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Original Research: Antithrombotic Therapy |

OSA Is a Risk Factor for Recurrent VTE

Alberto Alonso-Fernández, MD, PhD; Angela García Suquia, BPharm; Mónica de la Peña, MD; Raquel Casitas, MD; Javier Pierola, PhD; Antonia Barceló, MD PhD; Joan B. Soriano, MD, PhD; Carmen Fernández-Capitán, MD; Elizabet Martinez-Ceron, MD; Miguel Carrera, MD, PhD; Francisco García-Río, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This research was partially supported by grants from Direcció General d'Avaluació i Acreditació, Conselleria de Salut i Consum. Illes Balears 2009, Neumomadrid 2009, SEPAR 2008 [820], SEPAR-2010-820 and Comunidad de Madrid [S2010/BMD-2542], and Ministerio de Economía y Competitividad [PI10/00495].

aDepartment of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain

bDepartment of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain

cDepartment of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain

dResearch Unit, University Hospital Son Espases, Palma de Mallorca, (IdISPa) Spain

eInstituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain

fDepartment of Internal Medicine, University Hospital La Paz, Madrid, Spain

gCIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain

CORRESPONDENCE TO: Alberto Alonso-Fernández, MD, PhD, Servicio de Neumología, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1291-1301. doi:10.1016/j.chest.2016.07.011
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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.

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