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 levelsof 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 SBIand serum levels of sCD40L and sP-selectin are increased inpatients with obstructive sleep apnea (OSA).
Methods: SBI was studied by brain magnetic resonance imagesin 50 male patients with OSA and 15 obese male control subjectswho were free of comorbidities. In addition, the effects of3 months of treatment with nasal continuous positive airwaypressure (nCPAP) on serum parameters were studied in 24 patientswith moderate to severe OSA.
Measurements and Main Results: The percentage of SBI in patientswith moderate to severe OSA (25.0%) was higher than that ofobese control subjects (6.7%) or patients with mild OSA (7.7%).Serum levels of sCD40L and sP-selectin were significantly higherin patients with moderate to severe OSA than in obese controlsubjects (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 withmoderate to severe OSA.
Conclusions: These results suggest that serum levels of sCD40Land sP-selectin are elevated and SBI is more common in patientswith moderate to severe OSA, leading to elevated cerebrovascularmorbidity. Moreover, nCPAP may be useful for decreasing riskin patients with moderate to severe OSA.
Scientific Knowledge on the Subject
The occurrence of strokein patients with obstructive sleep apnea (OSA) is likely precededby subclinical cerebrovascular disease, often termed silentbrain infarction (SBI). The independent effects of OSA on theprevalence of SBI have not been clearly established.
What ThisStudy Adds to the Field
The prevalence of SBI is increasedin patients with OSA. The presence of SBI in OSA patients wasassociated 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 nasalcontinuous positive airway pressure.
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