Evaluation of Fibrinolytic Inhibitors: Alpha-2-Antiplasmin and Plasminogen Activator Inhibitor 1 in Patients with Obstructive Sleep Apnoea

PLoS One. 2016 Nov 18;11(11):e0166725. doi: 10.1371/journal.pone.0166725. eCollection 2016.


Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.

MeSH terms

  • Adult
  • Biomarkers
  • Blood Chemical Analysis
  • Blood Coagulation
  • Blood Gas Analysis
  • Case-Control Studies
  • Comorbidity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phenotype
  • Plasminogen Activator Inhibitor 1 / blood*
  • Polysomnography
  • Risk Factors
  • Sleep Apnea, Obstructive / blood*
  • Sleep Apnea, Obstructive / diagnosis
  • alpha-2-Antiplasmin*


  • Biomarkers
  • Plasminogen Activator Inhibitor 1
  • alpha-2-Antiplasmin

Grants and funding

This work was supported by Medical University of Lublin Scientific Grant DS 161.