More severe OSA found in adults with higher homocysteine levels
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Key takeaways:
- Those with at least 15 µmol/L plasma homocysteine had a high concentration.
- The likelihood for having OSA at an 8-year follow-up went up by 0.98% with a higher baseline homocysteine concentration.
Adults with elevated plasma homocysteine concentrations had greater apnea-hypopnea index scores, signaling more severe sleep apnea, according to results published in European Archives of Oto-Rhino-Laryngology.
“Homocysteine as a predictor of the AHI can be easily accessed through an affordable test and can contribute to the diagnosis of OSA by indicating the need for more specific tests, such as polysomnography, the gold standard exam for OSA diagnosis,” Monica L. Andersen, PhD, professor at the Federal University of São Paulo, told Healio.
“With these results in hand, clinicians should pay close attention to the homocysteine concentrations of their patients with OSA, as we have observed that elevated homocysteine concentrations are associated with a worse prognosis of this disorder over time,” Andersen said.
In the prospective, longitudinal epidemiological EPISONO study, Andersen and colleagues analyzed 854 adults with polysomnography data and completed sleep and general health questionnaires to determine the relationship between homocysteine (Hcy) concentrations and OSA/apnea-hypopnea index (AHI).
Over half of the population (54.4%) had an AHI of less than five events per hour, indicating no OSA, whereas 24.4% had an AHI of 5 to 15 events per hour (mild OSA), 12.4% had an AHI of 15 to 30 events per hour (moderate OSA) and 8.8% had an AHI greater than 30 events per hour (severe OSA).
Within the same study population, 561 adults completed a follow-up visit after 8 years, with high proportions of those with mild OSA (31.2%) and no OSA (29.8%), followed by smaller proportions of those with moderate (19.4%) or severe (19.6%) OSA.
An equation accounting for age, BMI, folic acid and cobalamin revealed that time and Hcy concentrations both had a significant effect on AHI, according to researchers.
Between those with normal plasma Hcy concentrations less than 10 µmol/L and those with high concentrations of at least 15 µmol/L, researchers observed a greater average AHI increase (7.43 events per hour) in the higher concentration group.
An AHI increase was also found among adults with moderate plasma Hcy concentrations (≥ 10 µmol/L and < 15 µmol/L) vs. those in the lowest concentration group (average, 3.2 events per hour).
“These findings represent another example of the importance of evaluating OSA as a whole, considering not only the associated anatomical issues, but the contribution of metabolism in the establishment of the disease,” Andersen said.
Further, in an assessment of the 465 adults without OSA in the initial cohort, the likelihood for having OSA at the follow-up visit went up by 0.98% (95% CI, 1.022-1.181) with a 1 µmol/L increase in baseline Hcy.
“It’s a low risk, but it exists,” Andersen said in a press release.
Slight significant rises in the odds for OSA at the 8-year follow-up were also observed with heightened age (OR = 1.025; 95% CI, 1.003-1.047), BMI (OR = 1.053; 95% CI, 1.004-1.105) and cobalamin concentrations (OR = 1.001; 95% CI, 1-1.002).
“Based on current studies, it is not possible to establish a causal relationship between OSA and elevated concentrations of homocysteine, but we have found an association between higher levels of this amino acid and the aggravation of OSA,” Andersen told Healio.
“Considering that homocysteine concentrations can be modulated by a diet rich in vitamin B12 and folate or by supplementation of these vitamins, it would be interesting to evaluate whether the adequate clinical management of hyperhomocysteinemia, known to reduce cardiovascular and cerebrovascular risks, will also offer benefits for the treatment or prevention of OSA,” Andersen added.
Reference:
- Blood test can help predict risk of obstructive sleep apnea. https://www.eurekalert.org/news-releases/1050064. Published July 1, 2024. Accessed July 1, 2024.