Obstructive Sleep Apnea Therapy with CPAP Reduces Independently the Levels of A-FABP and CRP

Authors: E. Sovová 1;  M. Hobzová 2;  D. Stejskal 3;  M. Sova 2;  V. Kolek 2;  D. Horáková 4;  J. Zapletalová 5
Authors‘ workplace: LF UP v Olomouci I. interní klinika – kardiologická, Klinika tělovýchovného lékařství a kardiovaskulární rehabilitace FN Olomouc 1;  LF UP v Olomouci Klinika plicních nemocí a tuberkulózy FN Olomouc 2;  LF UP v Olomouci Ústav lékařské chemie a biochemie 3;  LF UP v Olomouci Ústav preventivního lékařství 4;  LF UP v Olomouci Ústav lékařské biofyziky 5
Published in: Cesk Slov Neurol N 2012; 75/108(4): 438-442
Category: Original Paper


Obstructive sleep apnea (OSA) might be associated with metabolic syndrome and cardio­vascular disease (CVD). Adipocyte Fatty Acid-Binding Protein (A-FABP), is a member of a family of nine fatty acid-binding proteins and may represent a connection between OSA and cardiometabolic dysfunction. C-reactive protein (CRP) is a marker of inflammation and a risk factor for CVD. The study aimed to ascertain whether continuous positive airway pressure (CPAP) treatment results in decreased serum A-FABP and CRP levels and their possible asso­ciation.

Subjects and methods:
Eighty-one patients (70 males, mean age of 53.9 ±10.3 years) were evaluated by polysomnography, diagnosed with OSA and indicated for CPAP treatment. Anthropometric, clinical and laboratory investigations were performed and repeated after 1 year of CPAP treatment.

Patients had significantly decreased A-FABP levels (34.4 ng/mL; 24.8 ng/mL; p = 0.001), CRP levels (6.08 ±7.74; 4.29 ±4.9; p = 0.007), triacylglycerols (2.24 ±0.88; 2.13 ±1.32; p = 0.01), diastolic blood pressure (82 ±11; 79 ±7; p = 0.006) and improved OSA parameters: AHI (53.9; 5.6; p <0.0001), mean nocturnal oxygen saturation (91%; 94%, p <0.0001), ODI (55; 8, p <0.0001), and percen­tage of sleep time with oxygen saturation below 90% (28.2; 0; p <0.0001). BMI, waist, neck circumference, systolic blood pressure, total cholesterol, HDL cholesterol, LDL cholesterol, glucose and insulin did not change significantly. Decreases in A-FABP and CRP did not correlate significantly.

CPAP therapy of OSA patients reduces A-FABP and CRP levels. Since changes in A-FABP and CRP do not correlate, they may reflect the effect of various pathological events in the development of CVD.

Key words:
obstructive sleep apnea – Adipocyte Fatty Acid-Binding Protein – C reactive protein


1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disorder breathing among middle-aged adults. N Engl J Med 1993; 328(17): 1230–1235.

2. Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis 2009; 51(5): 434–451.

3. Šonka K, Slonková J. Spánková apnoe dospělého věku. Cesk Slov Neurol N 2008; 71/104(6): 643–656.

4. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004; 160(6): 521–530.

5. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25(9): 735–741.

6. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular. J Am Coll Cardiol 2008; 52(8): 686–717.

7. Jelic S, Le Jemtel TH. Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Cardiovasc Med 2008; 18(7):


8. Peled N, Kassirer M, Kramer MR, Rogowski O, Shlomi D, Fox B et al. Increased erythrocyte adhesiveness and aggregation in obstructive sleep apnea syndrome. Thromb Res 2008; 121(5): 631–636.

9. Ramar K, Caples SM. Vascular changes, cardiovascular disease and obstructive sleep apnea. Future Cardiol 2011; 7(2): 241–249.

10. Guven SF, Turkkani MH, Ciftci B, Ciftci TU, Erdogan Y. The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. Sleep Breath 2012; 16(1): 217–221.

11. Storch J, Corsico B. The emerging functions and mechanisms of mammalian fatty acid-binding proteins. Annu Rev Nutr 2008; 28: 73–95.

12. Tuncman G, Erbay E, Hom X, De Vivo I, Campos H, Rimm EB et al. A genetic variant at the fatty acid binding protein aP2 locus reduces the risk for hypertriglyceridemia, type 2 diabetes and cardiovascular disease. Proc Natl Acad Sci U S A 2006; 103(18): 6970–6975.

13. Tso AW, Xu A, Sham PC, Wat NM, Wang Y, Fong CH et al. Serum adipocyte fatty acid-binding protein as a new biomarker predicting the development of type 2 diabetes: a 10-year prospective study in a Chinese cohort. Diabetes Care 2007; 30(10): 2667–2672.

14. Erbay E, Cao H, Hotamisligil GS. Adipocyte/macrophage fatty acid binding proteins in metabolic syndrome. Curr Atheroscler Rep 2007; 9(3): 222–229.

