Obstructive sleep apnoea syndrome – an oxidative stress disorder
Abstract
Obstructive sleep apnoea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. However, the underlying mechanisms are not entirely understood. This review will summarize the evidence that substantiates the notion that the repeated apnoea-related hypoxic events in OSA, similarly to hypoxia/reperfusion injury, initiate oxidative stress. Thus, affecting energy metabolism, redox-sensitive gene expression, and expression of adhesion molecules. A limited number of studies substantiate this hypothesis directly by demonstrating increased free radical production in OSA leukocytes and increased plasma-lipid peroxidation. A great number of studies, however, support this hypothesis indirectly. Increase in circulating levels of adenosine and urinary uric acid in OSA are implicated with increased production of reactive oxygen species (ROS). Activation of redox-sensitive gene expression is suggested by the increase in some protein products of these genes, including VEGF, erythropoietin, endothelin-1, inflammatory cytokines and adhesion molecules. These implicate the participation of redox-sensitive transcription factors as HIF-1 AP-1 and NFkappaB. Finally, adhesion molecule-dependent increased avidity of OSA monocytes to endothelial cells, combined with diminished NO bioavailability, lead to exaggerated endothelial cell damage and dysfunction. Cumulatively, these processes may exacerbate atherogenic sequelae in OSA.
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Long-term chronic hypoxia caused by OSA can lead to changes in NLR, PLR, C-reactive protein levels, and serum inflammation markers.
“Long-term chronic hypoxia caused by OSA can lead to several physiological and biochemical modifications, such as changes in the NLR, PLR, and levels of C-reactive proteins and markers of serum inflammation [33–37].”
From Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances (2025) · cites this paper as [33]
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Circulating Endothelin-1 in Obstructive Sleep Apnea
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Susceptibility of LDL to Oxidative Stress in Obstructive Sleep Apnea
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Heat Shock Protein 72 Level Decreases During Sleep in Patients With Obstructive Sleep Apnea Syndrome
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Sleep Apnea and Cardiovascular Disease
Somers, V. K., White, D. P., Amin, R. S., Abraham, W. T., Costa, F., Culebras, A., Daniels, S. R., Floras, J. S., Hunt, C. E., Olson, L. J., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.05.002 · Cited by 1,510 · see citing works
“Some studies have reported increased levels of thiobarbituric acid reactive substances, isoprostanes, and oxidized low-density lipoprotein in OSA (100), although these changes have not been confirmed in other studies (101).”
ResultGoldberger, J. J., Cain, M. E., Hohnloser, S. H., Kadish, A. H., Knight, B. P., Lauer, M. S., Maron, B. J., Page, R. L., Passman, R. S., Siscovick, D., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189375 · Cited by 1,450 · see citing works
Sleep Apnea and Cardiovascular Disease
Somers, V. K., White, D. P., Amin, R. S., Abraham, W. T., Costa, F., Culebras, A., Daniels, S. R., Floras, J. S., Hunt, C. E., Olson, L. J., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189420 · Cited by 1,301 · see citing works
Obstructive sleep apnoea syndrome
Lévy, P., Kohler, M., McNicholas, W. T., Barbé, F., McEvoy, R. D., Somers, V. K., Lavie, L., & Pépin, J.-L. (2015) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2015.15 · Cited by 1,235 · see citing works
Self-citationRegulation of Oxygen Homeostasis by Hypoxia-Inducible Factor 1
Semenza, G. L. (2009) · Physiology · doi:10.1152/physiol.00045.2008 · Cited by 926 · see citing works
McNicholas, W. T., Bonsignore, M. R., & the Management Committee of EU COST ACTION B26 (2007) · European Respiratory Journal · doi:10.1183/09031936.00027406 · Cited by 911 · see citing works
Lavie, L. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.07.003 · Cited by 692 · see citing works
Self-citationObstructive Sleep Apnea and Cardiovascular Disease
Parish, J. M., & Somers, V. K. (2004) · Mayo Clinic Proceedings · doi:10.4065/79.8.1036 · Cited by 619 · see citing works
Endothelial Function in Obstructive Sleep Apnea and Response to Treatment
Ip, M. S. M., Tse, H.-F., Lam, B., Tsang, K. W. T., & Lam, W.-K. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200306-767oc · Cited by 615 · see citing works
“Other mechanisms for impaired nitric oxide–mediated endothelial function, including increased oxidant load, enhanced oxidation of low density lipoprotein, insulin resistance, and increased sympathetic activity (46, 47), have been demonstrated to be present in OSA ( 10 , 33, 48, 49).”
