Association between obstructive sleep apnea with recurrent pulmonary embolism: a meta-analysis

Obstructive sleep apnea (OSA) has been implicated in prothrombotic and inflammatory states that may predispose patients with pulmonary embolism (PE) to recurrence. However, the association between OSA and recurrent PE risk remains uncertain.

We systematically searched PubMed, Embase, Web of Science, Wanfang, and CNKI for longitudinal observational studies assessing OSA and recurrent PE. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the influence of heterogeneity.

Eight studies involving 6262 patients with PE were included; 671 (10.7%) had OSA, and 253 (4.0%) experienced recurrent PE during follow-up. Patients with OSA had nearly a two-fold higher risk of recurrent PE (RR, 2.46; 95% CI, 1.46-4.12; p < 0.001), with moderate heterogeneity (I² = 36%). The association was consistent across prospective and retrospective studies (RR, 2.61 vs. 2.57) and was notably stronger in smaller cohorts (< 200 participants; RR: 4.86) than in larger ones (≥ 200 participants; RR, 1.67). Other subgroup analyses (OSA diagnosis timing, apnea-hypopnea index cutoffs, follow-up duration, analytic model, and study quality) yielded similar results. Meta-regression suggested that study sample size may partly explain heterogeneity (p = 0.08).

Patients with OSA may be associated with a higher risk of recurrent PE. Although to be validated in large-scale prospective studies, screening for OSA in PE patients may improve risk stratification and secondary prevention strategies.