Abstract
PurposeObstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. The aim of the study was to assess the influence of OSAS on endothelial dysfunction and thrombosis biomarkers and to evaluate the effect of treatment with continuous positive airway pressure (CPAP) on biomarker levels.MethodsNT-proBNP, sICAM-1, endothelin-1, von Willebrand factor, D-dimers, and thrombin-antithrombin complex (TAT) were measured in 50 patients diagnosed with moderate-to-severe OSAS. All patients underwent transthoracic echocardiography, and 38 months after the inclusion, 16 CPAP users and 22 non-CPAP users were reassessed.ResultsSleep-related indices of apnea-hypopnea index (AHI) and mean SpO2 were associated with higher sICAM-1 levels (AHI < 30: 7.3 ± 4.7 vs. AHI ≥ 30: 19.5 ± 19.4 mg/ml, p = 0.04; SpO2 ≥ 90%: 11.9 ± 9.3 vs. SpO2 < 90%: 23.6 ± 25.8, p = 0.04). sICAM-1 levels were significantly higher in obese patients, particularly with BMI ≥ 40. Plasma levels of TAT were significantly correlated with the increased right ventricular size (right ventricular diameter ≤ 37 mm: 0.86 ± 0.70 vs. > 37 mm: 1.96 ± 1.20 ng/ml, p = 0.04). Endothelin-1 levels were higher in patients with decreased right ventricular function (right ventricle TDI-derived S′ ≥ 12 cm/s: 11.5 ± 10.9 vs. < 12 cm/s: 26.0 ± 13.2 pg/ml, p = 0.04). An increase in NT-proBNP was related to impaired parameters of the right ventricular contractile function. There were no correlations between long-term CPAP therapy and the levels of biomarkers.ConclusionSevere OSAS influences endothelial damage as manifested by an increase in sICAM-1 levels. Changes in right ventricular structure and function, observed mainly in patients with higher TAT and endothelin-1 levels, are also manifested by an increase in NT-proBNP levels. Long-term CPAP treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction.
Highlights
Obstructive sleep apnea syndrome (OSAS) is considered an epidemic disease in the modern world, affecting approximately 7% of men and 5% of women [1]
Long-term continuous positive airway pressure (CPAP) treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction
There was no significant difference in the levels of biomarkers between the patients with or without cardiovascular risk factors except for the significant influence of body weight on soluble form of intracellular adhesion molecule-1 (sICAM-1) and endothelin-1 (Table 2)
Summary
Obstructive sleep apnea syndrome (OSAS) is considered an epidemic disease in the modern world, affecting approximately 7% of men and 5% of women [1]. It is a chronic disorder characterized by recurrent episodes of upper airway collapse during sleep, resulting in hypoxia. It has been documented that repeated episodes of nocturnal hypoxia in OSAS patients may result with a hypercoagulable state, and it could be an independent risk factor for cardiovascular and cerebrovascular episodes [7]. Some studies have suggested significant correlations between OSAS and thrombin-antithrombin complex (TAT), D-dimers, and von Willebrand factor (vWF) [8, 9]. Elevated plasma levels of vWF may indicate endothelial dysfunction and are found in several cardiovascular diseases, e.g., as pulmonary artery hypertension
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