University Hospital; INSERM U1063 (Drs Trzepizur, Meslier, and Gagnadoux); Centre de Recherche Médicale et Sanitaire (Dr Le Vaillant), CNRS UMR8211-INSERM U988-EHESS; Department of Respiratory Diseases (Dr Pigeanne), Pôle Santé des Olonnes; Department of Respiratory Diseases (Dr Masson), Cholet Hospital; Department of Respiratory Diseases (Dr Humeau), Nouvelles Cliniques Nantaises; Department of Respiratory Diseases (Dr Bizieux-Thaminy), La Roche-sur-Yon Hospital; Department of Respiratory Diseases (Dr Goupil), Le Mans Hospital; and Department of Respiratory Diseases (Dr Chollet), Nantes University Hospital.

Correspondence to: Frédéric Gagnadoux, MD, PhD, Université d’Angers, CHU Angers, Département de Pneumologie, 4 rue Larrey, 49033 Angers Cedex, France; e-mail: frgagnadoux@chu-angers.fr


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;144(1):357-358. doi:10.1378/chest.13-0166
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To the Editor

We appreciate the correspondence of Dr Balta and colleagues about our study published in CHEST1 in which we examined the hypothesis of an independent cross-sectional association between nocturnal intermittent hypoxemia and dyslipidemia in patients investigated for suspected obstructive sleep apnea (OSA). We agree that physical activity influences lipid profile and that reduced activity levels may contribute to increased triglycerides and reduced high-density lipoprotein cholesterol levels. It remains unclear whether OSA or excessive daytime sleepiness affects objectively measured physical activity. In a recent study, men with untreated OSA had less metabolic improvement than obese patients without OSA after a 1-year healthy eating and physical activity/exercise intervention program.2 A previous randomized controlled trial found no increase in daytime physical activity under CPAP therapy, despite improvement in daytime sleepiness.3 There is no established method to best identify physical activity in patients with OSA, obesity, or both. A limited agreement has been found between self-reported questionnaires on physical activity and objective activity measurement with wrist actigraphy.4 It would have been very difficult to objectively measure physical activity in the large sample of our multisite study. Further studies are required to evaluate the contribution of physical activity on dyslipidemia in patients with OSA.

As mentioned by Dr Balta and colleagues, there is growing evidence in support of an independent association between OSA and cardiovascular diseases. Therefore, we entered into our multivariate regression analyses most cardiovascular diseases associated with OSA, including hypertension, ischemic heart disease, cardiac arrhythmia, congestive heart failure, and stroke. Recently, a high prevalence of OSA was observed in patients needing surgery for peripheral arterial disease.5 We acknowledge that a medical history of peripheral arterial disease has not been recorded in our database. Screening for pulmonary hypertension requires additional investigation, such as echocardiography. In isolation, OSA typically causes only mild pulmonary hypertension that does not require specific treatment. We acknowledge that renal, hepatic, and thyroid dysfunction may be observed in patients with OSA; however, in our large multisite study, biologic investigations were limited to those recommended by French guidelines for the management of OSA in routine practice, including fasting blood glucose, glycated hemoglobin, and fasting serum lipid levels.

References

Trzepizur W, Le Vaillant M, Meslier N, et al. Independent association between nocturnal intermittent hypoxemia and metabolic dyslipidemia. Chest. 2013;143(6):1584-1589. [PubMed]
 
Borel A-L, Leblanc X, Alméras N, et al. Sleep apnoea attenuates the effects of a lifestyle intervention programme in men with visceral obesity. Thorax. 2012;67(8):735-741. [CrossRef] [PubMed]
 
West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med. 2009;10(9):1056-1058. [CrossRef] [PubMed]
 
Igelström H, Emtner M, Lindberg E, Asenlöf P. Level of agreement between methods for measuring moderate to vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity. Phys Ther. 2013;93(1):50-59. [CrossRef] [PubMed]
 
Utriainen KT, Airaksinen JK, Polo O, et al. Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease. Eur Respir J. 2013;41(3):616-620.
 

Figures

Tables

References

Trzepizur W, Le Vaillant M, Meslier N, et al. Independent association between nocturnal intermittent hypoxemia and metabolic dyslipidemia. Chest. 2013;143(6):1584-1589. [PubMed]
 
Borel A-L, Leblanc X, Alméras N, et al. Sleep apnoea attenuates the effects of a lifestyle intervention programme in men with visceral obesity. Thorax. 2012;67(8):735-741. [CrossRef] [PubMed]
 
West SD, Kohler M, Nicoll DJ, Stradling JR. The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial. Sleep Med. 2009;10(9):1056-1058. [CrossRef] [PubMed]
 
Igelström H, Emtner M, Lindberg E, Asenlöf P. Level of agreement between methods for measuring moderate to vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity. Phys Ther. 2013;93(1):50-59. [CrossRef] [PubMed]
 
Utriainen KT, Airaksinen JK, Polo O, et al. Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease. Eur Respir J. 2013;41(3):616-620.
 
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