Comprehensive biomarker profiling in patients with obstructive sleep apnea

Clin Biochem. 2015 Mar;48(4-5):340-6. doi: 10.1016/j.clinbiochem.2014.09.005. Epub 2014 Sep 16.


Objectives: The pathophysiological links between obstructive sleep apnea syndrome (OSAS) and cardiovascular mortality are incompletely understood. We aimed to contribute to a better characterization by using comprehensive biomarker profiling quantifying hemodynamic cardiac stress, cardiomyocyte injury, inflammation, endothelial function, matrix turnover and metabolism.

Design and methods: In 65 patients with moderate or severe OSAS [apnea-hypopnea index (AHI) 39±20/h] and 33 patients with no or mild OSAS (AHI 8+4/h), B-type natriuretic peptide (BNP), N-terminal-pro-BNP (NT-proBNP), high-sensitivity cardiac troponin I (hs-cTnI), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), and insulin were measured before and after sleep. In a subgroup measurements were repeated in a second night with continuous positive airway pressure (CPAP).

Results: Patients with moderate/severe OSAS had higher insulin before sleep [median (interquartile range), 36.4 (21.9-52.1) vs. 20.8 (10.6-32.8)mU/mL; p=0.006], higher IL-6 after sleep [1.00 (0.73-1.58) vs. 0.72 (0.48-0.94)pg/mL; p=0.005], and larger relative overnight reduction in BNP [-9 (-35-0) vs. -3 (-21-13)%; p=0.04] than those with mild/no OSAS. Insulin before sleep was the only independent predictor of moderate/severe OSAS. Insulin before and IL-6 after sleep were independent predictors of severe OSAS, and when combined provided high diagnostic accuracy for severe OSAS (area under the receiver operator characteristic curve 0.80; 95%-confidence interval 0.69-0.91). In contrast, there were no significant differences in NT-proBNP, hs-cTnI, VEGF, and MMP-9 between moderate/severe and mild/no OSAS. Short-term CPAP had no impact on biomarker concentrations before and after sleep.

Conclusions: Significant OSAS is characterized by a distinct biomarker profile including high insulin before and high IL-6 after sleep.

Keywords: Biomarkers; Diurnal changes; Multimarker; Obstructive sleep apnea syndrome.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Female
  • Humans
  • Insulin / blood*
  • Interleukin-6 / blood*
  • Male
  • Middle Aged
  • Polysomnography / methods
  • Prospective Studies
  • Sleep Apnea, Obstructive / blood*
  • Sleep Apnea, Obstructive / diagnosis*
  • Vascular Endothelial Growth Factor A / blood


  • Biomarkers
  • IL6 protein, human
  • Insulin
  • Interleukin-6
  • Vascular Endothelial Growth Factor A