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The association between biomarker angiopoietin-like protein five and obstructive sleep apnea in patients undergoing bariatric surgery

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is prevalent in the bariatric population. OSA should be recognized in patients undergoing bariatric surgery preoperatively to prevent peri- and post-operative complications. Lipid metabolism-related biomarkers are associated with OSA. Triglyceride metabolism is, among others, regulated by angiopoietin-like protein five (ANGPTL5). We aimed to evaluate the level of ANGPTL5 in patients with OSA of different severity levels before and after bariatric surgery.

Methods

We performed a single-center prospective cohort study including a consecutive series of patients who underwent bariatric surgery. We collected the clinical data, polysomnography (PSG) or polygraphy (PG) parameters, and plasma derived via venipuncture before and 6 to 12 months after surgery. Lipid profile, glucose levels, and ANGPTL5 levels were assessed. ANGPTL5 levels were measured using an enzyme-linked immunosorbent assay (ELISA).

Results

The study included 88 patients for analysis. The patients were divided into two subgroups: no or mild OSA (apnea–hypopnea index (AHI) < 15 events/hour, n = 57) and moderate-to-severe OSA (AHI ≥ 15 events/hour, n = 31). The ANGPTL5 level was higher in the moderate-to-severe OSA group (20.5 [15.6, 26.5] ng/mL) compared to the no or mild OSA group (16.3 [12.5, 19.4] ng/mL) (p = 0.008). A significant positive correlation was observed between ANGPTL5 and AHI (ρ = 0.256, p = 0.017), apnea index (AI) (ρ = 0.318, p = 0.003), and triglyceride levels (ρ = 0.240, p = 0.025). ANGPTL5 levels were reduced significantly after bariatric surgery in both moderate-to-severe OSA (15.6 [10.3, 18.7] ng/mL) and no or mild OSA (13.4 [9.2, 15.8] ng/mL) groups, though to a lower level in the group without or mild OSA. Post-surgery, the significant positive correlation between ANGPTL5 and AHI (ρ = 0.210, p = 0.047), AI (ρ = 0.230, p = 0.034), and triglyceride (ρ = 0.397, p < 0.001) remained.

Conclusion

The data showed increased levels of ANGPTL5 in patients with moderate-to-severe OSA. Both AHI and ANGPTL5 levels decreased significantly after bariatric surgery. We also report an association between ANGPTL5 levels and OSA severity.

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Abbreviations

AHI:

Apnea-hypopnea index

AI:

Apnea index

ANGPTL:

Angiopoietin-like protein

AUC:

Area under the curve

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

CVD:

Cardiovascular disease

DDI:

Dasman Diabetes Institute

ELISA:

Enzyme-linked immunosorbent assay

HbA1C:

Glycosylated haemoglobin, type A1C

HDL:

High-density lipoprotein

HI:

Hypopnea index

HIF:

Hypoxemia-inducible factor 1

HsCRP:

High sensitivity C-reactive protein

LDL:

Low-density lipoprotein

LPL:

Lipoprotein lipase

LRYGB:

Laparoscopic Roux-en-Y gastric bypass

LSG:

Laparoscopic sleeve gastrectomy

OSA:

Obstructive sleep apnea

PG:

Polygraphy

PSG:

Polysomnography

ROC:

Receiver Operating Characteristic

T2D:

Type 2 diabetes

TGL:

Triglyceride

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Authors and Affiliations

  1. Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands

    M. Leentjens, P. F. N. Bosschieter & N. de Vries

  2. Department of Otolaryngology - Head & Neck Surgery, Medical Division, Dasman Diabetes Institute, Kuwait City, Kuwait

    Abdulmohsen Al-Terki

  3. Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands

    C. A. L. de Raaff

  4. Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands

    C. E. E. de Vries

  5. Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman, P.O. Box 1180, 15462, Kuwait City, Kuwait

    Maha Hammad, Irina Al-Khairi, Preethi Cherian, Mohamed Abu-Farha & Jehad Abubaker

  6. Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait

    Thangavel Alphonse Thanaraj & Arshad Channanath

  7. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands

    N. de Vries

  8. Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium

    N. de Vries

Authors
  1. M. Leentjens
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  2. P. F. N. Bosschieter
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  3. Abdulmohsen Al-Terki
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  4. C. A. L. de Raaff
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  5. C. E. E. de Vries
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  6. Maha Hammad
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  7. Thangavel Alphonse Thanaraj
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  8. Irina Al-Khairi
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  9. Preethi Cherian
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  10. Arshad Channanath
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  11. Mohamed Abu-Farha
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  12. N. de Vries
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Correspondence to Mohamed Abu-Farha.

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Leentjens, M., Bosschieter, P.F.N., Al-Terki, A. et al. The association between biomarker angiopoietin-like protein five and obstructive sleep apnea in patients undergoing bariatric surgery. Sleep Breath 27, 1443–1454 (2023). https://doi.org/10.1007/s11325-022-02736-6

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  • DOI: https://doi.org/10.1007/s11325-022-02736-6

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