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ABSTRACT. Introduction. Levels of C-reactive protein (CRP), an important serum marker of inflammation with major implications for cardiovascular morbidity and atherogenesis, are elevated among adult patients with sleep-disordered breathing (SDB). We hypothesized that elevated CRP plasma levels would also be present among children with SDB.Methods. Eighty-one children (mean age: 9.3 ؎ 3.7 years) underwent polysomnographic evaluations. Samples for plasma CRP level and lipid profile determinations were drawn the next morning.Results. Because plasma CRP levels were not normally distributed in this cohort, logarithmic transformation was applied. Log plasma CRP levels were significantly higher in the SDB group (obstructive apnea/ hypopnea index [AHI] of >5), compared with the mild SDB group (AHI of >1 and <5) and the control group (AHI of <1). Significant positive correlations were found between log CRP levels and AHI (r ‫؍‬ .53) and arousal index (r ‫؍‬ .28), whereas an inverse correlation was found between the lowest nocturnal arterial oxygen saturation and log CRP levels (r ‫؍‬ ؊.47). These correlations persisted after exclusion of outliers. Moreover, 94% of the children with elevated log CRP levels reported excessive daytime sleepiness and/or learning problems, compared with 62% of the children with normal log CRP levels.Conclusions. Plasma CRP levels were increased among some children with SDB and were correlated with AHI, arterial oxygen saturation nadir, and arousal index measures. These changes were particularly prominent among children who were sleepy or presented with neurobehavioral complaints. The intermittent hypoxemia and sleep fragmentation of SDB may underlie inflammatory responses, the magnitude of which may ultimately lead to the cardiovascular, cognitive, and behavioral morbidities of SDB. Pediatrics 2004;113:e564 -e569. URL: http: //www.pediatrics.org/cgi/content/full/113/6/e564; sleepdisordered breathing, C-reactive protein, atherogenesis.ABBREVIATIONS. SDB, sleep-disordered breathing; CRP, C-reactive protein; BMI, body mass index; HDL, high-density lipoprotein; TST, total sleep time; AHI, obstructive apnea/hypopnea index; SPo 2 , arterial oxygen saturation. S leep-disordered breathing (SDB) is characterized by repeated events of partial or complete upper airway obstruction during sleep, resulting in disruption of normal ventilation, hypoxemia, and sleep fragmentation. SDB is associated with neurobehavioral and cardiovascular morbidities. [1][2][3][4][5][6][7] The increased prevalence of hypertension and atherogenesis among SDB patients has been ascribed to sympathetic activation [8][9][10] and to endothelial dysfunction, 11-13 most likely resulting from initiation and propagation of inflammatory responses within the microvasculature.C-reactive protein (CRP), an important serum marker of inflammation, has emerged as one of the most powerful independent predictors of risk for future cardiovascular morbidity. [14][15][16] In addition, recent evidence suggests that CRP may directly participate in ath...