BackgroundInfluentialObstructive sleep apnoea and cardiovascular disease
Sánchez‐de‐la‐Torre, M., Campos‐Rodríguez, F., & Barbé, F. (2012) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(12)70051-6 · Cited by 492 · see citing works
Doherty, L. S., Kiely, J. L., Swan, V., & McNicholas, W. T. (2005) · Chest · doi:10.1378/chest.127.6.2076 · Cited by 485 · see citing works
Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome
Lv, R., Liu, X., Zhang, Y., Dong, N., Wang, X., He, Y., Yue, H., & Yin, Q. (2023) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-023-01496-3 · Cited by 521 · see citing works
Therapeutic potential of intermittent hypoxia: a matter of dose
Navarrete-Opazo, A. A., & Mitchell, G. S. (2014) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00208.2014 · Cited by 469 · see citing works
“For instance, IH consisting of hypercapnic hypoxia (6 min of 8% O2, 7% CO2; 6 min normoxic/normocapnic intervals, 90 min) does not increase TNF- or CRP in male piglets (227).”
BackgroundMethodInfluentialNeurocognitive Impairment in Obstructive Sleep Apnea
Lal, C., Strange, C., & Bachman, D. (2012) · Chest · doi:10.1378/chest.11-2214 · Cited by 406 · see citing works
Cardiovascular Morbidity in Obstructive Sleep Apnea
Gozal, D., & Gozal, D. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200608-1190pp · Cited by 399 · see citing works
Campos-Rodriguez, F., Martinez-Garcia, M. A., Martinez, M., Duran-Cantolla, J., Peña, M. D. L., Masdeu, M. J., Gonzalez, M., Campo, F. D., Gallego, I., Marin, J. M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201209-1671oc · Cited by 386 · see citing works
Xu, W., Chi, L., Row, B. W., Xu, R., Ke, Y., Xu, B., Luo, C., Kheirandish, L., Gozal, D., & Liu, R. (2004) · Neuroscience · doi:10.1016/j.neuroscience.2004.03.055 · Cited by 377 · see citing works
Obstructive Sleep Apnea and Type 2 Diabetes
Tasali, E., Mokhlesi, B., & Van Cauter, E. (2008) · Chest · doi:10.1378/chest.07-0828 · Cited by 371 · see citing works
Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link
Lavie, L., & Lavie, P. (2009) · European Respiratory Journal · doi:10.1183/09031936.00086608 · Cited by 370 · see citing works
Self-citationObstructive sleep apnea and type 2 diabetes
Rasche, K., Keller, T., Tautz, B., Hader, C., Hergenç, G., Antosiewicz, J., Giulio, C. D., & Pokorski, M. (2010) · European journal of medical research · doi:10.1186/2047-783x-15-s2-152 · Cited by 366 · see citing works
Obstructive Sleep Apnea and Metabolic Syndrome: Alterations in Glucose Metabolism and Inflammation
Tasali, E., & Ip, M. S. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-139mg · Cited by 365 · see citing works
Predictors of Elevated Nuclear Factor-κB–dependent Genes in Obstructive Sleep Apnea Syndrome
Ryan, S., Taylor, C. T., & McNicholas, W. T. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200601-066oc · Cited by 354 · see citing works
“There is growing evidence that sustained and intermittent hypoxia lead to significantly different molecular responses and different patterns of transcription factor activation (11, 28 , 29).”
