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Correspondence |

Potential Effects of Hypoxia Preconditioning in Obesity Hypoventilation Syndrome? FREE TO VIEW

Martin Burtscher, MD, PhD
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University of Innsbruck, Innsbruck, Austria

CORRESPONDENCE TO: Martin Burtscher, MD, PhD, University of Innsbruck, Fürstenweg 185, Innsbruck 6020, Austria


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1406. doi:10.1016/j.chest.2016.08.1480
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I have read with the greatest interest the article by Masa et al published in CHEST (July 2016) who demonstrated that severe oxygen desaturation was associated with reduced cardiovascular morbidity in patients with obesity hypoventilation syndrome (OHS). The authors discussed a putative role of ischemia preconditioning (IP) potentially contributing to the beneficial effects observed in these patients. In my opinion, this point should be addressed in greater detail.

First, IP is probably not the right term because it would mean blood flow restriction. In the present case, however, preconditioning stimuli are evoked rather by repeated hypoxic episodes due to hypoventilation, which should then be termed hypoxic preconditioning (HP). The distinction between these two types of preconditioning is important, especially regarding their potential for therapeutic use. In contrast to IP, HP is easily and safely applicable and has been used as a preconditioning stimulus since the 1990s. For instance, recently we were also able to demonstrate that even short periods (five sessions per week for 3 weeks) of HP resulted in improved exercise tolerance in patients with cardiovascular disease or COPD.

Second, it would be of utmost interest to discuss possible differences between the effects of intermittent hypoxia in patients with OSA with and without OHS. The high-frequency cycles of hypoxia/reoxygenation during the night in OSA (without OHS) are generally accepted to result in maladaptation. Thus, why is this not the case in patients with OHS in the most severe OSA studied by Masa et al? Would it be conceivable that it is the additional daytime hypoxia (and hypercapnia) with longer hypoxia/reoxygenation cycles evoking beneficial effects in these patients?

References

Masa J.F. .Corral J. .Romero A. .et al Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Chest. 2016;150:68-79 [PubMed]journal. [CrossRef] [PubMed]
 
Shizukuda Y. .Mallet R.T. .Lee S.C. .Downey H.F. . Hypoxic preconditioning of ischaemic canine myocardium. Cardiovasc Res. 1992;26:534-542 [PubMed]journal. [CrossRef] [PubMed]
 
Burtscher M. .Gatterer H. .Szubski C. .Pierantozzi E. .Faulhaber M. . Effects of interval hypoxia on exercise tolerance: special focus on patients with CAD or COPD. Sleep Breath. 2010;14:209-220 [PubMed]journal. [CrossRef] [PubMed]
 
Dewan N.A. .Nieto F.J. .Somers V.K. . Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015;147:266-274 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Masa J.F. .Corral J. .Romero A. .et al Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Chest. 2016;150:68-79 [PubMed]journal. [CrossRef] [PubMed]
 
Shizukuda Y. .Mallet R.T. .Lee S.C. .Downey H.F. . Hypoxic preconditioning of ischaemic canine myocardium. Cardiovasc Res. 1992;26:534-542 [PubMed]journal. [CrossRef] [PubMed]
 
Burtscher M. .Gatterer H. .Szubski C. .Pierantozzi E. .Faulhaber M. . Effects of interval hypoxia on exercise tolerance: special focus on patients with CAD or COPD. Sleep Breath. 2010;14:209-220 [PubMed]journal. [CrossRef] [PubMed]
 
Dewan N.A. .Nieto F.J. .Somers V.K. . Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015;147:266-274 [PubMed]journal. [CrossRef] [PubMed]
 
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