CHEST Guidelines-Response_chest

Response_chest_27 (1)

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The document is a correspondence regarding the study that investigates the role of Obstructive Sleep Apnea (OSA) as an independent risk factor for recurrent pulmonary embolism (PE). The authors, led by Alberto Alonso-Fernández and colleagues, from various medical departments in Spain, report that OSA significantly increases the risk of PE recurrence due to its association with a hypercoagulable state. The study found a higher prevalence of apnea-hypopnea index (AHI) ≥10/h in patients with recurrent PE compared to those without relapse. <br /><br />The response also highlights that OSA remains a risk factor even when adjusted for Body Mass Index (BMI), suggesting that the risk attributed to obesity might be related to OSA as well. CPAP (Continuous Positive Airway Pressure) compliance was explored but the study could not definitively conclude its impact on reducing PE recurrence risk due to the small sample size and uncontrolled design.<br /><br />Alonso-Fernández et al. respond to a letter by Serin et al., pointing out inaccuracies in the references used by Serin and clarifying that their model included AHI, nocturnal SaO2, D-dimer levels, and CT90, and not the factors mentioned by Serin such as BMI or Epworth Sleepiness Scale. They assert that D-dimer levels are increased in OSA patients and underline the importance of CT90 as a protective factor, possibly due to its capacity to distinguish between hypoxia types. They suggest further research on the effects of CPAP and the role of CT90 in mitigating OSA-associated hypercoagulable states.<br /><br />Separately, a note addresses mechanical ventilation strategies following lung transplantation, emphasizing the need for specific research to optimize care in this context, referencing ARDS (Acute Respiratory Distress Syndrome) guidelines and suggesting a lower pressure target for protective ventilation post-transplantation.

Keywords

Obstructive Sleep Apnea

Pulmonary Embolism

Alberto Alonso-Fernández

hypercoagulable state

apnea-hypopnea index

Body Mass Index

CPAP compliance

D-dimer levels

CT90

mechanical ventilation