Obstrüktif uyku apne sendromlu (OUAS) hastalarda kardiyovasküler hastalıklar için risk faktörü olan c-reaktif protein ve homosistein düzeyleri

Amaç: C-reaktif protein (CRP) ve homosistein aterosklerozis ve koroner arter hastalıkları için önemli risk faktörleridir. Bu çalışmada, OUAS'lı hastalar ile vücut kitle indeksi, yaş ve cinsiyet olarak eşleştirilmiş kontrol grubu arasında, ek hastalık, ilaç kullanma ve sigara içme durumlarının etkisini de dışlayarak, CRP ve homosistein seviyelerini ve bunların ilişkili olduğu parametreleri araştırmayı amaçladık. Gereç ve yöntem: Bu çalışma Ocak 2006-Ocak 2009 tarihleri arasında, bir vaka-kontrol çalışması olarak yürütüldü. OUAS şüphesi olan, 987 erkek hastaya gece boyu polisomnografi yapıldı. Dışlama kriterleri uygulandıktan sonra 230 kişi CRP ve homosistein ölçümleri için uygun bulundu. Vakalar apne-hipopne indeksine (AHİ) göre sınıflandırıldı: 36 kontrol (AHİ

C-reactive protein and homocysteine levels which are the risk factors of cardiovascular diseases for patients with obstructive sleep apnea syndrome (OSAS)

Aim: C-reactive protein (CRP) and homosystein are important risk factors for atherosclerosis and coronary hearth disease. We aimed to investigate the serum levels of CRP and homocysteine and related clinical parameters among the patients with OSAS and the control group who were matched for age, gender, body mass indeks (BMI), by excluding the effects of the co-existing disease, being on medication and smoking. Material and methods: This study was conducted between January 2006-January 2009, as a case-control study. 987 consecutive patients who were reffered for suspected OSAS underwent polisomnography. 230 subject were found suitable for CRP and homosistein measurement after application of the exclusion criterias. Cases were classified according to apnea-hypopnea index (AHI); 84 of them mild-moderate OSAS (30<AHI<5); 110 of them severe OSAS (AHI>30) and 36 of them control cases (AHI<5). To eliminate the statistical differences bet-ween groups in body mass index, 10 overweight cases of severe OSAS group were excluded from the study. Venous blood samples were taken between 7.00-8.00 am. Results: Plasma CRP level in both groups with OSAS was detected as significantly higher than in control group (p<0.001). However, a difference bet-ween the groups in terms of the levels of homocysteine was not detected (p=0.163). In step-wise regression analysis, the variables, actually explaining the increase in the levels of CRP were waist circumference (p=0.220 p=0.002) and the time passed in 90 and upper saturation (p=-0.145, p=0.039), levels of homosistein were inde-pendently associated with mesurments of Epworth sleepiness scale (b=0.160 p=0.015). Conclusion: We found that the patients with OSAS had low level inflammation determined by the level of CRP and this was related to the time passed in 90 and upper saturation at night and waist circumference. Otherwise, OSAS does not seem to create a cardiovascular risk because of increased homosistein.


1. Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM manual for scoring of sleep and assosiatiated events. Rules, terminology and technical Specifications. 1st Ed. Westchester, Illinois: American Academy of Sleep Medicine, 2007.

2. Young T, Paltla M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle age adults. N Engl Med 1993;328:1230-1235.

3. Young T, Shahar E, Nieto FJ, et al. Predictors of sleepdisordered breathing in community dwelling adults:the Sleep Heart Health Study. Arch Intern Med 2002;162:893–900.

4. Peppard PE, Young T, Palta M, et al. Longitudinal study of moderate weight change andsleep disordered breathing. JAMA 2000;284:3015–3021.

5. R. Wolk and V. K. Somers. Obesity-related cardiovascular disease: implications of obstructive sleep apnea. Diabetes, Obesity and Metabolism 2006;8:250–260.

6. Alam I, Lewis K, Stephens JW, Baxter J. N. Inflammation, obesity and comorbidity. Obesity reviews 2006;8:119–127.

7. Ross SD, Sheinhait IA, Harrison KJ, et al. Systematic review and metaanalysis of the literature regarding the diagnosis of sleep apnea. Sleep 2000;23(4):519-532.

8. Hatipoğlu U, Rubenstein I. Inflammation and obstructvesleep apnoea syndrome pathogensis: a working hypothesis. Respiration 2003;70:665–671.

9. Lagrand WK, Visser CA, Hermens WT, et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation 1999;100:96–102.

10. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C reactive protein on human endothelial cells. Circulation 2000;102:2165–2168.

11. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. Elevated Creactive protein in patients with obstructive sleep apnea. Circulation 2002;105:2462–2464.

12. Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of Creactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003;107:1129–1134.

13. Visser M, Bouter LM, McQuillan GM, et al. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999;282:2131–2135.

14. Hak AE, Stehouwer CD, Bots ML, et al. Associations of C-reactive protein with measures of obesity, insulin resistance, and subclinical atherosclerosis in healthy, middle aged women. Arterioscler Thromb Vasc Biol 1999;19:1986–1991.

15. Lui MM, Lam JC, Mak HK, et al. C-Reactive Protein Is Associated With Obstructive Sleep Apnea Independent of Visceral Obesity. Chest 2009;135:950–956.

