Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS)
, Giulia Scioscia 1,2,*, Anela Hoxhallari 1,2, Roberto Sabato 2, Simone Sorangelo 1,2, Giuseppe Mansueto 1,2, Antonella Giuliani 1,2, Maria Pia Foschino Barbaro 1,2 and Donato Lacedonia 1,2
Round 1
Reviewer 1 Report
It is very important study. However I found a few major and minor flaws:
1. Summary is very weak. I suggest to add a structured abstract. I mean with following sections: background and aim, material and methods, results and conclusions. I recommend to write clear background and conclusions because currently they are chaotic and unclear.
2. References: Authors cited a few outdated references. I recommend to remove articles older than 10 years.
3. Introduction is very simple. I recommend to add a paragraph and write about latest studies related to the topic and then write why presented study is novel and important. Furthermore Authors did not cite in first paragraph crucial, original and latest studies which confirm relationship between OSA and CVD which is the most important for the mortality risk.
I mean:
Urbanik D, Gać P, Martynowicz H, Poręba M, Podgórski M, Negrusz-Kawecka M, Mazur G, Sobieszczańska M, Poręba R. Obstructive sleep apnea as a predictor of reduced heart rate variability. Sleep Med. 2019 Feb;54:8-15. doi: 10.1016/j.sleep.2018.09.014.
Gać P, Urbanik D, Macek P, Martynowicz H, Mazur G, Poręba R. Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography. Respir Physiol Neurobiol. 2022 Jan;295:103782. doi: 10.1016/j.resp.2021.103782.
Urbanik D, Gać P, Martynowicz H, Podgórski M, Poręba M, Mazur G, Poręba R. Obstructive Sleep Apnea as a Predictor of Arrhythmias in 24-h ECG Holter Monitoring. Brain Sci. 2021 Apr 12;11(4):486. doi: 10.3390/brainsci11040486.
Above mentioned articles should be cited after this sentence "This phenomenon causes an increased risk of cardiovascular, endocrinological and neurological diseases, but also malignancies [3-6], with an associated increased risk of mortality rate [7]."
Furthermore Authors did not mention in first paragraph about relationship between breathing disorders and the upper airway volume and face skeletal patterns which confirm did not only soft structures are in relationship with breathing disorders. Please consider the following crucial and the latest papers to confirm this fact:
Vidal-Manyari PA, Arriola-Guillén LE, Jimenez-Valdivia LM, Dias-Da Silveira HL, Boessio-Vizzotto M. Effect of the application of software on the volumetric and cross-sectional assessment of the oropharyngeal airway of patients with and without an open bite: A CBCT study. Dent Med Probl. 2022;59(3):397–405. doi:10.17219/dmp/145287
Dastan F, Ghaffari H, Hamidi Shishvan H, Zareiyan M, Akhlaghian M, Shahab S. Correlation between the upper airway volume and the hyoid bone position, palatal depth, nasal septum deviation, and concha bullosa in different types of malocclusion: A retrospective cone-beam computed tomography study. Dent Med Probl. 2021;58(4):509–514. doi:10.17219/dmp/130099
4. Material and Methods: This chapter is described very briefly and does not contain key descriptions. Authors have to precisely describe whole procedures and devices which were used to collect data during sleep. What do you mean cardiorespiratory monitoring (CRM)? What kind of sleep study is it? Type 1, 2 or 3 according to AASM? Please descirbe it precisely and clearly.
Authors have to add a sample power and size calculation.
Authors have to add a clear inclusion and exclusion criteria for study participants.
Authors have to calculate the odds ratio (OR) between studied parameters not only a p value.
5. Authors have to report the study in accordance to the STROBE Statement https://www.equator-network.org/reporting-guidelines/strobe/
Author Response
It is very important study. However I found a few major and minor flaws:
Point 1. Summary is very weak. I suggest to add a structured abstract. I mean with following sections: background and aim, material and methods, results and conclusions. I recommend to write clear background and conclusions because currently they are chaotic and unclear.
Response1 : Thank you for your advice. We have modified the abstract in accordance with your suggestions.
Point 2. References: Authors cited a few outdated references. I recommend to remove articles older than 10 years.
Response 2: Thanks for the suggestion. We have removed articles older than 10 years
Point 3. Introduction is very simple. I recommend to add a paragraph and write about latest studies related to the topic and then write why presented study is novel and important. Furthermore Authors did not cite in first paragraph crucial, original and latest studies which confirm relationship between OSA and CVD which is the most important for the mortality risk.
I mean:
Urbanik D, Gać P, Martynowicz H, Poręba M, Podgórski M, Negrusz-Kawecka M, Mazur G, Sobieszczańska M, Poręba R. Obstructive sleep apnea as a predictor of reduced heart rate variability. Sleep Med. 2019 Feb;54:8-15. doi: 10.1016/j.sleep.2018.09.014.
Gać P, Urbanik D, Macek P, Martynowicz H, Mazur G, Poręba R. Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography. Respir Physiol Neurobiol. 2022 Jan;295:103782. doi: 10.1016/j.resp.2021.103782.