BackgroundMolecular Signatures of Obstructive Sleep Apnea in Adults: A Review and Perspective
Arnardóttir, E. S., Mackiewicz, M., Gíslason, Þ., Teff, K. L., & Pack, A. I. (2009) · SLEEP · doi:10.1093/sleep/32.4.447 · Cited by 347 · see citing works
Ryan, S., Taylor, C. T., & McNicholas, W. T. (2009) · Postgraduate Medical Journal · doi:10.1136/thx.2008.105577 · Cited by 340 · see citing works
Sleep, sleep-disordered breathing and metabolic consequences
Levy, P. A., Bonsignore, M. R., & Eckel, J. (2009) · European Respiratory Journal · doi:10.1183/09031936.00166808 · Cited by 339 · see citing works
Kerner, N. A., & Roose, S. P. (2016) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.01.134 · Cited by 338 · see citing works
Sleep and Cardiovascular Disease
Wolk, R. A., Gami, A. S., García‐Touchard, A., & Somers, V. K. (2005) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2005.07.002 · Cited by 327 · see citing works
Hypoxia and brain aging: Neurodegeneration or neuroprotection?
Burtscher, J., Mallet, R. T., Burtscher, M., & Millet, G. P. (2021) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101343 · Cited by 346 · see citing works
“resultant oxidative damage of biomolecules (Lavie, 2003), mitochondrial dysfunction (Duranteau et al.”
BackgroundBuchner, N. J., Sanner, B. M., Borgel, J., & Rump, L. C. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200611-1588oc · Cited by 317 · see citing works
All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age
Lavie, P., Lavie, L., & Herer, P. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00051504 · Cited by 318 · see citing works
Self-citationJean‐Louis, G., Zizi, F., Clark, L. T., Brown, C. D., & McFarlane, S. I. (2008) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27191 · Cited by 303 · see citing works
Sleep-disordered breathing and type 2 diabetes
Shaw, J. E., Punjabi, N. M., Wilding, J. P. H., Alberti, K. G. M. M., & Zimmet, P. (2008) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2008.04.025 · Cited by 296 · see citing works
“leukin-6, tumour necrosis factor, C-reactive protein, and platelet activation and coagulation factors have been described in OSA [87,89–100].”
BackgroundCrossing the apnoeic threshold: causes and consequences
Dempsey, J. A. (2004) · Experimental Physiology · doi:10.1113/expphysiol.2004.028985 · Cited by 281 · see citing works
“These effects are likely to be mediated through intermittent hypoxia causing oxidative stress and endothelial dysfunction and increased sympathetic nerve activity, leading eventually to daytime hypertension (Fletcher, 2003; Lavie, 2003).”
BackgroundMechanisms of cardiac dysfunction in obstructive sleep apnea
Baguet, J.-P., Barone‐Rochette, G., Tamisier, R., Levy, P. A., & Pépin, J. (2012) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2012.141 · Cited by 273 · see citing works
Redline, S., Sotres-Alvarez, D., Loredo, J., Hall, M., Patel, S. R., Ramos, A., Shah, N., Ries, A., Arens, R., Barnhart, J., et al. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1735oc · Cited by 270 · see citing works
Association of obstructive sleep apnea with hypertension: A systematic review and meta-analysis
Hou, H., Zhao, Y., Yu, W., Dong, H., Xue, X., Ding, J., Xing, W., & Wang, W. (2018) · Journal of Global Health · doi:10.7189/jogh.08.010405 · Cited by 346 · see citing works
Oxidative Stress—A Unifying Paradigm in Obstructive Sleep Apnea and Comorbidities
Lavie, L. (2008) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.08.003 · Cited by 266 · see citing works
Self-citationHeavy Snoring as a Cause of Carotid Artery Atherosclerosis
Lee, S. A., Amis, T. C., Byth, K., Larcos, G., Kairaitis, K., Robinson, T. D., & Wheatley, J. R. (2008) · SLEEP · doi:10.5665/sleep/31.9.1207 · Cited by 265 · see citing works
Obstructive Sleep Apnea, Hypoxia, and Nonalcoholic Fatty Liver Disease
Mesarwi, O. A., Loomba, R. S., & Malhotra, A. (2018) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201806-1109tr · Cited by 265 · see citing works
Chronic intermittent hypoxia predisposes to liver injury†
Savransky, V., Nanayakkara, A., Vivero, A., Li, J., Bevans‐Fonti, S., Smith, P. L., Torbenson, M. S., & Polotsky, V. Y. (2007) · Hepatology · doi:10.1002/hep.21593 · Cited by 257 · see citing works
Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea
McNicholas, W. T. (2009) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200903-0347pp · Cited by 249 · see citing works
Suzuki, Y., Jain, V., Park, A.-M., & Day, R. M. (2006) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2006.01.008 · Cited by 239 · see citing works
“This reoxygenation/reperfusion phase is thought to result in the production of reactive oxygen species (ROS) and the promotion of oxidative stress [15-17].”
