Mean Platelet Volume (MPV) in Obstructive Sleep Apnea (OSA) and Effect of Continuous Positive Airway Pressure (CPAP) Treatment on MPV in OSA

Abstract

Aims: In this study, our objective was to evaluate mean platelet volume (MPV), an indirect marker of platelet activation, in patients with obstructive sleep apnea (OSA), and assess the effect of OSA treatment with continuous positive airway pressure (CPAP) on MPV Methods: In this study, records of consecutive patients who underwent polysomnographic evaluation for OSA symptoms in the Sleep Disorders Laboratory during a one-year period were reviewed retrospectively. Patients who had both complete blood count and MPV measurements were included in the study. Results: A total of 158 patients, including 51 females (32.3%) and 107 males (67.7%), were included in the study. The mean age of the patients was 51±13 (min-18, max-82) years. OSA was detected in 74.1% (117/158) of the patients. It was determined that as the severity of OSA increased, hemoglobin and hematocrit values increased significantly. There was no significant difference in platelet count according to the presence and severity of OSA. The MPV was significantly lower in severe OSA cases compared to those without OSA and mild OSA cases. A negative correlation was observed between MPV and the apnea-hypopnea index, desaturation index, and the amount of oxygen saturation below 90% during sleep. There was no significant difference in median erythrocyte and thrombocyte counts, hematocrit percentage and hemoglobin values before and after treatment in OSA patients who used CPAP therapy. However, a significant decrease in MPV was observed after OSA treatment compared to pre-treatment. (p=0.021). Conclusions: The results of the study do not support an increase in MPV and hence platelet activation in severe OSA patients compared with those without OSA. However, the results suggest that one month of CPAP treatment reduces MPV and thus platelet activation in severe OSA patients. Further controlled, prospective studies including treatment outcomes are needed on this subject.

Keywords

• sleep apnea
• mean platelet volume
• obstructive sleep apnea
• platelets

Obstrüktif Uyku Apnede (OUA) Ortalama Trombosit Hacmi (OTH) ve OUA'da Sürekli Pozitif Hava Yolu Basıncı (CPAP) Tedavisinin OTH Üzerine Etkisi

Abstract

Amaç: Bu çalışmada amacımız, obstrüktif uyku apnesi (OUA) olan hastalarda trombosit aktivasyonunun dolaylı bir belirteci olan ortalama trombosit hacmini (OTH) değerlendirmek ve sürekli pozitif hava yolu basıncı (CPAP) ile OUA tedavisinin OTH üzerindeki etkisini değerlendirmektir. Metot: Bu çalışmada, Uyku Bozuklukları Laboratuvarı'nda bir yıl boyunca OSA semptomları nedeniyle polisomnografik değerlendirme yapılan ardışık hastaların kayıtları retrospektif olarak incelendi. Çalışmaya hem tam kan sayımı hem de MPV ölçümü yapılan hastalar dahil edildi. Bulgular: Çalışmaya 51 kadın (%32.3) ve 107 erkek (%67.7) olmak üzere toplam 158 hasta dahil edildi. Hastaların yaş ortalaması 51±13 (min-18, maks-82) yıldı. Hastaların %74,1'inde (117/158) OSA saptandı. OSA şiddeti arttıkça hemoglobin ve hematokrit değerlerinin anlamlı olarak arttığı belirlendi. Trombosit sayısında OSA varlığı ve şiddetine göre anlamlı bir fark yoktu. MPV, ağır OSA olgularında OSA olmayanlara ve hafif OSA olgularına kıyasla anlamlı derecede düşüktü. OTH ile apne-hipopne indeksi, desatürasyon indeksi ve uyku sırasında %90'ın altındaki oksijen satürasyonu miktarı arasında negatif bir korelasyon gözlendi. CPAP tedavisi kullanan OSA hastalarında tedavi öncesi ve sonrası medyan eritrosit ve trombosit sayıları, hematokrit yüzdesi ve hemoglobin değerlerinde anlamlı bir fark bulunmadı. Bununla birlikte, OSA tedavisi sonrasında tedavi öncesine kıyasla MPV'de anlamlı bir düşüş gözlendi. (p=0.021). Sonuç: Çalışmanın sonuçları, OSA'sı olmayanlara kıyasla ağır OSA hastalarında MPV'de ve dolayısıyla trombosit aktivasyonunda bir artışı desteklememektedir. Ancak, sonuçlar bir aylık CPAP tedavisinin ağır OUA hastalarında MPV'yi ve dolayısıyla trombosit aktivasyonunu azalttığını düşündürmektedir. Bu konuda tedavi sonuçlarını içeren daha ileri kontrollü, prospektif çalışmalara ihtiyaç vardır.

