Biomarkers associated with obstructive sleep apnea: A scoping review

Abstract

The overall validity of biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. We conducted a scoping review to provide assessments of biomarkers characteristics in the context of obstructive sleep apnea (OSA) and to identify gaps in the literature. A scoping review of studies in humans without age restriction that evaluated the potential diagnostic value of biological markers (blood, exhaled breath condensate, salivary, and urinary) in the OSA diagnosis was undertaken. Retained articles were those focused on the identification of biomarkers in subjects with OSA, the latter being confirmed with a full overnight or home-based polysomnography (PSG). Search strategies for six different databases were developed. The methodology of selected studies was classified using an adaptation of the evidence quality criteria from the American Academy of Pediatrics. Additionally the biomarkers were classified according to their potential clinical application. We identified 572 relevant studies, of which 117 met the inclusion criteria. Eighty-two studies were conducted in adults, 34 studies involved children, and one study had a sample composed of both adults and children. Most of the studies evaluated blood biomarkers. Potential diagnostic biomarkers were found in nine pediatric studies and in 58 adults studies. Only nine studies reported sensitivity and specificity, which varied substantially from 43% to 100%, and from 45% to 100%, respectively. Studies in adults have focused on the investigation of IL-6, TNF-α and hsCRP. There was no specific biomarker that was tested by a majority of authors in pediatric studies, and combinatorial urine biomarker approaches have shown preliminary promising results. In adults IL-6 and IL-10 seem to have a favorable potential to become a good biomarker to identify OSA.

Keywords: Biomarker; Diagnoses; Sleep apnea.

Fig. 1

Flow Diagram of literature search and selection criteria.

Fig 2

Distribution of children studies according to country (n=35). United States (n=21), Greece (n=5), China (n=3), South Korea (n=3), Italy (n=2), Brazil (n=1), Hungary (n=1).

Fig 3

Distribution of adults’ studies according to country (n=83). China (n=12), United States (n=12), Japan (n=11), Greece (n=8), Turkey (n=8), Spain (n=6), Brazil (n=3), UK (n=3), Germany (n=2), South Korea (n=2), Taiwan (n=2). In the following countries only one study was done: Arabia, Australia, Canada, France, India, Ireland, Israel, Israel/Sweden, Italy, Poland, Portugal, Sweden, Switzerland, Thailand. These countries are not represented in the graph.