Abstract
BackgroundGrowing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation.MethodsIn a prospective cohort study, patients with documented VTE, were followed for an indefinite length of time and VTE recurrence were documented and adjudicated. The primary outcome was recurrent VTE after anticoagulation discontinuation. Secondary outcomes included all-cause mortality and the clinical presentation of VTE. Univariable and multivariable analyses were performed to identify risk factors for recurrence and mortality.ResultsAmong the 2109 patients with documented VTE included, 74 patients had moderate to severe OSA diagnosis confirmed by home sleep test or polysomnography. During a median follow-up of 4.8 (interquartile range 2.5–8.0) years recurrent VTE occurred in 252 patients (9 with OSA and 243 without OSA). The recurrence risk in the univariable and multivariable analysis was not increased in patients with OSA, regardless of the time of diagnosis (before or after index VTE or pooled). VTE phenotype was significantly more often PE with or without associated deep vein thrombosis in the first event and recurrence for OSA patients compared to non-OSA patients. The risk of death was not increased in the OSA population compared to non-OSA patients in multivariable analysis.ConclusionsIn patients with OSA and VTE, the risk of all-cause mortality and VTE recurrence after anticoagulation discontinuation was not increased compared to non-OSA patients.
Highlights
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a major health issue
Though this study suggested an increased risk of venous thromboembolism (VTE) recurrence in obstructive sleep apnea (OSA) patients, prospective studies showed some conflicting results regarding VTE recurrence risk [27,28,29]
Symptomatic PE was confirmed if there was: (i) a high clinical probability and a high-probability ventilation-perfusion lung scan according to the PIOPED criteria, or (ii) a proximal DVT showed by ultrasonography in a patient with symptoms of PE, or (iii) a positive computed tomography pulmonary angiography (CTPA) showing a central filling defect outlined by contrast material or complete occlusion in a segmental or more proximal pulmonary artery
Summary
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a major health issue. Obstructive sleep apnea (OSA), characterized by periodic narrowing and obstruction of the pharyngeal airway during sleep [6], is a common disease (3 to 10% of the general population) [7,8,9], probably underestimated [10] and associated with the onset of cardiovascular and (2022) 20:1 metabolic comorbidities [11,12,13,14,15,16,17]. VTE and OSA have some risk factors in common such as age, obesity and immobility [18]. Growing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation
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