Impact of obstructive sleep apnea on outcomes of pulmonary embolism: A systematic review and meta‑analysis

Zhang,Wen; Ding,Yongmin

doi:10.3892/etm.2023.11819

Impact of obstructive sleep apnea on outcomes of pulmonary embolism: A systematic review and meta‑analysis

Authors:
- Wen Zhang
- Yongmin Ding
View Affiliations

Affiliations: Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang 312400, P.R. China
Published online on: February 1, 2023 https://doi.org/10.3892/etm.2023.11819
Article Number: 120
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The current review aimed to assess the effect of obstructive sleep apnea (OSA) on the severity and outcomes of pulmonary embolism (PE). PubMed, Embase, ScienceDirect, CENTRAL and Google Scholar were searched for studies assessing the impact of OSA on severity and outcomes of PE. A total of 12 studies were included. Meta‑analysis revealed that simplified PE severity index of >1 and pulmonary artery obstruction index score was significantly higher in patients with OSA as compared with controls, but there was no difference in right ventricle to left ventricle short‑axis diameter. The need for non‑invasive ventilation was significantly higher in patients with OSA but there was no difference in the need for mechanical ventilation. Patients with OSA had a significantly higher incidence of recurrence of PE. Meta‑analysis also showed a statistically significantly lower risk of in‑hospital mortality in patients with OSA as compared with controls, but without any difference in the risk of late mortality. Adjusted data on mortality indicated a significantly lower risk of mortality in PE patients with comorbid OSA. Limited data shows that comorbid OSA increases the severity of PE but has no effect on right ventricular function. OSA may increase the risk of recurrent PE. Paradoxically, the presence of OSA may also reduce the risk of in‑hospital mortality. Results must be interpreted with caution owing to high inter‑study heterogeneity and lack of matching of baseline characteristics. Current evidence needs to be confirmed by high‑quality prospective studies.

