Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2020; 13(04): 230-234
DOI: 10.5935/1984-0063.20190147
Original Article

Obstructive sleep apnea, intermittent hypoxemia and prothrombotic biomarkers

Kunal Deokar
1   Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India.
,
Sushant Meshram
1   Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India.
,
Gopal Chawla
2   All India Institute of Medical Sciences, Pulmonary Medicine and Sleep Disorders - New Delhi - Delhi - India.
,
Nana Kunjir
1   Government medical college, Pulmonary Medicine - Nagpur - Maharashtra - India.
,
Chetna Meshram
3   Government medical college, Pharmacology - Nagpur - Maharashtra - India.
,
Nupur Abrol
4   All India Institute of Medical Sciences, Anaesthesia - Delhi - Delhi - India.
,
Priyanka Gaikwad
5   Bhaktivedanta hospital, Paediatrics - Mumbai - Maharashtra - India.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Objective To study the serum levels of fibrinogen and d-dimer in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation and arousal index.

Methods It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer were measured in cases of OSA and controls.

Results Serum fibrinogen levels among OSA patients (268.47±53.11mg/dl) were elevated as compared to the levels in controls (221.52±65.84mg/dl) (p<0.05). Serum fibrinogen co-related positively with AHI (r=0.6381, p=0.0011) and ODI (r=0.7434, p=0.0000), negatively with minimal oxygen saturation (r=-0.4461, p=0.0329). There was no statistically significant correlation of fibrinogen with arousal index (r=0.2697, p=0.2133). There was no statistically significant difference between mean fasting d-dimer level in cases (0.12mg/L, 0.06±0.18mg/L) and controls (0.12mg/L, 0.02±0.22mg/L) (p=0.8926).

Conclusions The observation of elevated fibrinogen levels with the increasing severity of OSA and hypoxemic events makes OSA one of the important risk factor for cardiovascular disorders.

