Author`s Reply.

To the Editor,

We appreciate Dr. Nena’s comments about our review article entitled “Obstructive sleep apnea and its effects on cardiovascular diseases: a narrative review,” published in Anatol J Cardiol 2015; 15: 944-50, and her suggestion that mean platelet volume (MPV) may have prognostic importance as a risk factor for cardiovascular events and therapeutic importance as an indicator of a response to CPAP management in patients with obstructive sleep apnea (OSA) (1). MPV is a marker for thrombocyte activation. Larger platelets contain more granules and thromboxane A2 and express more glycoprotein receptors. Therefore, these platelets aggregate more quickly and adhere more strongly to collagen, and this potentially leads to either an increased frequency or severity of thromboembolic events. Because patients with OSA have an increased frequency of atrial fibrillation and stroke and because OSA has adverse effects on outcomes in patients with other cardiovascular disorders, measuring MPV may help classify patients into risk categories and identify patients who might need additional therapy.

One important issue in studies using MPV as an indicator of vascular events is whether to consider MPV as a continuous variable or as a categorical variable, which is of interest only if it is above the upper limit of normal or some other critical value based on outcome studies. Another important issue is the study population. Is it more important to study patients with underlying risk factors for cardiovascular disease or to study patients without any obvious evidence of cardiovascular disease? Karakaş et al. (2) analyzed MPV in controls and in patients with OSA with mild, moderate, and severe increases in apnea-hypopnea index (AHI). They found that it was significantly higher in patients with severe OSA than in control subjects. However, the reported values appeared to be within the normal range, and absolute differences were small (8.6 versus 7.8 femtoliters). They did find significant correlations between MPV and AHI and minimum O2 saturation. Nena et al. (3) studied 610 non-diabetic subjects with suspected OSA. MPV (12.1 femtoliters) was significantly higher in patients with severe OSA defined by an AHI greater than 30 events per hour than in controls (9.8 femtoliters). They found significant correlations between MPV and AHI and between MPV and the percent of time the O2 saturations were below 90%. This study suggested that there are significant correlations between MPV and important variables in patients with severe OSA. Varol et al. (4) studied 31 patients with severe OSA and measured MPV before and after treatment with CPAP for 6 months. The median MPV was significantly higher in patients with severe OSA than in control subjects, and there was a significant reduction in this volume after 6 months of CPAP therapy.

In our view, MPV is an easily available laboratory test that may identify patients with an increased risk for cardiovascular events and may represent a response parameter to monitor during treatment of these patients. It seems important to develop large prospective studies on its utility in patients with OSA