title: OSA Is a Risk Factor for Recurrent VTE.
abstract: BACKGROUND
  OSA is a risk factor for a first episode of pulmonary embolism (PE), although its impact on the risk of thromboembolism recurring is uncertain. Our objective was to explore the prognostic value of OSA after the discontinuation of oral anticoagulation (OAC) in patients with a first episode of PE.
  
  
  METHODS
  In 120 consecutive patients who had stopped OAC for a first episode of PE, we performed home respiratory polygraphy and recorded sleep characteristics, classic risk factors for PE, blood pressure measurements, spirometric parameters, physical activity, and levels of D-dimer and prothrombin fragment 1+2 (F1+2). Patients were followed for 5 to 8 years, and the main end point was PE recurrence. Restarting OAC for any thromboembolic event was evaluated as a secondary end point.
  
  
  RESULTS
  During the follow-up period, 19 patients had a PE recurrence, and 16 of them had an apnea-hypopnea index (AHI) ≥ 10 h-1. In a multivariate Cox regression model, an AHI ≥ 10 h-1(hazard ratio [HR], 20.73; 95% CI, 1.71-251.28), mean nocturnal oxygen saturation (nSao2) (HR, 0.39; 95% CI, 0.20-0.78), time with Sao2< 90% (CT90%) (HR, 0.90; 95% CI, 0.82-0.98), and D-dimer level (HR, 1.001; 95% CI, 1.00-1.002) were identified as independent risk factors for recurrent PE. Twenty-four patients resumed OAC, and AHI ≥ 10 h-1(HR, 20.66; 95% CI, 2.27-188.35), mean nSao2(HR, 0.54; 95% CI, 0.32-0.94), and Epworth Sleepiness Scale (ESS) (HR, 0.73; 95% CI, 0.56-0.97) were retained as independent risk factors for the resumption of OAC.
  
  
  CONCLUSIONS
  After a first episode of PE, OSA is an independent risk factor for PE recurrence or restarting OAC for a new thromboembolic event.
authors.affiliation: Department of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain. Electronic address: alberto.alonso@ssib.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Fernández
authors.affiliation: Department of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Angela García
authors.initials: AG
authors.lastname: Suquia
authors.affiliation: Department of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: de la Peña
authors.affiliation: Department of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Casitas
authors.affiliation: Research Unit, University Hospital Son Espases, Palma de Mallorca, (IdISPa) Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pierola
authors.affiliation: Department of Clinical Analysis, University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Barceló
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: Department of Internal Medicine, University Hospital La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Department of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Elizabet
authors.initials: E
authors.lastname: Martinez-Ceron
authors.affiliation: Department of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Carrera
authors.affiliation: Department of Pneumology, University Hospital La Paz, IdiPAZ, Madrid, Spain; CIBER Enfermedades Respiratorias, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: García-Río
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D054556:Venous Thromboembolism / Q000209:etiology*
chemical_list: D000925:Anticoagulants
keywords: D-dimer; pulmonary embolism; recurrent pulmonary embolism VTE; sleep apnea