Obstructive Sleep Apnea Syndrome: Blood Viscosity, Blood Coagulation Abnormalities, and Early Atherosclerosis
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Obstructive Sleep Apnea Syndrome: Blood Viscosity, Blood Coagulation Abnormalities, and Early Atherosclerosis Domenico Maurizio Toraldo • Francesco Peverini Michele De Benedetto • Francesco De Nuccio
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Received: 22 May 2012 / Accepted: 25 September 2012 / Published online: 18 October 2012 Ó Springer Science+Business Media New York 2012
Abstract Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for atherosclerosis and arterial thrombosis, which are associated with high cardiovascular (CV) morbidity and mortality. In studies performed in clinical populations with elevated CV event risk profiles, the occurrence of moderate to severe OSAS was very often accompanied by a worsened vascular function and increased prevalence of structural abnormalities. Recent investigations of atherosclerosis in OSAS have focused on thrombotic tendency and blood viscosity, providing new insight into mechanisms of the disease. Despite that knowledge about the mechanisms of development of CV disease in patients with OSAS is still incomplete, observations confirm a relationship between sleep-disordered breathing and the rheological properties (flow properties) of blood. While platelet dysfunction and hypercoagulability (PDMPs, PaI-1, and SF) play important roles in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS.
D. M. Toraldo (&) Third Division, ‘‘A. Galateo’’ Lung Disease Hospital, ASL Lecce, via a.c Casetti n. 2, 73100 Lecce, Italy e-mail: [email protected] F. Peverini Foundation for Research and Treatment of Sleep Disorders, Mater Dei Hospital, Rome, Italy M. De Benedetto Division of Otolaryngology, ‘‘V. Fazzi’’ Hospital, ASL Lecce, Lecce, Italy F. De Nuccio Laboratory of Human Anatomy and Neuroscience, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
Keywords Obstructive sleep apnea syndrome Blood viscosity Hemostatic alterations Early atherosclerosis
Introduction Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of complete or partial collapse of the upper airway during sleep, resulting in apneas or hypopneas, respectively. Repetitive episodes of obstruction cause intermittent drops in blood oxygen and increases in carbon dioxide levels, which can lead to frequent arousals from sleep [1]. The most important complications are cardiovascular (CV) disturbances, resulting in severe morbidity and mortality [2]. Increased blood clotting, caused by changes in the rheological properties (flow properties) of blood and plasma, seems to be an important factor linking OSAS and CV complications [3]. Atherosclerosis is a chronic inflammatory disease that has a silent course for a few decades before reaching clinical significance. Atherosclerosis is common in OSAS patients, and the majority of studies have demonstrated an excess of mortality in OSAS which is associated with the severity of the atherosclerosis [4, 5]. One study
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