Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea

Roland von Känel; Nico T. Malan; Mark Hamer; Gavin W. Lambert; Markus Schlaich; Manja Reimann; Leoné Malan

doi:10.1160/TH15-03-0206

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(01): 63-72
DOI: 10.1160/TH15-03-0206

Coagulation and Fibrinolysis

Schattauer GmbH Schattauer

Three-year changes of prothrombotic factors in a cohort of South Africans with a high clinical suspicion of obstructive sleep apnea

Roland von Känel

¹Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland

²Department of Clinical Research, University of Bern, Switzerland

³Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland

,

Nico T. Malan

⁴Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa

,

Mark Hamer

⁴Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa

⁵Department of Epidemiology and Public Health, University College London, UK

,

Gavin W. Lambert

⁶Baker IDI Heart & Diabetes Institute and Central Clinical School, Monash University, Melbourne, Victoria, Australia

,

Markus Schlaich

⁷Dobney Chair Clinical Research, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia

,

Manja Reimann

⁸Autonomic and Neuroendocrinological Laboratory Dresden, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany

,

Leoné Malan

⁴Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa

⁹Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, North West University, Potchefstroom, South Africa

› Author Affiliations

Abstract

Summary

A hypercoagulable state might be one important mechanism linking obstructive sleep apnea (OSA) with incident myocardial infarction and stroke. However, previous studies on prothrombotic factors in OSA are not uniform and cross-sectional. We longitudinally studied prothrombotic factors in relation to OSA risk, adjusting for baseline levels of prothrombotic factors, demographics, metabolic parameters, aspirin use, and life style factors. The Berlin Questionnaire and/or neck circumference were used to define high OSA risk in 329 South African teachers (48.0 % male, 44.6 % black) at baseline and at three-year follow-up. Von Willebrand factor (VWF), fibrinogen, D-dimer, plasminogen activator inhibitor-1, clot lysis time (CLT), and soluble urokinase-type plasminogen activator receptor (suPAR) were measured in plasma. At baseline 35.7 % of participants had a high risk of OSA. At follow-up, persistently high OSA risk, persistently low OSA risk, OSA risk remission, and new-onset OSA risk were present in 26.1 %, 53.2 %, 9.4 %, and 11.3 % of participants, respectively. New-onset OSA risk was associated with a significant and longitudinal increase in VWF, fibrinogen, CLT, and suPAR relative to persistently low OSA risk; in VWF, fibrinogen, and suPAR relative to remitted OSA risk; and in VWF relative to persistently high OSA risk. Persistently high OSA risk was associated with an increase in CLT and suPAR relative to persistently low OSA risk and in D-dimer relative to remitted OSA risk. Remitted OSA risk was associated with D-dimer decrease relative to persistently low OSA risk. In OSA, hypercoagulability is a dynamic process with a most prominent three-year increase in individuals with new-onset OSA risk.

Keywords

Blood coagulation - cardiovascular disease - fibrinolysis - longitudinal study - risk factor - sleep disordered breathing

Full Text

References

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