Keywords

• Uyku Apne
• ortalama trombosit hacmi
• obstruktif uyku apne
• trombositler

References

1. 1- Ralls F, Cutchen L. A contemporary review of obstructive sleep apnea. Curr Opin Pulm Med. 2019 Nov;25(6):578-593.
2. 2- Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest. 1988 Dec;94(6):1200-4.
3. 3- Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-98.
4. 4- Dredla BK, Castillo PR. Cardiovascular Consequences of Obstructive Sleep Apnea. Curr Cardiol Rep. 2019 Nov 9;21(11):137.
5. 5- Arnaud C, Bochaton T, Pépin JL, Belaidi E. Obstructive sleep apnoea and cardiovascular consequences: Pathophysiological mechanisms. Arch Cardiovasc Dis. 2020 May;113(5):350-8.
6. 6- Phillips B. Sleep-disordered breathing and cardiovascular disease. Sleep Med Rev. 2005 Apr;9(2):131-40. 7- Calvin AD, Somers VK. Obstructive sleep apnea and cardiovascular disease. Curr Opin Cardiol. 2009 Nov;24(6):516-20.
7. 8- Roux F, D'Ambrosio C, Mohsenin V. Sleep-related breathing disorders and cardiovascular disease. Am J Med. 2000 Apr 1;108(5):396-402.
8. 9- Henning BF, Zidek W, Linder B, Tepel M. Mean platelet volume and coronary heart disease in hemodialysis patients. Kidney Blood Press Res. 2002;25(2):103-8.

