Effects of continuous positive airway pressure on coagulability in obstructive sleep apnoea: a randomised, placebo-controlled crossover study
Open accessAbstract
INTRODUCTION: Obstructive sleep apnoea (OSA) is associated with increased cardiovascular risk, however the mechanisms are not well established. OBJECTIVES: This study aimed to determine whether treatment of OSA with nasal continuous positive airway pressure (CPAP) would favourably alter coagulability across the sleep-wake cycle. METHODS: In a randomised crossover trial, 28 patients received therapeutic or placebo CPAP, each for 2 months with a 1 month washout between treatments. After each treatment period, a 24 h coagulation study was conducted in the laboratory. Plasminogen activator inhibitor-1 (PAI-1), D-dimer, fibrinogen, von Willebrand Factor (vWF), factor VIII (FVIII), factor VII (FVII) and factor V (FV) were determined at seven time points over the day and night. RESULTS: At baseline, patients had severe OSA (Apnoea Hypopnoea Index 37.9 ± 23.9 events/h). Treatment of OSA with CPAP compared with placebo resulted in lower 24 h levels of vWF (-3.9%, p=0.013), FVIII (-6.2%, p=0.007) and FV (-4.2%, p<0.001). The greatest difference occurred during the nocturnal and early morning periods. In contrast, fibrinogen, D-dimer, FVII and PAI-1 did not differ between treatments, however all markers displayed diurnal variability independent of treatment. CONCLUSIONS: In this randomised, placebo-controlled crossover trial, treatment of OSA with CPAP reduced the early morning level of vWF, and nocturnal levels of FVIII and FV. These findings suggest that CPAP may reduce cardiovascular risk in OSA, in part through reducing risk of thrombosis.
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Possible pathophysiologic mechanisms linking OSA to myocardial ischemia include sympathetic nervous system hyperactivity, hypertension, endothelial dysfunction, metabolic dysregulation, insulin resistance, and a hypercoagulable state.
“A number of possible pathophysiologic mechanisms have been implicated including sympathetic nervous system hyperactivity, hypertension, endothelial dysfunction, metabolic dysregulation, insulin resistance, and hypercoagulable state.641,655–663”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [661]
The Discussion says hypertension, endothelial dysfunction and increased coagulation in OSA may contribute to cardiovascular events, and it links coagulation markers to myocardial infarction. The cited paper does not address sympathetic nervous system hyperactivity, metabolic dysregulation or insulin resistance as mechanisms, so it supports only part of the list. (LLM, conf=0.86)
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- [1]1. Thorax 2012;67:639e644. doi:10.1136/thoraxjnl-2011-200874 Sleep disordered breathing on July 23, 2023 by guest. Protected by copyright. http://thorax.bmj.com/ Thorax: first published as 10.1136/thoraxjnl-2011-200874 on 14 February 2012. Downloaded from REFERENCES
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- Authors
- Phillips, C. L., McEwen, B. J., Morel-Kopp, M.-C., Yee, B. J., Sullivan, D. R., Ward, C. M., Tofler, G. H., & Grunstein, R. R.
- Affiliations
- The University of Sydney (AU)
- Royal Prince Alfred Hospital (AU)
- Royal North Shore Hospital (AU)
- Corresponding author
- Phillips, Craig L
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2012-02-14
- Volume
- 67
- Issue
- 7
- Pages
- 639-644
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- OpenAlex
- W2118630296
- Semantic Scholar
- 68dddc68b17d721a487ee753a30b64c64bc6eae9
- Cited by
- 82
- References
- 55
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 9 · 2021: 12 · 2020: 5 · 2019: 7 · 2018: 5 · 2017: 3 · 2016: 5 · 2015: 10 · 2014: 9 · 2013: 4 · 2012: 4
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, continuous positive airway pressure, coagulability, von Willebrand factor, factor VIII, factor V, fibrinogen, D-dimer, plasminogen activator inhibitor-1, diurnal variation, thrombosis risk, cardiovascular risk
- MeSH terms
- Blood Coagulation, Female, Fibrin Fibrinogen Degradation Products, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, von Willebrand Factor, Treatment Outcome, Plasminogen Activator Inhibitor 1, Cross-Over Studies, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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