Xu Jiahuan, Wang Xingjian, Meng Fanqi, Zhao Tian, Tang Tingyu, Wu Wenjuan, Wang Wei
Institute of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China.
Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
Sleep Breath. 2021 Sep;25(3):1419-1426. doi: 10.1007/s11325-020-02258-z. Epub 2020 Nov 24.
The relationship between obstructive sleep apnea (OSA) and pulmonary embolism (PE) has been reported by some studies but the underlying mechanism remains unclear. We aimed to systematically assess the role of OSA on the disease prognosis of PE.
We searched for studies on the relationship of OSA and the prognosis of PE published up to February 2020 among PubMed, Web of Science, EMBASE, and Cochrane Library databases. Two independent reviewers conducted the process of study search and screening, quality assessment, and data extraction. Meta-analysis was carried out using RevMan 5.3.
A total of 9 articles were included, and the funnel plots suggested no evidence of publication bias among studies. The results showed that compared to PE patients without OSA, the PE patients with moderate-severe OSA were more likely to be high-risk type (OR = 1.96, 95% CI [1.14, 3.34]) and with higher index of disease severity (sPESI: OR = 2.29, 95% CI [1.50, 3.47]; PAOI%: MD = 13.52, 95% CI [7.2, 19.83]). The prevalence of recurrent PE was higher in PE patients with OSA than those without OSA (RR = 3.87, 95% CI [1.65, 9.07]). However, there was no significant difference in right ventricle to left ventricle short-axis diameter (MD = 0.08, 95% CI [- 0.06, 0.21]), length of hospital stay (MD = 1.03, 95% CI [- 1.11, 3.17]), or prevalence of deep vein thrombosis (OR = 0.87, 95% CI [0.48, 1.57]). Sensitivity and subgroup analysis showed that the pooled outcomes were stable.
OSA, especially moderate-severe OSA, was a risk factor for high-risk PE and recurrent PE. However, the current evidence showed that the length of hospital stay is not influenced by OSA.
一些研究报道了阻塞性睡眠呼吸暂停（OSA）与肺栓塞（PE）之间的关系，但其潜在机制仍不清楚。我们旨在系统评估OSA对PE疾病预后的作用。
我们在PubMed、Web of Science、EMBASE和Cochrane图书馆数据库中检索截至2020年2月发表的关于OSA与PE预后关系的研究。两名独立评审员进行研究检索、筛选、质量评估和数据提取过程。使用RevMan 5.3进行荟萃分析。
共纳入9篇文章，漏斗图显示研究间无发表偏倚证据。结果表明，与无OSA的PE患者相比，中度至重度OSA的PE患者更可能为高危类型（OR = 1.96，95%CI[1.14，3.34]）且疾病严重程度指数更高（简化肺栓塞严重性指数：OR = 2.29，95%CI[1.50，3.47]；肺血管阻塞指数%：MD = 13.52，95%CI[7.2，19.83]）。有OSA的PE患者复发性PE的患病率高于无OSA的患者（RR = 3.87，95%CI[1.65，9.07]）。然而，右心室与左心室短轴直径（MD = 0.08，95%CI[-0.06，0.21]）、住院时间（MD = 1.03，95%CI[-1.11，3.17]）或深静脉血栓形成患病率（OR = 0.87，95%CI[0.48，1.57]）无显著差异。敏感性和亚组分析表明汇总结果稳定。
OSA，尤其是中度至重度OSA，是高危PE和复发性PE的危险因素。然而，目前证据表明住院时间不受OSA影响。