BackgroundZhang, R., Wu, Y., Zhao, M. L., Liu, C., Zhou, L., Shen, S.-M., Liao, S., Yang, K., Li, Q. Y., & Wan, H. (2009) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.90415.2008 · Cited by 236 · see citing works
“Hypoxia is a complex physiological phenomenon, and many transcriptional regulators are activated during hypoxia (16, 37).”
BackgroundOxidative Stress and Left Ventricular Function with Chronic Intermittent Hypoxia in Rats
Chen, L., Einbinder, E., Zhang, Q., Hasday, J. D., Balke, C. W., & Scharf, S. M. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200504-560oc · Cited by 237 · see citing works
Craig, S. E., Kohler, M., Nicoll, D., Bratton, D. J., Nunn, A., Davies, R., & Stradling, J. (2012) · Thorax · doi:10.1136/thoraxjnl-2012-202178 · Cited by 228 · see citing works
Obstructive Sleep Apnea and Cardiovascular Disease
Pack, A. I., & Gislason, T. (2009) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2009.01.002 · Cited by 228 · see citing works
The Severity of Oxygen Desaturation Is Predictive of Carotid Wall Thickening and Plaque Occurrence
Baguet, J.-P., Hammer, L., Leívy, P., Pierre, H., Launois, S. H., Mallion, J.-M., & Pépin, J. (2005) · CHEST Journal · doi:10.1378/chest.128.5.3407 · Cited by 227 · see citing works
The Relationship between Obstructive Sleep Apnea and Alzheimer’s Disease
Andrade, A. G., Bubu, O. M., Varga, A. W., & Osorio, R. S. (2018) · Journal of Alzheimer's Disease · doi:10.3233/jad-179936 · Cited by 216 · see citing works
“Mounting evidence suggests that repetitive cycles of intermittent hypoxia followed by reoxygenation, characteristicofOSA,promoteROSproduction[137, 138]andreducebloodantioxidantcapacity[165].”
Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives
Levy, P. A., Pépin, J., Arnaud, C., Tamisier, R., Borel, J., Demattéis, M., Godin‐Ribuot, D., & Ribuot, C. (2008) · European Respiratory Journal · doi:10.1183/09031936.00013308 · Cited by 208 · see citing works
Endothelial Dysfunction in Obstructive Sleep Apnea
Budhiraja, R., Parthasarathy, S., & Quan, S. F. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26864 · Cited by 208 · see citing works
Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk
Parati, G., Lombardi, C., & Narkiewicz, K. (2007) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00400.2007 · Cited by 205 · see citing works
“preferential activation of inflammatory pathways may be a consequence of the intermittent reoxygenation that is characteristic of intermittent hypoxia and thus represents a variant of reperfusion injury (72).”
