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February 4, 2004

Mechanisms and Treatment of Obstructive Sleep Apnea—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(5):557. doi:10.1001/jama.291.5.557-c

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.

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