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. 2023 Apr;123(4):393-401.
doi: 10.1055/a-2000-8288. Epub 2022 Dec 19.

Sleep Apnea and Incident Unprovoked Venous Thromboembolism: Data from the Pays de la Loire Sleep Cohort

Wojciech Trzepizur  1   2 , Chloé Gervès-Pinquié  3 , Baptiste Heudes  1 , Margaux Blanchard  4 , Nicole Meslier  1   2 , Marie Jouvenot  5 , Sandrine Kerbat  6 , Raphael Le Mao  7   8 , Eline Magois  9 , Jean-Louis Racineux  3 , AbdelKebir Sabil  3   10 , Jérémie Thereaux  11   12 , Francis Couturaud  7 , Frédéric Gagnadoux  1   2 ; Pays de la Loire Cohort Study Group
Affiliations

Sleep Apnea and Incident Unprovoked Venous Thromboembolism: Data from the Pays de la Loire Sleep Cohort

Wojciech Trzepizur et al. Thromb Haemost. 2023 Apr.

Abstract

Background: Previous studies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and incident venous thromboembolism (VTE). More specifically, the association between OSA and unprovoked VTE was barely evaluated. We aimed to evaluate whether apnea hypopnea index (AHI) and nocturnal hypoxemia markers were associated with unprovoked VTE incidence in patients investigated for OSA.

Material and methods: Data from the Pays de la Loire Sleep Cohort were linked to the French health administrative data to identify incident unprovoked VTE in patients suspected for OSA and no previous VTE disease. Cox proportional hazards models were used to evaluate the association of unprovoked VTE incidence with AHI and nocturnal hypoxemia markers including the time spent under 90% of saturation (T90), oxygen desaturation index, and hypoxic burden (HB), a more specific marker of respiratory events related to hypoxia. The impact of continuous positive airway pressure (CPAP) was evaluated in the subgroup of patients who were proposed the treatment.

Results: After a median [interquartile range] follow-up of 6.3 [4.3-9.0] years, 104 of 7,355 patients developed unprovoked VTE, for an incidence rate of 10.8 per 1,000 patient-years. In a univariate analysis, T90 and HB predicted incident VTE. In the fully adjusted model, T90 was the only independent predictor (hazard ratio: 1.06; 95% confidence interval: [1.01-1.02]; p = 0.02). The CPAP treatment has no significant impact on VTE incidence.

Conclusion: Patients with more severe nocturnal hypoxia are more likely to have incident unprovoked VTE.

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Conflict of interest statement

W.T. reports support for attending meetings by ASTEN SANTE. C.G.-P. has nothing to disclose. B.H. has nothing to disclose. M.B. has nothing to disclose. N.M. reports support for attending meetings by ASTEN SANTE. M.J. has nothing to disclose. S.K. has nothing to disclose. R.L.M. received support for attending meetings by Astra Zeneca, GSK and Orkyn, and consulting fees from Astra Zeneca and GSK, outside the submitted work. E.M. has nothing to disclose. J.-L.R. has nothing to disclose. A.S. has nothing to disclose. J.T. received fees from Laboratoire Pierre Fabres, outside the submitted work. F.C. received consulting fees from Bayer, Pfizer, Astra, MSD, GSK, Leopharma, outside the submitted work. F.G. received support for attending meetings by ASTEN SANTE and ACTELION and consulting fees from NYXOAH, SEFAM, RESMED, CIDELEC, ASTEN SANTE, and BOEHRINGER INGELHEIM, outside the submitted work.

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