BackgroundBarceló, A., Barbé, F., de la Peña, M., Vila, M., Pérez, G., Piérola, J., Duran, J., & Agustí, A. G. N. (2006) · European Respiratory Journal · doi:10.1183/09031936.06.00067605 · Cited by 201 · see citing works
Sleep-Disordered Breathing and Cardiovascular Risk
Caples, S. M., García‐Touchard, A., & Somers, V. K. (2007) · SLEEP · doi:10.1093/sleep/30.3.291 · Cited by 201 · see citing works
Obesity, obstructive sleep apnoea and metabolic syndrome
LAM, J. C. M., MAK, J. C. W., & IP, M. S. M. (2012) · Respirology · doi:10.1111/j.1440-1843.2011.02081.x · Cited by 198 · see citing works
HDL dysfunction in obstructive sleep apnea
Tan, K. C. B., Chow, W.-S., Lam, J., LAM, B. K., Wong, W.-K., Tam, S., & Ip, M. (2005) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.04.024 · Cited by 200 · see citing works
Htoo, A. K., Greenberg, H. E., Tongia, S., Chen, G., Henderson, T., Wilson, D., & Liu, S. F. (2006) · Sleep And Breathing · doi:10.1007/s11325-005-0046-6 · Cited by 200 · see citing works
“When cells are stimulated by various signals, including ROS, I-κB is rapidly phosphorylated by I-κB kinase.”
BackgroundInfluentialCarotid body chemoreceptors: physiology, pathology, and implications for health and disease
Iturriaga, R., Alcayaga, J., Chapleau, M. W., & Somers, V. K. (2021) · Physiological Reviews · doi:10.1152/physrev.00039.2019 · Cited by 199 · see citing works
Antioxidant defense responses to sleep loss and sleep recovery
Everson, C. A., Laatsch, C. D., & Hogg, N. (2005) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00565.2004 · Cited by 192 · see citing works
“injury, and in this way contributes to cardiovascular complications and inflammatory processes [e.g., (7, 39 , 55)].”
BackgroundJullian‐Desayes, I., Joyeux‐Faure, M., Tamisier, R., Launois, S. H., Borel, A., Levy, P. A., & Pépin, J. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.07.004 · Cited by 195 · see citing works
Advances in Sleep-disordered Breathing
Pack, A. I. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200509-1478oe · Cited by 188 · see citing works
Relationship of Metabolic Syndrome and Obstructive Sleep Apnea
Parish, J. M., Adam, T. J., & Facchiano, L. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26910 · Cited by 188 · see citing works
“(15-89) (31-90) (15-75) (31-83) (29-51) (25-85) (29-80) (25-85)”
López-Jiménez, F. A., Kuniyoshi, F. H. S., Gami, A. S., & Somers, V. K. (2008) · CHEST Journal · doi:10.1378/chest.07-0800 · Cited by 186 · see citing works
Unexpected survival advantage in elderly people with moderate sleep apnoea
Lavie, P., & Lavie, L. (2009) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2009.00754.x · Cited by 183 · see citing works
“Although ischaemic preconditioning is elicited largely by exposure to up to five sublethal ischaemic events, chronic intermittent hypoxia resembling sleep apnoea also confers cardioprotection; furthermore, oxidative stress that is associated closely with sleep apnoea (Lavie, 2003) was implicated specifically in these…”
BackgroundSelf-citationChronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach
Sforza, E. A., & Roche, F. (2016) · Hypoxia · doi:10.2147/hp.s103091 · Cited by 184 · see citing works
Sleep-Disordered Breathing in Down Syndrome
Lal, C., White, D. R., Joseph, J. E., van Bakergem, K., & LaRosa, A. (2015) · CHEST Journal · doi:10.1378/chest.14-0266 · Cited by 182 · see citing works
Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea
Foster, G. E., Poulin, M. J., & Hanly, P. J. (2006) · Experimental Physiology · doi:10.1113/expphysiol.2006.035204 · Cited by 178 · see citing works
“Although the mechanism by which intermittent hypoxia leads to vascular disease in OSA is unknown, it has been proposed that sympathetic nervous system overactivity (Fletcher, 2001), oxidative stress (Lavie, 2003) and endothelial dysfunction (Lavie, 2003) contribute to it.”
