Original article
Long Term Effect of Autoadjusting Positive Airway Pressure on C-Reactive Protein and Interleukin-6 in Men With Obstructive Sleep Apnoea Syndrome
Efecto a largo plazo de la presión positiva automática en la vía aérea sobre la proteína C reactiva y la interleucina-6 en varones con síndrome de apnea obstructiva del sueño
Marta Drummonda,
, João Wincka, João Guimarãesb, Ana C. Santosc, João Almeidaa, João Marquesa
Corresponding author
a Departamento de Neumología, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal
b Departamento de Bioquímica y Patología Clínica, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal
c Departamento de Epidemiología e Higiene, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal
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Santos, João Almeida, João Marques" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Drummond" "email" => array:1 [ 0 => "marta.drummond@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "João" "apellidos" => "Winck" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "João" "apellidos" => "Guimarães" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "Ana C." "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "João" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 5 => array:3 [ "nombre" => "João" "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Neumología, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Departamento de Bioquímica y Patología Clínica, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Departamento de Epidemiología e Higiene, Hospital de João de Sao, Facultad de Medicina de Porto, Oporto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto a largo plazo de la presión positiva automática en la vía aérea sobre la proteína C reactiva y la interleucina-6 en varones con síndrome de apnea obstructiva del sueño" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-01-11" "fechaAceptado" => "2009-05-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec155536" "palabras" => array:3 [ 0 => "Obstructive sleep apnoea" 1 => "High sensitivity C- reactive protein" 2 => "Interleukin-6" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155537" "palabras" => array:3 [ 0 => "Proteína C reactiva de alta sensibilidad" 1 => "Interleucina-6" 2 => "Apnea obstructiva del sueño" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background and objectives</span><p class="elsevierStyleSimplePara elsevierViewall">Obstructive sleep apnoea (OSA) has been increasingly linked to cardiovascular disease. Inflammatory processes associated with OSA may contribute to this morbidity. Some studies have reported serum levels of high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) to be increased in these patients. Primary objective: investigate the impact of short and long-term autoadjusting positive airway pressure (APAP) therapy on IL-6 and hs-CRP serum levels in patients with moderate to severe obstructive sleep apnoea. Secundary Objective: evaluate the basal hs-CRP and IL-6 levels in OSA patients and its possible relation to OSA severity, independently of confounders and compare the hs-CRP levels in OSA patients with those in community controls.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">This is a prospective study including 98 male patients with moderate to severe OSA confirmed by domiciliary sleep study. Malignancy and chronic inflammatory diseases were exclusion criteria. hs-CRP and IL-6 serum levels were evaluated before APAP, 9 days and 6 months after therapy. Community controls (n=103) were selected using random digit dialling, and matched by age and body mass index (BMI) for comparison of hs-CRP levels at baseline.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The studied population had a mean age of 55.3±10.7 years, mean BMI 33.2±5.0kg/m2, mean apnoeahypopnoea index 51.7±21.3/h and mean desaturation index 86.3±5.3/h. The APAP compliance was good: 91.27&%×000B1;20.45 days usage and 5.76±1.59h/night of usage.</p><p class="elsevierStyleSimplePara elsevierViewall">Mean basal hs-CRP and IL-6 serum values were 0.52±0.53 μg/l and 17.7±22.5 μg/l, respectively. CRP levels at baseline correlated significantly with apnoea-hypopnoea index, desaturation index and minimum nocturnal oxygen saturation. IL-6 levels at baseline correlated significantly and negatively with minimum nocturnal oxygen saturation. When adjusting for confounding factors found in this study, all these relations lost significance.</p><p class="elsevierStyleSimplePara elsevierViewall">CRP is significantly increased in patients when compared to controls (<span class="elsevierStyleItalic">P</span>=.002) and when considering hs-CRP cardiovascular risk stratified categories, cases had significantly more patients at high risk of cardiovascular events than controls (<span class="elsevierStyleItalic">P</span>=.002).