1
|
Kovbasyuk Z, Ramos-Cejudo J, Parekh A, Bubu OM, Ayappa IA, Varga AW, Chen MH, Johnson AD, Gutierrez-Jimenez E, Rapoport DM, Osorio RS. Obstructive Sleep Apnea, Platelet Aggregation, and Cardiovascular Risk. J Am Heart Assoc 2024:e034079. [PMID: 39056328 DOI: 10.1161/jaha.123.034079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/31/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Although related, the precise mechanisms linking obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are unclear. Platelets are mediators of CVD risk and thrombosis and prior studies suggested associations of OSA and platelet activity. The aim of this study is to assess the link between OSA, platelet activity, and CVD-related risk factors. METHODS AND RESULTS We studied the association of OSA-measures and platelet aggregation in participants dually enrolled in the SHHS (Sleep Heart and Health Study) and FHS (Framingham Heart Study). We applied linear regression models with adjustment for demographic and clinical covariates and explored interactions with OSA and CVD-related factors, including age, sex, body mass index, hypertension, OSA diagnosis (apnea-hypopnea index 4%≥5), and aspirin use. Our final sample was of 482 participants (60 years [14.00], 50.4% female). No associations were observed between apnea-hypopnea index 4% and platelet aggregation in the main sample. Stratified analysis revealed an association in aspirin users (n=65) for our primary exposure (apnea-hypopnea index 4%, β=0.523; P<0.001; n=65), and secondary exposures: hypoxic burden (β=0.358; P<0.001), minimum saturation (β=-0.519; P=0.026), and oxygen desaturation index 3% (β=74.672; P=0.002). No associations were detected in nonaspirin users (n=417). CONCLUSIONS No associations were detected between OSA and platelet aggregation in a community sample. Our finding that OSA associates with increased platelet aggregation in the aspirin group, most of whom use it for primary prevention of CVD, suggests that platelet aggregation may mediate the adverse impact of OSA on vascular health in individuals with existing CVD risk, supporting further investigation.
Collapse
Affiliation(s)
- Zanetta Kovbasyuk
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Jaime Ramos-Cejudo
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ankit Parekh
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Omonigho M Bubu
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| | - Indu A Ayappa
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Andrew W Varga
- Division of Pulmonary Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai New York City NY
| | - Ming-Huei Chen
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | - Andrew D Johnson
- Population Sciences Branch National Heart, Lung, and Blood Institute Framingham MA
| | | | - David M Rapoport
- Division of Brain Aging Department of Psychiatry New York University Grossman School of Medicine New York City NY
| | - Ricardo S Osorio
- Healthy Brain Aging and Sleep Center Department of Psychiatry New York University Langone Medical Center New York City NY
| |
Collapse
|
2
|
Zeng J, He J, Chen M, Li J. Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome: A systemic review and meta-analysis. PLoS One 2024; 19:e0297815. [PMID: 38363791 PMCID: PMC10871486 DOI: 10.1371/journal.pone.0297815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Despite polysomnography (PSG) being acknowledged being considered the gold standard for diagnosing obstructive sleep apnea-hypopnea syndrome (OSAHS), researchers have been seeking a biomarker that is less invasive, more practical in detection, and cost-effective for diagnosing and assessing the severity of the disease. To address this concern, the values of mean platelet volume (MPV) between patients with OSAHS and healthy controls were compared, and the relationship between MPV and multiple sleep monitoring parameters was analyzed in this study. METHODS A comprehensive search was conducted