Yardim-Akaydin Sevgi, Caliskan-Can Emel, Firat Hikmet, Ardic Sadik, Simsek Bolkan
Gazi Universitesi, Eczacılık Fakultesi, Biyokimya AD. 06330-Etiler-Ankara Turkiye.
Antiinflamm Antiallergy Agents Med Chem. 2014 Mar;13(1):56-63. doi: 10.2174/18715230113129990015.
Inflammation is one of the pathophysiological pathways suggested for the development of cardiovascular disease in obstructive sleep apnea (OSA). The recurrent nocturnal episodes of hypoxia/reoxygenation observed in patients with OSA appear to be partly responsible for the systemic inflammatory response. The aim of this study was to investigate the role of inflammation by measuring the C-reactive protein (CRP) and fibrinogen levels, and erythrocyte sedimentation rate (ESR) in the OSA according to gender. This study included 139 apparently healthy subjects with newly diagnosed OSA and 27 control subjects who underwent overnight polysomnography and routine blood tests. Levels of inflammatory markers (CRP, fibrinogen, and ESR) were determined from the blood samples taken in the morning. The levels of CRP and fibrinogen were significantly higher in patients than in controls (p<0.0001 and p=0.001, respectively). Fibrinogen and ESR were significantly higher in the female patients than in the male patients (p<0.0001). In female patients, CRP and ESR correlated with time spent at oxygen saturation (T%SaO2)<90 (R=0.327, p=0.029 and R=0.301, p=0.05, respectively), T%SaO2<85 (R=0.482, p=0.001 and R=0.409, p=0.006, respectively), oxygen desaturation index (ODI) (R=0.298, p=0.047 and R=0.340, p=0.026, respectively), lowest oxygen saturation (SaO2) (R=-0.293, p=0.051 and R=-0.374, p=0.013, respectively), mean SaO2 (R=-0.408, p=0.005 and R=-0.385, p=0.011, respectively). In male patients, CRP correlated with T%SaO2<90 (R=0.267, p=0.009), T%SaO2<85 (R=0.279, p=0.006), mean SaO2 (R=-0.284, p=0.006) and fibrinogen correlated with T%SaO2<90 (R=0.282, p=0.028), and mean SaO2 (R=-0.252, p=0.05). In conclusion, increased values of systemic inflammatory markers and their correlations with sleep data observed in our study support other studies suggesting the possible involvement of inflammation in OSA. As this correlation is more apparent in female patients then the males, it suggests that there may be a stronger relation between OSA development and inflammation in females. Higher levels of CRP, fibrinogen, and ESR may result from the combined interactions of obesity, metabolic syndrome (MetS) and nocturnal hypoxia.
炎症是阻塞性睡眠呼吸暂停（OSA）患者发生心血管疾病的病理生理途径之一。OSA患者中反复出现的夜间缺氧/复氧发作似乎是全身炎症反应的部分原因。本研究的目的是通过测量C反应蛋白（CRP）、纤维蛋白原水平和红细胞沉降率（ESR），根据性别研究炎症在OSA中的作用。本研究纳入了139名新诊断为OSA的明显健康受试者和27名对照受试者，他们接受了整夜多导睡眠图检查和常规血液检查。从早晨采集的血样中测定炎症标志物（CRP、纤维蛋白原和ESR）的水平。患者的CRP和纤维蛋白原水平显著高于对照组（分别为p<0.0001和p=0.001）。女性患者的纤维蛋白原和ESR显著高于男性患者（p<0.0001）。在女性患者中，CRP和ESR与氧饱和度（T%SaO2）<90的时间相关（分别为R=0.327，p=0.029和R=0.301，p=0.05），T%SaO2<85的时间相关（分别为R=0.482，p=0.001和R=0.409，p=0.006），氧去饱和指数（ODI）相关（分别为R=0.298，p=0.047和R=0.340，p=0.026），最低氧饱和度（SaO2）相关（分别为R=-0.293，p=0.051和R=-0.374，p=0.013），平均SaO2相关（分别为R=-0.408，p=0.005和R=-0.385，p=0.011）。在男性患者中，CRP与T%SaO2<90相关（R=0.267，p=0.009），T%SaO2<85相关（R=0.279，p=0.006），平均SaO2相关（R=-0.284，p=0.006），纤维蛋白原与T%SaO2<90相关（R=0.282，p=0.028），平均SaO2相关（R=-0.252，p=0.05）。总之，我们研究中观察到的全身炎症标志物值升高及其与睡眠数据的相关性支持了其他研究，表明炎症可能参与了OSA。由于这种相关性在女性患者中比男性更明显，这表明女性OSA发展与炎症之间可能存在更强的关系。较高水平的CRP、纤维蛋白原和ESR可能是肥胖、代谢综合征（MetS）和夜间缺氧共同作用的结果。
