Response to Independent Association Between Obstructive Sleep Apnea and Noncalcified Coronary Plaque Demonstrated by Noninvasive Coronary Computed Tomography Angiography

Sharma et al with interest. The authors retrospectively studied 81 patients, with 49 having obstructive sleep apnea (OSA). These researchers found that an increase in OSA severity was associated with a greater burden of noncalcified and mixed plaques assessed with multidetector-row computed tomography after adjustment for age, race, smoking, and hypercholesterolemia (odds ratio: 14.2; 95% confidence interval: 1.3-158.5). However, as was mentioned by the authors, several confounding factors such as high blood pressure, use of lipid lowering medications, body mass index, and the presence of type 2 diabetes mellitus were not adjusted in this analysis, because all of these may independently affect coronary circulation. 2 These factors, and possibly a small sample, may explain the strikingly wide confidence interval received in their study.