The hypercoagulable state in sleep apnea is related to comorbid hypertension

J Hypertens. 2001 Aug;19(8):1445-51. doi: 10.1097/00004872-200108000-00013.


Objective: Obstructive sleep apnea (OSA) is associated with increased prevalence of atherosclerotic disease. A hypercoagulable state thought to underly atherosclerosis has been described in both OSA and systemic hypertension. We wondered about the respective contribution of apnea and hypertension to a hypercoagulable state.

Design: Eighty-seven subjects with symptoms suggestive of OSA, mean age 47 years (range 32-64 years), underwent polysomnography and blood pressure (BP) screening. OSA was diagnosed when respiratory disturbance index (RDI) > or = 15. Subjects having systolic BP (SBP) > 140 mmHg and/or diastolic BP (DBP) > 90 mmHg were classified as having hypertension. Three hypercoagulability markers were measured: thrombin/antithrombin III complex (TAT), fibrin D-dimer (DD), and von Willebrand factor antigen (vWF:ag).

Results: Analysis of variance and multiple linear regression were performed on the following four subject groups: (1) normotensive non-apneics (n = 19), (2) normotensive apneics (n = 38), (3) hypertensive non-apneics (n = 11), and (4) hypertensive apneics (n = 19). OSA (groups 2 and 4) had no significant main effect on hemostasis. Hypertensives (groups 3 and 4) had higher plasma levels of TAT (median/inter-quartile range, 148/59-188 versus 77/53-108 pmol/l; P = 0.009) and of DD (376/265-721 versus 303/190-490 ng/ml; P = 0.040) than normotensives (groups 1 and 2). Across all subjects, SBP was the only significant predictor of TAT (P = 0.001) and of DD (P = 0.004), whereas DBP was the only significant predictor of vWF:ag (P = 0.029). These findings persisted even after controlling for gender, age, body mass index, RDI, mean SaO2, and hematocrit.

Conclusion: Hypercoagulability in OSA is mediated by comorbid hypertension and might account for high cardiovascular morbidity in OSA in general.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antigens / analysis
  • Antithrombin III / analysis
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Disorders / physiopathology
  • Blood Pressure
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Hypertension / complications*
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Peptide Hydrolases / analysis
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / physiopathology
  • Systole
  • von Willebrand Factor / immunology


  • Antigens
  • Fibrin Fibrinogen Degradation Products
  • Von Willebrand antigen
  • antithrombin III-protease complex
  • von Willebrand Factor
  • Antithrombin III
  • Peptide Hydrolases