Skip to main content

Advertisement

SpringerLink
Log in

Correlation of changes in the red blood cell distribution width with the response to continuous positive airway pressure in patients with obstructive sleep apnea

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

It is recently found that the red blood cell distribution width (RDW) is independently associated with cardiovascular disease in patients with obstructive sleep apnea (OSA).The goal of this study is to investigate the correlation of RDW with the severity of OSA and whether RDW could be used to monitor the response to continuous positive airway pressure (CPAP) therapy in OSA patients. The study enrolled 70 participants. Control group (n = 24) consisted of patients with normal polysomnography and OSA group (n = 46) comprised patients with OSA of varying severity. RDW was measured before polysomnography in both groups. In addition, RDW was measured in the OSA group following 3 months of CPAP therapy. The RDW was significantly higher in the OSA group (p < 0.001), and this difference remained after adjusting for age and body mass index (p = 0.001). The RDW was approximately twofold greater in the OSA group (OR 2.126, 95% confidence interval 1.32–3.41; p = 0.002). On univariate analysis, the RDW was significantly correlated with hypoxia parameters, which was persistent with multivariate analysis. Furthermore, CPAP therapy reduced RDW (p = 0.002), and the change in the severity of 3% ODI by CPAP was correlated with the change in the RDW (r = 0.416, p = 0.013). The high RDW may be related to the pathophysiology of OSA. The high RDW in OSA may be associated with hypoxia. Therefore, treating OSA with CPAP could improve the RDW.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gopalakrishnan P, Tak T. Obstructive sleep apnea and cardiovascular disease. Cardiol Rev. 2011. https://doi.org/10.1097/CRD.0b013e318223bd08.

    Article  PubMed  Google Scholar 

  2. Fava C, Montagnana M, Favaloro EJ, Guidi GC, Lippi G. Obstructive sleep apnea syndrome and cardiovascular diseases. Semin Thromb Hemost. 2011. https://doi.org/10.1055/s-0031-1273092.

    Article  PubMed  Google Scholar 

  3. Lavie L, Polotsky V. Cardiovascular aspects in obstructive sleep apnea syndrome molecular issues, hypoxia and cytokine profiles. Respiration. 2009;78(4):361–70. https://doi.org/10.1159/000243552.

    Article  CAS  PubMed  Google Scholar 

  4. Ryan S, Taylor CT, McNicholas WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome? Thorax. 2009. https://doi.org/10.1136/thx.2008.105577.

    Article  PubMed  Google Scholar 

  5. Ciccone MM, Scicchitano P, Zito A, Cortese F, Boninfante B, Falcone VA, Quaranta VN, Ventura VA, Zucano A, Di Serio F, Damiani MF, Resta O. Correlation between inflammatory markers of atherosclerosis and carotid intima–media thickness in obstructive sleep apnea. Molecules. 2014. https://doi.org/10.3390/molecules19021651.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Berg S. Obstructive sleep apnea syndrome: current status. Clin Respir J. 2008. https://doi.org/10.1111/j.1752-699X.2008.00076.x.

    Article  PubMed  Google Scholar 

  7. Perkins SL. Examination of blood and bone marrow. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraksevas F, Glader BE, editors. Wintrobe’s clinical hematology. 11th ed. Utah: Lippincott Wilkins & Williams; 2003. pp. 5–25.

    Google Scholar 

  8. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, Swedberg K, Wang D, Yusuf S, Michelson EL, Granger CB, CHARM investigators. Red blood cell distribution width as a novel prognostic factor in heart failure: data from the CHARM program and the Duke databank. J Am Coll Cardiol. 2007. https://doi.org/10.1016/j.jacc.2007.02.067.

    Article  PubMed  Google Scholar 

  9. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010. https://doi.org/10.1016/j.amjcard.2009.09.027.

    Article  PubMed  Google Scholar 

  10. Drakopoulou M, Toutouzas K, Stefanadi E, Tsiamis E, Tousoulis D, Stefanadis C. Association of inflammatory markers with angiographic severity and extent of coronary artery disease. Atherosclerosis. 2009. https://doi.org/10.1016/j.atherosclerosis.2009.01.041.

    Article  PubMed  Google Scholar 

  11. Tonelli M, Sacks F. Arnold M, Moye L, Davis B, Pfeffer M, Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008. https://doi.org/10.1161/circulationaha.107.727545.

    Article  PubMed  Google Scholar 

  12. Weiss G, Goodnough LT. Anemia of chronic disease. N Eng J Med. 2005. https://doi.org/10.1056/NEJMra041809.

    Article  Google Scholar 

  13. Mozos I. Mechanisms linking red cell blood disorders and cardiovascular diseases. BioMed Res Int. 2015. https://doi.org/10.1155/2015/682054.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ozsu S, Abul Y, Gulsoy A, Bulbul Y, Yaman S, Ozlu T. Red cell distribution width in patients with obstructive sleep apnea syndrome. Lung. 2012. https://doi.org/10.1007/s00408-012-9376-x.

    Article  PubMed  Google Scholar 

  15. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991. https://doi.org/10.1093/sleep/14.6.540.