15. Hsu BG, Chen YC, Lee RP, Lee CC, Wang JH. Fasting serum level of fatty-acid-binding protein 4 positively correlates with metabolic syndrome in pa­tients with coronary artery disease. Circ J 2010; 74(2): 327–331.

16. Makowski L, Boord JB, Maeda K, Babaev VR, Uysal KT, Morgan MA et. al. Lack of macrophage fatty-acid-binding protein aP2 protects mice deficient in apolipoprotein E against atherosclerosis. Nat Med 2001; 7(6): 699–705.

17. Miyoshi T, Onoue G, Hirohata A, Hirohata S, Usui S, Hina K et al. Serum adipocyte fatty acid-binding protein is independently associated with coronary atherosclerotic burden measured by intravascular ultrasound. Atherosclerosis 2010; 211(1): 164–169.

18. Rhee EJ, Lee WY, Park CY, Oh KW, Kim BJ, Sung KC et al. The association of serum adipocyte fatty acid-binding protein with coronary artery disease in Korean adults. Eur J Endocrinol 2009; 160(2): 165–172.

19. Lamounier-Zepter V, Look C, Alvarez J, Christ T, Ravens U, Schunck WH et al. Adipocyte fatty acid-binding protein suppresses cardiomyocyte contraction: a new link between obesity and heart disease. Circ Res 2009; 105(4): 326–334.

20. Krusinova E, Pelikanova T. Fatty acid binding proteins in adipose tissue: a promising link between metabolic syndrome and atherosclerosis? Diabetes Res Clin Pract 2008; 82 (Suppl 2): S127–S134.

21. Tso AW, Lam TK, Xu A, Yiu KH, Tse HF, Li LS et al. Serum adipocyte fatty acid binding protein associated with ischemic stroke and early death. Neurology 2011; 76(23): 1968–1975.

22. Peeters W, de Kleijn DP, Vink A, de Weg S, Schoneveld AH, Ste SK et al. Adipocyte fatty acid binding protein in atherosclerotic plaques is associated with local vulnerability and is predictive for the occurrence of averse cardiovascular events. Eur Heart J 2011; 32(14): 1758–1768.

23. Lam DC, Xu A, Lam KS, Lam B, Lam JC, Lui MM et al. Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance. Eur Respir J 2009; 33(2): 346–351.

24. Bradley TG, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373(9657): 82–93.

25. Lam JC, Lam B, Yao TJ, Lai AY, Ooi CG, Tam S et al. A randomised controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea. Eur Respir J 2010; 35(1): 138–145.

26. Schiza SE, Mermigkis C, Panagiotis P, Bouloukaki I, Kallergis E, Tzanakis N et al. C-reactive protein evolution in obstructive sleep apnoea patients under CPAP therapy. Eur J Clin Invest 2010; 40(11): 968–975.

27. Zhao Q, Liu ZH, Zhao ZH, Luo Q, McEvoy RD, Zhang HL et al. Effects of obstructive sleep apnea and its treatment on cardiovascular risk in CAD patients. Respir Med 2011; 105(10): 1557–1564.

28. Sovova E, Hobzova M, Sova M, Stejskal D, Kolek V, Zapletalova J. Treatment of obstructive sleep apnea with continuous positive airway pressure decreases adipocyte fatty acid-binding protein levels. Biomed Pap Med Fac Univ Palacky Olomouc 2012; 156(1): 58–62.

29. Buchner NJ, Sanner BM, Borgel J, Rump LC. Continous positive airway pressure treatment of mild to moderate obstructive sleep apnea reduces cardiovascular risk. Am J Respir Crit Care Med 2007; 176(12): 1274–1280.

30. Marin JM, Carrizo SJ, Vincente E, Agusti AG. Long--term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observa­tional study. Lancet 2005; 365(9464): 1046–1053.

31. Drager LF, Borlotto LA, Figueiredo AC, Krieger EM, Lorenzi GF. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Care Med 2007; 176(7): 706–712.

32. Atkeson A, Yeh SY, Malhotra A, Jelic S. Endothelial function in obstructive sleep apnea. Prog Cardiovasc Dis 2009; 51(5): 351–362.

33. Horakova D, Stejskal D, Pastucha D, Muchova L, Janout V. Potential markers of insulin resistance in healthy vs obese and overweight subjects. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010; 154(3): 245–250.

34. Biron-Shental T, Schaiff WT, Ratajczak CK, Bildirici I, Nelson DM, Sadovsky Y. Hypoxia regulates the expression of fatty acid-binding proteins in primary term human trophoblasts. Am J Obstet Gynecol 2007; 197(5): 516.e1–516.e6.

35. Bagheri R, Qasim AN, Mehta NN, Terembula K, Kapoor S, Braunstein S et al. Relation of plasma fatty acid bindings proteins 4 and 5 with the metabolic syndrome, inflammation and coronary calcium in pa­tients with type 2 diabetes mellitus. Am J Cardiol 2010; 106(8): 1118–1123.

36. Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M et al. Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. Chest 2007; 132(3): 843–851.

37. Dorkova Z, Petrasova D, Molcanyiova A, Popovnakova M, Tkacova R. Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 2008; 134(4): 686–692.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2012 Issue 4

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account