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Juan F. Masa, MD, PhD; Jaime Corral, MD; Javier Gómez-de-Terreros, MD, PhD; María-Ángeles Sánchez-Quiroga, MD; Babak Mokhlesi, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

aPulmonary Section, San Pedro de Alcántara Hospital, Cáceres, Spain

bPulmonary Section, Virgen del Puerto Hospital, Plasencia, Spain

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

dCIBER de enfermedades respiratorias (CIBERES), Madrid, Spain

CORRESPONDENCE TO: Juan F. Masa, MD, PhD, Pulmonary Section, 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(6):1408. doi:10.1016/j.chest.2016.08.1470
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We are grateful to Dr Castellana and colleagues for their interest in our article recently published in CHEST. In their letter, they question the role of nocturnal hypoventilation and of tonic oxygen desaturation in the pathogenesis of cardiovascular comorbidity.

In our dataset, the severity of OSA and intermittent hypoxemia measured according to the oxygen desaturation index was the only factor associated with reduced cardiovascular morbidity. Sustained hypoxemia assessed by using daytime Pao2 and percentage of total sleep time with oxygen saturation < 90% was not associated with reduced cardiovascular morbidity. We cannot rule out with certainty whether there was an additive effect of sustained hypoxemia on top of intermittent hypoxemia in leading to reduced cardiovascular morbidity. However, if one assumes that sustained hypoxemia has a greater role in cardiovascular protection, we would have expected the hypoxemic patients with obesity hypoventilation syndrome and the lowest severity of OSA, based on the apnea-hypopnea index or oxygen desaturation index, to have the lowest prevalence of cardiovascular comorbidities.

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]
 

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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]
 
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