9. 10- Hekimsoy Z, Payzin B, Ornek T, Kandoğan G. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications. 2004 May-Jun;18(3):173-6.
10. 11- Dindar S, Cinemre H, Sengul E, Annakkaya AN. Mean platelet volume is associated with glycaemic control and retinopathy in patients with type 2 diabetes mellitus. West Indian Med J. 2013 Jul;62(6):519-23.
11. 12- Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002 Aug-Sep;13(5-6):301-6.
12. 13- Norgaz T, Hobikoglu G, Aksu H, Bolca O, Uyarel H, Eren M, Narin A. The relationship between preprocedural platelet size and subsequent in-stent restenosis. Acta Cardiol. 2004 Aug;59(4):391-5.
13. 14- Bath P, Algert C, Chapman N, Neal B; PROGRESS Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004 Mar;35(3):622-6.
14. 15- Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets. 2016 Nov;27(7):607-12.
15. 16- Varol E, Ozturk O, Gonca T, Has M, Ozaydin M, Erdogan D, et al. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest. 2010 Nov;70(7):497-502.
16. 17- Nena E, Papanas N, Steiropoulos P, Zikidou P, Zarogoulidis P, Pita E, et al. Mean Platelet Volume and Platelet Distribution Width in non-diabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets. 2012;23(6):447-54.
17. 18- Karakaş MS, Altekin RE, Baktır AO, Küçük M, Cilli A, Yalçınkaya S. Association between mean platelet volume and severity of disease in patients with obstructive sleep apnea syndrome without risk factors for cardiovascular disease. Turk Kardiyol Dern Ars. 2013;41(1):14-20.
18. 19- Akyol S, Çörtük M, Baykan AO, Kiraz K, Börekçi A, Şeker T, et al. Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome. Clinics (Sao Paulo). 2015;70(7):481-5.
19. 20- Ulusoy B, Oğuzhan T, Akyol M, Bozdemir K, Çiftçi B, Korkmaz MH. Insufficiency of positive airway pressure treatment on increased mean platelet volume: a prospective controlled study in patients with obstructive sleep apnea syndrome. Sleep Breath. 2020 Sep;24(3):885-91.
20. 21- Rahangdale S, Yeh SY, Novack V, Stevenson K, Barnard MR, Furman MI, et al. The influence of intermittent hypoxemia on platelet activation in obese patients with obstructive sleep apnea. J Clin Sleep Med. 2011;7(2):172-8.
21. 22- Sökücü SN, Ozdemir C, Dalar L, Karasulu L, Aydın S, Altın S. Is mean platelet volume really a severity marker for obstructive sleep apnea syndrome without comorbidities? Pulm Med. 2014;2014:754839.
22. 23- Kurt OK, Yildiz N. The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis. 2013;24(4):371-4.
23. 24- Bülbül Y, Aydın Özgür E, Örem A. Platelet indices in obstructive sleep apnea: the role of mean platelet volume, platelet distribution widht and plateletcrit. Tuberk Toraks. 2016;64(3):206-10.
24. 25- Jackson SR, Carter JM. Platelet volume: laboratory measurement and clinical application. Blood Rev. 1993;7(2):104-13.
25. 26- McShine RL, Sibinga S, Brozovic B. Differences between the effects of EDTA and citrate anticoagulants on platelet count and mean platelet volume. Clin Lab Haematol. 1990;12(3):277-85.
26. 27- Macey M, Azam U, McCarthy D, Webb L, Chapman ES, Okrongly D, Zelmanovic D, Newland A. Evaluation of the anticoagulants EDTA and citrate, theophylline, adenosine, and dipyridamole (CTAD) for assessing platelet activation on the ADVIA 120 hematology system. Clin Chem. 2002;48(6 Pt 1):891-9.
27. 28- Dastjerdi MS, Emami T, Najafian A, Amini M. Mean platelet volume measurement, EDTA or citrate? Hematology. 2006;11(5):317-9.
28. 29- Bath PM, Carney C, Markandu ND, MacGregor GA. Platelet volume is not increased in essential hypertension. J Hum Hypertens. 1994;8(6):457-9.
29. 30- Varol E, Ozturk O, Yucel H, Gonca T, Has M, Dogan A, Akkaya A. The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea. Platelets. 2011;22(7):552-6.
30. 31- Chang WD, Tseng CH, Tsou YA. Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis. BMC Pediatr. 2020 May 11;20(1):204.
31. 32- Zeng GH, Xu G, Liu HY, Gao Z. Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome in children. Medicine (Baltimore). 2022;101(43):e31505
32. 33- Simsek G, Haytoglu S, Muluk NB, Arikan OK, Cortuk M, Kiraz K. Mean Platelet Volume Decreases in Adult Patients With Obstructive Sleep Apnea After Uvulopalatal Flap Surgery. J Craniofac Surg. 2015;26(7):2152-4.
33. 34- Özdemir C, Sökücü S, Aydın Ş, Önür ST, Kara K. Response of Blood Parameters to PAP Treatment in Patients with Obstructive Sleep Apnea. Noro Psikiyatr Ars. 2018;56(3):182-5.
34. 35- Kutlucan A, Bulur S, Kır S, Bulur S, Önder E, Aslantaş Y, Ekinözü İ, Aydn Y, Özhan H. The relationship between mean platelet volume with metabolic syndrome in obese individuals. Blood Coagul Fibrinolysis. 2012;23(5):388-90.
35. 36- Shah B, Sha D, Xie D, Mohler ER 3rd, Berger JS. The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: the National Health And Nutrition Examination Survey, 1999-2004. Diabetes Care. 2012;35(5):1074-8. 37- Kabutomori O, Kanakura Y, Iwatani Y. Characteristic changes in platelet-large cell ratio, lactate dehydrogenase and C-reactive protein in thrombocytosis-related diseases. Acta Haematol. 2007;118(2):84-7. 38- Zhang KJ, Lu QY, Li P, Zhang P, Niu XQ. [Significance of platelet parameters and lactate dehydrogenase level in differential diagnosis for thrombocytosis]. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2010;18(4):972-5.