Hypercoagulability, Obstructive Sleep Apnea, and Pulmonary Embolism

To the Editor We read with great interest the article written by Hong et al. They found that prothrombin time in patients with obstructive sleep apnea (OSA) was shorter compared with controls, concluding that OSA might lead to a prothrombotic state, a probable contributing factor to the increase in cardiovascular complications in OSA, including ischemic heart disease and stroke. Observational studies suggest that suppression of apneas by continuous positive airway pressure (CPAP) may improve cardiovascular outcomes. Nevertheless, recent data from a large randomized clinical trial did not prevent cardiovascular events in patients with moderate-to-severe OSA, despite significant reduction in daytime sleepiness. One possible explanation is that they included patients with previous cardiovascular disease with an established atherosclerosis burden in arterial vessels and heart remodeling, which could be, by this time, unalterable by the CPAP effect.

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