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Abstract
Obstructive sleep apnea (OSA) is a risk factor for cardiovascular syndromes. Venous
thromboembolism (VTE) is a chronic disease, and pulmonary embolism (PE) is the major
expression of VTE and the third most frequent cardiovascular disease. An increasing
and emerging number of cross-sectional and longitudinal studies have linked OSA to
VTE, and have postulated different putative pathways to explain how OSA might increase
the risk of PE. We aim to provide a critical overview of the existing evidence about
the complex relationship between these two conditions, with some factors and confounding
variables still to be clarified. A global interpretation of the studies shows OSA
is highly prevalent in VTE patients. This association represents a major public health
burden, given the high prevalence and the mortality rates of both disorders. Although
still not proven, OSA may induce a persistent hypercoagulable state that may contribute
to increase VTE rate and its recurrence. Coagulant activity, platelet function and
fibrinolytic system may improve after continuous positive airway pressure (CPAP) in
OSA. However, there is a still a lack of randomized controlled trials to evaluate
the potential of CPAP and/or extend oral anticoagulation to reduce PE incidence, recurrence
and mortality by PE in patients with OSA.