Abstract 13147: Obstructive Sleep Apnea Associates With Elevated Leukocytes and Markers of Inflammation in the Multi-Ethnic Study of Atherosclerosis (MESA)
Introduction: Obstructive sleep apnea (OSA) is associated with incident cardiovascular disease (CVD), which may reflect dysregulation of pathways leading to atherosclerosis. Inflammation and adaptive immunity participate in the pathogenesis of atherosclerosis, and may be influenced by OSA-related stresses. No prior community-based study has examined the associations of OSA with both leukocytes and serum inflammatory markers.
Hypothesis: Biomarkers of inflammation are associated with OSA severity in a community-based cohort. We particularly focused on White Blood Cell (WBC), which has not been well-studied in association with OSA. Since OSA has been associated more strongly with CVD in middle-age vs. old age, we explored potential age modification.
Methods: We analyzed data from MESA participants who underwent polysomnography in conjunction with Exam 5 (2010-13) and had available biomarkers from that exam. The primary analysis (n=1344) modeled WBC count and Cystatin-C as outcomes (available for largest subset, n=1344), with log Apnea Hypopnea Index (AHI) as the exposure. Secondary analysis evaluated high-sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, and intercellular-adhesion molecule-1 (ICAM-1) (n=228) as outcomes, and considered dichotomized OSA as absent (AHI <5) or present (AHI ≥5) as the exposure.
Results: The primary sample (n=1344) had a mean age 68.5 ±9 y, and was 47% male; 14% of individuals had severe OSA (AHI ≥30). Increasing AHI associated with male sex, body mass index (BMI), and a higher prevalence of diabetes (DM) and hypertension (HTN). After adjusting for age, sex, race, smoking, BMI, DM, HTN, and statins, AHI associated significantly with WBC (beta=0.017; p=0.034). Associations tended to be stronger in those age <65 y (beta=0.031; p=0.011). However, the p for interaction was not significant. A fully adjusted model also showed elevated hsCRP in those with OSA (AHI ≥5) (beta=0.357; p=0.011). Associations with Cystatin-C, D-dimer, and ICAM-1 did not attain significance after adjustments.
Conclusions: Elevation of WBC count and hsCRP in individuals with OSA suggests heightened inflammation and innate immunity as a novel mechanism that links OSA with increased cardiovascular risk.
- Community-based care
- Inflammation and inflammatory markers
- Sleep apnea
- Cardiovascular disease
Author Disclosures: G.R. Geovanini: None. N.S. Jenny: None. R. Wang: None. S.J. Shea: None. J.D. Kaufman: None. M. Allison: None. N.M. Punjabi: None. R. Tracy: None. P. Libby: None. S. Redline: None.
- © 2016 by American Heart Association, Inc.