Perception of sleep duration in adult patients with suspected obstructive sleep apnea

Ricardo L. M. Duarte; Bruno A. Mendes; Tiago S. Oliveira-e-Sá; Flavio J. Magalhães-da-Silveira; David Gozal

doi:10.1371/journal.pone.0238083

Peer Review History

Original SubmissionJune 19, 2020
14 Jul 2020 Decision Letter - James Andrew Rowley, Editor PONE-D-20-18917 Perception of sleep duration in adult patients with suspected obstructive sleep apnea PLOS ONE Dear Dr. Gozal, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The academic editor agrees with the reviewers comments and hopes that the authors can reply to them in detail. Please submit your revised manuscript by Aug 28 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, James Andrew Rowley Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include additional information regarding the questionnaire about their sleep study satisfaction used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if the questionnaire it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Discrepancies between subjective and objective measures of total sleep time are frequent among insomnia patients, but this issue remains scarcely investigated in OSA. The authors attempted to evaluate if sleep perception is affected by the severity of OSA. They performed a 3-month cross-sectional study of Brazilian adults undergoing PSG. Objective sleep time was assessed from PSG and subjective sleep time by a self-reported questionnaire. Sleep perception index was defined by the ratio of subjective and objective values.Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups, and SPI significantly decreases with increasing OSA severity. This was a very interesting and well-written paper or an important topic in sleep medicine. My comments are minor in nature. For example, in the 2nd paragraph of Introduction, the authors should specify that this is "chronic" insomnia (i.e. > 3 mos). Acute insomnia is quite different in nature and may be confusing to some readers. Additionally, on line 190, it should say "TST" not TTS. Otherwise, no major issues, the authors do a great job of listing Limitations. Reviewer #2: This is an interesting paper that reflects a phenomenon often observed in clinical practice. Introduction: - Would also mention the role of HSATs in OSA diagnosis. - Say "patients with insomnia" rather than "insomniacs" - Appreciate that the hypothesis is clearly stated Methods: - Please clarify what is meant by "incomplete clinical data" as an exclusion criterion - Why was information about medical comorbidities collected by self-report rather than by chart review? - Were there particularly categories of "sleep medications" that were inquired about for this study? Information collected on duration of medication use? - Please explain why GOAL was used as the screening questionnaire (rather than other, more commonly encountered questionnaires) Results: - Under "Sleep Perception" - please define TTS - Why was the discriminatory ability of the ESS and GOAL questionnaire determined? This does not add new information to the literature, and was not stated as a hypothesis/aim for the current study. Discussion: - Please clarify - are you defining sleep fragmentation increased oxygen desaturation index and arousal index? If so, please cite references for both components of this definition. - The paragraphs about the GOAL questionnaire and ESS are unrelated to the rest of the manuscript and stated hypothesis/aim; suggest to remove these paragraphs. - Please include further discussion about the gender discrepancies and SPI mentioned in the Results section. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Daniel A. Barone, MD Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0238083.r001
Revision 1
24 Jul 2020 Author Response Dear Editor and Reviewers: We would like to thank the reviewers for their comments and acknowledge the contributions of such critiques to improvements in the manuscript. The detailed answer to all the pertinent questions raised by the Reviewers follows below. 5. Review Comments to the Author Reviewer #1: Discrepancies between subjective and objective measures of total sleep time are frequent among insomnia patients, but this issue remains scarcely investigated in OSA. The authors attempted to evaluate if sleep perception is affected by the severity of OSA. They performed a 3-month cross-sectional study of Brazilian adults undergoing PSG. Objective sleep time was assessed from PSG and subjective sleep time by a self-reported questionnaire. Sleep perception index was defined by the ratio of subjective and objective values. Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups, and SPI significantly decreases with increasing OSA severity. This was a very interesting and well-written paper or an important topic in sleep medicine. My comments are minor in nature. For example, in the 2nd paragraph of Introduction, the authors should specify that this is "chronic" insomnia (i.e. > 3 mos). Acute insomnia is quite different in nature and may be confusing to some readers. Following the Reviewer's comment, we now use the term chronic insomnia to better characterize this disorder. Additionally, on line 190, it should say "TST" not TTS. Otherwise, no major issues, the authors do a great job of listing Limitations. We apologize for the oversight which is now corrected. Reviewer #2: This is an interesting paper that reflects a phenomenon often observed in clinical practice. Introduction: - Would also mention the role of HSATs in OSA diagnosis. As suggested by the Reviewer, the introduction was rewritten mentioning the role of home sleep studies in the diagnosis of OSA. - Say "patients with insomnia" rather than "insomniacs" Accordingly, the term “insomniacs” was has been replaced by “patients with insomnia”. - Appreciate that the hypothesis is clearly stated Methods: - Please clarify what is meant by "incomplete clinical data" as an exclusion criterion The “incomplete clinical data” mention refers to the absence of one or more of the following clinical parameters of interest to the study: subjective analysis of total sleep time, insomnia symptoms, use of sleeping medications, and/or Epworth Sleepiness Scale. An explanation has now been included in the Methods section. - Why was information about medical comorbidities collected by self-report rather than by chart review? Comorbidities (hypertension, diabetes mellitus, and insomnia symptoms) were systematically collected immediately before the polysomnography was performed, thus it was not necessary to resort to medical record review. - Were there particularly categories of "sleep medications" that were inquired about for this study? Information collected on duration of medication use? Unfortunately, data related to the different types of sleeping medications were not systematically collected. Instead, the use of sleeping pills was categorically answered as yes or no. However, it should be emphasized that only the regular/daily use of these drugs was considered to be a positive response. This observation on the regular use of these drugs has now been placed in the revised version of the manuscript. - Please explain why GOAL was used as the screening questionnaire (rather than other, more commonly encountered questionnaires) The GOAL questionnaire is a simplified instrument for OSA screening in adults, which was recently published (2020), possibly explaining why it is less cited than other instruments with a similar purpose. Notwithstanding, we agree with the Reviewer that its use is outside the main scope of the study, justifying removal. Results: - Under "Sleep Perception" - please define TTS We apologize for the spelling mistake being the correct term (TST) inserted in the manuscript. - Why was the discriminatory ability of the ESS and GOAL questionnaire determined? This does not add new information to the literature, and was not stated as a hypothesis/aim for the current study. As explained above and according to the Reviewer's comment, we removed the data regarding the discriminatory power of the GOAL and ESS, since these data are outside the main objectives of the study. Discussion: - Please clarify - are you defining sleep fragmentation increased oxygen desaturation index and arousal index? If so, please cite references for both components of this definition. We agree with the Reviewer that the paragraph deserves further clarification. We rewrote the text explaining that intermittent hypoxemia is related to the oxygen desaturation index, while sleep fragmentation is related to the arousal index. - The paragraphs about the GOAL questionnaire and ESS are unrelated to the rest of the manuscript and stated hypothesis/aim; suggest to remove these paragraphs. As mentioned above, these paragraphs have been removed from the revised manuscript. - Please include further discussion about the gender discrepancies and SPI mentioned in the Results section. As insightfully suggested by the Reviewer, we have written a new paragraph with possible gender-related discrepancies about sleep perception. Sincerely, The Authors Attachments Attachment Submitted filename: Response to Reviewers (dg).docx https://doi.org/10.1371/journal.pone.0238083.r002
10 Aug 2020 Decision Letter - James Andrew Rowley, Editor Perception of sleep duration in adult patients with suspected obstructive sleep apnea PONE-D-20-18917R1 Dear Dr. Gozal, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, James Andrew Rowley Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors did a fine job and have addressed all my (minor) concerns. From my perspective, the paper is ready to be published. Reviewer #2: Thanks for the opportunity to review this manuscript revision. The authors have addressed all initially stated concerns in this revision. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Daniel A Barone Reviewer #2: No https://doi.org/10.1371/journal.pone.0238083.r003
Formally Accepted
17 Aug 2020 Acceptance Letter - James Andrew Rowley, Editor PONE-D-20-18917R1 Perception of sleep duration in adult patients with suspected obstructive sleep apnea Dear Dr. Gozal: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. James Andrew Rowley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0238083.r004

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