Obstructive sleep apnea remained significantly associated with VTE (relative risk 1.31, 95% CI 1.15-1.50) as well as DVT, PE, and CVA in the 28 days following total hip arthroplasty, even after extensive propensity matching for associated comorbidities.
OSA was significantly associated with increased 28-day VTE incidence after THA following propensity score matching.
Prior to propensity score matching, the OSA cohort carried a significantly higher risk of all five outcomes assessed in the 28 days following THA surgery.
Following propensity score matching, OSA remained significantly associated with DVT, PE, and CVA as secondary outcomes.
The study used a large retrospective multicentric cohort design drawing from a deidentified aggregated electronic health record platform.
OSA is described as a prevalent condition strongly associated with significant cardiovascular comorbidities and a predictor of poor outcomes in the postsurgical population.
This research suggests that people with obstructive sleep apnea (OSA) — a condition where breathing repeatedly stops and starts during sleep — face a meaningfully higher risk of developing dangerous blood clots and strokes in the month following hip replacement surgery. Analyzing records from over 180,000 patients who had total hip arthroplasty across a large U.S. database, the researchers found that those with an OSA diagnosis were about 31% more likely to develop venous thromboembolism (blood clots in the veins) within 28 days after surgery compared to similar patients without OSA. This elevated risk held up even after the researchers carefully accounted for other health conditions that commonly occur alongside OSA, such as obesity, heart disease, and diabetes. The study also found that the individual components of blood clot risk — deep vein thrombosis (clots in the legs) and pulmonary embolism (clots in the lungs) — as well as stroke were all significantly more common in OSA patients after hip replacement, even after statistical matching. Notably, heart attack risk did not remain statistically significant after this matching process, suggesting that the blood-clotting and cerebrovascular risks may be more specifically tied to OSA rather than simply reflecting the broader burden of other illnesses. This research matters because hip replacement is one of the most commonly performed surgeries, and blood clots are a well-known serious complication. These findings suggest that having OSA may be an important independent risk factor that surgeons, anesthesiologists, and post-operative care teams should consider when planning preventive strategies for patients undergoing hip replacement. The authors call for further research to understand the biological mechanisms behind why OSA increases clotting risk after surgery.
Fowler C, Tlimat A, Kaelber D, Tan K, Bliwise D, Collop N, et al.. (2026). Obstructive sleep apnea is associated with a higher 28-day incidence of venous thromboembolism and stroke after total hip arthroplasty.. Sleep & breathing = Schlaf & Atmung. https://doi.org/10.1007/s11325-026-03657-4