C-reactive protein and carotid intima-media thickness in children with sleep disordered breathing
Arcangelo Iannuzzi1, Maria Rosaria Licenziati, Fausto De Michele
1Department of Internal Medicine, A. Cardarelli Hospital, Naples, Italy.
Insights
Obstructive sleep apnea (OSA) in children is linked to higher high-sensitivity C-reactive protein (Hs-CRP) levels, primarily due to overweight and obesity. OSA did not show an association with subclinical atherosclerosis in this study.
Area of Science:
- Pediatric Endocrinology
- Sleep Medicine
- Cardiovascular Health
Background:
- Obesity is a significant risk factor for sleep disordered breathing (SDB) in children.
- High-sensitivity C-reactive protein (Hs-CRP) predicts cardiovascular morbidity in adults and is linked to overweight.
- Increased carotid intima-media thickness (IMT) is associated with cardiovascular risk factors.
Purpose of the Study:
- To evaluate the effect of SDB on Hs-CRP levels and IMT in children.
- To assess the association between SDB, obesity, Hs-CRP, and IMT in children not specifically selected for snoring.
Main Methods:
- 101 children (aged 5-15 years) were studied.
- Quantitative B-mode ultrasound measured IMT.
- Overnight polysomnography determined the apnea-hypopnea index (AHI): AHI < 1 (controls), 1-5 (mild SDB), ≥ 5 (obstructive sleep apnea - OSA).
Main Results:
- AHI significantly correlated with Hs-CRP (r=0.32, p=0.002) in all children.
- Obese children had a higher probability of OSA (HR 3.3, p=0.02).
- Hs-CRP was higher in children with OSA (p=0.011), but this association was mediated by BMI.
- IMT was not associated with AHI or SDB.
Conclusions:
- OSA in children is associated with elevated Hs-CRP, mainly mediated by overweight and obesity.
- No association was found between OSA and subclinical atherosclerosis (IMT).
- Early childhood prevention of OSA is crucial to prevent irreversible arterial damage seen in adults.
Study Objectives:
Obesity is a risk factor for sleep disordered breathing (SDB) in children. Plasma levels of high-sensitivity C-reactive protein (Hs-CRP) are predictive of cardiovascular morbidity in adults, and CRP levels are associated with over-weight. Increased carotid intima-media thickness (IMT) is associated with several cardiovascular risk factors. We evaluated the effect of SDB on CRP levels and IMT in lean and obese children not selected for snoring.
Methods:
101 children (age 5-15 years) attending a weight clinic or scheduled for routine visit. IMT was measured with quantitative B-mode ultrasound scans. The apnea-hypopnea index (AHI) was measured overnight: AHI < 1 defined controls, AHI ≥ 1 to < 5 = mild SDB, and AHI ≥ 5 = obstructive sleep apnea (OSA).
Results:
AHI was significantly associated with Hs-CRP concentration (r = 0.32, p = 0.002) in all 101 children irrespective of age and sex. Body mass index (BMI) was higher in OSA children than controls (25.5 ± 7.0 vs 22.1 ± 6.9, p = 0.05). Obese children had 3.3 times more probability of having OSA (HR 3.3, 95% CI 1.2-9.3, p = 0.02) than lean children. Hs-CRP values were significantly higher in children with OSA than in children without (p = 0.011), but not when BMI z-score was added as covariate. IMT was not associated with AHI or SDB.
Conclusions:
The results of this study suggest an association between OSA and Hs-CRP concentrations (mainly mediated by overweight and obesity), but not between OSA and subclinical atherosclerosis. There is scope for prevention in childhood before OSA syndrome causes the irreversible damage to arteries observed in adult patients.
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