Evaluation of Blood Levels of C-Reactive Protein Marker in Obstructive Sleep Apnea: A Systematic Review, Meta‐Analysis and Meta-Regression

Abstract

(1) Introduction: High sensitivity C-reactive protein (hs-CRP) and CRP are inflammatory biomarkers associated with several inflammatory diseases. In both pediatric and adult individuals with Obstructive Sleep Apnea (OSA) higher hs-CRP and CRP were observed, compared to controls. With the present systematic review, meta-analysis and meta-regression we expand upon previous meta-analyses in four ways: (1) We included 109 studies (96 in adults and 13 in children); (2) we reported subgroup and meta-regression analyses in adults with OSA compared to controls on the serum and plasma levels of hs-CRP; (3) we reported subgroup and meta-regression analyses in adults with OSA compared to controls on the serum and plasma levels of CRP; (4) we reported serum and plasma levels of both hs-CRP and CRP in children with OSA, always compared to controls. (2) Materials and Methods: The PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases were searched to retrieve articles published until 31 May 2020, with no restrictions. The data included basic information involving the first author, publication year, country of study, ethnicity of participants in each study, age, BMI, and AHI of both groups, and mean and standard deviation (SD) of plasma and serum levels of CRP and hs-CRP. (3) Results: A total of 1046 records were retrieved from the databases, and 109 studies were selected for the analysis (96 studies reporting the blood levels of hs-CRP/CRP in adults and 13 studies in children). For adults, 11 studies reported plasma hs-CRP, 44 serum hs-CRP, 9 plasma CRP, and 32 serum CRP levels. For children, 6 studies reported plasma hs-CRP, 4 serum hs-CRP, 1 plasma CRP, and 2 serum CRP levels. Compared to controls, the pooled MD of plasma hs-CRP levels in adults with OSA was 0.11 mg/dL (p < 0.00001). Compared to controls, the pooled MD of serum hs-CRP levels in adults with OSA was 0.09 mg/dL (p < 0.00001). Compared to controls, the pooled MD of plasma CRP levels in adults with OSA was 0.06 mg/dL (p = 0.72). Compared to controls, the pooled MD of serum CRP levels in adults with OSA was 0.36 mg/dL (p < 0.00001). Compared to controls, the pooled MD of plasma hs-CRP, serum hs-CRP, plasma hs-CRP, and serum hs-CRP in children with OSA was 1.17 mg/dL (p = 0.005), 0.18 mg/dL (p = 0.05), 0.08 mg/dL (p = 0.10), and 0.04 mg/dL (p = 0.33), respectively. The meta-regression showed that with a greater apnea-hypapnea index (AHI), serum hs-CRP levels were significantly higher. (4) Conclusions: The results of the present systematic review, meta-analysis and meta-regression showed that compared to healthy controls plasma and serum levels of hs-CRP and serum CRP level were higher in adults with OSA; for children, and compared to controls, just plasma hs-CRP levels in children with OSA were higher.

Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review

“…C-reactive protein (CRP) is an inflammatory biomarker associated with untreated OSA [50] which decreased shortly after the initiation of CPAP treatment [51]. CRP has recently been assessed as a risk factor for OSA in four prospective studies in population cohorts.…”

Evaluation of Blood Levels of Omentin-1 and Orexin-A in Adults with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

“…Several factors including environmental and genetic factors, and even internal conditions (hormones, cytokines, and other biomarkers), might lead to the emergence and maintenance of OSA. Smoking [ 12 ] and alcohol consumption [ 13 ], and alterations in the blood levels of intercellular adhesion molecule-1 [ 14 ], monocyte chemoattractant protein-1 [ 15 ], adiponectin [ 16 ], C-reactive protein [ 17 ], cortisol [ 18 ], interleukin-6 [ 19 ], tumor necrosis factor-alpha [ 20 ], astrocytic protein (S100B) [ 21 ], neuron-specific enolase [ 21 ], and polymorphisms [ 22 , 23 , 24 ] were observed among adults with OSA, compared to healthy controls.…”

Effect of Continuous Positive Airway Pressure on Changes of Plasma/Serum Ghrelin and Evaluation of These Changes between Adults with Obstructive Sleep Apnea and Controls: A Meta-Analysis

“…It has been shown the impact of ethnicity on the prevalence and severity of OSA that this impact can be related to ethnic differences in adipose tissue distributions [ 7 ]. Apart from the environmental and demographical factors, the studies reported that genetic [ 8 , 9 , 10 , 11 ] and blood [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] factors could also affect the prevalence or development of OSA.…”