Obstructive Sleep Apnea as a Modifier of Systemic Thromboembolic Risk Following Retinal Vein Occlusion

BACKGROUND: Systemic vascular risk stratification following retinal vein occlusion (RVO) remains limited. We evaluated whether comorbid obstructive sleep apnea (OSA) modifies thromboembolic risk following RVO. METHODS: Retrospective cohort study using TriNetX Analytics Network. RVO patients with versus without prior OSA were matched 1:1 on demographics and comorbidities. Incident outcomes at 1, 3, and 5 years included hazard ratios (HR [95% confidence interval]) of anticoagulation initiation, composite venous thromboembolism (VTE; pulmonary embolism or deep vein thrombosis), myocardial infarction, composite arterial thromboembolism (ATE; cerebral infarction, transient ischemic attack, or arterial embolism), cerebral infarction, hemorrhagic stroke, carotid disease, and mortality. Secondary matched analysis compared central RVO (CRVO) versus branch RVO (BRVO) among OSA patients. RESULTS: After matching, 10,728 patients remained per cohort. OSA was associated with increased anticoagulation initiation (1 year: HR 1.38 [1.18-1.61]; 3 years: HR 1.29 [1.16-1.44]; 5 years: HR 1.32 [1.19-1.45]), VTE (1 year: HR 1.48 [1.20-1.82]; 3 years: HR 1.46 [1.26-1.69]; 5 years: HR 1.44 [1.26-1.63]), and myocardial infarction (3 years: HR 1.21 [1.06-1.38]; 5 years: HR 1.17 [1.04-1.31]). ATE, cerebral infarction, hemorrhagic stroke, and carotid disease hazards were similar. All-cause mortality was lower among OSA patients at 3 years (HR 0.88 [0.80-0.96]) and 5 years (HR 0.90 [0.83-0.98]). Among OSA patients, CRVO showed higher mortality than BRVO (1 year: HR 1.50 [1.20-1.89]; 3 years: HR 1.29 [1.11-1.49]; 5 years: HR 1.33 [1.18-1.51]). CONCLUSIONS: Comorbid OSA identifies a subgroup of RVO patients at higher hazard for venous thromboembolism and myocardial infarction. Within this subgroup, CRVO may carry higher all-cause mortality hazard than BRVO.