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Patients affected by the overlap of COPD and OSA have a particularly unfavourable prognosis. The L-arginine\/nitric oxide (NO) pathway plays an important role in regulating pulmonary vascular function. Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) interfere with NO production. Methods: We analysed the serum concentrations of ADMA, SDMA, L-arginine, L-citrulline, and L-ornithine in a large sample of the Icelandic general population together with chronic airflow obstruction (CAO), a key physiological marker of COPD that was assessed by post-bronchodilator spirometry (FEV1\/FVC &lt; LLN). OSA risk was determined by the multivariable apnoea prediction (MAP) index. Results: 713 individuals were analysed, of whom 78 (10.9%) showed CAO and 215 (30%) had MAP &gt; 0.5. SDMA was significantly higher in individuals with CAO (0.518 [0.461\u20130.616] vs. 0.494 [0.441\u20130.565] \u00b5mol\/L; p = 0.005), but ADMA was not. However, ADMA was significantly associated with decreasing FEV1 percent predicted among those with CAO (p = 0.002). ADMA was 0.50 (0.44\u20130.56) \u00b5mol\/L in MAP \u2264 0.5 versus 0.52 (0.46\u20130.58) \u00b5mol\/L in MAP &gt; 0.5 (p = 0.008). SDMA was 0.49 (0.44\u20130.56) \u00b5mol\/L versus 0.51 (0.46\u20130.60) \u00b5mol\/L, respectively (p = 0.004). The highest values for ADMA and SDMA were observed in individuals with overlap of CAO and MAP &gt; 0.5, which was accompanied by lower L-citrulline levels. Conclusions: The plasma concentrations of ADMA and SDMA are elevated in COPD patients with concomitant intermittent hypoxaemia. This may account for impaired pulmonary NO production, enhanced pulmonary vasoconstriction, and disease progression.<\/jats:p>","DOI":"10.3390\/jcm12165230","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T12:10:23Z","timestamp":1691755823000},"page":"5230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Biomarkers of the L-Arginine\/Dimethylarginine\/Nitric Oxide Pathway in People with Chronic Airflow Obstruction and Obstructive Sleep Apnoea"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3499-4827","authenticated-orcid":false,"given":"Juliane","family":"Hannemann","sequence":"first","affiliation":[{"name":"Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin H.","family":"Thorarinnsdottir","sequence":"additional","affiliation":[{"name":"Primary Health Care of the Capital Area, 103 Reykjavik, Iceland"},{"name":"Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-9449","authenticated-orcid":false,"given":"Andr\u00e9 F. S.","family":"Amaral","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK"},{"name":"NIHR Imperial Biomedical Research Centre, London W2 1NY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3597-6276","authenticated-orcid":false,"given":"Edzard","family":"Schwedhelm","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Schmidt-Hutten","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Stang","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryndis","family":"Benediktsdottir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland"},{"name":"Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9447-8627","authenticated-orcid":false,"given":"Ingibj\u00f6rg","family":"Gunnarsd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, 102 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00f3rarinn","family":"Gislason","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland"},{"name":"Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3770-5357","authenticated-orcid":false,"given":"Rainer","family":"B\u00f6ger","sequence":"additional","affiliation":[{"name":"Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1164\/rccm.202005-1990OC","article-title":"Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study","volume":"203","author":"Patel","year":"2021","journal-title":"Am. 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