Fabian Geissenberger1, Florian Schwarz2,3, Michael Probst2, Sabine Haberl1, Asawari Parkhe1, Christian Faul1, Dirk von Lewinski4, Thomas Kroencke2, Martin Schwaiblmair1,3, Wolfgang von Scheidt1,3, Thomas M Berghaus5,6. 1. Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany. 2. Department of Radiology, University Hospital Augsburg, Augsburg, Germany. 3. Ludwig-Maximilians-University Munich, Munich, Germany. 4. Division of Cardiology, Medical University of Graz, Graz, Austria. 5. Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany. thomas.berghaus@uk-augsburg.de. 6. Ludwig-Maximilians-University Munich, Munich, Germany. thomas.berghaus@uk-augsburg.de.
Abstract
INTRODUCTION: Obstructive sleep apnea (OSA) may have prothrombotic effects. OBJECTIVE: To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE). METHODS: In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy. RESULTS: Obstructive sleep apnea patients with an apnea-hypopnea index (AHI) ≥ 15/h cohort were significantly older (p < 0.001) and had significantly lower oxygen saturations (p = 0.008) when acute PE was diagnosed. The sPESI scores (p < 0.001), the PAOI (p = 0.005) and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) values (p = 0.009), were significantly higher in the AHI ≥ 15/h subgroup. In a multivariate regression analysis, the AHI remains a significant predictor for sPESI scores ≥ 1 (p = 0.003), increased NT-proBNP levels (p = 0.047), and elevated PAOI (p = 0.032). During the median follow-up time of 53 (interquartile range 38-70) months, all-cause and cardiovascular-related mortality was significantly higher in the AHI ≥ 15/h cohort (p = 0.004 and p = 0.015, respectively). CONCLUSIONS: Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute PE possibly due to its prothrombotic effects.
INTRODUCTION: Obstructive sleep apnea (OSA) may have prothrombotic effects. OBJECTIVE: To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE). METHODS: In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy. RESULTS: Obstructive sleep apneapatients with an apnea-hypopnea index (AHI) ≥ 15/h cohort were significantly older (p < 0.001) and had significantly lower oxygen saturations (p = 0.008) when acute PE was diagnosed. The sPESI scores (p < 0.001), the PAOI (p = 0.005) and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) values (p = 0.009), were significantly higher in the AHI ≥ 15/h subgroup. In a multivariate regression analysis, the AHI remains a significant predictor for sPESI scores ≥ 1 (p = 0.003), increased NT-proBNP levels (p = 0.047), and elevated PAOI (p = 0.032). During the median follow-up time of 53 (interquartile range 38-70) months, all-cause and cardiovascular-related mortality was significantly higher in the AHI ≥ 15/h cohort (p = 0.004 and p = 0.015, respectively). CONCLUSIONS: Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute PE possibly due to its prothrombotic effects.
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