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Dose-response relationship between obstructive sleep apnoea severity and C-reactive protein levels: data from the
Ludger Grote1,2, Haralampos Gouveris3, Lea Lethuillier4
1Centre for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
ERJ Open Research
|January 7, 2026
Summary
Obstructive sleep apnoea (OSA) is linked to higher C-reactive protein (CRP) levels, indicating increased systemic inflammation. This association is dose-dependent and independent of other factors, with obesity worsening the effect.
Area of Science:
- Cardiology
- Pulmonology
- Inflammation Research
Background:
- Obstructive sleep apnoea (OSA) is characterized by intermittent hypoxia, which is known to promote systemic inflammation.
- C-reactive protein (CRP) is a key biomarker for systemic inflammation.
Purpose of the Study:
- To evaluate the association between the severity of obstructive sleep apnoea (OSA) and circulating C-reactive protein (CRP) levels.
- To assess CRP as a marker of systemic inflammation in a large, pan-European patient cohort.
Main Methods:
- Cross-sectional analysis of the European Sleep Apnoea Database (ESADA) cohort.
- Inverse probability weighted regression adjustment within a linear mixed-effects model (LMEM).
- Analysis included anthropometrics, comorbidities, study centre, and year of analysis as covariates.
Main Results:
- A cohort of 18,445 subjects was analyzed, with a median apnoea-hypopnoea index (AHI) of 22.1 events/h.
- CRP levels showed a significant dose-response relationship with OSA severity (p<0.001).
- The apnoea-hypopnoea index (AHI) was an independent predictor of CRP (p<0.001), alongside age and female sex. Obesity (BMI ≥35 kg/m²) had the strongest independent effect on CRP levels.
Conclusions:
- A robust, independent, dose-response relationship exists between OSA severity and systemic inflammation.
- The combination of OSA and obesity significantly amplifies systemic inflammation.
- Further research is warranted to explore CRP's prognostic value for cardiovascular events in OSA patients.
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