The interaction of obstructive sleep apnea and obesity on the inflammatory markers C-reactive protein and interleukin-6: the Icelandic Sleep Apnea Cohort

Sleep. 2012 Jul 1;35(7):921-32. doi: 10.5665/sleep.1952.


Study objectives: To assess the relative roles and interaction of obstructive sleep apnea (OSA) severity and obesity on interleukin-6 (IL-6) and C-reactive protein (CRP) levels.

Design: Cross-sectional cohort.

Setting: The Icelandic Sleep Apnea Cohort.

Participants: 454 untreated OSA patients (380 males and 74 females), mean ± standard deviation age 54.4 ± 10.6 yr.

Interventions: N/A.

Measurements and results: Participants underwent a sleep study, abdominal magnetic resonance imaging to measure total abdominal and visceral fat volume, and had fasting morning IL-6 and CRP levels measured in serum. A significantly higher correlation was found for BMI than visceral fat volume with CRP and IL-6 levels. Oxygen desaturation index, hypoxia time, and minimum oxygen saturation (SaO₂) significantly correlated with IL-6 and CRP levels, but apnea-hypopnea index did not. When stratified by body mass index (BMI) category, OSA severity was associated with IL-6 levels in obese participants only (BMI > 30 kg/m²). A multiple linear regression model with interaction terms showed an independent association of OSA severity with IL-6 levels and an interaction between OSA severity and BMI, i.e., degree of obesity altered the relationship between OSA and IL-6 levels. An independent association of OSA severity with CRP levels was found for minimum SaO₂ only. A similar interaction of OSA severity and BMI on CRP levels was found for males and postmenopausal women.

Conclusions: OSA severity is an independent predictor of levels of IL-6 and CRP but interacts with obesity such that this association is found only in obese patients.

Keywords: C-reactive protein; Obstructive sleep apnea; interleukin-6; obesity; visceral fat.

MeSH terms

  • Abdominal Fat / anatomy & histology
  • Biomarkers / blood
  • Body Mass Index
  • C-Reactive Protein / analysis*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Interleukin-6 / blood*
  • Intra-Abdominal Fat / anatomy & histology
  • Male
  • Middle Aged
  • Obesity / blood
  • Obesity / complications*
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / complications*


  • Biomarkers
  • Interleukin-6
  • C-Reactive Protein