Association Between Obstructive Sleep Apnea and Pulmonary Embolism

doi:10.1016/j.mayocp.2013.02.005

Mayo Clinic Proceedings

Volume 88, Issue 6, June 2013, Pages 579-587

https://doi.org/10.1016/j.mayocp.2013.02.005 Get rights and content

Abstract

Objectives

To compare the prevalence of obstructive sleep apnea (OSA) in patients with pulmonary embolism (PE) with a sex-, age-, and body mass index (BMI)–matched, population-based control group and to assess the association between OSA and PE.

Methods

We performed a case-control study from October 1, 2006, through November 30, 2009. We included 107 patients with PE and a control group (n=102) without PE in University Hospitals Son Espases and La Paz in Spain. Variables included in the analysis were medical history, anthropometric variables (weight, height, BMI, and neck circumference), Epworth Sleepiness Scale score, home respiratory polygraphy, basic biochemical profile and hemogram, spirometry, and physical activity.

Results

The mean ± SD apnea-hypopnea index (AHI) was significantly higher in patients with PE than population controls (21.2±20.6 vs 11.5±15.9 h⁻¹; P<.001). The presence of an AHI greater than 5 h⁻¹ and hypersomnolence (Epworth Sleepiness Scale score ≥11) was more frequent in PE patients than in controls (14.0% vs 4.9%; P=.0002). A crude model analysis by several cutoffs revealed that the AHI was significantly associated with PE. After adjustment for age, sex, smoking, BMI, lung function, and all known PE risk factors, the odds ratio for PE was 3.7 (95% CI, 1.3-10.5; P=.01).

Conclusion

A higher prevalence of OSA was detected in patients diagnosed as having acute PE than controls. This study identified a significant and independent association between OSA and PE.

Section snippets

Ethics Statement

The study was approved by the institutional ethics committee at the hospitals, and all participants gave their written informed consent.

Participants

Consecutive patients newly diagnosed as having PE and population-based volunteers were included in the study from October 1, 2006, through November 30, 2009. We performed a 2-center case-control study (University Hospital Son Espases, Palma de Mallorca, and University Hospital La Paz, Madrid, Spain). We included all patients with a previous (6-12 months) PE

Results

Figure 1 shows the CONSORT flowchart for the study participants. A total of 107 (66 men) consecutive patients with newly diagnosed PE and 102 (59 men) population-based volunteers were included in the study. The main demographic and functional characteristics of all participants are given in Table 1. Anthropometric characteristics, smoking habits, daily physical activity level, lung function, and blood pressure did not differ between patients with PE and controls . Dyslipidemia was more frequent

Discussion

Our study provides 2 main findings of interest. First, OSA is more frequent in patients with PE than in a population sample without previous history of PE. Second, there is a significant and independent association between OSA and PE. There are only 3 previous studies that evaluated the potential relationship between OSA and PE.5, 6, 7 Arnulf et al⁶ reported that 63% of 72 patients with PE or DVT had an AHI greater than 15 h⁻¹. They concluded a possible association between OSA and PE exists

Conclusion

Our results demonstrate that OSA prevalence is higher in patients with PE than controls. We also found a significant and independent association between sleep apnea and PE. Future studies will be needed to study intermediate mechanisms explaining this relationship. Furthermore, additional data regarding genetic and acquired disorders as PE risk factors are needed to better assess risk in the individual, to target appropriate prophylaxis, and to clarify whether CPAP treatment could decrease PE

Acknowledgments

We thank Margalida Bosch, Mónica Iglesias, Ángel Ríos, Meritxell López, and Meritxell Arqué for their assistance in the coordination of the study.

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Our study aligns with the literature in concluding that OSA has deleterious effects on postoperative outcomes of cardiac surgery patients. Further research to better stratify OSA patients by severity are still needed. Additionally heightened awareness of the need to screen, diagnose, and properly treat patients for OSA is needed.
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Two equal-sized cohorts comprised of 85,912 matched pairs were obtained. The OSA cohort demonstrated significantly higher rates of future ICU admissions, hospital admissions, emergency room visits, and outpatient visits. Matching for comorbid cardiovascular conditions continued to demonstrate higher healthcare utilization in the OSA group. Short-term outcomes during the index hospitalization were relatively similar between groups.
This retrospective database study demonstrated that OSA may be an independent marker of higher future healthcare utilization. On the other hand, the length of stay during the index hospitalization was not elevated. Prospective studies are needed to confirm these findings and investigate the impact of directing additional resources to inpatients with OSA.

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: Grant Support: This research was partially supported by grants from Direcció General d'Avaluació i Acreditació, Conselleria de Salut i Consum, Illes Balears 2009, Neumomadrid 2009 and SEPAR 2008 (820), and Ministerio de Educación y Ciencia (SAF2007-62270).

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Original articleAssociation Between Obstructive Sleep Apnea and Pulmonary Embolism

Abstract

Objectives

Methods

Results

Conclusion

Section snippets

Ethics Statement

Participants

Results

Discussion

Conclusion

Acknowledgments

J Thromb Haemost

Lancet

Chest

Chest

Arch Bronconeumol

Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study

Arch Intern Med

Venous thromboembolism (VTE) in Europe: the number of VTE events and associated morbidity and mortality

Thromb Haemost

Acute pulmonary embolism

N Engl J Med

Risk factors for venous thromboembolism

Circulation

Obstructive sleep apnea and venous thromboembolism

JAMA

Snoring and the risk of obstructive sleep apnea in patients with pulmonary embolism

Sleep

Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr

Am J Respir Crit Care Med

Association of physical activity with sleep-disordered breathing

Sleep Breath

A case-control study of seated immobility at work as a risk factor for venous thromboembolism

J R Soc Med

Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome

Am J Respir Crit Care Med

An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome

Thromb Haemost

In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome

Respiration

Association between sleep apnea severity and blood coagulability: treatment effects of nasal continuous positive airway pressure

Sleep Breath

Silent brain infarction and platelet activation in obstructive sleep apnea

Am J Respir Crit Care Med

Original article
Association Between Obstructive Sleep Apnea and Pulmonary Embolism