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Correspondence |

OSA and Recurrent VTE: Causality or Cause? FREE TO VIEW

Sibel Ocak Serin, MD; Gulsah Karaoren, MD; Antonio M. Esquinas, MD, PhD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Internal Medicine, Istanbul Umraniye Research Hospital, Istanbul, Turkey

bDepartment of Anesthesiology and Reanimation, Istanbul Umraniye Research Hospital, Istanbul, Turkey

cIntensive Care Unit, Hospital Morales Meseguer, Murcia, Spain

CORRESPONDENCE TO: Gulsah Karaoren, MD, Department of Anesthesiology and Reanimation, Istanbul Umraniye Research Hospital, Umraniye, Istanbul, Turkey 34380


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


Chest. 2017;151(2):514-515. doi:10.1016/j.chest.2016.10.063
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We have read with great interest the article written by Alonso-Fernández et al published in CHEST (December 2016). However, there are some key aspects to take into account for proper practical implications.

In the literature, OSA is classified according to the apnea-hypopnea index (AHI) as follows: AHI < 5, snoring; AHI 5-15, mild; AHI 16-30, moderate; AHI > 30, severe. In the study by Alonso-Fernández et al, patients with an AHI ≥ 10/h and those with an AHI > 30/h were included, and the authors did not provide information regarding the basis for selecting patients with an AHI ≥ 10 and the reason for excluding patients with an AHI of 5-9.

It is well known that obesity is one of the most important risk factors for both OSA and recurrent pulmonary embolism (PE). In their study, there were 30 obese patients among 120 patients included. However, when groups were evaluated, all patients had a BMI < 30 kg/m2. Moreover, no significant difference in BMI was found between patients with and those without PE recurrence and between those with and those receiving ongoing oral anticoagulation therapy (Tables 2 and 5 of original article).

In the study, CPAP was prescribed to 31 patients with OSA. The authors concluded that CPAP compliance (CPAP use > 4 h/night) tended to be lower among patients with PE recurrence when compared with those without recurrence (17% vs 64%; P = .051). Does a P value < .05 allow such a conclusion? We consider that it is an important aspect for proper clinical extrapolation.

The authors compared patients with OSA and adequate CPAP compliance and patients not receiving OSA or patients with poor CPAP compliance to assess the effect of CPAP treatment on the risk of PE recurrence or restarting anticoagulation and found no significant differences between groups. The authors explained this finding by stating that it was “probably due to small sample size.” However, in the manuscript, the authors stated “probably due to small sample size” to explain a finding more than once. This should be mentioned in the limitations of the study rather than in the text itself. In addition, this may also indicate the need for a larger sample size in this study.

In the study, the results seem conflicting. Almost all parameters evaluated (mean BMI, D-dimer, FEV1/FVC, baseline arterial oxygen saturation, and Epworth Sleepiness Scale) were mild to moderate in severity. In addition, there was no significant difference in these parameters between groups in patients with an AHI ≥ 10. Thus, how could arterial oxygen saturation, D-dimer, and ESS be independent risk factors? Further clinical prospective clinical trials are needed to confirm these associations.

References

Alonso-Fernández A. .García Suquia A. .de la Peña M. .et al OSA is a risk factor for recurrent VTE. Chest. 2016;150:1291-1301 [PubMed]journal. [CrossRef] [PubMed]
 
Zeleznik J. . Normative aging of the respiratory system. Clin Geriatr Med. 2003;19:1-18 [PubMed]journal. [CrossRef] [PubMed]
 
Burton L.A. .Sumukadas D. . Optimal management of sarcopenia. Clin Interv Aging. 2010;5:217-228 [PubMed]journal. [PubMed]
 

Figures

Tables

References

Alonso-Fernández A. .García Suquia A. .de la Peña M. .et al OSA is a risk factor for recurrent VTE. Chest. 2016;150:1291-1301 [PubMed]journal. [CrossRef] [PubMed]
 
Zeleznik J. . Normative aging of the respiratory system. Clin Geriatr Med. 2003;19:1-18 [PubMed]journal. [CrossRef] [PubMed]
 
Burton L.A. .Sumukadas D. . Optimal management of sarcopenia. Clin Interv Aging. 2010;5:217-228 [PubMed]journal. [PubMed]
 
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