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(Stroke. 2007;38:853.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Drager and Lorenzi-Filho

Roberto Munoz, MD

Department of Neurology, Hospital de Navarra, Pamplona, Spain

Joaquín Duran-Cantolla, MD, PhD

Sleep Unit, Department of Pneumology, Hospital Txagorritxu, Vitoria-Gasteiz, Spain

Eduardo Martínez-Vila, MD, PhD

Department of Neurology, Clínica Universitaria de Navarra, Pamplona, Spain

Jaime Gallego, MD, PhD

Department of Neurology, Hospital de Navarra, Pamplona, Spain

Ramón Rubio, MD, PhD

Sleep Unit, Department of Pneumology, Hospital Txagorritxu, Vitoria-Gasteiz, Spain

Felipe Aizpuru, MD, PhD

Research Unit, Hospital Txagorritxu, Vitoria-Gasteiz, Spain

Germán De La Torre, MD, PhD

Sleep Unit, Department of Pneumology, Hospital Txagorritxu, Vitoria-Gasteiz, Spain

Response:

The authors make a note highlighting the importance of the biological plausibility as a condition to establish the causative relationship between a risk factor and a disease. In their study,¹ they have found that the severity of sleep apnea (expressed as AHI) was directly correlated with the presence of early markers of atherosclerosis in middle-aged patients, as are arterial stiffness and intima-media thickness. However, another marker, carotid diameter, correlated better with oxygen desaturation.

In line with this study, we have found that AHI is the only significant variable that correlates with risk of incident stroke, and not oxygen desaturation (T90). In our opinion, those different findings are not in contradiction because, as we know, pathophysiological mechanisms leading to stroke are different and interrelated. Assuming this point, we agree with Drager and colleagues in that better knowledge of sleep apnea and other emergent stroke risk factors brings us a great opportunity to make progress in prevention and treatment of multiple mechanisms of cerebrovascular diseases.²

Acknowledgments

Disclosures

None.

References

1. Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005; 172: 613–618.[Abstract/Free Full Text]
2. Casado-Naranjo I, Munoz R. Sleep apnea and stroke: new evidence, new challenges. Neurologia. 2005; 6; 273–275.

This Article Full Text (PDF) All Versions of this Article: 38/3/853    most recent 01.STR.0000257318.13681.7dv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Munoz, R. Articles by De La Torre, G. Search for Related Content PubMed PubMed Citation Articles by Munoz, R. Articles by De La Torre, G.