Obstructive sleep apnea has been linked to myocardial infarction and increased levels of prothrombotic hemostasis factors. However, little is known about the incidence and risk of venous thromboembolism (VTE) in these patients.
Data from the National Hospital Discharge Survey (NHDS) were analyzed from 1979 through 2005. International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM) codes were used to identify patients with sleep disordered breathing (SDB) and VTE.
Among 2,434,123 patients hospitalized with SDB from 1979 to 2005, the incidence of pulmonary embolism (PE) was 24,953 (1.03%), deep vein thrombosis (DVT) 28,378 (1.17%), and VTE 47,160 (1.94%). There were 1,464,485 (60%) males, and 969,638 (40%) females with SDB. Incidence of PE in males with SDB was 0.69 %, DVT 1.2 %, and VTE 1.68%. Incidence of PE in females with SDB was 1.53%, DVT 1.12%, and VTE 2.32%. Among patients 60 years of age and older with SDB; incidence of PE was 1.09%, DVT 1.49%, and VTE 2.3%. The relative risk for VTE in all SDB patients compared to non SDB was 1.72 (95% CI=1.70–1.74). Relative risk for VTE in females with SDB compared to females without SDB was 2.11 (95% CI=2.08–2.14). Among patients older than 60 years, relative risk was 1.28 (95% CI= 1.26–1.30).
Sleep disordered breathing including obstructive sleep apnea, central sleep apnea, and obesity hypoventilation syndrome is a significant risk factor for VTE. This is likely related to the prothrombotic state in sleep apnea patients. This risk is more prominent in women, and less prominent in patients 60 years of age and older.
Identifying SDB as a risk factor for VTE will aid in providing appropriate level of prophylaxis, and more prompt diagnosis for these patients.
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