0
Correspondence |

OSA Among Patients With PneumoniaSleep Apnea and Pneumonia: A Higher Risk for Complications or Simply an Overlapping Disorder? FREE TO VIEW

Ahmed S. BaHammam, MD, FCCP; Antonio M. Esquinas Rodriguez, MD, PhD
Author and Funding Information

From the University Sleep Disorders Center (Dr BaHammam), College of Medicine, and National Plan for Science and Technology, King Saud University; and the Intensive Care Unit (Dr Esquinas Rodriguez), Hospital Morales Meseguer.

CORRESPONDENCE TO: Ahmed S. BaHammam, MD, FCCP, University Sleep Disorders Center, College of Medicine and National Plan for Science and Technology, King Saud University, Box 225503, Riyadh 11324, Saudi Arabia; e-mail: ashammam2@gmail.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST 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. 2014;146(5):e176. doi:10.1378/chest.14-1513
Text Size: A A A
Published online
To the Editor:

We read with interest the article by Lindenauer et al1 in CHEST (May 2014), who retrospectively reported the outcome of patients hospitalized with pneumonia who had coexisting OSA. The study showed higher initial rates of mechanical ventilation, with a modestly lower risk for inpatient mortality among patients with pneumonia who had OSA. However, a few points need clarification before associating OSA with increased rate of mechanical ventilation and lower risk for inpatient mortality in patients with pneumonia.

The authors reported that obesity was more prevalent among patients with OSA (37.8% vs 6.2%); however, they did not report the BMI. It is difficult to attribute the findings to OSA alone.1 We think that the higher initial rates of mechanical ventilation and the lower mortality rates could be explained by obesity. It is known that obese patients in the ICU require mechanical ventilation more often than normal-weight patients and for longer periods.2 Morbidly obese patients devote a good proportion of total body oxygen consumption to maintain the high demand of the respiratory work, even during quiet breathing, which results in a decreased ventilatory reserve and a predisposition to respiratory failure even during mild pulmonary or systemic insults.3 Moreover, studies have shown no increase in mortality of obese patients who were in the ICU and mechanically ventilated compared with normal-weight patients.4 Current evidence suggests that adipocyte-secreted hormones such as leptin and IL-10 have immunomodulatory properties that might suppress the inflammatory response and improve host survival in obese patients with severe illness.5

Therefore, it is possible that the reported differences in hospital course and outcome between patients hospitalized with pneumonia with and without OSA are due to obesity. Future studies should assess the effect of OSA on hospital course and outcome of patients with pneumonia while controlling for BMI.

References

Lindenauer PK, Stefan MS, Johnson KG, Priya A, Pekow PS, Rothberg MB. Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia. Chest. 2014;145(5):1032-1038. [CrossRef] [PubMed]
 
El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120(6):1989-1997. [CrossRef] [PubMed]
 
Bahammam AS, Al-Jawder SE. Managing acute respiratory decompensation in the morbidly obese. Respirology. 2012;17(5):759-771. [CrossRef] [PubMed]
 
Martino JL, Stapleton RD, Wang M, et al. Extreme obesity and outcomes in critically ill patients. Chest. 2011;140(5):1198-1206. [CrossRef] [PubMed]
 
Bornstein SR, Licinio J, Tauchnitz R, et al. Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab. 1998;83(1):280-283. [CrossRef] [PubMed]
 

Figures

Tables

References

Lindenauer PK, Stefan MS, Johnson KG, Priya A, Pekow PS, Rothberg MB. Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia. Chest. 2014;145(5):1032-1038. [CrossRef] [PubMed]
 
El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120(6):1989-1997. [CrossRef] [PubMed]
 
Bahammam AS, Al-Jawder SE. Managing acute respiratory decompensation in the morbidly obese. Respirology. 2012;17(5):759-771. [CrossRef] [PubMed]
 
Martino JL, Stapleton RD, Wang M, et al. Extreme obesity and outcomes in critically ill patients. Chest. 2011;140(5):1198-1206. [CrossRef] [PubMed]
 
Bornstein SR, Licinio J, Tauchnitz R, et al. Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab. 1998;83(1):280-283. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543