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Retrospective Case Control Study Showing a Positve Association With Obstructive Sleep Apnea and Thromboembolism
October 2015, Vol 148, No. 4_MeetingAbstracts
Sleep Disorders | October 2015
Retrospective Case Control Study Showing a Positve Association With Obstructive Sleep Apnea and Thromboembolism Shahzad Khan, MD; Joann Petrini, PhD; Jose Mendez, MD; Wing-Tai Kong, MD Danbury Hosptial, New Milford, CT Chest. 2015;148(4_MeetingAbstracts):1067A. doi:10.1378/chest.2219652
Abstract SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Evaluate the hypothesis of a possible association between obstructive sleep apnea (OSA) and increased venous vascular disease, specifically deep vein thrombosis (DVT) and pulmonary emboli (PE). METHODS: This was a retrospective chart review of patients that had a nocturnal polysomnography (NPSG) for suspected OSA and a venous duplex, CT pulmonary angiogram (CTA) or ventilation perfusion scans (V/Q scan) with the suspicion of DVT or PE between the years 2011-2013. The following variables were collected: patient’s demographics, results of the imaging (duplex, CTA or V/Q), patient BMI, history of smoking, AHI (apnea-hypopnea index), CT-90 (time with saturation below 90% in minutes), O2 nadir (%), history of malignancy, congestive heart failure (ejection fraction less than 45%), history of bariatric surgery, surgery of any kind within 6 months and history of immobility. Statistical analysis was conducted with the Vassar Stats program using ANOVA and Fisher Exact 2-Tail test. RESULTS: Ninety-eight patients had both a sleep study and a study to rule out venous thromboembolism (VTE) during the study period. Mean age was 59 years (range 26-93); 47(48%) were male, with a mean BMI of 33.2 (range 19-51.6). Of those included 52 (53.1%) had an AHI >15 (moderate OSA) and 14 patients (14%) had a positive PE test. Of the 14 patients with a positive PE test, 11 (78.6%) were found to have an AHI >15 and 3/14 (21%) showed an AHI less than 15. All the patients with a positive PE study had OSA when considering the AHI at 5. Of the 84 patients with a negative PE study, 41 (48.8%) had an AHI >15. Utilizing the Fisher Exact 2-Tail test we were able to find a positive correlation between patients with an AHI>15 and thromboembolic events with a p= 0.0464. This was then re-calculated by excluding patients with known thrombophilic past medical histories and was found to give a statistically significant p=0.0342. CONCLUSIONS: Considering the limitations of a retrospective design and small sample size, it appears that OSA may be associated with a higher incidence of thromboembolic disease. CLINICAL IMPLICATIONS: Inclusion of obstructive sleep apnea into thromboembolic risk stratification scores could change the way current clinical practicioners evaluate patients that were previosly thought to
be low risk. Future large scale prospective studies will be usefull in identifying the role OSA plays in thromboembolic disease.
DISCLOSURE: The following authors have nothing to disclose: Shahzad Khan, Joann Petrini, Jose Mendez, Wing-Tai Kong No Product/Research Disclosure Information
Sleep Disorders | October 2015
Retrospective Case Control Study Showing a Positve Association With Obstructive Sleep Apnea and Thromboembolism Shahzad Khan, MD; Joann Petrini, PhD; Jose Mendez, MD; Wing-Tai Kong, MD Danbury Hosptial, New Milford, CT Chest. 2015;148(4_MeetingAbstracts):1067A. doi:10.1378/chest.2219652
Abstract SESSION TITLE: Sleep Disorders Posters II: Consequences of OSA and Treatment SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Evaluate the hypothesis of a possible association between obstructive sleep apnea (OSA) and increased venous vascular disease, specifically deep vein thrombosis (DVT) and pulmonary emboli (PE). METHODS: This was a retrospective chart review of patients that had a nocturnal polysomnography (NPSG) for suspected OSA and a venous duplex, CT pulmonary angiogram (CTA) or ventilation perfusion scans (V/Q scan) with the suspicion of DVT or PE between the years 2011-2013. The following variables were collected: patient’s demographics, results of the imaging (duplex, CTA or V/Q), patient BMI, history of smoking, AHI (apnea-hypopnea index), CT-90 (time with saturation below 90% in minutes), O2 nadir (%), history of malignancy, congestive heart failure (ejection fraction less than 45%), history of bariatric surgery, surgery of any kind within 6 months and history of immobility. Statistical analysis was conducted with the Vassar Stats program using ANOVA and Fisher Exact 2-Tail test. RESULTS: Ninety-eight patients had both a sleep study and a study to rule out venous thromboembolism (VTE) during the study period. Mean age was 59 years (range 26-93); 47(48%) were male, with a mean BMI of 33.2 (range 19-51.6). Of those included 52 (53.1%) had an AHI >15 (moderate OSA) and 14 patients (14%) had a positive PE test. Of the 14 patients with a positive PE test, 11 (78.6%) were found to have an AHI >15 and 3/14 (21%) showed an AHI less than 15. All the patients with a positive PE study had OSA when considering the AHI at 5. Of the 84 patients with a negative PE study, 41 (48.8%) had an AHI >15. Utilizing the Fisher Exact 2-Tail test we were able to find a positive correlation between patients with an AHI>15 and thromboembolic events with a p= 0.0464. This was then re-calculated by excluding patients with known thrombophilic past medical histories and was found to give a statistically significant p=0.0342. CONCLUSIONS: Considering the limitations of a retrospective design and small sample size, it appears that OSA may be associated with a higher incidence of thromboembolic disease. CLINICAL IMPLICATIONS: Inclusion of obstructive sleep apnea into thromboembolic risk stratification scores could change the way current clinical practicioners evaluate patients that were previosly thought to
be low risk. Future large scale prospective studies will be usefull in identifying the role OSA plays in thromboembolic disease.
DISCLOSURE: The following authors have nothing to disclose: Shahzad Khan, Joann Petrini, Jose Mendez, Wing-Tai Kong No Product/Research Disclosure Information