Hypoxemia and obesity modulate plasma C-reactive protein and interleukin-6 levels in sleep-disordered breathing
Riva Tauman1, Louise M O'Brien, David Gozal
1Kosair Children's Hospital Research Institute, University of Louisville, Louisville, KY 40202, USA.
Insights
Children with sleep-disordered breathing (SDB) show increased levels of C-reactive protein (CRP) and interleukin-6 (IL-6), indicating inflammation. These inflammatory markers rise with SDB severity, independent of obesity.
Area of Science:
- Pediatric Sleep Medicine
- Cardiovascular Inflammation
- Biomarkers of Disease
Background:
- C-reactive protein (CRP) and interleukin-6 (IL-6) are key pro-inflammatory markers linked to atherosclerosis.
- Elevated CRP is observed in obese children, a population with high snoring prevalence.
- The independent contributions of sleep-disordered breathing (SDB) and obesity to inflammation in snoring children require elucidation.
Purpose of the Study:
- To investigate the independent roles of SDB and obesity in driving inflammatory processes in snoring children.
- To assess the relationship between SDB severity and levels of CRP and IL-6.
- To determine if obesity modifies the association between SDB and inflammation.
Main Methods:
- Prospective study involving 244 children (mean age 8.9 years) undergoing polysomnography.
- Measurement of plasma C-reactive protein (CRP) and interleukin-6 (IL-6) levels.
- Correlation analysis of inflammatory markers with apnea-hypopnea index (AHI), BMI, and oxygen saturation (SpO2).
Main Results:
- Children with SDB exhibited elevated plasma CRP and IL-6 levels compared to controls.
- A significant severity-dependent increase in CRP was observed with increasing AHI.
- CRP and IL-6 levels correlated with SDB severity (AHI) and nocturnal oxygen desaturation, independent of obesity.
Conclusions:
- Sleep-disordered breathing in children is associated with significant, severity-dependent increases in pro-inflammatory markers CRP and IL-6.
- These inflammatory changes occur independently of obesity, highlighting SDB as a critical factor.
- Findings underscore the importance of addressing SDB to mitigate cardiovascular risk in children.
Abstract:
C-reactive protein (CRP) and interleukin-6 (IL-6) are pro-inflammatory proteins and important risk factors for atherosclerosis. Plasma CRP levels in snoring children may or may not be elevated. Since obesity is prevalent among snoring children and is associated with elevated CRP levels, we aimed to investigate the relative contributions of sleep-disordered breathing (SDB) and obesity to the inflammatory processes in snoring children in this prospective study. Two hundred forty-four children (mean age 8.9 +/- 3.4 years) underwent polysomnographic evaluation. CRP was measured the following morning, and plasma IL-6 levels from 111 randomly selected children were also examined. Plasma CRP and IL-6 levels were elevated in children with SDB. Log plasma CRP levels were higher in the moderate-severe SDB group (apnea/hypopnea index, AHI > or = 5) compared to the mild SDB group (AHI > or = 1 and <5; p < 0.0001) or the control group (AHI < 1; p = 0.0001). Log plasma CRP levels correlated with AHI, arousal index, relative BMI, and SpO(2) nadir (r = 0.30, p < 0.0001; r = 0.21, p = 0.002; r = 0.39, p < 0.0001, r = -0.36, p < 0.0001, respectively). Log plasma CRP levels were lower in children with SpO(2) nadir > or =90 (p < 0.0001). Sub-analysis of the 116 non-obese children in the cohort revealed similar findings. Log plasma IL-6 levels were increased in children with moderate-severe SDB compared to controls (p = 0.03) and correlated with AHI (r = 0.28, p = 0.003) and SpO(2) nadir (r = -0.24, p = 0.02). Children with SDB display significant severity-dependent increases in plasma CRP and IL-6 levels independent of obesity.
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