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CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role?

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Abstract

Background—aim

C-reactive protein (CRP) is directly implicated in atherogenesis and associated cardiovascular morbidity in patients with obstructive sleep apnea (OSA). Effective continuous positive airway pressure (CPAP) treatment has been shown to gradually decrease CRP levels and thus consequently improve disease-related cardiovascular morbidity. However, the influence of gender on the CRP evolution pattern has never been assessed before. The aim of our study was to investigate possible gender differences in CRP evolution in OSA patients 3 and 6 months after the start of effective CPAP treatment.

Methods

The study population consisted of 436 patients (252 males/184 females) with newly diagnosed moderate to severe OSA and good CPAP compliance assessed by a thorough follow up. High-sensitivity C-reactive protein (hs-CRP) was assessed before CPAP initiation and at the third and sixth month of the follow-up period.

Results

C-reactive protein values showed a statistically significant decrease at the third and sixth month of CPAP therapy [initial values 0.79 ± 0.65 mg/dL versus 0.70 ± 0.52 mg/dL (p < 0.05) after 3 months and 0.30 ± 0.33 mg/dL (p < 0.001) after 6 months of CPAP therapy]. When patients were divided into males and females, the above evolution pattern was changed. At the third month time point, the CRP values showed a statistically significant decrease only in males (from 0.74 ± 0.53 mg/dL to 0.61 ± 0.5 mg/dL, p < 0.01) while females showed only minimal and insignificant changes (from 0.87 ± 0.79 mg/dL to 0.83 ± 0.51 mg/dL, p > 0.05). After 6 months’ treatment, CRP decreased significantly in both genders (males from 0.74 ± 0.53 mg/dL to 0.28 ± 0.32 mg/dL, p < 0.001 and females from 0.87 ± 0.79 mg/dL to 0.34 ± 0.36 mg/dL, p < 0.001).

Conclusion

Our results suggest a delay in the normalization of CRP levels in females despite effective CPAP treatment. A time period of at least 6 months appeared to be required in women in order to reduce CRP levels and consequent cardiovascular risk. In contrast, CPAP’s protective role in males is achieved at an earlier time point. Gender-related hormonal and genetic factors may influence the above CRP evolution pattern.

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Author information

Authors and Affiliations

  1. Sleep Disorders Unit, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Voutes, 71110, Greece

    Izolde Bouloukaki, Eleni Mavroudi, Eleni Tzortzaki, Nikolaos Siafakas & Sophia E. Schiza

  2. Sleep Disorders Center, Pulmonary Department, 401 General Army Hospital, Athens, Greece

    Charalampos Mermigkis & Demetrios Mermigkis

  3. Department of Cardiology, University General Hospital, Voutes, 71110, Heraklion, Crete, Greece

    Eleftherios Kallergis

  4. Sleep Disorders Center, Henry Dunant Hospital, Athens, Greece

    Charalampos Mermigkis & Georgios Varouchakis

  5. Thrakis 61A, Brilissia, Athens, Greece

    Charalampos Mermigkis

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  1. Charalampos Mermigkis
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  2. Izolde Bouloukaki
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Correspondence to Charalampos Mermigkis.

Additional information

Charalampos Mermigkis and Izolde Bouloukaki made an equal contribution to this study.

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Mermigkis, C., Bouloukaki, I., Mermigkis, D. et al. CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role?. Sleep Breath 16, 813–819 (2012). https://doi.org/10.1007/s11325-011-0580-3

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