OSA Is a Risk Factor for Recurrent VTE

Abstract

Background: OSA is a risk factor for a first episode of pulmonary embolism (PE), although its impact on the risk of thromboembolism recurring is uncertain. Our objective was to explore the prognostic value of OSA after the discontinuation of oral anticoagulation (OAC) in patients with a first episode of PE.

Methods: In 120 consecutive patients who had stopped OAC for a first episode of PE, we performed home respiratory polygraphy and recorded sleep characteristics, classic risk factors for PE, blood pressure measurements, spirometric parameters, physical activity, and levels of D-dimer and prothrombin fragment 1+2 (F1+2). Patients were followed for 5 to 8 years, and the main end point was PE recurrence. Restarting OAC for any thromboembolic event was evaluated as a secondary end point.

Results: During the follow-up period, 19 patients had a PE recurrence, and 16 of them had an apnea-hypopnea index (AHI) ≥ 10 h^-1. In a multivariate Cox regression model, an AHI ≥ 10 h^-1 (hazard ratio [HR], 20.73; 95% CI, 1.71-251.28), mean nocturnal oxygen saturation (nSao₂) (HR, 0.39; 95% CI, 0.20-0.78), time with Sao₂ < 90% (CT90%) (HR, 0.90; 95% CI, 0.82-0.98), and D-dimer level (HR, 1.001; 95% CI, 1.00-1.002) were identified as independent risk factors for recurrent PE. Twenty-four patients resumed OAC, and AHI ≥ 10 h^-1 (HR, 20.66; 95% CI, 2.27-188.35), mean nSao₂ (HR, 0.54; 95% CI, 0.32-0.94), and Epworth Sleepiness Scale (ESS) (HR, 0.73; 95% CI, 0.56-0.97) were retained as independent risk factors for the resumption of OAC.

Conclusions: After a first episode of PE, OSA is an independent risk factor for PE recurrence or restarting OAC for a new thromboembolic event.

Keywords: D-dimer; pulmonary embolism; recurrent pulmonary embolism VTE; sleep apnea.