The Plasminogen System and Transforming Growth Factor-β in Subjects With Obstructive Sleep Apnea Syndrome: Effects of CPAP Treatment.
BACKGROUND
Obstructive sleep apnea syndrome (OSAS) has emerged as a risk factor for cardiovascular disease. A prothrombotic state may affect coagulation and participate in the atherosclerotic process in subjects with OSAS. These alterations in coagulation seem to involve the plasminogen activation system. We evaluated the imbalances of the plasminogen activation system related to OSAS, and we assessed the effects of CPAP on the plasminogen activation system.


METHODS
Thirty-nine subjects were submitted to a home-based cardiorespiratory sleep study, and 14 healthy subjects (apnea-hypopnea index < 5) were used as controls. Serum levels of urokinase-type plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and active transforming growth factor-β (TGF-β) were measured. These molecules were reassessed in only 17 of the subjects after 1 month of CPAP.


RESULTS
PAI-1 and tPA were significantly higher in the subjects with OSAS compared with the controls, whereas TGF-β and uPA levels were lower. PAI-1 showed a significant positive correlation with the apnea-hypopnea index, percentage of time spent at O2 saturation < 90%, and oxygen desaturation index, whereas TGF-β was inversely related to all 3 of these parameters. After the CPAP therapy, PAI-1 significantly decreased, whereas TGF-β showed a significant increase, although the values did not reach those of the controls. uPA and tPA did not show significant differences after the treatment.


CONCLUSIONS
Our results suggest an imbalance of fibrinolysis related to OSAS and an improvement of the prothrombotic state after the CPAP treatment.
Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Rome, Italy.
Alessia
A
Steffanina
Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Rome, Italy.
Lidia
L
Proietti
Department of Pneumology and Respiratory Intensive Care Unit, University Hospital of Cattinara, Trieste, Italy. Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Rome, Italy.
Caterina
C
Antonaglia
Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Rome, Italy.
Paolo
P
Palange
Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Rome, Italy.
Elena
E
Angelici
Section of Histology, Department of Anatomy, Histology, Forensic Medicine, and Orthopedics, Sapienza University of Rome, Via A Scarpa 16, Rome, Italy. rita.canipari@uniroma1.it.
Rita
R
Canipari
D000368:Aged; D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications / Q000628:therapy*; D019851:Thrombophilia / Q000097:blood / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000097:blood*; D016212:Transforming Growth Factor beta / Q000097:blood*; D014568:Urokinase-Type Plasminogen Activator / Q000097:blood*
D017395:Plasminogen Activator Inhibitor 1; D016212:Transforming Growth Factor beta; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D010100:Oxygen
CPAP; PAI-1; TGF-β; sleep apnea; tPA; uPA