Trzepizur Wojciech, Gervès-Pinquié Chloé, Heudes Baptiste, Blanchard Margaux, Meslier Nicole, Jouvenot Marie, Kerbat Sandrine, Mao Raphael Le, Magois Eline, Racineux Jean-Louis, Sabil AbdelKebir, Thereaux Jérémie, Couturaud Francis, Gagnadoux Frédéric
Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.
INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France.
Thromb Haemost. 2023 Apr;123(4):393-401. doi: 10.1055/a-2000-8288. Epub 2022 Dec 19.
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.
Data from the 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.
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]; = 0.02). The CPAP treatment has no significant impact on VTE incidence.
Patients with more severe nocturnal hypoxia are more likely to have incident unprovoked VTE.
既往研究报道了阻塞性睡眠呼吸暂停（OSA）与静脉血栓栓塞症（VTE）发病之间的关联存在不一致的结果。更具体地说，几乎未评估OSA与不明原因VTE之间的关联。我们旨在评估呼吸暂停低通气指数（AHI）和夜间低氧血症标志物是否与因OSA接受检查的患者不明原因VTE的发病率相关。
来自[具体研究名称未给出]的数据与法国卫生行政数据相关联，以确定疑似OSA且既往无VTE病史的患者发生的不明原因VTE。采用Cox比例风险模型评估不明原因VTE发病率与AHI以及夜间低氧血症标志物之间的关联，这些标志物包括饱和度低于90%的时间（T90）、氧去饱和指数和低氧负荷（HB），HB是与缺氧相关的呼吸事件的更特异性标志物。在接受治疗的患者亚组中评估持续气道正压通气（CPAP）的影响。
在中位[四分位间距]随访6.3[4.3 - 9.0]年期间，7355例患者中有104例发生不明原因VTE，发病率为每1000患者年10.8例。在单因素分析中，T90和HB可预测VTE发病。在完全调整模型中，T90是唯一的独立预测因素（风险比：1.06；95%置信区间：[1.01 - 1.02]；P = 0.02）。CPAP治疗对VTE发病率无显著影响。
夜间低氧血症更严重的患者更有可能发生不明原因的VTE。
