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The role of obstructive sleep apnea on the prognosis of pulmonary embolism: a systemic review and meta-analysis

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The relationship between obstructive sleep apnea (OSA) and pulmonary embolism (PE) has been reported by some studies but the underlying mechanism remains unclear. We aimed to systematically assess the role of OSA on the disease prognosis of PE.

Methods

We searched for studies on the relationship of OSA and the prognosis of PE published up to February 2020 among PubMed, Web of Science, EMBASE, and Cochrane Library databases. Two independent reviewers conducted the process of study search and screening, quality assessment, and data extraction. Meta-analysis was carried out using RevMan 5.3.

Results

A total of 9 articles were included, and the funnel plots suggested no evidence of publication bias among studies. The results showed that compared to PE patients without OSA, the PE patients with moderate-severe OSA were more likely to be high-risk type (OR = 1.96, 95% CI [1.14, 3.34]) and with higher index of disease severity (sPESI: OR = 2.29, 95% CI [1.50, 3.47]; PAOI%: MD = 13.52, 95% CI [7.2, 19.83]). The prevalence of recurrent PE was higher in PE patients with OSA than those without OSA (RR = 3.87, 95% CI [1.65, 9.07]). However, there was no significant difference in right ventricle to left ventricle short-axis diameter (MD = 0.08, 95% CI [− 0.06, 0.21]), length of hospital stay (MD = 1.03, 95% CI [− 1.11, 3.17]), or prevalence of deep vein thrombosis (OR = 0.87, 95% CI [0.48, 1.57]). Sensitivity and subgroup analysis showed that the pooled outcomes were stable.

Conclusion

OSA, especially moderate-severe OSA, was a risk factor for high-risk PE and recurrent PE. However, the current evidence showed that the length of hospital stay is not influenced by OSA.

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Funding

This work was supported by grants from the National Key Research and Development Program of China (No. 2016YFC1304502) and the Medicine and Health Technology Project of Zhejiang Province (No. 12KYB003).

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Authors and Affiliations

  1. Institute of Respiratory Medicine, Zhejiang Hospital, Hangzhou, China

    Jiahuan Xu, Tian Zhao, Tingyu Tang & Wenjuan Wu

  2. Institute of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China

    Jiahuan Xu, Xingjian Wang, Fanqi Meng & Wei Wang

Authors
  1. Jiahuan Xu
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  2. Xingjian Wang
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  3. Fanqi Meng
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  4. Tian Zhao
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  6. Wenjuan Wu
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  7. Wei Wang
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Contributions

JH Xu: study design, data analysis, manuscript drafting, and final approval of the version to be published. XJ Wang: in charge of the process of study searching and assessment and data extraction and final approval of the version to be published. FQ Meng, T Zhao, TY Tang, and WJ Wu: providing language help, data analysis, writing assistance, and final approval of the version to be published. W Wang: study design, data interpretation, critical manuscript revision, and final approval of the version to be published.

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Correspondence to Wei Wang.

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Xu, J., Wang, X., Meng, F. et al. The role of obstructive sleep apnea on the prognosis of pulmonary embolism: a systemic review and meta-analysis. Sleep Breath 25, 1419–1426 (2021). https://doi.org/10.1007/s11325-020-02258-z

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