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Chi-Hang Lee, MBBS; See-Meng Khoo, MBBS
Author and Funding Information

Affiliations: Drs. Lee and Khoo are affiliated with the National University Health System, National University of Singapore.

Correspondence to: Chi-Hang Lee, MBBS, Cardiac Department, National University Heart Center, National University of Singapore, 5, Lower Kent Ridge Rd, Singapore 119074; e-mail: mdclchr@nus.edu.sg


Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(5):1445. doi:10.1378/chest.09-1713
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To the Editor:

We thank Dr. BaHammam for showing interest in our study.1 Regarding the higher prevalence of obstructive sleep apnea observed in our study when compared with his, there are fundamental differences between the two studies. In the study by BaHammam et al,2 apart from being limited by a much smaller sample size (n = 50), patients with both acute myocardial infarction (n = 34) and unstable angina (n = 16) were included. There was no mention of the treatment administered (ie, revascularization vs medical therapy). On the other hand, all patients recruited into our study had ST-segment elevation myocardial infarction and were successfully treated with primary percutaneous coronary intervention. A direct comparison between the two studies, in our opinion, is inappropriate.

In our study,1 only clinically stable and conscious patients were recruited. None of our recruited patients received sedation during hospitalization. It is extremely unlikely that the patients, during the acute phase of myocardial infarction, had consumed alcohol. Chronic alcoholism, COPD, and neurologic disease were not exclusion criteria in our study. But our study is a real-world study that aimed to detect obstructive sleep apnea in patients who had been admitted to the hospital with ST-segment myocardial infarction. The clinical relevance would have been significantly reduced if patients with these concomitant conditions had been excluded. The fact of the matter is obstructive sleep apnea was present in these patients during the acute period of myocardial infarction, and it is important to identify them because of the potential adverse consequences on cardiovascular hemodynamics.

Studies2,3 on the diagnostic value of high apnea-hypopnea index detected during the acute phase of cardiovascular events are too small to be conclusive, and the data are conflicting. Therefore, we believe our “hypothesis,” which is stated in the “Discussion” section of our article, is reasonable.

Lee CH, Khoo SM, Tai BC, et al. Obstructive sleep apnea in patients admitted for acute myocardial infarction: prevalence, predictors, and effect on microvascular perfusion. Chest. 2009;135:1488-1495. [PubMed] [CrossRef]
 
BaHammam A, Al-Mobeireek A, Al-Nozha M, et al. Behaviour and time-course of sleep disordered breathing in patients with acute coronary syndromes. Int J Clin Pract. 2005;59:874-880. [PubMed]
 
Skinner MA, Choudhury MS, Homan SD, et al. Accuracy of monitoring for sleep-related breathing disorders in the coronary care unit. Chest. 2005;127:66-71. [PubMed]
 

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References

Lee CH, Khoo SM, Tai BC, et al. Obstructive sleep apnea in patients admitted for acute myocardial infarction: prevalence, predictors, and effect on microvascular perfusion. Chest. 2009;135:1488-1495. [PubMed] [CrossRef]
 
BaHammam A, Al-Mobeireek A, Al-Nozha M, et al. Behaviour and time-course of sleep disordered breathing in patients with acute coronary syndromes. Int J Clin Pract. 2005;59:874-880. [PubMed]
 
Skinner MA, Choudhury MS, Homan SD, et al. Accuracy of monitoring for sleep-related breathing disorders in the coronary care unit. Chest. 2005;127:66-71. [PubMed]
 
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