Obstructive sleep apnea (OSA) and venous thromboembolism (VTE) share multiple risk factors and comorbidities, and several studies have reported a frequent coexistence of both conditions. However, the prevalence and clinical relevance of OSA among patients with acute VTE remain incompletely characterized.

Systematic review and meta-analysis including studies reporting OSA prevalence in patients with acute VTE. PRISMA recommendations were followed. Each step was performed by ≥2 investigators. We searched Pubmed/Cochrane/Embase until September 2024 using free/MeSH/Emtree terms related to VTE/PE/DVT and OSA. Quality of evidence was evaluated. A meta-analysis was conducted to estimate the pooled prevalence across the studies according to different criteria. Heterogeneity was assessed (I2 statistics) and subgroup, sensitivity and meta-regression analysis were conducted.

From 5066 articles retrieved, 25 studies were eligible. Quality assessment of studies suggested low risk of bias for internal validity but frequent high risk of bias regarding external validity. Meta-analyses revealed an OSA prevalence defined by an apnea–hypopnea index (AHI)≥5, ≥15 and ≥30 of 70% (95%CI 63–76%), 41% (95%CI 32–50%) and 21% (95%CI 16–26%), respectively. Prevalence was 8% (95%CI 4–13%) in studies assessing a known diagnosis of OSA through screening of health records. Heterogeneity was high (I2>70%).

Systematic sleep assessment in patients with VTE identifies a substantial burden of sleep-disordered breathing, with wide variability across studies. Mild AHI elevations should be interpreted cautiously, whereas moderate-to-severe OSA and hypoxemia-related phenotypes appear more clinically relevant. These findings support a targeted clinical evaluation and the need for prospective studies in this population.