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Original Research |

Obstructive Sleep Apnea is a Risk Factor for Recurrent Venous Thromboembolism

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

Conflict of interest statements for each author:

Financial 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)

1Department of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain

2Department of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain

3Department of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain

4Research Unit. University Hospital Son Espases, Palma de Mallorca, (IdISPa) Spain

5Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain

6Department of Internal Medicine, University Hospital La Paz, Madrid, Spain

7CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain

Correspondence: Dr. Alberto Alonso Fernández, Servicio de Neumología. Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.011
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Abstract

BackGround  Obstructive sleep apnea (OSA) is a risk factor for a first episode of pulmonary embolism (PE), although its impact on the risk of thromboembolism recurrence is uncertain. Our objective was to explore the prognostic value of OSA after discontinuing 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 a home respiratory polygraphy and recorded sleep characteristics, classical risk factors for PE, blood pressure, spirometric parameters, physical activity and levels of D-dimer and prothrombin fragment 1+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 (hazard ratio [HR], 20.73; 95%CI, 1.71-251.28), mean nocturnal oxygen saturation (SaO2) (HR, 0.39; 95%CI, 0.20-0.78), time with SaO2<90% (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. 24 patients resumed OAC, and AHI ≥10 (HR, 20.66; 95%CI, 2.27-188.35), mean nocturnal SaO2 (HR, 0.54; 95%CI, 0.32-0.94) and Epworth sleepiness score (HR, 0.73; 95%CI, 0.56-0.97) were retained as independent risk factors to resume 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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