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Title: Response to Hudgel: Poor diet, poor sleep in sleep apnea, which is the cart and which is the horse?

Author
item REDLINE, SUSAN - Brigham & Women'S Hospital
item REID, MICHELLE - Brigham & Women'S Hospital
item SHEA, STEVEN - Columbia University - New York
item WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC)
item CASTRO-DIEHL, CECILIA - Boston University
item JOHNSON, DAYNA - Brigham & Women'S Hospital
item HUANG, TIANYI - Brigham & Women'S Hospital
item ST-ONGE, MARIE - Columbia University - New York

Submitted to: Sleep
Publication Type: Other
Publication Acceptance Date: 2/1/2019
Publication Date: 3/19/2019
Citation: Redline, S., Reid, M., Shea, S., Wood, A.C., Castro-Diehl, C., Johnson, D.A., Huang, T., St-Onge, M.P. 2019. Response to Hudgel: Poor diet, poor sleep in sleep apnea, which is the cart and which is the horse?. Sleep. 42(3):zsz025. https://doi.org/10.1093/sleep/zsz025.
DOI: https://doi.org/10.1093/sleep/zsz025

Interpretive Summary:

Technical Abstract: We appreciate Dr. Hudgel's detailed critique of our article. We agree with many of Dr. Hudgel's points, and specifically with the importance of helping patients with obstructive sleep apnea (OSA) meet optimal weight targets—our paper was never intended to discourage weight management, nor did we suggest that CPAP be used as a sole treatment for OSA. Rather, our analyses suggest the need for better health promotion programs for patients with OSA given the association of OSA with a poorer diet. We also suggest that sleep apnea management should include efforts to improve not only the apnea–hypopnea index, but also sleep quality, which likely influences multiple health outcomes, including dietary behaviors. Sleep apnea and diet are probably inter-related in more complex ways than is routinely considered. Additional studies are needed to fully understand the impact of CPAP on dietary behaviors and the interaction of CPAP and diet quality on health outcomes in patients with OSA. We hope our article will stimulate further research investigating the neurophysiological pathways that may mediate associations among OSA, sleep quality, and cardiometabolic health and support the development of clinical trials that test multimodal interventions in patients with OSA.