Coagulation and Fibrinolysis in Obstructive Sleep Apnoea

Abstract

Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.

Influence of the Interaction Between Depressive Symptoms and Sleep Disorders on Cardiovascular Diseases Occurrence

“…The study of Bikov et al indicated that the increased risk of CVD from sleep disorders may be associated with accelerated blood clotting and platelet activation. 29 Patients with depression may have increased platelet activation, which was thought to contribute to the development of atherosclerosis and peripheral artery disease. 30 , 31 Activation of the coagulation system by depressive symptoms and sleep disorders may be another common pathway to increase the risk of CVD.…”

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases

“…Hypoxemia and altered hemodynamics in OSA can precipitate a pro-coagulant state, which could further accentuate coagulopathy related to COVID-19. 41 The angiotensin converting enzyme 2 (ACE2) has been identified as the entry receptor of SARS-CoV-2. 42 Both in OSA and in obese patients, there is an increased expression of ACE2 receptors, which would favor the union of the virus.…”

Proteomic profiling for prediction of recurrent cardiovascular event in patients with acute coronary syndrome and obstructive sleep apnea: A post-hoc analysis from the ISAACC study

“…In addition, a previous study of OSA patients compared to non-OSA patients reported a profile of 65 proteins, highlighting a differentially expressed profile pattern of TFPI in patients with OSA [52]. These pathways have been previously described as targets of the pathophysiological consequences of OSA [37,40,50,53]. Specifically, these three proteins play a key role in regulating the inflammatory response and oxidative stress, together with an effect on endothelial dysfunction.…”

“…STK4 is a key component of the Hippo signaling pathway and is thus an essential regulator of cardiac development and regeneration/repair after injury [46,47]. TFPI is implicated in the development of atherosclerosis [48,49] and is associated with fibrinogen levels [50,51]. In addition, a previous study of OSA patients compared to non-OSA patients reported a profile of 65 proteins, highlighting a differentially expressed profile pattern of TFPI in patients with OSA [52].…”