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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
1   Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
2   Department of Clinical Research, University of Bern, Switzerland
3   Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
,
Nico T. Malan
4   Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
,
Mark Hamer
4   Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
5   Department of Epidemiology and Public Health, University College London, UK
,
Gavin W. Lambert
6   Baker IDI Heart & Diabetes Institute and Central Clinical School, Monash University, Melbourne, Victoria, Australia
,
Markus Schlaich
7   Dobney Chair Clinical Research, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
,
Manja Reimann
8   Autonomic and Neuroendocrinological Laboratory Dresden, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
,
Leoné Malan
4   Hypertension in Africa Research Team (HART), Faculty of Health Sciences North West University, Potchefstroom, South Africa
9   Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, North West University, Potchefstroom, South Africa
› Author Affiliations
Financial support: The study was partly funded by The Metabolic Syndrome Institute, France; the South African Medical Research Council; ROCHE Diagnostics; North-West University; NorthWest Department of Education, South Africa; and National Research Foundation (NRF). Any opinion, findings and conclusions or recommendations expressed in this material are those of the authors and therefore the NRF does not accept any liability in regard thereto.
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Publication History

Received: 06 March 2015

Accepted after major revision: 10 July 2015

Publication Date:
22 November 2017 (online)

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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