C-reactive protein improves the ability to detect cardiometabolic risk in mild-to-moderate obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA), particularly in the mild‐to‐moderate range, affects up to 40% of the adult general population. While it is clear that treatment should be pursued in severe cases of OSA, when and how to best treat OSA in the mild‐to‐moderate range remains complicated, despite its high prevalence. The aim of this study was to compare the relative utility of apnea/hypopnea index (AHI) versus a biomarker of inflammation, C‐reactive protein (CRP), in identifying the presence and severity of hypertension and hyperglycemia. Middle‐aged (n = 60) adults with mild‐to‐moderate OSA (AHI between 5 and 29 events per hour) underwent 8‐h polysomnography, a physical examination including measures of blood pressure and body mass index, and a fasting morning blood draw for glucose and CRP. CRP levels were associated with greater odds for having hypertension and hyperglycemia compared to AHI. Receiver‐operating characteristics (ROC) curves revealed that adding CRP to standard clinical factors (age, sex, and BMI) yielded moderately good to strong risk models for the disorders (AUC = 0.721 and AUC = 0.813, respectively). These preliminary findings suggest that including a measure of CRP improves the ability for clinicians to detect cases of mild‐to‐moderate OSA with true cardiometabolic risk, with implications in improving prognosis and treatment within this clinically gray area.

Circulating C-reactive protein levels in patients with suspected obstructive sleep apnea

“…10,24 Among patients with OSA, BMI, sex, and anatomic characteristics such as neck circumference have been shown to be determinants of inflammation, and the addition of CRP to these clinical variables improves the detection of cardiometabolic conditions. [25][26][27][28][29] However, in contrast to previous findings, in our study the inclusion of CRP with patient characteristics (age, sex, BMI) did not increase the ability to detect hypertension, diabetes, and cardiac comorbidities in patients with OSA. Determinants of elevated CRP and PSG variables have been previously studied although they remain less clear, with some studies showing a positive association between CRP and AHI.…”

Assessment of the relationship between endocan and obstructive sleep apnea severity

“…In line with previous studies, hsCRP also was found to be higher among patients with severe OSA in the present research [40]. According to the previous studies hsCRP has been found to be associated with cardiovascular risk factors such as obesity, hyperglycemia and hypertension [41]. In our study these factors were not significantly different among OSA groups.…”

Confounded by obesity and modulated by urinary uric acid excretion, sleep‐disordered breathing indirectly relates to hyperuricaemia in males: A structural equation model

“…Elevated CRP levels were associated, even to a greater extent than SDB, with SBP and fasting glucose levels. (Gaines et al, 2017) We speculate that the mitigating effect in our present study between hypertension and hyperglycaemia, the former positively whereas the latter negatively associated with hyperuricaemia, negates the association of objective disrupted sleep or high CRP levels with hyperuricaemia. On the other hand, estimated anaerobic thresholds (continuous data) were inversely associated with serum UA levels (continuous data) in people with chronic heart failure (Leyva, Chua, Anker, & Coats, 1998).…”