Impact of Obstructive Sleep Apnea on the Levels of Placental Growth Factor (PlGF) and Their Value for Predicting Short-Term Adverse Outcomes in Patients with Acute Coronary Syndrome

PLoS One. 2016 Mar 1;11(3):e0147686. doi: 10.1371/journal.pone.0147686. eCollection 2016.


Background: Placental growth factor (PlGF) induces angiogenesis and promotes tissue repair, and plasma PlGF levels change markedly during acute myocardial infarction (AMI). Currently, the impact of obstructive sleep apnea (OSA) in patients with AMI is a subject of debate. Our objective was to evaluate the relationships between PlGF levels and both the severity of acute coronary syndrome (ACS) and short-term outcomes after ACS in patients with and without OSA.

Methods: A total of 538 consecutive patients (312 OSA patients and 226 controls) admitted for ACS were included in this study. All patients underwent polygraphy in the first 72 hours after hospital admission. The severity of disease and short-term prognoses were evaluated during the hospitalization period. Plasma PlGF levels were measured using an electrochemiluminescence immunoassay.

Results: Patients with OSA were significantly older and more frequently hypertensive and had higher BMIs than those without OSA. After adjusting for age, smoking status, BMI and hypertension, PlGF levels were significantly elevated in patients with OSA compared with patients without OSA (19.9 pg/mL, interquartile range: 16.6-24.5 pg/mL; 18.5 pg/mL, interquartile range: 14.7-22.7 pg/mL; p<0.001), and a higher apnea-hypopnea index (AHI) was associated with higher PlGF concentrations (p<0.003). Patients with higher levels of PlGF had also an increased odds ratio for the presence of 3 or more diseased vessels and for a Killip score>1, even after adjustment.

Conclusions: The results of this study show that in patients with ACS, elevated plasma levels of PlGF are associated with the presence of OSA and with adverse outcomes during short-term follow-up.

Trial registration: NCT01335087.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / diagnosis
  • Aged
  • Biomarkers / blood
  • Case-Control Studies
  • Continuous Positive Airway Pressure
  • Female
  • Humans
  • Male
  • Middle Aged
  • Placenta Growth Factor
  • Pregnancy Proteins / blood*
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Sleep Apnea, Obstructive / blood*
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / therapy
  • Treatment Outcome


  • Biomarkers
  • PGF protein, human
  • Pregnancy Proteins
  • Placenta Growth Factor

Associated data


Grants and funding

Supported by: ResMed Ltd. (Australia), Fondo de Investigación Sanitaria (PI10/02763 and PI10/02745), the Spanish Respiratory Society (SEPAR), the Catalonian Cardiology Society, Esteve-Teijin (Spain), Oxigen Salud (Spain), and ALLER.