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Published in:

01-02-2015

Platelet–lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome

Authors: Handan Inonu Koseoglu, Fatih Altunkas, Asiye Kanbay, Sibel Doruk, Ilker Etikan, Osman Demir

Published in: Journal of Thrombosis and Thrombolysis | Issue 2/2015

Abstract

There is a strong relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease (CVD). Chronic intermittent hypoxia, inflammation, oxidative stress, and endothelial dysfunction may constitute etiologic mechanisms, linking OSAS to CVD. Inflammation play an important role in the development of CVD. Platelet–lymphocyte ratio (PLR) is a new biomarker showing inflammation. No previous study has ever investigated the association between PLR, CVD and OSAS severity in patients with OSAS. This study was designed to investigate the association between PLR and CVD in patients with OSAS, and relationship between severity of OSAS, polysomnographic parameters and PLR. This was a cohort study in which patients who had undergone a full night polysomnoraphy for diagnosis of OSA were recruited. Patients were divided according to their apnea-hypopnea index (AHI) scores into OSAS negative (Group 1: AHI < 5), mild (Group 2: AHI, 5–15), moderate (Group 3:AHI,15–30), and severe OSAS (Group 4: AHI > 30) groups. The presence of heart failure, coronary artery disease or arrhythmia was defined as CVD. A total of 424 patients were included in this study. There were 57, 93, 82, and 192 patients in Groups 1, 2, 3, and 4, respectively. PLR were significantly different between groups (Group 1: 87.38; Group 2: 95.07; Group 3: 97.01, Group 4: 126.9, P < 0.05). PLR were significantly correlated with AHI, oxygen desaturation index, average and minimum O₂ saturation values (P < 0.05). Values of PLR were significantly higher in patients with CVD compared with those without. Multiple regression analysis demonstrated that PLR is an independent predictor of CVD. PLR cut-off value for demonstrating the presence of CVD is higher than 108.56. In the light oh findings, PLR is strongly associated with the severity of OSAS and cardiovascular disease in OSAS patients. PLR might be used as a biomarker to predict CVD in OSAS patients.

McNicholas WT, Bonsigore MR (2007) Management committee of EU COST ACTION B26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence basic and research priorities. Eur Respir J 29(1):156–178PubMedCrossRef

Weiss JW, Launois SH, Anand A, Garpestad E (1999) Cardiovascular morbidity in obstructive sleep apnea. Prog Cardiovasc Dis 41(5):367–376PubMedCrossRef

Yang WS, Lee WJ, Funahashi T et al (2001) Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin. J Clin Endocrinol Metab 86(8):3815–3819PubMedCrossRef

Shetty GK, Economides PA, Horton ES, Mantzoros CS, Veves A (2004) Circulating adiponectin and resistin levels in relation to metabolic factors, inflammatory markers, and vascular reactivity in diabetic patients and subjects at risk for diabetes. Diabetes Care 27(10):2450–2457PubMedCrossRef

Kohler M, Stradling JR (2010) Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol 7(12):677–685PubMed

Ryan S, Taylor CT, McNicholas WT (2009) Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J 85(1010):693–698PubMedCrossRef

Jennings LK (2009) Mechanisms of platelet activation: need for new strategies to protect against platelet-mediated atherothrombosis. Thromb Haemost 102(2):248–257PubMed

Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP (2003) Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost 9(3):177–190PubMedCrossRef

Dotsenko O, Chaturvedi N, Thom SA et al (2007) Platelet and leukocyte activation, atherosclerosis and inflammation in European and South Asian men. J Thromb Haemost 5(10):2036–2042PubMedCentralPubMedCrossRef

10.

Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22(5):667–689

11.

Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification, 1st edn. American Academy of Sleep Medicine, Westchester

12.

EEG arousals: scoring rules and examples: a preliminary report from the sleep disorders Atlas task force of the American sleep disorders relationship. Sleep 1992; 15(2):173–184

13.

Williams MS (2012) Platelets and depression in cardiovascular disease: a brief review of the current literature. World J Psychiatry 2(6):114–123PubMedCentralPubMedCrossRef

14.

Thaulow E, Erikssen J, Sandvik L, Stormorken H, Cohn PF (1991) Blood platelet count and function are related to total and cardiovascular death in apparently healthy men. Circulation 84(2):613–617PubMedCrossRef

15.

Stissing T, Dridi NP, Ostrowski SR, Bochsen L, Johansson PI (2011) The influence of lowplatelet count onwhole blood aggregometry assessed by Multiplate. Clin Appl Thromb Hemost 17(6):211–217CrossRef

16.