</p><p class="elsevierStyleSimplePara elsevierViewall">After adjustment for BMI and arterial hypertension, cases had an almost twofold moderate risk of cardiovascular events and more than a twofold severe risk of cardiovascular events when compared to controls.</p><p class="elsevierStyleSimplePara elsevierViewall">We found no significant difference between hs-CRP and IL-6 concentrations pre-treatment and in two moments post-treatment (9 days and 6 months) (CRP: <span class="elsevierStyleItalic">P</span>=.720 and <span class="elsevierStyleItalic">P</span>=.387, respectively; IL-6: <span class="elsevierStyleItalic">P</span>=.266 and <span class="elsevierStyleItalic">P</span>=.238, respectively).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">OSA is associated with a low-grade inflammatory process; hs-CRP serum levels are elevated in OSA patients when comparing to community controls, independently of age and BMI and the former have a significantly higher risk of cardiovascular events when compared to the latter. There was no significant decrease of both inflamatory mediators (hs-CRP, IL-6) after short and long-term APAP therapy.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">La apnea obstructiva del sueño (AOS) se ha vinculado de forma creciente con las enfermedades cardiovasculares. Los procesos inflamatorios asociados a la AOS pueden contribuir a esta morbilidad. Algunos estudios han señalado que las concentraciones séricas de proteína C reactiva de alta sensibilidad (PCR-as) y de interleucina-6 (IL-6) están aumentadas en estos pacientes. El objetivo principal del estudio has sido investigar la repercusión a corto y largo plazo del tratamiento de presión positiva automática en la vía aérea (APAP) sobre las concentraciones séricas de PCR-as e IL-6 en pacientes con AOS clasificada entre moderada y grave. Como objetivo secundario, nos propusimos evaluar las concentraciones basales de PCRas e IL-6 en los pacientes con AOS y su posible relación con la gravedad de dicho síndrome, independientemente de los factores de confusión, y comparar las concentraciones de PCR-as en los afectados de AOS con los de una población de control procedente de la comunidad.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio prospectivo que ha incluido a 98 pacientes varones con AOS de moderada a grave, confirmada mediante un estudio domiciliario del sueño. Las neoplasias malignas y las enfermedades inflamatorias crónicas fueron criterios de exclusión. Se evaluaron las concentraciones séricas de PCR-as y de IL-6 antes de la APAP, a los 9 días y a los 6 meses del tratamiento. Los controles de la comunidad (n=103), que se seleccionaron mediante llamadas telefónicas aleatorias, se emparejaron por edad e índice de masa corporal (IMC) con el grupo de pacientes con objeto de comparar las concentraciones de PCR-as al inicio del estudio.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La población estudiada presentaba una media (± desviación estándar) de edad de 55,3±10,7 años, un IMC medio de 33,2±5,0kg/m2, un índice medio de apneas-hipopneas de 51,7±21,3/h y un índice de desaturación de 86,3±5,3/h. El cumplimiento del tratamiento con APAP fue bueno, con un uso de un 91,27±20,45% de los días y de 5,76±1,59h/noche.</p><p class="elsevierStyleSimplePara elsevierViewall">Al inicio del estudio, los valores séricos medios de PCR-as e IL-6 fueron de 0,52±0,53 y 17,7±22,5 μg/l, respectivamente. Los de PCR-as se correlacionaban de forma significativa con el índice de apneas-hipopneas, el índice de desaturación y la saturación de oxígeno mínima durante la noche, y los de IL-6 estaban correlacionados de forma significativa y negativa con la saturación de oxígeno mínima durante la noche. Al ajustar por los factores de confusión encontrados en el estudio, todas estas relaciones perdieron significación. La PCR-as se encontraba significativamente elevada en los pacientes respecto a los controles (<span class="elsevierStyleItalic">P</span>=.002). Al considerar las categorías de estratificación del riesgo cardiovascular mediante la PCR-as, en el grupo de pacientes era significativamente mayor el número de personas con riesgo elevado de episodios cardiovasculares en comparación con el grupo control (<span class="elsevierStyleItalic">P</span>=.002).</p><p class="elsevierStyleSimplePara elsevierViewall">Tras el ajuste por IMC e hipertensión arterial, el grupo de pacientes presentaba un riesgo moderado casi 2 veces superior y un riesgo importante más de 2 veces superior de desarrollar episodios cardiovasculares en comparación con el grupo de control.</p><p class="elsevierStyleSimplePara elsevierViewall">No encontramos diferencias significativas entre las concentraciones de PCR-as e IL-6 antes del tratamiento y en los 2 períodos posteriores, es decir, a los 9 días y a los 6 meses (PCR: <span class="elsevierStyleItalic">P</span>=.720 y <span class="elsevierStyleItalic">P</span>=.387; IL-6: <span class="elsevierStyleItalic">P</span>=.266 y <span class="elsevierStyleItalic">P</span>=.238, respectivamente).