Hemostatic implications of endothelial cell apoptosis in obstructive sleep apnea

Patients with obstructive sleep apnea (OSA) are at increased risk of atherothrombosis independent of the Framingham risk factors. Studies on hemostasis factors in OSA are scarce and inconsistent. We sought to understand the variation in atherothrombotic propensity as a function of apoptotic circulat...

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Published in:	Sleep & breathing Vol. 12; no. 4; pp. 331 - 337
Main Authors:	El Solh, Ali A., Akinnusi, Morohunfolu E., Berim, Ilya G., Peter, A. Misha, Paasch, Linda L., Szarpa, Kristie R.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer-Verlag 01-11-2008 Springer Springer Nature B.V
Subjects:	Adult Apoptosis Apoptosis - physiology Atherosclerosis - blood Babies Biological and medical sciences Continuous Positive Airway Pressure Dentistry Development. Senescence. Regeneration. Transplantation Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes Endothelium, Vascular - physiopathology Enzyme-Linked Immunosorbent Assay Fundamental and applied biological sciences. Psychology Hemostasis - physiology Humans Internal Medicine Male Medical sciences Medicine Medicine & Public Health Nervous system (semeiology, syndromes) Neurology Original Article Otorhinolaryngology Oxygen - blood Pediatrics Pneumology/Respiratory System Polysomnography Reference Values Risk Factors Sleep apnea Sleep Apnea, Obstructive - blood Sleep Apnea, Obstructive - therapy Sleep disorders Sleep. Vigilance Thrombophilia - blood Thrombophilia - therapy Thromboplastin - metabolism Thrombosis - blood Vertebrates: nervous system and sense organs von Willebrand Factor - metabolism Sleep apnea von Willebrand factor Tissue factor Apoptosis Endothelium Endothelium . Sleep apnea Endothelial cell Nervous system diseases Sleep apnea syndrome Hemostatic Respiratory disease Sleep disorder Sleep Sleep wake cycle Neurological disorder Willebrand factor
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Summary:	Patients with obstructive sleep apnea (OSA) are at increased risk of atherothrombosis independent of the Framingham risk factors. Studies on hemostasis factors in OSA are scarce and inconsistent. We sought to understand the variation in atherothrombotic propensity as a function of apoptotic circulating endothelial cells (CECs) in OSA by investigating the relationship between CEC apoptosis and plasma levels of hemostatic factors tissue factor (TF) and von Willebrand Factor (vWF) in apneic subjects. Apoptotic CECs were detected by flow cytometry in 35 male subjects free of cardiovascular diseases (AHI range 8–43) and 12 healthy male controls (AHI range 2–5) before and after 8 weeks of nasal continuous positive airway pressure (nCPAP). Quantitative determination of TF and vWF was performed using an enzyme-linked immunosorbent assay (ELISA) kit. The mean levels of TF (66.78 ± 41.59 pg/ml) and vWF (189.70 ± 69.24 IU/dl) were significantly higher in OSA patients compared with those in healthy subjects (42.83 ± 14.18 pg/ml; and 124.48 ± 31.43 IU/dl). Apoptotic CECs were elevated in patients with OSA and correlated strongly with TF and vWF levels ( p = 0.02 and p < 0.001; respectively). There were no correlations between TF, vWF and apnea hypopnea index, or arousal index. Only the percentage of time spent <90% oxygen saturation was inversely associated with TF ( r = 0.38; p = 0.02). Following nCPAP therapy, there was significant decrease in TF levels that correlated with decrease in apoptotic CECs. In patients with OSA, increased prothrombotic factors are strongly determined by apoptotic CECs. Treatment with nCPAP may alleviate the coagulation propensity.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1520-9512 1522-1709
DOI:	10.1007/s11325-008-0182-x