Obstructive sleep apnea is associated with worse clinical‐radiological risk scores of pulmonary embolism

Abstract

Summary Obstructive sleep apnea is a risk factor for pulmonary embolism, although its association with pulmonary embolism severity is unknown. Our objective was to study if obstructive sleep apnea is associated with worse pulmonary embolism severity scores and greater extent of arterial obstruction. In consecutive pulmonary embolism patients, we performed respiratory polygraphy and recorded sleep characteristics, classical risk factors for pulmonary embolism and physical activity 6–12 months after the pulmonary embolism episode. Simplified Geneva Prognostic Score and Pulmonary Embolism Severity Index were calculated at the time of the pulmonary embolism diagnosis. The Pulmonary Artery Obstruction Index and the right ventricle to left ventricle diameter ratio were measured by computed tomography pulmonary angiography. We included 120 patients, of whom 45.8% had moderate‐severe obstructive sleep apnea (apnea–hypopnea index > 15 hr−1). There was a larger proportion of moderate‐severe obstructive sleep apnea patients in the third and fourth Pulmonary Artery Obstruction Index quartiles and in the III‐V Pulmonary Embolism Severity Index levels compared with apnea–hypopnea index < 15 hr−1 group. However, no differences were found between the proportion of patients with or without moderate‐severe obstructive sleep apnea in their stratification by simplified Geneva Prognostic Score. The mean adjusted values of the simplified Geneva Prognostic Score, Pulmonary Embolism Severity Index and Pulmonary Artery Obstruction Index scores were higher in the apnea–hypopnea index > 15 hr−1 group (p < .05). Multiple linear regression analysis identified apnea–hypopnea index as the only independent factor related to Pulmonary Artery Obstruction Index and Pulmonary Embolism Severity Index, whereas desaturation index was associated with simplified Geneva Prognostic Score. Patients with pulmonary embolism and moderate‐severe obstructive sleep apnea had greater pulmonary artery obstruction as well as more pulmonary embolism severity, assessed by both the simplified Geneva Prognostic Score and the Pulmonary Embolism Severity Index, compared with patients with apnea–hypopnea index ≤ 15 hr−1. Moreover, these prognostic indices were independently related to sleep parameters.

Prognostic Impact of Obstructive Sleep Apnea in Patients Presenting with Acute Symptomatic Pulmonary Embolism

“…As shown in a previous study, OSA confers a greater pulmonary artery obstruction, therefore leading to RV strain and cardiogenic shock. 26 However, our study did not find a significant difference in the rates of echocardiographic RV dysfunction between both groups. The fact that there was not a large proportion of patients with OSA with coexisting RV dysfunction (25%) may have several explanations.…”

Sex-differences in the effect of obstructive sleep apnea on patients hospitalized with pulmonary embolism and on in-hospital mortality

“…As a consequence, we do not have information on the severity of OSA, which has demonstrated prognostic value in PE 36 . Second, the absence of laboratory and imaging data and data on medical treatment during hospital stay prevents us from predicting outcomes in PE 1 . Third, we had no data on use of continuous positive airway pressure (CPAP), which is the primary treatment for OSA and may reduce exaggerated coagulant activity and platelet function and improve fibrinolytic capacity in affected patients 19 .…”

“…Pulmonary embolism (PE) generates a substantial burden for public health services because of its high morbidity and mortality. It is the most life-threatening form of venous thromboembolism and the third most frequent cause of vascular death worldwide 1 , 2 . The main risk factors for PE are age, active cancer, congenital or acquired thrombophilia, hormone replacement and oral contraceptive therapy, previous PE, and obesity.…”

Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

“…13,14 Meanwhile, our findings have been confirmed by a recent study. 15 These observations might be explained by several circumstances: on the one hand, it has been postulated that the elevation in pulmonary arterial pressure seems to be generally mild in OSA and severe RV dysfunction only appears in the presence of other underlying diseases, such as CHF with an impaired cardiac reserve, for example Sajkov and McEvoy 3 and Furlan et al 14 In our study population, such comorbidities were rare, possibly explaining the fact that we didn`t observe any association between the severity of OSA and the prevalence of RV dysfunction.…”