Summary
Recent evidence suggests that obstructive sleep apnea is a significant and independent
risk factor for a number of cardiovascular disorders. Since the association between
obstructive sleep apnea and cardiovascular disease is mediated by endothelial dysfunction,
hypercoagulability and platelet abnormalities, we sought to investigate whether sleep
apnea may also be considered a risk factor for venous thromboembolism (VTE). We carried
out an electronic search in Medline and Scopus using the keywords “apnea” OR “apnoea”
AND “venous thromboembolism” OR “deep vein thrombosis” OR “pulmonary embolism” in
“Title/Abstract/Keywords”, with no language or date restriction. Fifteen studies (8
case-control, 4 retrospective observational, 2 prospective case-control and 1 prospective
observational) were finally selected for this systematic review. In all studies except
one (14/15; 93%), obstructive sleep apnea was found to be an independent risk factor
for VTE, either deep-vein thrombosis (DVT) or pulmonary embolism (PE). In the two
prospective case-control studies the risk of DVT or PE was found to be two-to three-fold
higher in patients with obstructive sleep apnea than in those without. In conclusion,
the current epidemiological evidence supports the hypothesis that obstructive sleep
apnea may be an independent risk factor for VTE.
Keywords
Venous thromboembolism - thrombosis - sleep apnea - risk