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

Abstract

We determined sex differences in the prevalence of obstructive sleep apnea (OSA) among patients hospitalized with pulmonary embolism (PE) in Spain (2016–2018). We also compared outcomes according to the presence of OSA, and identified variables associated with in-hospital-mortality (IHM) after PE using the Spanish National Hospital Discharge Database. We identified 46,794 hospital admissions for PE; of these, 5.47% had OSA. OSA was more prevalent among men than women (7.57% vs. 3.65%, p < 0.001), as in the general population. Propensity score matching did not reveal differences in concomitant conditions or procedures between patients with and without OSA, except for the use of non-invasive ventilation, which was more frequent in patients with OSA. IHM was similar in patients with and without OSA (3.58% vs. 4.31% for men and 4.39% vs. 4.93% for women; p > 0.05). Older age, cancer, atrial fibrillation, non-septic shock, and need for mechanical ventilation increased IHM in men and women with OSA hospitalized with PE. The logistic regression model showed no sex differences in IHM among patients with OSA.

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

“…There are several limitations to the present review. First, despite including several new studies ( 9 , 10 , 15-17 ) as compared with a previous review ( 11 ), the total number of studies in the present review was not very high. A significant limitation was the difference in the reporting of outcomes by the studies which significantly restricted the number of studies in each 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).…”

“…First, it has been suggested that right ventricle dysfunction due to PE may be more tolerated in patients with OSA as they are adapted to recurring right heart pressure overloads provoked by poor pulmonary perfusion due to repeated oxygen desaturation during sleep. Thus, the right ventricles in OSA patients may be more resistant to injury and hemodynamic collapse due to acute PE which may, in turn, reduce the risk of early mortality ( 9 , 15 ). Second, Joshi et al ( 10 ) suggested that OSA patients have higher hemoglobin levels due to repeated hypoxemias which may have a protective role in PE by preventing worsening of hypoxia.…”

“…An obesity paradox has been noted wherein patients with higher body mass index have improved outcomes in acute diseases possibly due to improved medical care or due to higher metabolic reserves ( 35 , 36 ). It is plausible that such associations could have led to improved survival in OSA patients ( 15 ). However, it should also be noted that the data for in-hospital mortality was mostly from registry-based studies which are prone to errors in record-keeping and data entry.…”