View Figures

View References

1	Stein PD, Matta F and Hughes MJ: Hospitalizations for high-risk pulmonary embolism. Am J Med. 134:621–625. 2021.PubMed/NCBI View Article : Google Scholar
2	Becattini C and Agnelli G: Risk stratification and management of acute pulmonary embolism. Hematology Am Soc Hematol Educ Program. 2016:404–412. 2016.PubMed/NCBI View Article : Google Scholar
3	Casazza F, Becattini C, Bongarzoni A, Cuccia C, Roncon L, Favretto G, Zonzin P, Pignataro L and Agnelli G: Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian pulmonary embolism registry (IPER). Thromb Res. 130:847–852. 2012.PubMed/NCBI View Article : Google Scholar
4	Elias A, Mallett S, Daoud-Elias M, Poggi JN and Clarke M: Prognostic models in acute pulmonary embolism: A systematic review and meta-analysis. BMJ Open. 6(e010324)2016.PubMed/NCBI View Article : Google Scholar
5	Patel SR: Obstructive sleep apnea. Ann Intern Med. 171:ITC81–ITC96. 2019.PubMed/NCBI
6	Diamond JA and Ismail H: Obstructive sleep apnea and cardiovascular disease. Clin Geriatr Med. 37:445–456. 2021.PubMed/NCBI View Article : Google Scholar
7	Alonso-Fernández A, Toledo-Pons N and García-Río F: Obstructive sleep apnea and venous thromboembolism: Overview of an emerging relationship. Sleep Med Rev. 50(101233)2020.PubMed/NCBI View Article : Google Scholar
8	Geissenberger F, Schwarz F, Probst M, Haberl S, Parkhe A, Faul C, von Lewinski D, Kroencke T, Schwaiblmair M, von Scheidt W and Berghaus TM: Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute pulmonary embolism. Clin Res Cardiol. 109:13–21. 2020.PubMed/NCBI View Article : Google Scholar
9	Berghaus TM, Geissenberger F, Konnerth D, Probst M, Kröncke T and Schwarz F: Right-to-left ventricular diameter ratio at computed tomographic pulmonary angiography in patients with acute pulmonary embolism and obstructive sleep apnea. Clin Med Insights Circ Respir Pulm Med. 14(1179548420976430)2020.PubMed/NCBI View Article : Google Scholar
10	Joshi AA, Hajjali RH, Gokhale AV, Smith T, Dey AK, Dahiya G, Lerman JB, Sajja AP, Kanwar M and Raina A: Outcomes of patients hospitalized for acute pulmonary embolism by obstructive sleep apnea status. Pulm Circ. 11(2045894021996224)2021.PubMed/NCBI View Article : Google Scholar
11	Xu J, Wang X, Meng F, Zhao T, Tang T, Wu W and Wang W: The role of obstructive sleep apnea on the prognosis of pulmonary embolism: A systemic review and meta-analysis. Sleep Breath. 25:1419–1426. 2021.PubMed/NCBI View Article : Google Scholar
12	Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 88(105906)2021.PubMed/NCBI View Article : Google Scholar
13	Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M and Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, 2013.
14	Zhang XF, Gao YM, Zhu GF, Yang JH, Ding SF and Liu S: Obstructive sleep apnea-hypopnea syndrome in patients with pulmonary thromboembolism: Clinical features and management. Zhonghua Jie He He Hu Xi Za Zhi. 35:180–183. 2012.PubMed/NCBI(In Chinese).
15	de-Miguel-Diez J, Lopez-Herranz M, Hernandez-Barrera V, Jimenez D, Monreal M, Jiménez-García R and López-de-Andrés A: Sex-differences in the effect of obstructive sleep apnea on patients hospitalized with pulmonary embolism and on in-hospital mortality. Sci Rep. 11(18390)2021.PubMed/NCBI View Article : Google Scholar
16	Le Mao R, Jiménez D, Bikdeli B, Porres-Aguilar M, García-Ortega A, Rosa V, Schellong S, Mazzolai L, Rivera-Civico F and Monreal M: RIETE Investigators. Prognostic impact of obstructive sleep apnea in patients presenting with acute symptomatic pulmonary embolism. Thromb Haemost. 121:808–815. 2021.PubMed/NCBI View Article : Google Scholar
17	Seckin ZI, Helmi H, Weister TJ, Lee A and Festic E: Acute pulmonary embolism in patients with obstructive sleep apnea: Frequency, hospital outcomes, and recurrence. J Clin Sleep Med. 16:1029–1036. 2020.PubMed/NCBI View Article : Google Scholar
18	Toledo-Pons N, Alonso-Fernández A, de la Peña M, Pierola J, Barceló A, Fernández-Capitán C, Lorenzo A, Mejía Núñez JA, Carrera M, Soriano JB, et al: Obstructive sleep apnea is associated with worse clinical-radiological risk scores of pulmonary embolism. J Sleep Res. 29(e12871)2020.PubMed/NCBI View Article : Google Scholar
19	Xiao Y, Yang LR, Zhu GF, Zhang Y, Wu CT and Zhang WM: Effect of obstructive sleep apnea on the severity of acute pulmonary thromboembolism. Zhonghua Yi Xue Za Zhi. 99:739–743. 2019.PubMed/NCBI View Article : Google Scholar : (In Chinese).
20	Konnerth D, Schwarz F, Probst M, Seidler M, Wagner T, Faul C, von Scheidt W, Schwaiblmair M and Berghaus TM: Is acute pulmonary embolism more severe in the presence of obstructive sleep apnea? Results from an observational cohort study. J Thromb Thrombolysis. 46:253–259. 2018.PubMed/NCBI View Article : Google Scholar
21	Alonso-Fernández A, Suquia AG, de la Peña M, Casitas R, Pierola J, Barceló A, Soriano JB, Fernández-Capitán C, Martinez-Ceron E, Carrera M and García-Río F: OSA Is a risk factor for recurrent VTE. Chest. 150:1291–1301. 2016.PubMed/NCBI View Article : Google Scholar
22	Xie J, Wei YX, Liu S, Zhang W, Zhang XF and Li J: Obstructive sleep apnea hypopnea syndrome as a reason for active management of pulmonary embolism. Chin Med J (Engl). 128:2147–2153. 2015.PubMed/NCBI View Article : Google Scholar
23	Piazza G: Submassive pulmonary embolism. JAMA. 309:171–180. 2013.PubMed/NCBI View Article : Google Scholar
24	Zhou XY, Ben SQ, Chen HL and Ni SS: The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: A meta-analysis. Respir Res. 13(111)2012.PubMed/NCBI View Article : Google Scholar
25	Venetz C, Jiménez D, Méan M and Aujesky D: A comparison of the original and simplified pulmonary embolism severity index. Thromb Haemost. 106:423–428. 2011.PubMed/NCBI View Article : Google Scholar
26	Guo F, Zhu G, Shen J and Ma Y: Health risk stratification based on computed tomography pulmonary artery obstruction index for acute pulmonary embolism. Sci Rep. 8(17897)2018.PubMed/NCBI View Article : Google Scholar
27	Testelmans D, Spruit MA, Vrijsen B, Sastry M, Belge C, Kalkanis A, Gaffron S, Wouters EFM and Buyse B: Comorbidity clusters in patients with moderate-to-severe OSA. Sleep Breath. 26:195–204. 2022.PubMed/NCBI View Article : Google Scholar
28	Ng ACC, Chow V, Yong ASC, Chung T and Kritharides L: Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration. 85:408–416. 2013.PubMed/NCBI View Article : Google Scholar
29	Hong SN, Yun HC, Yoo JH and Lee SH: Association between hypercoagulability and severe obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg. 143:996–1002. 2017.PubMed/NCBI View Article : Google Scholar
30	Palareti G: How D-dimer assay can be useful in deciding the duration of anticoagulation after venous thromboembolism: A review. Expert Rev Hematol. 8:79–88. 2015.PubMed/NCBI View Article : Google Scholar
31	Akyol S, Cortuk M, Baykan AO, Kiraz K, Borekci A, Seker T, Gur M and Cayli M: Biventricular myocardial performance is impaired in proportion to severity of obstructive sleep apnea. Texas Hear Inst J. 43:119–125. 2016.PubMed/NCBI View Article : Google Scholar
32	Ende-Verhaar YM, Kroft LJM, Mos ICM, Huisman MV and Klok FA: Accuracy and reproducibility of CT right-to-left ventricular diameter measurement in patients with acute pulmonary embolism. PLoS One. 12(e0188862)2017.PubMed/NCBI View Article : Google Scholar
33	Sajkov D and McEvoy RD: Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis. 51:363–370. 2009.PubMed/NCBI View Article : Google Scholar
34	Wong LF, Akram AR, McGurk S, Van Beek EJR, Reid JH and Murchison JT: Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a ‘tipping point’ on CT pulmonary angiography. Br J Radiol. 85:1471–1476. 2012.PubMed/NCBI View Article : Google Scholar
35	Ho KS, Wu L, Sheehan J and Salonia J: Obesity paradox? Improved in-hospital mortality in patients admitted for sepsis vs septic shock: A propensity score match analysis. Chest. 156 (Suppl 1)(A1141)2019.
36	Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, Myrda K, Lekston A, Poloński L and Rozentryt P: The obesity paradox in acute coronary syndrome: A meta-analysis. Eur J Epidemiol. 29:801–812. 2014.PubMed/NCBI View Article : Google Scholar