Abstract

To the Editor

We thank Alkhuja and colleagues for their interest in our article “Considerations in Women with Hypertension.”¹ We agree that the association among the comorbidities of hypertension, obesity, and obstructive sleep apnea (OSA) is well established. The sex-specific degree of interaction among these variables has not, however, been well studied. The presence of obesity is strongly associated with the development of hypertension.² Epidemiologic evidence also supports an association between sleep-disordered breathing and hypertension³; however, data specifically addressing high blood pressure in patients with OSA, stratified by the presence of obesity, are scarce.⁴Epidemiologic association and longitudinal cohort studies provide evidence that OSA poses an increased risk for adverse health outcomes, including cardiovascular disease and total mortality.^3,5Obesity has been associated with OSA, and in both sexes, an increasing body mass index correlates positively with severity of this disease.⁶ Although data from the 1999–2002 National Health and Nutrition Examination Survey indicated more women (33.4%) than men (27.3%) have a body mass index ≥30, women did not have higher rates of OSA.⁶