Obstructive sleep apnea (OSA) has been implicated in both cardiovascular and cerebrovascular diseases. Systemic inflammation and coagulation may be related to cardiovascular pathophysiology in patients with OSA. Fibrinogen is a major coagulation protein associated with inflammation, and long-term elevated plasma fibrinogen is associated with an increased risk of major cardiovascular diseases. We assessed whether severity of OSA is associated with levels of fibrinogen in newly diagnosed, untreated, and otherwise healthy OSA patients.
We studied 36 men with OSA and 18 male control subjects (apnea–hypopnea index [AHI] <5 events/h). OSA patients were divided into mild (AHI ≥5 < 15 events/h) and severe (AHI ≥15 events/h) OSA groups. Morning fibrinogen levels in OSA patients were compared to those in control subjects of similar age, body mass index, blood pressure, smoking habits, and alcohol consumption.
Fibrinogen levels were significantly elevated in patients with severe OSA compared to both control (P = 0.003) and mild OSA (P = 0.02) subjects after adjustment for covariates. However, there were no significant differences in fibrinogen levels between mild OSA and control subjects. Fibrinogen levels were directly related to AHI and arousal index and inversely related to mean and lowest oxygen saturation during sleep.
Severity of OSA was associated with increased fibrinogen level independent of other factors, suggesting that apneic events and oxygen desaturation during sleep are mechanisms for increased fibrinogen levels in patients with OSA.
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The authors are grateful to J. Denise Wetzel, CCHMC Medical Writer, for critical review of the manuscript. These studies were supported by an American Heart Association Scientist Development Grant (0730129 N, AS) and the National Institutes of Health (NIH) grants HL-70302, HL-65176, TW05463, TW05469, and 1 UL1 RR024150. This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Conflict of interest
Dr. Somers has served as a consultant for Respicardia, NeuPro, Apnex and ResMed and is an investigator on studies funded with a gift to Mayo Foundation from the Philips-Respironics Foundation. The other authors declare that they have no conflict of interest.
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Shamsuzzaman, A., Amin, R.S., Calvin, A.D. et al. Severity of obstructive sleep apnea is associated with elevated plasma fibrinogen in otherwise healthy patients. Sleep Breath 18, 761–766 (2014). https://doi.org/10.1007/s11325-014-0938-4
- Sleep apnea
- Cardiovascular disease
- Risk factors