Obstructive Sleep Apnea and Obesity Are Associated with Hypertension in a Particular Pattern: A Retrospective Study
Round 1
Reviewer 1 Report
I have two main comments on this nice article regarding the interactions between obesity and OSAS with hypertension.
1) Extensive editing of English is required, particularly in Discussion section.
2) In the discussion, it is important to stress out that both conditions are related to microvascular dysfunction, and that the latter condition is associated with arterial hypertension and might be a target for specific treatments.
Obes Res Clin Pract. 2017 Jan-Feb;11(1):114-117. doi: 10.1016/j.orcp.2016.12.005. Epub 2017 Jan 2. Long-term effects of bariatric surgery on peripheral endothelial function and coronary microvascular function
Severe OSAS causes systemic microvascular dysfunction: Clinical evaluation of ninety-eight OSAS patients.
Clin Otolaryngol. 2019 May;44(3):412-415. doi: 10.1111/coa.13285. Epub 2019 Feb 5.
Author Response
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Author Response File: 
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Reviewer 2 Report
Confounding factors need to be mention in statistical section. And also mention in tables.
It is better to compare obese and non-obese people in Table 1 as follow:
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Obese subject |
Non obese subject |
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Non-sever OSA group |
Sever OSA group |
P value |
Non-sever OSA group |
Sever OSA group |
P value |
P interaction |
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It is better to report the other of the results in this way.
Author Response
Thank you for your comments. A point-by-point response to the comments is provided in response letter.
Author Response File: Author Response.docx
Reviewer 3 Report
Yunyan Xia, et al. presented an article about sleep apnea, obesity and hypertension. The followings are some comments to be addressed.
Comments
1. The three main targets, sleep apnea, obesity and hypertension, in this article were discussed for so many times in the scientific history. Based on what the authors found, sleep apnea was related to elevated diastolic blood pressure while obesity was related to elevated systolic blood pressure. Such findings may be the unique portion of this article. However, authors did not emphasize much on this finding in the whole article. The reason to explain such finding was not disclosed or discussed, either. I suggest you to reduce the paragraphs about those what are well-known and to increase the paragraphs about what’s new.
2. Authors used three parameters about hypertension: hypertension in the history; recorded systolic blood pressure and recorded diastolic blood pressure. The definitions of all the three parameters can be further improved. For example, how to define “hypertension” in the history? Second, the patient must receive blood pressure measurements for multiple times during the whole study period. Which measurement was enrolled in the study? And why?
3. For figure 3, please modify “.00” and “1.00” to “negative” and “positive” or any other clearer expression.
Author Response
Thank you for your comments. A point-by-point response to the comments is provided in response letter.
Author Response File: Author Response.docx
Reviewer 4 Report
Thank you for possibility to reviw manuscript titled: Interaction Effects of Obstructive Sleep Apnea and Obesity on Hypertension in Adult Population: A Retrospective Study. I found a lot of strenghts of this: it is well written, polysomnography-gold standard was conducted, the topic is interesting both for clinicians and researchers. However there are also flaws and shortcomings: Major flaws: 1) Conclusion are not novel. Hundreds of studies on the effects of obesity and OSA on blood pressure have previously shown links. The authors did not show any new relationships 1) Methodology .Where psg was conducted ? in sleep lab? Was it I level or II level of sleep test? 2) Polysomnography methodology is described very superficially, no information concerning electrodes placements, sensors , details of scoring etc 3) Authors did not used recommended by AASM PSG score rules (A. Score a respiratory event as a hypopnea if ALL of the following criteria are met:a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), . The duration of the ≥30% drop in signal excursion is ≥10 seconds. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal. 4) The authors did not present most of basic polysomnographic parameters. ( N1, N2, N3, REM, SE, WASO, heart rate, sleep latency etc). Authors should provide these parameters in entire study group as well as in studied subgroups. 5) Did authors assess sleep fragmentation? It may influence blood pressure Minor shortcomings 6) Table 1 Smoking history should be specified, Does it means previous or actual smoking? 7) Table 1 “Drinking “how did authors definite “drinkers”? 8) Hyper-SBD, hyper- DBD- the abbreviations should be expanded.Author Response
Thank you for your comments. A point-by-point response to the comments is provided in response letter.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
the paper has substantially improved after major revisions of the authors
Reviewer 3 Report
Yunyan Xia, et al. presented an article about sleep apnea, obesity and hypertension. All my previous comments were properly answered and the relative paragraphes were properly modified. I don't have further comment.
Reviewer 4 Report
The manuscript has been corrected due to reviewer recommendations.
