Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy.
Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy.
复制标题
阻塞性睡眠呼吸暂停对接受双重抗血小板治疗的急性冠脉综合征患者血小板功能的影响
DOI：
10.1161/jaha.118.008808
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发表时间：
2018-08-07
影响因子：
5.4
通讯作者：
Wei Y
中科院分区：
文献类型：
--
作者：
Gong W;Wang X;Fan J;Nie S;Wei Y
背景阻塞性睡眠呼吸暂停(OSA)是急性冠脉综合征(ACS)的新危险因素。多项研究表明，OSA与诱导的血小板反应性有关。然而，OSA是否对接受双重抗血小板治疗的急性冠脉综合征患者的血小板功能有影响尚不清楚。方法和结果这是一项横断面观察性研究，纳入服用维持性阿司匹林和氯吡格雷治疗的急性冠脉综合征患者。将阻塞性睡眠呼吸暂停低通气指数定义为≥15次/小时。用血栓弹性图评估花生四烯酸或二磷酸腺苷途径的抑制率，并确定治疗中高残留血小板反应性的患者。使用自动血细胞计数器对血样进行常规分析，获得血小板指数。对127例接受双重抗血小板治疗的急性冠脉综合征患者进行分析。阻塞性睡眠呼吸暂停综合征患者的平均血小板体积、血小板大细胞比率等血小板体积指数明显升高。阻塞性睡眠呼吸暂停综合征患者(n=68)与非阻塞性睡眠呼吸暂停患者(n=59)相比，腺苷二磷酸受体通路的抑制率显著降低(P=0.028)。在调整了潜在的混杂因素后，阻塞性睡眠呼吸暂停综合征患者在氯吡格雷治疗后有更高的残余血小板反应性(调整后的优势比：3.2 5，95%可信区间：1.19-8.87，P=0.021)。结论在接受双重抗血小板治疗的急性冠脉综合征患者中，OSA与血小板体积指数的升高、氯吡格雷诱导的抗血小板效应的降低以及治疗中高残留血小板反应性的增加有关。
Background Obstructive sleep apnea (OSA) is a novel risk factor for acute coronary syndrome (ACS). Several studies have shown OSA to be associated with induced platelet reactivity. However, whether OSA have effects on platelet function profiles in ACS patients taking dual antiplatelet therapy remains unexplored. Methods and Results This was a cross‐sectional observational study, in which ACS patients taking maintenance aspirin and clopidogrel therapy were included. OSA was defined as an apnea‐hypopnea index ≥15 events/hour. The inhibitory rate of arachidonic acid or adenosine diphosphate pathway were assessed with thrombelastography and defined patients with high residual on‐treatment platelet reactivity. Platelet indices were obtained from routine analysis of blood samples using an automated blood cell counter. A total of 127 ACS patients taking dual antiplatelet therapy were analyzed. Platelet volume indices, including mean platelet volume and platelet large cell ratio, were significantly increased in patients with OSA. Patients with OSA (n=68) had significantly lower inhibitory rate of adenosine diphosphate receptor pathway (P=0.028) compared with those without (n=59). After adjustment for potential confounders, patients with OSA were more likely to have high residual on‐treatment platelet reactivity after clopidogrel therapy (adjusted odds ratio: 3.25, 95% confidence interval: 1.19–8.87, P=0.021). Conclusions In ACS patients taking dual antiplatelet therapy, OSA is associated with an increased level of platelet volume indices, reduced clopidogrel‐induced antiplatelet effects and a greater prevalence of high residual on‐treatment platelet reactivity.