title: Association between polysomnographic measures of disrupted sleep and prothrombotic factors.
abstract: BACKGROUND
  Subjective sleep disturbances have been associated with increased risk of coronary artery disease (CAD). We hypothesized that disrupted sleep as verified by polysomnography is associated with increased levels of prothrombotic hemostasis factors previously shown to predict CAD risk.
  
  
  METHODS
  Full-night polysomnography was performed in 135 unmedicated men and women (mean age +/- SD, 36.8 +/- 7.8 years) without a history of sleep disorders. Morning fasting plasma levels of von Willebrand Factor (VWF) antigen, soluble tissue factor (sTF) antigen, d-dimer, and plasminogen activator inhibitor (PAI)-1 antigen were determined. Statistical analyses were adjusted for age, gender, ethnicity, body mass index, BP, and smoking history.
  
  
  RESULTS
  Higher total arousal index (ArI) was associated with higher levels of VWF (beta = 0.25, p = 0.011, DeltaR(2) = 0.045), and longer wake after sleep onset was associated with higher levels of sTF (beta = 0.23, p = 0.023, DeltaR(2) = 0.038). More nighttime spent at mean oxygen saturation < 90% (beta = 0.20, p = 0.020, DeltaR(2) = 0.029) and higher apnea-hypopnea index (AHI) [beta = 0.19, p = 0.034, DeltaR(2) = 0.024] were associated with higher PAI-1. There was a trend for a relationship between mean oxygen desaturation < 90% and PAI-1 (p = 0.053), even after controlling for AHI. Total ArI (beta = 0.28, p = 0.005, DeltaR(2) = 0.056) and WASO (beta = 0.25, p = 0.017, DeltaR(2) = 0.042) continued to predict VWF and sTF, respectively, even after controlling for AHI.
  
  
  CONCLUSIONS
  Polysomnographically verified sleep disruptions were associated with prothrombotic changes. Measures of sleep fragmentation and sleep efficiency were related to VWF and sTF, respectively. Apnea-related measures were related to PAI-1. Our findings suggest that sleep disruptions, even in a relatively healthy population, are associated with potential markers of prothrombotic cardiovascular risk.
authors.affiliation: Department of General Internal Medicine, University Hospital Berne, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.affiliation: Medicine, University of California San Diego, La Jolla, CA.
authors.forename: José S
authors.initials: JS
authors.lastname: Loredo
authors.affiliation: Departments of Psychiatry, University of California San Diego, La Jolla, CA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.affiliation: Department of General Internal Medicine, University Hospital Berne, Switzerland.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.affiliation: Division of Statistics, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA.
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.affiliation: Departments of Psychiatry, University of California San Diego, La Jolla, CA. Electronic address: jdimsdale@ucsd.edu.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
mesh_terms: D000328:Adult; D000941:Antigens / Q000097:blood*; D001143:Arousal / Q000502:physiology; D003328:Coronary Thrombosis / Q000097:blood* / Q000209:etiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications; D012892:Sleep Deprivation / Q000097:blood; D012894:Sleep Stages / Q000502:physiology; D019851:Thrombophilia / Q000097:blood* / Q000209:etiology; D013925:Thromboplastin / Q000378:metabolism*; D014841:von Willebrand Factor / Q000276:immunology
chemical_list: D000941:Antigens; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C029417:Von Willebrand antigen; C036309:fibrin fragment D; D014841:von Willebrand Factor; D013925:Thromboplastin; D010100:Oxygen