Putative associations between inflammatory biomarkers, obesity, and obstructive sleep apnea

Siraj Omar Wali; Md Dilshad Manzar; Mohammed M Abdelaziz; Ranya Alshomrani; Faris Alhejaili; Jamil Al-Mughales; Wail Alamoudi; David Gozal

doi:10.4103/atm.atm_644_20

Putative associations between inflammatory biomarkers, obesity, and obstructive sleep apnea

Ann Thorac Med. 2021 Oct-Dec;16(4):329-336. doi: 10.4103/atm.atm_644_20. Epub 2021 Sep 15.

Authors

Siraj Omar Wali¹, Md Dilshad Manzar², Mohammed M Abdelaziz³, Ranya Alshomrani¹, Faris Alhejaili¹, Jamil Al-Mughales⁴, Wail Alamoudi⁵, David Gozal⁶

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, Sleep Medicine and Research Center, Sleep Medicine Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
² Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia.
³ Department of Medicine, Wythenshawe Hospital, Manchester University NHS Trust, Manchester, UK.
⁴ Department of Clinical Laboratory Medicine, Immunology Lab, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
⁵ Department of Medicine, King Abdulaziz University - Rabigh Branch, Rabigh, Saudi Arabia.
⁶ Department of Child Health, Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, USA.

Abstract

Background: Previous studies have reported increased levels of inflammatory mediators in patients with obstructive sleep apnea (OSA), but their relation with the severity of OSA is controversial.

Objective: To address potential relationships between OSA-related inflammatory markers, namely, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and fibrinogen, with different oxygenation parameters and with BMI.

Methods: All eligible patients with suspected OSA newly referred to the Sleep Medicine Research Center at King Abdulaziz University Hospital, Jeddah, were evaluated demographically and anthropometrically, and underwent overnight polysomnography. Fasting morning blood samples were collected to measure serum levels of CRP, fibrinogen, TNF-α, and IL-6. Potential correlations between these inflammatory mediators and severity measures of OSA and body mass index (BMI) were explored.

Results: Sixty-four patients completed the study (40 with OSA and 24 without OSA). Significantly increased levels of CRP, fibrinogen, IL-6, and TNF-α emerged in patients with OSA compared to non-OSA. Significant associations between log CRP and log fibrinogen levels emerged with increasing BMI. However, there was no significant association between any of the inflammatory markers and the severity of OSA based on the apnea/hypopnea index or oxyhemoglobin saturation-derived parameters.

Conclusions: OSA patients exhibit increased levels of inflammatory mediators that do not appear to be associated with polysomnographic measures, but exhibit positive correlation with the degree of adiposity.

Keywords: C-reactive protein; SpO2; fibrinogen; inflammation; interleukin-6; obstructive sleep apnea; tumor necrosis factor-alpha.