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Nocturnal Intermittent Hypoxemia and Metabolic DyslipidemiaNocturnal Hypoxemia and Metabolic Dyslipidemia FREE TO VIEW

Sevket Balta, MD; Mehmet Aydogan, MD; Sait Demirkol, MD; Turgay Celik, MD; Seyfettin Gumus, MD; Murat Unlu, MD; Ugur Kucuk, MD
Author and Funding Information

From the Department of Cardiology (Drs Balta, Demirkol, Unlu, Celik, and Kucuk), and Department of Pulmonary Medicine (Drs Aydogan and Gumus), Gulhane Medical Academy Ankara.

Correspondence to: Sevket Balta, MD, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St, 06018 Etlik-Ankara, Turkey; e-mail: drsevketb@gmail.com


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Chest. 2013;144(1):357. doi:10.1378/chest.12-3109
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To the Editor:

We read with interest the article by Trzepizur et al1 in CHEST (June 2013). They investigated the hypothesis of an independent association between nocturnal intermittent hypoxemia and dyslipidemia in obstructive sleep apnea (OSA). Total cholesterol and low-density lipoprotein cholesterol were not associated with oxygen desaturation index (ODI). In contrast, nocturnal intermittent hypoxemia and OSA severity were associated with higher triglyceride (TG) levels and lower high-density lipoprotein cholesterol (HDL-c) levels after adjustment for confounding factors. The association among ODI, TG, and HDL-c was independent of the metabolic syndrome.

Metabolic dyslipidemia is one of the most important cardiac risk factors. Regular physical activity may improve metabolic dyslipidemia.2 Factors such as reduced activity levels and increased appetite may be associated with metabolic dyslipidemia in patients with OSA.3 The authors did not mention the relationship between physical activity and higher TG levels and lower HDL-c levels. We think that the results of the study would be stronger if the authors talked about physical activity in patients.

OSA is one of the more critical clinical manifestations of sleep-disordered breathing.4 It is a prevalent sleep disorder leading to cardiovascular and metabolic complications.5 OSA has been related most notably to hypertension, but also to several other cardiovascular diseases, including peripheral arterial disease, ischemic heart disease, heart failure, stroke, cardiac arrhythmias, and pulmonary hypertension.4 These factors not only affect OSA but also influence metabolic syndrome. It would be useful if the authors provided data about these risk factors, especially heart failure, peripheral arterial disease, and pulmonary hypertension.

Finally, renal or hepatic dysfunction; any abnormality in thyroid function tests; inflammatory diseases; confounding effects of sex; confounding effects of some medications, such as antihypertensive treatment including angiotensin-converting enzyme inhibitors, angiotensin receptor blocker, beta blockers, aspirin, and medications for weight loss; and a medical history of drug addiction may influence metabolic dyslipidemia.6 The results of the study might be stronger if the authors had given information about these factors. We believe that these findings will provide advantageous information about the measurements of the association among ODI, TG, and HDL-c independent of the metabolic syndrome.

References

Trzepizur W, Le Vaillant M, Meslier N, et al. Independent association between nocturnal intermittent hypoxemia and metabolic dyslipidemia. Chest. 2013;143(6):1584-1589. [PubMed]
 
Demirkol S, Cakar M, Balta S, Unlu M, Ay SA, Karaman M. To maintain a proper follow-up of the patients with coronary artery disease is as nearly important as medications [published online ahead of print November 29, 2012]. Int J Cardiol. doi: 10.1016/j.ijcard.2012.11.106.
 
Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-719. [CrossRef] [PubMed]
 
Wolk R, Kara T, Somers VK. Sleep-disordered breathing and cardiovascular disease. Circulation. 2003;108(1):9-12. [CrossRef] [PubMed]
 
Sorajja D, Gami AS, Somers VK, Behrenbeck TR, Garcia-Touchard A, Lopez-Jimenez F. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest. 2008;133(4):927-933. [CrossRef] [PubMed]
 
Kono M, Tatsumi K, Saibara T, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131(5):1387-1392. [CrossRef] [PubMed]
 

Figures

Tables

References

Trzepizur W, Le Vaillant M, Meslier N, et al. Independent association between nocturnal intermittent hypoxemia and metabolic dyslipidemia. Chest. 2013;143(6):1584-1589. [PubMed]
 
Demirkol S, Cakar M, Balta S, Unlu M, Ay SA, Karaman M. To maintain a proper follow-up of the patients with coronary artery disease is as nearly important as medications [published online ahead of print November 29, 2012]. Int J Cardiol. doi: 10.1016/j.ijcard.2012.11.106.
 
Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-719. [CrossRef] [PubMed]
 
Wolk R, Kara T, Somers VK. Sleep-disordered breathing and cardiovascular disease. Circulation. 2003;108(1):9-12. [CrossRef] [PubMed]
 
Sorajja D, Gami AS, Somers VK, Behrenbeck TR, Garcia-Touchard A, Lopez-Jimenez F. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest. 2008;133(4):927-933. [CrossRef] [PubMed]
 
Kono M, Tatsumi K, Saibara T, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131(5):1387-1392. [CrossRef] [PubMed]
 
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