Thromb Haemost 2021; 121(06): 808-815
DOI: 10.1055/s-0040-1721506
Stroke, Systemic or Venous Thromboembolism

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

Raphael Le Mao
1  Département de Médecine Vasculaire, Interne et Pneumologie, EA3878, Groupe d'Etude de la Thrombose de Bretagne Occidentale, Centre hospitalo-universitaire de Brest, Université de Bretagne Occidentale, Brest, France
2  Centre d'Investigation Clinique INSERM 1412, Brest, France
David Jiménez
3  Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
4  Department of Medicine, Universidad de Alcalá, (IRYCIS), Madrid, Spain
5  CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
Behnood Bikdeli
6  Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
7  Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, United States
8  Cardiovascular Research Foundation, New York, New York, United States
Mateo Porres-Aguilar
9  Adult Thrombosis Medicine, Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC), Jewish General Hospital, Department of Medicine, McGill University, Montreal, Quebec, Canada
Alberto García-Ortega
10  Department of Respiratory Medicine, Hospital La Fe, Valencia, Spain
Vladimir Rosa
11  Department of Internal Medicine. Hospital Universitario Virgen de Arrixaca, Murcia, Spain
Sebastian Schellong
12  Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany
Lucia Mazzolai
13  Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
Francisco Rivera-Civico
14  Department of Internal Medicine, Hospital de Poniente, El Ejido, Almeria, Spain
Manuel Monreal
5  CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
15  Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
16  Department of Medicine, Universidad Católica de Murcia, Murcia, Spain
the RIETE Investigators› Author Affiliations
Funding None.


Background In patients with pulmonary embolism (PE), there is a lack of comprehensive data on the prevalence and prognostic significance of pre-existing obstructive sleep apnea (OSA).

Methods In this study of patients with PE from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence of OSA, and the association between pre-existing OSA and the outcomes of all-cause mortality, PE-related mortality, recurrences, and major bleeding over 30 days after initiation of PE treatment. Additionally, we also examined rates of outcomes within 90 days and 1 year following the diagnosis of PE.

Results Of 4,153 patients diagnosed with PE, 241 (5.8%; 95% confidence interval [CI]: 5.1–6.6%) had pre-existing OSA. Overall, 166 (4.0%; 95% CI: 3.4–4.6%) died during the first 30 days of follow-up. In multivariable analysis, the OSA syndrome was not a significant predictor of death from any cause (odds ratio [OR]: 1.5; 95% CI: 0.8–2.9; p = 0.19). However, patients with pre-existing OSA had an increased PE-specific mortality (adjusted OR: 3.0; 95% CI: 1.3–6.8; p = 0.01) compared with those without OSA. OSA was not significantly associated with 30-day recurrent venous thromboembolism (adjusted OR: 0.6; 95% CI: 0.1–4.7; p = 0.65) or major bleeds (adjusted OR: 1.0; 95% CI: 0.4–2.2; p = 1.0). Findings were similar at 90-day and 1-year follow-ups.

Conclusion In patients presenting with PE, pre-existing OSA is relatively infrequent. Patients with OSA were at increased risk of PE-related mortality when compared with those without OSA.

Authors' Contributions

Study concept and design: R.L.-M., D.J., B.B., and M.M. Acquisition of data, analysis and interpretation of data, and statistical analysis: R.L.-M., D.J., B.B. M.P.-A, A.G.-O, V.R., S.S., L.M., F.R.-C, and M.M. Critical revision of the manuscript for important intellectual content: R.L.-M., D.J., B.B. M.P.-A, A.G.-O, V.R., S.S., L.M., F.R.-C, and M.M. Study supervision: D.J. and M.M. The corresponding author, D.J., had full access to all the data in the study and had final responsibility for the decision to submit for publication.

* A full list of the RIETE investigators is given in [Supplementary Appendix A].

Supplementary Material

Publication History

Received: 17 July 2020

Accepted: 31 October 2020

Publication Date:
30 December 2020 (online)

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