REM-related obstructive sleep apnea and vertigo: A retrospective case-control study

Po-Yueh Chen; Tzu-Ying Chen; Pin-Zhir Chao; Wen-Te Liu; Chyi-Huey Bai; Sheng-Teng Tsao; Yi-Chih Lin

doi:10.1371/journal.pone.0252844

Peer Review History

Original SubmissionFebruary 2, 2021
11 Mar 2021 Decision Letter - Giannicola Iannella, Editor PONE-D-21-02581 Patients with Vertigo Have a Higher Risk of REM-Related Obstructive Sleep Apnea PLOS ONE Dear Dr. Lin, 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. Please submit your revised manuscript by Apr 12 2021 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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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: Maybe more fascinating title would be: REM-Related Obstructive Sleep Apnea and Vertigo: a Retrospective case-control study. Introduction - Add reference line 1 of vertigo prevalence. - ‘’A national Taiwan study’’ insert p value data. - ‘’ In recent population-based case–control studies’’Describe data of the population analyzed in the study to highilight the connection and add this reference: doi: 10.5664/jcsm.5080. - ‘’ OSA is a frequent disorder characterized by’’ also cite other classical sleep stage in children and elderly patients using these references: doi:10.1164/ajrccm.162.2.9908058; DOI: 10.20452/pamw.15283 ; DOI: 10.1093/sleep/30.7.837 Study design - Cite AASM guidelines for PSG describing better the procedures Ethical approval is written in red: modify Tables describe in wich group was performed the analysis: total vs control, total vs vertigo or what? In the captations specify: Abbreviations: st90, sleep time… Discussion PSG index is not anymore considered the only effective tool to evaluate sleep breathing disorder especially in children. Describe a different procedure and the data reported in this study doi: 10.1016/j.ijporl.2017.04.021. Minor corrections: Introduction - correct ‘’were experiencing’’; - modify center in centre; - correct tumor in tumour; - who were blindend in who was blinded; - t test in t-test; - or exinergic activity in orexinergic activity; Discussion - correct ‘’tends’’ in tended Reviewer #2: The paper claims an innovative topic about sleep apnea. However, I have some doubts in relation to your evidences. Introduction: You cited your unpublished article without a sufficient definition of the parameters used to perform it. Methods: You said that 171 patients were enrolled with a diagnosis of OSA, but you did not classify the grade of vertigo disease of 58 patients and how it was diagnosed. Moreover, there were not given any information about the type of dizziness, the other symptomatology referred, and the previous eventual ear diseases. Discussion You asserted that “In our study, REM-related OSA had a CPAP acceptance rate of only 3.4%.”, but not described how you collected these data (duration of disease, duration of CPAP treatment etc…). Could you clarify these topics? ****** 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: No 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. Attachments Attachment Submitted filename: Revisor response.docx https://doi.org/10.1371/journal.pone.0252844.r001
Revision 1
12 May 2021 Author Response We thank the reviewers for their constructive comments. We have revised the manuscript to address all the questions and comments raised by the three reviewers. We highlight changes made to the original version by setting the text colour to red. Our specific responses to each comment are as follows: Responses to reviewers #1: Maybe more fascinating title would be: REM-Related Obstructive Sleep Apnea and Vertigo: a Retrospective case-control study. � We are grateful for all of your constructive comments, and we revised our title Introduction � Add reference line 1 of vertigo prevalence. - Thank you for the comment. We add the reference in the article. - [Please see line 65, introduction section; line 299, reference section] � ‘’A national Taiwan study’’ insert p value data. - Thank you for the comment. We add p value in the article. - [Please see line 70, introduction section] � ‘’ In recent population-based case–control studies’’Describe data of the population analyzed in the study to highilight the connection and add this reference: doi: 10.5664/jcsm.5080. - Thank you for the comment. We highlight the connection and add the reference in the article. - [Please see line 72-76, introduction section; line 319-324, reference section] - A recent population-based case–control study, 5,025 newly diagnosed with sleep apnea patients from the National Health Insurance Research Database of Taiwan, has been demonstrated sleep apnea is significantly associated with a higher incidence (hazard ratio, 1.71) of vertigo [5]. Vertigo symptoms of Ménière's disease patients with OSAS can be improved by CPAP therapy [6]. � ‘’ OSA is a frequent disorder characterized by’’ also cite other classical sleep stage in children and elderly patients using these references: DOI: 10.20452/pamw.15283 ; - Thank you for the comment. We add the reference in the article. [Please see line 79-81, introduction section; line 325-328, reference section] - OSA should be always suspected in elderly patients who show typical nighttime or daytime symptoms of sleep apnea. PSG is a necessary examination for the diagnosis of OSA in elderly patients [7]. � DOI: 10.1093/sleep/30.7.837 and doi:10.1164/ajrccm.162.2.9908058; - Thank you for the comment. We add the reference in the article. [Please see line 84-87, introduction section; line 329-336, reference section] - OSA may be predominantly a REM phenomenon in children and increasing in apnea severity may be secondary to changes in upper airway neuromotor control, changes in REM density [8], or upper airway muscle fatigue due to change in respiratory duty cycle [9]. Study design � Cite AASM guidelines for PSG describing better the procedures - Thank you for the