Effects of Apnea, Obesity, and Statin Therapy on Proprotein Convertase Subtilisin/Kexin 9 Levels in Patients with Obstructive Sleep Apnea

Abstract

<b><i>Objectives:</i></b> Obstructive sleep apnea (OSA) is a common condition closely related to obesity, insulin resistance, dyslipidemia, and cardiovascular disease. The aim of this study was to explore the possible relationship between OSA and proprotein convertase subtilisin/kexin type 9 (<i>PCSK9</i>). <b><i>Methods:</i></b> Full-night polysomnography was performed on 150 participants who were divided into three groups: controls, OSA patients on statin therapy, and OSA patients not on statin therapy. Biochemical markers, plasma low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subclasses, and <i>PCSK9</i> were determined. <b><i>Results:</i></b> <i>PCSK9</i> was highest in OSA patients on statins compared to the control group and to OSA patients not on statins (<i>p</i> = 0.036 and <i>p</i> = 0.039, respectively), after adjustment for body mass index (BMI). LDL diameter was greater in OSA patients not on statins compared to OSA patients on statins (<i>p</i> = 0.032). <i>PCSK9</i> was highest in the group of patients with all three risk factors (diagnosed OSA, statins, BMI ≥25 kg/m²) compared to groups with no, one, and two risk factors (<i>p</i> = 0.031, <i>p</i> = 0.001, and <i>p</i> = 0.029, respectively). Presence of OSA, statin therapy, and BMI ≥25 kg/m² when combined were independently associated with higher levels of <i>PCSK9</i> when adjusted for antihypertensive therapy, small dense LDL, and HDL 3c subclass (odds ratio = 2.849; interquartile range [1.026–7.912], <i>p</i> = 0.044). <b><i>Conclusion:</i></b> Statin therapy was closely related to <i>PCSK9</i>. OSA along with obesity and statin use induces elevation of <i>PCSK9</i>.