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To the Editor: Dr Shamsuzzaman and colleagues¹ concluded that obstructive sleep apnea (OSA), which is often undiagnosed, can worsen cardiac and vascular disease. They also suggested that untreated OSA may decrease the effectiveness of conventional therapeutic strategies. Although the authors discussed several possible mechanisms that may occur during sleep, they did not address the effects of OSA on pulmonary hypertension and the right ventricle during wakefulness. Sanner et al,² for instance, concluded that OSA can cause mild pulmonary hypertension even in the absence of pulmonary disease, which, in patients with normal left ventricular function, is strongly related to severity of OSA. In another study, Sanner et al³ reported that 18% of patients with OSA had impaired right ventricular ejection fraction, and that 95% of these patients had clinical signs or symptoms of mild right ventricular failure. Marrone and Bonsignore⁴ found that mild pulmonary hypertension may be present at rest in . . . [Full Text of this Article]

Nasir Hussain, MD
nhussain@utmb.edu

Bernard Karnath, MD
Department of Internal Medicine
University of Texas Medical Branch
Galveston

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