Prevalence of obstructive sleep apnea in acute phase of pulmonary embolism: Preliminary results of ESAET study

<b>Introduction:</b> Currently, Sleep-Disordered breathing has recognized prothrombotic effects and there is growing evidence that obstructive sleep apnea (OSA) is highly prevalent in pulmonary embolism (PE) and might increase its risk. <b>Aims:</b> To assess the prevalence of OSA in the acute phase of PE, and the association between OSA and the presence of right ventricular (RV) dysfunction <b>Methods:</b> We performed a multicenter and observational study in consecutive hemodynamically stable patients with acute symptomatic PE. Recruited patients underwent an overnight sleep study and transthoracic echocardiography within the first 48 hours of diagnosis. <b>Results:</b> 82 patients have been recruited. Mean apnea-hypopnea index (AHI) was 24/h (SD 21.27), 66 patients (80.5%) with OSA criteria (AHI≥5h). Patients with AHI≥15/h presented significantly higher thrombus load by computerized tomography (CT) (49% vs 47%; p=0.013) and by D-dimer levels (50% vs 44%; p=0.094); and impaired RV function measured by RV/left ventricle ratio&gt;0.9 (27% vs 23%; p=0.03). We also observed an elevated PE severity score defined by PESIs score ≥1 in these patients, but it was not statistically significant (83% vs 72%; p=0.25). Multiple logistic regression analysis revealed an association between patients with AHI ≥ 15/h and thrombus load (OR 3.1; CI 95%, 1.2-7.5; p=0.018), and impaired RV functions (OR 1.7; CI95%, 1.1-4.2; p=0.032), when adjusted by PESIs score, gender and body mass index. <b>Conclusion:</b> OSA is highly prevalent in patients with hemodynamically stable acute PE. Patients with acute PE and moderate-severe OSA (AHI≥15/h) had more PE severity, characterized by greater thrombotic burden and presence of RV dysfunction.