across medical databases, including PubMed, Web of Science, EMBASE, CNKI, and Wanfang, up until August 2, 2023, to identify published articles related to OSAHS. This study reviewed the literature regarding the values of MPV in individuals with OSAHS and control groups, the Pearson/Spearman correlation coefficients between MPV and sleep monitoring parameters, and the odds ratios (OR) of MPV concerning the occurrence of cardiovascular diseases (CVDs) in patients with OSAHS. Meta-analyses were performed using standardized mean difference (SMD), Fisher's z values correlation coefficients (ZCOR) and odds ratio (OR) as effect variables. A fixed-effect model was used if the heterogeneity was not significant (I2<50%); otherwise, a random-effect model was applied. We will also combine the treatment effect estimates of individual trials using fixed-effect and random-effects models. Statistical analysis was carried out by employing STATA 11.0 and R 4.1.3. RESULTS In total, 31 articles were selected for the final analysis. The study involved 3604 patients and 1165 control individuals. The MPV in the OSAHS group was considerably elevated in comparison to the healthy controls (SMD = 0.37, 95%CI = 0.21-0.53, P < 0.001), particularly among individuals with severe OSAHS (SMD = 0.57, 95%CI = 0.23-0.90, P = 0.001). Subgroup analysis based on ethnicity, mean body mass index (BMI), and study design type also revealed a considerably higher MPV in the OSAHS category in comparison to the healthy controls. Furthermore, MPV showed correlations with various sleep monitoring parameters. The elevation of MPV may be one of the risk factors for CVDs in individuals with OSAHS (adjusted OR = 1.72, 95%CI = 1.08-2.73, P = 0.022). CONCLUSION MPV is a relatively simple, cost-effective, and practical indicator of the severity of OSAHS, with its values being linked to the risk of CVDs in individuals with OSAHS.
Collapse
Affiliation(s)
- Jun Zeng
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - MeiFeng Chen
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - Jia Li
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Zhang Y, Hao W, Fan J, Guo R, Ai H, Que B, Wang X, Dong J, Nie S. Association Between Obstructive Sleep Apnea and Cardiovascular Events in Acute Coronary Syndrome Patients With or Without Revascularization - A Prospective Cohort Study. Circ J 2023; 87:1369-1379. [PMID: 37612051 DOI: 10.1253/circj.cj-23-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND The effects of obstructive sleep apnea (OSA) on the prognosis of acute coronary syndrome (ACS) without revascularization remain unclear, so the aim of the present study was to elucidate the association of OSA with subsequent cardiovascular events in ACS patients with and without revascularization.Methods and Results: We prospectively recruited hospitalized ACS patients undergoing sleep monitoring between June 2015 and January 2020. OSA was defined as an apnea-hypopnea index ≥15 events/h. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. Among 1,927 patients, 52.6% had OSA and 69.4% underwent revascularization. During a 2.9-year follow-up (1.5-3.6 years), the risk of MACCE was similar in patients with or without revascularization. OSA was an independent predictor of MACCE in the non-revascularization group (22.6% vs. 14.6%; hazard ratio (HR) 1.861; 95% confidence interval (CI) 1.239-2.796; P=0.003) but not in revascularization group (22.3% vs. 19.3%; HR 1.135; 95% CI 0.882-1.460; P=0.324). The incremental risk in the non-revascularization group was attributable to more hospitalizations for unstable angina (14.2% vs. 8.6%; HR 1.896; 95% CI 1.124-3.199; P=0.016). CONCLUSIONS For patients with ACS, OSA was independently associated with higher risk of recurrent cardiovascular events among patients without revascularization but not among patients undergoing revascularization. The benefits of suitable OSA treatment for patients without revascularization need further investigation.
