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Correspondence |

Hierarchy of Comorbidity Indicators for Obstructive Sleep Apnea FREE TO VIEW

Burton Abrams, MS
Author and Funding Information

From Zeger-Abrams, Inc.

Correspondence to: Burton Abrams, MS, 221 Linden Dr, Elkins Park, PA 19027; e-mail: burtabrams@hotmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Mr Abrams is the Executive Vice President of Zeger-Abrams Inc., a paid position in an engineering company that has no involvement in the practice of medicine, and is a member of the Board of Directors of the American Sleep Apnea Association.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1491-1492. doi:10.1378/chest.09-2998
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To the Editor:

Epidemiologic studies of the comorbidities of obstructive sleep apnea (OSA) have produced a list of many comorbidities, some more prevalent than others. This correspondence posits that the comorbidities, with a prevalence in the OSA population that is significantly higher than their prevalence in the general population are the strongest indicators of OSA, even though these may not be the most prevalent in the OSA population.

The indicator strengths of 11 OSA comorbidities are computed by forming the ratio of each one’s prevalence in the OSA population to its prevalence in the general population. Each OSA comorbidity and its prevalence were selected from an Australian study.1 This study included > 60,000 hospital patients who had been diagnosed with OSA. These patients were the ones diagnosed with OSA from > 1.5 million randomly selected hospital records in New South Wales. The results of the computations are shown in Table 1,2-5 in which the comorbidities are listed in descending order of OSA indicator strength. The sources for the estimated prevalence in the United States of each comorbidity are referred to in the table.

The recent publication1 of the data for the prevalence of each comorbidity in a very large OSA population provides a necessary ingredient for the calculations. The database from which it was computed comprises a segment of New South Wales residents selected only by the fact that they were admitted to a hospital. Medical rules in New South Wales require that all public and some private hospitals collect all inpatient hospital records data and report them monthly to the database in the Department of Health. On the other hand, the comprehensive epidemiologic studies2-5 for each comorbidity have been performed in the United States. The assumption is made that the broadly-based Australian statistics for the prevalence of each comorbidity in the OSA population would apply to other countries with similar life styles, such as the United States.

Table Graphic Jump Location
Table 1 —Comorbidity Hierarchy of Obstructive Sleep Apnea Indicator Strengths in the United States

OSA = obstructive sleep apnea; US = United States.

It is important to recognize that OSA in Australia probably is largely undiagnosed, as it is in the United States. As a result, the statistics in reference1 may be skewed because they are representative of only the diagnosed OSA population, not the entire OSA population. Data skewing may have occurred based on the comorbidities that the Australian medical practitioners had used as possible indicators of OSA to prompt its subsequent diagnosis. Even so, the uniqueness of this database makes it the only source to date on which to base a hierarchical analysis.

The strongest indicators are at the top of Table 1, because the prevalence of each in the OSA population is much larger than the prevalence of that comorbidity in the general population, even though they are not the most prevalent comorbidities in the OSA population. Atrial fibrillation and flutter is clearly the strongest indicator of OSA, gout second, and congestive heart failure a close third.

Huang QR, Qin Z, Zhang S, Chow CM. Clinical patterns of obstructive sleep apnea and its comorbid conditions: a data mining approach. J Clin Sleep Med. 2008;46:543-550. [PubMed]
 
Lloyd-Jones D, Adams R, Carnethon M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;1193:e21-e181. [CrossRef] [PubMed]
 
Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;415:778-799. [CrossRef] [PubMed]
 
Akinbami L. Asthma Prevalence, Health Care Use and Mortality:United States, 2003-2005. 2006; Hyattsville, MD National Center for Health Statistics
 
Schober SE, Carroll MD, Lacher DA, Hirsch R. High Serum Total Cholesterol-An Indicator for Monitoring Cholesterol Lowering Efforts: U.S. Adults, 2005-2006. 2007; Hyattsville, MD National Center for Health Statistics NCHS Data Brief. No.2.
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Comorbidity Hierarchy of Obstructive Sleep Apnea Indicator Strengths in the United States

OSA = obstructive sleep apnea; US = United States.

References

Huang QR, Qin Z, Zhang S, Chow CM. Clinical patterns of obstructive sleep apnea and its comorbid conditions: a data mining approach. J Clin Sleep Med. 2008;46:543-550. [PubMed]
 
Lloyd-Jones D, Adams R, Carnethon M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;1193:e21-e181. [CrossRef] [PubMed]
 
Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;415:778-799. [CrossRef] [PubMed]
 
Akinbami L. Asthma Prevalence, Health Care Use and Mortality:United States, 2003-2005. 2006; Hyattsville, MD National Center for Health Statistics
 
Schober SE, Carroll MD, Lacher DA, Hirsch R. High Serum Total Cholesterol-An Indicator for Monitoring Cholesterol Lowering Efforts: U.S. Adults, 2005-2006. 2007; Hyattsville, MD National Center for Health Statistics NCHS Data Brief. No.2.
 
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