Prevalence of Obstructive Sleep Apnea Among Patients With Venous Thromboembolism: A Systematic Review and Meta-Analysis.

Abstract

<h4>Introduction</h4>Obstructive sleep apnea (OSA) and venous thromboembolism (VTE) share multiple risk factors and comorbidities, and several studies have reported a frequent coexistence of both conditions. However, the prevalence and clinical relevance of OSA among patients with acute VTE remain incompletely characterized.<h4>Methods</h4>Systematic review and meta-analysis including studies reporting OSA prevalence in patients with acute VTE. PRISMA recommendations were followed. Each step was performed by ≥2 investigators. We searched Pubmed/Cochrane/Embase until September 2024 using free/MeSH/Emtree terms related to VTE/PE/DVT and OSA. Quality of evidence was evaluated. A meta-analysis was conducted to estimate the pooled prevalence across the studies according to different criteria. Heterogeneity was assessed (I² statistics) and subgroup, sensitivity and meta-regression analysis were conducted.<h4>Results</h4>From 5066 articles retrieved, 25 studies were eligible. Quality assessment of studies suggested low risk of bias for internal validity but frequent high risk of bias regarding external validity. Meta-analyses revealed an OSA prevalence defined by an apnea-hypopnea index (AHI)≥5, ≥15 and ≥30 of 70% (95%CI 63-76%), 41% (95%CI 32-50%) and 21% (95%CI 16-26%), respectively. Prevalence was 8% (95%CI 4-13%) in studies assessing a known diagnosis of OSA through screening of health records. Heterogeneity was high (I²>70%).<h4>Conclusions</h4>Systematic sleep assessment in patients with VTE identifies a substantial burden of sleep-disordered breathing, with wide variability across studies. Mild AHI elevations should be interpreted cautiously, whereas moderate-to-severe OSA and hypoxemia-related phenotypes appear more clinically relevant. These findings support a targeted clinical evaluation and the need for prospective studies in this population.