16. Guileminault C, Kirişoğlu C, Ohayon MM. C-reactive protein and sleep disordered breathing. Sleep 2004;27:1507–1511.

17. Sharma SK, Mishra HK, Sharma H, et al. Obesity, and not obstructive sleep apnea, is responsible for increased serum hs CRP levels in patients with sleep disordered breathing in Delhi. Sleep Med 2008;9:149–156.

18. Can M, Açıkgöz S, Mungan G, et al. Serum cardiovascular risk factors in obstructive sleep apnea. Chest 2006;129(2):233-237.

19. Zouaoui BK, Meerhaeghe VA, Doumit S, et al. Sleep apnoea/hypopnoea index is an independent predictor of highsensitivity C reactive protein elevation. Respiration 2006; 73(2):243 246.

20. Mazza A, Bossone E, Mazza F, Distante A. Homocysteine andcardiovascular risk. Arch Chest Dis 2004;62(1):29-33.

21. Jialal I, Devaraj S, Venugopal SK. C-reactive protein: riskmarker or mediator inatherothrombosis? Hypertension 2004;44:6–11.

22. Jhons MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540-545.

23. Chobanian AV, Bakris GL, Black HR, et al. The seventh Report of the Joint National Committee on Prevention, Detection, Eveluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-2572.

24. Hauge T, Persson J, Sjolund K. Neuropeptides in the düodenal mucosa of chronic alcolic heavy drinkers. Alcohol 2001;36:213-218.

25. Rechtschaffen A, Kales A eds. A manual of standardized terminology techniques and scoring system for sleep stages of human subjects. Los Angeles, CA: Brain Information Service/ Brain Reserch Instıtue, Unıversty of California at Los Angeles, 1968. Guileminault C, Kirisoglu C, Ohayon MM(2004) C reactive protein and sleep-disordered breathing. Sleep 27:1507–1511

26. Peled N, Kassirer M, Shitrit D, et al. The association of OSA with insulin resistance, inflammation and metabolic syndrome. Respir Med 2007;101:1696–1701.

27. Saletu M, Nosiska D, Kapfhammer G, et al. Structural and serum surrogate markers of cerebrovascular disease in obstructive sleep apnea (OSA): association of mild OSA with early atherosclerosis. J Neurol 2006;253:746–752.

28. Barceló A, Barbé F, Llompart E, et al. Effects of obesity on Creactive protein level and metabolic disturbances in male patients with obstructive sleep apnea. Am J Med 2004;117:118–121.

29. Ryan S, Nolan GM, Hannigan E, et al. Cardiovascular risk markers in obstructive sleep apnea syndrome and correlation with obesity. Thorax 2007;62:509–514

30. Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 2007;30:29–34.

31. Minoguchi K, Yokoe T, Tazaki T, et al. Increased carotid intimamedia thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 2005;172:625–630.

32. Kokturk O, Çiftçi TU, Mollarecep E, et al. Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 2005;46:801–809.

33. Can M, Açıkgöz S, Mungan G, et al. Serum cardiovascular risk factors in obstructive sleep apnea. Chest 2006;129:233–237.

34. Lear SA, Chen MM, Birmingham CL, et al. The relationship between simple anthropometric indices and C-reactive protein: ethnic and gender differences. Metabolism 2003;52:1542

35. Trakada G, Chrousos GP, Pejovic S, Vgontzas AN. Sleep apnea and its assosiation with the stres system, inflammation, insulin rezistance and visceral obesity. Sleep Medicine Clinics 2007;2:251- 261.

36. Torzewski M, Rist C, Mortensen RF, et al. C-reactive protein in the arterial intima: role of C-reactive protein reseptor-dependent monocyte recruitment in atherogenesis. Arterioscler Thromb Vasc Biol 2000;20:2094-2099.

37. Chung S, Yoon IY, Shin YK, et al. Endothelial dysfunction and Creactive protein in relation with the severity of obstructive sleep apnea. Sleep 2007;30(8):997-1001.

38. Kapsimalis F, Varouchakis G, Manousaki A, et al. Association of sleep apnea severty and obesity with insulin resistance, C-reactive protein and leptin levels in male patients with obstructive sleep apnea. Lung 2008;186(4):209-217.

39. Matsui H, Ihara Y, Fujio Y, et al. Induction of IL-6 by hypoxia is mediated by NF-kB and NF-IL-6 in cardiac myocyte. Cardiovasc Res 1999;42:104-112.

40. Tazaki T, Minoguchi K, Yokoe T, et al. Increased levels and activity of matrix metalloproteinase-9 in obstruktive sleep apnea syndrome. Am J Respir Crit Care Med 2004;170:1354-1359.

41. Lavie, L, Perelman A, Lavie P. Plasma homosisteine levels in obstructive sleep apnoea association with cardiovascular morbidty. Chest 2001;120:900-908.

42. Yehuda S, Sredni B, Carasso RL, Kenigsbuch-sredni D. REM Sleep Deprivation in Rats Results in Inflammation and Interleukin-17 Elevation. Journal of Interferon&Cytocin Research 2009;29(7):393-398.

43. Yavuz Z, Ursavaş A, Ege E. Homocysteine levels in patients with obstructive sleep apnea syndrome.Tüberküloz ve Toraks Dergisi 2008;56(1):37-42.

Kaynak Göster

  • ISSN: 1302-4922
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018