Changes in sleep-disordered breathing from the acute to the stable phase of pulmonary embolism: The ESAET study.

Autores de IIS La Fe

• Alberto García Ortega

  Autor

• Grace Jacqueline Oscullo Yépez

  Autor

• José Daniel Gómez Olivas

  Autor

• Amina Bekki

  Autor

• Thais Carolina Beauperthuy Levy

  Autor

• 

  Miguel Ángel Martínez García

  Autor

Participantes ajenos a IIS La Fe

• Manas-Baena, Eva
• Cano-Pumarega, Irene
• Barbero, Esther
• Garcia-Sanchez, Aldara
• Ingles, Marina
• Mompean, Sergio
• Calvillo, Pilar
• Jimenez-Aguilella, Juan Jose
• Navarrete, Javier
• Cervero, Alba
• Jimenez, David
• ESAET investigators

Grupos

• Neumología

  

  Leader

  Miguel Ángel Martínez García

Abstract

BACKGROUND: /Objective: Sleep-disordered breathing (SDB) may change from the acute to stable phase of some cardiovascular disorders, but little is known whether these dynamic changes also exist in pulmonary embolism (PE). This study aimed to analyze the changes in the apnea-hypopnea index (AHI) from the acute to stable phase of PE as well as the factors associated. PATIENTS/METHODS: We conducted a prospective, longitudinal and multicenter study of consecutive adults requiring hospitalization for non-hypotensive acute PE, with a protocol including clinical, imaging (transthoracic echocardiography [TTE] and computed tomography), blood tests and a sleep study within 48h of diagnosis of PE. After 3 months of follow-up, the sleep study was repeated. Right ventricular (RV) dysfunction was defined according to TTE criteria. RESULTS: One hundred and eleven patients (mean age [SD]: 63 [15] years; body mass index: 28.4 [4.7] kg/m2) were included. The initial AHI was 24.4 (21.8) events/h (AHI=5: 82.8%; AHI=30: 33.3%). Seventy-seven patients (69.4%) had RV dysfunction. In the overall cohort, the AHI decreased by 8.7 events/h from the acute to stable phase (24.4/h vs. 15.7/h; p=0.013). Patients with RV dysfunction showed a greater decrease in AHI (mean decrease 12.3/h vs. 0.43/h). In the multivariable analysis a drop of an AHI=5 events/hour was independently associated with the presence of initial RV dysfunction (hazard ratio 3.9; 95%CI 1.3 to 12.1). CONCLUSIONS: In hemodynamically stable patients with acute PE, there is a transient but clinically significant decrease in the AHI from the acute to stable phase, particularly when initially presenting with RV dysfunction.

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Keywords

• Obstructive sleep apnea; Sleep-disordered breathing; Pulmonary embolism; Right ventricular dysfunction; Sleep study; Cardiovascular disorders