The Association between the Levels of Inflammatory Serum Markers and Severity of Obstructive Sleep Apnea
Background and Objective: Higher concentration of systemic inflammatory markers is reported in patients with obstructive sleep apnea (OSA). Levels of inflammatory markers may be associated with severity of OSA. Objective of this study was to evaluate the correlation between level of inflammation markers and OSA severity.
Materials and Methods: Fifty six patients with symptoms and signs of OSA free of prevalent medical conditions including cardiovascular disease, diabetes mellitus, and hypertension were recruited in this study. Full night polysomnography (PSG) was performed for all the study participants. Participants’ blood samples were taken to analyze serum concentrations of Creactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the morning after PSG.
Results: The mean age of participants was 40.32 ± 10.78 years with mean body mass index (BMI) of 28.72 ± 4.96 kg/m2. 46 participants (82%) were male. Based on Apnea/Hypopnea Index (AHI), 43 participants (76%) had AHI ≥ 5. Signifi-cant difference was found between serum CRP levels in patients with and without OSA (P = 0.03). However, no signif-icant association was observed in terms of ESR levels between the study groups. After adjustment for age, BMI, neck circumference, and heart rate, CRP had no significant difference between the two study groups. In linear regression model, only BMI was correlated with CRP.
Conclusion: This study indicated that BMI is an independent risk factor for elevation of CRP in patients with OSA. Further researches are needed to explore the effects of sleep-related hypoxia on inflammatory serum markers.
Unnikrishnan D, Jun J, Polotsky V. Inflamma- tion in sleep apnea: an update. Rev Endocr Metab Dis- ord 2015; 16: 25-34.
Ryan S, McNicholas WT. Intermittent hypoxia and activation of inflammatory molecular pathways in OSAS. Arch Physiol Biochem 2008; 114: 261-6.
Kosacka M, Korzeniewska A, Jankowska R. The evaluation of body composition, adiponectin, C- reactive protein and cholesterol levels in patients with obstructive sleep apnea syndrome. Adv Clin Exp Med 2013; 22: 817-24.
Chung S, Yoon IY, Shin YK, et al. Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome. Sleep 2007; 30: 997-1001.
Friedman M, Samuelson CG, Hamilton C, et al.Effect of continuous positive airway pressure on C- reactive protein levels in sleep apnea: a meta-analysis.Otolaryngol Head Neck Surg 2012; 147: 423-33.
Yardim-Akaydin S, Caliskan-Can E, Firat H, et al. Influence of gender on C-reactive protein, fibrino- gen, and erythrocyte sedimentation rate in obstructive sleep apnea. Antiinflamm Antiallergy Agents Med Chem 2014; 13: 56-63.
Mills PJ, Natarajan L, von Kanel R, et al. Diur- nal variability of C-reactive protein in obstructive sleep apnea. Sleep Breath 2009; 13: 415-20.
Kheirandish-Gozal L, Capdevila OS, Tauman R, et al. Plasma C-reactive protein in nonobese chil- dren with obstructive sleep apnea before and after ade- notonsillectomy. J Clin Sleep Med 2006; 2: 301-4.
Ridker PM, Hennekens CH, Buring JE, et al. C- reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836-43.
Kuo HK, Yen CJ, Chang CH, et al. Relation of C-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol 2005; 4: 371-80.
Tauman R, Ivanenko A, O'Brien LM, et al. Plasma C-reactive protein levels among children with sleep- disordered breathing. Pediatrics 2004; 113: e564-e569.
Gozal D, Kheirandish-Gozal L, Bhattacharjee R, et al. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci (Elite Ed) 2012:2410-22.
Lui MM, Lam JC, Mak HK, et al. C-reactive pro- tein is associated with obstructive sleep apnea independ- ent of visceral obesity. Chest 2009; 135: 950-6.
