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. 2017 Oct 1;143(10):996-1002.
doi: 10.1001/jamaoto.2017.1367.

Association Between Hypercoagulability and Severe Obstructive Sleep Apnea

Seung-No Hong  1 , Hee-Chul Yun  1 , Joon Hyuk Yoo  1 , Seung Hoon Lee  1
Affiliations

Association Between Hypercoagulability and Severe Obstructive Sleep Apnea

Seung-No Hong et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Obstructive sleep apnea (OSA) is related to the increased risk of cardiovascular disease. Although the pathogenesis of this association remains unclear, an alteration in coagulability is suspected as a link.

Objective: To investigate the association between the severity of OSA and blood coagulability.

Design, setting, and participants: A retrospective cohort study conducted at a tertiary care university hospital evaluated 146 patients with OSA from January 1, 2009, to July 31, 2015. The participants were divided into 4 groups according to the severity of OSA: control, mild, moderate, and severe.

Main outcomes and measures: Association between the severity of OSA and coagulation test results, including platelet count, bleeding time, prothrombin time (PT) in seconds and as international normalized ratio (INR), and activated partial thromboplastin time.

Results: Of the 146 patients, 135 (92.5%) were men; mean (SD) age was 34.8 (11.1) years. The control group included 41 (28.1%) patients; mild OSA, 32 (21.9%); moderate OSA, 30 (20.5%); and severe OSA, 43 (29.5%). Significant correlations were found between the apnea-hypopnea index and the PT seconds (Spearman r coefficient, -0.30; 95% CI, -0.44 to -0.14) and PT INR (Spearman r coefficient, -0.30; 95% CI, -0.44 to -0.14). There were significant differences between the OSA severity groups for PT seconds for the control group (mean, 11.26 [0.78] seconds) vs the moderate OSA group (10.74 [0.62] seconds; mean difference [MD], 0.52; 95% CI, 0.27 to 1.01) and the severe OSA group (10.67 [0.77] seconds; MD, 0.59; 95% CI, 0.14 to 1.03). Significant differences were also noted in PT INR between the control group (1.00 [0.07]) vs the moderate OSA group (0.95 [0.05]; MD, 0.04; 95% CI, 0.01 to 0.07) and the severe OSA group (0.94 [0.07]; MD, 0.05; 95% CI, 0.02 to 0.08). However, there was no significant difference between the control and mild OSA groups in PT seconds.

Conclusions and relevance: These results suggest that patients with moderate to severe OSA have elevated blood coagulability markers compared with healthy individuals, which may contribute to the occurrence of cardiovascular complications.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1.
Figure 1.. Correlation Between the Apnea-Hypopnea Index Grades and Coagulation Test Results
A, Platelet (PLT) count. B, Prothrombin time as international normalized ratio (PT INR). C, Activated partial thromboplastin time. Apnea-Hypopnea Index is defined as the number of apnea and hypopnea episodes per hour. To convert PLTs to ×109/L, multiply by 1.
Figure 2.
Figure 2.. Results From the Coagulation Tests According to the Apnea-Hypopnea Index (AHI) Grade
A, The control group had significantly higher values of prothrombin time as international normalized ratio (PT INR) compared with those of the moderate and severe obstructive sleep apnea (OSA) groups. B, There was no significant difference in the platelet (PLT) count between the AHI groups. To convert PLTs to ×109/L, multiply by 1. Data shown as medians; error bars indicate 95% CIs. aCompared with control, P ≤ .008 for the test (adjusted with a Bonferroni correction).
Figure 3.
Figure 3.. Correlation Between the Minimum Arterial Blood Saturation (Min Sao2) and the Coagulation Test Results
A, Prothrombin time as international normalized ratio (PT INR). B, Platelet (PLT) count. To convert PLTs to ×109/L, multiply by 1.
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