Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Abstract

Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.

Obstructive Sleep Apnea Syndrome: Links Betwen Pathophysiology and Cardiovascular Complications

“…Kritikou et al [48] reported some difference between apneic males and females: male OSAS subjects showed increased levels of CRP, IL-6 and TNF-receptor 1, and female OSAS subjects also showed higher CRP levels than controls. The short-term cPAP treatment did not improve the markers of inflammation [48]; at least 3 months of treatment were needed to reduce CRP levels [42].…”

“…C-reactive protein (CRP) is an acute-phase protein produced by the liver and is one of the most studied biomarkers of lowgrade inflammation in cardiovascular diseases, as it is a risk factor for atherosclerosis and cardiovascular morbidity and mortality [42]. Several researchers have evaluated the role of CRP in OSAS with conflicting results, probably due to the presence of obesity or pre-existing CAD [42].…”

“…C-reactive protein (CRP) is an acute-phase protein produced by the liver and is one of the most studied biomarkers of lowgrade inflammation in cardiovascular diseases, as it is a risk factor for atherosclerosis and cardiovascular morbidity and mortality [42]. Several researchers have evaluated the role of CRP in OSAS with conflicting results, probably due to the presence of obesity or pre-existing CAD [42]. In OSAS subjects (30 patients with a median AHI of 25 per hour), increased levels of circulating inflammatory molecules, such as CRP and cytokines, have been found, as well as increased leukocyte activation and adhesion molecules expression [39].…”

Influencia de la altura en los niveles de proteína C reactiva en adultos con adiposidad visceral abdominal

“…Diversos estudios han asociado una proporcionalidad directa entre los niveles de PCR y el grado de adiposidad visceral, por lo que en la Figura 2 se observaría un incremento significativo en los niveles de PCR, lo cual representaría que la hipoxia produciría cambios en la expresión génica mediados por factores de transcripción como el receptor antagonista de la interleucina 1 (IL-1ra), factor de necrosis tumoral (FNT) y el factor nuclear de interleucina 6 (IL-6) (9)(10)(11)(12)(13) .…”

Efectos inducidos por la hipoxia crónica intermitente en rata y cobaya como modelos animales de la apnea obstructiva del sueño

“…Por otro lado, los niveles en suero de la proteína C-reactiva (PCR), marcador universal de inflamación, se ven aumentados en el SAHS y se correlaciona con el IAH 183,232 . Sin embargo, con el tratamiento de la AOS con CPAP se observan niveles diferentes de la proteína y, por tanto, no aclara su participación en la patogénesis del SAHS [233][234][235] .…”