Department of Medicine, Danbury Hospital-Nuvance Health, Danbury, CT, USA.
Department of Research and Innovation, Danbury Hospital-Nuvance Health, Danbury, CT, USA.
Clin Invest Med. 2021 Oct 3;44(3):E55-63. doi: 10.25011/cim.v44i3.36708.
Purpose: Obstructive sleep apnea (OSA) leads to endothelial dysfunction and platelet hyperactivity, which are linked to increased risk of cardiovascular disease and implicated in the development of aspirin resistance. We hypothesized that aspirin resistance is prevalent among OSA patients and aimed to explore effects of continuous positive airway pressure (CPAP) therapy on aspirin responsiveness. Methods: In Phase 1, prevalence of aspirin resistance was determined cross-sectionally in a group of OSA patients (n=59) on daily low-dose aspirin (81 mg) taken before entering the study, for primary or secondary prevention. In Phase 2, aspirin responsiveness before and after initiation of CPAP therapy was compared and stratified by endothelial function in a cohort of aspirin-naïve patients with newly diagnosed OSA (n=18). Results: In Phase 1, prevalence of aspirin resistance was 17%; most patients (56%) were on CPAP therapy. In Phase 2, initiation of CPAP therapy was associated with significant improvement in endothelial function (p=0.03). The mean pre-CPAP aspirin resistance units (ARU) was 569 (SD=75). In subjects with endothelial dysfunction (44%), the mean decrease after initiation of CPAP therapy was 43 ARU (SD=81, p=0.18). In contrast, subjects with normal endothelial function experienced the mean decrease of 8 ARU (SD=116, p=0.83). Conclusion: Aspirin resistance may be prevalent among OSA patients. After initiation of CPAP therapy, we observed a trend towards improvement in aspirin responsiveness among patients with endothelial dysfunction. The role of endothelial dysfunction and aspirin resistance should be explored in further studies that focus on the effect of CPAP on cardiovascular outcomes.
阻塞性睡眠呼吸暂停（OSA）可导致内皮功能障碍和血小板高反应性，从而增加心血管疾病的风险，并与阿司匹林抵抗的发生有关。我们假设 OSA 患者中存在阿司匹林抵抗，并旨在探讨持续气道正压通气（CPAP）治疗对阿司匹林反应性的影响。
在第 1 阶段，通过对一组正在服用每日低剂量阿司匹林（81mg）的 OSA 患者（n=59）进行横断面研究，确定阿司匹林抵抗的患病率，这些患者正在接受研究前的一级或二级预防。在第 2 阶段，比较了一组新诊断为 OSA 的阿司匹林初治患者（n=18）在开始 CPAP 治疗前后的阿司匹林反应性，并根据内皮功能进行分层。
在第 1 阶段，阿司匹林抵抗的患病率为 17%；大多数患者（56%）正在接受 CPAP 治疗。在第 2 阶段，开始 CPAP 治疗与内皮功能显著改善相关（p=0.03）。CPAP 治疗前的平均阿司匹林抵抗单位（ARU）为 569（SD=75）。在内皮功能障碍患者（44%）中，CPAP 治疗后平均下降 43 ARU（SD=81，p=0.18）。相比之下，内皮功能正常的患者平均下降 8 ARU（SD=116，p=0.83）。
阿司匹林抵抗可能在 OSA 患者中普遍存在。在开始 CPAP 治疗后，我们观察到内皮功能障碍患者的阿司匹林反应性有改善的趋势。内皮功能障碍和阿司匹林抵抗的作用应在进一步的研究中探讨，这些研究应重点关注 CPAP 对心血管结局的影响。
