Egyptian Journal of Chest Disease and Tuberculosis (Jan 2020)

Obstructive sleep apnea is a great threat in patients with acute pulmonary embolism

  • Doaa M Magdy,
  • Ahmed Metwally,
  • Mohamed Adam

DOI
https://doi.org/10.4103/ejcdt.ejcdt_208_19
Journal volume & issue
Vol. 69, no. 4
pp. 698 – 701

Abstract

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Background Patients with sleep apnea (SA) experience repeated episodes of hypoxia interspersed with intervals of reoxygenation that may have systemic implications. Thus, this study aimed to determine the prevalence of SA in patients presented with pulmonary embolism (PE). Patients and methods In all, 120 patients with first-episode acute PE confirmed by pulmonary angiography were included in this study. Simplified pulmonary embolism severity index was determined at the time of PE diagnosis. Full-night polysomnography was performed. Patients were divided into two groups: the low risk (n=70) and the high risk (n=50). Results Regarding the distribution of the patients according to their simplified pulmonary embolism severity index risk class, 38 (54%) of the low-risk group had SA while 23 (46%) of the high-risk group had SA. The overall prevalence of SA among patients presented with PE was 50.8%. The severity of SA was determined by apnea–hypopnea index; 59 (49.2%) normal, 20 (16.7%) mild, 18 (15%) moderate, and 23 (19.1%) severe. BMI, and neck and waist circumference were significantly increased among the high-risk group. The most frequent clinical presentation among the high-risk group PE was snoring (48%) and excessive sleepiness (36%), respectively. Witnessed apnea was not different between both groups. Also, Epworth sleepiness scale scale reported higher scores. Regarding polysomnography recordings, stages 1 and 2 and rapid eye movement sleep were significantly different in both groups, while apnea–hypopnea index, desaturation index, and time spent with oxygen saturation less than 90% were significantly increased in the high-risk group PE. Conclusion SA is a common prevalent disorder among patients with PE. Snoring and excessive daytime sleepiness were a frequent complaint in the high-risk group PE. Hence, these findings support the concept of association between obstructive sleep apnea and PE. However, obstructive sleep apnea should be evaluated for all patients with the unidentifiable cause of PE.

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