doi: 10.1161/01.CIR.0000161819.76138.5E
(Circulation. 2005;111:1978-1984.)
© 2005 American Heart Association, Inc.
Pediatric Cardiology |
Variation of C-Reactive Protein Levels in Adolescents
Association With Sleep-Disordered Breathing and Sleep Duration
From the Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University (E.K.L., S.R.), and Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine (E.K.L., C.L.R., H.L.K., A.S.-I., J.L.E., N.L.J., A.M.V.Z., S.R.), Cleveland, Ohio, and Departments of Pathology (R.P.T., N.S.J.) and Biochemistry (R.P.T.), University of Vermont, Burlington.
Correspondence to Emma K. Larkin, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Triangle Building Suite 260, 10400 Euclid Ave, Cleveland, OH 44106. E-mail emma.larkin{at}case.edu
Received November 4, 2004; revision received February 4, 2005; accepted February 9, 2005.
Background— There is increasing evidence that sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular disease (CVD) in adults. C-reactive protein (CRP), a marker of systemic inflammation, is an important predictor of future cardiovascular events. The goal of this study was to quantify the associations of SDB, sleep duration, and CRP in adolescents to better understand the role of SDB in CVD risk.
Methods and Results— Adolescents (n=143; age, 13 to 18 years; 36% black; 50% female) with a wide range of SDB severity underwent polysomnography and measurement of high-sensitivity CRP. SDB was quantified with the apnea hypopnea index (AHI) and oxygen desaturation measures. Sleep duration was estimated from 7-day actigraphy. The independent and dose-response associations of SDB with CRP were addressed through linear mixed-effects models. Forty-eight percent were overweight or obese, and 12% had SDB (AHI 
5). CRP levels varied with increasing body mass index and SDB. After adjustment for body mass index , age, sex, and race, mean CRP levels were 0.50, 0.43, 0.97, and 1.66 mg/L for SDB severity levels of AHI <1, 1 to 4.9, 5 to 14.9, and 15, respectively (P=0.0049, AHI 15 versus <1). Adjusted mean CRP levels demonstrated a dose response with SDB above a threshold AHI of 5. This association was partially explained by overnight hypoxemia and less so by sleep duration.
Conclusions— In adolescents free of known CVD, an AHI 5 is associated with increasing levels of CRP, suggesting that pediatric SDB may confer additional CVD risk beyond that of obesity.
Key Words: body mass index • C-reactive protein • inflammation • sleep apnea syndromes
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