C-Reactive Protein Levels and the Risk of Incident Cardiovascular and Cerebrovascular Events in Patients with Obstructive Sleep Apnea

Ayas, Najib; Allen, A J Hirsch; Fox, Nurit; Peres, Bernardo Urbanetto; Mehrtash, M; Humphries, Karin H.; Jen, Rachel; Taylor, Carolyn; Eeden, Stephan F. van

doi:10.1007/s00408-019-00237-0

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…Subsequent meta‐analyses 7‐9 have demonstrated robust associations between OSA and elevated CRP levels, confirming the finding of Nadeem et al Additionally, the severity of OSA was found to be correlated with the elevation of CRP levels 40 . Elevated CRP levels in patients with OSA also increase cardiovascular risks 41,42 . Therefore, appropriate treatment strategies for resolving OSA and reducing CRP levels among these patients may prevent further cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

et al. 2020

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Objectives/Hypothesis To evaluate associations between sleep surgery and CRP (C‐reactive protein) levels in adults with obstructive sleep apnea (OSA). Study Design Meta‐analysis. Methods Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C‐reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random‐effects model. Results Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea–hypopnea index (AHI) after surgery was significantly reduced by −21.1 (95% confidence interval [CI], −28.4 to −13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = −0.39, 95% CI, −0.67 to −0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: −0.72 vs. −0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high‐sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow‐up period (i.e., <6 vs. >6 months). Conclusions Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180–1187, 2021

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Section: Discussionmentioning

confidence: 99%

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

et al. 2020

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“…The major outcome of interest was a composite of incident cardiovascular and cerebrovascular events which included cardiovascular death, hospitalization for cardiovascular conditions, stroke and cardiac procedures (percutaneous coronary intervention-PCI, coronary artery bypass graft-CABG); follow-up time was 8 years from PSG date for all patients. The outcomes were obtained by linking our cohort to provincial health databases as has been done in previous studies [8]. The codes indicating deaths from cardiovascular-related causes are summarized in S1 Table in S1 File; hospitalizations, procedures and events codes and definitions are in S2 Table in S1 File.…”

Section: Ascertainment Of Cardiovascular Eventsmentioning

confidence: 99%

“…Circulating levels of inflammatory markers may be a potentially useful method to risk stratify OSA patients [8]. Inflammation plays a pivotal role in the initiation and progression of CVD [9].…”

Section: Introductionmentioning

confidence: 99%

Circulating levels of cell adhesion molecules and risk of cardiovascular events in obstructive sleep apnea

et al. 2021

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Background Obstructive sleep apnea (OSA) patients are at increased risk of cardiovascular disease (CVD). Cell adhesion molecules (CAM) are increased in OSA and CAM are also implicated in the development of CVD. Research question Do CAM (ICAM-1, VCAM-1 and E-selectin) have prognostic value in identifying risk of cardiovascular events in OSA? Study design and methods Patients with suspected OSA referred for a polysomnogram provided a fasting blood sample. Plasma levels of ICAM-1, VCAM-1 and E-selectin were determined by multiplex Luminex Assay (Milliporesigma ON, Canada). Cardiovascular events were determined by deterministic linkage to provincial health databases. Results 418 patients were included in the analysis. Mostly male (68.2%), mean age of 50.7 yrs, median AHI 16.5 events/hour, and mean BMI of 31.7 kg/m2. 36 cardiovascular events occurred in 8-yrs of follow up. Higher levels of ICAM-1 were associated with developing CVD (HR = 3.65 95% CI 1.40–9.53, 2nd and 3rd tertiles vs. 1st tertile), including in patients with OSA (HR = 3.1 95% CI 1.16–8.25). E-selectin was significantly associated with cardiovascular events in patients with moderate to severe OSA (HR = 3.31 95% CI 0.94–11.72, 2nd and 3rd tertiles vs. 1st tertile) but not in patients without moderate to severe OSA (HR = 0.67 95% CI 0.19–2.38), p-value for interaction = 0.07. Interpretation In a suspected OSA cohort, patients with higher levels of ICAM-1 (>816 ng/ml) were significantly more likely to experience a cardiovascular event within 8 years after PSG. In moderate to severe OSA patients, a higher E-selectin (>36.4 ng/ml) was significantly associated with cardiovascular events.

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“…The excessive infiltration of inflammatory cells is also highlighted by the formation of subepithelial oedema in OSA patients as documented by histology. Among these proteins, circulating CRP is an important predictive factor of cardiovascular risk involved in the onset and progression of atherosclerosis 13 , 14 . Its pro-inflammatory and atherogenic properties have been found in endothelial cells, both smooth and striated muscle cells and macrophages.…”

Section: Proteomics Approachesmentioning

confidence: 99%

A review of the “OMICS” for management of patients with obstructive sleep apnoea

Conte

Greco

Toraldo

et al. 2020

Acta Otorhinolaryngol Ital

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C-Reactive Protein Levels and the Risk of Incident Cardiovascular and Cerebrovascular Events in Patients with Obstructive Sleep Apnea

Cited by 14 publications

References 17 publications

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

Circulating levels of cell adhesion molecules and risk of cardiovascular events in obstructive sleep apnea

A review of the “OMICS” for management of patients with obstructive sleep apnoea

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