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Mechanisms and Treatment of Obstructive Sleep Apnea—Reply
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In Reply: Drs Hussain and Karnath point out the possibility of an association between OSA and both pulmonary hypertension and right ventricular dysfunction. Although systemic circulatory changes have been extensively examined, studies of pulmonary hemodynamics in patients with OSA, and the effects of treatment on these measures, are limited. One important impediment to such studies is the invasive approach needed for measurements of pulmonary arterial pressure, particularly in patients with OSA in whom obesity may impair the quality of noninvasive echocardiographic estimates of pulmonary artery pressure. Other confounding issues that obscure a clear identification of a causal interaction between OSA and both pulmonary hypertension and right ventricular dysfunction include considerations related to body mass index, coexisting obesity-hypoventilation syndrome, pulmonary disease,1 and other comorbidities.
Marrone and Bonsignore2 noted that, while patients with OSA may have a relatively higher prevalence of increased pulmonary artery pressures, it is not clear that treatment of . . . [Full Text of this Article]
Abu S. M. Shamsuzzaman, MBBS, PhD;
Bernard J. Gersh, MBChB, Dphil;
Virend K. Somers, MD, DPhil
somers.virend@mayo.edu
Mayo Clinic
Rochester, Minn
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