Can biomarkers predict the risk of cardiovascular disease in patients with obstructive sleep apnea syndrome?

Biomarkers in obstructive sleep apnea syndrome

Authors

Keywords:

OSAS, cardiovascular disease, biomarker, AHI

Abstract

Background/Aim: Obstructive sleep apnea syndrome (OSAS) is a clinical syndrome characterized by recurrent partial or total obstruction of the upper airway. Cardiovascular disease (CVD) is more common in OSAS patients. Biomarkers can predict the progression of OSAS disease and the occurrence of CVD. Here we investigate the effects of age, gender, body mass index (BMI), comorbidities, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), atherogenic index of plasma (AIP), C-reactive protein-to-albumin ratio (CAR) and monocyte to HDL cholesterol (MHR) on the severity of OSAS and the occurrence of CVD in OSAS patients.

Method: This cross-sectional study included 172 OSAS patients presenting to Erzincan Binali Yildirim University Mengucek Gazi Training and Research Hospital, Sleep Service between 01.01.2021 and 31.08.2022. Polysomnography (PSG) was applied to patients participating in the study, and routine complete blood and biochemistry tests were performed. Comorbidities and demographic data of the participants were recorded.

Results: The frequency of CVD, chronic pulmonary disease (CPD) and hyperlipidemia increased as the severity of OSAS increased (P=0.005, P<0.001, P=0.016, respectively). As the severity of OSAS disease increased, only the MHR indices increased (P=0.009). When OSAS groups with and without CVD were examined, OSAS patients with CVD were older and had higher BMI (P<0.001, P=0.001, respectively). In addition, tended to be females with hyperlipidemia, diabetes mellitus (DM) and high Charlson Comorbidity Index (CCI) scores (all P<0.001). When the polysomnography of OSAS patients with CVD was evaluated, apnea-hypopnea index (AHI), non-rapid eye movement (NREM)-AHI (NREM-AHI), respiratory disorder index (RDI) and oxygen desaturation index (ODI) values were higher and sleep efficiency (SE) values were lower than patients with OSAS without CVD (P=0.002, P=0.002, P=0.003, P<0.001, P<0.001, respectively).

Conclusion: CVD is common in OSAS patients. As the severity of OSAS increases, the risk of developing CVD increases. Elderly female OSAS patients with hyperlipidemic, DM, high BMI, and Charlson Comorbidity Index (CCI) constitute a relatively risky group for CVD. OSAS patients with high AHI, NREM-AHI, RDI, ODI, and low SE values should be monitored more closely for CVD.

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References

Duran J, Esnaola S, Rubio R, Iztueta Á. Obstructive Sleep Apnea–Hypopnea and Related Clinical Features in a Population-based Sample of Subjects Aged 30 to 70 Yr. Am J Respir Crit Care Med. 2001 Mar 17;163(3):685–9. doi: 10.1164/ajrccm.163.3.2005065. DOI: https://doi.org/10.1164/ajrccm.163.3.2005065

Atan D, Kundi FCS, Özcan KM, Dere H. A New Predictor for Obstructive Sleep Apnea Syndrome: Monocyte to HDL Ratio. Indian J Otolaryngol Head Neck Surg. 2017 Jun 11;69(2):142–6. doi: 10.1007/s12070-016-0980-6 DOI: https://doi.org/10.1007/s12070-016-0980-6

Shamsuzzaman A, Gersh B, Somers V. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003 Oct 8;290(14):1906-14. doi: 10.1001/jama.290.14.1906 DOI: https://doi.org/10.1001/jama.290.14.1906

Takama N, Kurabayashi. Influence of untreated sleep-disordered breathing on the long-term prognosis of patients with cardiovascular disease. Am J Cardiol. 2009 Mar 1;103(5):730-4. doi: 10.1016/j.amjcard.2008.10.035 DOI: https://doi.org/10.1016/j.amjcard.2008.10.035

Naruko T, Ueda M, Haze K, van der Wal AC, van der Loos CM, Itoh A, et al. Neutrophil Infiltration of Culprit Lesions in Acute Coronary Syndromes. Circulation Circulation. 2002 Dec 3;106(23):2894-900. doi: 10.1161/01.cir.0000042674.89762.20. DOI: https://doi.org/10.1161/01.CIR.0000042674.89762.20

Imhof B, Aurrand-Lions M. Angiogenesis and inflammation face off. Nat Med. 2006 Feb;12(2):171-2. doi: 10.1038/nm0206-171. DOI: https://doi.org/10.1038/nm0206-171

Lattanzi S, Brigo F, Silvestrini M. Blood pressure profile and nocturnal oxygen desaturation. J Clin Hypertens (Greenwich). 2018 Apr;20(4):656-8. doi: 10.1111/jch.13259. DOI: https://doi.org/10.1111/jch.13259

Lattanzi S, Brigo F, Silvestrini M. Obstructive sleep apnea syndrome and the nocturnal blood pressure profile. J Clin Hypertens (Greenwich). 2018 Jun;20(6):1036-8. doi: 10.1111/jch.13316. DOI: https://doi.org/10.1111/jch.13316

Lattanzi S, Vernieri F, Silvestrini M. Blood pressure variability and neurocognitive functioning. Clin Hypertens (Greenwich). 2018 Apr;20(4):645-7. doi: 10.1111/jch.13232. DOI: https://doi.org/10.1111/jch.13232

Wang J, Shi X, Ma C, Zheng H, Xiao J Bian H, et al. Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular disease: a systematic review and meta-analysis. J Hypertens. 2017 Jan;35(1):10-7. doi: 10.1097/HJH.0000000000001159. DOI: https://doi.org/10.1097/HJH.0000000000001159

Tedla YG, Yano Y, Carnethon M, Greenland P. Association Between Long-Term Blood Pressure Variability and 10-Year Progression in Arterial Stiffness. Hypertension. 2017 Jan;69(1):118-27. doi: 10.1161/HYPERTENSIONAHA.116.08427.14. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.116.08427

Lattanzi S, Carbonari L, Pagliariccio G, Bartolini M. Cagnetti C, Viticchi G, et al. Neurocognitive functioning and cerebrovascular reactivity after carotid endarterectomy. Neurology. 2018 Jan 23;90(4):e307-15. doi:10.1212/WNL.0000000000004862. DOI: https://doi.org/10.1212/WNL.0000000000004862

Ribeiro A, Lotufo P, Fujita C Goulart A, Chor D G Mill J, et al Association between short-term systolic blood pressure variability and carotid intima-media thickness in ELSA-Brasil baseline. Am J Hypertens. 2017 Oct 1;30(10):954-60. doi: 10.1093/ajh/hpx076. DOI: https://doi.org/10.1093/ajh/hpx076

Dursunoğlu N, Dursunoğlu D. Obstructive sleep apnea syndrome, endothelial dysfunction and coronary atherosclerosis. Tuberkuloz ve Toraks. 2005 Jan 1;53(3):299-30

Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010 Dec;7(12):677-85. doi: 10.1038/nrcardio.2010.145. DOI: https://doi.org/10.1038/nrcardio.2010.145

Ryan S, Taylor C, Nicholas MC W. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Thorax. 2009 Jul;64(7):631-6. doi: 10.1136/thx.2008.105577. DOI: https://doi.org/10.1136/thx.2008.105577

Nadeem R, Molnar J, Madbouly E, Nida M, Aggarwal S, Sajid H, et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med. 2013 Oct 15;9(10):1003-12. doi: 10.5664/jcsm.3070. DOI: https://doi.org/10.5664/jcsm.3070

Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb Hemost. 2018 Jan;24(1):139-44. doi: 10.1177/1076029616677803. DOI: https://doi.org/10.1177/1076029616677803

Turak O, Özcan F, İşleyen A, Başar F, Gül M, Yilmaz S, et al. Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis. Can J Cardiol. 2013 Dec;29(12):1672-8. doi: 10.1016/j.cjca.2013.05.005. DOI: https://doi.org/10.1016/j.cjca.2013.05.005

Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage. Stroke. 2016 Jun;47(6):1654-7. doi: 10.1161/STROKEAHA.116.013627. DOI: https://doi.org/10.1161/STROKEAHA.116.013627

Lattanzi S, Cagnetti C, Rinaldi C, Angelocola S. Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio improves outcome prediction of acute intracerebral hemorrhage. J Neurol Sci. 2018 Apr 15;387:98-102. doi: 10.1016/j.jns.2018.01.038. DOI: https://doi.org/10.1016/j.jns.2018.01.038

Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017 Feb 16;8(34):57489-94. doi: 10.18632/oncotarget.15423. DOI: https://doi.org/10.18632/oncotarget.15423

Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018 Apr 15;387:115-8. doi: 10.1016/j.jns.2018.02.002. DOI: https://doi.org/10.1016/j.jns.2018.02.002

Dotsenko O, Chaturverdi N, Thom S, Wright AR, Mayet J, Shore A, et al. Platelet and leukocyte activation, atherosclerosis and inflammation in European and South Asian men. J Thromb Haemost. 2007 Oct;5(10):2036-42. doi: 10.1111/j.1538-7836.2007.02711.x. DOI: https://doi.org/10.1111/j.1538-7836.2007.02711.x

Duman H, Çinier G, Bakırcı EM, Duman H, Şimşek Z, Hamur H, et al. Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burden in Patients With Acute Coronary Syndrome. Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029618824418. doi: 10.1177/1076029618824418. DOI: https://doi.org/10.1177/1076029618824418

Topuz MF, Ture N, Akdag G, Arik O, Gulhan PY. The importance of systemic immune-inflammation index in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2022 Oct;279(10):5033-8. doi: 10.1007/s00405-021-07227-0. DOI: https://doi.org/10.1007/s00405-021-07227-0

Dobiášová M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001 Oct;34(7):583-8. doi: 10.1016/s0009-9120(01)00263-6. DOI: https://doi.org/10.1016/S0009-9120(01)00263-6

