Obstructive Sleep Apnea and Pulmonary Embolism: Prevalence, Severity and the Association of Sleep-Disordered Breathing with Thromboembolic Disease
5 affiliations
- 1Pneumology Department, Marina Baixa University Hospital, 03570 Alicante, Spain
- 2Pneumology Department, San Juan de Alicante University Hospital, 03550 Alicante, Spain
- 3Department of Clinical Medicine, Miguel Hernández University, 03550 Alicante, Spain
- 4Molecular Biology Department, Instituto Bernabeu, 03016 Alicante, Spain
- 5Pneumology Department, Dr. Balmis General University Hospital, 03010 Alicante, Spain
Abstract
Background/Objectives: Obstructive sleep apnea (OSA) and pulmonary embolism (PE) share several risk factors, while emerging evidence suggests a potential pathophysiological link beyond these common determinants. We aimed to characterize the prevalence and severity of OSA in patients with acute PE and to investigate whether the apnea–hypopnea index (AHI) is independently associated with PE and its clinical course. Methods: In this prospective, single-center, case–control study, 128 consecutive patients with acute PE and 252 outpatient controls with other respiratory diseases underwent home respiratory polygraphy. In patients with PE, the sleep study was performed at least three months after the acute event. OSA was diagnosed and graded according to international consensus criteria. Logistic regression models were used to evaluate associations between AHI and PE, acute PE severity, chronic deep vein thrombosis (DVT), and venous thromboembolism (VTE) recurrence. Results: OSA was present in 55.5% of patients with PE, with severe OSA in 28.9%, compared with 42.1% and 13.9%, respectively, among controls (p = 0.013 and p = 0.001). Patients with PE had a higher AHI (21.21 ± 19.29 vs. 14.81 ± 14.26 events/h; p = 0.007) and oxygen desaturation index (19.86 ± 18.77 vs. 13.30 ± 13.79; p = 0.003). Each 10-events/h increase in AHI was independently associated with PE after adjustment for age, sex, BMI, and established VTE risk factors (OR 1.205, 95% CI 1.019–1.426; p = 0.029). AHI was not independently associated with intermediate–high/high-risk PE or chronic DVT. Among patients who discontinued anticoagulation, VTE recurrence was higher in those with OSA (36.0% vs. 13.3%; p = 0.049). Conclusions: OSA is highly prevalent and frequently severe in patients with acute PE. Increasing AHI is independently associated with the presence of PE, supporting a clinically relevant association between sleep-disordered breathing and thromboembolic disease. Because OSA was not systematically reassessed after documented resolution of PE, persistence of OSA independently of residual thromboembolic disease cannot be definitively established. Whether the observed association between OSA and recurrent VTE after anticoagulation withdrawal is confirmed in larger prospective studies remains to be determined.
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BibTeX
@article{perezferrer2026obstructive,
title = {{Obstructive Sleep Apnea and Pulmonary Embolism: Prevalence, Severity and the Association of Sleep-Disordered Breathing with Thromboembolic Disease}},
author = {Patricia Pérez-Ferrer and Eusebi Chiner and Ignacio Boira and Juan José Piqueras and Adela Martínez-Sanchis and Luis Hernández-Blasco},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207892},
url = {https://www.mdpi.com/2077-0383/15/20/7892},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Obstructive Sleep Apnea and Pulmonary Embolism: Prevalence, Severity and the Association of Sleep-Disordered Breathing with Thromboembolic Disease
AU - Patricia Pérez-Ferrer
AU - Eusebi Chiner
AU - Ignacio Boira
AU - Juan José Piqueras
AU - Adela Martínez-Sanchis
AU - Luis Hernández-Blasco
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207892
UR - https://www.mdpi.com/2077-0383/15/20/7892
AB - Background/Objectives: Obstructive sleep apnea (OSA) and pulmonary embolism (PE) share several risk factors, while emerging evidence suggests a potential pathophysiological link beyond these common determinants. We aimed to characterize the prevalence and severity of OSA in patients with acute PE and to investigate whether the apnea–hypopnea index (AHI) is independently associated with PE and its clinical course. Methods: In this prospective, single-center, case–control study, 128 consecutive patients with acute PE and 252 outpatient controls with other respiratory diseases underwent home respiratory polygraphy. In patients with PE, the sleep study was performed at least three months after the acute event. OSA was diagnosed and graded according to international consensus criteria. Logistic regression models were used to evaluate associations between AHI and PE, acute PE severity, chronic deep vein thrombosis (DVT), and venous thromboembolism (VTE) recurrence. Results: OSA was present in 55.5% of patients with PE, with severe OSA in 28.9%, compared with 42.1% and 13.9%, respectively, among controls (p = 0.013 and p = 0.001). Patients with PE had a higher AHI (21.21 ± 19.29 vs. 14.81 ± 14.26 events/h; p = 0.007) and oxygen desaturation index (19.86 ± 18.77 vs. 13.30 ± 13.79; p = 0.003). Each 10-events/h increase in AHI was independently associated with PE after adjustment for age, sex, BMI, and established VTE risk factors (OR 1.205, 95% CI 1.019–1.426; p = 0.029). AHI was not independently associated with intermediate–high/high-risk PE or chronic DVT. Among patients who discontinued anticoagulation, VTE recurrence was higher in those with OSA (36.0% vs. 13.3%; p = 0.049). Conclusions: OSA is highly prevalent and frequently severe in patients with acute PE. Increasing AHI is independently associated with the presence of PE, supporting a clinically relevant association between sleep-disordered breathing and thromboembolic disease. Because OSA was not systematically reassessed after documented resolution of PE, persistence of OSA independently of residual thromboembolic disease cannot be definitively established. Whether the observed association between OSA and recurrent VTE after anticoagulation withdrawal is confirmed in larger prospective studies remains to be determined.
SN - 2077-0383
ER -