Gholinataj Jelodar Mohsen, Rahimi Besharat, Mirzaei Samaneh
Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
Clinical Research Development Center, Shahid Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
Can Respir J. 2025 Jul 10;2025:8848869. doi: 10.1155/carj/8848869. eCollection 2025.
Venous thromboembolism (VTE) is widespread and poses significant risks of illness and death, making it a vital public health issue. Obstructive sleep apnea (OSA), which is the most prevalent sleep disorder, is connected to an increased possibility of cardiovascular diseases and VTE. The length of VTE treatment hinges mainly on the frequency of its recurrence in patients. Our data about VTE and its recurrence in OSA patients are limited. In this review, we aim to investigate the risk of VTE recurrence in OSA patients and evaluate the role of continuous positive airway pressure (CPAP) therapy in mitigating this risk. A literature search gathered information about VTE pathogenesis and its potential recurrence mechanism in OSA. The recurrent episodes of partial or complete obstruction of the upper airway in OSA lead to intermittent lack of oxygen. Hypoxemia acts as a central cornerstone of VTE incidence in OSA patients, leads to activating all the vertices of Virchow's triad, and creates the appropriate condition for the developmental and even recurrence of VTE. Intermittent hypoxia causes an increase in the inflammatory state and coagulation activity, leading to oxidative stress and endothelial dysfunction. Furthermore, it results in heightened viscosity and venous stasis. The results of previous studies on VTE recurrence in OSA patients are conflicting. Even though the use of CPAP leads to diminished proinflammatory cytokines and oxidative stress indicators, there is currently insufficient clinical evidence to support that this therapy can prevent recurrent VTE in patients with OSA. Further investigation is necessary to gain a better comprehension of the probability and frequency of relapse of VTE in OSA patients, as the present research has generated inconclusive outcomes.
静脉血栓栓塞症（VTE）广泛存在，会引发重大疾病和死亡风险，使其成为一个至关重要的公共卫生问题。阻塞性睡眠呼吸暂停（OSA）是最常见的睡眠障碍，与心血管疾病和VTE的发生可能性增加有关。VTE治疗的时长主要取决于患者复发的频率。我们关于OSA患者VTE及其复发的数据有限。在本综述中，我们旨在研究OSA患者VTE复发的风险，并评估持续气道正压通气（CPAP）治疗在降低这种风险中的作用。文献检索收集了有关OSA中VTE发病机制及其潜在复发机制的信息。OSA中上呼吸道部分或完全阻塞的反复发作会导致间歇性缺氧。低氧血症是OSA患者VTE发生的核心基石，会激活维勒三联征的所有要素，并为VTE的发展甚至复发创造合适条件。间歇性缺氧会导致炎症状态和凝血活性增加，从而导致氧化应激和内皮功能障碍。此外，它还会导致血液粘度增加和静脉淤滞。先前关于OSA患者VTE复发的研究结果相互矛盾。尽管使用CPAP会导致促炎细胞因子和氧化应激指标减少，但目前尚无足够的临床证据支持这种治疗可预防OSA患者复发性VTE。由于目前的研究结果尚无定论，因此有必要进行进一步调查，以更好地了解OSA患者VTE复发的可能性和频率。
