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Original Research: Sleep Disorders |

Protective Cardiovascular Effect of Sleep Apnea Severity in Obesity Hypoventilation Syndrome

Juan F. Masa, MD, PhD; Jaime Corral, MD; Auxiliadora Romero, MD; Candela Caballero, MD; Joaquin Terán-Santos, MD, PhD; Maria L. Alonso-Álvarez, MD, PhD; Teresa Gomez-Garcia, MD; Mónica González, MD, PhD; Soledad López-Martín, MD; Pilar De Lucas, MD, PhD; José M. Marin, MD, PhD; Sergi Marti, MD, PhD; Trinidad Díaz-Cambriles, MD; Eusebi Chiner, MD, PhD; Miguel Merchan, MStat; Carlos Egea, MD, PhD; Ana Obeso, MD; Babak Mokhlesi, MD
Author and Funding Information

FUNDING/SUPPORT: Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo) PI050402, Spanish Respiratory Foundation 2005 (FEPAR), and Air Liquide Spain.

aSan Pedro de Alcántara Hospital, Cáceres, Spain

bUniversity Hospital, Burgos, Spain

cIIS Fundación Jiménez Díaz, Madrid, Spain

dValdecilla Hospital, Santander, Spain

eGregorio Marañon Hospital, Madrid, Spain

fMiguel Servet Hospital, Zaragoza, Spain

gValld'Hebron Hospital, Barcelona, Spain

hDoce de Octubre Hospital, Madrid, Spain

iSan Juan Hospital, Alicante, Spain

jSleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain

kVirgen del Rocío Hospital, Sevilla, Spain

lCIBER de Enfermedades Respiratorias, Madrid, Spain

mDepartment of Biochemistry, Molecular Biology and Physiology, Faculty of Medicine, Valladolid University, Valladolid, Spain

nDepartment of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL

CORRESPONDENCE TO: Juan F. Masa, MD, San Pedro de Alcántara Hospital, Avda Pablo Naranjo s/n, 10003 Cáceres, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):68-79. doi:10.1016/j.chest.2016.02.647
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Background  Obesity hypoventilation syndrome (OHS) is associated with a high burden of cardiovascular morbidity (CVM) and mortality. The majority of patients with OHS have concomitant OSA, but there is a paucity of data on the association between CVM and OSA severity in patients with OHS. The objective of our study was to assess the association between CVM and OSA severity in a large cohort of patients with OHS.

Methods  In a cross-sectional analysis, we examined the association between OSA severity based on tertiles of oxygen desaturation index (ODI) and CVM in 302 patients with OHS. Logistic regression models were constructed to quantify the independent association between OSA severity and prevalent CVM after adjusting for various important confounders.

Results  The prevalence of CVM decreased significantly with increasing severity of OSA based on ODI as a continuous variable or ODI tertiles. This inverse relationship between OSA severity and prevalence of CVM was seen in the highest ODI tertile and it persisted despite adjustment for multiple confounders. Chronic heart failure had the strongest negative association with the highest ODI tertile. No significant CVM risk change was observed between the first and second ODI tertiles. Patients in the highest ODI tertile were younger, predominantly male, more obese, more hypersomnolent, had worse nocturnal and daytime gas exchange, lower prevalence of hypertension, better exercise tolerance, and fewer days hospitalized than patients in the lowest ODI tertile.

Conclusions  In patients with OHS, the highest OSA severity phenotype was associated with reduced risk of CVM. This finding should guide the design of future clinical trials assessing the impact of interventions aimed at decreasing cardiovascular morbidity and mortality in patients with OHS.

Trial Registry  Clinicaltrial.gov; No.: NCT01405976; URL: www.clinicaltrials.gov

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