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The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath

Sleep Disorders Center, Atatürk Chest Diseases, Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Sleep And Breathing (Impact Factor: 2.87). 02/2011; 16(1):217-21. DOI: 10.1007/s11325-011-0492-2
Source: PubMed

ABSTRACT There is an increased risk of cardiovascular and cerebrovascular events in patients with obstructive sleep apnea (OSA). High-sensitivity C-reactive protein (hs-CRP) is a marker that predicts atherosclerotic complications. However, there are contradictory results about the correlation between serum hs-CRP levels and OSA severity. The purpose of this work was to evaluate the relationship between hs-CRP levels and the severity of OSA in newly diagnosed OSA patients.
The study group was composed of 76 patients with clinical suspicion of OSA. Subjects with body mass indexes (BMI) ≥30 kg/m(2) were classified as obese. Full-night polysomnography (PSG) was performed on all patients. Patients with an apnea-hypopnea index (AHI) ≥5 were considered to have OSA, and patients with an AHI <5 were accepted as the control group. Blood samples were taken from all patients to analyze serum hs-CRP levels the morning after PSG.
The serum hs-CRP levels were significantly higher in the OSA group (4.03 ± 3.58 mg/L) than in the control group (2.41 ± 1.95 mg/L) (p = 0.013). This high level was positively correlated with BMI (r = 0.376, p = 0.001) and with AHI (r = 0.280, p = 0.014). In multiple regression analysis, elevated hs-CRP levels were associated with AHI (F = 3.293, p = 0.033), which was independent of obesity.
Patients with OSA have elevated serum levels of hs-CRP, a marker for inflammation and an independent risk predictor for cardiovascular morbidity. The severity of OSA is responsible for the elevation of hs-CRP.

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    • "It is of interest that we recorded higher levels of hsCRP in RA patients with OSA. In consistent to our study, several works have demonstrated increased hsCRP values among OSA patients [34] [35] [36]. The postulated mechanism of the association between OSA and hsCRP is complex. "
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    ABSTRACT: Aim of the work To assess obstructive sleep apnea (OSA) as one of the common primary sleep disorders in patients with rheumatoid arthritis (RA) and study its correlation to disease activity and pulmonary function tests. Patients and methods This study included 30 female patients with RA who fulfilled the American College of Rheumatology/European league against rheumatism classification criteria. All the patients were subjected to full medical history, thorough clinical examination with evaluation of the disease activity using disease activity score-28 (DAS28), laboratory assessment of highly sensitive C-reactive protein (hsCRP), pulmonary function tests (PFTs) (FVC, FEV1 and FEV1/FVC) and one night polysomnography at the sleep laboratory. Results Polysomnographic data revealed OSA in 14 RA patients (46.7%). Patients with OSA showed longer disease duration (7.0 ± 1.94 years), higher BMI (30.8 ± 2.48), hsCRP level (6.7 ± 0.6 mg/L) and DAS28 (4.9 ± 1.85) than patients with no OSA (4.0 ± 1.72 years, 20.3 ± 1.55, 4.9 ± 0.3 mg/L and 3.7 ± 1.28 respectively). There was non-significant difference between both groups regarding the PFTs (p > 0.05). The study showed a significant correlation between AHI (apnea-hypopnea index) and BMI, hsCRP and DAS28 (r = 0.45, 0.43 and 0.51, respectively) (p < 0.05). No significant correlation was detected between AHI and PFTs. Conclusion Obstructive sleep apnea is commonly associated with RA patients; these findings possibly suggest common underlying pathological mechanisms which may be linked to chronic inflammation. Co-existence of OSA in RA patients may influence the disease activity and the level of circulating inflammatory markers. Considering diagnosis and treatment of this sleep disorder in RA patients may help in improved clinical care, better prognosis and avoid rheumatoid-associated morbidities.
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    • "C-reactive protein (CRP) is an acute-phase inflammatory protein produced by the liver and promotes adhesion molecule expression. The serum high-sensitivity CRP levels were significantly higher in the OSA patients (Kageyama et al. 2006; Bhushan et al. 2009; Guven et al. 2012), independent of obesity (Kageyama et al. 2006; Bhushan et al. 2009; Guven et al. 2012). Genes of the inflammatory mediators TNF-a, interleukin 1 b (IL-1b), MIP-2, and P-selectin are overexpressed in the larynx and soft palate in OSA (Almendros et al. 2008), and upregulate the inflammatory cascade. "
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    • "Cytokines such as C-reactive protein, tumor necrosis factor-a, and interleukin-6 (IL-6) have been found to be linked to sleepiness, fatigue, and the development of cardiovascular and metabolic disorders (Alves et al., 2012). Independent of obesity, the above cytokines and C-reactive protein were also elevated in OSAS patients (Vgontzas et al., 2000; Guven et al., 2012; Villa et al., 2012). "
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