Shamsuzzaman AS, Winnicki M, Lanfranchi P,et al. Elevated C-reactive protein in patients with ob- structive sleep apnea. Circulation 2002; 105: 2462-4.
Bhushan B, Guleria R, Misra A, et al. Obstruc- tive sleep apnoea correlates with C-reactive protein in obese Asian Indians. Nutr Metab Cardiovasc Dis 2009;19: 184-9.
Kokturk O, Ciftci TU, Mollarecep E, Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 2005; 46: 801-9.
Visser M, Bouter LM, McQuillan GM, et al. El- evated C-reactive protein levels in overweight and obese adults. JAMA 1999; 282: 2131-5.
Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108: 812-21.
American Academy of Sleep Medicine. Interna- tional classification of sleep disorders. 2nd ed. Washing- ton, DC: American Academy of Sleep Medicine, 2005.
Guven SF, Turkkani MH, Ciftci B, et al. The re- lationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath 2012; 16: 217-21.
Guilleminault C, Kirisoglu C, Ohayon MM. C-reactive protein and sleep-disordered breathing. Sleep 2004; 27: 1507-11.
Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 2007; 30: 29-34.
Min JY, Jang JY, Kim HY, et al. A relationship between the obstructive sleep apnea syndrome and the erythrocyte sedimentation rate. Clin Exp Otorhino- laryngol 2009; 2: 126-30.
Banhiran W, Durongphan A, Saleesing C, et al. Diagnostic properties of the STOP-Bang and its modi-fied version in screening for obstructive sleep apnea in Thai patients. J Med Assoc Thai 2014; 97: 644-54.
Reis R, Teixeira F, Martins V, et al. Validation of a Portuguese version of the STOP-Bang question- naire as a screening tool for obstructive sleep apnea: Analysis in a sleep clinic. Rev Port Pneumol (2006)2015; 21: 61-8.
Ruangkana P, Chinvarun Y, Udommongkol C, et al. Excessive daytime sleepiness and obstructive sleep apnea in Thai epileptic patients. J Med Assoc Thai 2014; 97: S175-S180.
Leng Y, Ahmadi-Abhari S, Wainwright NW, etal. Daytime napping, sleep duration and serum C reac- tive protein: a population-based cohort study. BMJ Open 2014; 4: e006071.
Davies RJ, Stradling JR. The relationship be- tween neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J 1990; 3: 509-14.
Mortimore IL, Marshall I, Wraith PK, et al. Neck and total body fat deposition in nonobese and obese pa- tients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 1998; 157: 280-3.
Chen X, Pensuksan WC, Lohsoonthorn V, et al. Obstructive sleep apnea and multiple anthropometric indices of general obesity and abdominal obesity among young adults. Int J Soc Sci Stud 2014; 2: 89-99.
Peppard PE, Young T, Palta M, et al. Longitu- dinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284: 3015-21.
Newman AB, Foster G, Givelber R, et al. Pro- gression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 2005; 165: 2408-13.
Barvaux VA, Aubert G, Rodenstein DO.Weight loss as a treatment for obstructive sleep ap- noea. Sleep Med Rev 2000; 4: 435-52.
Kao TW, Lu IS, Liao KC, et al. Associations between body mass index and serum levels of C- reactive protein. S Afr Med J 2009; 99: 326-30.
Baba MM, Balogun MO, Kolawole BA, et al.Relationship between C-Reactive Protein and Body Mass Index in Nigerians with Type II Diabetes Melli- tus. Niger J of Clin Med 2012; 4.
Nagasawa SY, Ohkubo T, Masaki K, et al. As- sociations between Inflammatory Markers and Subclin-ical Atherosclerosis in Middle-aged White, Japanese- American and Japanese Men: The ERA-JUMP Study. J Atheroscler Thromb 2015; 22: 590-8.
|Issue||Vol 1 No 3 (2016): Summer|
|Obstructive sleep apnea Inflammatory serum markers Body mass index (BMI)|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|