Sleep Apnea Syndrome - Fibrinogen - Hypoxia


Publication History

Received: 22 November 2019

Accepted: 01 April 2020

Article published online:
09 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Lamberts M, Nielsen OW, Lip GYH, Ruwald MH, Christiansen CB, Kristensen SL, et al. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy: follow-up of 4.5 million Danish adults. J Intern Med. 2014 Dec;276(6):659-66.
  • 2 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005 Nov;353(19):2034-41.
  • 3 Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995 Oct;96(4):1897-904.
  • 4 Usui Y, Tomiyama H, Hashimoto H, Takata Y, Inoue Y, Asano K, et al. Plasma B-type natriuretic peptide level is associated with left ventricular hypertrophy among obstructive sleep apnoea patients. J Hypertens. 2008;26:117-23.
  • 5 Maeder MT, Ammann P, Rickli H, Schoch OD, Korte W, Hürny C, et al. N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea. Sleep Breath. 2008 Mar;12(1):7-16.
  • 6 Milleron O, Pilliere R, Foucher A, Roquefeuil F, Aegerter P, Jondeau G, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J. 2004 May;25(9):728-34.
  • 7 Freitas IGA, Bruin PF, Bittencourt L, Bruin VMS, Tufik S. What can blood biomarkers tell us about cardiovascular risk in obstructive sleep apnea?. Sleep Breath. 2015 Sep;19(3):755-68.
  • 8 Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature. Ann Intern Med. 1993 Jun;118(12):956-63.
  • 9 Maresca G, Di Blasio A, Marchioli R, Di Minno G. Measuring plasma fibrinogen to predict stroke and MI: an update. Arterioscler Thromb Vasc Biol. 1999 Jun;19(6):1368-77.
  • 10 Amiral J, Fareed J. Thromboembolic diseases: biochemical mechanisms and new possibilities of biological diagnosis. Semin Thromb Hemost. 1996;22(Suppl 1):41-8.
  • 11 Barceló A, Morell-Garcia D, Sanchís P, Peña-Zarza JA, Bauça JM, Piérola J, et al. Prothrombotic state in children with obstructive sleep apnea. Sleep Med. 2019 Jan;53:101-5.
  • 12 Steiner S, Jax T, Evers S, Hennersdorf M, Schwalen A, Strauer BE. Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk. Cardiology. 2005;104(2):92-6.
  • 13 Wessendorf TE, Thilmann AF, Wang YM, Schreiber A, Konietzko N, Teschler H. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med. 2000;162(6):2039-42.
  • 14 Bouloukaki I, Mermigkis C, Tzanakis N, Kallergis E, Moniaki V, Mauroudi E, et al. Evaluation of inflammatory markers in a large sample of obstructive sleep apnea patients without comorbidities. Mediators Inflamm. 2017;4573756.
  • 15 von Känel R, Princip M, Schmid JP, Barth J, Znoj H, Schnyder U, Meister- Langraf RE. Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction. BMC Cardiovasc Disord. 2018 Nov;18(1):213.
  • 16 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003 Dec;42(6):1206-52.
  • 17 American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan;33(Suppl 1):S62-S69.
  • 18 World Health Organization (WHO). Guidelines for controlling and monitoring the tobacco epidemic. Geneva: WHO; 1998. p. 76-101.
  • 19 Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012 Oct 15;8(5):597-619.
  • 20 Clauss A. Rapid physiological coagulation method in determination of fibrinogen. Acta Haematol. 1957 Apr;17(4):237-46.
  • 21 Scarano L, Bernardi E, Prandoni P, Sardella C, Rossi L, Carraro P, et al. Accuracy of two newly described D-dimer tests in patients with suspected deep venous thrombosis. Thromb Res.1997 Apr;86(2):93-9.
  • 22 Killick SB, Pentek PG, Mercieca JE, Clarke MF, Bevan DH. Comparison of immunofiltration assay of plasma D-dimer with diagnostic imaging in deep vein thrombosis. Br J Haematol.1997 Mar;96(4):846-9.
  • 23 Bartsch P, Haeberli A, Hauser K, Gubser A, Straub PW. Fibrinogenolysis in the absence of fibrin formation in severe hypobaric hypoxia. Aviat Space Environ Med. 1988;59:428-32.
  • 24 Bendz B, Sevre K, Andersen TO, Sandset PM. Low molecular weight heparin prevents activation of coagulation in a hypobaric environment. Blood Coagul Fibrinolysis. 2001 Jul;12(5):371-4.
  • 25 Konnerth D, Schwarz F, Probst M, Seidler M, Wagner T, Faul C, et al. Is acute pulmonary embolism more severe in the presence of obstructive sleep apnea? Results from an observational cohort study. J Thromb Thrombolysis. 2018 Aug;46(2):253-9.
  • 26 Nakanishi K, Tajima F, Nakata Y, Osada H, Sugiyama K, Maruta H, et al. Hypercoagulable state in a hypobaric, hypoxic environment causes nonbacterial thrombotic endocarditis in rats. J Pathol. 1997 Mar;181(3):338-46.
  • 27 Dean RT, Wilcox I. Possible atherogenic effects of hypoxia during obstructive sleep apnea. Sleep. 1993 Dec;16(Suppl 8):S15-S22.
  • 28 Gertler JP, Weibe DA, Ocasio VH, Abbott WM. Hypoxia induces procoagulant activity in cultured human venous endothelium. J Vasc Surg. 1991 Mar;13(3):428-33.
  • 29 Halász P. Arousal from sleep. In: Kushida CA, editor. Obstructive sleep apnea pathophysiology, comorbidities, and consequences. New York: CRC Press; 2007. p. 149-69.
  • 30 Mehra R, Xu F, Babineau DC, Tracy RP, Jenny NS, Patel SR, Redline S. Sleep-disordered breathing and prothrombotic biomarkers: crosssectional results of the Cleveland Family Study. Am J Respir Crit Care Med. 2010 Sep;182(6):826-33.
  • 31 von Känel R, Loredo JS, Ancoli-Israel S, Mills PJ, Natarajan L, Dimsdale JE. Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest. 2007 Mar;131(3):733-9.