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Peter K. Lindenauer, MD; Mihaela S. Stefan, MD; Karin G. Johnson, MD; Aruna Priya, MA, MSc; Penelope S. Pekow, PhD; Michael B. Rothberg, MD, MPH
Author and Funding Information

From the Center for Quality of Care Research (Drs Lindenauer, Stefan, and Pekow and Ms Priya), the Division of General Internal Medicine (Drs Lindenauer and Stefan), and the Division of Neurology (Dr Johnson), Baystate Medical Center; the Tufts University School of Medicine (Drs Lindenauer, Stefan, and Johnson); the School of Public Health and Health Sciences (Dr Pekow), University of Massachusetts-Amherst; and the Department of Medicine (Dr Rothberg), Medicine Institute, Cleveland Clinic.

CORRESPONDENCE TO: Peter K. Lindenauer, MD, Baystate Medical Center, Center for Quality of Care Research, 280 Chestnut St, Springfield, MA 01199; e-mail: peter.lindenauer@baystatehealth.org


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.

FUNDING/SUPPORT: This study was supported by the Agency for Healthcare Research and Quality [Grant R01HS018723]. Dr Stefan is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant K01HL114631].

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-e177. doi:10.1378/chest.14-1592
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To the Editor:

We thank Drs BaHammam and Esquinas Rodriguez for their letter about our recent study.1 As they correctly note, the prevalence of obesity (as reflected by International Classification of Diseases, Ninth Revision, codes) was roughly six times higher among patients with OSA than in those without OSA. Given the high potential for obesity to serve as a confounder, our multivariable analyses included obesity as a covariate, thereby yielding an estimate of the independent association between OSA and the two outcomes we studied: (1) in-hospital mortality and (2) initiation of mechanical ventilation or transfer to the ICU after the second hospital day (a measure of clinical deterioration). In light of the comments by Drs BaHammam and Esquinas Rodriguez, it is also worth noting that in the multivariable analyses (presented in e-Tables 2 and 3 of our article), obesity remained associated with lower in-hospital mortality. However, obesity was not associated with late mechanical ventilation in these analyses. Finally, although we did not include these results in the article, we also investigated the possibility of an interaction between obesity and OSA. The P value for the interaction term was .81, suggesting that patients with OSA and obesity had similar outcomes to patients with OSA who were not obese.

Acknowledgments

Role of sponsors: The content of this publication is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality nor the National Heart, Lung, and Blood Institute.

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]
 

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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]
 
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