BackgroundInfluentialSahebkar, A., Kotani, K., Șerban, M.-C., Ursoniu, S., Mikhailidis, D. P., Jones, S. R., Ray, K. K., Blaha, M. J., Rysz, J., Toth, P. P., et al. (2015) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2015.05.022 · Cited by 178 · see citing works
Palombi, K., Renard, E., Levy, P. A., Chiquet, C., Deschaux, C., Romanet, J. P., & Pépin, J. (2006) · British Journal of Ophthalmology · doi:10.1136/bjo.2005.087452 · Cited by 174 · see citing works
Effects of different acute hypoxic regimens on tissue oxygen profiles and metabolic outcomes
Reinke, C., Bevans‐Fonti, S., Drager, L. F., Shin, M., & Polotsky, V. Y. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00492.2011 · Cited by 174 · see citing works
“There was a general assumption that the pathogenesis of intermittent hypoxia and sleep apnea is similar to ischemiareperfusion injury (22, 23, 31).”
BackgroundItzhaki, S., Dorchin, H., Clark, G., Lavie, L., Lavie, P., & Pillar, G. (2007) · Chest · doi:10.1378/chest.06-0965 · Cited by 172 · see citing works
Self-citationObstructive Sleep Apnea and Inflammation
McNicholas, W. T. (2009) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.10.005 · Cited by 171 · see citing works
Belaïdi, E., Joyeux‐Faure, M., Ribuot, C., Launois, S. H., Levy, P. A., & Godin‐Ribuot, D. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.12.050 · Cited by 169 · see citing works
Intermittent Hypoxia: Cause of or Therapy for Systemic Hypertension?
Serebrovskaya, T. V., Manukhina, E. B., Smith, M. L., Downey, H. F., & Mallet, R. T. (2008) · Experimental Biology and Medicine · doi:10.3181/0710-mr-267 · Cited by 168 · see citing works
“The pro-inflammatory factors NF-jB (228, 230, 264, 265) and iNOS (233, 234) are activated in the OSA setting in response to ROS.”
BackgroundObstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong
Lam, J., LAM, B. K., Lam, C.-L., Fong, D., Wang, J. K. L., Tse, H., Lam, K. S. L., & Ip, M. (2005) · Respiratory Medicine · doi:10.1016/j.rmed.2005.10.003 · Cited by 165 · see citing works
Hypoxia, energy balance and obesity: from pathophysiological mechanisms to new treatment strategies
Kayser, B., & Vergès, S. (2013) · Obesity Reviews · doi:10.1111/obr.12034 · Cited by 165 · see citing works
“The desaturation-reoxygenation sequence typical of OSA leads to oxidative stress, with production of reactive oxygen species (95), contributing to the development of systemic inflammation (96).”
BackgroundLavie, L., & Lavie, P. (2006) · Medical Hypotheses · doi:10.1016/j.mehy.2005.10.033 · Cited by 164 · see citing works
Self-citationEffect of sleep apnea on cognition and mood
El-Ad, B., & Lavie, P. (2005) · International Review of Psychiatry · doi:10.1080/09540260500104508 · Cited by 166 · see citing works
“Sleep apnea has been linked to development of hypertension, increased cardiovascular morbidity, and, on cellular and molecular levels, to an increased oxidative stress leading to endothelial damage by activation of cytokines and a decrease in plasma levels of nitric oxide (Lavie, 2003).”
BackgroundLiu, L., Cao, Q., Guo, Z., & Dai, Q. (2016) · The Journal of Clinical Hypertension · doi:10.1111/jch.12639 · Cited by 160 · see citing works
Inflammation, Oxidative Stress, and the Vascular Endothelium in Obstructive Sleep Apnea
Jelić, S., & Jemtel, T. H. L. (2008) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2008.11.008 · Cited by 162 · see citing works
Cardiovascular Drugs and Serum Uric Acid
Reyes, A. J. (2003) · Cardiovascular Drugs and Therapy · doi:10.1023/b:card.0000015855.02485.e3 · Cited by 163 · see citing works
“Oxidative stress could also mediate part of the increase in cardiovascular risk caused by sleep apnoea [217].”
