Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome

Abstract

Objective: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent upper airway obstruction and intermittent hypoxia during sleep. Intermittent hypoxia and increased inflammatory activity plays a role in increased risk of cardiovascular disease in the OSAS. OSAS is an important cause of morbidity and mortality and cardiovascular disorders are the most important complications of OSAS. Mean platelet volume (MPV) is a marker of platelet activation and function, and increased platelet volume is associated with increased platelet activity. Different diseases related with inflammation, hypoxia, vascular injury, thrombosis and atherosclerosis were found to be associated with MPV. In this study, we aimed to investigate the relationship between OSAS and MPV. Methods: In this retrospective study, data of sex and age matched 33 patients with moderate OSAS, 34 patients with severe OSAS and 30 healthy subjects were evaluated. Results: The mean MPV was found in control, moderate OSAS and severe OSAS groups as 7.83±1.00, 8.26±1.40 and 8.94±1.20 (fL) respectively. The mean MPV value was significantly higher in severe OSAS group than control subjects (p=0.001). In correlation analysis, there were positive correlation between MPV with apnea-hypopnea index and total sleep time, and negative correlation between MPV with platelet count and minimum oxygen saturation (Respectively, p=0.003 / R=0.295, p=0.030 / R=0.221, p=0.011 / R= -0.257, p=0.019 / R= -0.238). Conclusion: In this study, the increased MPV was associated with severe OSAS and the results of this study suggest that the platelet activation is increased in OSAS. Hypoxia caused by OSAS, due to the activated platelets, may play a role in the development of cardiovascular diseases which is an important cause of morbidity and mortality in OSAS. J Clin Exp Invest 2013; 4 (4): 492-496

Keywords

• Complete Blood Count, Hypoxia, Mean Platelet Volume, Obstructive Sleep Apnea Syndrome.

Obstrüktif uyku apne sendromu ile ortalama trombosit hacmi arasındaki ilişkinin incelenmesi

Öz

Amaç: Obstrüktif uyku apne sendromu (OUAS) uyku sırasında tekrarlayan üst havayolu obstüksiyonu ve tekrarlayan aralıklı hipoksi ile karakterizedir ve aralıklı hipoksi ve inflamatuar aktivite artışı bu hastalıkta kardiyovasküler risk artışında rol oynamaktadır. OUAS önemli bir morbidite ve mortalite nedenidir ve en önemli komplikasyonları kardiyovasküler bozukluklardır. Ortalama trombosit hacmi (OTH) trombosit aktivasyonu ve fonksiyonunu gösteren bir belirteçtir ve artmış trombosit hacmi trombosit aktivite artışı ile ilişkilidir. İnflamasyon, hipoksi, vasküler hasar, tromboz ve ateroskleroz ile ilişkili farklı hastalıklar OTH ile ilişkili bulunmuştur. Bu çalışmada OUAS ile OTH arasındaki ilişkinin araştırılması amaçlanmıştır. Yöntemler: Bu çalışmada cinsiyet ve yaş bakımından benzer 33 orta OUAS ve 34 ağır OUAS hastası ile 30 sağlıklı bireyin verileri retrospektif olarak değerlendirildi. Bulgular: Kontrol, orta ve ağır OUAS gruplarında OTH ortalaması sırasıyla; 7,83±1,00, 8,26±1,40 ve 8,94±1,20 (fL) bulundu ve ağır OUAS grubunda kontrol grubuna göre anlamlı yüksekti (p=0,001). Korelasyon analizinde; OTH ile apne-hipopne indeksi ve toplam uyku süresi arasında pozitif, trombosit sayısı ve minimum oksijen saturasyonu arasında negatif korelasyon bulundu (Sırasıyla, p=0,003 / R=0,295; p=0,030 / R=0,221; p=0,011 / R= -0,257; p=0,019 / R= -0,238). Sonuç: Bu çalışmada ağır OUAS ile OTH artışı ilişkili bulunmuştur ve bu çalışmanın sonuçları OUAS’ta trombosit aktivasyonunun arttığını göstermektedir. OUAS’ta gelişen hipoksi trombosit aktivasyonuna yol açarak OUAS’ta önemli morbidite ve mortalite nedeni olan kardiyovasküler hastalıkların gelişiminde bir rol oynayabilir.

