Obesity modulates the association between sleep apnea treatment and CHI3L1 levels but not CHIT1 activity in moderate to severe OSA: an observational study

Unnur Dilja Teitsdottir,Thorarinn Gislason,Petur Henry Petersen,Erla Bjornsdottir,Erna Sif Arnardottir

doi:10.1007/s11325-018-1731-6

Unnur Dilja Teitsdottir, Thorarinn Gislason + Show 3 more

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https://doi.org/10.1007/s11325-018-1731-6

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Abstract

PurposeThe inflammatory markers chitinase-3-like protein 1 (CHI3L1) and chitotriosidase (CHIT1) have both been associated with cardiovascular complications. The aim of this preliminary observational study was to assess the roles and interaction of obstructive sleep apnea (OSA) severity and body mass index (BMI) with plasma CHI3L1 levels and CHIT1 activity in patients with moderate to severe OSA. The second aim was to assess the roles and interaction of positive airway pressure (PAP) treatment and BMI on the expression of the same proteins.MethodsThe study included 97 OSA patients with an apnea–hypopnea index (AHI) ≥ 15 and full usage of PAP treatment after 4 months. Plasma CHI3L1 levels and CHIT1 activity were measured before and after treatment.ResultsMultiple linear regression analysis demonstrated an independent association of BMI on CHI3L1 levels (p < 0.05) but not on CHIT1 activity. The OSA severity markers (AHI and oxygen desaturation index) did not independently or in interaction with BMI levels associate with CHI3L1 levels or with CHIT1 activity (p > 0.05). A two-way repeated measures ANOVA revealed a significant interaction between PAP treatment effect (before vs. after) and BMI groups (< 35 kg/m2 vs. ≥ 35 kg/m2) on CHI3L1 levels (p = 0.03) but not on CHIT1 activity (p = 0.98).ConclusionsObesity independently associated with CHI3L1 levels. Association between OSA severity and CHI3L1 levels or CHIT1 activity (independent of or dependent on obesity level) could not be confirmed. However, decrease was observed in CHI3L1 levels after PAP treatment in severely obese OSA patients but not in those less obese.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Iceland, Reykjavik, Iceland 4 Reykjavik University, Reykjavik, IcelandObstructive sleep apnea (OSA) is a common disorder characterized by periodic reduction or cessation of airflow due to narrowing of the upper airway during sleep
The obstructive sleep apnea (OSA) severity markers (AHI and oxygen desaturation index) did not independently or in interaction with body mass index (BMI) levels associate with chitinase-3-like protein 1 (CHI3L1) levels or with CHIT1 activity (p > 0.05)
A two-way repeated measures ANOVA revealed a significant interaction between positive airway pressure (PAP) treatment effect and BMI groups (< 35 kg/m2 vs. ≥ 35 kg/m2) on CHI3L1 levels (p = 0.03) but not on CHIT1 activity (p = 0.98)

Summary

Introduction

OSA can effectively be treated with positive airway pressure (PAP) treatment [1]. Untreated OSA patients are at increased risk of developing cardiovascular complications such as hypertension, stroke, and cardiovascular disease [2]. Obesity is an important risk factor for both OSA and cardiovascular events. Obesity and OSA activate similiar biological pathways of sympathetic activity, oxidative stress, and low-grade systemic inflammation [3]. It has been a challenge separating the independent roles of OSA on cardiovascular disorders from those of obesity. It is likely that the role of OSA in cardiovascular disease is to some degree dependent on obesity. In our previous publications [4,5,6], we have found a moderating effect of obesity on how

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