The Changes Of Serum IL-6 And CRP Levels In Patients With OSAHS And OSAHS Associated CHD

Objectives: To investigat the serum interleukin-6(IL-6)andC-reactive protein(CRP) levels in patients with obstructive sleepapnea-hypopnea syndrome(OSAHS)without compilcations andin those with obsturctive sleep apnea-hypopnea syndromeassociated coronary heart disease(OSAHS+CHD). To study thecorrelation between the two biochemical factors and OSAHSand OSAHS+CHD in order to explore the change ofpathophysiology in patients with OSAHS and the pathogenesisand predictor of OSAHS+CHD.Methods: Forty males with OSAHS were includedrandomly in the study, who were made a diagnosis by usingpolysomnography. The standard of diagnosis according todiagnostic standard formulated by group of sleep-breath diseaseto Chinese Medical Association. All patients with OSAHS weredivided into two groups: 26 OSAHS patients withoutcomplications (age= 45.85±9.29, BMI=29.68±2.28kg/m²)and14 OSAHS+CHD patients(age =50.43±9.19, BMI=30.30±3.20kg/m²). Occurrence of CHD was later than OSAHS inpatients with OSAHS+CHD. The standard of diagnosisaccording to clinical diagnostic standard formulated byISFC/WHO in 1979. There were 20 man in control subjects (age=45.50±10.25, BMI=28.76±2.02kg/m2), who were excludedOSAHS and CHD. There were no significant differences in ageand BMI among control subjects, OSAHS and OSAHS+CHD.Smoking, drinking, diets, drugs and other disturbance factorswere excluded in this study. All observed subjects in this studywere excluded infection, liver and nephridium disease,rheumatic disease, cerebrovascular, malignancy, diabetesmellitus, hypertension and other diseases which can elevate theserum IL-6 and CRP levels. Fasting venous blood were obtainedfrom all observed subjects after sleep-breathing monitoringwithin the following 5 minutes in the next morning. Serum IL-6and CRP concentrations were measured by ELISA and recordthe sleep-breathing parameters, including apnea hypopneaindex(AHI), percentage of sleep time below 90% oxygensaturation(SaO2<90%), percentage of sleep time the totalduration of apnea/hypopnea, the lowest SaO2, average lowestSaO2 and the longest duration of apnea/hypopnea. Serum IL-6and CRP levels were compared respectively among controlsubjects, OSAHS and OSAHS+CHD patients. Sleep-breathingparameters of the later two groups were also comparedrespectively. Furthermore, to analyze the correlations betweenthe two factors and sleep-breathing parameters in OSAHS andOSAHS+CHD patients, respectively.Results: 1. Serum IL-6 and CRP concentrations were 17.83±11.03pg/ml, 0.47 ±0.36mg/L in control subjects, were35.17±17.84pg/ml, 1.84±1.13mg/L in OSAHS patients and58.00±33.70pg/ml, 3.43±1.76mg/L in OSAHS+CHD patients,respectively. Serum IL-6 and CRP were both higher inOSAHS patients than control subjects and there were statisticalsignificances(q=3.936, p<0.01; q=5.668, p<0.01). There weresimilar results in patients with OSAHS+CHD compared withcontrol subjects (q=7.780, p<0.01; q=10.478, p<0.01)and inpatients with OSAHS+CHD compared with OSAHSpatients(q=4.647, p<0.01; q=5.920, p<0.01). 2. Compared withOSAHS patients, all AHI, SaO2<90% and percentage of sleeptime the total duration of apnea/hypopnea were higher inOSAHS+CHD patients(t=2.190, p<0.05; t=2.583, p<0.05;t=2.197, p<0.05), both the lowest SaO2 and average lowest SaO2were lower in OSAHS+CHD patients (t=3.008, p<0.01; t=2.410,p<0.05). But there were no differences in the longest duration ofapnea/hypopnea between the two groups(t=1.724; p>0.05). 3.The serum IL-6 levels were correlated positively with serumCRP levels in both OSAHS and OSAHS+CHD patients(r=0.608,p<0.01; r=0.583, p<0.05). 4.The linear correlations were foundbetween the two factors and sleep-breathing parameters inpatients with OSAHS and OSAHS+CHD as follows: â‘ Theserum IL-6 levels were correlated positively with AHI both inOSAHS and OSAHS+CHD patients (r=0.574, p<0.01; r=0.611,p<0.05), were correlated positively with SaO2<90%(r=0.618,p<0.01; r=0.606, p<0.05), were correlated positively withpercentage of sleep time the total duration ofapnea/hypopnea(r=0.556, p<0.01; r=0.655, p<0.05),werecorrelated negatively with the lowest SaO2(r=-0.613, p<0.01;r=-0.647, p<0.05), were correlated negatively with the averagelowest SaO2(r=-0.545, p<0.01; r=-0.582, p<0.05) and were nocorrelated with longest duration of apnea/hypopnea(r=0.234,p>0.05; r=0.099, p>0.05).â‘¡The correlations between serumCRP and sleep-breathing parameters were as same as serumIL-6. CRP levels in both OSAHS and OSAHS+CHD pantientswere correlated positively with AHI(r=0.765, p<0.01; r=0.727,p<0.01), were correlated positively with SaO2<90%(r=0.684,p<0.01; r=0.565, p<0.05), were correlated positively withpercentage of sleep time the total duration ofapnea/hypopnea(r=0.724, p<0.01; r=0.590, p<0.05),werecorrelated negatively with the lowest SaO₂(r=-0.692, p<0.01;r=-0.644, p<0.05), were correlated negatively with the averagelowest SaO₂(r=-0.623, p<0.01; r=-0.588, p<0.05)and were nocorrelated with longest duration of apnea/hypopnea(r=0.252,p>0.05; r=0.079, p>0.05). 4. In the three groups both serum IL-6and CRP levels were correlated positively with BMI(controlpatients: r=0.701, p<0.01; r=0.671, p<0.01; OSAHS: r=0.609,p<0.01; r=0.466, p<0.05; OSAHS+CHD: r=0.697, p<0.01;r=0.547, p<0.05).Conclusions: 1. Despite controlling for age, BMI andexcluding disturbance factors such as smoking, drinking, dietsand drugs, the serum IL-6, CRP concentrations in patients withOSAHS and OSAHS+CHD were higher than those in controlsubjects. The two factors levels were both correlated positively...