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Correspondence |

Introducing High-Sensitivity Cardiac Troponin T as a Biomarker of OSA-Related Cardiovascular Morbidity in Obesity Hypoventilation Syndrome FREE TO VIEW

Denis Monneret, PharmD, PhD; Philippe Giral, MD, PhD; Dominique Bonnefont-Rousselot, PharmD, PhD; Frederic Roche, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Metabolic Biochemistry, La Pitié-Salpêtrière-Charles Foix University Hospital, Paris, France

bPierre et Marie Curie University and UMR_S1166 Institute of Cardiometabolism and Nutrition, Paris, France

cDepartment of Biochemistry and CNRS UMR8258 – INSERM U1022 and Faculty of Pharmacy, Sorbonne Paris Cité, Paris, France

dClinical and Exercise Physiology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France

CORRESPONDENCE TO: Denis Monneret, PharmD, PhD, Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Assistance Publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France


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


Chest. 2016;150(6):1408-1409. doi:10.1016/j.chest.2016.08.1467
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We read with interest the recent article published by Masa et al in CHEST (July 2016) reporting that the prevalence of cardiovascular morbidity (CVM) in obesity hypoventilation syndrome (OHS) was lower in patients with the highest OSA severity. The authors suggested ischemic preconditioning as a potential protective mechanism explaining this unexpected inverse relationship between OSA severity and CVM. Through a logistic regression, they compared CVM between three oxygen desaturation index-based tertiles, but one could be surprised by the phenotypic contrast of the severest oxygen desaturation index subgroup. Indeed, these patients were younger (‒7 to ‒8 years) and more active physically (+12%-+14%, 6-meter walking distance), included fewer hypertensive (‒9% to ‒14%) and diabetic patients (‒10%), and were predominantly men (+19%-+25%) and more obese (BMI, +8%-+10%). Considering these phenotypic differences, the conclusions should be interpreted with caution and need to be further confirmed. With this perspective, a biomarker approach would be helpful for evaluating the cardiovascular risk. Among potential candidates, circulating high-sensitivity cardiac troponin T (hs-cTnT) would be of great interest, since it has been shown to be detectable with increased concentrations in more than 70% of patients with severe OSA and has proved to be an independent factor associating OSA severity and risk of heart failure. Accordingly, an increased level of hs-cTnI, the “rival” biomarker, has also been found to be independently associated with OSA severity. The initial studies did not find any relationship between circulating troponin concentrations and OSA severity because they used first-generation troponin assays, which were not sufficiently sensitive. Since that time, the “high-sensitivity” generations have appeared and are characterized by an optimal analytical precision, that is, a coefficient of variation ≤ 10% at the 99th percentile of troponin concentrations in a normal reference population, defined as 14 ng/L for hs-cTnT. Interestingly, the higher median hs-cTnT concentration was previously found to be 6 ng/L (interquartile range, 4-10) in patients with severe OSA, which is a level similar to that associated with incident coronary heart disease (hazard ratio [HR], about 1.3), mortality (HR, about 1.5), and hospitalization for heart failure (HR, about 2.2) in the general population (hs-cTnT: range, 6- 8 ng/L). Since it has never been evaluated in OHS but is related to OSA severity and is predictive of CVM, hs-cTnT concentrations could be relevantly assayed in the present study if a plasma/serum bank is available or should at least be introduced in further studies aiming at verifying these controversial results.

References

Masa J.F. .Corral J. .Romero A. .et al Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Chest. 2016;150:68-79 [PubMed]journal. [CrossRef] [PubMed]
 
Randby A. .Namtvedt S.K. .Einvik G. .et al Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest. 2012;142:639-646 [PubMed]journal. [CrossRef] [PubMed]
 
Querejeta Roca G. .Redline S. .Punjabi N. .et al Sleep apnea is associated with subclinical myocardial injury in the community. The ARIC-SHHS study. Am J Respir Crit Care Med. 2013;188:1460-1465 [PubMed]journal. [CrossRef] [PubMed]
 
Einvik G. .Røsjø H. .Randby A. .et al Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: data from the Akershus Sleep Apnea Project. Sleep. 2014;37:1111-1116 [PubMed]journal. [PubMed]
 
Saunders J.T. .Nambi V. .de Lemos J.A. .et al Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation. 2011;123:1367-1376 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Masa J.F. .Corral J. .Romero A. .et al Protective cardiovascular effect of sleep apnea severity in obesity hypoventilation syndrome. Chest. 2016;150:68-79 [PubMed]journal. [CrossRef] [PubMed]
 
Randby A. .Namtvedt S.K. .Einvik G. .et al Obstructive sleep apnea is associated with increased high-sensitivity cardiac troponin T levels. Chest. 2012;142:639-646 [PubMed]journal. [CrossRef] [PubMed]
 
Querejeta Roca G. .Redline S. .Punjabi N. .et al Sleep apnea is associated with subclinical myocardial injury in the community. The ARIC-SHHS study. Am J Respir Crit Care Med. 2013;188:1460-1465 [PubMed]journal. [CrossRef] [PubMed]
 
Einvik G. .Røsjø H. .Randby A. .et al Severity of obstructive sleep apnea is associated with cardiac troponin I concentrations in a community-based sample: data from the Akershus Sleep Apnea Project. Sleep. 2014;37:1111-1116 [PubMed]journal. [PubMed]
 
Saunders J.T. .Nambi V. .de Lemos J.A. .et al Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation. 2011;123:1367-1376 [PubMed]journal. [CrossRef] [PubMed]
 
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