Silent brain infarction and platelet activation in obstructive sleep apnea.
BACKGROUND
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.


OBJECTIVE
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.


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.
Minoguchi
Kenji
K
First Department of Internal Medicine, Showa University, School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. minochan@fn.catv.ne.jp
Yokoe
Takuya
T
Tazaki
Toshiyuki
T
Minoguchi
Hideko
H
Oda
Naruhito
N
Tanaka
Akihiko
A
Yamamoto
Mayumi
M
Ohta
Shin
S
O'Donnell
Christopher P
CP
Adachi
Mitsuru
M
D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000473:pathology; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology; D002097:C-Reactive Protein / Q000032:analysis; D023201:CD40 Ligand / Q000097:blood; D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D019007:P-Selectin / Q000097:blood; D015539:Platelet Activation; D017286:Polysomnography; D012044:Regression Analysis; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications* / Q000628:therapy
D015415:Biomarkers; D019007:P-Selectin; D023201:CD40 Ligand; D002097:C-Reactive Protein