Acute pulmonary embolism in patients with obstructive sleep apnea: frequency, hospital outcomes, and recurrence

Abstract

Study Objectives: The objectives of this study were to assess the effect of obstructive sleep apnea (OSA) on the risk of acute pulmonary embolism (PE), hospital outcomes including mortality, and PE recurrence. Methods: We retrospectively enrolled adult patients, admitted to Mayo Clinic Hospital in Rochester, Minnesota, within a 5-year period (2009)(2010)(2011)(2012)(2013). We compared frequency of PE, hospital mortality, and secondary outcomes in patients with OSA versus patients without OSA. We assessed risk of PE recurrence in relation to compliance with OSA therapy. Results: Of 25,038 patients, 3,184 (13%) had OSA and 283 (1.1%) experienced PE. Frequency of PE in patients with and without OSA was 2.4% versus 0.9% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.9-3.3; P < .001). OSA was independently associated with increased risk of PE after adjusting for demographics and comorbidities (OR, 1.44; 95% CI, 1.07-1.9; P =.017). Adjusted hospital mortality was increased in patients with PE (OR, 2.88; 95% CI, 1.7-4.9; P <.001) but not in patients with OSA (OR, 0.98; 95% CI, 0.7-1.4, P =.92). OSA was not a significant determining factor for mortality in patients who experienced a PE (OR, 0.56; 95% CI, 0.1.1-2.78; P =.47), adjusting for demographics, PE severity, and Charlson comorbidity index. Adjusted risk of PE recurrence was greater in patients with OSA compared with patients without OSA (OR, 2.21; 95% CI, 1.05-4.68; P < .04). The patients compliant with OSA therapy had a lower rate of PE recurrence (16% vs 32%; P = not significant). Conclusions: Although OSA significantly increases risk of acute PE occurrence and recurrences, related hospital mortality was not greater in patients with OSA compared with those without OSA. OSA therapy might have a modifying effect on PE recurrence.

Impact of obstructive sleep apnea on outcomes of pulmonary embolism: A systematic review and meta‑analysis

“…After evaluation of full-texts 11 were excluded as they did not satisfy the inclusion criteria. Finally, 12 studies were included in the present review (8)(9)(10)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Obstructive Sleep Apnea as a Risk Factor for Venous Thromboembolism: A Systematic Review

“…This finding was not reported in any other study that was analyzed in this review. Seckin et al found that patients with OSA who were treated with positive airway pressure (PAP) therapy had a 30% reduction in the relative risk for PE recurrence; however, this result was not statistically significant, possibly due to the small sample size of the subcohort [89]. A higher risk of recurrent VTE was reported in patients who are poorly compliant with CPAP therapy [69].…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…A different trial involving over 25 000 participants concluded that risk of acute pulmonary embolism (PE) occurrence and recurrence is significantly elevated with OSA compared with those without. 367 Treatment for OSA might have a modifying effect on PE occurrence.…”

“…Another study explored the impact of OSA on the risk of acute pulmonary embolism, hospital outcomes including mortality, and PE recurrence. 367 Adult patients from a single hospital system (Mayo Clinic, Rochester, Minn) were retrospectively enrolled over a 5year period. Frequency of PE, hospital mortality, and secondary outcomes were evaluated in participants with versus without OSA.…”