CHEST Guidelines-Response_chest

Response_chest_5

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In a letter to the editor of CHEST, Ahmed S. BaHammam and Antonio M. Esquinas Rodriguez discuss a study by Lindenauer et al. on the outcomes of patients with pneumonia who also have Obstructive Sleep Apnea (OSA). The study found that these patients experienced higher rates of initial mechanical ventilation but had a modestly lower risk for inpatient mortality. BaHammam and Rodriguez highlight the significant prevalence of obesity among these patients (37.8% vs. 6.2% in those without OSA) as a factor not thoroughly addressed in the study, suggesting that obesity could be contributing to the observed outcomes rather than OSA alone. Obese patients generally require mechanical ventilation more often, but also show no increased mortality compared to normal-weight patients, potentially due to protective immunomodulatory effects from adipocyte-secreted hormones.<br /><br />In response, Lindenauer and colleagues clarify that their multivariable analysis included obesity as a covariate to separate its effect from that of OSA on the outcomes. Their findings indicated that, while obesity was linked to lower in-hospital mortality, it was not associated with the necessity for late mechanical ventilation. Additionally, they found no significant interaction effect between obesity and OSA, suggesting similar outcomes for patients with OSA regardless of obesity status. This response aims to clarify that the findings related to OSA are not entirely confounded by obesity, as their analysis aimed to account for it.<br /><br />This exchange underlines the importance of considering confounders like obesity in studies examining comorbid conditions and their outcomes. Both letters reinforce the need for future research to further untangle the effects of OSA and obesity on pneumonia outcomes.

Keywords

pneumonia

obstructive sleep apnea

OSA

obesity

mechanical ventilation

inpatient mortality

adipocyte hormones

multivariable analysis

confounders

comorbid conditions