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La AOS está asociada con un proceso inflamatorio de bajo grado. Las concentraciones séricas de PCR-as se encuentran elevadas en los pacientes con AOS al compararlas con las de un grupo de control procedente de la comunidad, independientemente de la edad y del IMC. Además, el grupo de pacientes presentaba un riesgo significativamente mayor de desarrollar episodios cardiovasculares que el de control. No se observó una disminución significativa de las concentraciones de los mediadores inflamatorios (PCRas e IL-6) tras el tratamiento de APAP a corto ni a largo plazo.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:57 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The occurrence of sleepdisordered breathing among middle-aged adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Young" 1 => "M. Palta" 2 => "J. 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| Year/Month | Html | Total | |
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| 2024 July | 27 | 22 | 49 |
| 2024 June | 30 | 20 | 50 |
| 2024 May | 33 | 24 | 57 |
| 2024 April | 20 | 21 | 41 |
| 2024 March | 13 | 13 | 26 |
| 2024 February | 22 | 13 | 35 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 16 | 17 | 33 |
| 2023 January | 17 | 28 | 45 |
| 2022 December | 22 | 26 | 48 |
| 2022 November | 22 | 16 | 38 |
| 2022 October | 19 | 32 | 51 |
| 2022 September | 18 | 25 | 43 |
| 2022 August | 21 | 30 | 51 |
| 2022 July | 18 | 36 | 54 |
| 2022 June | 16 | 32 | 48 |
| 2022 May | 20 | 35 | 55 |
| 2022 April | 11 | 31 | 42 |
| 2022 March | 17 | 33 | 50 |
| 2022 February | 17 | 24 | 41 |
| 2022 January | 16 | 34 | 50 |
| 2021 December | 15 | 46 | 61 |
| 2021 November | 17 | 47 | 64 |
| 2021 October | 24 | 51 | 75 |
| 2021 September | 23 | 72 | 95 |
| 2021 August | 15 | 38 | 53 |
| 2021 July | 11 | 38 | 49 |
| 2021 June | 16 | 30 | 46 |
| 2021 May | 17 | 27 | 44 |
| 2021 April | 41 | 57 | 98 |
| 2021 March | 21 | 21 | 42 |
| 2021 February | 9 | 16 | 25 |
| 2021 January | 11 | 6 | 17 |
| 2020 December | 15 | 11 | 26 |
| 2020 November | 9 | 9 | 18 |
| 2020 October | 5 | 9 | 14 |
| 2020 September | 13 | 3 | 16 |
| 2020 August | 14 | 15 | 29 |
| 2020 July | 18 | 16 | 34 |
| 2020 June | 9 | 8 | 17 |
| 2020 May | 17 | 14 | 31 |
| 2020 April | 18 | 17 | 35 |
| 2020 March | 19 | 17 | 36 |
| 2020 February | 22 | 14 | 36 |
| 2020 January | 15 | 19 | 34 |
| 2019 December | 20 | 13 | 33 |
| 2019 November | 23 | 11 | 34 |
| 2019 October | 9 | 7 | 16 |
| 2019 September | 8 | 10 | 18 |
| 2019 August | 12 | 9 | 21 |
| 2019 July | 12 | 27 | 39 |
| 2019 June | 11 | 11 | 22 |
| 2019 May | 8 | 12 | 20 |
| 2019 April | 18 | 35 | 53 |
| 2019 March | 11 | 13 | 24 |
| 2019 February | 11 | 8 | 19 |
| 2019 January | 11 | 9 | 20 |
| 2018 December | 16 | 12 | 28 |
| 2018 November | 18 | 13 | 31 |
| 2018 October | 11 | 11 | 22 |
| 2018 September | 10 | 7 | 17 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 10 | 4 | 14 |
| 2018 March | 7 | 5 | 12 |
| 2018 February | 7 | 8 | 15 |
| 2018 January | 4 | 7 | 11 |
| 2017 December | 5 | 10 | 15 |
| 2017 November | 4 | 6 | 10 |
| 2017 October | 6 | 5 | 11 |
| 2017 September | 8 | 16 | 24 |
| 2017 August | 11 | 19 | 30 |
| 2017 July | 11 | 8 | 19 |
| 2017 June | 10 | 14 | 24 |
| 2017 May | 4 | 4 | 8 |
| 2017 April | 5 | 2 | 7 |
| 2017 March | 5 | 48 | 53 |
| 2017 February | 3 | 2 | 5 |
| 2017 January | 4 | 3 | 7 |
| 2016 December | 7 | 6 | 13 |
| 2016 November | 11 | 8 | 19 |
| 2016 October | 3 | 12 | 15 |
| 2016 September | 4 | 6 | 10 |
| 2016 August | 7 | 6 | 13 |
| 2016 July | 7 | 2 | 9 |
| 2016 May | 1 | 0 | 1 |
| 2016 March | 10 | 0 | 10 |
| 2016 February | 4 | 0 | 4 |
| 2016 January | 6 | 0 | 6 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 43 | 15 | 58 |
| 2015 September | 41 | 10 | 51 |
| 2015 August | 32 | 6 | 38 |
| 2015 July | 41 | 4 | 45 |
| 2015 June | 40 | 9 | 49 |
| 2015 May | 60 | 11 | 71 |
| 2015 April | 22 | 8 | 30 |
| 2015 March | 37 | 9 | 46 |
| 2015 February | 34 | 3 | 37 |
| 2015 January | 32 | 3 | 35 |
| 2014 December | 26 | 7 | 33 |
| 2014 November | 34 | 6 | 40 |
| 2014 October | 63 | 9 | 72 |
| 2014 September | 41 | 9 | 50 |
| 2014 August | 37 | 6 | 43 |
| 2014 July | 30 | 11 | 41 |
| 2014 June | 38 | 9 | 47 |
| 2014 May | 46 | 8 | 54 |
| 2014 April | 65 | 13 | 78 |
| 2014 March | 64 | 14 | 78 |
| 2014 February | 56 | 13 | 69 |
| 2014 January | 49 | 10 | 59 |
| 2013 December | 37 | 6 | 43 |
| 2013 November | 27 | 9 | 36 |
| 2013 October | 32 | 9 | 41 |
| 2013 September | 35 | 8 | 43 |
| 2013 August | 38 | 7 | 45 |
| 2013 July | 48 | 19 | 67 |
| 2013 June | 37 | 20 | 57 |
| 2013 May | 29 | 9 | 38 |
| 2013 April | 21 | 6 | 27 |
| 2013 March | 10 | 3 | 13 |
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