Karataş M, Çanga Y, Özcan K, İpek G, Güngör B, Onuk T, et al. Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention. Am J Emerg Med. 2016 Feb;34(2):240-4. doi: 10.1016/j.ajem.2015.10.049. DOI: https://doi.org/10.1016/j.ajem.2015.10.049

Deng X, Gu W, Li Y, Liu M, Li Y, Gao X. Age-group-specific associations between the severity of obstructive sleep apnea and relevant risk factors in male and female patients. PLoS One. 2014 Sep 11;9(9):e107380. doi: 10.1371/journal.pone.0107380. DOI: https://doi.org/10.1371/journal.pone.0107380

Sweed RA, Hassan S, ElWahab NHA, Aref SR, Mahmoud MI. Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients. Sleep Breath. 2019 Dec;23(4):1079-85. doi: 10.1007/s11325-019-01783-w. DOI: https://doi.org/10.1007/s11325-019-01783-w

Ünal M, Öztürk L, Kanik A. The role of oxygen saturation measurement and body mass index in distinguishing between non-apnoeic snorers and patients with obstructive sleep apnoea syndrome. Clin Otolaryngol Allied Sci. 2002 Oct;27(5):344-6. doi: 10.1046/j.1365-2273.2002.00592.x. DOI: https://doi.org/10.1046/j.1365-2273.2002.00592.x

Gündüz C, Basoglu OK, Hedner J, Zou D, Bonsignore MR, Hein H, et al. Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database. Respirology. 2018 Dec;23(12):1180-9. doi: 10.1111/resp.13372. DOI: https://doi.org/10.1111/resp.13372

Wu W Te, Tsai SS, Shih TS, Lin MH, Chou TC, Ting H, et al. The Association between Obstructive Sleep Apnea and Metabolic Markers and Lipid Profiles. PLoS One. 2015 Jun 26;10(6):e0130279. doi: 10.1371/journal.pone.0130279. DOI: https://doi.org/10.1371/journal.pone.0130279

Gileles-Hillel A, Kheirandish-Gozal L, Gozal D. Biological plausibility linking sleep apnoea and metabolic dysfunction. Nat Rev Endocrinol. 2016 May;12(5):290-8. doi: 10.1038/nrendo.2016.22. DOI: https://doi.org/10.1038/nrendo.2016.22

Jun JC, Drager LF, Najjar SS, Gottlieb SS, Brown CD, Smith PL, et al. Effects of sleep apnea on nocturnal free fatty acids in subjects with heart failure. Sleep. 2011 Sep 1;34(9):1207-13. doi: 10.5665/SLEEP.1240. DOI: https://doi.org/10.5665/SLEEP.1240

Uygur F, Tanriverdi H, Aktop Z, Erboy F, Altinsoy B, Damar M, et al. The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease. Heart Lung. 2016 Mar-Apr;45(2):121-5. doi: 10.1016/j.hrtlng.2016.01.002. DOI: https://doi.org/10.1016/j.hrtlng.2016.01.002

Yayla Ç, Akboğa MK, Gayretli Yayla K, Ertem AG, Efe TH, Şen F, et al. A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio. Biomark Med. 2016 May;10(5):485-93. doi: 10.2217/bmm-2016-0022. DOI: https://doi.org/10.2217/bmm-2016-0022

Zhang Y, Li S, Guo YL, Wu NQ, Zhu CG, Gao Y, et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Ann Med. 2016 Aug;48(5):305-12. doi: 10.3109/07853890.2016.1168935. DOI: https://doi.org/10.3109/07853890.2016.1168935

Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med. 2008 Feb 15;177(4):369-75. doi: 10.1164/rccm.200608-1190PP. DOI: https://doi.org/10.1164/rccm.200608-1190PP

Campos-Rodriguez F, Martinez-Garcia MA, Reyes-Nuñez N, Caballero-Martinez I, Catalan-Serra P, Almeida-Gonzalez CV. Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women. Am J Respir Crit Care Med. 2014 Jun 15;189(12):1544-50. doi: 10.1164/rccm.201311-2012OC. DOI: https://doi.org/10.1164/rccm.201311-2012OC

Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y. Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies. Int J Cardiol. 2013 Nov 5;169(3):207-14. doi: 10.1016/j.ijcard.2013.08.088. DOI: https://doi.org/10.1016/j.ijcard.2013.08.088

Loke YK, Brown JWL, Kwok CS, Niruban A, Myint PK. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):720-8. doi: 10.1161/CIRCOUTCOMES.111.964783. DOI: https://doi.org/10.1161/CIRCOUTCOMES.111.964783

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Published

2023-02-21

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Research Article

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1.
Ölmez H, Tosun M, Ünver E, Çoşkun R, Yalçın GS, Doğan M, Arslan YK. Can biomarkers predict the risk of cardiovascular disease in patients with obstructive sleep apnea syndrome? Biomarkers in obstructive sleep apnea syndrome. J Surg Med [Internet]. 2023 Feb. 21 [cited 2024 May 25];7(2):160-4. Available from: https://jsurgmed.com/article/view/7716