BackgroundPack, A. I. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2401008 · Cited by 161 · see citing works
Obstructive sleep apnea and cardiovascular disease
Butt, M., Dwivedi, G., Khair, O. A., & Lip, G. Y. H. (2009) · International Journal of Cardiology · doi:10.1016/j.ijcard.2009.05.021 · Cited by 161 · see citing works
Chronic Intermittent Hypoxia/Reoxygenation Facilitate Amyloid-β Generation in Mice
Shiota, S., Takekawa, H., Matsumoto, S., Takeda, K., Nurwidya, F., Yoshioka, Y., Takahashi, F., Hattori, N., Tabira, T., Mochizuki, H., et al. (2013) · Journal of Alzheimer s Disease · doi:10.3233/jad-130419 · Cited by 155 · see citing works
“A numbers of studies have produced supportive evidence for the presence of oxidative stress in OSA patients [41] [42] [43] [44] [45]; some studies went on to show reversible oxidative stress after treatment of continuous positive airway pressure therapy [41] [42] [44] [45].”
BackgroundPhenotypic and Functional Characterization of Blood γδ T Cells in Sleep Apnea
Dyugovskaya, L., Lavie, P., & Lavie, L. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200210-1226oc · Cited by 160 · see citing works
“Sleep apnea–related oxidative stress and a state of inflammatory cell activation resulting in endothelial cell injury have been proposed as one of the underlying mechanisms responsible for atherogenesis in this syndrome (4, 5 ).”
BackgroundInfluentialSelf-citationObstructive sleep apnoea and stroke
Yaggi, H. K., & Mohsenin, V. (2004) · The Lancet Neurology · doi:10.1016/s1474-4422(04)00766-5 · Cited by 157 · see citing works
Hypoxia: The Force that Drives Chronic Kidney Disease
Fu, Q., Colgan, S. P., & Shelley, C. S. (2016) · Clinical Medicine & Research · doi:10.3121/cmr.2015.1282 · Cited by 154 · see citing works
Cardiovascular Consequences of Sleep Apnea
Selim, B. J., Won, C. H. J., & Yaggi, H. K. (2010) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2010.02.010 · Cited by 152 · see citing works
Obstructive sleep apnea and cognitive impairment: Addressing the blood–brain barrier
Lim, D. C., & Pack, A. I. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2012.12.003 · Cited by 149 · see citing works
Sleep and Cardiovascular Disease: An Overview
Malhotra, A., & Loscalzo, J. (2008) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.10.004 · Cited by 147 · see citing works
Mechanisms and Clinical Consequences of Untreated Central Sleep Apnea in Heart Failure
Costanzo, M. R., Khayat, R., Ponikowski, P. P., Augostini, R. S., Stellbrink, C., Mianulli, M. J., & Abraham, W. T. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.025 · Cited by 150 · see citing works
Endothelial Cell Apoptosis in Obstructive Sleep Apnea
Solh, A. A. E., Akinnusi, M. E., Baddoura, F. H., & Mankowski, C. R. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200611-1598oc · Cited by 147 · see citing works
“These mechanisms include the phenomenon of hypoxia reoxygenation (30), oxidative stress ( 31 ), and release of proinflammatory markers (32), all of which have been described to cause endothelial cell apopto-”
BackgroundObstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension
Golbin, J. M., Somers, V. K., & Caples, S. M. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-143mg · Cited by 145 · see citing works
“Each acute oxyhemoglobin desaturation is coupled to an episode of reoxygenation, a process thought to promote oxidative stress through formation of reactive oxygen species (6, 7 ), a cascade that may be associated with heightened inflammation (8, 9) and mitochondrial dysfunction (10).”
