title: C-reactive protein and carotid intima-media thickness in children with sleep disordered breathing.
abstract: OBJECTIVE
  Obesity is a risk factor for sleep disordered breathing (SDB) in children. Plasma levels of high-sensitivity C-reactive protein (Hs-CRP) are predictive of cardiovascular morbidity in adults, and CRP levels are associated with over-weight. Increased carotid intima-media thickness (IMT) is associated with several cardiovascular risk factors. We evaluated the effect of SDB on CRP levels and IMT in lean and obese children not selected for snoring.
  
  
  METHODS
  101 children (age 5-15 years) attending a weight clinic or scheduled for routine visit. IMT was measured with quantitative B-mode ultrasound scans. The apnea-hypopnea index (AHI) was measured overnight: AHI < 1 defined controls, AHI ≥ 1 to < 5 = mild SDB, and AHI ≥ 5 = obstructive sleep apnea (OSA).
  
  
  RESULTS
  AHI was significantly associated with Hs-CRP concentration (r = 0.32, p = 0.002) in all 101 children irrespective of age and sex. Body mass index (BMI) was higher in OSA children than controls (25.5 ± 7.0 vs 22.1 ± 6.9, p = 0.05). Obese children had 3.3 times more probability of having OSA (HR 3.3, 95% CI 1.2-9.3, p = 0.02) than lean children. Hs-CRP values were significantly higher in children with OSA than in children without (p = 0.011), but not when BMI z-score was added as covariate. IMT was not associated with AHI or SDB.
  
  
  CONCLUSIONS
  The results of this study suggest an association between OSA and Hs-CRP concentrations (mainly mediated by overweight and obesity), but not between OSA and subclinical atherosclerosis. There is scope for prevention in childhood before OSA syndrome causes the irreversible damage to arteries observed in adult patients.
authors.affiliation: Department of Internal Medicine, A. Cardarelli Hospital, Naples, Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Iannuzzi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Licenziati
authors.forename: Fausto
authors.initials: F
authors.lastname: De Michele
authors.forename: Maria Carmela
authors.initials: MC
authors.lastname: Verga
authors.forename: Carlo
authors.initials: C
authors.lastname: Santoriello
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Buono
authors.forename: Maurizio
authors.initials: M
authors.lastname: Renis
authors.forename: Loredana
authors.initials: L
authors.lastname: Lembo
authors.forename: Bruno
authors.initials: B
authors.lastname: D'Agostino
authors.forename: Donato
authors.initials: D
authors.lastname: Cappetta
authors.forename: Mario
authors.initials: M
authors.lastname: Polverino
authors.forename: Francesca
authors.initials: F
authors.lastname: Polverino
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis*; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications; D015588:Observer Variation; D017286:Polysomnography / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000097:blood* / Q000150:complications
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; intima-media thickness; obstructive sleep apnea