Kim Jinkwan, Lee Seok Jun, Choi Kyung-Mee, Lee Seung Ku, Yoon Dae Wui, Lee Seung Gwan, Shin Chol
Department of Biomedical Laboratory Science, College of Health Science, Jungwon University, Chung-Buk, Republic of Korea.
Department of Biomedical Laboratory Science, College of Health Science, Cheong-Ju University, Chung-Buk, Republic of Korea.
PLoS One. 2016 Sep 29;11(9):e0163017. doi: 10.1371/journal.pone.0163017. eCollection 2016.
Obstructive sleep apnea syndrome (OSA) has been recognized as a common health problem, and increasing obesity rates have led to further remarkable increases in the prevalence of OSA, along with more prominent cardiovascular morbidities. Though previous studies have reported an independent relationship between elevated high sensitivity C-reactive protein (hsCRP) levels and OSA, the issue remains controversial owing to inadequate consideration of obesity and various confounding factors. So far, few population based studies of association between OSA and hsCRP levels have been published. Therefore, the purpose of the present study was to investigate whether OSA is associated with increased hsCRP levels independent of obesity in a large population-based study. A total of 1,835 subjects (968 men and 867 women) were selected from a larger cohort of the ongoing Korean Genome and Epidemiology Study (KoGES). Overnight polysomnography was performed on each participant. All participants underwent anthropometric measurements and biochemical analyses, including analysis of lipid profiles and hsCRP levels. Based on anthropometric data, body mass index (BMI) and waist hip ratio (WHR) were calculated and fat mass (FM) were measured by means of multi-frequency bioelectrical impedance analysis (BIA). Mild OSA and moderate to severe OSA were defined by an AHI >5 and ≥15, respectively. The population was sub-divided into 3 groups based on the tertile cut-points for the distribution of hsCRP levels. The percentage of participants in the highest tertile of hsCRP increased dose-dependently according to the severity of OSA. After adjustment for potential confounders and obesity-related variables (BMI, WHR, and body fat) in a multiple logistic model, participants with moderate to severe OSA had 1.73-, 2.01-, and 1.61-fold greater risks of being in the highest tertile of hsCRP levels than participants with non-OSA, respectively. Interaction between obesity (BMI ≥25kg/m2) and the presence of moderate-to-severe OSA was significant on the middle tertile levels of hsCRP (OR = 2.4), but not on the highest tertile, compared to the lowest tertile. OSA is independently associated with elevated hsCRP levels and may reflect an increased risk for cardiovascular morbidity. However, we found that OSA and obesity interactively contribute to individuals with general levels of hsCRP (<1.01 mg/dl). The short-term and long-term effects of elevated hsCRP levels on cardiovascular risk in the context of OSA remain to be defined in future studies.
阻塞性睡眠呼吸暂停综合征（OSA）已被公认为是一个常见的健康问题，肥胖率的上升导致OSA的患病率进一步显著增加，同时心血管疾病的发病率也更为突出。尽管先前的研究报告了高敏C反应蛋白（hsCRP）水平升高与OSA之间存在独立关系，但由于对肥胖和各种混杂因素考虑不足，这个问题仍存在争议。到目前为止，很少有基于人群的关于OSA与hsCRP水平之间关联的研究发表。因此，本研究的目的是在一项大型基于人群的研究中，调查OSA是否与独立于肥胖的hsCRP水平升高有关。从正在进行的韩国基因组与流行病学研究（KoGES）的一个更大队列中选取了总共1835名受试者（968名男性和867名女性）。对每位参与者进行了整夜多导睡眠图监测。所有参与者都接受了人体测量和生化分析，包括血脂谱分析和hsCRP水平分析。根据人体测量数据，计算了体重指数（BMI）和腰臀比（WHR），并通过多频生物电阻抗分析（BIA）测量了脂肪量（FM）。轻度OSA和中度至重度OSA分别定义为呼吸暂停低通气指数（AHI）>5和≥15。根据hsCRP水平分布的三分位数切点，将人群分为3组。hsCRP最高三分位数的参与者百分比根据OSA的严重程度呈剂量依赖性增加。在多因素逻辑模型中对潜在混杂因素和肥胖相关变量（BMI、WHR和体脂）进行调整后，中度至重度OSA的参与者处于hsCRP水平最高三分位数的风险分别是非OSA参与者的1.73倍、2.01倍和1.61倍。与最低三分位数相比，肥胖（BMI≥25kg/m²）与中度至重度OSA的存在之间的相互作用在hsCRP的中间三分位数水平上显著（比值比=2.4），但在最高三分位数上不显著。OSA与hsCRP水平升高独立相关，可能反映了心血管疾病发病风险的增加。然而，我们发现OSA和肥胖对hsCRP一般水平（<1.01mg/dl）的个体有交互作用。hsCRP水平升高对OSA背景下心血管风险的短期和长期影响仍有待未来研究确定。
