To the Editor.
—Dr Hoeg1 omitted one of the most important risk factors for all cardiovascular diseases, CHD included. Obstructive sleep apnea (OSA) is today's sleeping giant. The incidence of OSA is reported at 25% among middle-aged men and 9% among middle-aged women.2 Obstructive sleep apnea has a high correlation with obesity, hypertension, cardiovascular disease, stroke, transient ischemic attack, and congestive heart failure. Separating OSA as an independent risk factor is difficult, but studies are under way. In the meantime, physicians must learn to diagnose and treat OSA, not only to improve their patients' general well-being, but also to help reduce coronary artery disease risk.
Davidson TM. Expanding and Understanding Risk Factors for Coronary Heart Disease. JAMA. 1997;278(8):636. doi:10.1001/jama.1997.03550080046034