OSA a Prognostic Factor for Recurrent Pulmonary Embolism

Obstructive sleep apnea (OSA) may be a predictive factor of recurrent pulmonary embolism (PE), according to research presented at the CHEST Annual Meeting 2019.

Previous research has shown a higher prevalence of OSA in patients with acute PE. Researchers conducted a literature review to determine any link between OSA and recurrent PE. They searched Medline and the Cochrane Library for English-language studies that included the following terms: sleep apnea syndromes; sleep apnea, obstructive; pulmonary embolism; and thrombosis. They used the Quality in Prognosis Studies (QUIPS) tool to assess methodological quality and risk of bias.

Six studies were included in the final analysis: four prospective cohort studies, one prospective case-control study, and one single-arm prognostic study. All studies were deemed low quality and heterogeneous due to different objectives, outcomes, and definitions of OSA. QUIPS found all to be at moderate to high risk of bias.

Despite variable primary outcomes, the researchers noted several themes. OSA was an independent risk factor for recurrent PE in two studies. In the first study, patients with an apnea-hypopnea index >10 had a hazard ratio of 20.73 (95% CI, 1.71 to 251.58).

In the second study, recurrent PE was observed in 21.4% of patients with OSA compared with 6.8% of patients without OSA. Patients with PE and OSA had significantly elevated d-dimer levels after anticoagulation cessation: 35% with OSA versus 19% without OSA.

One study observed an improved sensitivity and specificity of current risk prediction models for recurrent PE when OSA was added as a prognostic factor. In addition, patients treated with positive airway pressure therapy had a trend toward decreased PE recurrence.

“If prospective studies are confirmatory, it would be reasonable to incorporate OSA as a standard item in prediction tools for recurrent PE,” the authors concluded.


Moores A, Patel S, Holley A, et al. OSA as a risk for recurrent pulmonary embolism: a systematic review. Presented at the CHEST Annual Meeting 2019. October 19-23, 2019; New Orleans, Louisiana.