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J Clin Endocrinol Metab. 2014 Sep;99(9):3390-8. doi: 10.1210/jc.2013-3939. Epub 2014 May 13.

Impairment of high-density lipoprotein resistance to lipid peroxidation and adipose tissue inflammation in obesity complicated by obstructive sleep apnea.

Author information

Cardiovascular Research Group (R.Y., M.F., R.A., Y.L., S.H., S.K., J.S., R.M., A.G., P.D., M.J., H.S.), Core Technologies Facility, University of Manchester, Manchester M13 9PT, United Kingdom; Cardiovascular Trials Unit (R.Y., M.F. S.K., J.S., H.S.) and Department of Clinical Biochemistry (M.F., P.P.), Central Manchester University Hospitals, National Health Service Foundation Trust, Manchester M13 9WL, United Kingdom; and Departments of Medicine (P.T., A.A.S.) and Surgery (B.A.), the North West Diabetes Local Research Network (M.G.), Salford Royal National Health Service Foundation Trust, Salford M6 8HD, United Kingdom.



Obstructive sleep apnea (OSA) complicates morbid obesity and is associated with increased cardiovascular disease incidence. An increase in the circulating markers of chronic inflammation and dysfunctional high-density lipoprotein (HDL) occur in severe obesity.


The objective of the study was to establish whether the effects of obesity on inflammation and HDL dysfunction are more marked when complicated by OSA.


Morbidly obese patients (n = 41) were divided into those whose apnea-hypoapnea index (AHI) was more or less than the median value and on the presence of OSA [OSA and no OSA (nOSA) groups]. We studied the antioxidant function of HDL and measured serum paraoxonase 1 (PON1) activity, TNFα, and intercellular adhesion molecule 1 (ICAM-1) levels in these patients. In a subset of 19 patients, we immunostained gluteal sc adipose tissue (SAT) for TNFα, macrophages, and measured adipocyte size.


HDL lipid peroxide levels were higher and serum PON1 activity was lower in the high AHI group vs the low AHI group (P < .05 and P < .0001, respectively) and in the OSA group vs the nOSA group (P = .005 and P < .05, respectively). Serum TNFα and ICAM-1 levels and TNFα immunostaining in SAT increased with the severity of OSA. Serum PON1 activity was inversely correlated with AHI (r = -0.41, P < .03) in the OSA group. TNFα expression in SAT directly correlated with AHI (r = 0.53, P < .03) in the subset of 19 patients from whom a biopsy was obtained.


Increased serum TNFα, ICAM-1, and TNFα expression in SAT provide a mechanistic basis for enhanced inflammation in patients with OSA. Decreased serum PON1 activity, impaired HDL antioxidant function, and increased adipose tissue inflammation in these patients could be a mechanism for HDL and endothelial dysfunction.

[Indexed for MEDLINE]

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