BackgroundInteractions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1
Javaheri, S., Javaheri, S., Somers, V. K., Gozal, D., Mokhlesi, B., Mehra, R., McNicholas, W. T., Zee, P. C., Campos‐Rodríguez, F., Martínez‐García, M. Á., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.02.059 · Cited by 157 · see citing works
Does obstructive sleep apnea cause endothelial dysfunction? A critical review of the literature
Hoyos, C. M., Melehan, K. L., Liu, P. Y., Grunstein, R. R., & Phillips, C. L. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.06.003 · Cited by 142 · see citing works
Tennessen, J. M., Bertagnolli, N. M., Evans, J. M., Sieber, M., Cox, J. E., & Thummel, C. S. (2014) · G3 Genes Genomes Genetics · doi:10.1534/g3.114.010652 · Cited by 141 · see citing works
“…acid production in humans is commonly associated with disorders in which oxidative metabolism is disrupted, such as cardiac failure, acute stroke, sleep apnea, and the onset of type 2 diabetes (Fessel 1980; Leyva et al. 1998; Fang and Alderman 2000; Lavie 2003; Weir et al. 2003; Bhole et al. 2010).”
Chen, H.-Y., Cheng, I.-C., Pan, Y.-J., Chiu, Y.-L., Hsu, S.-P., Pai, M.-F., Yang, J.-Y., Peng, Y.-S., Tsai, T.-J., & Wu, K.-D. (2011) · Kidney International · doi:10.1038/ki.2011.151 · Cited by 140 · see citing works
Obstructive sleep apnea, pain, and opioids
Lam, K. K., Kunder, S., Wong, J., Doufas, A. G., & Chung, F. F. (2015) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000000265 · Cited by 141 · see citing works
Oxidative stress inflammation and endothelial dysfunction in obstructive sleep apnea
Lavie, L. (2012) · Frontiers in Bioscience-Elite · doi:10.2741/e469 · Cited by 139 · see citing works
Self-citationHypoxic Conditioning as a New Therapeutic Modality
Vergès, S., Chacaroun, S., Godin‐Ribuot, D., & Baillieul, S. (2015) · Frontiers in Pediatrics · doi:10.3389/fped.2015.00058 · Cited by 134 · see citing works
“Desaturation–reoxygenation sequences lead to oxidative stress and the production of reactive oxygen species (ROS) (1).”
BackgroundInfluentialKuvat, N., Tanrıverdi, H., & Armutçu, F. (2020) · The Clinical Respiratory Journal · doi:10.1111/crj.13175 · Cited by 136 · see citing works
- Authors
- Lavie, L.
- Affiliations
- Technion – Israel Institute of Technology (IL)
- Corresponding author
- Lavie, Lena
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2003-02
- Volume
- 7
- Issue
- 1
- Pages
- 35-51
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W1988114644
- Cited by
- 993
- References
- 134
- Citations by year
- 2026: 17 · 2025: 44 · 2024: 28 · 2023: 30 · 2022: 33 · 2021: 43 · 2020: 42 · 2019: 31 · 2018: 38 · 2017: 37 · 2016: 44 · 2015: 51 · 2014: 58 · 2013: 48 · 2012: 51
- FWCI
- 4.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Health, State of Israel
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Keywords
- obstructive sleep apnea, oxidative stress, hypoxia/reoxygenation injury, reactive oxygen species, lipoprotein oxidation, adhesion molecules, adenosine, uric acid, HIF-1, NF-κB, AP-1, endothelial dysfunction, monocyte adhesion, nitric oxide bioavailability, atherosclerosis, cardiovascular risk
- MeSH terms
- Cardiovascular Diseases, Free Radicals, Humans, Leukocytes, Lymphokines, Nitric Oxide, Lipid Peroxidation, Endothelial Growth Factors, Oxidative Stress, Hyperhomocysteinemia, Sleep Apnea, Obstructive, Intercellular Signaling Peptides and Proteins, Vascular Endothelial Growth Factors, Vascular Endothelial Growth Factor A
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