Metabolic dysfunction in OSA: Is there something new under the sun?

Area of Science:

• Cardiovascular Science
• Metabolic Science
• Sleep Medicine

Background:

• Obstructive sleep apnea (OSA) is a growing global health challenge.
• OSA involves chronic intermittent hypoxia, apnea, hypopnea, and fragmented sleep.
• Metabolic and cardiovascular diseases are common in OSA patients, irrespective of weight.

Purpose of the Study:

• To explore the mechanisms underlying metabolic dysfunction in OSA.
• To review recent basic, translational, and clinical research on OSA and metabolic disorders.
• To discuss the effects of positive airway pressure (PAP) treatment on metabolic health in OSA.

Main Methods:

• Review of current scientific literature on obstructive sleep apnea and metabolic dysfunction.
• Analysis of evidence linking chronic intermittent hypoxia, sleep fragmentation, and metabolic pathways.
• Examination of the roles of the carotid body, gut microbiota, and circadian rhythms.

Main Results:

• Chronic intermittent hypoxia and sleep fragmentation are linked to insulin resistance.
• OSA and intermittent hypoxia are associated with non-alcoholic fatty liver disease.
• Gut dysbiosis and circadian misalignment may mediate metabolic syndrome development in OSA.
• OSA independently predicts impaired lipid levels and may affect cerebral metabolism.

Conclusions:

• Obstructive sleep apnea significantly contributes to metabolic dysfunction through various interconnected mechanisms.
• Emerging evidence highlights the roles of the gut microbiome and circadian rhythms in OSA's metabolic consequences.
• Positive airway pressure therapy shows potential for mitigating metabolic disorders associated with OSA.