C-reactive Protein and Carotid Intima-media Thickness in Children with Sleep Disordered Breathing

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2013 May 16

PMID 23674941

Citations 9

Authors

Arcangelo Iannuzzi

Maria Rosaria Licenziati

Fausto De Michele

Maria Carmela Verga

Carlo Santoriello

Luigi Di Buono

Maurizio Renis

Loredana Lembo

Bruno dAgostino

Donato Cappetta

Mario Polverino

Francesca Polverino

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Carotid Intima-Media Thickness and Cardiovascular Risk in Adolescents with Overweight or Obesity: Are There Gender-Related Differences?.

Saleh C Rev Cardiovasc Med. 2024; 25(10):352.

PMID: 39484138 PMC: 11522746. DOI: 10.31083/j.rcm2510352.

Di Bonito P, Di Sessa A, Licenziati M, Corica D, Wasniewska M, Del Giudice E Rev Cardiovasc Med. 2024; 25(4):141.

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Early Atherosclerotic Inflammatory Pathways in Children with Obstructive Sleep Apnea.

Smith D, Schuler C, Hossain M, Huang G, McConnell K, Urbina E J Pediatr. 2021; 239:168-174.

PMID: 34450122 PMC: 9020582. DOI: 10.1016/j.jpeds.2021.08.031.

Evaluation of Blood Levels of C-Reactive Protein Marker in Obstructive Sleep Apnea: A Systematic Review, Meta-Analysis and Meta-Regression.

Imani M, Sadeghi M, Farokhzadeh F, Khazaie H, Brand S, Dursteler K Life (Basel). 2021; 11(4).

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The cardiovascular risk in paediatrics: the paradigm of the obstructive sleep apnoea syndrome.

Zaffanello M, Piacentini G, La Grutta S Blood Transfus. 2020; 18(3):217-225.

PMID: 32203011 PMC: 7250680. DOI: 10.2450/2020.0283-19.

References

Bhattacharjee R, Kim J, Kheirandish-Gozal L, Gozal D . Obesity and obstructive sleep apnea syndrome in children: a tale of inflammatory cascades. Pediatr Pulmonol. 2010; 46(4):313-23. DOI: 10.1002/ppul.21370. View

Kaditis A, Alexopoulos E, Kalampouka E, Kostadima E, Germenis A, Zintzaras E . Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. Am J Respir Crit Care Med. 2004; 171(3):282-6. DOI: 10.1164/rccm.200407-928OC. View

PHILLIPS B, Somers V . Neural and humoral mechanisms mediating cardiovascular responses to obstructive sleep apnea. Respir Physiol. 2000; 119(2-3):181-7. DOI: 10.1016/s0034-5687(99)00113-9. View

Bixler E, Vgontzas A, Lin H, Liao D, Calhoun S, Fedok F . Blood pressure associated with sleep-disordered breathing in a population sample of children. Hypertension. 2008; 52(5):841-6. PMC: 3597109. DOI: 10.1161/HYPERTENSIONAHA.108.116756. View

Kwok K, Ng D, Cheung Y . BP and arterial distensibility in children with primary snoring. Chest. 2003; 123(5):1561-6. DOI: 10.1378/chest.123.5.1561. View

Iannuzzi A, Licenziati M, Acampora C, Salvatore V, Auriemma L, Romano M . Increased carotid intima-media thickness and stiffness in obese children. Diabetes Care. 2004; 27(10):2506-8. DOI: 10.2337/diacare.27.10.2506. View

Ridker P, Hennekens C, Buring J, Rifai N . C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342(12):836-43. DOI: 10.1056/NEJM200003233421202. View

Archenti A, Pasqualinotto L . Childhood obesity: the epidemic of the third millenium. Acta Biomed. 2008; 79(2):151-5. View

Brunetti L, Tesse R, Miniello V, Colella I, Delvecchio M, Logrillo V . Sleep-disordered breathing in obese children: the southern Italy experience. Chest. 2010; 137(5):1085-90. DOI: 10.1378/chest.09-1529. View

10.

Punjabi N, Beamer B . C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep. 2007; 30(1):29-34. PMC: 1978354. DOI: 10.1093/sleep/30.1.29. View

11.

Iannuzzi A, Licenziati M, Vacca M, De Marco D, Cinquegrana G, Laccetti M . Comparison of two diets of varying glycemic index on carotid subclinical atherosclerosis in obese children. Heart Vessels. 2010; 24(6):419-24. DOI: 10.1007/s00380-008-1138-6. View

12.

Larkin E, Rosen C, Kirchner H, Storfer-Isser A, Emancipator J, Johnson N . Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation. 2005; 111(15):1978-84. DOI: 10.1161/01.CIR.0000161819.76138.5E. View

13.

Drager L, Bortolotto L, Krieger E, Lorenzi-Filho G . Additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension. 2008; 53(1):64-9. DOI: 10.1161/HYPERTENSIONAHA.108.119420. View

14.

Kuczmarski R, Ogden C, Guo S, Grummer-Strawn L, Flegal K, Mei Z . 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11. 2002; (246):1-190. View

15.

Brodsky L . Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989; 36(6):1551-69. DOI: 10.1016/s0031-3955(16)36806-7. View

16.

Nieto F, YOUNG T, Lind B, Shahar E, Samet J, Redline S . Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000; 283(14):1829-36. DOI: 10.1001/jama.283.14.1829. View

17.

Tsaoussoglou M, Bixler E, Calhoun S, Chrousos G, Sauder K, Vgontzas A . Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities. J Clin Endocrinol Metab. 2009; 95(1):143-50. PMC: 2805493. DOI: 10.1210/jc.2009-0435. View

18.

Lui M, Lam J, Mak H, Xu A, Ooi C, Lam D . C-reactive protein is associated with obstructive sleep apnea independent of visceral obesity. Chest. 2009; 135(4):950-956. DOI: 10.1378/chest.08-1798. View

19.

Ridker P . High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation. 2001; 103(13):1813-8. DOI: 10.1161/01.cir.103.13.1813. View

20.

Bradley T, Floras J . Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2008; 373(9657):82-93. DOI: 10.1016/S0140-6736(08)61622-0. View