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.
"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   . The postulated mechanism of the association between OSA and hsCRP is complex. "
[Show abstract][Hide abstract] 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.
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.
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.
"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. "
"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). "
[Show abstract][Hide abstract] ABSTRACT: The current treatment of obstructive sleep apnea syndrome (OSAS) focuses on alleviation of symptoms by increasing airway patency during sleep through positive airway pressure, oral appliances, changes in sleep position, weight loss, or surgical treatment. Continuous positive airway pressure (CPAP) is currently the treatment of choice and prevents upper airway obstruction, resulting in improved sleep architecture and daytime symptoms. Despite proven efficacy, adherence to CPAP treatment is still not efficient. The new methods of rehabilitation (exercise training programs, hypoglossal nerve stimulation) for patients with OSAS are currently modified. The aim of the present study was to present recent developments in the field of selected aspects of rehabilitation in patients with OSAS. Database search was focused on exercise training programs and electrostimulation of genioglossus muscle. The search for articles on the rehabilitation interventions for OSAS was performed using the PubMed database from 1966 to 2013. Most of the findings have shown beneficial effects of rehabilitation. In detail, we describe the recent developments and potential adverse effects of electrostimulation and physical exercises. According to the results of studies presented, the above therapy might support conventional treatment or may be an alternative for patients with poor compliance to CPAP therapy, mandibular advancement devices, or ineffective results of surgical procedures as well.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 07/2013; 36(4). DOI:10.1097/MRR.0b013e3283643d5f · 1.28 Impact Factor
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