Use of blood biomarkers to screen for obstructive sleep apnea

Abstract

PurposeObstructive sleep apnea (OSA) is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study.Patients and methodsThis multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c), C-reactive protein (CRP), uric acid, erythropoietin (EPO), and interleukin-6 (IL-6).ResultsThe study enrolled 264 subjects. The combination of HbA1c+CRP+EPO (area under the curve 0.78) was superior to the Epworth Sleepiness Scale (ESS; 0.53) and STOP-Bang (0.70) questionnaires. In non-obese subjects, the combination of biomarkers (0.75) was superior to body mass index (BMI; 0.61). Sensitivity and specificity results, respectively, were: HbA1c+CRP+EPO (81% and 60%), ESS (78% and 19%), STOP-Bang (75% and 52%), BMI (81% and 56%), and BMI in non-obese patients (81% and 38%).ConclusionWe verify our hypothesis and replicate our prior feasibility findings that OSA is associated with a characteristic signature cluster of biomarker changes in men. Concurrent elevations of HbA1c, CRP, and EPO levels should generate a high suspicion of OSA and may have utility as an OSA screening tool. Biomarker combinations correlate with OSA severity and, therefore, may assist sleep centers in identifying and triaging higher risk patients for sleep study diagnosis and treatment.

Circulating microRNA profile as a potential biomarker for obstructive sleep apnea diagnosis

“…Up to 80% of individuals with moderate-to-severe OSA remain undiagnosed 9 . Diagnosis requires overnight recordings, including time- and resource-consuming procedures 9 .…”

“…Up to 80% of individuals with moderate-to-severe OSA remain undiagnosed 9 . Diagnosis requires overnight recordings, including time- and resource-consuming procedures 9 . High-throughput diagnostic systems may improve the underdiagnoses of the disease and could reduce unnecessary procedures, decreasing the use of healthcare resources.…”

Red cell distribution width: a new tool for the severity prediction of sleep apnoea syndrome in children

“…In adults, recent studies have used the combination of glycated haemoglobin, erythropoietin and CRP for the diagnostic screening of OSA and its severity, with sensitivity >80% [25]. CPAP therapy has been shown to correct the increase of urine erythropoietin excretion in individuals with severe OSA [26].…”

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

“…Its pro-inflammatory and atherogenic properties have been found in endothelial cells, both smooth and striated muscle cells and macrophages. Its levels, as well as those of IL-6, are strongly associated with oxidative stress or anoxia 10 , 15 A similarly important role in the clinical picture of the OSA patient is the high level of TNF-α observed; it is, in fact, a pro-inflammatory cytokine with an important role in the host defence, which at the same time mediates the onset of a series of pathological processes including atherosclerosis, septic shock and autoimmune diseases. The release of TNF-α is mediated by IL-6, as well as by other pro-inflammatory cytokines such as IL-2, IFN-γ and by TNF-α itself through a positive feedback process 16 .…”