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Vol. 61. Issue 2.
Pages 216-217 (February 2008)
Vol. 61. Issue 2.
Pages 216-217 (February 2008)
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Heart Failure, Obesity and Sleep Apnea
Insuficiencia cardiaca, obesidad y apnea del sueño
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Miguel A Ariasa, Sonia Bartoloméa, Fernando Lópeza, Luis Rodríguez-Padiala
a Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, España,
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To the Editor:

The article written by Zamora et al1 provided an excellent description of the phenomenon known as the obesity paradox in heart failure patients, in this case in a population of heart failure outpatients who had received adequate concomitant treatment for heart failure.

Obstructive sleep apnea­hypopnea syndrome (OSAHS) is highly prevalent among the general population and is related to the development of various cardiovascular complications that determine patient prognosis, among them, ventricular dysfunction, systemic and pulmonary hypertension, cerebrovascular disease, and cardiac rhythm disorders.2-5 In addition, obesity is the main risk factor of OSAHS, with a direct relation observed between the degree of obesity and the severity of the sleep disorder. It has been estimated that as many as 40% to 90% of obese patients present OSAHS.6 Furthermore, OSAHS is very common in patients with heart failure, both those with left ventricular systolic dysfunction and those with normal systolic function.7 There is also evidence that OSAHS in subjects with heart failure is an additional independent predictor of mortality in this population.8

Zamora et al1 did not analyze the possibility of OSAHS in the patients of their series, something also not undertaken in various previous studies that have uncovered the phenomenon of the obesity paradox in heart failure.9 In view of the data discussed, it appears plausible to assume that OSAHS diagnosis and treatment in obese subjects with heart failure could widen the differences in mortality compared to nonobese subjects even further, something that would enhance the magnitude of the obesity paradox in heart failure. Evidently, future studies in this field will provide an answer to this hypothesis.

Bibliography
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Zamora E, Lupón J, Urrutia A, González B, Mas D, Pascual T, et al..
¿El índice de masa corporal influye en la mortalidad de los pacientes con insuficiencia cardiaca? Rev Esp Cardiol, 60 (2007), pp. 1027-34
[2]
Arias MA, García-Río F, Alonso-Fernández A, Mediano O, Martínez I, Villamor J..
Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men..
Circulation, 112 (2005), pp. 375-83
[3]
Arias MA, García-Río F, Alonso-Fernández A, Martínez I, Villamor J..
Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study..
Eur Heart J, 27 (2006), pp. 1106-13
[4]
Arias MA, Sánchez AM..
Obstructive sleep apnea and its relationship to cardiac arrhythmias..
J Cardiovasc Electrophysiol, 18 (2007), pp. 1006-14
[5]
Terán SJ, Alonso Álvarez ML..
El corazón, el sueño y la respiración..
Rev Esp Cardiol, 59 (2006), pp. 5-8
[6]
Arias MA, Alonso-Fernández A, García-Río F, Pagola C..
Association between obesity and obstructive sleep apnoea..
Eur Heart J, 26 (2005), pp. 2744-5
[7]
Arias MA, García-Río F, Alonso-Fernández A, Sánchez AM..
Síndromes de apneas-hipopneas durante el sueño e insuficiencia cardiaca..
Rev Esp Cardiol, 60 (2007), pp. 415-27
[8]
Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu KL, et al..
Influence of obstructive sleep apnea on mortality in patients with heart failure..
J Am Coll Cardiol, 49 (2007), pp. 1625-31
[9]
Curtis JP, Selter JG, Wang Y, Rathore SS, Jovin IS, Jadbabaie F, et al..
The obesity paradox: body mass index and outcomes in patients with heart failure..
Arch Intern Med, 165 (2005), pp. 55-61
Idiomas
Revista Española de Cardiología (English Edition)

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