Urbanik D, Gać P, Martynowicz H, Podgórski M, Poręba M, Mazur G, Poręba R. Obstructive Sleep Apnea as a Predictor of Arrhythmias in 24-h ECG Holter Monitoring. Brain Sci. 2021 Apr 12;11(4):486. doi: 10.3390/brainsci11040486.
Above mentioned articles should be cited after this sentence "This phenomenon causes an increased risk of cardiovascular, endocrinological and neurological diseases, but also malignancies [3-6], with an associated increased risk of mortality rate [7]."
Response 3: Thank you. With much interest we read and added the articles mentioned to the text.
Point 4. Furthermore Authors did not mention in first paragraph about relationship between breathing disorders and the upper airway volume and face skeletal patterns which confirm did not only soft structures are in relationship with breathing disorders. Please consider the following crucial and the latest papers to confirm this fact:
Vidal-Manyari PA, Arriola-Guillén LE, Jimenez-Valdivia LM, Dias-Da Silveira HL, Boessio-Vizzotto M. Effect of the application of software on the volumetric and cross-sectional assessment of the oropharyngeal airway of patients with and without an open bite: A CBCT study. Dent Med Probl. 2022;59(3):397–405. doi:10.17219/dmp/145287
Dastan F, Ghaffari H, Hamidi Shishvan H, Zareiyan M, Akhlaghian M, Shahab S. Correlation between the upper airway volume and the hyoid bone position, palatal depth, nasal septum deviation, and concha bullosa in different types of malocclusion: A retrospective cone-beam computed tomography study. Dent Med Probl. 2021;58(4):509–514. doi:10.17219/dmp/130099
Response 4: As you wrote, the association between craniofacial malformations and sleep disordered breathing is of extreme interest. In fact, we have added the mentioned articles to the text as you recommended.
Point 5. Material and Methods: This chapter is described very briefly and does not contain key descriptions. Authors have to precisely describe whole procedures and devices which were used to collect data during sleep. What do you mean cardiorespiratory monitoring (CRM)? What kind of sleep study is it? Type 1, 2 or 3 according to AASM? Please descirbe it precisely and clearly.
Response 5: Thank you for the suggestion, we totally agree with you. We have described the procedure better.
Point 6. Authors have to add a sample power and size calculation.
Response 6: Interesting observation. We calculated the sample size to be 135.
Point 7. Authors have to add a clear inclusion and exclusion criteria for study participants.
Response 7: Thanks for the suggestion. The study was conducted on all patients who referred to our center for a suspected sleep disorder and subsequently performed all the examinations described. At the end of all examinations, subjects were included if they had an Overlap Syndrome or OHS. We have highlighted the criteria of inclusion and exclusion.
Point 8. Authors have to calculate the odds ratio (OR) between studied parameters not only a p value.
Response 8: Thank you, extremely interesting observation. Our work is only intended to be a report of the differences between the two groups, and that is why we did not assess risk.
Point 9. Authors have to report the study in accordance to the STROBE Statement https://www.equator-network.org/reporting-guidelines/strobe/
Response 9: I completely agree with your observation. We used the template and the order established by the journal for that we did not follow the STROBE statement.
Reviewer 2 Report
Dear Authors
I have carefully reviewed your manuscript entitled "Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS)”. Following careful consideration, I have several concerns, including insufficient information about the study subjects (demographic and anthropometric data) and criteria for the selection of study subjects. I have several questions that should be clearly responded.
1.As the authors describe in table 1, significant difference in age between OS and OSH was shown. How could the authors compare all the data including sleep study, PFT, and comorbidities between two groups? Please clarify the selection criteria for the study subjects.
2. The authors should properly present the information about the subjects and units for variables.
3. Particularly, it is important to know about smoking history or status of subjects in OS because this may critically affect on the results. The authors should describe about the effect of smoking between them in discussion
Author Response
Dear Authors
I have carefully reviewed your manuscript entitled "Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS)”. Following careful consideration, I have several concerns, including insufficient information about the study subjects (demographic and anthropometric data) and criteria for the selection of study subjects. I have several questions that should be clearly responded.
First of all, thank you for your time and your suggestions.
Point 1. As the authors describe in table 1, significant difference in age between OS and OSH was shown. How could the authors compare all the data including sleep study, PFT, and comorbidities between two groups? Please clarify the selection criteria for the study subjects.
Response 1: Thank you for the observation. We have clarified the types of statistical analysis used in the statistical analysis paragraph.
Point 2. The authors should properly present the information about the subjects and units for variables.
Response 2: Thank you for the suggestion. We have added units to all the variables in the text.
Point 3. Particularly, it is important to know about smoking history or status of subjects in OS because this may critically affect on the results. The authors should describe about the effect of smoking between them in discussion
Response 3: Thank you for your advice. Cigarette smoking is a major factor in the pathogenesis of respiratory diseases. Following your suggestion, we have emphasised this problem in the text.
Round 2
Reviewer 1 Report
I don't have further remarks. I recommend to publish the manuscript unaltered.
Reviewer 2 Report
Dear Authors
I have carefully reviewed your manuscript entitled "Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS)”. The revisions that you made to the manuscript are very effective in addressing the remaining concerns.
