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Original Research: SLEEP MEDICINE |

Circulating Carbon Monoxide Level Is Elevated After Sleep in Patients With Obstructive Sleep Apnea

Masayoshi Kobayashi, MD; Naoki Miyazawa, MD, PhD; Mitsuhiro Takeno, MD, PhD; Shuji Murakami, MD; Yohei Kirino, MD, PhD; Akiko Okouchi, MD; Takeshi Kaneko, MD, PhD; Yoshiaki Ishigatsubo, MD, PhD
Author and Funding Information

*From the Department of Internal Medicine and Clinical Immunology (Drs. Kobayashi, Miyazawa, Takeno, Murakami, Kirino, and Ishigatsubo), Yokohama City University Graduate School of Medicine; the Department of Internal Medicine (Dr. Okouchi), Yokohama Seamen's Insurance Hospital; and the Respiratory Center, Yokohama City University Medical Center (Dr. Kaneko), Yokohama, Japan.

Correspondence to: Yoshiaki Ishigatsubo, MD, PhD, Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan; e-mail: ishigats@med.yokohama-cu.ac.jp


For editorial comment see page 895

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Dr. Takeno was supported by a 2006 grant from the Yokohama Foundation for Advancement of Medical Science. Dr. Ishigatsubo was supported by grants from the Ministry of Education, Culture, Sports, and Technology of Japan (Yokohama City University Center of Excellence Program), and Yokohama City University (2006 Strategic Research project K18006).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):904-910. doi:10.1378/chest.07-2904
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Background:  Patients with obstructive sleep apnea (OSA) have an increased risk of cardiovascular morbidity. This study aimed to determine circulating carbon monoxide (CO) levels, which have been suggested to be a marker of cardiovascular risk in patients with OSA.

Methods:  Venous blood samples were obtained from 35 patients with OSA and 17 age-matched, healthy control subjects before and after polysomnography. Concentrations of venous CO and serum heme oxygenase (HO)-1 were determined by gas chromatography and enzyme-linked immunosorbent assay, respectively.

Results:  Circulating CO levels in OSA patients were significantly increased in the morning, but not in the evening. The change in CO level, which was defined as a gap between the presleep and postsleep CO levels, correlated with apnea-hypopnea index and hypoxia duration as a percentage of total sleep time. No difference was found in serum HO-1 levels between OSA patients and control subjects. Treatment with continuous positive airway pressure (CPAP) resulted in normalization of the postsleep CO level.

Conclusions:  The postsleep circulating CO level is helpful for assessing the clinical severity of OSA. Moreover, treatment of OSA with CPAP can potentially reduce the risk of the disease associated cardiovascular events.

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