Background. Previous studies indicated sleep-disordered breathing (SDB) is associated with cardiovascular disease (CVD). Systemic inflammation is recognized as a risk factor for CVD. Studies examining SDB and inflammation are limited. Methods. We studied sleep duration, snoring, snorting, and daytime sleepiness, and an additive SDB score. The main outcome was a C-reactive protein (CRP) of >1？mg/dL. Results. Snoring, snorting, daytime sleepiness, and sleeping >7 or <7 hours, and the additive score were significantly associated with high CRP. The additive score was not associated in men but moderately associated in women in a multivariable model adjusting for age, gender, race/ethnicity, education, smoking, hypertension, alcohol intake, physical activity, body mass index, depression, diabetes, hypertension, and total cholesterol (P-interaction？ ). For race/ethnicity, the association was strongest in Mexican Americans/others, modest in Non-Hispanic whites, and absent in Non-Hispanic blacks (P-interaction？ ). Conclusions. The association between SDB and high CRP was present mainly in women and Mexican Americans, implying SDB has a residual, independent association with inflammation after controlling for lifestyle and metabolic risk factors like BMI, physical activity, depression, diabetes, and cholesterol. 1. Introduction Sleep-disordered breathing (SDB) is a common, chronic disorder in which there is sleep-related repeated upper airway collapse resulting in episodes of hypoxemia and arousal [1]. Nationwide, SDB affects approximately 12–18 million people, nearly 4% of the population [2]. SDB is described as markedly undiagnosed [3] (especially in women [4]). SDB is a public health concern as it has been associated with cardiovascular disease (CVD) [5], motor vehicle crashes, [3, 6, 7] neuropsychological deficits [8], and mortality [9]. Recent US and Japanese studies have shown an association between SDB markers and C-reactive protein (CRP), a biomarker of inflammation and predictor of future risk of CVD [10–13]. For example, strong positive associations occurred in a study of 69 healthy men, controlling for age, BMI, waist circumference, and percent body fat [1]. Also, a study of 18 men and 4 women showed elevated CRP levels with newly diagnosed obstructive sleep apnea in a multivariate analysis controlling for age, sex, BMI, smoking, alcohol, LDL, and HDL [10]. A study of 30 men with newly diagnosed obstructive sleep apnea and 14 obese controls showed higher CRP in those with obstructive sleep apnea than the obese controls. However, the studies were small
References
[1]
N. M. Punjabi and B. A. Beamer, “C-reactive protein is associated with sleep disordered breathing independent of adiposity,” Sleep, vol. 30, no. 1, pp. 29–34, 2007.
[2]
T. Young, M. Palta, J. Dempsey, P. E. Peppard, F. J. Nieto, and K. M. Hla, “Burden of sleep apnea: rationale, design, and major findings of the Wisconsin sleep cohort study,” Wisconsin Medical Journal, vol. 108, no. 5, pp. 246–249, 2009.
[3]
T. Young, J. Blustein, L. Finn, and M. Palta, “Sleepiness, driving and accidents: sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults,” Sleep, vol. 20, pp. 608–613, 1977.
[4]
T. Young, J. Skatrud, and P. E. Peppard, “Risk factors for obstructive sleep apnea in adults,” Journal of the American Medical Association, vol. 291, no. 16, pp. 2013–2016, 2004.
[5]
R. Budhiraja, P. Budhiraja, and S. F. Quan, “Sleep-disordered breathing and cardiovascular disorders,” Respiratory Care, vol. 55, no. 10, pp. 1322–1330, 2010.
[6]
T. Young, L. Finn, P. E. Peppard et al., “Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort,” Sleep, vol. 31, no. 8, pp. 1071–1078, 2008.
[7]
M. E. Howard, A. V. Desai, R. R. Grunstein et al., “Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers,” American Journal of Respiratory and Critical Care Medicine, vol. 170, no. 9, pp. 1014–1021, 2004.
[8]
H. C. Kim, T. Young, G. Matthews, S. M. Weber, A. R. Woodard, and M. Palta, “Sleep-disordered breathing and neuropsychological deficits: a population-based study,” American Journal of Respiratory and Critical Care Medicine, vol. 156, no. 6, pp. 1813–1819, 1997.
[9]
N. M. Punjabi, B. S. Caffo, J. L. Goodwin et al., “Sleep-disordered breathing and mortality: a prospective cohort study,” Plos Medicine, vol. 6, no. 8, Article ID 1000132, 2009, http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000132.
[10]
A. S. M. Shamsuzzaman, M. Winnicki, P. Lanfranchi et al., “Elevated C-reactive protein in patients with obstructive sleep apnea,” Circulation, vol. 105, no. 21, pp. 2462–2464, 2002.
