Thromb Haemost 2023; 123(04): 393-401
DOI: 10.1055/a-2000-8288
Coagulation and Fibrinolysis

Sleep Apnea and Incident Unprovoked Venous Thromboembolism: Data from the Pays de la Loire Sleep Cohort

Wojciech Trzepizur
1   Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
2   INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
,
Chloé Gervès-Pinquié
3   Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
,
Baptiste Heudes
1   Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
,
Margaux Blanchard
4   ESEO, Angers, France
,
Nicole Meslier
1   Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
2   INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
,
Marie Jouvenot
5   Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
,
Sandrine Kerbat
6   EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, Rennes University, Rennes University Hospital, Rennes, France
,
Raphael Le Mao
7   Department of Internal Medicine and Pneumology, CHU Brest, Brest, France
8   Inserm U1304 GETBO, Univ_Brest, Brest, France
,
Eline Magois
9   Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
,
Jean-Louis Racineux
3   Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
,
AbdelKebir Sabil
3   Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
10   Cloud Sleep Lab, Paris, France
,
Jérémie Thereaux
11   Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University of Bretagne Occidentale, Brest, France
12   Department of Metabolic Surgery, Brest University Hospital, Brest, France
,
Francis Couturaud
7   Department of Internal Medicine and Pneumology, CHU Brest, Brest, France
,
1   Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
2   INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
,
on behalf of the Pays de la Loire Cohort Study Group › Author Affiliations
Funding This study was supported by a grant from the Institut de Recherche en Santé Respiratoire des Pays de la Loire (IRSR), Beaucouzé, France.


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Abstract

Background Previous studies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and incident venous thromboembolism (VTE). More specifically, the association between OSA and unprovoked VTE was barely evaluated. We aimed to evaluate whether apnea hypopnea index (AHI) and nocturnal hypoxemia markers were associated with unprovoked VTE incidence in patients investigated for OSA.

Material and Methods Data from the Pays de la Loire Sleep Cohort were linked to the French health administrative data to identify incident unprovoked VTE in patients suspected for OSA and no previous VTE disease. Cox proportional hazards models were used to evaluate the association of unprovoked VTE incidence with AHI and nocturnal hypoxemia markers including the time spent under 90% of saturation (T90), oxygen desaturation index, and hypoxic burden (HB), a more specific marker of respiratory events related to hypoxia. The impact of continuous positive airway pressure (CPAP) was evaluated in the subgroup of patients who were proposed the treatment.

Results After a median [interquartile range] follow-up of 6.3 [4.3–9.0] years, 104 of 7,355 patients developed unprovoked VTE, for an incidence rate of 10.8 per 1,000 patient-years. In a univariate analysis, T90 and HB predicted incident VTE. In the fully adjusted model, T90 was the only independent predictor (hazard ratio: 1.06; 95% confidence interval: [1.01–1.02]; p = 0.02). The CPAP treatment has no significant impact on VTE incidence.

Conclusion Patients with more severe nocturnal hypoxia are more likely to have incident unprovoked VTE.

Supplementary Material



Publication History

Received: 22 July 2022

Accepted: 08 December 2022

Accepted Manuscript online:
19 December 2022

Article published online:
20 January 2023

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