Abstract
Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.
Highlights
Obstructive sleep apnoea (OSA) is the most common type of sleep-related respiratory disorder
AHI, apnoea-hypopnoea index; AI, apnoea index; desaturaion index (DI), desaturation index; RDT, respiratory disturbances time; SpO2 mean, mean oxygen saturation; SpO2 min, minimum oxygen saturation; t90, time in which oxygen saturation dropped below 90%; SD, standard deviation * p-value = Mann-Whitney test. doi:10.1371/journal.pone.0166725.t001
We found a positive correlation between plasma plasminogen activator inhibitor 1 (PAI-1) and body mass index (BMI) in the patients with OSA (r = 0.29; p = 0.04)
Summary
Obstructive sleep apnoea (OSA) is the most common type of sleep-related respiratory disorder. It is characterized by repetitive pauses in breathing during sleep or considerably reduced air flow despite the effort to breathe normally. Recent studies have focused on the effects of sleep disorders on blood clotting and fibrinolysis. Its components are involved in various processes, including embryogenesis, angiogenesis and wound healing [15]. It may play a role in pathological processes. Obstructive sleep apnoea induces thrombophilia and impairs fibrinolysis, which explains the increased risk of cardiovascular disease in these patients [18, 19]. Elevated TAT (thrombin-antithrombin III), a well-known marker of coagulant activity, has been reported [21]
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