Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute pulmonary embolism

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Obstructive sleep apnea (OSA) may have prothrombotic effects.


To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE).


In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy.


Obstructive sleep apnea patients with an apnea–hypopnea index (AHI) ≥ 15/h cohort were significantly older (p < 0.001) and had significantly lower oxygen saturations (p = 0.008) when acute PE was diagnosed. The sPESI scores (p < 0.001), the PAOI (p = 0.005) and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) values (p = 0.009), were significantly higher in the AHI ≥ 15/h subgroup. In a multivariate regression analysis, the AHI remains a significant predictor for sPESI scores ≥ 1 (p = 0.003), increased NT-proBNP levels (p = 0.047), and elevated PAOI (p = 0.032). During the median follow-up time of 53 (interquartile range 38–70) months, all-cause and cardiovascular-related mortality was significantly higher in the AHI ≥ 15/h cohort (p = 0.004 and p = 0.015, respectively).


Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute PE possibly due to its prothrombotic effects.

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The authors gratefully acknowledge the excellent assistance of Mrs. Tanja Wagner and Mrs. Sabine Siedka during the preparation and execution of the study. Mrs. Yvonne Eglinger provided most valuable support in proof reading the manuscript.

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Correspondence to Thomas M. Berghaus.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical standards

All study participants gave informed consent and the trial was approved by our institutional review boards (project number 080-11 with an amendment BKF 2017-3). All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments.

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Geissenberger, F., Schwarz, F., Probst, M. et al. Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute pulmonary embolism. Clin Res Cardiol 109, 13–21 (2020).

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  • Pulmonary embolism
  • Obstructive sleep apnea
  • Coagulation disorder
  • Pulmonary artery obstruction
  • Prognosis