Abstract

IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA (289.74 ± 23.30 ng/ml) compared to the control group (217.60 ± 21.74 ng/ml, p = 0.028). The increase in IGFBP4 correlated significantly and positively with AHI (r = .574, p = .01) and AI (r = .794, p = .001) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery (225.89 ± 18.16 ng/ml, p = 0.012). This was accompanied by a prominent improvement in OSA (AHI 8.97 ± 2.37 events/h, p = 0.001). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.

Highlights

  • Obstructive sleep apnea (OSA) is a chronic sleep disorder that features fragmented sleep

  • Control participants had a mean age of 5 year, while participants with OSA had a mean age of 43 ± 2 years (p = 0:246)

  • We report a significant increase in circulating IGFBP4 in a group of adults with OSA, and we present IGFBP4 as an OSA biomarker

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Summary

Introduction

Obstructive sleep apnea (OSA) is a chronic sleep disorder that features fragmented sleep. OSA treatment options involve lifestyle modifications, weight reduction, and the use of surgical procedures or external therapies that help keeping an open airway during. In a meta-analysis protocol for bariatric surgery, the consideration of a surgical weight-loss procedure was strongly recommended for treating people with obesity and OSA [9]. The loss of excess weight per se is an important factor to relieve symptoms of OSA, ENT surgical intervention is one of the methods employed for OSA management that demonstrate being effective. These surgeries mitigate symptoms of OSA by enlarging and stabilizing the upper airway to reduce upper airway obstruction [10]. While postsurgery improvement is evident, the mechanisms/biochemical factors that are related to OSA and involved in the postsurgery improvement are yet to be identified

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