Collapse
Affiliation(s)
- Ying Zhang
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University
| | - Wen Hao
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Jingyao Fan
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Ruifeng Guo
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Hui Ai
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Bin Que
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Xiao Wang
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Jianzeng Dong
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Shaoping Nie
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| |
Collapse
|
4
|
The Use of Aspirin Increases the Risk of Major Adverse Cardiac and Cerebrovascular Events in Hypertensive Patients with Obstructive Sleep Apnea for the Primary Prevention of Cardiovascular Disease: A Real-World Cohort Study. J Clin Med 2022; 11:jcm11237066. [PMID: 36498638 PMCID: PMC9737230 DOI: 10.3390/jcm11237066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Hypertensive patients with obstructive sleep apnea (OSA) are at high risk for cardiovascular diseases (CVDs), and the utility of aspirin for primary cardiovascular prevention in this population remains uncertain. (2) Methods: In this retrospective cohort study using data from the Urumchi Hypertension Database (UHDATA), hypertensive patients older than 18 years old with a first-time diagnosis of OSA were divided into three groups depending on aspirin history. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome. Secondary outcomes included MACCE components, ischemic events, cardiac events, cerebrovascular events, and gastrointestinal bleeding risk. The inverse probability of treatment weighting (IPTW) method was used to balance the confounding factors among the groups, and the Cox proportional hazards model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). (3) Results: In persistent aspirin users, the risk of MACCE events (HR 2.11, 95%CI 1.23-3.63), ischemic events (HR 2.58, 95%CI 1.42-4.69), cerebrovascular events (HR 2.55, 95%CI 1.44-4.51), and non-fatal cerebral infarction (HR 3.14, 95%CI 1.69-5.84) was significantly elevated. (4) Conclusions: Continuous aspirin use increases the incidence of cardiovascular adverse events in hypertensive patients with OSA receiving aspirin for primary prevention of cardiovascular disease.
Collapse
|
5
|
Lao M, Cheng Y, Gao X, Ou Q. The interaction among OSA, CPAP, and medications in patients with comorbid OSA and cardiovascular/cerebrovascular disease: a randomized controlled trial. BMC Pulm Med 2022; 22:99. [PMID: 35313858 PMCID: PMC8939073 DOI: 10.1186/s12890-022-01879-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 01/08/2023] Open
Abstract
Background Most patients with comorbid sleep apnea (OSA), cardiovascular (CV) disease, and/or cerebrovascular (CeV) disease simultaneously take medications. Whether OSA and continuous positive airway pressure (CPAP) interact with CV/CeV medications remains unknown. This study aimed to determine the interaction among OSA, CPAP, and CV/CeV medications; the effects of medications on major adverse cardiac and cerebrovascular events, and survival in patients with comorbid OSA and CV/CeV. Methods This was a post hoc analysis of the data from one center of the Sleep Apnea Cardiovascular Endpoints Study. Participants (aged 45–75 years) with comorbid OSA and CV/CeV were randomized to receive usual care with or without CPAP from December 2008 to November 2013. The primary endpoint was death and the secondary endpoint was a composite of death, myocardial infarction, stroke, hospitalization for unstable angina, heart failure, and transient ischemic attack. Results In total, 131 patients were analyzed. Sixty-three were in the CPAP group and 68 were in the usual care group, 41 had good adherence to CPAP (65.1%), and the median follow-up time was 43.0 (35.0, 54.0) months. In Cox regression analysis, ACE inhibitors and nitrates were independent factors for decreased survival in patients with comorbid OSA and CV/CeV (chi-square = 22.932, P = 0.003; ACE inhibitors: OR 7.241, P = 0.048, 95% CI 1.016–51.628; nitrates: OR 18.012, P = 0.011, 95% CI 1.923–168.750). ACE inhibitors increased mortality and secondary endpoints in the CPAP group (chi-square = 4.134, P = 0.042) but not in patients with good CPAP adherence. Clopidogrel and nitrates decreased survival in usual care group (clopidogrel: chi-square = 5.312, P = 0.021; nitrates: chi-square = 6.417, P = 0.011), but not in CPAP group. Conclusions OSA may predispose patients with CV/CeV and CV/CeV medications to a negative effect. CPAP treatment may neutralize the negative effects of OSA by relieving chronic intermittent hypoxia. Trial registration ClinicalTrials.gov (NCT00738179, first registration date: 20/08/2008).
