Reggiani Monica, Karttunen Vesa, Wartiovaara-Kautto Ulla, Riutta Asko, Uchiyama Shinichiro, Hillbom Matti
Department of Neurology, University of Oulu and Oulu University Hospital, P.O. Box 25, 900029 OYS, Finland ; Department of Neurology, "A. Avogadro" University, Novara, Italy.
Stroke Res Treat. 2012;2012:945849. doi: 10.1155/2012/945849. Epub 2012 Nov 6.
Obstructive sleep apnoea (OSA) carries an increased risk of ischaemic stroke, but the underlying mechanism is not clear. As right-to-left shunting can occur through a patent foramen ovale (PFO) during periods of apnoea, we investigated nocturnal changes in fibrinolytic activity and platelet function in subjects who had OSA with or without PFO and in controls. We determined plasminogen activator inhibitor 1 (PAI-1) activity and antigen and platelet activation parameters. The severity of OSA was verified by polygraphy and PFO was detected by ear oximetry. We found a higher PAI-1 activity and antigen and a lower ratio of 2,3-dinor-PGF(1α) to 2,3-dinor-TXB(2) in the subjects with OSA than in the controls. Linear regression analysis showed the apnoea-hypopnoea index (β-coefficient, 0.499; P = 0.032) and PFO (β-coefficient, 0.594; P = 0.015) to be associated independently with PAI-1 activity in the morning, while the increment in PAI-1:Ag from evening to morning was significantly associated with the presence of PFO (r(s) = 0.563, P = 0.002). Both OSA and PFO reduce fibrinolytic activity during nocturnal sleep. We hypothesize that subjects having both OSA and PFO may develop a more severe prothrombotic state during sleep than those having either OSA or PFO alone.
阻塞性睡眠呼吸暂停（OSA）会增加缺血性中风的风险，但其潜在机制尚不清楚。由于在呼吸暂停期间可通过卵圆孔未闭（PFO）发生右向左分流，我们调查了患有或未患有PFO的OSA患者以及对照组夜间纤溶活性和血小板功能的变化。我们测定了纤溶酶原激活物抑制剂1（PAI-1）的活性、抗原及血小板激活参数。通过多导睡眠图验证OSA的严重程度，并通过经皮耳血氧饱和度测定法检测PFO。我们发现，与对照组相比，OSA患者的PAI-1活性和抗原更高，2,3-二去甲-前列腺素F（1α）与2,3-二去甲-血栓素B（2）的比率更低。线性回归分析显示，呼吸暂停低通气指数（β系数，0.499；P = 0.032）和PFO（β系数，0.594；P = 0.015）与早晨的PAI-1活性独立相关，而PAI-1抗原从晚上到早晨的增量与PFO的存在显著相关（r(s) = 0.563，P = 0.002）。OSA和PFO均可降低夜间睡眠期间的纤溶活性。我们推测，同时患有OSA和PFO的患者在睡眠期间可能比单独患有OSA或PFO的患者形成更严重的血栓前状态。
