Sleep Apnea and Incident Unprovoked Venous Thromboembolism: Data from the Pays de la Loire Sleep Cohort.

BACKGROUND: Previous studies have reported inconsistent findings regarding the association between obstructive sleep apnea (OSA) and incident venous thromboembolism (VTE). More specifically, the association between OSA and unprovoked VTE was barely evaluated. We aimed to evaluate whether apnea hypopnea index (AHI) and nocturnal hypoxemia markers were associated with unprovoked VTE incidence in patients investigated for OSA. MATERIAL AND METHODS: Data from the Pays de la Loire Sleep Cohort were linked to the French health administrative data to identify incident unprovoked VTE in patients suspected for OSA and no previous VTE disease. Cox proportional hazards models were used to evaluate the association of unprovoked VTE incidence with AHI and nocturnal hypoxemia markers including the time spent under 90% of saturation (T90), oxygen desaturation index, and hypoxic burden (HB), a more specific marker of respiratory events related to hypoxia. The impact of continuous positive airway pressure (CPAP) was evaluated in the subgroup of patients who were proposed the treatment. RESULTS: After a median [interquartile range] follow-up of 6.3 [4.3-9.0] years, 104 of 7,355 patients developed unprovoked VTE, for an incidence rate of 10.8 per 1,000 patient-years. In a univariate analysis, T90 and HB predicted incident VTE. In the fully adjusted model, T90 was the only independent predictor (hazard ratio: 1.06; 95% confidence interval: [1.01-1.02]; p = 0.02). The CPAP treatment has no significant impact on VTE incidence. CONCLUSION: Patients with more severe nocturnal hypoxia are more likely to have incident unprovoked VTE.

[Therapeutic alternatives to continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome]. / Modalités thérapeutiques du syndrome d'apnées-hypopnées obstructives du sommeil de l'adulte en dehors de la pression positive continue.

Oral appliance therapy (OAT) is the main therapeutic alternative to continuous positive airway pressure (CPAP). OAT has been recommended as an appropriate first-line treatment option for moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients without severe cardiovascular comorbidity. The lower efficacy of OAT in reducing sleep-disordered breathing could be offset by a higher compliance relative to CPAP, resulting in similar health outcomes in terms of sleepiness, neurobehavioral functioning, quality of life and blood pressure. Electrical stimulation of the hypoglossal nerve is a promising treatment approach for moderate to severe OSAHS. Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing. There are currently no medications to treat OSAHS effectively. At least fifty percent of OSAHS patients are affected by central obesity and related metabolic disorders. To date, there is no evidence that treating OSAHS may improve comorbid metabolic disorders. Weight-loss intervention is a central component of the strategies used to improve the cardiovascular risk-factor profile in patients with OSAHS and obesity.

Worsening of Obstructive Sleep Apnea Associated with Catheter-Related Superior Vena Cava Syndrome.

ABSTRACT: There is growing evidence that fluid accumulation in the neck contributes to the pathogenesis of obstructive sleep apnea (OSA). We describe a case of catheter-related superior v ena cava (SVC) thrombosis revealed by rapid onset of typical symptoms of OSA. A marked improvement in OSA severity was observed after central venous catheter removal, anticoagulant therapy, and SVC angioplasty.