Prognostic Impact of Obstructive Sleep Apnea in Patients Presenting with Acute Symptomatic Pulmonary Embolism

Thromb Haemost. 2021 Jun;121(6):808-815. doi: 10.1055/s-0040-1721506. Epub 2020 Dec 30.

Abstract

Background: In patients with pulmonary embolism (PE), there is a lack of comprehensive data on the prevalence and prognostic significance of pre-existing obstructive sleep apnea (OSA).

Methods: In this study of patients with PE from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence of OSA, and the association between pre-existing OSA and the outcomes of all-cause mortality, PE-related mortality, recurrences, and major bleeding over 30 days after initiation of PE treatment. Additionally, we also examined rates of outcomes within 90 days and 1 year following the diagnosis of PE.

Results: Of 4,153 patients diagnosed with PE, 241 (5.8%; 95% confidence interval [CI]: 5.1-6.6%) had pre-existing OSA. Overall, 166 (4.0%; 95% CI: 3.4-4.6%) died during the first 30 days of follow-up. In multivariable analysis, the OSA syndrome was not a significant predictor of death from any cause (odds ratio [OR]: 1.5; 95% CI: 0.8-2.9; p = 0.19). However, patients with pre-existing OSA had an increased PE-specific mortality (adjusted OR: 3.0; 95% CI: 1.3-6.8; p = 0.01) compared with those without OSA. OSA was not significantly associated with 30-day recurrent venous thromboembolism (adjusted OR: 0.6; 95% CI: 0.1-4.7; p = 0.65) or major bleeds (adjusted OR: 1.0; 95% CI: 0.4-2.2; p = 1.0). Findings were similar at 90-day and 1-year follow-ups.

Conclusion: In patients presenting with PE, pre-existing OSA is relatively infrequent. Patients with OSA were at increased risk of PE-related mortality when compared with those without OSA.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hemorrhage / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / epidemiology*
  • Pulmonary Embolism / mortality
  • Recurrence
  • Registries
  • Risk Assessment
  • Risk Factors
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / epidemiology*
  • Sleep Apnea, Obstructive / mortality
  • Time Factors