Postsurgical vascular outcomes and their association with obstructive sleep apnea: results from a national cohort

SESSION TITLE: OSA: New Therapeutic Targets SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Obstructive sleep apnea (OSA) is a common disorder that has been associated with cardiovascular disease and venous thromboembolism. Assessing the independent impact of OSA on these outcomes can be challenging without a sufficiently large model. We used a very large, national database to examine the association of OSA with these outcomes in postsurgical patients after propensity matching. METHODS: We queried the TriNetX U.S. Collaborative Network, a large database collecting anonymized electronic health record and claims-derived data of over 91 million patients from all 50 U.S. states. Using in-platform analytics, we assessed patients with CPT codes for coronary artery bypass grafting (CABG) and total knee arthroplasty (TKA). We then examined the 1-year incidence of myocardial infarction (MI), cerebrovascular accident (CVA), deep vein thrombosis (DVT), and pulmonary embolism (PE) using ICD-10-CM diagnostic codes. We analyzed the association of each outcome with OSA before and after in-platform propensity matching to account for demographics and comorbidities (including hypertension, heart failure, atrial fibrillation, end stage kidney disease, chronic obstructive pulmonary disease, tobacco use, obesity, hyperlipidemia, and prior DVT, PE, MI, or CVA). RESULTS: Of 91,495,219 patients in the cohort, 139,797 underwent TKA between 03/2012 and 03/2022, with 26,116 of these diagnosed with OSA. Of the 113,681 patients without OSA, 1.4% were diagnosed with MI within a year of intervention vs 3.1% of those with OSA (p<0.001), OR 2.3 (95%CI 2.1–2.5). OSA was also significantly associated (p<0.001) with CVA (2.1 vs 4.4%; OR 2.1, 2.0–2.3), DVT (3.0 vs 5.7%; OR 1.9, 1.8–2.1), and PE (1.6 vs 3.7%; OR 2.4, 2.2–2.5). Following propensity matching, OSA remained significantly associated with all 1-year outcomes among TKA patients (p<0.001) with ORs of 1.3 for MI (1.2–1.5), 1.2 for CVA (1.1–1.3), 1.2 for DVT (1.1–1.3) and 1.5 for PE (1.3–1.7). In the same time frame, 65,877 patients underwent CABG, with 10,165 having OSA. OSA was significantly associated (p<0.001) with CVA (6.0 vs 10.0%; OR 1.7, 1.6–1.9), DVT (3.3 vs 6.8%; OR 2.2, 2.0–2.4), and PE (1.9 vs 4.2%; OR 2.3, 2.0–2.5). Following propensity matching, OSA remained significantly associated with all 1-year outcomes among CABG patients (p<0.001) with ORs of 1.3 for CVA (1.2–1.4), 1.4 for DVT (1.2–1.6) and 1.4 for PE (1.2–1.7). CONCLUSIONS: OSA was associated with all outcomes despite broad propensity matching, particularly with PE incidence. While limitations include inability to assess for use of continuous positive airway pressure (CPAP) therapy, these findings confirm earlier studies that suggest a procoagulant effect in un- and undertreated OSA. CLINICAL IMPLICATIONS: OSA may represent an acquired hypercoagulable condition, with further investigation necessary to identify both the pathophysiology contributing to this disorder and whether prophylactic measures may be of clinical benefit. DISCLOSURES: No relevant relationships by Dennis Auckley No relevant relationships by Lauren Chism No relevant relationships by Cosmo Fowler No relevant relationships by Stephen Pastores No disclosure submitted for Stephen Pastores