Effect of obstructive sleep apnea on the severity of acute pulmonary thromboembolism

Abstract

Objective: To investigate the effect of obstructive sleep apnea (OSA) on the severity of acute pulmonary thromboembolism (PTE). Methods: Clinical data of patients with acute PTE and OSA who were admitted to Anzhen Hospital from January 2015 to December 2017 were retrospectively analyzed in this study.According to the apnea hypopnea index (AHI), patients were divided into AHI≤15/h group and AHI>15/h group. The levels of oxygen desaturation index (ODI), mean pulse oxygen saturation (MSO(2)), the lowest pulse oxygen saturation (LSaO(2)), oxygen saturation<90% time ratio (Ts90%), hemoglobin, hematocrit (HCT), blood platelet, mean platelet volume (MPV), platelet distribution width (PDW), hypersensitive C-reactive protein (hsCRP), homocysteine (HCY), prothrombin time, activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer, fibrin degredation product (FDP), B-type natriuretic peptide, cardiac troponin I (cTnI), arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)) were compared between AHI≤15/h group and AHI>15/h group. Differences in the severity of PTE between the two groups were compared; binary Logistic regression model was used to analyze the risk factors of acute PTE severity. Results: A total of 75 patients with acute PTE and OSA were enrolled. Patients in the AHI>15/h group were significantly older [(68.7±9.9) vs (62.8±12.8) years old, P=0.029], and were more likely to have chronic heart failure and/or lung disease (53.1% vs 23.1%, P=0.012) and elevated Pulmonary Embolism Severity Index scores (61.2% vs 30.8%, P=0.012) than those in the AHI≤15/h group. Compared to the AHI>15/h group, the levels of D-dimer and B-type natriuretic peptide were much lower in the AHI ≤15/h group [243.0 (140.0, 471.5) vs 408.0 (258.0, 1 009.5) μg/L, P=0.01; 48.0 (19.8, 87.5) vs 70.0 (34.5, 201.0) ng/L, P=0.039], while arterial oxygen partial pressure was significantly higher [(79.0±10.6) vs (73.4±8.2) mmHg (1 mmHg=0.133 kPa), P=0.015]. In patients with acute PTE and OSA, AHI (P=0.030) and B-type natriuretic peptide level (P=0.023) were independently associated with an increased risk of acute PTE severity. Conclusion: In patients with PTE and OSA, moderate or severe OSA may aggravate the severity of acute PTE.