Hemostatic alterations in patients with obstructive sleep apnea: an observational study

Basavaraj P. Belaldavar; Tejaswini J. S.; Samanvaya Soni

doi:10.18203/issn.2454-5929.ijohns20192718

Authors

Basavaraj P. Belaldavar Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
Tejaswini J. S. Department of ENT and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
Samanvaya Soni Department of ENT and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20192718

Keywords:

Obstructive sleep apnea, Coagulation profile, Prothrombin time

Abstract

Background: Obstructive sleep apnoea (OSA) is characterized by repetitive partial or complete collapse of the upper airway during sleep, which results in disruptions of normal sleep architecture. It is associated with cardiopulmonary consequences like hypertension, myocardial infarction and stroke. Although the pathogenesis of this association remains unclear, an alteration in coagulability is suspected as a linkage. Hence, the present study aims at the reliability of Bleeding time, platelet count, PT, aPTT and INR to assess the effect on OSA patients’ cardiovascular system.

Methods: This is an observational study done on 32 individuals diagnosed with OSA after level I polysomnography from time period of January 01, 2018 to December 31, 2018. The blood coagulation parameters studied for each individual were platelet count, bleeding time (BT), activated partial thromboplastin time (aPTT) and prothrombin time (PT/INR).

Results: Out of a total 32 subjects, 17 (53.13%) were male and 15 (46.87%) were female. There is a significant difference in mean prothrombin time (p=0.022). Kruskal-Wallis test showed a significant difference in the median of the PT/INR (p=0.01) and AHI (p<0.001) for different categories of OSA. Prothrombin time is the only factor which is affecting the OSA.

Conclusions: Patients with severe OSA may have elevated coagulability levels, particularly in the length of prothrombin time. The potential for anticoagulant and antiplatelet medications to reduce mortality in patients with OSA merits exploration, particularly for patients who are unwilling or unable to achieve full control of OSA with currently available treatment options.

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Author Biography

Basavaraj P. Belaldavar, Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

ENT postgraduate

References

Immelmann K. Schlafverhaltenbei Mensch und Tier. Konstanz: Byk-Gulden-Lomberg; 1964.

Singleton WB. Partial velum palatiectomy for relief of dyspnoea in brachycephalic breeds. J Small AnimPract. 1962;3:215-6.

American Academy of Sleep Medicine. Obstructive sleep apnea syndrome. In: The International Classification of Sleep Disorders Revised Diagnostic and Coding Manual. 2001: 52–58.

Barrett. K, Barman S, Boitano S, Brooks H. Ganong’s Review of Medical Physiology: Electrical Activity of the Brain, Sleep–Wake States, & Circadian Rhythms. 24th ed. New York: McGraw- Hill Medical; 2012.

Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.

Young TB, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. Occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5.

He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients. Chest. 1988;94(1):9-14.

Partinen M, Guilleminault C. Daytime sleepiness and vascular morbidityat seven- year follow-up in obstructive sleep apnea patients. Chest. 1990;97:27-32.

Strohl KP, Saunders NA, Sullivan CA. Clinical aspects of sleep apnea syndromes. In : Sullivan C, Saunders NA (eds). Sleep and breathing. Lung biology in health and disease. Volume 14. New York: Marcel Dekker; 1984: 365-402.

McNamara SG, Cistulli PA, Strohl KP, Sullivan CE. Clinical aspects of sleep apnea. In : Sullivan C, Saunders NA (eds). Sleep and breathing. 2nd edition. Lung biology in health and disease. Volume 14. New York: Marcel Dekker; 1993: 493-528.

Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D. Neuropsychological sequelae of obstructive sleep apnea–hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10:772–85.

Shamsuzzaman S.M, Gersh J, Somers K. Obstructive Sleep Apnea. Implications for Cardiac and Vascular Disease. JAMA. 2003;290:1906-12.

Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Medicine. 2010;11(5):441–6.

Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20:705–6.

Hong SN, Yun HC, Yoo JH, Lee SH. Association Between Hypercoagulability and Severe Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg. 2017: 1-7.

Eisensehr I, Ehrenberg BL, Noachtar S ,Korbett K, Byrne A, McAuley A et al. Platelet activation, epinephrine, and blood pressure in obstructive sleep apnoea syndrome. Neurology. 1998;51:188–95.

Wessendorf TE, Thilmann AF, Wang YM, Schreiber A, Konietzko N, Teschler H. Fibrinogen levels and obstructive sleep apnoea in ischemic stroke. Am J Respir Crit Care Med. 2000;162:2039–42.

Chin K, Ohi M, Kita H, Noguchi T, Otsuka N, Tsuboi T et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnoea syndrome. Am J Respir Crit Care Med. 1996;153:1972–6.