Obstructive sleep apnoea and risk of recurrent venous thromboembolism

Abstract

INTRODUCTION: Pulmonary embolism (PE) has a cumulative recurrence rate of about 25% at 5 years, which is associated with an increased mortality rate and chronic pulmonary hypertension. There is evidence that Obstructive Sleep Apnea syndrome (OSA) is an independent risk factor for first PE episode but its impact on PE recurrence is uncertain. AIMS AND OBJECTIVES: To investigate whether OSA was associated with an increased risk of recurrent PE and to analyze the potential effect of OSA on oral anticoagulation (OA) resumption. METHODS: We included patients with PE diagnosed by computed tomography angiography that had completed at least 3 months of OA. Patients were classified as having OSA when apnoea-hypopnea index (AHI) ≥10 h-1 (Stardust polygraph). They were followed up 78±16 months. RESULTS: We included 120 patients with PE. 71 (59.2%) patients had OSA. 19 patients presented PE recurrence and 16 of them had OSA. The prevalence of OSA was significantly higher in patients with PE recurrence compared with those who did not relapse (84 vs. 54%, p=0.012). Patients with OSA had a higher and independent risk of recurrent PE than those without OSA (HR: 20.73; 95% CI1.71-251.28). 24 (20%) patients resumed OA (19 PE and 5 deep vein thrombosis cases), and 20 of them had OSA. Mean nocturnal SaO2, %, OSA and Epworth sleepiness score were independent risk factors to resume OA. CONCLUSIONS: OSA is an independent risk factor for recurrent PE and for resuming OA. Despite identification of classical PE recurrence risk factors, and new prophylaxis regimens, the occurrence of PE is growing, so it could be helpful to identify a new group of patients with a high risk of recurrence who might require longer OA and/or CPAP.