Anahtar Kelimeler

• Hipoksi, Obstrüktif Uyku Apne Sendromu, Ortalama Trombosit Hacmi, Tam Kan Sayımı

References

1. Garvey JF, Taylor CT, McNicholas WT. Cardiovascu- lar disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J 2009;33:1195-1205.
2. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long- term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observa- tional study. Lancet 2005;365:1046-1053.
3. McNicholas WT, Bonsigore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 2007;29:156-178.
4. Zamarron C, Garcia Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evi- dence. Eur J Intern Med 2008;19:390-398.
5. Toraldo DM, Peverini F, De Benedetto M, De Nuccio F. Obstructive sleep apnea syndrome: blood viscos- ity, blood coagulation abnormalities, and early athero- sclerosis. Lung 2013;191:1-7.
6. Parish JM, Somers VK. Obstructive sleep ap- nea and cardiovascular disease. Mayo Clin Proc 2004;79:1036-1046.
7. Martin JF, Shaw T, Heggie J, Penington DG. Measure- ment of the density of human platelets and its relation- ship to volume. Br J Haematol 1983;54:337-352.
8. Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopula- tions: relationship of platelet volume to ultrastruc- ture, enzymatic activity, and function. Br J Haematol 1982;50:509-519.

9. Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol 2009;31:277-297.
10. Akgul O, Uyarel H, Pusuroglu H, et al. Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myo- cardial infarction. Acta Cardiol 2013;68:307-314.
11. Şen HS, Abakay Ö, Taylan M, et al. The importance of mean platelet volume in early mortality of pulmonary embolism. J Clin Exp Invest 2013;4:298-301.
12. Yılmaz N, Özkan OV, Büyükbaş S, et al. Mean platelet volume in patients with acute pancreatitis. J Clin Exp Invest 2011;2:362-365.
13. Arica S, Ozer C, Arica V, et al. Evaluation of the mean platelet volume in children with familial Mediterranean fever. Rheumatol Int 2012;32:3559-3563.
14. Ayhan Tuzcu E, Arica S, Ilhan N, et al. Relationship between mean platelet volume and retinopathy in pa- tients with type 2 diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2013 Aug 17 (Epub ahead of print).
15. Erden EŞ, Dokuyucu R, Demirköse M, et al. Investi- gation of mean platelet volume in chronic obstructive pulmonary disease during stable and acute exacerba- tion. J Clin Exp Invest 2013 (In press).
16. Varol E, Ozturk O, Gonca T, et al. Mean platelet vol- ume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 2010;70:497- 502.
17. Kurt OK, Yildiz N. The importance of laboratory pa- rameters in patients with obstructive sleep apnea syn- drome. Blood Coagul Fibrinolysis 2013;24:371-374.
18. Iber C, Ancoli-Israel S, Chesson A, et al. American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, ter- minology and technical specifications, 1 st ed. West- chester, IL: American Academy of Sleep Medicine; 2007.
19. El Solh AA, Akinnusi ME, Baddoura FH, Mankowski CR. Endothelial cell apoptosis in obstructive sleep ap- nea: a link to endothelial dysfunction. Am J Respir Crit Care Med 2007;175:1186-1191.
20. Williams A, Scharf SM. Obstructive sleep apnea, car- diovascular disease, and inflammation--is NF-kappaB the key? Sleep Breath 2007;11:69-76.
21. Freynhofer MK, Tajsic M, Wojta J, Huber K. Bio- markers in acute coronary artery disease. Wien Med Wochenschr 2012;162:489-498.
22. Coppinger JA, Cagney G, Toomey S, et al. Character- ization of the proteins released from activated plate- lets leads to localization of novel platelet proteins in human atherosclerotic lesions. Blood 2004;103:2096- 2104.
23. Gawaz M, Langer H, May AE. Platelets in inflamma- tion and atherogenesis. J Clin Invest 2005;115:3378- 3384.
24. Karpatkin S. Heterogeneity of human platelets. II. Functional evidence suggestive of young and old platelets. J Clin Invest 1969;48:1083-1087.
25. Kilicli-Camur N, Demirtunc R, Konuralp C, et al. Could mean platelet volume be a predictive marker for acute myocardial infarction? Med Sci Monit 2005;11:387- 392.
26. Smith NM, Pathansali R, Bath PM. Platelets and stroke. Vasc Med 1999;4:165-172.
27. Arikanoglu A, Yucel Y, Acar A, et al. The relationship of the mean platelet volume and C-reactive protein lev- els with mortality in ischemic stroke patients. Eur Rev Med Pharmacol Sci 2013;17:1774-1777.
28. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47-58.
29. Geiser T, Buck F, Meyer BJ, et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002;69:229-234.
30. Hui DS, Ko FW, Fok JP, et al. The effects of nasal continuous positive airway pressure on platelet acti- vation in obstructive sleep apnea syndrome. Chest 2004;125:1768-1775.
31. Kanbay A, Tutar N, Kaya E, et al. Mean platelet vol- ume in patients with obstructive sleep apnea syn- drome and its relationship with cardiovascular diseas- es. Blood Coagul Fibrinolysis 2013;24:532-536.
32. Nena E, Papanas N, Steiropoulos P, et al. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep ap- noea syndrome: new indices of severity? Platelets 2012;23:447-454.