[11]
H. K. Meier-Ewert, P. M. Ridker, N. Rifai et al., “Effect of sleep loss on C-Reactive protein, an inflammatory marker of cardiovascular risk,” Journal of the American College of Cardiology, vol. 43, no. 4, pp. 678–683, 2004.
[12]
T. Yokoe, K. Minoguchi, H. Matsuo et al., “Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure,” Circulation, vol. 107, no. 8, pp. 1129–1134, 2003.
[13]
D. Gozal, V. M. Crabtree, O. S. Capdevila, L. A. Witcher, and L. Kheirandish-Gozal, “C-reactive protein, obstructive sleep apnea, and cognitive dysfunction in school-aged children,” American Journal of Respiratory and Critical Care Medicine, vol. 176, no. 2, pp. 188–193, 2007.
[14]
M. Yao, N. Tachibana, M. Okura et al., “The relationship between sleep-disordered breathing and high-sensitivity C-reactive protein in Japanese men,” Sleep, vol. 29, no. 5, pp. 661–665, 2006.
[15]
S. Taheri, D. Austin, L. Lin, J. Nieto, T. Young, and E. Mignot, “Correlates of serum C-reactive protein (CRP)—No association with sleep duration or sleep disordered breathing,” Sleep, vol. 30, no. 8, pp. 991–996, 2007.
[16]
C. Guilleminault, C. Kirisoglu, and M. M. Ohayon, “C-reactive protein and sleep-disordered breathing,” Sleep, vol. 27, no. 8, pp. 1507–1511, 2004.
[17]
K. Z. Boudjeltia, A. Van Meerhaeghe, S. Doumit et al., “Sleep apnoea-hypopnoea index is an independent predictor of high-sensitivity C-reactive protein elevation,” Respiration, vol. 73, no. 2, pp. 243–246, 2006.
[18]
National Sleep Foundation, “Poll reveals differences among ethnic groups,” 2010, http://www.sleepfoundation.org/press-releases/2010.
[19]
National Center for Health Statisitcs, “The National Health and Nutrtion Examination Survey 2005-2006: Survey Operations Manuals, Brochures, Consent Documents,” 2010, http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/current_nhanes_5_06.html.
[20]
National Center for Health Statisitcs, “The National Health and Nutrtion Examination Survey 2007-2008: Survey Operations Manuals, Brochures, Consent Documents,” 2010, http://www.cdc.gov/nchs/nhanes/nhanes2007-2008/current_nhanes_07_08.html/.
[21]
T. A. Pearson, G. A. Mensah, W. Alexander et al., “Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the centers for disease control and prevention and the American heart association,” Circulation, vol. 107, no. 3, pp. 499–511, 2003.
[22]
J. E. Gangwisch, S. B. Heymsfield, B. Boden-Albala et al., “Sleep duration as a risk factor for diabetes incidence in a large US sample,” Sleep, vol. 30, no. 12, pp. 1667–1673, 2007.
[23]
L. M. O'Brien, C. B. Mervis, C. R. Holbrook et al., “Neurobehavioral implications of habitual snoring in children,” Pediatrics, vol. 114, no. 1, pp. 44–49, 2004.
[24]
K. G. Baron, K. Liu, C. Chan, E. Shahar, R. Hasnain-Wynia, and P. Zee, “Race and ethnic variation in excessive daytime sleepiness: the multi-ethnic study of atherosclerosis,” Behavioral Sleep Medicine, vol. 8, no. 4, pp. 231–245, 2010.
[25]
A. P. Burke, R. P. Tracy, F. Kolodgie et al., “Elevated C-reactive protein values and atherosclerosis in sudden coronary death: association with different pathologies,” Circulation, vol. 105, no. 17, pp. 2019–2023, 2002.
[26]
B. Lindahl, H. Toss, A. Siegbahn, P. Venge, and L. Wallentin, “Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease,” The New England Journal of Medicine, vol. 343, no. 16, pp. 1139–1147, 2000.
[27]
A. S. M. Shamsuzzaman, B. J. Gersh, and V. K. Somers, “Obstructive sleep apnea: implications for cardiac and vascular disease,” Journal of the American Medical Association, vol. 290, no. 14, pp. 1906–1914, 2003.
[28]
C. J. Williams, F. B. Hu, S. R. Patel, and C. S. Mantzoros, “Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes,” Diabetes Care, vol. 30, no. 5, pp. 1233–1240, 2007.
[29]
T. Young, L. Finn, D. Austin, and A. Peterson, “Menopausal status and sleep-disordered breathing in the Wisconsin sleep cohort study,” American Journal of Respiratory and Critical Care Medicine, vol. 167, no. 9, pp. 1181–1185, 2003.
[30]
L. Lorusso, S. V. Mikhaylova, E. Capelli, D. Ferrari, G. K. Ngonga, and G. Ricevuti, “Immunological aspects of chronic fatigue syndrome,” Autoimmunity Reviews, vol. 8, no. 4, pp. 287–291, 2009.
