Obstructive Sleep Apnea and Risk for Thromboembolic Complication Among Patients With Polycystic Ovary Syndrome: A Retrospective Cohort Study

Objective To evaluate the association between obstructive sleep apnea (OSA) and thromboembolic events among women with polycystic ovary syndrome (PCOS). Design Retrospective cohort study with propensity score matching. Setting Multicenter electronic health record database (TriNetX US Collaborative Network). Population Women aged 18–45 years with a diagnosis of PCOS between 2012 and 2021. Methods Women with PCOS were stratified according to subsequent diagnosis of OSA and matched 1:1 with PCOS patients without OSA using propensity scores. Incident pulmonary embolism (PE) and venous thromboembolism (VTE) occurring after a 1‐year reference period were assessed using Cox proportional hazards models. Main Outcome Measures Incident pulmonary embolism and venous thromboembolism. Results After propensity score matching, 20 052 women were included (10 026 per group). All analyses were conducted within this propensity score‐matched cohort. PE incidence was higher among women with OSA compared with those without OSA (2.88 vs. 1.48 per 1000 person‐years; absolute difference 1.40 per 1000 person‐years; incidence rate ratio [IRR] 1.94, 95% CI 1.49–2.53; hazard ratio [HR] 1.95, 95% CI 1.50–2.54). VTE incidence was also increased (3.74 vs. 2.87 per 1000 person‐years; absolute difference 0.87 per 1000 person‐years; IRR 1.30, 95% CI 1.06–1.60; HR 1.32, 95% CI 1.07–1.61). These associations persisted across clinically relevant subgroups and increased over long‐term follow‐up. Conclusion Among women with PCOS, comorbid OSA is associated with an increased risk of thromboembolic events, particularly pulmonary embolism. These findings support consideration of OSA screening and enhanced thromboembolic risk assessment in women with PCOS.