Increased platelet activation in sleep apnea subjects with intermittent hypoxemia

Increased platelet activation in sleep apnea subjects with intermittent hypoxemia

Purpose Obstructive sleep apnea (OSA) is independently associated with increased risk for stroke and other cardiovascular diseases. Since activated platelets play an important role in cardiovascular disease, the objective of this study was to determine whether platelet reactivity was altered in OSA...

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Bibliographic Details
Published in:Sleep & breathing Vol. 24; no. 4; pp. 1537 - 1547
Main Authors: Krieger, Ana C., Anand, Ranjini, Hernandez-Rosa, Evelyn, Maidman, Allison, Milrad, Sara, DeGrazia, Miles Q., Choi, Alexander J., Oromendia, Clara, Marcus, Aaron J., Drosopoulos, Joan H. F.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-12-2020
Springer Nature B.V
Subjects:
Agonists
Apnea
Cardiovascular disease
Cardiovascular diseases
CD40L protein
Collagen
Dentistry
Epinephrine
Flow cytometry
Hypoxemia
Internal Medicine
Medicine
Medicine & Public Health
Monocytes
Neurology
Otorhinolaryngology
P-selectin
Pediatrics
Platelet aggregation
Pneumology/Respiratory System
Sleep
Sleep apnea
Sleep Breathing Physiology and Disorders • Original Article
Sleep disorders
Surface markers
Thrombin
Thrombosis
Intermittent hypoxemia
Cardiovascular disease
Stroke
Platelet aggregation
Platelet activation
Obstructive sleep apnea
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Summary:Purpose Obstructive sleep apnea (OSA) is independently associated with increased risk for stroke and other cardiovascular diseases. Since activated platelets play an important role in cardiovascular disease, the objective of this study was to determine whether platelet reactivity was altered in OSA subjects with intermittent nocturnal hypoxemia. Methods Thirty-one subjects, without hypertension or cardiovascular disease and not taking medication, participated in the study. Subjects were stratified based on OSA-related oxygen desaturation index (ODI) recorded during overnight polysomnography. Platelet reactivity to a broad panel of agonists (collagen, thrombin, protease-activated receptor1 hexapeptide, epinephrine, ADP) was measured by monitoring platelet aggregation and ATP secretion. Expression of platelet activation markers CD154 (CD40L) and CD62P (P-selectin) and platelet-monocyte aggregates (PMA) was quantified by flow cytometry. Results Epinephrine-induced platelet aggregation was substantially decreased in OSA subjects with significant intermittent hypoxemia (ODI ≥ 15) compared with subjects with milder hypoxemia levels (ODI < 15) (area under curve, p  = 0.01). In addition, OSA subjects with ODI ≥ 15 exhibited decreased thrombin-induced platelet aggregation ( p  = 0.02) and CD40L platelet surface expression ( p  = 0.05). Platelet responses to the other agonists, CD62P platelet surface expression, and PMA levels were not significantly different between groups. Reduction in platelet responses to epinephrine and thrombin, and decreased CD40L surface marker expression in significant hypoxemic OSA individuals, is consistent with their platelets being in an activated state. Conclusions Increased platelet activation was present in otherwise healthy subjects with intermittent nocturnal hypoxemia due to underlying OSA. This prothrombotic milieu in the vasculature is likely a key contributing factor toward development of thrombosis and cardiovascular disease. Trial registration NCT00859950
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content type line 23
Deceased
ISSN:1520-9512
1522-1709
DOI:10.1007/s11325-020-02021-4