Blood biomarkers of endocrine, immune, inflammatory, and metabolic systems in obstructive sleep apnea

• Published in: Clinical biochemistry Vol. 49; no. 12; pp. 854 - 861
• Main Authors: Fleming, Wesley Elon, Ferouz-Colborn, Aliya, Samoszuk, Michael K., Azad, Armaghan, Lu, Jiuliu, Riley, John S., Cruz, Amabelle B., Podolak, Susann, Clark, Doni J., Bray, Kurtis R., Southwick, Paula C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adult; Biomarkers; Biomarkers - blood; CRP; Diagnosis; Endocrine System Diseases - blood; Endocrine System Diseases - diagnosis; Endocrine System Diseases - etiology; Erythropoietin; Follow-Up Studies; HbA1c; Humans; Immune System Diseases - blood; Immune System Diseases - diagnosis; Immune System Diseases - etiology; Inflammation - blood; Inflammation - diagnosis; Inflammation - etiology; Male; Metabolic Syndrome - blood; Metabolic Syndrome - diagnosis; Metabolic Syndrome - etiology; Middle Aged; Obstructive sleep apnea; OSA; Polysomnography; Prognosis; Prospective Studies; ROC Curve; Screening; Sleep Apnea, Obstructive - blood; Sleep Apnea, Obstructive - complications; CRP; Screening; Erythropoietin; Biomarkers; Diagnosis; OSA; Obstructive sleep apnea; HbA1c
• ISSN: 0009-9120; 1873-2933; 1873-2933
• DOI: 10.1016/j.clinbiochem.2016.05.005

Obstructive sleep apnea (OSA) is a common disorder, affecting over 100 million adults. Untreated OSA leads to serious health consequences and perturbations in endocrine, immune, inflammatory, and metabolic systems. Study objectives are to evaluate the association between OSA and biomarkers, and to test the hypothesis that a combination of markers may be useful in screening for OSA. A multicenter trial was conducted enrolling symptomatic male patients with suspected OSA. All subjects underwent in-laboratory overnight polysomnography. A non-symptomatic control group was also obtained. Eleven biomarkers were tested: HbA1c, CRP, EPO, IL-6, uric acid, cortisol, hGH, prolactin, testosterone, DHEA (Beckman Coulter UniCel DxC 600i Synchron® Access® Clinical Systems), IGF-1. 73 male subjects were enrolled; 26 had moderate/severe OSA. ROC curve analysis showed HbA1c, CRP, EPO, IL-6, and Uric Acid (AUCs: 0.76, 0.73, 0.65, 0.65, 0.61) were superior to the Epworth Sleepiness Scale (AUC: 0.52). Concurrent elevation of HbA1c and CRP provide even greater predictive power. A combination of elevated HbA1c, CRP, and EPO provided 0.08 increase in AUC (0.84 [0.75 - 0.94]) over individual markers (p<0.05), with high sensitivity (85%), and specificity (79%) for moderate/severe OSA. OSA induces characteristic endocrine, immune, inflammatory, and metabolic disturbances that can be detected with blood biomarkers. These biomarkers are superior to standard screening questionnaires. Various clusters of these biomarkers have an even greater association with OSA and thus may represent physiologic signatures of the disorder that may have value in initial screening for OSA as well as for follow-up of therapy response. •Significant health issues are associated with obstructive sleep apnea (OSA)•Blood biomarkers identify OSA-induced endocrine, immune, inflammatory, and metabolic system changes•Prospective multicenter trial, 73 subjects•Clusters of biomarkers may represent physiologic signatures of OSA that may have value in screening•Biomarkers are superior to standard screening questionnaires