STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease and prothrombotic conditions. However, OSA's relationship with venous thromboembolism (VTE) remains unclear, as previous works have made only limited adjustments for potential confounders. This study aims to evaluate the incidence and risk of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), in OSA patients.

METHODS In this nationwide, population-based cohort study using Korea's National Health Insurance Database, adults newly diagnosed with OSA were matched up to 1:5 with individuals without sleep apnea using propensity scores. Matching variables included age, sex, income, smoking history, body mass index, physical activity, and key comorbidities. The primary outcome was the incidence of VTE. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) for VTE.

RESULTS During a follow-up period of 7.5 ± 2.0 years (mean ± SD), 2214 incident VTE were identified among 133 245 patients with OSA, corresponding to an incidence rate of 287.5 per 100 000 person-years. This rate was higher than the incidence rate of 205.0 per 100 000 person-years observed in 629 994 matched controls. OSA was associated with a higher risk of VTE (HR, 1.68; 95% CI = 1.60% to 1.75%), including PE (HR, 1.82; 95% CI = 1.71% to 1.93%) and DVT (HR, 1.54; 95% CI = 1.44% to 1.65%). The study's findings remained consistent in subgroup analyses across sociodemographic and comorbid factors and in sensitivity analyses excluding individuals with a history of cancer.

CONCLUSIONS OSA is independently associated with an increased risk of VTE, including both PE and DVT. Statement of Significance Evidence regarding the association between obstructive sleep apnea (OSA) and venous thromboembolism (VTE) is limited, as previous studies have only partially adjusted for potential confounders. This population-based cohort study identified a higher incidence of VTE among individuals with OSA compared to controls, who were propensity score-matched based on various sociodemographic and comorbid factors. The study's findings remained consistent in subgroup analyses across sociodemographic and comorbid factors, as well as in sensitivity analyses excluding individuals with a history of cancer.