Association between obstructive sleep apnea and venous thromboembolism recurrence: results from a French cohort

Abstract

Background Growing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation. Methods In a prospective cohort study, patients with documented VTE, were followed for an indefinite length of time and VTE recurrence were documented and adjudicated. The primary outcome was recurrent VTE after anticoagulation discontinuation. Secondary outcomes included all-cause mortality and the clinical presentation of VTE. Univariable and multivariable analyses were performed to identify risk factors for recurrence and mortality. Results Among the 2109 patients with documented VTE included, 74 patients had moderate to severe OSA diagnosis confirmed by home sleep test or polysomnography. During a median follow-up of 4.8 (interquartile range 2.5–8.0) years recurrent VTE occurred in 252 patients (9 with OSA and 243 without OSA). The recurrence risk in the univariable and multivariable analysis was not increased in patients with OSA, regardless of the time of diagnosis (before or after index VTE or pooled). VTE phenotype was significantly more often PE with or without associated deep vein thrombosis in the first event and recurrence for OSA patients compared to non-OSA patients. The risk of death was not increased in the OSA population compared to non-OSA patients in multivariable analysis. Conclusions In patients with OSA and VTE, the risk of all-cause mortality and VTE recurrence after anticoagulation discontinuation was not increased compared to non-OSA patients.

Obstructive Sleep Apnea and Venous Thromboembolism: Unraveling the Emerging Association

“…Excess adipose tissue in individuals with obesity can lead to chronic inflammation and an imbalance in the production of prothrombotic factors, thereby increasing the risk of both OSA and VTE. The visceral fat accumulation further exacerbates these effects, creating a vicious cycle of inflammation and thrombogenesis [ 2 ].…”

“…Given the emerging association between OSA and VTE, it is crucial to prioritize the screening and identification of OSA in patients with VTE. Healthcare providers should be vigilant and recognize the potential coexistence of these conditions, understanding that addressing OSA in VTE patients may have significant clinical implications [ 2 ]. When evaluating patients with VTE, healthcare providers should consider the possibility of underlying OSA, particularly in individuals who share common risk factors such as obesity, older age, and comorbidities.…”

“…OSA is a sleeprelated breathing disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to disrupted sleep patterns and intermittent hypoxia. On the other hand, VTE encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE) and occurs due to the formation of blood clots within the venous system [1][2][3].…”

The Association between Obstructive Sleep Apnea and Venous Thromboembolism: A Bidirectional Two-Sample Mendelian Randomization Study

“…However, the results of observational studies remain somewhat controversial. A five-year prospective study involving 2109 subjects concluded that OSA did not increase the risk of VTE recurrence [13]. Another retrospective analysis involving 1,584 patients, of which 848 were women, revealed an intriguing discovery suggesting that OSA may serve as an independent risk factor for VTE solely in women, rather than in men [14].…”

“…A 5-year prospective study involving 2,109 subjects concluded that OSA did not increase the risk of VTE recurrence. 13 Another retrospective analysis involving 1,584 patients, of which 848 were women, revealed an intriguing discovery suggesting that OSA may serve as an independent risk factor for VTE solely in women, rather than in men. 14 Moreover, patients with VTE were found to have a higher prevalence of OSA, 15 suggesting a potential bidirectional relationship.…”