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American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 612-617, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200608-1141OC

Original Article

Silent Brain Infarction and Platelet Activation in Obstructive Sleep Apnea

Kenji Minoguchi1, Takuya Yokoe1, Toshiyuki Tazaki1, Hideko Minoguchi1, Naruhito Oda1, Akihiko Tanaka1, Mayumi Yamamoto1, Shin Ohta1, Christopher P. O'Donnell2 and Mitsuru Adachi1

1 First Department of Internal Medicine, Showa University, Tokyo, Japan; and 2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence and requests for reprints should be addressed to Kenji Minoguchi, M.D., Ph.D., First Department of Internal Medicine, Showa University, School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. E-mail: minochan{at}fn.catv.ne.jp

Rationale: Silent brain infarction (SBI) and increased levels of soluble CD40 ligand (sCD40L) and soluble P-selectin (sP-selectin) are associated with an increased risk of cerebrovascular disease.

Objectives: The aim of this study was to evaluate whether SBI and serum levels of sCD40L and sP-selectin are increased in patients with obstructive sleep apnea (OSA).

Methods: SBI was studied by brain magnetic resonance images in 50 male patients with OSA and 15 obese male control subjects who were free of comorbidities. In addition, the effects of 3 months of treatment with nasal continuous positive airway pressure (nCPAP) on serum parameters were studied in 24 patients with moderate to severe OSA.

Measurements and Main Results: The percentage of SBI in patients with moderate to severe OSA (25.0%) was higher than that of obese control subjects (6.7%) or patients with mild OSA (7.7%). Serum levels of sCD40L and sP-selectin were significantly higher in patients with moderate to severe OSA than in obese control subjects (p < 0.05) or patients with mild OSA (p < 0.05). In addition, nCPAP significantly decreased serum levels of sCD40L (p < 0.03) and sP-selectin (p < 0.01) in patients with moderate to severe OSA.

Conclusions: These results suggest that serum levels of sCD40L and sP-selectin are elevated and SBI is more common in patients with moderate to severe OSA, leading to elevated cerebrovascular morbidity. Moreover, nCPAP may be useful for decreasing risk in patients with moderate to severe OSA.

Key Words: sleep apnea • platelet • brain infarction • atherosclerosis


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
The occurrence of stroke in patients with obstructive sleep apnea (OSA) is likely preceded by subclinical cerebrovascular disease, often termed silent brain infarction (SBI). The independent effects of OSA on the prevalence of SBI have not been clearly established.

What This Study Adds to the Field
The prevalence of SBI is increased in patients with OSA. The presence of SBI in OSA patients was associated with an elevation in markers of platelet activation (soluble CD40L and soluble P-selectin) and systemic inflammation (C-reactive protein), and these increases are reduced by nasal continuous positive airway pressure.

 

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