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VOLUME 13 , ISSUE 5 ( September-October, 2022 ) > List of Articles


Salivary C-reactive Protein as a Biomarker in Children with Sleep Disorders: An Evaluative Study

Nagashree Prabhu, Vabitha Shetty

Keywords : Biomarkers, Children, C-reactive protein, Saliva, Sleep disorders

Citation Information : Prabhu N, Shetty V. Salivary C-reactive Protein as a Biomarker in Children with Sleep Disorders: An Evaluative Study. World J Dent 2022; 13 (5):498-502.

DOI: 10.5005/jp-journals-10015-2087

License: CC BY-NC 4.0

Published Online: 22-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To evaluate salivary C-reactive protein (CRP) levels in children with skeletal class II malocclusion and with a positive history of sleep disorders. Materials and methods: Twenty-one children aged 8–12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study (group I). Twenty-one age and gender-matched children with no skeletal malocclusion and no reported history of sleep disorders served as a comparison group (group II). All children were evaluated regarding their sleep history and clinically examined to determine craniofacial morphology. Children of group I were subjected to a radiographic assessment including evaluation of airway space. Unstimulated saliva was collected from all children. Salivary CRP was measured using CRP LEIT kit (Agappe) with calibrator, which is a latex-enhanced turbidimetric immunoassay. Statistical analysis for intergroup comparison (two groups) for normally distributed data was done using t-test. Results: There was a significantly higher level of salivary CRP, in children of group I when compared to that of group II children (p < 0.01). Conclusion: Salivary CRP may be a simple and noninvasive tool in the identification and screening of children at high risk for sleep disorders. Clinical significance: Routine salivary CRP monitoring could be a valuable biomarker in early recognition and treatment sleep disorders in children.

