title: Sleepiness, inflammation and oxidative stress markers in middle-aged males with obstructive sleep apnea without metabolic syndrome: a cross-sectional study.
abstract: BACKGROUND
  The simultaneous occurrence of metabolic syndrome and excessive daytime sleepiness are very common in obstructive sleep apnea (OSA) patients. Both conditions, if present in OSA, have been reported to be associated with inflammation and disruption of oxidative stress balance that impair the cardiovascular system. To verify the impact of daytime sleepiness on inflammatory and oxidative stress markers, we evaluated OSA patients without significant metabolic disturbance.
  
  
  METHODS
  Thirty-five male subjects without diagnostic criteria for metabolic syndrome (Adult Treatment Panel III) were distributed into a control group (n = 10) (43 ± 10.56 years, apnea-hypopnea index - AHI 2.71 ± 1.48/hour), a non-sleepy OSA group (n = 11) (42.36 ± 9.48 years, AHI 29.48 ± 22.83/hour) and a sleepy OSA group (n = 14) (45.43 ± 10.06 years, AHI 38.20 ± 25.54/hour). Excessive daytime sleepiness was considered when Epworth sleepiness scale score was ≥ 10. Levels of high-sensitivity C-reactive protein, homocysteine and cysteine, and paraoxonase-1 activity and arylesterase activity of paraoxonase-1 were evaluated.
  
  
  RESULTS
  Patients with OSA and excessive daytime sleepiness presented increased high-sensitivity C-reactive protein levels even after controlling for confounders. No significant differences were found among the groups in paraoxonase-1 activity nor arylesterase activity of paraoxonase-1. AHI was independently associated and excessive daytime sleepiness tended to have an association with high-sensitivity C-reactive protein.
  
  
  CONCLUSIONS
  In the absence of metabolic syndrome, increased inflammatory response was associated with AHI and daytime sleepiness, while OSA was not associated with abnormalities in oxidative stress markers.
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. d.andaku@terra.com.br.
authors.forename: Daniela Kuguimoto
authors.initials: DK
authors.lastname: Andaku
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. vaniadalmeida@uol.com.br.|, Rua Napoleão de Barros, 925, CEP 04024-002, São Paulo, SP, Brazil. vaniadalmeida@uol.com.br.
authors.forename: Vânia
authors.initials: V
authors.lastname: D'Almeida
authors.affiliation: Department of Medicine, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. glauciacarneiro@uol.com.br.
authors.forename: Gláucia
authors.initials: G
authors.lastname: Carneiro
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. soniahix@uol.com.br.|Department of Morphology and Physiology, Faculdade de Medicina do ABC-FUABC, Santo André, SP, Brazil. soniahix@uol.com.br.
authors.forename: Sônia
authors.initials: S
authors.lastname: Hix
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. sergio.tufik@unifesp.br.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil. sonia.togeiro@sono.org.br.
authors.forename: Sônia Maria
authors.initials: SM
authors.lastname: Togeiro
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis*; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D010641:Phenotype; D012737:Sex Factors; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein