Skip to main content
SpringerLink
Log in

TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The polysomnography (PSG) index of the apnea hypopnea index (AHI) is considered the ‘gold standard’ for stratifying the severity of obstructive sleep apnea (OSA). However, AHI cannot reflect the true characteristic of chronic intermittent hypoxia (CIH), which may trigger systemic inflammation in some OSA patients. High-sensitivity C-reactive protein (hsCRP) is considered a biomarker of systemic inflammation in OSA patients. The aim of the present study was to evaluate the relationship between PSG variables and hsCRP in men with severe OSA. Men with severe OSA (AHI ≥30 events/h) diagnosed by PSG were enrolled. AHI and body mass index were matched between a high hsCRP group (hsCRP ≥3.0 mg/L) and a low hsCRP group. A blood sample was taken for serum hsCRP analysis. Multiple regression analysis was performed to assess independent predictors of high hsCRP. One hundred and fifty-two subjects were enrolled in the study (76 in each group). Mean serum hsCRP was 3.76 ± 2.13 mg/L. The mean percentage of total sleep time spent with SaO2 <90 % (TST) in the high hsCRP group was significantly higher than in the low hsCRP group (20.99 ± 18.52 vs. 5.84 ± 7.30, p < 0.001). Multivariate analysis showed that TST was the strongest predictor, contributing to 27.7 % of hsCRP variability (β = 0.496, p < 0.01). TST may be superior to AHI for evaluating CIH among OSA patients. The severity of OSA should be stratified by a combination of AHI and other hypoxia variables.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  2. Douglas NJ, Polo O (1994) Pathogenesis of obstructive sleep apnoea/hypopnoea syndrome. Lancet 344:653–655

    Article  CAS  PubMed  Google Scholar 

  3. Haverkate E, Thompson SG, Pyke SDM, Gallimore JR (1997) Production of C-reactive protein and risk of coronary events in stable and unstable angina. Lancet 349:462–466

    Article  CAS  PubMed  Google Scholar 

  4. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L (2000) Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. N Engl J Med 343:1139–1147

    Article  CAS  PubMed  Google Scholar 

  5. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR (2002) Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 347:1557–1565

    Article  CAS  PubMed  Google Scholar 

  6. Levy P, Pepin JL, Arnaud C, Tamisier R, Borel JC, Dematteis M, Godin-Ribuot D, Ribuot C (2008) Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives. Eur Respir J 32:1082–1095

    Article  CAS  PubMed  Google Scholar 

  7. Punjabi NM, Beamer BA (2007) C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 30:29–34

    PubMed  Google Scholar 

  8. Lui MM, Lam JC, Mak HK, Xu A, Ooi C, Lam DC, Mak JC, Khong PL, Ip MS (2009) C-reactive protein is associated with obstructive sleep apnea independent of visceral obesity. Chest 135:950–956

    Article  CAS  PubMed  Google Scholar 

  9. Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK (2002) Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 105:2462–2464

    Article  CAS  PubMed  Google Scholar 

  10. Kokturk O, Ciftci TU, Mollarecep E, Ciftci B (2005) Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 46:801–809

    Article  CAS  PubMed  Google Scholar 

  11. Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M (2003) 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 107:1129–1134

    Article  CAS  PubMed  Google Scholar 

  12. Akashiba T, Akahoshi T, Kawahara S, Majima T, Horie T (2005) Effects of long-term nasal continuous positive airway pressure on C-reactive protein in patients with obstructive sleep apnea syndrome. Intern Med 44:899–900

    Article  PubMed  Google Scholar 

  13. Ishida K, Kato M, Kato Y, Yanagihara K, Kinugasa Y, Kotani K, Igawa O, Hisatome I, Shigemasa C, Somers VK (2009) Appropriate use of nasal continuous positive airway pressure decreases elevated C-reactive protein in patients with obstructive sleep apnea. Chest 136:125–129

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Iber C, Medicine AAoS (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications for the American Academy of Sleep Medicine, 1st ed. American Academy of Sleep Medicine, Westchester

  15. Chen NH, Johns MW, Li HY, Chu CC, Liang SC, Shu YH, Chuang ML, Wang PC (2002) Validation of a Chinese version of the Epworth sleepiness scale. Qual Life Res 11:817–821

    Article  PubMed  Google Scholar 

  16. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  17. Szmitko PE, Wang CH, Weisel RD, de Almeida JR, Anderson TJ, Verma S (2003) New markers of inflammation and endothelial cell activation: part I. Circulation 108:1917–1923