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  1. Asker S, Asker M, Sarikaya E, et al. Oxidative stress parameters and their correlation with clinical, metabolic and polysomnographic parameters in severe obstructive sleep apnea syndrome. Int J Clin Exp Med 2015;8(7):11449–11455.
  2. Gozal D. Sleep, sleep disorders and inflammation in children. Sleep Med 2009;10(Suppl 1):S12–S16. DOI: 10.1016/j.sleep.2009.07.003
  3. Takahashi Y, Kipnis DM, Daughaday WH. Growth hormone secretion during sleep. J Clin Investig 1968;47(9):2079–2090. DOI: 10.1172/JCI105893
  4. Dahl R. The impact of inadequate sleep on children's daytime cognitive function. Semin Pediatr Neurol 1996;3(1):44–50. DOI: 10.1016/s1071-9091(96)80028-3
  5. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998;102(3):616–620. DOI: 10.1542/peds.102.3.616
  6. Archontogeorgis K, Nena E, Papanas N, et al. Biomarkers to improve diagnosis and monitoring of obstructive sleep apnea syndrome: current status and future perspectives. Pulm Med 2014;2014:930535. DOI: 10.1155/2014/930535
  7. Marcus CL, Brooks LJ, Ward SD, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130(3):e714–e755. DOI: 10.1542/peds.2012-1672
  8. Spruyt K, Gozal D. Screening of Pediatric sleep-disordered breathing: a proposed unbiased discriminative set of questions using clinical severity scales. Chest 2012;142(6):1508–1515. DOI: 10.1378/chest.11-3164
  9. Gozal D. Serum, urine, and breath-related biomarkers in the diagnosis of obstructive sleep apnea in children: is it for real? Curr Opin Pulm Med 2012;18(6):561–567. DOI: 10.1097/MCP.0b013e328358be2d
  10. Lamm C, Mandeli J, Kattan M. Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children. Pediatr Pulmonol 1999;27(4):267–272. DOI: 10.1002/(sici) 1099-0496(199904)27:4<267::aid-ppul7>;2-x
  11. Sivan Y, Kornecki A, Schonfeld T. Screening obstructive sleep apnoea syndrome by home videotape recording in children. Eur Respir J 1996;9(10):2127–2131. DOI: 10.1183/09031936.96.09102127
  12. Brouillette RT, Morielli A, Leimanis A, et al. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000;105(2):405–412. DOI: 10.1542/peds.105.2.405
  13. Andreu AL, Chiner E, Sancho-Chust JN, et al. Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea. Eur Respir J 2012;39(2):305–312. DOI: 10.1183/09031936.00013311
  14. Peker Y, Hedner J, Norum J, et al. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 2002;166(2):159–165. DOI: 10.1164/rccm.2105124
  15. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448–454. DOI: 10.1056/NEJM199902113400607
  16. Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol 2018;9:754. DOI: 10.3389/fimmu.2018.00754
  17. Li K, Wei P, Qin Y, et al. Is C-reactive protein a marker of obstructive sleep apnea?: a meta-analysis. Medicine 2017;96(19):e6850. DOI: 10.1097/MD.0000000000006850
  18. Meier-Ewert HK, Ridker PM, Rifai N, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004;43(4):678–683. DOI: 10.1016/j.jacc.2003.07.050
  19. Huynh NT, Morton PD, Rompre PH, et al. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop 2011;140(6):762–770. DOI: 10.1016/j.ajodo.2011.03.023
  20. Kim J, Bhattacharjee R, Dayyat E, et al. Increased cellular proliferation and inflammatory cytokines in tonsils derived from children with obstructive sleep apnea. Pediatr Res 2009;66(4):423–428. DOI: 10.1203/PDR.0b013e3181b453e3
  21. Anusha Y, Shetty V, Hegde AM. Correlation of nutritional status to sleep problems in school going children: a preliminary study. Indian J Sleep Med 2018;13(1):1–4. DOI: 10.5005/jp-journals-10069-0015
  22. Patacchioli FR, Tabarrini A, Ghiciuc CM, et al. Salivary biomarkers of obstructive sleep apnea syndrome in children. Pediatr Pulmonol 2014;49(11):1145–1152. DOI: 10.1002/ppul.22972
  23. Katyal V, Pamula Y, Daynes CN, et al. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013;144(6):860–871. DOI: 10.1016/j.ajodo.2013.08.015
  24. Growth Reference 5–19 Years—BMI-for-age (5–19 Years); 2021.
  25. Yamuna Priya K, Muthu Prathibha K. Methods of collection of saliva—a review. Int J Oral Health Dent 2017;3(3):149–148. DOI: 10.18231/2395-499X.2017.0032
  26. Zeigenhagen G, Drahovshy D. Klinishe Bedeutung des C-reaktive protein. Med klin 1983;78:45–50.
  27. Tauman R, Ivanenko A, O'Brien LM, et al. Plasma C-reactive protein levels among children with sleep-disordered breathing. Pediatrics 2004;113(6):e564–e569.
  28. Larkin EK, Rosen CL, Kirchner HL, et al. Variation of C-reactive protein levels in adolescents: association with sleep-disordered breathing and sleep duration. Circulation 2005;111(15):1978–1984. DOI: 10.1161/01.CIR.0000161819.76138.5E
  29. Kaditis AG, Alexopoulos EI, Kalampouka E, et al. Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. Am J Respir Crit Care Med 2005;171(3):282–286. DOI: 10.1164/rccm.200407-928OC
  30. Cao Y, Song Y, Ning P, et al. Association between tumor necrosis factor alpha and obstructive sleep apnea in adults: a meta-analysis update. BMC Pulm Med 2020;20(1):1–7. DOI: 10.1186/s12890-020-01253-0
  31. Gozal D, Kheirandish-Gozal L, Bhattacharjee R, et al. C-reactive protein and obstructive sleep apnea syndrome in children. Front Biosci (Elite Ed) 2012;4(7):2410–2422. DOI: 10.2741/e553
  32. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health 2015;1(1):40–43. DOI: 10.1016/j.sleh.2014.12.010
  33. Dzierzewski JM, Donovan EK, Kay DB, et al. Sleep inconsistency and markers of inflammation. Front Neurol 2020;11:1042. DOI: 10.3389/fneur.2020.01042
  34. Ingram DG, Matthews CK. Effect of adenotonsillectomy on C-reactive protein levels in children with obstructive sleep apnea: a meta-analysis. Sleep Med 2013;14(2):172–176. DOI: 10.1016/j.sleep.2012.11.011
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