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Anna Randby, MD; Virend K. Somers, MD, PhD, FCCP; Torbjørn Omland, MD, PhD, MPH
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From the Division of Medicine (Drs Randby and Omland), Akershus University Hospital; Institute of Clinical Medicine (Drs Randby and Omland), University of Oslo, Oslo, Norway; and Division of Cardiovascular Diseases, Department of Internal Medicine (Dr Somers), Mayo Foundation for Medical Education and Research.

Correspondence to: Torbjørn Omland, MD, PhD, MPH, Division of Medicine, Akershus University Hospital, NO-1478 Lørenskog, Norway; e-mail: torbjorn.omland@medisin.uio.no


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Omland has received research grant support and speaker’s honoraria from Abbott Laboratories, Roche Diagnostics, and Siemens Healthcare Diagnostics Inc. Dr Somers has served as a consultant for Johnson & Johnson Services, Inc; Medtronic, Inc; Merck & Co, Inc; ResMed; Respircardia, Inc (Cardiac Concepts); Respironics, Inc; Apnex Medical, Inc; NeuPro; Deshum Medical, LLC; and Sova Pharmaceuticals, Inc. He has received research grants from the Phillips Respironics Sleep and Breathing Foundation, ELA Medical and Select Research, Inc; and National Institutes of Health. Dr Randby has reported that no potential 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. See online for more details.


Chest. 2013;143(1):278. doi:10.1378/chest.12-2466
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To the Editor:

We appreciate Dr Argulian’s interest in our recent article in CHEST1 (September 2012) about the association between circulating cardiac troponin T levels measured by a high-sensitivity assay (hs-cTnT) and the prevalence of obstructive sleep apnea (OSA) in a sample derived from the general population oversampled for subjects at high risk of OSA. Dr Argulian observes that the prevalence of detectable hs-cTnT was 43% and compares this value to other US general population-based samples. Because hs-cTnT values are known to be strongly associated with age in population-based samples and the subjects included in our study were relatively young (mean age, 48.4 years),1 it seems most relevant to compare the values we obtained with those observed in similar age segments in other studies. As pointed out by Dr Argulian, the prevalence in participants aged 40 to 50 years in the Dallas Heart Study was 24%,2 that is, significantly lower than the overall prevalence found in our study. However, the prevalence of detectable hs-cTnT in subjects without OSA in our study was 30%, which is not very different from the values observed in the Dallas Heart Study.

We documented a univariate dose-response relationship between severity of OSA and hs-cTnT levels. Dr Argulian further suggests investigating the association between the top quartile of hs-cTnT and the severity of OSA. Based on this suggestion, we substituted our dependent variable (detectable hs-cTnT >3 ng/L) with the top quartile (>5.61 ng/L). By logistic regression analysis, an apnea-hypopnea index of 5 to 29.9 was associated with an OR of 1.86 (95% CI, 1.17-2.98) for hs-cTnT in the top quartile, and an apnea-hypopnea index of ≥30 was associated with an OR of 4.47 (95% CI, 2.50-7.90). However, in a multivariate model, OSA did not emerge as an independent predictor of hs-cTnT in the upper quartile in this population-based cohort, confirming the conclusion drawn in our original report.

Randby A, Namtvedt SK, Einvik G, et al. Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest. 2012;142(3):639-646. [CrossRef] [PubMed]
 
de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304(22):2503-2512. [CrossRef] [PubMed]
 

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Randby A, Namtvedt SK, Einvik G, et al. Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest. 2012;142(3):639-646. [CrossRef] [PubMed]
 
de Lemos JA, Drazner MH, Omland T, et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA. 2010;304(22):2503-2512. [CrossRef] [PubMed]
 
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