comment. We add the reference in the article. [Please see line 106-113,methods section; line 341-345, reference section] - According to the third edition of the International Classification of Sleep Disorders (ICSD-3), OSA defined as PSG-determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA (e.g., unrefreshing sleep, daytime sleepiness, fatigue or insomnia, awakening with a gasping or choking sensation, loud snoring, or witnessed apneas), or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms). In addition to apneas and hypopneas index, the RDI includes respiratory effort-related arousals (RERAs) [11]. � Ethical approval is written in red: - Thank you for the comment. We revised the color. [Please see line 141-145,methods section] � Tables describe in wich group was performed the analysis: total vs control, total vs vertigo or what? - Thank you for the comment. We add the description below the tables [Please see line 153-154,result section; line 160-161, result section; table 1 and 2] - Comparison of the control group and the vertigo group was performed the t-test to evaluate the difference; except the gender were performed the chi square test. � In the captations specify: Abbreviations: st90, sleep time… - Thank you for the comment. We add the description below the tables [Please see line 156-159, result section; table 2] - RDI, Respiratory disturbance index; ODI, oxygen desaturation index; ST90, sleep time with SpO2< 90%; CT90, cumulative time percentage with SpO2 < 90%. LSAT, lowest oxygen saturation; mean SAT, mean oxygen saturation; PLMI, periodic leg movement index. Discussion � PSG index is not anymore considered the only effective tool to evaluate sleep breathing disorder especially in children. Describe a different procedure and the data reported in this study doi: 10.1016/j.ijporl.2017.04.021. - Thank you for the comment. We add the reference in the article. [Please see line 239-242, discussion section; line 374-377, reference section ] - Clinically, polysomnography and home sleep apnea testing can be performed for the diagnosis of OSA. Watch-PAT in one kind of home sleep apnea testing, which can detect REM sleep well as PSG. As for pediatric patients, Watch-PAT is also an effective device for diagnosing sleep disordered breathing [19]. Minor corrections: Introduction - correct ‘’were experiencing’’; � we delete this paragraph. - modify center in centre; � we delete this paragraph. - correct tumor in tumour; � [Please see line 48, abstract section; line 114, methods section] - who were blindend in who was blinded; � [Please see line 131, methods section] - t test in t-test; � [Please see line 135, methods section; line 153, results section] - or exinergic activity in orexinergic activity; � [Please see line 224, discussion section] Discussion - correct ‘’tends’’ in tended� [Please see line 252, discussion section] Responses to reviewers #2: Introduction: You cited your unpublished article without a sufficient definition of the parameters used to perform it. - Thank you for the comment. We delete this paragraph. - [Please see line 91-95, introduction section] Methods: You said that 171 patients were enrolled with a diagnosis of OSA, but you did not classify the grade of vertigo disease of 58 patients and how it was diagnosed. Moreover, there were not given any information about the type of dizziness, the other symptomatology referred, and the previous eventual ear diseases. - Thank you for the comment. We revised this paragraph. - [Please see line 114-121, methods section] - We define vertigo group as patients who had two or more clinical visits due to vertigo within two years before the diagnosis of OSA. Besides, patients who experienced at least three months between two vertigo episodes. Fifty-eight patients were allocated to the vertigo group, and 113 patients who had no complaints of dizziness or vertigo within two years before the diagnosis of OSA were allocated to the control group. Discussion You asserted that “In our study, REM-related OSA had a CPAP acceptance rate of only 3.4%.”, but not described how you collected these data (duration of disease, duration of CPAP treatment etc…). Could you clarify these topics? - Thank you for the comment. We revised this paragraph. We delete “In our study, REM-related OSA had a CPAP acceptance rate of only 3.4%.” and change to “One study showed REM related OSA is the risk factor for dropout from CPAP therapy, (odds ratio, 41.984) [Hoshino T et al., 2018].” [Please see line 235-237, discussion section] - Hoshino T, Sasanabe R, Tanigawa T, Murotani K, Arimoto M, Ueda H, Shiomi T. Effect of rapid eye movement-related obstructive sleep apnea on adherence to continuous positive airway pressure. J Int Med Res. 2018 Jun;46(6):2238-2248. doi: 10.1177/0300060518758583. Epub 2018 Apr 3. PMID: 29614906; PMCID: PMC6023053. Attachments Attachment Submitted filename: Response-to-Reviewers REMOSA PLOSONE 20210428 version 3.00.docx https://doi.org/10.1371/journal.pone.0252844.r002
24 May 2021 Decision Letter - Giannicola Iannella, Editor REM-Related Obstructive Sleep Apnea and Vertigo: a Retrospective case-control study. PONE-D-21-02581R1 Dear Dr. Lin, 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, Giannicola Iannella, M.D Academic Editor PLOS ONE Additional Editor Comments (optional): The authors clarified many aspects suggested by the reviewers and improved the manuscript. In my opinion it deserved the publication on PLOS-ONE Reviewers' comments: - https://doi.org/10.1371/journal.pone.0252844.r003
Formally Accepted
3 Jun 2021 Acceptance Letter - Giannicola Iannella, Editor PONE-D-21-02581R1 REM-Related Obstructive Sleep Apnea and Vertigo: a Retrospective case-control study. Dear Dr. Lin: 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. Giannicola Iannella Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0252844.r004

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