Michael V Genuardi1, Aman Rathore2, Rachel P Ogilvie3, Rebecca S DeSensi2, Priya V Borker2, Jared W Magnani2, Sanjay R Patel2. 1. Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: michael.genuardi@pennmedicine.upenn.edu. 2. Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3. Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh School of Medicine, Pittsburgh, PA; Optum, Boston, MA.
Abstract
BACKGROUND: Previous studies suggesting that OSA may be an independent risk factor for VTE have been limited by reliance on administrative data and lack of adjustment for clinical variables, including obesity. RESEARCH QUESTION: Does OSA confer an independent risk of incident VTE among a large clinical cohort referred for sleep-disordered breathing evaluation? STUDY DESIGN AND METHODS: We analyzed the clinical outcomes of 31,309 patients undergoing overnight polysomnography within a large hospital system. We evaluated the association of OSA severity with incident VTE, using Cox proportional hazards modeling accounting for age, sex, BMI, and common comorbid conditions. RESULTS: Patients were of mean age 50.4 years, and 50.1% were female. There were 1,791 VTE events identified over a mean follow-up of 5.3 years. In age- and sex-adjusted analyses, each 10-event/h increase in the apnea-hypopnea index was associated with a 4% increase in incident VTE risk (hazard ratio [HR], 1.04; 95% CI, 1.02-1.06). After adjusting for BMI, this association disappeared (HR, 1.01; 95% CI, 0.99-1.03). In contrast, nocturnal hypoxemia had an independent association with incident VTE. Patients with > 50% sleep time spent with oxyhemoglobin saturation < 90% are at 48% increased VTE risk compared with those without nocturnal hypoxemia (HR, 1.48; 95% CI, 1.16-1.69). INTERPRETATION: In this large cohort, we found that patients with more severe OSA as measured by the apnea-hypopnea index are more likely to have incident VTE. Adjusted analyses suggest that this association is explained on the basis of confounding by obesity. However, severe nocturnal hypoxemia may be a mechanism by which OSA heightens VTE risk.
BACKGROUND: Previous studies suggesting that OSA may be an independent risk factor for VTE have been limited by reliance on administrative data and lack of adjustment for clinical variables, including obesity. RESEARCH QUESTION: Does OSA confer an independent risk of incident VTE among a large clinical cohort referred for sleep-disordered breathing evaluation? STUDY DESIGN AND METHODS: We analyzed the clinical outcomes of 31,309 patients undergoing overnight polysomnography within a large hospital system. We evaluated the association of OSA severity with incident VTE, using Cox proportional hazards modeling accounting for age, sex, BMI, and common comorbid conditions. RESULTS: Patients were of mean age 50.4 years, and 50.1% were female. There were 1,791 VTE events identified over a mean follow-up of 5.3 years. In age- and sex-adjusted analyses, each 10-event/h increase in the apnea-hypopnea index was associated with a 4% increase in incident VTE risk (hazard ratio [HR], 1.04; 95% CI, 1.02-1.06). After adjusting for BMI, this association disappeared (HR, 1.01; 95% CI, 0.99-1.03). In contrast, nocturnal hypoxemia had an independent association with incident VTE. Patients with > 50% sleep time spent with oxyhemoglobin saturation < 90% are at 48% increased VTE risk compared with those without nocturnal hypoxemia (HR, 1.48; 95% CI, 1.16-1.69). INTERPRETATION: In this large cohort, we found that patients with more severe OSA as measured by the apnea-hypopnea index are more likely to have incident VTE. Adjusted analyses suggest that this association is explained on the basis of confounding by obesity. However, severe nocturnal hypoxemia may be a mechanism by which OSA heightens VTE risk.
Authors: Stuart F Quan; George T O'Connor; Jason S Quan; Susan Redline; Helaine E Resnick; Eyal Shahar; David Siscovick; Duane L Sherrill Journal: Sleep Breath Date: 2007-09 Impact factor: 2.816
Authors: Katarzyna Jóźwik-Plebanek; Aleksander Prejbisz; Ewa Wypasek; Barbara Pręgowska-Chwała; Katarzyna Hanus; Anna M Kaszuba; Magdalena Januszewicz; Przemysław Bieleń; Marek Kabat; Mariusz Kruk; Piotr Dobrowolski; Anna Klisiewicz; Paweł Śliwiński; Andrzej Januszewicz; Anetta Undas Journal: J Hypertens Date: 2017-05 Impact factor: 4.844
Authors: Margaret C Fang; Dongjie Fan; Sue Hee Sung; Daniel M Witt; John R Schmelzer; Steven R Steinhubl; Steven H Yale; Alan S Go Journal: Med Care Date: 2017-12 Impact factor: 2.983
Authors: Sara Lindström; Marine Germain; Marta Crous-Bou; Erin N Smith; Pierre-Emmanuel Morange; Astrid van Hylckama Vlieg; Hugoline G de Haan; Daniel Chasman; Paul Ridker; Jennifer Brody; Mariza de Andrade; John A Heit; Weihong Tang; Immaculata DeVivo; Francine Grodstein; Nicholas L Smith; David Tregouet; Christopher Kabrhel Journal: Hum Genet Date: 2017-05-20 Impact factor: 4.132
Authors: Richard B Berry; Rohit Budhiraja; Daniel J Gottlieb; David Gozal; Conrad Iber; Vishesh K Kapur; Carole L Marcus; Reena Mehra; Sairam Parthasarathy; Stuart F Quan; Susan Redline; Kingman P Strohl; Sally L Davidson Ward; Michelle M Tangredi Journal: J Clin Sleep Med Date: 2012-10-15 Impact factor: 4.062
Authors: Tetyana Kendzerska; Andrea S Gershon; Gillian Hawker; Richard S Leung; George Tomlinson Journal: PLoS Med Date: 2014-02-04 Impact factor: 11.069