Changes in sleep-disordered breathing from the acute to the stable phase of pulmonary embolism and impact of right ventricular dysfunction: preliminary findings of ESAET study

Introduction: Acute pulmonary embolism (PE) may result in a transient increase in sleep-disordered breathing (SDB), mainly in patients with right ventricular dysfunction (RVD) (figure). Aims: To assess the changes in the number and severity of SDB from the acute to the stable phase of PE and the role of the RVD. Methods: Prospective observational study made in 43 hemodynamically stable acute PE patients, who underwent a respiratory polygraphy (RP1) and a transthoracic echocardiography (TTE) within the first 48 hours of starting anticoagulant therapy. RP (RP2) was re-evaluated 3 months later. Significant changes in obstructive Apnea-Hypopnea Index (oAHI) was defined as oAHIRP1 - oAHIRP2 ≥ mean oAHI change in the whole sample. Results: Mean oAHIRP1 was 25.3 (±22.3) and oAHIRP2 was 20.2 (±20.7) (p=0.09). Mean oxygen desaturation index 4% (ODI) in RP1 and RP2 were 25.8 (±23.5) and 19.3 (±16.3), respectively (p=0.02). Right ventricle (RV)/left ventricle ratio>0.9 were associated to transient increase in oAIH (OR 4.5 [1.2-17.1];p=0.026). We also observed a significant decrease in oAHI in patients with enlarged RV by TTE and central PE (-4 vs -0.8;p Conclusion: There was a decrease in SDB in stable phase of PE. RVD and thrombotic load during the acute phase of PE produces a transient increase in the SDB.