Obstructive sleep apnea and outcomes in acute pulmonary embolism: A large-scale database study

To evaluate the impact of obstructive sleep apnea (OSA) on outcomes of acute pulmonary embolism (PE). The primary objective was to compare 30-day mortality and incidence of cardiac arrest in patients with known OSA who developed acute PE versus those with acute PE without OSA.

A retrospective cohort study was conducted using the TriNetX global health research network. Two cohorts were defined: adult patients with OSA and acute PE, and adult patients with PE without OSA. Propensity score matching was used to address demographic and comorbidity differences. Data from January 1, 2013, to December 1, 2024, were analyzed, with a one-month follow-up for secondary outcomes.

The OSA group (n = 3,547,220) had higher PE incidence proportion (3.48% vs 0.639%) and prevalence (3.794% vs 0.708%) than the control group (n = 103,659,571). Following propensity score matching, 76,636 individuals per group were identified. Patients with OSA with PE demonstrated lower risks of cardiac arrest (RD -0.175%, RR 0.636 [CI, 0.539-0.751]; P < 0.0001) and all-cause mortality (RD -3.511%, RR 0.555 [CI, 0.533-0.579]; P < 0.0001) within one-month post-PE diagnosis compared to non-OSA patients with PE.

In the OSA population, the risk of PE is increased, while the probability of short-term mortality or cardiac arrest post diagnosis of PE is significantly low. These data suggest a complex relationship between OSA and the risk of PE and necessitate further evaluation of the potential mechanisms and clinical significance.