CHEST Guidelines-OSA-Among-Patients-With-Pneumonia

OSA-Among-Patients-With-Pneumonia_chest

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In a correspondence to the editor of CHEST, Drs. Ahmed S. BaHammam and Antonio M. Esquinas Rodriguez discuss a study by Lindenauer et al. that explored outcomes of pneumonia patients with obstructive sleep apnea (OSA). The original study found higher initial rates of mechanical ventilation and a lower rate of inpatient mortality in patients with pneumonia who also had OSA. However, BaHammam and Esquinas Rodriguez argue that these findings could be influenced by obesity, which was more prevalent in patients with OSA (37.8% vs. 6.2%). They suggest the outcomes might be attributed more to obesity than OSA itself, citing known needs of obese patients for mechanical ventilation and different mortality risks in ICUs. Additionally, obesity might affect outcomes due to the immunomodulatory properties of hormones such as leptin and IL-10, potentially improving survival in severe illnesses. They call for further investigations that control for body mass index (BMI) to truly determine OSA's impact.<br /><br />In response, Lindenauer et al. acknowledged the high prevalence of obesity among OSA patients and noted that their multivariable analyses had accounted for obesity as a covariate. This allowed them to estimate the independent effects of OSA on outcomes like in-hospital mortality and the need for mechanical ventilation or ICU transfer beyond the second day of hospitalization, illustrating a more nuanced understanding of OSA's impact in the presence of confounding factors like obesity. This exchange underscores the complexity of accurately attributing clinical outcomes to intertwined health conditions and the importance of comprehensive analyses in medical research.

Keywords

pneumonia

obstructive sleep apnea

OSA

obesity

mechanical ventilation

mortality

BMI

ICU

leptin

immunomodulatory