Collapse
Affiliation(s)
- Miaochan Lao
- Department of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, No. 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Yilu Cheng
- Department of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, No. 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Xinglin Gao
- Geriatric Respiratory Department I, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Qiong Ou
- Department of Sleep Center, Department of Geriatric Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, No. 106 Zhongshan Er Rd, Guangzhou, 510080, China.
| |
Collapse
|
6
|
Marsee MK, Shariff FS, Wiarda G, Watson PJ, Sualeh AH, Brenner TJ, McCoy ML, Al-Fadhl HD, Jones AJ, Davis PK, Zimmer D, Folsom C. Use of Thromboelastography and Rotational Thromboelastometry in Otolaryngology: A Narrative Review. J Clin Med 2022; 11:jcm11041119. [PMID: 35207392 PMCID: PMC8876674 DOI: 10.3390/jcm11041119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
In the field of otolaryngology—head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient’s real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis.
Collapse
Affiliation(s)
- Mathew K. Marsee
- Department of Graduate Medical Education, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA
- Correspondence:
| | - Faisal S. Shariff
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (F.S.S.); (P.J.W.)
| | - Grant Wiarda
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA;
| | - Patrick J. Watson
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (F.S.S.); (P.J.W.)
| | - Ali H. Sualeh
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Toby J. Brenner
- Department of Biochemistry, Indiana Wesleyan University, Marion, IN 46953, USA;
| | - Max L. McCoy
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Hamid D. Al-Fadhl
- Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA; (A.H.S.); (M.L.M.); (H.D.A.-F.)
| | - Alexander J. Jones
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.J.J.); (P.K.D.)
| | - Patrick K. Davis
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.J.J.); (P.K.D.)
| | - David Zimmer
- Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Craig Folsom
- Department of Otolaryngology, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA;
| |
Collapse
|
7
|
Zolotoff C, Bertoletti L, Gozal D, Mismetti V, Flandrin P, Roche F, Perek N. Obstructive Sleep Apnea, Hypercoagulability, and the Blood-Brain Barrier. J Clin Med 2021; 10:jcm10143099. [PMID: 34300265 PMCID: PMC8304023 DOI: 10.3390/jcm10143099] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated episodes of intermittent hypoxia (IH) and is recognized as an independent risk factor for vascular diseases that are mediated by a multitude of mechanistic pathophysiological cascades including procoagulant factors. The pro-coagulant state contributes to the development of blood clots and to the increase in the permeability of the blood-brain barrier (BBB). Such alteration of BBB may alter brain function and increase the risk of neurodegenerative diseases. We aim to provide a narrative review of the relationship between the hypercoagulable state, observed in OSA and characterized by increased coagulation factor activity, as well as platelet activation, and the underlying neural dysfunction, as related to disruption of the BBB. We aim to provide a critical overview of the existing evidence about the effect of OSA on the coagulation balance (characterized by increased coagulation factor activity and platelet activation) as on the BBB. Then, we will present the emerging data on the effect of BBB disruption on the risk of underlying neural dysfunction. Finally, we will discuss the potential of OSA therapy on the coagulation balance and the improvement of BBB.
Collapse
Affiliation(s)
- Cindy Zolotoff
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Correspondence: ; Tel.: +33-477-421-452
| | - Laurent Bertoletti
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, MU Women’s and Children’s Hospital, University of Missouri, Columbia, MO 65201, USA;
| | - Valentine Mismetti
- Service de Pneumologie et d’Oncologie Thoracique, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France;
| | - Pascale Flandrin
- Laboratoire d’Hématologie, Hôpital Nord, CHU Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France;
| | - Frédéric Roche
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
- Service de Physiologie Clinique et de l’Exercice, Centre VISAS, CHU Saint Etienne, F-42270 Saint-Priest-en-Jarez, France
| | - Nathalie Perek
- U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet Saint-Étienne, F-42270 Saint-Priest-en-Jarez, France; (L.B.); (F.R.); (N.P.)
