CPAP reduces hypercoagulability, as assessed by thromboelastography, in severe obstructive sleep apnoea

Toukh, Mazen; Pereira, Effie J.; Falcon, Bani Jadiel; Liak, Christina; Lerner, Marina; Hopman, Wilma M.; Iscoe, Steve; Fitzpatrick, Michael; Othman, Maha

doi:10.1016/j.resp.2012.06.022

Cited by 27 publications

(23 citation statements)

References 33 publications

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“…A single abnormality factor is seldom enough to cause venous thrombosis, as it may require a synergy of several factors. TOUKH et al [40] used thromboelastography to assess coagulability, which provides information about the full spectrum of the haemostatic process, (from the initial formation of fibrin until lysis of the clot) and found that OSA patients had a procoagulant state that was reduced after 2 weeks of CPAP. As a result, there may be a thrombosis threshold where the trend to cause thrombin is not effectively regulated by antithrombotic mechanisms.…”

Section: Discussionmentioning

confidence: 99%

High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

et al. 2015

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Obstructive sleep apnoea is a risk factor for pulmonary embolism. Elevated D-dimer levels and other biomarkers are associated with recurrent pulmonary embolism. The objectives were to compare the frequency of elevated D-dimer levels (>500 ng·mL ) and further coagulation biomarkers after oral anticoagulation withdrawal in pulmonary embolism patients, with and without obstructive sleep apnoea, including two control groups without pulmonary embolism.We performed home respiratory polygraphy. We also measured basic biochemical profile and haemogram, and coagulation biomarkers (D-dimer, prothrombin fragment 1+2, thrombin-antithrombin complex, plasminogen activator inhibitor 1, and soluble P-selectin).64 (74.4%) of the pulmonary embolism cases and 41 (46.11%) of the controls without pulmonary embolism had obstructive sleep apnoea. Plasmatic D-dimer was higher in PE patients with OSA than in those without obstructive sleep apnoea. D-dimer levels were significantly correlated with apnoeahypopnoea index, and nocturnal hypoxia. There were more patients with high D-dimer after stopping anticoagulants in those with pulmonary embolism and obstructive sleep apnoea compared with PE without obstructive sleep apnoea (35.4% versus 19.0%, p=0.003). Apnoea-hypopnoea index was independently associated with high D-dimer.Pulmonary embolism patients with obstructive sleep apnoea had higher rates of elevated D-dimer levels after anticoagulation discontinuation for pulmonary embolism than in patients without obstructive sleep apnoea and, therefore, higher procoagulant state that might increase the risk of pulmonary embolism recurrence. @ERSpublications Pulmonary embolism patients with sleep apnoea are more likely to have elevated postanticoagulation plasma D-dimer

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Section: Discussionmentioning

confidence: 99%

High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

et al. 2015

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“…However, the major health problem in OSAS patients is the increased risk for all-cause mortality and in particular cardiovascular mortality, and its independent association with cardiovascular complications, including hypertension, coronary artery disease, myocardial infarction, congestive heart failure and stroke [2]. The association between atherosclerotic vascular diseases and OSAS persists after controlling for known cardiovascular risk factors such as diabetes, hypertension, smoking and dyslipidaemia [3,4]. Evidence linking OSAS to cardiovascular disorders are provided by a recent cohort study [5] in which an independent association between apnea-hypopnoea index (AHI) used to estimate OSAS severity and cardiovascular diseases (heart attack, stroke, congestive heart failure and all-cause mortality) has been found, but this association became non-significant after controlling for potential confounding factors.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure

et al. 2015

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Further studies are required to determine the precise role of hypercoagulability in the cardiovascular pathogenesis of OSAS, particularly its interaction with oxidative stress, thrombotic tendency and endothelial dysfunction. Nasal continuous positive airway pressure (nCPAP), the gold standard treatment for OSAS, not only significantly reduced apnea-hypopnoea indices but also markers of hypercoagulability, thus representing a potential mechanisms by which CPAP reduces the rate of cardiovascular morbidity and mortality in OSAS patients.

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“…Interestingly, the observed hypercoagulable state appears to be reversible if the underlying OSA is treated with CPAP therapy (Toukh et al . , Hong et al . ).…”

Section: Pre‐existing Conditions That Influence Anaesthetic Managementmentioning

confidence: 99%

“…Preoperative CPAP therapy can also improve comorbidities including hypertension and hypercoagulability (Toukh et al . , Hong et al . ).…”

Section: Anaesthesia In Brachycephalic Breedsmentioning

confidence: 99%

Anaesthesia of brachycephalic dogs

Downing¹,

Gibson²

2018

J of Small Animal Practice

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Brachycephalic breeds of dog have grown in popularity in the UK and so form an increasing proportion of cases requiring anaesthesia. These breeds are predisposed to several conditions, notably brachycephalic obstructive airway syndrome and gastro‐oesophageal reflux, that have important implications for anaesthetic management and carry high risk for complications. This review incorporates peer‐reviewed veterinary literature with clinical experience in a discussion on perioperative management of brachycephalic dogs. We focus on preoperative identification of common concurrent conditions, practical strategies for reducing anaesthetic risk and improving postoperative management. Comparisons of brachycephalic obstructive airway syndrome with the human condition of obstructive sleep apnoea are included where appropriate.

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CPAP reduces hypercoagulability, as assessed by thromboelastography, in severe obstructive sleep apnoea

Cited by 27 publications

References 33 publications

High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea

Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure

Anaesthesia of brachycephalic dogs

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