    Article  PubMed  Google Scholar 

  16. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra M, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM. American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med. 2012. https://doi.org/10.5664/jcsm.2172.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Flemons WW, Buysse D, Redline S, Pack A, Strohl K, Wheatley T, Young T, Douglas N, Levy P, McNicholas W, Fleetham J, White D, Schmidt-Nowarra W, Carley D, Romaniuk J. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.

    Article  Google Scholar 

  18. Feliciano A, Linhans R, Marçôa R, Cysneiros A, Martinho C, Reis RP, Penque D, Pinto P, Bárbara C. Hematologic evaluation in males with obstructive sleep apnea before and after positive airway pressure. Rev Port Pneumol. 2017. https://doi.org/10.1016/j.rppnen.2016.12.001.

    Article  PubMed  Google Scholar 

  19. Sokucu N, Özdemir C, Dalar L, Karasulu L, Aydin Ş, Altin S. Complete blood count alterations after six months of continuous positive airway pressure treatment in patients with severe obstructive sleep apnea. J Clin Sleep Med. 2014. https://doi.org/10.5664/jcsm.3958.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gunbatar H, Sertogullarından B, Ekin S, Akdag S, Arisoy A, Sayhan H. The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness. Med Sci Monit. 2014. https://doi.org/10.12659/MSM.891001.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sokucu NS, Karasulu L, Dalar L, Seyhan EC, Altin S. Can red blood cell distribution width predict severity of obstructive sleep apnea syndrome? J Clin Sleep Med. 2012. https://doi.org/10.5664/jcsm.2146.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gordon P, Sanders MH. Sleep 7: positive airway pressure therapy for obstructive sleep apnea/hypopnea syndrome. Thorax. 2005. https://doi.org/10.1136/thx.2003.007195.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Xie X, Pan L, Ren D, Du C, Guo Y. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med. 2013. https://doi.org/10.1016/j.sleep.2013.07.006.

    Article  PubMed  Google Scholar 

  24. Hegglin A, Schoch OD, Korte W, Hahn K, Hurny C, Münzer T. Eight months of continuous positive airway pressure (CPAP) decrease tumor necrosis factor alpha (TNFA) in men with obstructive sleep apnea syndrome. Sleep Breath. 2012. https://doi.org/10.1007/s11325-011-0512-2.

    Article  PubMed  Google Scholar 

  25. Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost. 2003; 9:177–190.

    Article  CAS  PubMed  Google Scholar 

  26. Yilmaz Avci A, Avci S, Lakadamyali H, Can U. Hypoxia and inflammation indicate significant differences in the severity of obstructive sleep apnea within similar apnea–hypopnea index groups. Sleep Breath. 2017. https://doi.org/10.1007/s11325-017-1486-5.

    Article  PubMed  Google Scholar 

  27. Varol E, Ozturk O, Gonca T, Has M, Ozaydın M, Erdogan D, Akkaya A. Mean platelet volume is increased in patients with severe obstructive sleep apnea. Scand J Clin Lab Investig. 2010. https://doi.org/10.3109/00365513.2010.520733.

    Article  Google Scholar 

  28. Kurt OK, Yildiz N. The importance of laboratory parameters in patients with obstructive sleep apnea syndrome. Blood Coagul Fibrinolysis. 2013. https://doi.org/10.1097/mbc.0b013e32835d53d4.

    Article  PubMed  Google Scholar 

  29. Kivanç T, Kulaksizoglu S, Lakadamyali H, Eyupoglu F. Importance of laboratory parameters in patients with obstructive sleep apnea and their relationship with cardiovascular disease. J Clin Lab. 2018. https://doi.org/10.1002/jcla.22199.

    Article  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Pulmonary Medicine, Baskent University Faculty of Medicine, Ankara, Turkey

    Huseyin Lakadamyali

  2. Department of Pulmonary Medicine, Medova Hospital, Konya, Turkey

    Tulay Kivanc

  3. Department of Neurology, Baskent University Faculty of Medicine, Baskent University Hospital, Saray Mah, Yunus Emre Cad, No. 1, 07400, Alanya, Antalya, Turkey

    Aynur Yilmaz Avci

Authors
  1. Huseyin Lakadamyali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tulay Kivanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aynur Yilmaz Avci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HL and TK conceived and designed the study, acquired the data, and wrote the manuscript. AYA critically revised the manuscript and contributed important intellectual content.

Corresponding author

Correspondence to Aynur Yilmaz Avci.

Ethics declarations

Conflict of interest

Lakadamyali H. declares that he has no conflict of interest. Kivanc T. declares that he has no conflict of interest. Yilmaz Avci A. declares that she has no conflict of interest.

Ethical approval

This study was approved by Ministry of Health Research and Training Center Clinical Research Ethical Committee approval number 2015-110 and conducted in accordance with Declaration of Helsinki 1964.

Informed consent

Informed consent was obtained from all participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lakadamyali, H., Kivanc, T. & Yilmaz Avci, A. Correlation of changes in the red blood cell distribution width with the response to continuous positive airway pressure in patients with obstructive sleep apnea. Sleep Biol. Rhythms 17, 141–148 (2019). https://doi.org/10.1007/s41105-018-0191-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41105-018-0191-5

Keywords

Search

Navigation