title: Obstructive sleep apnea, obesity, and the development of acute respiratory distress syndrome.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) may increase the risk of respiratory complications and acute respiratory distress syndrome (ARDS) among surgical patients. OSA is more prevalent among obese individuals; obesity can predispose to ARDS.
  
  
  OBJECTIVE
  It is unclear whether OSA independently contributes towards the risk of ARDS among hospitalized patients.
  
  
  METHODS
  This is a pre-planned retrospective subgroup analysis of the prospectively identified cohort of 5,584 patients across 22 hospitals with at least one risk factor for ARDS at the time of hospitalization from a trial by the US Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score. A total of 252 patients (4.5%) had a diagnosis of OSA at the time of hospitalization; of those, 66% were obese. Following multivariate adjustment in the logistic regression model, there was no significant relationship between OSA and development of ARDS (OR = 0.65, 95%CI = 0.32-1.22). However, body mass index (BMI) was associated with subsequent ARDS development (OR = 1.02, 95%CI = 1.00-1.04, p = 0.03). Neither OSA nor BMI affected mechanical ventilation requirement or mortality.
  
  
  CONCLUSIONS
  Prior diagnosis of OSA did not independently affect development of ARDS among patients with at least one predisposing condition, nor the need for mechanical ventilation or hospital mortality. Obesity appeared to independently increase the risk of ARDS.
authors.affiliation: Division of Pulmonary and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.
authors.forename: Lioudmila V
authors.initials: LV
authors.lastname: Karnatovskaia
authors.affiliation: Division of Pulmonary and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.
authors.forename: Augustine S
authors.initials: AS
authors.lastname: Lee
authors.affiliation: Division of Anesthesiology, University of Vermont, Burlington, VT.
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Bender
authors.affiliation: Division of Anesthesiology, Harvard University, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.affiliation: Division of Pulmonary and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.
authors.forename: Emir
authors.initials: E
authors.lastname: Festic
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*
keywords: acute respiratory distress syndrome; obesity; obstructive sleep apnea