Iijima R, Ndrepepa G, Mehilli J et al (2007) Relationship between platelet count and 30 day clinical outcomes after percutaneous coronary interventions. Pooled analysis of four ISAR trials. Thromb Haemost 98(4):852–857PubMed

17.

Nikolsky E, Grines CL, Cox DA et al (2007) Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am J Cardiol 99(8):1055–1061PubMedCrossRef

18.

Vidwan P, Lee S, Rossi JS, Stouffer GA (2010) Relation of platelet count to bleeding and vascular complications in patients undergoing coronary angiography. Am J Cardiol 105(9):1219–1222PubMedCrossRef

19.

Hung J, Whitford EG, Parsons RW, Hillman DR (1990) Association of sleep apnoea with myocardial infarction in men. Lancet 336(8710):261–264PubMedCrossRef

20.

Peker Y, Hedner J, Kraiczi H, Löth S (2000) Respiratory disturbance index: an independent predictor of mortality in coonary artery disease. Am J Respir Crit Care Med 162(1):81–86PubMedCrossRef

21.

Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27(3):401–407PubMedCrossRef

22.

Bassetti C, Aldrich MS (1999) Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 22(2):217–223PubMed

23.

Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384PubMedCrossRef

24.

Grunstein RR, Stenlof K, Hedner J, Sjostrom L (1995) Impact of obstructive sleep apnea and sleepiness on metabolic and cardiovascular risk factors in the swedish obese subjects (SOS) study. Int J Obes Relat Metab Disord 19(6):410–418PubMed

25.

Kashyap R, Hock LM, Bowman TJ (2001) Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath 5(4):167–172PubMedCrossRef

26.

Shepard JW Jr (1992) Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 13(3):437–458PubMed

27.

Coy TV, Dimsdale JE, Ancoli-Israel S, Clausen J (1996) Sleep apnoea and sympathetic nervous system activity: a review. J Sleep Res 5(1):42–50PubMedCrossRef

28.

Takama N, Kurabayasi M (2009) Influence of untreated sleep disordered breathing on the longterm prognosis of patients with cardiovascular disease. Am J Cardiol 103(5):730–734PubMedCrossRef

29.

Imhof BA, Aurrand-Lions M (2006) Angiogenesis and inflammation face off. Nat Med 12(2):171–172PubMedCrossRef

30.

Horne BD, Anderson JL, John JM et al (2005) Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45(10):1638–1643PubMedCrossRef

31.

Azab B, Shah N, Akerman M, McGinnJr JT (2012) Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-STelevation myocardial infarction. J Thromb Thrombolysis 34(3):326–334PubMedCrossRef

32.

Sunbul M, Gerin F, Durmus E et al (2013) Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. doi:10.3109/10641963.2013.804547

33.

Geiser T, Buck F, Meyer BJ, Bassetti C, Haeberli A, Gugger M (2002) In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 69(3):229–234PubMedCrossRef

34.

Hui DS, Ko FW, Fok JP et al (2004) The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome. Chest 125(5):1768–1775PubMedCrossRef

35.

Minoguchi K, Yokoe T, Tazaki T et al (2007) Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med 175(6):612–617PubMedCrossRef

36.

Varol E, Ozturk O, Gonca T et al (2010) Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Invest 70(7):497–502PubMedCrossRef

37.

Nena E, Papanas N, Steiropoulos P et al (2012) Mean platelet volume and platelet distribution width in nondiabetic subjects with obstructive sleep apnoea syndrome: new indices of severity? Platelets 23(6):447–454PubMedCrossRef

38.

Widmer A, Linka AZ, Attenhofer Jost CH et al (2003) Mechanical complications after myocardial infarction reliably predicted using C-reactive protein levels and lymphocytopenia. Cardiolog 99(1):25–31CrossRef

39.

Acanfora D, Gheorghiade M, Trojano L et al (2001) Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure. Am Heart J 142(1):167–173PubMedCrossRef

40.

Ommen SR, Gibbons RJ, Hodge DO, Thomson SP (1997) Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol 79(6):812–814PubMedCrossRef

Title: Platelet–lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome
Authors: Handan Inonu Koseoglu
Fatih Altunkas
Asiye Kanbay
Sibel Doruk
Ilker Etikan
Osman Demir
Publication date: 01-02-2015
Publisher: Springer US
Published in: Journal of Thrombosis and Thrombolysis / Issue 2/2015
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-014-1103-4

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