Complete Blood Count Alterations after Six Months of Continuous Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea

Abstract

Study Objectives: The cardiovascular complications caused by obstructive sleep apnea (OSA) decrease after continuous positive airway pressure treatment (CPAP). Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk. Methods: From a selection of patients with symptoms of nocturnal snoring and/or excessive daytime sleepiness, 36 males with an apnea-hypopnea index (AHI) > 30/h and 22 age-matched normal male controls with AHI < 5/h were included. Patients with OSA underwent another night of CPAP titration, and 11 patients were excluded at the 6-month evaluation due to poor compliance with the home CPAP therapy. Complete blood count parameters of compliant patients and the control group were evaluated. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is characterized by collapse of the upper airway during sleep, recurring apnea, intermittent hypoxemia, and daytime sleepiness. The severity of OSA is evaluated in terms of the number of apnea/hypopnea episodes per hour of sleep and is expressed as the apnea-hypopnea index (AHI). 1Red blood cell distribution width (RDW) is a numerical measure of the size variability of circulating erythrocytes and is routinely reported as a component of the complete blood count in the differential diagnosis of anemia. Disorders related to ineffective erythropoiesis or increased red blood cell destruction cause greater size heterogeneity and thus a higher RDW. 2,3Several studies have reported increased platelet activation and aggregation in patients with OSA. 4,5 It has been shown that platelet size, as measured by mean platelet volume (MPV), correlates with platelet reactivity, and is regarded as an easy and useful tool for indirect monitoring of platelet activity. As larger platelets have greater thrombotic potential, the RDW, MPV, and platelet distribution width (PDW) have been shown to be related to cardiovascular morbidity and mortality in patients with cardiac diseases. In OSA patients, RDW, MPV, and PDW are newly recognized indicators of the severity of the condition that are associated with no additional cost compared to a routinely performed complete blood count. 11-14Continuous positive airway pressure (CPAP) therapy is the gold standard in patients with severe OSA. MPV is reduced after CPAP therapy in severe OSA patients, indicating that CPAP therapy has cardioprotective effects. 15 To our knowledge, the effect of CPAP therapy on RDW and PDW in OSA patients has not been reported; thus, we decided to investigate this possibility. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk. These markers increase in patients with OSA. The effect of CPAP treatment on these parameters was evaluated. Study Impact: Our data suggest that complete blood count parameters such as MPV, PDW, and RDW changed ...

Platelet indices in obstructive sleep apnea: the role of mean platelet volume, platelet distribution widht and plateletcrit

“…Another study by Kurt et al reported a meaningful correlation between PDW and AHI (17). Moreover in some studies, it was proposed that treatment with continuous positive airway pressure (CPAP) devices and surgical intervention significantly reduce MPV and PDW values in patients with severe OSA (10)(11)(12)24). On contrary, almost similar number of study reported no relationship between MPV and OSA, and between PDW and OSA (13)(14)(15)(16)(17)(18).…”

“…MPV was also reported to be correlated with disease severity and inflammation in patients with obstructive sleep apnea and therefore, it could be used as a marker to predict cardiovascular diseases in patients with OSA (6)(7)(8). Moreover continuous positive airway pressure treatment (CPAP) reported to cause a significant decrease in the MPV and PDW values in patients with OSA (10)(11)(12). On contrary, some other studies reported no relationship between MPV and OSA, and between PDW and OSA (13)(14)(15)(16)(17)(18).…”

Effect of CPAP Treatment on Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) in Patients With Sleep Apnea Syndrome

“…This improvement in PDW values with CPAP treatment is a quite reasonable result. However, regarding this issue very few publications could be found in the literature (12), and thus, we do not know the exact mechanisms.…”

“…Although there are a number of studies related to MPV and OSA, only a few studies report regarding the change in PDW values after CPAP treatment (12). Sökücü et al (12) reported in a comparison of 44 patients with severe OSA and control group that MPV values were found to be higher in the severe OSA group, whereas PDW values were similar. In contrast to our study, they reported decreased MPV values and increased PDW values after 6 months of CPAP treatment in their study.…”

“…Although previous studies have indicated a positive effect of CPAP treatment on MPV values, to the best of our knowledge, there are very few studies reporting the changes in PDW values (12). This study aimed to determine whether a change in MPV and PDW values would be detected in patients with OSA who underwent CPAP treatment.…”