title: Protective Cardiovascular Effect of Sleep Apnea Severity in Obesity Hypoventilation Syndrome.
abstract: 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.
  
  
  BACKGROUND
  Clinicaltrial.gov; No.: NCT01405976; URL: www.clinicaltrials.gov.
authors.affiliation: San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain. Electronic address: fmasa@separ.es.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Masa
authors.affiliation: San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Corral
authors.affiliation: Virgen del Rocío Hospital, Sevilla, Spain.
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Romero
authors.affiliation: Virgen del Rocío Hospital, Sevilla, Spain.
authors.forename: Candela
authors.initials: C
authors.lastname: Caballero
authors.affiliation: University Hospital, Burgos, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Terán-Santos
authors.affiliation: University Hospital, Burgos, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Alonso-Álvarez
authors.affiliation: IIS Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gomez-Garcia
authors.affiliation: Valdecilla Hospital, Santander, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: González
authors.affiliation: Gregorio Marañon Hospital, Madrid, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: López-Martín
authors.affiliation: Gregorio Marañon Hospital, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: De Lucas
authors.affiliation: Miguel Servet Hospital, Zaragoza, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Marin
authors.affiliation: Valld'Hebron Hospital, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Marti
authors.affiliation: Doce de Octubre Hospital, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Díaz-Cambriles
authors.affiliation: San Juan Hospital, Alicante, Spain.
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.affiliation: San Pedro de Alcántara Hospital, Cáceres, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Merchan
authors.affiliation: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Egea
authors.affiliation: CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Biochemistry, Molecular Biology and Physiology, Faculty of Medicine, Valladolid University, Valladolid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Obeso
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D065840:Protective Factors; D012720:Severity of Illness Index; D013030:Spain
keywords: cardiovascular risk; obesity hypoventilation syndrome; precision medicine; sleep apnea