| |
Collapse
|
8
|
Mochol J, Gawrys J, Gajecki D, Szahidewicz-Krupska E, Martynowicz H, Doroszko A. Cardiovascular Disorders Triggered by Obstructive Sleep Apnea-A Focus on Endothelium and Blood Components. Int J Mol Sci 2021; 22:5139. [PMID: 34066288 PMCID: PMC8152030 DOI: 10.3390/ijms22105139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. Among arousal from sleep, increased thoracic pressure and enhanced sympathetic activation, intermittent hypoxia is now considered as one of the most important pathophysiological mechanisms contributing to the development of endothelial dysfunction. Nevertheless, not much is known about blood components, which justifies the current review. This review focuses on molecular mechanisms triggered by sleep apnea. The recurrent periods of hypoxemia followed by reoxygenation promote reactive oxygen species (ROS) overproduction and increase inflammatory response. In this review paper we also intend to summarize the effect of treatment with continuous positive airway pressure (CPAP) on changes in the profile of the endothelial function and its subsequent potential clinical advantage in lowering cardiovascular risk in other comorbidities such as diabetes, atherosclerosis, hypertension, atrial fibrillation. Moreover, this paper is aimed at explaining how the presence of OSA may affect platelet function and exert effects on rheological activity of erythrocytes, which could also be the key to explaining an increased risk of stroke.
Collapse
Affiliation(s)
| | | | | | | | | | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.); (J.G.); (D.G.); (E.S.-K.); (H.M.)
| |
Collapse
|
9
|
Wang J, Li X, Pu J, Jin S, Jia L, Li X, Liu F, Yang Y. Mean platelet volume and coronary plaque vulnerability: an optical coherence tomography study in patients with non-ST-elevation acute coronary syndrome. BMC Cardiovasc Disord 2019; 19:128. [PMID: 31142268 PMCID: PMC6542039 DOI: 10.1186/s12872-019-1115-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/21/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The association between mean platelet volume (MPV) and coronary plaque vulnerability in patients with non-ST-elevation ACS (NSTE-ACS) has not been investigated. We performed a retrospective study to evaluate the association between MPV and plaque vulnerability using optical coherence tomography (OCT). METHODS Consecutive NSTE-ACS patients who underwent pre-intervention OCT examination in our center were included in this study. Features of coronary plaques in the culprit arteries were classified as rupture, nonrupture with thin-cap fibroatheroma (TCFA), and nonrupture and non-TCFA. ROC analyses were used to determine the predictive efficacy of MPV for plaque rupture, and multivariate logistic regression analysis was performed to evaluate the potential independent predictors of plaque vulnerability. RESULTS Overall, 94 patients were included in this study. We identified 17 patients with plaque rupture, 10 with nonrupture with TCFA, and 67 with nonrupture and non-TCFA. ROC analyses showed that MPV ≥ 10.5 fL was predictive of plaque rupture in NSTE-ACS patients. Univariate analyses indicated that patients with higher MPV (≥ 10.5 fL) had higher body mass index and poorer lipid profiles compared to those with lower MPV. Moreover, those with higher MPV had higher incidences of plaque rupture and thrombosis (both P < 0.05). Results of multivariate analyses showed that diabetes and higher platelet distribution width (PDW) were independent risk factors of TCFA (P = 0.032 and 0.046, respectively), while diabetes, higher BMI, higher PDW, and higher MPV were independent determinants of plaque rupture in our cohorts (P all < 0.05). CONCLUSIONS Higher MPV is independently associated with higher risk of plaque rupture as evidenced by OCT in our cohort of NSTE-ACS patients.
Collapse
Affiliation(s)
- Jun Wang
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Xing Li
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Jun Pu
- The Renji Hospital of Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Siyu Jin
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Lu Jia
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Xiaomei Li
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Fen Liu
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Yining Yang
- Department of Coronary Heart Disease, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China.
| |
Collapse
|