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Serum biomarkers of obstructive sleep apnea
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H. Erhan Dincer, MD FCCP FAASM VA Southern Nevada Health Care System
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erhan_dincer{at}yahoo.com H. Erhan Dincer, MD FCCP FAASM
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Can and colleagues have reported a cohort of OSA patients with elevated serum levels of homocysteine and CRP in the current issue of Chest (February 2006) (1). They further stated that these serum markers could be used as predictor of long-term prognosis for cardiovascular disease. Editorial comment by Olson LJ and Somers VK has pointed out potential weaknesses of this study including lack of information regarding co-morbidities, medications, gender of control group and low mean BMI in the control group. The relationship between OSA and cardiovascular disease is complex, and an understanding of the mechanisms continues to evolve. In recent years, several serum markers have been studied in patients with OSA such as natriuretic peptides (A- and B-type) (2), CRP (3), IL-6 (4), endothelin-1 (5), fibrinogen (6), leptin (7), homocysteine (8), adenosine (9), uric acid (9), nitric oxide (10) and orexin-A (11). Although present study revealed a relation in elevated serum levels of homocysteine, CRP and OSA, we are far beyond making a statement whether any of these serum markers would be useful in clinical practice to predict high-risk patients for potential cardiovascular consequences of obstructive sleep apnea. Based on available data so far, only CRP and fibrinogen are promising. There have been conflicting results on other serum markers including homocysteine. Further large-scale studies will show whether a serum marker would be useful in a clinical setting to determine high-risk OSA patients whom may need more aggressive approach for treatment of their sleep apnea. References: 1.Can M, Acikgoz S, Mungan G, et al. Serum cardiovascular risk factors in obstructive sleep apnea. Chest 2006;129:233-237. 2. Svatikova A, Shamsuzzaman AS, Wolk R, et al. Plasma natriuretic peptide in obstructive sleep apnea. Am J Cardiol 2004;94:529-532. 3. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. . Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002;105:2462-2464. 4. Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and Interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003; 107: 1129-1134. 5. Jordan W, Reinbacher A, Cohrs S, et al. Obstructive sleep apnea: Plasma endohtelin-1 precursor but not endothelin-1 levels are elevated and decline with nasal continuous positive airway pressure. Peptides 2005;26(9):1654-1660. 6. Wessendorf T, Thillman A, Wang Y, et al. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med 2000; 162:2039-2042. 7. Schafer H, Pauleit D, Sudhop T, et al. Body fat distribution, serum leptin, and cardiovascular serum risk factors in men with obstructive sleep apnea. Chest 2002; 122: 829-839. 8. Svatikova A, Wolk R, Magera MJ, et al. Plasma homocysteine in obstructive sleep apnoea. Eur Heart J 2004;25:1325-1329. 9. Saito H, Nishimura M, Shibuya E, et al. Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine. Chest 2002;122:1686-1694. 10. Schulz R, Schmidt D, Blum A, et al. Decreased plasma levels of nitric oxide derivates in obstructive sleep apnoea: response to CPAP therapy. Thorax 2000;56:1046-1051. 11. Sakurai S, Nishijima T, Takahashi S, et al. Low plasma orexin-A levels were improved by continuous positive airway pressure treatment in patients with severe obstructive sleep apnea-hypopnea syndrome. Chest 2005; 127:731 -737. |
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