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

Sleep Breath. 2018 Dec;22(4):1101-1109. doi: 10.1007/s11325-018-1731-6. Epub 2018 Oct 11.


Purpose: The 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.

Methods: The 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.

Results: Multiple 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).

Conclusions: Obesity 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.

Keywords: Chitinase-3-like protein 1; Chitotriosidase; Obesity; Obstructive sleep apnea; Positive airway pressure.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Biomarkers / blood
  • Body Mass Index
  • Chitinase-3-Like Protein 1 / blood*
  • Comorbidity
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Obesity / blood*
  • Obesity / complications
  • Obesity / therapy*
  • Polysomnography
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / blood*
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / therapy*
  • Treatment Outcome


  • Biomarkers
  • CHI3L1 protein, human
  • Chitinase-3-Like Protein 1