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Prognostic Impact of Obstructive Sleep Apnea in Patients Presenting with Acute Symptomatic Pulmonary EmbolismFunding 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.
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].
Received: 17 July 2020
Accepted: 31 October 2020
30 December 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Jiménez D, de Miguel-Díez J, Guijarro R. et al; RIETE Investigators. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J Am Coll Cardiol 2016; 67 (02) 162-170
- 2 Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol 2013; 18 (02) 129-138
- 3 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
- 4 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
- 5 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 2019; 140 (20) e774-e801
- 6 Barbero E, Bikdeli B, Chiluiza D. et al. Performance of early prognostic assessment independently predicts the outcomes in patients with acute pulmonary embolism. Thromb Haemost 2018; 118 (04) 798-800
- 7 Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003; 290 (14) 1906-1914
- 8 Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis 2015; 7 (08) 1311-1322
- 9 Jaffe LM, Kjekshus J, Gottlieb SS. Importance and management of chronic sleep apnoea in cardiology. Eur Heart J 2013; 34 (11) 809-815
- 10 Jiménez D, Bikdeli B, Quezada A. et al; RIETE investigators. Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study. BMJ 2019; 366: l4416
- 11 Laporte S, Mismetti P, Décousus H. et al. RIETE Investigators. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008; 117 (13) 1711-1716
- 12 Muriel A, Jiménez D, Aujesky D. et al; RIETE Investigators. Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk. J Am Coll Cardiol 2014; 63 (16) 1675-1683
- 13 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147 (08) 573-577
- 14 Bikdeli B, Jimenez D, Hawkins M. et al; RIETE Investigators. Rationale, design and methodology of the computerized registry of patients with venous thromboembolism (RIETE). Thromb Haemost 2018; 118 (01) 214-224
- 15 Riera-Mestre A, Jiménez D, Muriel A. et al; RIETE investigators. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. J Thromb Haemost 2012; 10 (05) 751-759
- 16 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263 (20) 2753-2759
- 17 Remy-Jardin M, Remy J, Wattinne L, Giraud F. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography. Radiology 1992; 185 (02) 381-387
- 18 Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med 1998; 129 (12) 1044-1049
- 19 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457-481
- 20 Bosanquet JP, Bade BC, Zia MF. et al. Patients with venous thromboembolism appear to have higher prevalence of obstructive sleep apnea than the general population. Clin Appl Thromb Hemost 2011; 17 (06) E119-E124
- 21 Arnulf I, Merino-Andreu M, Perrier A, Birolleau S, Similowski T, Derenne JP. Obstructive sleep apnea and venous thromboembolism. JAMA 2002; 287 (20) 2655-2656
- 22 Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165 (09) 1217-1239
- 23 Peng YH, Liao WC, Chung WS. et al. Association between obstructive sleep apnea and deep vein thrombosis / pulmonary embolism: a population-based retrospective cohort study. Thromb Res 2014; 134 (02) 340-345
- 24 Xie J, Li F, Wu X, Hou W. Prevalence of pulmonary embolism in patients with obstructive sleep apnea and chronic obstructive pulmonary disease: the overlap syndrome. Heart Lung 2019; 48 (03) 261-265
- 25 Ghiasi F, Ahmadpoor A, Amra B. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism. J Res Med Sci 2015; 20 (07) 662-667
- 26 Toledo-Pons N, Alonso-Fernández A, de la Peña M. et al. Obstructive sleep apnea is associated with worse clinical-radiological risk scores of pulmonary embolism. J Sleep Res 2020; 29 (02) e12871
- 27 May AM, Van Wagoner DR, Mehra R. OSA and cardiac arrhythmogenesis: mechanistic insights. Chest 2017; 151 (01) 225-241
- 28 Alonso-Fernández A, de la Peña M, Romero D. et al. Association between obstructive sleep apnea and pulmonary embolism. Mayo Clin Proc 2013; 88 (06) 579-587
- 29 Mañas E, Barbero E, Chiluiza D. et al; POPE Investigators. Impact of obstructive sleep apnea on cardiovascular outcomes in patients with acute symptomatic pulmonary embolism: rationale and methodology for the POPE study. Clin Cardiol 2017; 40 (12) 1182-1188