Prevalence of obstructive sleep apnea in acute phase of pulmonary embolism: Preliminary results of ESAET study

Introduction: Currently, Sleep-Disordered breathing has recognized prothrombotic effects and there is growing evidence that obstructive sleep apnea (OSA) is highly prevalent in pulmonary embolism (PE) and might increase its risk. Aims: To assess the prevalence of OSA in the acute phase of PE, and the association between OSA and the presence of right ventricular (RV) dysfunction Methods: We performed a multicenter and observational study in consecutive hemodynamically stable patients with acute symptomatic PE. Recruited patients underwent an overnight sleep study and transthoracic echocardiography within the first 48 hours of diagnosis. Results: 82 patients have been recruited. Mean apnea-hypopnea index (AHI) was 24/h (SD 21.27), 66 patients (80.5%) with OSA criteria (AHI≥5h). Patients with AHI≥15/h presented significantly higher thrombus load by computerized tomography (CT) (49% vs 47%; p=0.013) and by D-dimer levels (50% vs 44%; p=0.094); and impaired RV function measured by RV/left ventricle ratio>0.9 (27% vs 23%; p=0.03). We also observed an elevated PE severity score defined by PESIs score ≥1 in these patients, but it was not statistically significant (83% vs 72%; p=0.25). Multiple logistic regression analysis revealed an association between patients with AHI ≥ 15/h and thrombus load (OR 3.1; CI 95%, 1.2-7.5; p=0.018), and impaired RV functions (OR 1.7; CI95%, 1.1-4.2; p=0.032), when adjusted by PESIs score, gender and body mass index. Conclusion: OSA is highly prevalent in patients with hemodynamically stable acute PE. Patients with acute PE and moderate-severe OSA (AHI≥15/h) had more PE severity, characterized by greater thrombotic burden and presence of RV dysfunction.