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Relationship Between Sleep-Disordered Breathing and Markers of Systemic Inflammation in Women From the General Population
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Inflammation)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
2012 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no 2, p. 147-154Article in journal (Refereed) Published
Abstract [sv]

Sleep-disordered breathing (SDB) is a risk factor for cardiovascular disease (CVD). The underlying pathogenesis is not clear. In patients with obstructive sleep apnoea syndrome (OSAS) elevated levels of inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6) and tumour necrosis factor a (TNFa) have been found. These markers have also been shown as independent markers of CVD in other populations. The aim of the study was to investigate the association between SDB and systemic inflammation in a population-based cohort of women. From 6817 women who previously answered a questionnaire concerning snoring habits, 230 habitually snoring women and 170 women regardless of snoring status went through polysomnography, anthropometric measurements and blood sampling. Analyses were made for CRP, TNFa, IL-6, myeloperoxidase (MPO) and lysozyme. The levels of CRP, IL-6 and lysozyme were significantly higher in subjects with apnoeahypopnoea index (AHI) =15 compared with women with lower AHI. All inflammatory markers except MPO correlated to AHI and oxygen desaturation measures, and to waist circumference. In multiple linear regressions adjusting for age, waist circumference and smoking, independent correlations between oxygen desaturation indices (ODI) and inflammation were found for IL-6 (P = 0.03 for % sleep time with saturation <90%) and TNFa (P = 0.03 for ODI 3%). No significant correlations were found between AHI and inflammation. Also, for women from the general population there is an independent correlation between SDB and inflammation, even after adjusting for obesity. The results indicate that intermittent hypoxia, and not the AHI, is related to systemic inflammation seen in OSAS.

Place, publisher, year, edition, pages
2012. Vol. 21, no 2, p. 147-154
Keywords [en]
sleep apnea, inflammation, women
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97948DOI: 10.1111/j.1365-2869.2011.00946.xISI: 000301931500004OAI: oai:DiVA.org:uu-97948DiVA, id: diva2:173076
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Snoring and Sleep Apnea in Women: Risk Factors, Signs and Consequences
Open this publication in new window or tab >>Snoring and Sleep Apnea in Women: Risk Factors, Signs and Consequences
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Obesity is a risk factor for snoring and sleep apnea, but data on other factors in relation to obesity are ambiguous. Symptoms of sleep apnea in women have not been fully elucidated. OSAS is an important risk factor for cardiovascular disease (CVD). A common feature in patients with CVD and sleep apnea is an increase in systemic inflammation.

From the general population 7,051 women ≥ 20 years answered a questionnaire on snoring and sleep disturbances. Habitual snoring was found in 8% of the total population, and influenced by age, obesity and smoking. The highest prevalence (14%) was found in women 50-59 years. In lean women, alcohol dependence was associated with snoring, while physical inactivity was a risk factor for snoring in obese women.

Further, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of > 25, no pharyngeal characteristics predicted sleep apnea.

When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI (EDS, falling asleep involuntarily during day, waking up unrefreshed and fatigue). No symptoms correlated to AHI independently of snoring.

Blood samples were analysed for systemic inflammation (CRP, TNFα, IL-6, myeloperoxidase (MPO) and lysozyme). Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia.

In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to BMI. Daytime symptoms are independently related to snoring per se. Despite a strong correlation between obesity and inflammation, an independent relationship between sleep apnea and inflammatory markers was found.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 412
Keywords
snoring, sleep apnea, women, general population, risk factors, daytime sleepiness, inflammation, pharynx
Identifiers
urn:nbn:se:uu:diva-9515 (URN)978-91-554-7383-9 (ISBN)
Public defence
2009-01-30, Skoog salen, ing 78-79, Akademiska sjukhuset, Uppsala, 13:00
Opponent
Supervisors
Available from: 2009-01-23 Created: 2009-01-23Bibliographically approved

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Svensson, MalinVenge, PerJanson, ChristerLindberg, Eva

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