    Article  PubMed  Google Scholar 

  18. Ridker PM, Stampfer MJ, Rifai N (2001) Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA 285:2481–2485

    Article  CAS  PubMed  Google Scholar 

  19. Shamsuzzaman ASM, Gersh BJ, Somers VK (2003) Obstructive sleep apnea. JAMA 290:1906–1914

    Article  CAS  PubMed  Google Scholar 

  20. Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G (2005) Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 172:613–618

    Article  PubMed  Google Scholar 

  21. Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M, Christaki P, Bouros D (2007) Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea–hypopnea syndrome. Chest 132:843–851

    Article  CAS  PubMed  Google Scholar 

  22. Sharma S, Mishra HK, Sharma H, Goel A, Sreenivas V, Gulati V, Tahir M (2008) Obesity, and not obstructive sleep apnea, is responsible for increased serum hs-CRP levels in patients with sleep-disordered breathing in Delhi. Sleep Med 9:149–156

    Article  CAS  PubMed  Google Scholar 

  23. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB (1999) Elevated C-reactive protein levels in overweight and obese adults. JAMA 282:2131–2135

    Article  CAS  PubMed  Google Scholar 

  24. Volna J, Kemlink D, Kalousova M, Vavrova J, Majerova V, Mestek O, Svarcova J, Sonka K, Zima T (2011) Biochemical oxidative stress-related markers in patients with obstructive sleep apnea. Med Sci Monit 17:CR491–CR497

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Roche F, Gaspoz JM, Pichot V, Picard-Kossovsky M, Maudoux D, Garcin A, Celle S, Sforza E, Barthelemy JC, Proof, Groups SS (2009) Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly. Eur Respir J 33:797–803

    Article  CAS  PubMed  Google Scholar 

  26. Tamaki S, Yamauchi M, Fukuoka A, Makinodan K, Koyama N, Tomoda K, Yoshikawa M, Kimura H (2009) Production of inflammatory mediators by monocytes in patients with obstructive sleep apnea syndrome. Intern Med 48:1255–1262

    Article  PubMed  Google Scholar 

  27. Chung S, Yoon IY, Shin YK, Lee CH, Kim JW, Lee T, Choi DJ, Ahn HJ (2007) Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome. Sleep 30:997–1001

    PubMed Central  PubMed  Google Scholar 

  28. Muraki I, Tanigawa T, Yamagishi K, Sakurai S, Ohira T, Imano H, Kitamura A, Kiyama M, Sato S, Shimamoto T, Konishi M, Iso H, Investigators C (2010) Nocturnal intermittent hypoxia and C reactive protein among middle-aged community residents: a cross-sectional survey. Thorax 65:523–527

    Article  PubMed  Google Scholar 

  29. Svensson M, Venge P, Janson C, Lindberg E (2012) Relationship between sleep-disordered breathing and markers of systemic inflammation in women from the general population. J Sleep Res 21:147–154

    Article  PubMed  Google Scholar 

  30. Asano K, Takata Y, Usui Y, Shiina K, Hashimura Y, Kato K, Saruhara H, Yamashina A (2009) New index for analysis of polysomnography, ‘integrated area of desaturation’, is associated with high cardiovascular risk in patients with mild to moderate obstructive sleep apnea. Respiration 78:278–284

    Article  PubMed  Google Scholar 

  31. Ryan S, Taylor CT, McNicholas WT (2005) Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 112:2660–2667

    Article  CAS  PubMed  Google Scholar 

  32. Greenberg H, Ye X, Wilson D, Htoo AK, Hendersen T, Liu SF (2006) Chronic intermittent hypoxia activates nuclear factor-kappaB in cardiovascular tissues in vivo. Biochem Biophys Res Commun 343:591–596

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors appreciate the help of Bin Yang with blood sample measurement and Wen-Jin Ye with statistical analysis.

Conflict of interest

All authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China

    Xiao-Bin Zhang & Hui-Qing Zen

  2. Sleep Center, Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, No 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, People’s Republic of China

    Qi-Chang Lin, Gong-Ping Chen, Li-Da Chen & Hua Chen

Authors
  1. Xiao-Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui-Qing Zen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qi-Chang Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gong-Ping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Li-Da Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hua Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi-Chang Lin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, XB., Zen, HQ., Lin, QC. et al. TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea. Eur Arch Otorhinolaryngol 271, 2745–2750 (2014). https://doi.org/10.1007/s00405-014-3044-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-014-3044-0

Keywords

Search

Navigation